Skip to main content

Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia

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.

References

  1. Rupp SM, Miller RD, Gencarelli PJ. Vecuroniuminduced neuromuscular blockade during enflurane, isoflurane, and halothane anesthesia in humans. Anesthesiology 1984; 60: 102–5.

    PubMed  Article  CAS  Google Scholar 

  2. Huizinga ACT, Vandenbrom RHG, Wierda JMKH, Hommes FDM, Hennis PJ. Intubating conditions and onset of neuromuscular block of rocuronium (Org 9426); a comparison with suxamethonium. Acta Anaesthesiol Scand 1992; 36: 463–8.

    PubMed  CAS  Google Scholar 

  3. Yasuda N, Lockhart SH, Eger EI II, et al. Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth Analg 1991; 72: 316–24.

    PubMed  Article  CAS  Google Scholar 

  4. Tasuda N, Lockhart SH, Eger EI II, et al. Kinetics of desflurane, isoflurane, and halothane in humans. Anesthesiology 1991; 74: 489–98.

    Article  Google Scholar 

  5. Viby-Mogensen J, Engbaek J, Eriksson LI, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.

    PubMed  CAS  Google Scholar 

  6. Oris B, Crul JF, Vandermeersch E, Van Aken H, Van Egmond J, Sabbe MB. Muscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia. Anesth Analg 1993; 77: 570–3.

    PubMed  Article  CAS  Google Scholar 

  7. Plaud B, Proost JH, Wierda JMKH, Barre J, Debaene B, Meistelman C. Pharmacokinetics and pharmacodynamics of rocuronium at the vocal cords and the adductor pollicis in humans. Clin Pharmacol Ther 1995; 58: 185–91.

    PubMed  Article  CAS  Google Scholar 

  8. Cooper RA, Maddineni VR, Mirakhur RK, Wierda JMKH, Brady M, Fitzpatrick KTJ. Time course of neuromuscular effects and pharmacokinetics of rocuronium bromide (Org 9426) during isoflurane anaesthesia in patients with and without renal failure. Br J Anaesth 1993; 71: 222–6.

    PubMed  Article  CAS  Google Scholar 

  9. Viby-Mogensen J, Jensen E, Werner M, Kirkegaard Nielsen H. Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand 1988; 32: 45–8.

    PubMed  CAS  Article  Google Scholar 

  10. Girling KJ, Mahajan RP. The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry. Anesth Analg 1996; 82: 1257–60.

    PubMed  Article  CAS  Google Scholar 

  11. Kumar N, Mirakhur RK, Symington MJJ, McCarthy GJ. Potency and time course of action of rocuronium during desflurane and isoflurane anaesthesia. Br J Anaesth 1996; 77: 488–91.

    PubMed  CAS  Google Scholar 

  12. Donlon JV Jr, Savarese JJ, Ali HH, Teplik RS. Human dose-response curves for neuromuscular blocking drugs. A comparison of two methods of construction and analysis. Anesthesiology 1980; 53: 161–6.

    PubMed  Article  CAS  Google Scholar 

  13. Pollard BJ. Interactions involving relaxants.In:Pollard BJ (Ed.) Applied Neuromuscular Pharmacology. Oxford University Press 1994; 202–28.

  14. Muir AW, Anderson KA, Pow E. Interaction between rocuronium bromide and some drugs used during anaesthesia. Eur J Anaesthesiol 1994; 11(Suppl9): 93–8.

    Google Scholar 

  15. Vanlinthout LEH, Booij LHDJ, van Esmond J, Robertson EN. Effect of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium. Br J Anaesth 1996; 76: 389–95.

    PubMed  CAS  Google Scholar 

  16. Taivainen T, Meretoja OA. The neuromuscular blocking effects of vecuronium during sevoflurane, halothane and balanced anaesthesia in children. Anaesthesia 1995; 50: 1046–9.

    PubMed  Article  CAS  Google Scholar 

  17. Agoston S. Interactions of volatile anaesthetics with rocuronium bromide in perspective. Eur J Anaesthesiol 1994; 11(Suppl9): 107–11.

    Google Scholar 

  18. Saitoh Y, Toyooka H, Amaha K. Recoveries of posttetanic twitch and train-of-four responses after administration of vecuronium with different inhalation anaesthetics and neuroleptanaesthesia. Br J Anaesth 1993; 70: 402–4.

    PubMed  Article  CAS  Google Scholar 

  19. Wierda JMKH, Proost JH, Schiere S, Hommes FDM. Pharmacokinetics and pharmacokinetic/dynamic relationship of rocuronium bromide in humans. Eur J Anaesthesiol 1994; 11(Suppl 9): 66–74.

    Google Scholar 

  20. Von Klinzing S, Klein U, Eiselt U. Effect of rocuronium under sufentanil/isoflurane and sufentanil/propofol anaesthesia (German). Anaesthesiol Reanim 1996; 21: 149–52.

    PubMed  CAS  Google Scholar 

  21. Servin FS, Lavaut E, Kleef U, Desmonts JM. Repeated doses of rocuronium bromide administered to cirrhotic and control patients receiving isoflurane. Anesthesiology 1996; 84: 1092–100.

    PubMed  Article  CAS  Google Scholar 

  22. Shanks CA, Fragen RJ, Ling D. Continuous intravenous infusion of rocuronium (Org 9426) in patients receiving balanced, enflurane, or isoflurane anesthesia. Anesthesiology 1993; 78: 649–51.

    PubMed  Article  CAS  Google Scholar 

  23. Driessen JJ, Crul JF, Jansen R, van Egmond J. Isoflurane and neuromuscular blocking drugs. Anaesthesiology & Intensive Care Medicine 1986; 182: 76–82.

    CAS  Google Scholar 

  24. Meretoja OA, Wirtavuori K, Taivainen T, Olkkola KT. Time course of potentiation of mivacurium by halothane and isoflurane in children. Br J Anaesth 1996; 76: 235–8.

    PubMed  CAS  Google Scholar 

  25. Kansanaho M, Olkkola KT. Quantifying the effect of isoflurane on mivacurium infusion requirements. Anaesthesia 1996; 51: 133–6.

    PubMed  Article  CAS  Google Scholar 

  26. Wright PMC, Hart P, Lau M, et al. The magnitude and time course of vecuronium potentiation by desflurane versus isoflurane. Anesthesiology 1995; 82: 404–11.

    PubMed  Article  CAS  Google Scholar 

  27. Harper NJN, Martlew R, Strang T, Wallace M. Monitoring neuromuscular block by acceleromyography: comparison of the mini-accelerograph with the myograph 2000. Br J Anaesth 1994; 72: 411–4.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hinnerk Wulf.

Additional information

Acceleromyographs and related software provided by Organon Technika (Eppelheim, Germany).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03012702

Keywords

  • Isoflurane
  • Sevoflurane
  • Rocuronium
  • Desflurane
  • Neuromuscular Block