Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia

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.

Section: Discussionmentioning

confidence: 98%

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

Reid

Breslin

Mirakhur

et al. 2001

“…Some demand a 30 to 40 min equilibration period of the muscular compartment when using inhaled anesthetics with a high blood-gas solubility, particularly for determination of infusion rates of neuromuscular blocking drugs. 13 Xenon has the lowest blood-gas solubility of all inhaled anesthetics by a wide margin. The solubility of volatile anesthetics in muscle is influenced by body temperature and the patient's age.…”

Section: Discussionmentioning

confidence: 99%

Xenon does not modify mivacurium induced neuromuscular block

Kunitz

Baumert

Hecker

et al. 2005

Purpose:The interaction between mivacurium and inhaled anesthetics is known, with the exception of xenon. We compared the pharmacodynamics of mivacurium during xenon anesthesia vs total iv anesthesia with propofol.Methods: This randomized controlled trial was carried out in the Aachen University Hospital. Forty-two adult patients ASA I or II, aged 18 to 60 yr, were randomized to receive either xenon or propofol anesthesia. Anesthesia was induced with propofol and remifentanil in both groups (each n = 21). The xenon group received xenon via facemask until an end-expiratory concentration of 60% was reached for one minute. Meanwhile, the acceleromyograph was calibrated and a train-of-four stimulation of the adductor pollicis muscle was started. After stabilization of the signal for five minutes, a single bolus of 0.16 mg·kg -1 mivacurium was injected. Anesthesia was maintained with xenon and remifentanil or with propofol and remifentanil.Results: There were no significant differences between groups with respect to onset time (xenon 180 ± 64 vs propofol 195 ± 77 sec; P = 0.39), duration (xenon 16.18 ± 4.97 vs propofol 15.68 ± 6.17 min; P = 0.73), recovery index (xenon 5.63 ± 2.48 vs propofol 5.73 ± 2.12 min; P = 0.42) and clinical recovery (xenon 8.75 ± 2.57 vs propofol 9.28 ± 2.28 min; P = 0.22). Conclusion:We conclude that the neuromuscular blocking effects of mivacurium are similar when given during propofol vs xenon anesthesia. (xénon 180 ± 64 vs propofol 195 ± 77 s ; P = 0,39), à sa durée (xénon 16,18 ± 4,97 vs propofol 15,68 ± 6,17 min ; P = 0,73), à l'indice de récupération (xénon 5,63 ± 2,48 vs propofol 5,73 ± 2,12 min ; P = 0,42) et à la récupération clinique (xénon 8,75 ± 2,57 vs propofol 9,28 ± 2,28 min ; P = 0,22). Objectif : L'interaction entre le mivacurium et les anesthésiques Résultats : Il n'y a pas eu de différence intergroupe significative quant au délai d'installation du bloc Conclusion : Les effets neuromusculaires bloquants du mivacurium sont similaires pendant l'anesthésie au propofol ou au xénon.T HE combination of a short-acting opioid and neuromuscular blocking drug, such as remifentanil and mivacurium, allow rapid emergence and recovery from anesthesia. 1 On the other hand, it is well known that most inhaled anesthetics variably prolong and enhance the effects of nondepolarizing neuromuscular blocking drugs, compared to total iv anesthesia. 2-4 Xenon, a rediscovered inhaled anesthetic with an extremely low blood-gas solubility of 0.115 to 0.14 5 and a minimum alveolar concentration (MAC) of 63 to 71%, 6,7 has proven its clinical safety and efficacy in the past. 8 With its ecological and pharmacological qualities, xenon is an interesting alternative to other inhaled anesthetics. The combination of a short-acting opioid, a short duration

“…Quinze minutes après le début de la perfusion, sa vitesse était plus grande (P < 0,05) pour le groupe propofol (7,5 ± 4 and rocuronium. 5 However, prolongation of the duration of action of neuromuscular blocking agents is not always found, 6,7 and in certain settings the degree of potentiation is very modest. 8 In one study, isoflurane did not alter mivacurium infusion rates compared with propofol.…”

Section: Méthode : Chez 48 Patients Consentants Classifiés Asa I Ou mentioning

confidence: 99%

“…9 One possible explanation is that potentiation with volatile agents takes time to develop, because of the time taken for equilibrium of the agent with muscle tissue. 10 Sevoflurane has been reported to potentiate blockade produced by mivacurium, 11 rocuronium, 5,7 vecuronium, 12 and cisatracurium, 4 but the effect is not always consistent. For example, only a slight decrease was found for the ED 50 of mivacurium, and no change in its duration of action.…”

Section: Méthode : Chez 48 Patients Consentants Classifiés Asa I Ou mentioning

confidence: 99%

Sevoflurane and isoflurane, but not propofol, decrease mivacurium requirements over time

Motamed

Donati

2002

P Pu ur rp po os se e: : Volatile anesthetic agents potentiate neuromuscular blockade, but the magnitude of potentiation appears to be time dependent. The time course of this interaction was studied by measuring mivacurium infusion rates during sevoflurane, isoflurane and propofol anesthesia.M Me et th ho od ds s: : After informed consent, anesthesia was induced in 48 ASA physical status I-II adults with propofol, fentanyl and mivacurium 0.25 mg·kg -1 and maintained with N 2 O (60%) and one of the three agents chosen at random: sevoflurane 1.9%; isoflurane 1.2%; or propofol 100-150 µg·kg -1 ·min -1 . Train-of-four stimulation was applied every 15 sec to the ulnar nerve. Neuromuscular blockade was monitored with accelerometry. At 5% recovery of the first twitch (T1), a mivacurium infusion was started and adjusted every five minutes to maintain 90-95% T1 depression.R Re es su ul lt ts s: : The time to 5% T1 recovery after the initial dose was similar in all groups (13-15 min). Fifteen minutes after the start of the infusion mivacurium requirements were greater (P < 0.05) in the propofol group (7.5 ± 1.7 µg·kg -1 ·min -1 ; mean ± SD) than in either isoflurane (4.7 ± 1.6 µg·kg -1 ·min -1 ) or sevoflurane (4.5 ± 1.5 µg·kg -1 ·min -1 ) group. Then, the rate remained stable for propofol (6.2 ± 1.4 µg·kg -1 ·min -1 after 90 min of infusion) while it decreased with isoflurane to 2.9 ± 1.6 µg·kg -1 ·min -1 at 90 min (P < 0.05 vs propofol) and to 1.4 ± 1.0 µg·kg -1 ·min -1 in the sevoflurane group (P < 0.05 vs propofol and isoflurane).