Cumulation characteristics of cisatracurium and rocuronium during continuous infusion

Abstract

Purpose: The dissimilar pharmacokinetic properties of cisatracurium (CIS) and rocuronium (ROC) predict different potential for drug cumulation when these drugs are administered by continuous infusion. A study was therefore undertaken to compare cumulation potential of CIS and ROC during surgical procedures of relatively long duration (2-4 hr). Methods: Sufentanil/propofol-N 2 O anesthesia was administered to 40 ASA I and II adults. In a double-blind protocol, patients were randomly allocated to receive a continuous iv infusion of either CIS or ROC, titrated in progressive increments or decrements as required to achieve and maintain 95 ± 5% depression of the T1 response of the adductor pollicis muscle, using a Datex NMT-100 Relaxograph EMG monitor applied at the wrist. At the end of surgery, 60 µg·kg -1 neostigmine plus 15 µg·kg -1 atropine were administered for reversal. Results: The duration of infusion was 104 ± 33 min in group CIS and 110 ± 23 min in group ROC (P=NS). In both groups, a progressive decrease in potency-adjusted infusion rates was observed after 30 min, then stabilized beyond 60 min. When allowing for an initial period of stabilization, mean potency-adjusted infusion requirements were: CIS 0.81 ± 0.02 µg·kg -1 ·min -1 and ROC 5.58 ± 1.94 µg·kg -1 ·min -1 . There were no differences between groups at any time with regard to potency-adjusted infusion requirements necessary to maintain 90-99% block (P=NS). However, drug costs/hr for maintenance of neuromuscular block were less with CIS ($3.57 ± 0.09) than with ROC ($6.03 ± 0.27), P < 0.001. Conclusion: When adjusted to equipotency, infusion requirements of CIS and ROC vary at similar rates during general anesthesia. Despite pharmacokinetic differences, neither drug demonstrates cumulation for infusion lasting up to 3.5 hr.Objectif : Les propriétés pharmacocinétiques différentes du cisatracurium (CIS) et du rocuronium (ROC) laissent présager un potentiel différent d'accumulation lorsqu'on les administre en perfusion continue. Une étude a donc été menée pour comparer le potentiel d'accumulation de CIS et de ROC pendant des interventions chirurgicales de durée relativement longue (2-4 h). Méthode : Une anesthésie à base de sufentanil/propofol-N 2 O a été administrée à 40 adultes d'état physique ASA I et II. Selon un protocole à double insu, les patients ont été répartis de façon aléatoire et ont reçu une perfusion iv continue de CIS ou de ROC en doses progressives ou dégressives comme l'exigent la réalisation et le maintien d'une dépression de 95 ± 5 % de la réponse à T1 du muscle adducteur du pouce, en utilisant un moniteur Datex NMT-100 Relaxograph EMG appliqué au poignet. À la fin de l'opération, 60 µg·kg -1 de néostigmine et 15 µg·kg -1 d'atropine ont été administrés pour renverser le bloc. Résultats : La perfusion a duré 104 ± 33 min dans le groupe CIS et 110 ± 23 min dans le groupe ROC (P=NS). Dans les deux groupes, une baisse progressive des vitesses de perfusion ajustée en fonction de la puissance a été observée après 30 min, puis stabilisée a...

Sevoflurane and isoflurane, but not propofol, decrease mivacurium requirements over time

“…The same phenomenon has been reported in other infusion studies with mivacurium, 11,15 cisatracurium, 16 rocuronium, 16 atracurium 17 and vecuronium. 17 Infusion rates are relatively high when the patient recovers from a bolus dose, as occurred in all the above studies, because enough drug had to be provided not only to maintain blockade, but also to prevent recovery from the bolus dose.…”

Effective method of continuous rocuronium administration based on effect-site concentrations using a pharmacokinetic/pharmacodynamic model during propofol–remifentanil anesthesia

“…The suitability of rocuronium for continuous infusion is well known, but the optimal rate of administration of a continuous infusion of rocuronium has not yet been clearly defined. Several studies have reported that the dose of rocuronium required to induce muscle relaxation does not decrease over time [2,4,5]. The differences among individuals in terms of their sensitivity to neuromuscular blocking agents in general and rocuronium in particular may be affected by several factors.…”

“…However, the continuous administration of drugs provides a more stable blood concentration and is more useful in maintaining patient stability under conditions with varying requirements, such as during surgery. Continuous infusions of rocuronium within a short period do not result in accumulation of the drug [2], and its administration for longer durations in intensive care patients results in only a moderately prolonged recovery time [3].…”

Use of rocuronium administered by continuous infusion in dogs

“…Rocuronium is suitable for continuous infusions as there are no active metabolites produced. Short duration infusions have been shown not to accumulate in humans following continuous infusion (Miller et al. 2000) and longer durations (greater than 5 hours) resulted in only a moderately prolonged recovery time (Sparr et al.…”