Dose-response and time-course of the effect of rocuronium bromide during sevoflurane anaesthesia

Abstract

SummaryTo evaluate the influence of sevoflurane on the dose-response relationship and on the time-course of the effect of rocuronium, 60 adult patients undergoing elective plastic surgery were randomly allocated to either the control or the sevoflurane group. Anaesthesia was maintained with 60% nitrous oxide in oxygen and thiopentone in the control group and with 60% nitrous oxide in oxygen and an end-tidal concentration of 1.75% sevoflurane in the sevoflurane group. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s and the percentage depression of the first twitch of the train-of-four was used as the study parameter. The dose-response relationship of rocuronium in the two groups was determined by the cumulative dose-response technique. The dose-response curve of rocuronium in the sevoflurane group was shifted to the left compared to the control group, indicating a potentiation of rocuronium-induced neuromuscular block. The effective doses of rocuronium required to produce 50%, 90% and 95% twitch depression in the sevoflurane group were decreased by 30.5%, 26.7% and 25.2%, respectively, compared to the control group. Following the administration of a total dose of rocuronium of 400 mg.kg ¹1 , the duration of action of, and the recovery from, rocuronium were both significantly prolonged by sevoflurane. There were significant differences in the duration of peak effect, clinical duration, recovery index and the total duration of action between the control and the sevoflurane groups. [14] have also been studied. Several publications show that anaesthetic agents potentiate the neuromuscular effects of rocuronium in the same order as for other nondepolarising neuromuscular blocking agents, namely: enflurane and isoflurane > halothane > intravenous anaesthetic agents. It has been demonstrated that such potentiation is not evident during induction and only becomes significant as anaesthesia becomes more prolonged [15]. However, there is no information on the dose-response relationship and the time-course of the effect of rocuronium during sevoflurane anaesthesia in adult patients. The purpose of this study was to determine the effects of sevoflurane anaesthesia on the dose-response relationship and on the pharmacodynamics of rocuronium in healthy adult patients.

Effects of Sevoflurane and Adenosine Receptor Antagonist on the Sugammadex-Induced Recovery from Rocuronium-Induced Neuromuscular Blockade: An Ex-vivo Study

“…We sealed the organ bath with a exible lm and added sevo urane intermittently to achieve the desired concentration in the Krebs buffer solution. In a clinical experiment, it took about 40 min for sevo urane to equilibrate between blood and muscle component and make effect on muscle [20,21]. However, in some studies, sevo urane was only needed 10 min for sevo urane to make effect [21].…”

Time Course of Rocuronium-Induced Neuromuscular Blockade in Pediatric Patients: A Phase III, Randomized, Dose-Response Study

“…The concentration of sevoflurane used varied somewhat between patients and reflected the practices of the hospitals participating in this study and the clinical needs of the patient. As reported in the literature, the concentration of sevoflurane may enhance the effect of rocuronium [17][18][19], with this potentiating effect of inhalational agents also reported to be time-dependant [20,21]. Onset of action of rocuronium may also potentially be shortened during anesthesia with sevoflurane [22], particularly when there is a very long duration of sevoflurane exposure [23].…”

Comparison of the duration of neuromuscular blockade following a single bolus dose of rocuronium during laparoscopic gynaecological surgery vs conventional open surgery

“…Rocuronium metabolism can be influenced by a large number of factors including sex , age , BMI , temperature , hypoxia , haemodynamics and inhalation of anaesthetic vapours . In the present study, we standardised our technique to eliminate confounding factors.…”