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Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol

Le desflurane, comparé à l’isoflurane, au sêvoflurane ou au propofol, réduit davantage la vitesse de perfusion thérapeutique utile (PTU) du cisatracurium

Abstract

Purpose

The present study investigated the interaction between the cumulative dose requirements of cisatracurium and anesthesia with isoflurane, sevoflurane, desflurane or propofol using closedloop feedback control.

Methods

Fifty-six patients (18–85 yr, vitrectomies of more than one hour) were studied. In the volatile anesthetics groups, anesthesia was maintained by 1.3 MAC of isoflurane, sevoflurane or desflurane; in the propofol group, anesthesia was maintained by a continuous infusion of 6–8 mg·kg−1hr−1 propofol. After bolus application of 0.1 mgmg·kg−1 cisatracurium, aTI%-level of 10% of control level (train-of-four stimulation every 20 sec) was maintained using closed-loop feedback controlled infusion of cisatracurium. The effective therapeutic infusion rate (ETI) was estimated from the asymptotic steady-state infusion rate lss The lss was derived from fitting an asymptotic line to the measured cumulative dose requirement curve. The ETI of the different groups was compared using Kruskal-Wallistest, followed by rank sum test, corrected for the number of comparisons,P < 0.05 was regarded as showing significant difference.

Results

ETI in the isoflurane group was 35.6 ±8.6 μg·m−2·min−1, in the sevoflurane group 36.4-± 11.9 μg·m−2·min−1, in the desflurane group 23.8 ± 6.3 μg·m−2·min−1. The ETI of the volatile anesthetic groups were all significantly lower than the ETI in the propofol group at 6 1.7 ± 25.3 μg·m−2·min−1 (P < 0.002). The ETI in the desflurane group was significantly lower than in all other groups (P < 0.02).

Conclusion

In comparison to propofol, isoflurane, sevoflurane and desflurane reduce the cumulative dose requirements of cisatracurium to maintain a 90% neuromuscular blockade by 42%, 41 % and 60%, respectively.

Résumé

Objectif

Rechercher l’interaction entre la dose cumulative nécessaire de cisatracurium et l’anesthésie avec de l’isoflurane, du sévoflurane, du desflurane ou du propofol, en utilisant un système de rétroaction en boucle fermée.

Méthode

L’étude a porté sur 56 patients (18–85 ans, vitrectomie de plus d’une heure). Chez les patients qui ont reçu un anesthésique volatil, l’anesthésie a été entretenue avec 1,3 CAM d’isoflurane, de sévoflurane ou de desflurane; chez ceux qui ont eu du propofol, on a administré une perfusion continue de 6–8 mg·kg−1·h−1 de propofol. Après l’administration d’un bolus de 0,1 mg·kg−1·h−1 de cisatracurium, une première réponse Tlà 10 % (d’une stimulation en train-de-quatre répétée toutes les 20 s) a été maintenue au moyen d’une perfusion de cisatracurium contrôlée par un système de rétroaction en boucle fermée. La vitesse de perfusion thérapeutique utile (PTU) a été évaluée à partir de la vitesse de perfusion asymptotique àl’équilibre P. La Pe a été dérivée de l’ajustement d’une ligne asymptotique à la courbe de la dose cumulative nécessaire. La PTU des différents groupes a été comparée à l’aide du test de Kruskal-Wallis, suivi du test de la somme des rangs, ajusté en fonction du nombre de comparaisons,P < 0,05 a été considéré comme une différence significative.

Résultats

La PTU associée à l’isoflurane a été de 35,6 ± 8,6 mg·m−2·min−1; au sévoflurane, 36,4 ± 11,9 mg·m−2·min−1 et au desflurane, 23,8 ± 6,3 mg·m−2·min−1. La PTU associée aux anesthésiques volatils a été significativement plus basse que celle qui est associée au propofol, 6 1,7 ± 25,3 mg·m−2·min−1 (P < 0,002). La PTU associée au desflurane a été significativement plus basse que celles qui concernent tous les autres anesthésiques (P < 0,02).

Conclusion

Comparés au propofol, l’isoflurane, le sévoflurane et le desflurane réduisent de 42 %, 41 % et 60 %, respectivement, la dose cumulative nécessaire de cisatracurium pour maintenir un blocage neuromusculaire à 90 %.

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Correspondence to Thomas M. Hemmerling.

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Hemmerling, T.M., Schuettler, J. & Schwilden, H. Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol. Can J Anesth 48, 532 (2001). https://doi.org/10.1007/BF03016828

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Keywords

  • Isoflurane
  • Sevoflurane
  • Vecuronium
  • Enflurane
  • Rocuronium