Abstract
Purpose
To determine the magnitude of the potentiation of rocuronium by desflurane, isoflurane and sevoflurane 1.5 MAC anaesthesia.
Methods
In a prospective, randomised, study in 80 patients, the cumulative dose-effect curves for rocuronium were determined during anaesthesia with desflurane, sevoflurane and isoflurane (with N2O 70%, 15 min steady state) or total intravenous anaesthesia (TIVA) using propofol/fentanyl. Neuromuscular block was assessed by acceleromyography (TOF-Guard®) after train-of-four (TOF) stimulation of the ulnar nerve (2Hz every 12sec, 200 μsec duration), Rocuronium was administered in increments of 100 μg·kg−1 until first twitch (T1) depression > 95%.
Results
Rocuronium led to more pronounced T1 depression with desflurane or sevoflurane anaesthesia than with TIVA. The ED50 and ED95 were lower during desflurane (95 ± 25 and 190 ± 80 μg·kg−1) and sevoflurane (120 ±30 and 210 ± 40 μg·kg−1) than with TIVA (150 ± 40 and 310 ± 90 μg·kg−1) (P < .01), while the difference was not significant for isoflurane (130 ± 40 and 250 ± 90 μg·kg−1). Following equi-effective dosing (T1 > 95%) the duration to 25% T1 recovery, recovery index (25/75), and TOF0.70 was: 13.2 ± 1.8, 12.7 ± 3.4, and 26.9 ± 5.7 min during anaesthesia with desflurane; 15.5 ± 5.0, 11.4 ± 3.8, and 31.0 ± 6.0 min with sevoflurane; 13.9 ± 4.7, 10.7 ± 3.3, and 26.3 ± 8.9 min with isoflurane; and 13.9 ± 3.9, 11.3 ± 5.7, and 27.5 ± 8,2 min with TIVA anaesthesia (P: NS).
Conclusion
Interaction of rocuronium and volatile anaesthetics resulted in augmentation of the intensity of neuromuscular block but did not result in significant effects on duration of or recovery from the block.
Résumé
Objectif
Déterminer l’importance de la potentialisation du rocuronium lors de l’anesthésie utilisant une CAM de 1,5 de desflurane, d’isoflurane et de sévoflurane.
Méthode
Dans une étude randomisée et prospective chez 80 patients, les courbes cumulatives de l’effet en fonction de la dose pour le rocuronium ont été déterminées pendant l’anesthésie avec du desflurane, du sévoflurane et de l’isoflurane (avec N2O 70 %, à l’état d’équilibre après 15 min) ou pendant l’anesthésie exclusivement intraveineuse (AEI) utilisant du propofol et du fentanyl. La profondeur du bloc neuromusculaire a été mesurée à l’aide d’un accéléromyographe (TOF-Guard®) après une stimulation du nerf cubital en train de quatre (TDQ), (2 Hz toutes les 12 s, durée de 200 μs). Le rocuronium a été administré en accroissements de 100 μg·kg−1 jusqu’à ce que la première réponse (R1) atteigne une réduction > 95 %.
Résultats
Le rocuronium provoque des dépressions de R1 plus marquée lors de l’anesthésie avec le desflurane ou le sévoflurane que lors de l’AEI. Les ED50 et ED95 ont été plus faibles avec desflurane (95 ± 25 et 190 ± 80 μg·kg−1) et sévoflurane (120 ± 30 et 210 ± 40 μg·kg−1) qu’avec l’AEI (150 ± 40 et 310 ± 90 μg·kg−1) (P < .01), tandis que la différence n’était pas significative avec isoflurane (130 ± 40 et 250 ± 90 μg·kg−1). A la suite d’un dosage à effet équivalent (R1 > 95%) la durée de la récupération à 25 % Rj, l’index de récupération (25/75) et le train de quatre0,70 étaient: 13,2 ± 1,8; 12,7 ± 3,4 et 26,9 ± 5,7 min pendant l’anesthésie avec desflurane; 15,5 ± 5,0; 11,4 ± 3,8 et 31,0 ± 6,0 min avec le sévoflurane; 13,9 ± 4,7; 10,7 ± 3,3 et 26,3 ± 8,9 min avec l’isoflurane; enfin, 13,9 ± 3,9; 11,3 ± 5,7 et 27,5 ± 8,2 min avec l’AEI (P: NS).
Conclusion
L’interaction du rocuronium et des anesthésiques volatils a provoqué l’augmentation de l’intensité du bloc neuromusculaire mais n’a pas eu d’effet significatif sur la durée du bloc ou sur la récupération qui a suivi.
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Acceleromyographs and related software provided by Organon Technika (Eppelheim, Germany).
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Wulf, H., Ledowski, T., Linstedt, U. et al. Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia. Can J Anaesth 45, 526–532 (1998). https://doi.org/10.1007/BF03012702
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DOI: https://doi.org/10.1007/BF03012702