Attenuated ventilatory response to hypoxaemia at vecuronium‐induced partial neuromuscular block

Abstract

The effect of a partial neuromuscular block on the ventilatory response to hypercarbia and to hypoxaemia was studied in 11 non-anaesthetized male subjects. Respiratory frequency, tidal volume, minute volume, respiratory timing and drive were measured during air breathing and during stimulation by hypercarbia and hypoxaemia. The ventilatory response was defined as the ratio between, respectively, tidal volume and minute volume during ventilation stimulated by hypercarbia and hypoxaemia compared to measurements during air breathing. The ventilatory measurements were repeated on three separate occasions: before neuromuscular block was established, during an infusion of vecuronium aiming at a mechanical adductor pollicis train-of-four (TOF) ratio of 0.70, and after the infusion had been stopped and the neuromuscular block had spontaneously recovered to a TOF ratio of > 0.90. Resting ventilation during air breathing remained with minor variations throughout the experiment. The ventilatory response to hypercarbia was not affected at a TOF ratio of 0.70 as compared to measurements before vecuronium and at a TOF ratio of > 0.90. In contrast, the ventilatory response to hypoxaemia was markedly reduced at a TOF ratio of 0.70. We conclude that a mechanical TOF ratio of 0.70 following vecuronium may be associated with an inadequate ventilatory response to hypoxaemia.

Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium

“…[34][35][36] Further investigations specifically comparing recovery in the LA to that in the AP may be warranted. Data are presented as mean (SD).…”

Retrospective analysis of spontaneous recovery from neuromuscular blockade produced by empirical use of rocuronium

“…Previous studies in volunteers have shown that pharyngeal function [2,3], airway muscle function [7], and also hypoxic ventilatory drive could be impaired [8,9], and residual paralysis could result in upper airway obstruction [7] and aspiration [3]. Clinical studies in surgical patients have also demonstrated a higher risk of critical postoperative respiratory events in patients with residual muscular blockade with a TOF ratio of \0.9 [10,11].…”

Neurotransmission in the carotid body and anesthesia

“…Currently used neuromuscular blockers are believed to be specific for muscle-type nAChRs. However, a series of studies in humans has shown that nondepolarizing neuromuscular blockers, such as vecuronium and pancuronium, inhibit hypoxic ventilatory responses at very low concentrations [116][117][118]. Igarashi et al hypothesized that vecuronium inhibits neuronal nAChRs in the carotid body, leading to depression of hypoxic ventilatory response [119].…”