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

  • Joan E. Reid
  • Dara S. Breslin
  • Rajinder K. Mirakhur
  • Agnes H. Hayes
General Anesthesia

Abstract

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<0.5–0.1). 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.

Résumé

Objectife: Examiner l’influence de l’administration continue de sévoflurane ou d’isoflurane pendant le renversement d’un bloc neuromusculaire induit avec du rocuronium et de la néostigmine.

Méthode: Cent vingt patients, répartis en trois groupes égaux, ont reçu au hasard du sévoflurane, de l’isoflurane ou du propofol pour le maintien de l’anesthésie. Le bloc neuromusculaire a été induit avec du rocuronium et placé sous monitorage d’une stimulation en train-dequatre (TDQ) du nerf cubital et d’un enregistrement de la force de contraction du muscle adducteur du pouce. La néostigmine a été administrée au moment de la première réponse en TDQ d’une récupération à 25 %. À ce moment. l’administration de l’anesthésique volatil a été stoppée, ou le propofol réduit, chez la moitié des patients de chaque groupe (n=20 dans chaque groupe). Le temps nécessaire pour atteindre un ratio de 0,8 du TDQ et le nombre de patients qui atteignent cette mesure cible en moins de 15 min ont été enregistrés.

Résultats: Le temps (moyenne±écart type) de récupération du ratio de 0,8 du TDQ a été de 12,0±5,5 et de 6,8±2,3 min avec le sévoflurane continu et stoppé; 9.0±8,3 et 5,5±3,0 min avec l’isoflurane continu et stoppé; 5,2±2,8 et 4,7±1,5 min avec le propofol continue et stoppé (P<0,5−01). Seulement 9 et 15 patients ayant reçu du sévoflurane et de l’isoflurane en administration continue ont atteint le ratio de 0,8 du TDQ en moins de 15 min (P<0,001 pour le sévoflurance).

Conclusion: L’administration continue de sévoflurane et, dans une moindre mesure, d’isoflurane, a retardé le renversement d’un bloc neuromusculaire induit avec du rocuronium.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Joan E. Reid
    • 1
  • Dara S. Breslin
    • 1
  • Rajinder K. Mirakhur
    • 1
  • Agnes H. Hayes
    • 1
  1. 1.From the Department of Anaesthetics and Intensive Care MedicineThe Queen’s University of BelfastBelfastN. Ireland, UK

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