Xenon does not modify mivacurium induced neuromuscular block

Abstract

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

Xenon-based anesthesia: theory and practice

“…32 A potentiating interaction or clear antagonism has not been demonstrated. Xenon has no influence on the effects of nondepolarizing muscle relaxants [33][34][35] which can thus be combined according to surgical needs. In any case, xenon concentration should be kept as high as possible.…”

Clinical efficacy of xenon versus propofol

“…Two studies assessed how nondepolarizing muscle relaxation was affected by xenon. [ 15 , 16 ] Both studies included the time of onset, duration (T 25 ), clinical recovery (T 25–0.8 ), and recovery index (T 25–75 ). No significant differences were observed between the xenon group and the propofol group (Table 3 ).…”

A practical rule for optimal flows for xenon anaesthesia in a semi-closed anaesthesia circuit

“…The high price of xenon due to its low availability as well as its high minimum alveolar concentration (MAC) value of 63% results in very high costs of a combined xenon/opioid anaesthesia, which limits the use of xenon mainly to clinical trials. [8][9][10] One important reason for the lack of clinical data is a technical one: nowadays, only a small number of anaesthesia circuits are suited for xenon anaesthesia. The closed anaesthesia circuit (Physioflex, Draeger, Luebeck, Germany) was favoured; however, this company does not produce this device any longer.…”