A Pilot Study Using Rocuronium to Prevent Intermediate Syndrome After Organophosphorus Insecticide Poisoning
A Pilot Study Using Rocuronium to Prevent Intermediate Syndrome After Organophosphorus Insecticide Poisoning
Organophosphate pesticide poisoning causes close to 300 000 deaths per year worldwide. Many
 patients who ingest organophosphates require ventilation; of these patients approximately 50%
 die. Much of the mortality in these ventilated patients is secondary to intermediate
 syndrome. This is because OP pesticides inhibit acetylcholinesterase, causing an excess of
 acetylcholine at nerve synapses and the neuromuscular junction (NMJ). At the NMJ, the excess
 acetylcholine causes overstimulation and damage, which may lead to sudden respiratory arrest
 or prolonged ventilation and its associated complications.

 The investigators believe that blocking these receptors using a neuromuscular blocking agent
 such as Rocuronium will protect the NMJ from damage and thus prevent intermediate syndrome
 and reduce number of intubated days and mortality.

 In this pilot randomised controlled trial Rocuronium, a competitive nicotinic receptor
 antagonist, will be used to bind to the receptor at the neuromuscular junction and to block
 the effects of the accumulated acetylcholine. The effects of OP pesticide on cholinesterase
 in the blood will then be monitored and Rocuronium withdrawn using Sugammadex as the OP is
 eliminated from the body.
Primary outcome: Number of days intubated
Inclusion criteria:

 -  Male or female

 -  Age over 16

 -  Clinical diagnosis of OP insecticide poisoning

 -  Admission to Intensive Care Unit for Ventilation

 -  Informed consent from family

 -  Train of four measurement > 50%

 Exclusion criteria:

 -  Age 16 or under

 -  Pregnant

 -  Consent not obtained from patient or patient's family