H D de Boer

Publications (20)91.8 Total impact

• Article: Train-of-four ratio recovery often precedes twitch recovery when neuromuscular block is reversed by sugammadex.

  L M Staals, J J Driessen, J Van Egmond, H D De Boer, M Klimek, E A Flockton, M M J Snoeck
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  ABSTRACT: Sugammadex reverses rocuronium-induced neuromuscular block (NMB). In all published studies investigating sugammadex, the primary outcome parameter was a train-of-four (TOF) ratio of 0.9. The recovery time of T1 was not described. This retrospective investigation describes the recovery of T1 vs. TOF ratio after the reversal of NMB with sugammadex. Two studies were analyzed. In study A, a phase II dose-finding study, ASA I-II patients received an intravenous (IV) dose of rocuronium 1.2 mg/kg, followed by an IV dose of sugammadex (2.0, 4.0, 8.0, 12.0 or 16.0 mg/kg) or placebo (0.9% saline) after 5 min. In study B, a phase III trial comparing patients with renal failure and healthy controls, rocuronium 0.6 mg/kg was used to induce NMB; sugammadex 2.0 mg/kg was administered at reappearance of T2. Neuromuscular monitoring was performed by acceleromyography and TOF nerve stimulation. The primary efficacy variable was time from the administration of sugammadex to recovery of the TOF ratio to 0.9. Retrospectively, the time to recovery of T1 to 90% was calculated. After the reversal of rocuronium-induced NMB with an optimal dose of sugammadex [16 mg/kg (A) or 2 mg/kg (B)], the TOF ratio recovered to 0.9 significantly faster than T1 recovered to 90%. Clinical signs of residual paralysis were not observed. After the reversal of NMB by sugammadex, full recovery of the TOF ratio is possible when T1 is still depressed. The TOF ratio as the only measurement for the adequate reversal of NMB by sugammadex may not always be reliable. Further investigations for clinical implications are needed.
  Acta Anaesthesiologica Scandinavica 07/2011; 55(6):700-7. · 2.19 Impact Factor
• Article: Sugammadex and rescue reversal.

  R K Mirakhur, M O Shields, H D de Boer
  Anaesthesia 02/2011; 66(2):140-1; author reply 141. · 2.96 Impact Factor
• Article: Sugammadex in patients with myasthenia gravis.

  H D de Boer, J van Egmond, J J Driessen, L H J D Booij
  Anaesthesia 06/2010; 65(6):653. · 2.96 Impact Factor
• Article: A new approach to anesthesia management in myasthenia gravis: reversal of neuromuscular blockade by sugammadex.

  H D de Boer, J van Egmond, J J Driessen, L H J D Booij
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  ABSTRACT: A neuromuscular blocking drug (NMBD) induced neuromuscular blockade (NMB) in patients with myasthenia gravis usually dissipates either spontaneously or by administration of neostigmine. We administered sugammadex to a patient with myasthenia gravis to reverse a rocuronium-induced profound NMB. NMBDs predispose such patients to severe postoperative residual paralysis and respiratory complications. Sugammadex binds steroidal NMBDs and, therefore reverses a rocuronium or vecuronium-induced NMB, without interfering with cholinergic transmission. A rapid and complete recovery from profound NMB was achieved and no adverse events were observed. This case suggests that sugammadex is a safe and effective antagonist of a rocuronium induced NMB blockade in patients with myasthenia gravis.
  Revista espanola de anestesiologia y reanimacion 03/2010; 57(3):181-4.
• Article: In vivo animal studies with sugammadex.

  L H D J Booij, J van Egmond, J J Driessen, H D de Boer
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  ABSTRACT: A review is presented of animal studies of the selective steroidal neuromuscular blocking drug binding agent sugammadex. These studies demonstrate that sugammadex is faster in onset than the currently used acetylcholinesterase inhibitors, has no muscarinic effects, and is characterised by lack of adverse effects on other organs. These results offer support for the further development of sugammadex for clinical use in humans.
  Anaesthesia 04/2009; 64 Suppl 1:38-44. · 2.96 Impact Factor
• Article: Reversal of rocuronium-induced (1.2 mg kg-1) profound neuromuscular block by accidental high dose of sugammadex (40 mg kg-1).

  A L Molina, H D de Boer, M Klimek, M Heeringa, J Klein
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  ABSTRACT: Sugammadex is the first selective relaxant binding agent and reverses rocuronium-induced neuromuscular block. A case is reported in which a patient accidentally received a high dose of sugammadex (40 mg kg-1) to reverse a rocuronium-induced (1.2 mg kg-1) profound neuromuscular block. A fast and efficient recovery from profound neuromuscular block was achieved and no adverse events or other safety concerns were reported.
  BJA British Journal of Anaesthesia 06/2007; 98(5):624-7. · 4.24 Impact Factor
• Article: Time course of action of sugammadex (Org 25969) on rocuronium-induced block in the Rhesus monkey, using a simple model of equilibration of complex formation.

  H D de Boer, J van Egmond, F van de Pol, A Bom, J J Driessen, L H D J Booij
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  ABSTRACT: Reversal of neuromuscular block can be accomplished by chemical encapsulation of rocuronium by sugammadex (Org 25969), a synthetic gamma-cyclodextrin derivative. The present study determined the time course of the reversal action of sugammadex on rocuronium-induced block in the anaesthetized Rhesus monkey using train-of-four stimulation. A bolus injection of rocuronium 100 microg kg(-1) (about 1xED(90)) was given to determine the degree of neuromuscular block reached by this dose. After complete spontaneous recovery, a rapid bolus injection of sugammadex, 1 mg kg(-1), was given and at different time intervals (15, 30 or 60 min, in three different experiments) the effect of another rocuronium bolus injection of 100 microg kg(-1) was determined. Injection of the first dose of rocuronium resulted in a mean neuromuscular block (depression of first twitch) of 93 (SEM=1.6)%. Fifteen minutes after injection of sugammadex the same rocuronium dose resulted in 17% (SEM=5.6) block. After 30 and 60 min these maximum blocks amounted to 49% (SEM=7.6) and 79% (SEM=4.2), respectively. The estimated half-life of sugammadex in Rhesus monkey is 30 (SEM=4.9) min. The half-life of sugammadex (Org 25969), a new fast and efficient reversal agent for rocuronium-induced block, is relatively short in the Rhesus monkey, implying the possibility to perform neuromuscular block by rocuronium shortly after reversal of a prior block. In translation to the human situation differences in rocuronium sensitivity and kinetics should be taken into account.
  BJA British Journal of Anaesthesia 12/2006; 97(5):681-6. · 4.24 Impact Factor
• Article: The effect of Sugammadex (Org 25969) on profound neuromuscular block as induced by vecuronium in the anaesthetised Rhesus monkey: A-533

  H. D. de Boer, L. M. Staals, J. J. Driessen, F. van de Pol, A. Bom, J. van Egmond
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  ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
  European Journal of Anaesthesiology 05/2006; 23:138. · 2.23 Impact Factor
• Article: Sugammadex, a new reversal agent for neuromuscular block induced by rocuronium in the anaesthetized Rhesus monkey.

  H D de Boer, J van Egmond, F van de Pol, A Bom, L H D J Booij
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  ABSTRACT: Binding of the steroidal molecule of rocuronium by a cyclodextrin is a new concept for reversal of neuromuscular block. The present study evaluated the ability of Sugammadex Org 25969, a synthetic gamma-cyclodextrin derivative, to reverse constant neuromuscular block of about 90% induced by rocuronium or the non-steroidal neuromuscular blocking drugs, mivacurium or atracurium, in the anaesthetized Rhesus monkey. After a bolus injection of rocuronium, mivacurium or atracurium, a continuous infusion of these drugs was started to maintain the first twitch contraction of the train-of-four at approximately 10% of its baseline value. After a steady state block of at least 10 min the infusion was stopped and the preparation was allowed to recover spontaneously. This process was repeated, but at the time the infusion was stopped, either sugammadex 0.5 or 1.0 mg kg(-1) was given in the rocuronium-induced blockade and sugammadex 1.0 mg kg(-1) was given in the mivacurium- and atracurium-induced blockade. Sugammadex caused a rapid and complete reversal of rocuronium-induced neuromuscular block. The recovery time to train of four ratio=0.9 after spontaneous recovery was 14.4 min (sd=3.4 min; n=14). This was reduced significantly (P<0.001) to 3.7 min (sd=3.3 min; n=4) with sugammadex 0.5 mg kg(-1) and to 1.9 min (sd=1.0 min; n=4) with sugammadex 1.0 mg kg(-1). Signs of residual blockade or re-curarization were not observed. Reversal of mivacurium- or atracurium-induced neuromuscular block (n=2 in each experiment) by sugammadex (1.0 mg kg(-1)) was not effective. In all experiments, injection of sugammadex had no effects on blood pressure or heart rate. Sugammadex is effective in reversing rocuronium, but not mivacurium- or atracurium-induced neuromuscular block.
  BJA British Journal of Anaesthesia 04/2006; 96(4):473-9. · 4.24 Impact Factor
• Article: Chemical encapsulation of rocuronium by synthetic cyclodextrin derivatives: reversal of neuromuscular block in anaesthetized Rhesus monkeys.

  H D de Boer, J van Egmond, F van de Pol, A Bom, L H D J Booij
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  ABSTRACT: At present, reversal of neuromuscular block induced by steroidal neuromuscular blocking agents (NMBAs) is achieved by administration of cholinesterase inhibitors. Chemical encapsulation of steroidal NMBAs, such as rocuronium, by a cyclodextrin is a new concept in neuromuscular block reversal. The present study evaluates the capacity of nine synthetic cyclodextrin derivatives (Org 25288, Org 25289, Org 25467, Org 25168, Org 25169, Org 25555, Org 25166, Org 26142, and Org 25969) to reverse constant neuromuscular block of approximately 90%, induced by rocuronium infusion in the Rhesus monkey, using single twitch stimulation. The ability of these cyclodextrin derivatives to reverse neuromuscular block was compared with the reversal of the same neuromuscular block by the commonly used combination of neostigmine and atropine. After a bolus injection of rocuronium, continuous infusion was started to reduce twitch contractions to approximately 10% of baseline values. After a steady state block of at least 10 min the infusion was stopped and the preparation was allowed to recover spontaneously. This process was repeated, but at the time the infusion was stopped, either one of the nine cyclodextrin derivatives or a combination of neostigmine and atropine was given. Recovery with cyclodextrin derivatives Org 26142 and Org 25969 was faster than after a combination of neostigmine and atropine (P<0.05). Injection of these cyclodextrin derivatives did not affect blood pressure or heart rate. Signs of residual block or recurarization were not observed in any of these experiments. In the experiments in which a combination of neostigmine and atropine was given, two animals showed signs of abdominal discomfort as frequently seen after the administration of neostigmine and significant changes in circulatory variables. Chemical encapsulation or chelation of rocuronium is a new concept in reversing neuromuscular block induced by rocuronium.
  BJA British Journal of Anaesthesia 03/2006; 96(2):201-6. · 4.24 Impact Factor
• Article: Anesthetic management in a child with Arnold-Chiari malformation and bilateral vocal cord paralysis.

  A C W Setz, H D De Boer, J J Driessen, G J Scheffer
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  ABSTRACT: We report a case of a child who was scheduled for an emergency ventriculoperitoneal shunt procedure. The patient had a type II Arnold-Chiari malformation (ACM) and associated hydrocephalus and presented with near complete respiratory obstruction from bilateral abductor vocal cord palsy. Early diagnosis and management of airway abnormalities associated with ACM may be lifesaving. Chiari malformations and anesthesia management are discussed.
  Pediatric Anesthesia 01/2006; 15(12):1105-7. · 2.10 Impact Factor
• Article: Testicular carcinoma: postmortem diagnosis after a car accident.

  H D de Boer, M H T M Haerkens, W van der Stappen, G van Ingen, T Wobbes
  The Lancet 06/2002; 359(9318):1666. · 38.28 Impact Factor
• Source

  Available from: oxfordjournals.org

  Article: Successful epidural anaesthesia for Caesarean section in a patient with spondyloepiphyseal dysplasia.

  H D de Boer, A Hemelaar, R van Dongen, M J Gielen
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  ABSTRACT: Spondyloepiphyseal dysplasia congenita is a rare genetic entity in which it is very important to involve anaesthetists early on to discuss the possible anaesthetic complications for both general or regional anaesthesia. A case is described of a patient with spondyloepiphyseal dysplasia and multifetal pregnancy in which successful epidural anaesthesia for caesarean section was performed.
  BJA British Journal of Anaesthesia 02/2001; 86(1):133-4. · 4.24 Impact Factor
• Article: Mitral valve myxoma: an unusual reason for rejecting a donor heart.

  H D de Boer, N de Jonge, W J de Boer
  The Journal of Heart and Lung Transplantation 10/1999; 18(9):924-5. · 4.33 Impact Factor
• Article: Pseudoaneurysm of the left ventricle after isolated pericarditis and Staphylococcus aureus septicemia.

  H D de Boer, N J Elzenga, W J de Boer, J J Meuzelaar
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  ABSTRACT: Left ventricular pseudoaneurysm after isolated pericarditis as a result of Staphylococcal septicemia is very rare. A case of a very young patient is described. Diagnosis is made by echocardiography. Immediate surgical resection of the pseudoaneurysm is the therapy of choice.
  European Journal of Cardio-Thoracic Surgery 02/1999; 15(1):97-9. · 2.55 Impact Factor
• Article: Early repair of postinfarction ventricular septal rupture: infarct exclusion, septal stabilization, and left ventricular remodeling.

  H D de Boer, W J de Boer
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  ABSTRACT: A surgical technique for safe early repair of ventricular septal rupture is described. The technique consists of exclusion of the infarcted area, septal stabilization, and remodeling of the left ventricle with an internal two-patch method. This technique is simple and reliable, and it appeared favorable in an elderly patient group. Six of 7 patients were treated with good results.
  The Annals of Thoracic Surgery 03/1998; 65(3):853-4. · 3.74 Impact Factor
• Article: Correlates of survival in patients with postinfarction ventricular septal defect.

  H D de Boer, M A Mariani, W J de Boer
  The Annals of Thoracic Surgery 02/1998; 65(1):299-300. · 3.74 Impact Factor
• Article: Sharp incision of the anterior mitral leaflet due to penetrating trauma: report of a case and long-term follow-up.

  H D de Boer, H P Hamer, T Ebels, W J de Boer
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  ABSTRACT: A case is described of sharp incision of the anterior leaflet of the mitral valve, due to penetrating trauma to the chest with a knife. The lesion of the mitral leaflet was diagnosed with echocardiography and successfully repaired with autologous pericardial tissue. Follow up after 15 years showed normal mitral valve function.
  European Journal of Cardio-Thoracic Surgery 01/1998; 13(1):101-3. · 2.55 Impact Factor
• Article: Pseudoaneurysm of the left ventricle after isolated pericarditis and Staphylococcus aureus septicemia

  H.D. de Boer, N.J. Elzenga, W.J. de Boer, J.J. Meuzelaar
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  ABSTRACT: Left ventricular pseudoaneurysm after isolated pericarditis as a result of Staphylococcal septicemia is very rare. A case of a very young patient is described. Diagnosis is made by echocardiography. Immediate surgical resection of the pseudoaneurysm is the therapy of choice.
  European Journal of Cardio-Thoracic Surgery.
• Article: Anesthetic management in a child with Arnold-Chiari malformation and bilateral vocal cord paralysis

  A. C. Setz, H. D. De Boer, J. J. Driessen, G. J. Scheffer
  [show abstract] [hide abstract]
  ABSTRACT: We report a case of a child who was scheduled for an emergency ventriculoperitoneal shunt procedure. The patient had a type II Arnold-Chiari malformation (ACM) and associated hydrocephalus and presented with near complete respiratory obstruction from bilateral abductor vocal cord palsy. Early diagnosis and management of airway abnormalities associated with ACM may be lifesaving. Chiari malformations and anesthesia management are discussed.
  Paediatr Anaesth. 15(12):1105-7.