The effect of rocuronium on ventilatory leak and sealing pressure using a supraglottic airway device: A randomized clinical trial.

Abstract

The transition of ventilatory leak and sealing pressure in supraglottic airway devices after administration of neuromuscular blocking agents is unclear. We hypothesized that ventilatory leak would decrease due to the increase in sealing pressure after administration of 0.15 and 0.30 mg/kg rocuronium iv. Forty patients were randomly assigned to a control group or one of two rocuronium groups. After induction of general anaesthesia, an i-gel^® was inserted before rocuronium administration. The ventilatory leak and sealing pressure were measured immediately. Then, 0.15 mg/kg or 0.30 mg/kg rocuronium iv was administered and the ventilatory leak and sealing pressure were measured again. In the control group, measurements were obtained just after insertion of the supraglottic airway device and 5 minutes later, without any additional drug administration. Similar decrements in ventilatory leak of approximately 3% were registered in all three groups. There were no changes in sealing pressure in any of the groups. However, multiple logistic regression analysis demonstrated that the reduced height of the first twitch response to train-of-four stimulation after administration of rocuronium was a determinant of a decrease in sealing pressure (odds ratio: 0.97, 95% confidence interval: 0.95-0.99, P = .04). Our results suggest that ventilatory leak with a supraglottic airway device decreases independently of neuromuscular blockade, although the neuromuscular blockade may potentially decrease sealing pressure. Registration of Clinical trials: UMIN Clinical Trials Registry (registration ID: UMIN000027061, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000031018).