Neuromuscular blocking effects and train‐of‐four fade with cisatracurium: comparison with other nondepolarising relaxants

Abstract

SummaryNeuromuscular blocking drugs exhibit different degrees of fade in response to train-of-four stimulation believed to represent their relative prejunctional effects. The present study was designed to compare the train-of-four fade after cisatracurium and compare this with other commonly used muscle relaxants. Train-of-four fade during onset and recovery of block were recorded after administration of cisatracurium 0.05 or 0.1 mg.kg ¹1 , atracurium 0.5 mg.kg ¹1 , vecuronium 0.08 mg.kg ¹1 , mivacurium 0.15 mg.kg ¹1 or rocuronium 0.6 mg.kg ¹1 to patients anaesthetised with fentanyl, nitrous oxide and a propofol infusion. Neuromuscular monitoring was by stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. The onset and recovery of block were also measured. Train-of-four fade during onset of block was greater with the lower dose of cisatracurium compared with the higher dose of cisatracurium and all other relaxants. Train-of-four fade during recovery was similar. The median times (and ranges) for the onset of maximum block were 3.4 (2.1-5.6), 1.5 (1.2-2.3), 2.1 (1.2-2.6), 2.0 (1.5-2.7) and 1.0 (0.7-1.3) min for cisatracurium 0.1 mg.kg ¹1 and atracurium, mivacurium, vecuronium and rocuronium, respectively. The median times (and ranges) for the recovery of T 1 to 25% of control and to a train-of-four ratio of 0.8 were 41 (21-50) and 65 (40-78); 43 (37-54) and 69 (58-79); 15 (11-20) and 25 (19-30); 31 (23-46) and 60 (45-117); and 33 (18-57) and 50 (28-76) min following cisatracurium, 0.1 mg.kg ¹1 , atracurium, mivacurium, vecuronium and recuronium, respectively.

Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol

“…The onset time of the bolus application of 0.1 mg·kg -1 cisatracurium at the adductor pollicis muscle was between three to five minutes, comparable to results in other studies. [7][8][9] The controller performance was regarded as sufficient at an average difference from 2.0% (group D) to 3.2% (group I) between the set point of T1%=10% and the measured degree of neuromuscular blockade. The controller performance for cisatracurium was different from those found for other non-depolarizing muscle relaxants such as vecuronium, 10,11 atracurium 12,13 or rocuronium.…”

Time course and train-of-four fade of mivacurium block during sevoflurane and intravenous anaesthesia

“…The clinical significance of this prejunctional action is not clear and it has not been correlated with the potency of the drug or the speed of onset of the neuromuscular block [12,13]. Recent studies have found no differences in TOF fade between the more frequently used agents (mivacurium, atracurium, rocuronium, vecuronium and cisatracurium), although there have been previously reported differences between pancuronium and d-tubocurarine [13,14].…”

“…The degree of fade in response to TOF stimulation is correlated to the action of the neuromuscular blocking agent on the presynaptic receptor [12,13]. This action induces an inhibition of the positive feedback decreasing transmitter output [14].…”

Comparative fading responses induced by mivacurium, cisatracurium, and d-tubocurarine in the evoked muscular compound action potentials of the cat

“…First, there are differences in the muscle and monitoring apparatus used to measure neuromuscular responses. In the human study by Carroll et al [16], twitch tensions of the adductor pollicis muscle, which is classified as a slow-twitch muscle, were measured by a mechanomyograph (MMG). In contrast, we studied electromyographic (EMG) responses in the fast-twitch gastrocnemius muscle.…”