Duration of exposure to sevoflurane affects dose–response relationship of vecuronium

Abstract

The purpose of this study was to quantify the relationship between the dose-response curve of vecuronium and duration of exposure to an end-tidal concentration of 1.7% sevoflurane in 67% nitrous oxide and oxygen. Forty adult patients, in groups of 10, were allocated randomly to receive vecuronium by a cumulative dose method at intervals of 15 min (group 15), 30 min (group 30), 60 min (group 60) or 90 min (group 90) after starting inhalation of sevoflurane. Neuromuscular function was monitored by acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation. Dose-response curves were constructed by least-squares regression analysis and the effective doses of vecuronium (ED50, ED90 and ED95) were estimated and compared between groups. Mean (SEM) ED50, ED90 and ED95 were 16.8 (0.5), 32.6 (1.7) and 40.9 (2.4) micrograms kg-1, respectively, in group 15; 10.6 (1.0), 20.8 (1.7) and 26.2 (2.2) micrograms kg-1, respectively, in group 30; 11.2 (1.1), 21.7 (1.6) and 27.3 (1.8) micrograms kg-1, respectively, in group 60; and 11.0 (1.1), 21.7 (1.6) and 27.5 (1.9) micrograms kg-1, respectively, in group 90. The values obtained in group 15 were significantly higher than those in the other three groups (P < 0.05). The results indicate that the duration of sevoflurane anaesthesia influences the dose-response of vecuronium and 30 min inhalation of 1.7% end-tidal concentration is sufficient to achieve a stable potentiating effect.

The neuromuscular effects of rocuronium under sevoflurane-remifentanil or propofol-remifentanil anesthesia: a randomized clinical comparative study in an Asian population

“…The potentiation of the neuromuscular blocking effects of muscle relaxants by inhalational anesthetics is well known [3–5]. Consequently, inhalational anesthetics can decrease the dose requirement of muscle relaxants and prolong both the duration of action and recovery from neuromuscular block.…”

“…The dose-response curves of rocuronium under sevoflurane, isoflurane, or desflurane shifts to the left compared with those obtained during propofol anesthesia [4]. The interaction of inhalational anesthetics and muscle relaxants is a time-dependent phenomenon and the potentiation effect varies among inhalational agents [5]. Sevoflurane markedly potentiates muscle relaxants, shortening the onset time compared with other anesthetics.…”

Neuromuscular Blockade by Vecuronium during Induction with 5% Sevoflurane or Propofol

“…12 This decreased effect of vecuronium in the present study is mainly due to the short duration of exposure to sevoflurane because of the study design. Duration-dependent potentiation of neuromuscular blockade associated with exposure to volatile inhaled anaesthetic agents has been reported with enflurane, halothane, isoflurane and sevoflurane.…”

Duration of vecuronium-induced neuromuscular block can be predicted by change of skin temperature over the thenar muscles

“…If we use sevoflurane to maintain general anesthesia in the study protocol, there is a possibility that DUR25 would be prolonged time-dependently without any changes in ET and ST. However, previous studies [17,18] indicate that 30 min of exposure to sevoflurane anesthesia is sufficient to achieve a stable potentiating effect on vecuronium. Therefore, sevoflurane has probably minor or no influence on the variations in DUR25s produced by repeated administration of vecuronium after 30 min of inhalation.…”

“…The anesthetics used in this study, such as propofol, fentanyl, and nitrous oxide, have only a minor inhibitory effect on neuromuscular transmission [16], whereas it is well known that potent volatile anesthetics potentiate the action of neuromuscular blocking drugs [16][17][18] and that the degree of potentiation is dependent on the time of exposure to the anesthetics [17,18]. If we use sevoflurane to maintain general anesthesia in the study protocol, there is a possibility that DUR25 would be prolonged time-dependently without any changes in ET and ST.…”