Effect of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium

Vanlinthout, L.E.H.; Booij, L.H.D.J.; Egmond, J. van; Robertson, E. N.

doi:10.1093/bja/76.3.389

Cited by 90 publications

(41 citation statements)

References 24 publications

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“…Various studies in the past have shown that, at equal MAC values, isoflurane and sevoflurane potentiate the neuromuscular blocking potency and increase the duration of action of vecuronium to an approximately similar degree [26,27]. The degree of potentiation by sevoflurane of the dose-response relationship of rocuronium in our study appeared to be similar to that of enflurane and isoflurane in the above study [10] at 1 MAC but to be greater than that of halothane.…”

Section: ¹1supporting

confidence: 72%

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

et al. 1998

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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.

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Section: ¹1supporting

confidence: 72%

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

et al. 1998

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“…Prior administration of SCh does not appear to affect the potency of rocuronium. 7 Isoflurane augments and prolongs the neuromuscular blockade of NDMRs, 8 which was not apparent in this patient. Electrolytes, acid-base balance and temperature were within normal ranges, as were renal and liver function values, and, therefore, cannot explain the altered duration of rocuronium blockade.…”

Section: éLéments Cliniquesmentioning

confidence: 60%

Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient

Munir

Jaffar

Arshad

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report a case of reduced duration of action of rocuronium in a patient with normocalcemic hyperparathyroidism (HPT).C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 56-yr-old patient with primary HPT, who had had surgical resection of three and a half parathyroid glands nine months previously, was referred to our institution for further investigation of a persistent increase in parathyroid hormone. Preoperatively, the patient had a normal serum ionized and total calcium. The patient was diagnosed with a persistent parathyroid adenoma and was scheduled for an elective parathyroidectomy.

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“…[14][15][16] This may be the reason why in a recent study there was no marked prolongation in average reversal time of rapacuronium during sevoflurane compared to propofol anesthesia as the reversal was carried out within only about 15 min of relaxant and anesthetic administration. 1 7 These results are at variance with the findings of Lowry et al who showed a more marked effect of sevoflurane on rocuronium block during spontaneous recovery even after shorter periods of volatile agent administration.…”

Section: Discussionmentioning

confidence: 97%

Neostigmine antagonism of rocuronium block during anesthesia with sevoflurance, isoflurane or propofol

Reid

Breslin

Mirakhur

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To examine the influence of continuing administration of sevoflurane or isoflurane during reversal of rocuronium induced neuromuscular block with neostigmine.Methods: One hundred and twenty patients, divided into three equal groups, were randomly allocated to maintenance of anesthesia with sevoflurane, isoflurane or propofol. Neuromuscular block was induced with rocuronium and monitored using train-of-four (TOF) stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. Neostigmine was administered when the first response in TOF had recovered to 25%. At this time the volatile agent administration was stopped or propofol dosage reduced in half the patients in each group (n = 20 in each group). The times to attain TOF ratio of 0.8, and the number of patients attaining this end point within 15 min were recorded.Results: The times (mean ± SD) to recovery of the TOF ratio to 0.8 were 12.0 ± 5.5 and 6.8 ± 2.3 min in the sevoflurane continued and sevoflurane stopped groups, 9.0 ± 8.3 and 5.5 ± 3.0 min in the isoflurane continued and isoflurane stopped groups, and 5.2 ± 2.8 and 4.7 ±1.5 min in the propofol continued and propofol stopped groups (P < 0.5-01). Only 9 and 15 patients in the sevoflurane and isoflurane continued groups respectively had attained a TOF ratio of 0.8 within 15 min (P < 0.001 for sevoflurane).Conclusions: The continued administration of sevoflurane, and to a smaller extent isoflurane, results in delay in attaining adequate antagonism of rocuronium induced neuromuscular block. REVIOUS studies have shown that antagonism of block with relaxants such as vecuronium is impeded in the presence of potent volatile agents such as sevoflurane and isoflurane. [1][2][3] It has also been shown that sevoflurane anesthesia potentiates the effect of rocuronium compared with isoflurane and propofol anesthesia. 4 Although there are reports of antagonism of rocuronium block with neostigmine, these have generally examined the influence of the dosage or the timing of administration of the anticholinesterase. [5][6][7] The aim of the present study was to examine the effect of the sevoflurane on the antagonism of rocuronium by neostigmine, and compare it with the effects of isoflurane, and intravenous anesthesia.

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Effect of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium

Cited by 90 publications

References 24 publications

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

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

Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient

Neostigmine antagonism of rocuronium block during anesthesia with sevoflurance, isoflurane or propofol

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