Effects of Residual Concentrations of Isoflurane on the Reversal of Vecuronium-induced Neuromuscular Blockade

Baurain, Michel; D’Hollander, Alain; Mélot, Christian; Dernovoi, Boris; Barvais, Luc

doi:10.1097/00000542-199103000-00014

Cited by 53 publications

(31 citation statements)

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“…Measurements of T1 ⁄ control and train-of-four ratio (TOFR) were taken 3 min, 6 min, 9 min, 12 min and 15 min after the administration of neostigmine, and the values for the two groups were compared. It has been shown that 15 min after the administration of neostigmine at a T1 ⁄ control value of 0.25, TOFR often does not return to 0.9 [14][15][16][17].…”

Section: Methodsmentioning

confidence: 99%

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Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Saitoh

Hattori²,

Sanbe³

et al. 2004

Anaesthesia

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SummaryReversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 lg.kg )1 and atropine 20 lg.kg )1 were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).

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Section: Methodsmentioning

confidence: 99%

“…Further, it has been postulated that if neostigmine 40 lg.kg )1 is administered when T1 ⁄ control = 0.25, TOFR returns to a value of 0.9 after about 15 min [14][15][16]. For this reason, recovery from neuromuscular blockade was studied for 15 min after neostigmine administration in this study.…”

mentioning

confidence: 96%

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Saitoh

Hattori²,

Sanbe³

et al. 2004

Anaesthesia

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“…1 In our study also, the reversal was slowed in the presence of sevoflurane, and to some extent isoflurane anesthesia, and in some patients the block had not reversed even by 30 min. However, when the volatile agent administration was discontinued at the time of neostigmine administration, the reversal times were not different from the propofol groups.…”

Section: Discussionsupporting

confidence: 55%

“…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.…”

mentioning

confidence: 99%

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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“…Addition of 1 MAC isoflurane was found to decrease the T4/Tt values by 10-15%. 21 In the present study, approximately 0.4 MAC isoflurane was used, and the results are between those obtained with nitrous oxide-narcotic and nitrous oxide-isoflurane anaesthesia. 2j The effect of neostigmine given at the same twitch height recovery was the same in Montrtal and in Paris.…”

Section: Discussionmentioning

confidence: 56%

Neuromuscular effects of vecuronium and neostigmine in Montreal and Paris

et al. 1994

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The potency of vecuronium was reported to be greater in Montreal than (28,5 5:6,8 In 1969, Katz et al. ~ reported that the maximum blockade attained after a single dose of d-tubocurarine or sueeinylcholine was greater and the duration of action was longer in New York than in London. The study was performed before dose-response techniques became common practice in the evaluation of muscle relaxants, and before a standard mode of stimulation, the train-of-four, 2 was introduced into clinical use and research. L'intervalle entre l~njection et le bloc maximum dtait de (moyenne • ET) 3,9 5:1,3 min~ Paris et 4,5 + 1,3 min~ Montrdal (NS). La dur~e d'action, c'est-~-dire le temps entre l'injection de vEcuronium et la rdcupdration de 25%, dtait plus courte h ParisRecently, Fiset et al. 3 performed another transatlantic study, and compared the dose-response curves for vecuronium between Montl~al and Paris. In spite of similar demographic data in both centres and an identical anaesthetic and neuromuscular technique, the Paris doseresponse curve was shifted to the fight by 30%, that is, vecuronium was more potent in Montreal. The difference could not be explained by differences in age, sex, weight or body habitus, because these variables were similar in both cities. Disposition of the drug probably had little effect on these differences, because dose-response data are CAN J ANAESTH 1994 / 41: 10 / pp908-12

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Effects of Residual Concentrations of Isoflurane on the Reversal of Vecuronium-induced Neuromuscular Blockade

Cited by 53 publications

References 0 publications

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

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

Neuromuscular effects of vecuronium and neostigmine in Montreal and Paris

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