Abstract
Purpose
The aim of this study was to assess the effect of rocuronium pretreatment at 3 and 1.5 min before succinylcholine administration on fasciculations, neuromuscular blockade and intubating conditions.
Methods
Sixty ASA I or II adults scheduled for elective surgery were anaesthetised with midazolam, fentanyl, propofol, N2O and isoflurane. They were randomised in a double blind manner into three groups: group ROC-3 min (n = 22) received 0.05 mg·kg−1 rocuronium, 3 min before 2 mg·kg−1 succinylcholine; group ROC-1.5 min (n = 20) received 0.05 mg·kg−1 rocuronium 1.5 min before 2 mg·kg−1 succinylcholine; and group NO ROC (n = 18) had no rocuronium before injection of 2 mg·kg−1 succinylcholine. Fasciculations and intubating conditions were evaluated by the same physician who was unaware of the randomisation. Neuromuscular block was measured at the adductor pollicis with an accelerometer.
Results
The incidence of fasciculations was lower in the ROC-3 min (9%) and ROC-1.5 mm (30%) groups than in the NO ROC group (83%;P < 0.001 ). The intensity of fasciculations was also less in both pretreatment groups. No statistical difference was noted between pretreatment at 3 and 1.5 min. Intubating conditions, onset time and duration of succinylcholine blockade were comparable in all three groups.
Conclusion
The incidence and severity of succinylcholine fasciculations can be reduced by giving 0.05 mg·kg−1 rocuronium either 1.5 min or 3 min before succinylcholine. The effects of 2 mg·kg−1 succinylcholine with rocuronium pretreatment, and 1 mg·kg−1 succinylcholine, without pretreatment, are similar with respect to intubating conditions, onset of paralysis and duration of blockade.
Résumé
Objectif
Évaluer l’influence du rocuronium administré 3 et 1,5 min avant la succinylcholine sur les fasciculations, le bloc neuromusculaire et les conditions d’intubation.
Méthodes
Soixante patients ASA I et II programmés pour une chirurgie non urgente ont été anesthésiés avec du midazolam, du fentanyl, du propofol et de l’isoflurane. Ils ont été assignés aléatoirement et en double aveugle à trois groupes: le groupe ROC-3 min (n = 22) a reçu le rocuronium 0,05 mg·kg−1 3 min avant la succinylcholine 2 mg·kg−1; le groupe ROC-1,5 min (n = 20) a reçu le rocuronium 0,05 mg·kg−1 1,5 min avant la succinylcholine 2 mg·kg−1 et le groupe NO ROC (n = 18) n’a pas reçu de rocuronium avant l’injection de la succinylcholine 1 mg·kg−1. Un même médecin non informé de la randomisation a évalué les fasciculations et les conditions d’intubation. Un accéléromètre a servi à mesurer le bloc neuromusculaire au niveau de l’adducteur du pouce.
Résultats
L’incidence des fasciculations était plus faible dans les groupes ROC-3 min (9%) et ROC-1,5 min (30%) que dans le groupe NO ROC (83% ; P < 0,001 ). Les fasciculations étaient aussi moins intenses dans les deux groupes prétraités mais sans différence statistique entre 3 et 1,5 min. Les conditions d’intubation, la vitesse d’installation et la durée d’action du bloc à la succinylcholine ne différaient pas entre les trois groupes.
Conclusion
L’administration de rocuronium, que ce soit 1,5 ou 3 min avant la succinylcholine. peut réduire l’incidence et l’intensité des fasciculations. Leffet de la succinylcholine 2 mg·kg−1 avec prétraitement au rocuronium est comparable avec celle de la succinylcholine 1 mg·kg−1 sans prétraitement au regard des conditions d’intubation, de la vitesse d’installation de la paralysie et de la durée du bloc.
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References
Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapidsequence induction of anesthesia in adult patients. Anesthesiology 1993; 79: 913–8.
Silverman DG, Donati F. Undesirable effects of succinylcholine.In: Silverman DG (Ed.). Neuromuscular Block in Perioperative and Intensive Care. Philadelphia: J.B. Lippincott Co., 1994: 276–96.
Hartman GS, Fiamengo SA, Riker WF Jr. Succinylcholine: mechanism of fasciculations and their prevention by d-tubocurarine or diphenylhydantoin. Anesthesiology 1986; 65: 405–13.
Cullen DJ. The effect of pretreatment with nondepolarizing muscle relaxants on the neuromuscular blocking action of succinylcholine. Anesthesiology 1971; 35: 572–8.
Pinchak AC, Smith CE, Shepard LS, Patterson L. Waiting time after non-depolarizing relaxants alter muscle fasciculation response to succinylcholine. Can J Anaesth 1994; 41: 206–12.
Horrow JC, Lambert DH. The search for an optimal interval between pretreatment dose ofd-tubocurarine and succinylcholine. Can Anaesth Soc J 1984; 31: 528–33.
England AJ, Richards KM, Feldman SA. The effect of rate of stimulation on force of contraction in a partially paralyzed rat phrenic nerve hemidiaphragm preparation. Anesth Analg 1997; 84: 882–5.
Szalados JE, Donati F, Bevan DR. Effects ofd-tubocurarine pretreatment on succinylcholine twitch augmentation and neuromuscular blockade. Anesth Analg 1991; 71: 55–9.
Pace NL. Prevention of succinylcholine myalgias: a meta-analysis. Anesth Analg 1990; 70: 477–83.
Masey SA, Glazebrook CW, Goat VA. Suxamethonium: a new look at pretreatment. Br J Anaesth 1983; 55: 729–33.
Manchikanti L, Grow JB, Colliver JA, Canella MG, Hadley CH. Atracurium pretreatment for succinylcholine-induced fasciculations and postoperative myalgia. Anesth Analg 1985; 64: 1010–4.
Blitt CD, Carlson GL, Rolling GD, Hameroff SR, Otto CW. A comparative evaluation of pretreatment with nondepolarizing neuromuscular blockers prior to the administration of succinylcholine. Anesthesiology 1981; 55: 687–9.
Sosis M, Broad T, Larijani GE, Marr AT. Comparison of atracurium and d-tubocurarine for prevention of succinylcholine myalgia. Anesth Analg 1987; 66: 657–9.
Virtue RW. Comparison of gallamine with d-tubocurarine effects on fasciculations after succinylcholine. Anesth Analg 1975; 54: 81–2.
O’Sullivan EP, Williams NE, Calvey TN. Differential effects of neuromuscular blocking agents on suxamethonium-induced fasciculations and myalgias. Br J Anaesth 1988; 60: 367–71.
Law Min JC, Bekavac I, Glavinovic MI, Donati F, Bevan DR. Iontophoretic study of speed of action of various muscle relaxants. Anesthesiology 1992; 77: 351–6.
Cooper RA, Mirakhur RK, Elliot P, McCarthy GJ. Estimation of the potency of ORG 9426 using two different modes of nerve stimulation. Can J Anaesth 1992; 39: 139–42.
Lepage JY, Malinovsky JM, Lechevalier T, Cozian A, Pinaud M. Neuromuscular transmission analyser: mechanomyography vs acceleromyography. Anesthesiology 1995; 83: A891.
Girling KJ, Mahajan RP. The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry. Anesth Analg 1996; 82: 1257–60.
Bevan DR, Fiset P, Balendran P, Law-Min JC, Ratcliffe A, Donati F. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth 1993; 40: 127–32.
Maddineni VR, Mirakhur R.K, McCoy EP, Fee JPH, Clarke RSJ. Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium. Anaesthesia 1993; 48: 940–5.
Szalados JE, Donati F, Bevan DR. Nitrous oxide potentiates succinylcholine neuromuscular blockade in humans. Anesth Analg 1991; 72: 18–21.
McCoy ÉP, Mirakhur RK, Connolly FM, Loan PB. The influence of the duration of control stimulation on the onset and recovery of neuromuscular block. Anesth Analg 1995; 80: 364–7.
Stevens JB, Vescovo MV, Harris KC, Walker SC, Hickey R. Tracheal intubation using alfentanil and no muscle relaxant: is the choice of hypnotic important? Anesth Analg 1997; 84: 1222–6.
Manchikanti L. Diazepam does not prevent succinylcholine-induced fasciculations and myalgia. A comparative evaluation of the effect of diazepam and d-tubocurarine pretreatments. Acta Anaesthesiol Scand 1984; 28: 523–8.
Krieg N, Crul JF, Booij LHDJ. Relative potency of ORG NC 45, pancuronium, alcuronium, and tubocurarine in anaesthetized man. Br J Anaesth 1980; 52: 783–8.
Mahajan RP, Laverty J. Lung function after vecuronium pretreatment in young, healthy patients. Br J Anaesth 1992; 69: 318–9.
Engbœk J, Howardy-Hansen, Ørding H, Viby-Mogensen J. Precurarization with vecuronium and pancuronium in awake, healthy volunteers: the influence of neuromuscular transmission and pulmonary function. Acta Anaesthesiol Scand 1985; 29: 117–20.
Ali HH, Savarese JJ. Stimulus frequency and doseresponse curve to d-tubocurarine in man. Anesthesiology 1980; 52: 36–9.
Findlay GP, Spittal MJ. Rocuronium pretreatment reduces suxamethonium-induced myalgia: comparison with vecuronium. Br J Anaesth 1996; 76: 526–9.
Thompson-Bell G, Joshi GP, Whitten CW. Effects of pretreatment with rocuronium on succinylcholine-induced fasciculations and myalgia: a comparison with tubocurarine and placebo. Anesthesiology 1996; 85: A828.
Moorthy SS, Dierdorf SF. Pain on injection of rocuronium bromide (Letter). Anesth Analg 1995; 80: 1067.
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Motamed, C., Choquette, R. & Donati, F. Rocuronium prevents succinylcholine-induced fasciculations. Can J Anaesth 44, 1262–1268 (1997). https://doi.org/10.1007/BF03012773
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DOI: https://doi.org/10.1007/BF03012773