The Effect of D Vitamin Status on Different Neuromuscular Blocker Agents Reverse Time

Prospective observational study was carried out in the same centre after the approval of the University Hospital by the ethical committee of non-invasive research (Duzce University, School of Medicine, Ethics Committee of Non-invasive clinical research approval for application Date: 11.10.2013, Decision Number: 2013/439) and done by Anaesthesiology Department in the same centre. This research was also funded by our University Scientific Research Project Coordinating Department (2014.04.02.221).

Eighty-four patients with ASA I-III status, undergoing surgery under general anaesthesia between the ages of 18 and 65 years were included the study. Twenty millilitre blood samples were taken from the antecubital ven before the operation, after taken the approval of all patients. 1.25 (OH) 2 vitamin D, 25 (OH) 2 vitamin D, calcium, magnesium, phosphorus and parathormone levels were measured in the blood samples. All patients were randomly divided into two groups with double blindness. At the end of the operation, a 2 mg/kg dose of Sugammadex (Group Sugammadex n = 40) and 0.55 mg/kg + 0.015 mg/kg atropine Neostigmine (to the other group) were administered intravenously. The patients were also divided into two groups, having vitamin D levels above 30 ng/mL and below 30 ng/mL.

All patients were connected to a kinemyograph, which placed the neuromuscular transmission (NMT) module (GE Health Care) on the patients' adductor pollicis muscle before the anaesthesia induction. Patients body temperature were monitored and maintained within 35-37 0 C. Subsequently, the hypnotic agent was given at the beginning of the operation and Train of Four (TOF) values were recorded as % values throughout the operation. All patients received 2 mg of Midazolam intravenously for premedication. All patients were monitored by standard monitoring and received 2 mg / kg Propofol and 1 mcg/kg Fentanyl. Train of Four (TOF) stimulation started at 1 Hz intervals at a frequency of 2 Hz in 1-minute intervals. The initial values determined were recorded as the baseline TOF values and 0.5 mg / kg Rocuronium (Esmeron amp, Organon, Holland) was administered intravenously, which was calculated on ideal body weight. The time to complete disappearance of response to TOF stimulation was recorded as T0 and endotracheal intubation was performed.

Anaesthetic maintenance was proven by 50% oxygen + 50% air + 2% volume Sevoflurane via endotracheal tube. Remifentanil was administered intravenously at 0.05-1 mcgr /kg /h. When a 2-point response to TOF was received, the muscle relaxant was administered in repeated doses as 10 mg of Rocuronium.

The total muscle relaxant quantities were recorded. At the end of the operation: when 2 responses to TOF stimulation were taken, the following times were recorded until the extubation phase by administering at least 2 mg/kg of Sugammadex (Bridion flk, Merck Sharp & Dohme) or 0.05 mg/kg of Neostigmine (Neostigmin amp, Adeka, Turkey) and 0.05 mg/kg of Atropine per kg body weight.