Influência do sevoflurano e do isoflurano na recuperação do bloqueio neuromuscular produzido pelo cisatracúrio

Braga, Angélica de Fátima de Assunção; Braga, Franklin Sarmento da Silva; Potério, Glória Maria Braga; Cremonesi, E; Mauro, Gislaine

doi:10.1590/s0034-70942002000500001

Cited by 4 publications

(9 citation statements)

References 25 publications

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“…[36–39] The mechanism behind this interaction has still not been fully elucidated. Potentiation may occur due to several factors: effect of volatile agents on acetylcholine receptor channels; action on the central nervous system, causing reflex medullary depression and contributing to tone reduction with skeletal muscular relaxation; decreased postjunctional synaptic membrane sensitivity to depolarization caused by acetylcholine; and increased muscle blood flow, allowing a higher amount of NMB to reach the site of action.…”

Section: Discussionmentioning

confidence: 99%

Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade

Santos

Braga²,

Junqueira³

et al. 2017

Medicine

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This research aimed to assess the use of neuromuscular blockers (NMB) and its reversal, associated or not with neuraxial blockade, after general anesthesia.This retrospective study analyzed 1295 patients that underwent surgery with general anesthesia at Prof. Dr. José Aristodemo Pinotti Hospital in 2013. The study included patients aged >1 year, with complete, readable medical charts and anesthetic records.Rocuronium (ROC) was the most used NMB (96.7%), with an initial dose of 0.60 (0.52–0.74) mg/kg and total dose of 0.38 (0.27–0.53) mg/kg/h. In 24.3% of the cases, neuraxial blockade was associated with a significantly longer anesthesia (P < .001) than in cases without neuraxial block, regardless of technique (total intravenous (TIV) vs intravenous and inhalational (IV+IN)). In 71.9% of the cases, a single dose of NMB was used. Patients under TIV general anesthesia associated with neuraxial blockade had a lower total dose of ROC (mg/kg/h) in comparison with TIV GA alone (0.30 (0.23–0.39) and 0.42 (0.30–0.56) mg/kg/h, respectively, P < .001). The same was observed for patients under IV+IN GA (0.32 (0.23–0.41) and 0.43 (0.31–0.56) mg/kg/h, respectively, P < .001). The duration of anesthesia was longer according to increasing number of additional NMB doses (P < .001). Dose of neostigmine was 2.00 (2.00–2.00) mg or 29.41 (25.31–33.89) μg/kg. The interval between neostigmine and extubation was >30 minutes in 10.9% of cases.The most widely used NMB was ROC. Neuroaxial blockade (spinal or epidural) was significantly associated with reduced total dose of ROC (mg/kg/h) during general anesthesia, even in the absence of neuromuscular monitoring and regardless of general anesthetic technique chosen. In most cases, neostigmine was used to reverse neuromuscular block. The prolonged interval between neostigmine and extubation (>30 minutes) was neither associated with total doses of ROC or neostigmine, nor with the time of NMB administration. This study corroborates the important role of quantitative neuromuscular monitors and demonstrates that neuraxial blockade is associated with reduced total ROC dose. Further studies are needed to evaluate the possible role of neuraxial blockade in reducing the incidence of postoperative residual curarization.

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Section: Discussionmentioning

confidence: 99%

Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade

Santos

Braga²,

Junqueira³

et al. 2017

Medicine

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“…Other authors have found a similar onset time (1.50 minutes) in children receiving 0.5 mg.kg -1 atracurium 27 . Recovery time (T ) is a comparison standard largely independent of neuromuscular blocker dose and is inversely correlated to drug metabolization 8, 28 . However, for a drug where redistribution plays a major role in recovery, this ratio (T ) may increase after high doses, serial doses or continuous infusion.…”

Section: Discussionmentioning

confidence: 99%

“…Several papers have shown that volatile anesthetics potentiate neuromuscular blockers action, thus prolonging their duration. This phenomenon is not yet well understood, but some factors might be involved, such as an action on acetylcholine receptors, action on the central nervous system with reflex medullary depression, decreased post-junctional membrane sensitivity to acetylcholine-induced depolarization, or even increased muscle blood flow [28][29][30] .…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged neuromuscular junction recovery time depending on the type of anesthetics has been studied for rocuronium. Some authors have found a prolonged T in adults with rocuronium and sevoflurane as compared to isoflurane (26.3 and 14.7 minutes, respectively) 28 . The slower recovery time observed by some authors may be due to lower rocuronium doses or the association of intravenous anesthetics 20,34,35 .…”

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confidence: 98%

“…A different study has shown a 70% decrease in mivacurium dose in children anesthetized with isoflurane as compared to those anesthetized with halothane 23 . A period of 30 to 45 minutes is taken into account when studying the influence of volatile anesthetics on neuromuscular blockers, that is, enough time for its diffusion in the muscle compartment and to establish a balance among inhaled alveolar, plasma and muscular concentrations 28,[33][34][35] . Sevoflurane was the volatile anesthetic drug used in this study and was administered for more than 30 to 45 minutes.…”

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Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos

Módolo¹,

Júnior²,

Croitor³

et al. 2002

Rev. Bras. Anestesiol.

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General anesthesia with cisatracurium and sevoflurane for a patient with primary carnitine deficiency receiving L-carnitine therapy

Ai¹,

Yan²

2021

Medicine

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Rationale:Lipid storage myopathies (LSMs) are a series of genetic disorders of lipid metabolism predominantly affecting muscle. The low incidence and lethal properties of this disease make anesthesia experience limited in such patients. Among all etiologies of LSMs, primary carnitine deficiency (PCD) is now considered highly treatable by early administration of L-carnitine, though it remains unclear whether L-carnitine is effective enough to protect diseased muscle against conventionally used neuromuscular blocking agents (NMBAs) during general anesthesia. Currently, no data are available concerning possible prolonged muscle weakness in these cases.Patient concerns:This case presents a 43-year-old female who was diagnosed with a PCD-induced LSM 3 years ago due to fatigability and exertional myalgias and has been treated with L-carnitine ever since. At the time of this report, she was admitted for uterine fibroids and scheduled for selective open gynecologic surgery under general anesthesia.Diagnosis:The patient's diagnosis of PCD-induced LSM was based on the clinical features, muscle biopsy, and diminished organic cation/carnitine transporter 2 (OCTN2) transporter activity in the patient's skin fibroblasts.Interventions:L-carnitine was taken by the patient until the morning of surgery. General anesthesia with cisatracurium and sevoflurane was selected as the anesthetic plan during the operation. The train-of-four (TOF) test was adopted as additional monitoring, particularly to track the recovery of neuromuscular function.Outcomes:The patient was extubated successfully following a spontaneously restored TOF ratio (TOFR) of 0.9. Nonetheless, we recorded a prolonged efficacy of cisatracurium in the clinical duration and the recovery time with TOFRs of 0.7 and 0.9, respectively.Lessons:The conventional dose of cisatracurium combined with a low dose of sevoflurane can be safely used in patients with LSMs without additional anesthetic risks. Meanwhile, continuous TOF monitoring is recommended to perform high-quality anesthesia.

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Influência do sevoflurano e do isoflurano na recuperação do bloqueio neuromuscular produzido pelo cisatracúrio

Abstract: The recovery from cisatracurium-induced neuromuscular block was longer during anesthesia with volatile agents as compared to propofol. The most pronounced effect was observed with sevoflurane.

Cited by 4 publications

References 25 publications

Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade

Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade

Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos

General anesthesia with cisatracurium and sevoflurane for a patient with primary carnitine deficiency receiving L-carnitine therapy

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