Abstract
This study compared the potency and time course of action of rocuronium (ORG 9426) in elderly and young patients during nitrous oxide-opioid anaesthesia. One hundred ASA physical status I– II patients (60, âgéd 65–80 yr, and 40, âgéd 20–45 yr) were studied by measuring the force of contraction of the adductor pollicis in response to train-of-four stimulation of the ulnar nerve. After induction of anaesthesia with thiopentone and maintenance with N2O/O2 and fentanyl, rocuronium 120,160, 200, or 240 μg · kg −1 was administered to determine dose-response curves. When maximum block had been obtained,further rocuronium to a total of 300 μg · kg −1 was given. Additional doses of 100 μg · kg−1 were administered when the first twitch height (T1) had recovered to 25% control. At the end of surgery neuromuscular blockade was allowed, whenever possible, to recover spontaneously until T1 was 90% of control before administration of neostigmine. There was no difference in the potency of rocuronium in the elderly and the younger patients. The ED50 was 196 ±8 (SEE for the mean) in elderly,vs 215 ±17 iμg · kg − 1 in young patients (NS). When individual cumulative dose-response curves were constructed, the ED50 was 203 ± 7(SEM) and 201 ± 10 μg · kg − 1 in the elderly and the young respectively (NS). However, the onset of maximum neuromuscular block was slower in the elderly 3.7 ±1.1 (SD) vs 3.1 ± 0.9 min, P < 0.05). The time to 25% T 1 recovery was longer in the elderly (11.8 ± 8.1 vs 8.0 ± 6.5 min,P <0.05) as was the recovery index, time from 25 to 75% T1 recovery (15.5 ± 6.2 vs 11.2 ± 4.9 min, P< 0.05). The duration of neuromuscular block after each maintenance dose was longer in the elderly (P <0.01) and increased gradually with time. It is concluded that rocuronium is an intermediate-acting neuromuscular blocking drug with a similar potency in elderly and young patients, but the onset and recovery of neuromuscular blockade are slower in the elderly.
Résumé
Cette ’étude compare la puissance et l’ évolution temporelle de l’effet du rocuronium (ORG 9426) chez des patients âgés et des jeunes pendant une anesthésie au protoxyde d’azote associé à un opiacé. Cent patients ASA classes I– II (60 sujets de 60 à 80 ans et 40, de 20 à 40 ans) font l’objet de l’étude qui consiste à mesurer la force de contraction de l’adducteur court du pouce en réponse a la stimulation du nerf cubital au train de quatre. Après l’induction de l’anesthésie au thiopental et le maintien au N2O/O2 avec fentanyl, du rocuronium est administré aux doses de 120, 160, 200 et 240 μg · kg− 1 pour déterminer la relation dose effet. Une fois le block maximum obtenu,on donne une dose supplemental de rocuronium jusqu’à un total de 300 μg · kg − 1. On ajoute des doses de 100 μg · kg− 1 dès que la première contraction (T1) revient à 25% du contrôle. A la fin de la chirurgie, on laisse le block récupérer spontanément, lorsque c’est possible, jusqu’à ce que T1 atteigne 90% du contrôle avant d’administrer de la néostigmine. On ne retrouve pas de différence de puissance pour le rocuronium entre les patients jeunes et les patients âgés. La DE50 est de 196 ± 8 (SEE pour la moyenne) chez les patients âgés vs 215 ± 17 μg · kg− 1 chez les jeunes (NS). Lorsqu’on construit des courbes dose-effet individuelles cumulatives, la DE50 est respectivement de 203 ± 7 (SEM) et de 201 ± 10 μg · kg− 1 chez les personnes âgées et les jeunes (NS). Cependant le block neuromusculaire survient plus lentement chez le sujet âgé (3,7 ± 1,1 (SD) vs 3.1 ± 0,9P <0,05). La periode de recouvrement de T1 à 25% se prolonge dans le groupe âgé (11, 8 ± 8,1 vs 8,0 ± 6,5 min,P <0,05) de même que l’index de récupération (5,5 ± 6.2 vs 11,2 ± 4,9 min,P <0,05). La durée du block neuro-musculaire après chaque dose de maintien est plus longue pour le groupe âgé (P <0,01) et augmente progressivement avec le temps. On conclut que le rocuronium est un myorelaxant à action intermédiaire dont la puissance ne diffère pas chez les patients âgées et les jeunes. Son d’action débute plus lentement et sa durée de récupération est plus longue chez le sujet âgé.
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Bevan, D.R., Fiset, P., Balendran, P. et al. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth 40, 127–132 (1993). https://doi.org/10.1007/BF03011309
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DOI: https://doi.org/10.1007/BF03011309