Skip to main content
SpringerLink
Log in

Sevoflurane and isoflurane impair edrophonium reversal of vecuronium-induced neuromuscular block

  • Published:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

A dose-response relationship study for edrophonium to examine the modification of volatile anaesthetics on reversal of vecuronium block.

Methods

One hundred and twenty ASA (I–II) patients were anaesthetized with sevoflurane, isoflurane (I minimum alveolar anaesthetic concentration [MAC] end-tidal concentration), or fentanyl-diazepam anaesthesia, in combination with 66% nitrous oxide (n = 40 for each group). The evoked electromyogram (EMG) response of the abductor digiti minimi was monitored at 20 sec intervals following train-of-four (TOF) stimulation of the ulnar nerve. The initial neuromuscular block was produced by vecuronium 100 μg · kg−1. When the amplitude of the first response (T1) had spontaneously recovered to 10% of the control, edrophonium (0, 125, 400, 700 or 1000 μg · kg−1; eight patients each) was randomly administered, and the ratio of the fourth TOF to the first response (TOFR ) was monitored at one minute intervals for 10 min.

Results

Sevoflurane and isoflurane impaired the edrophonium-assisted TOFR recovery in an edrophonium dose and time dependent manner. The dose-response curves at 10 min exhibited a greater shift to the right in the sevoflurane and isoflurane groups than in the fentanyl-diazepam-nitrous oxide group (P < 0.05). Higher ED50 values (the edrophonium dose required to obtain TOFR value of 50%) in the sevoflurane (> 1000 μg · kg−1) and isoflurane groups (851 · μg · kg−1) were observed than in the fentanyl-diazepam-nitrous oxide group (339 μg · kg−1) (P < 0.05).

Conclusion

One MAC sevoflurane and isoflurane anaesthesia impair edrophonium reversal of vecuronium block to a similar degree.

Résumé

Objectif

Créer une courbe de relation dose/efet pour l’édrophonium afin étudier les modifications provoquées par les anesthésiques volatils sur l’antagonisme du bloc au vécuronium.

Méthodes

Cent vingt patients ASA I et II étaient anesthésiés avec du sévoflurane, de l’isoflurane (concentration alvéolaire télé-expiratoire minimale [MAC] 1) ou avec fentanyl-diazépam associés au protoxyde 60% (n = 40 par groupe). La réponse électromyographique (EMG) évoquée à l’abducteur du petit doigt était monitorée à des intervalles de 20 sec après stimulation du nerf cubital au train-de-quatre (TOF). Le bloc neuromusculaire initial était produit par du vécuronium 100 μg · kg−1. Aprés la récupération de l’amplitude de la première réponse (T1) à 10% du contrôle, l’édrophonium (0, 125, 400, 700 ou 100 μg · kg−1; huit patients pour chaque dose) était administré aléatoirement et le rapport de la quatrième réponse sur la première du TOF (TOFR) était monitorée à toutes les minutes pour dix min.

Résultats

Le sévoflurane et l’isoflurane ont altéré la récupération assistée par l’édrophonium du TOFR proportionellement au temps et à la dose. Les courbes dose-effet à dix min révélaient une déviation vers la droite des groupes sévoflurane plus marquée que pour le groupe fentanyl-diazépam-protoxyde d’azote (P < 0,05). Dans les groupes sévoflurane (> 1000 μg · kg−1) et isoflurane (851 μg · kg−1), des valeurs ED50 (tes doses d’édrophonium requises pour obtenir un TOFR de 50%) plus élevées ont été observées que dans le groupe fentanyl-diazépam-protoxyde d’azote (339 μg · kg−1; P < 0,05).

Conclusion

À MAC 1, le sévoflurane et l’isoflurane entrave au même degré l’antagonisme par l’édrophonium du bloc produit par le vécuronium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Delisle S, Bevan DR. Impaired neostigmine antagonism of pancuronium during enflurane anaesthesia in man. Br J Anaesth 1982; 54: 441–5.

    Article  CAS  PubMed  Google Scholar 

  2. Dernovoi B, Agoston S, Barvais L, Baurain M, Lefebvre R, d’Hollander A. Neostigmine antagonism of vecuronium paralysis during fentanyl, halothane, isoflurane, and enflu rane anesthesia. Anesthesiology 1987; 66: 698–701.

    Article  CAS  PubMed  Google Scholar 

  3. Baurain MJ, d’Hollander AA, Melot C, Dernovoi BS, Barvais L. Effects of residual concentrations of isoflurane on the reversal of vecuronium-induced neuromuscular blockade. Anesthesiology 1991; 74: 474–8.

    Article  CAS  PubMed  Google Scholar 

  4. Lee C, Tsai S-K, Kwan W-K, Chen B-J, Cheng ML. Desflurane potentiates atracurium in humans: a compara tive study with isoflurane. J Clin Anesth 1992; 4: 448–54.

    Article  CAS  PubMed  Google Scholar 

  5. Morita T, Tsukagoshi H, Sugaya T, Saito S, Sato H, Fujita T. Inadequate antagonism of vecuronium-induced neuro muscular block by neostigmine during sevoflurane or isoflurane anesthesia. Anesth Analg 1995; 80: 1175–80.

    CAS  PubMed  Google Scholar 

  6. Smith CE, Donati F, Bevan DR. Dose-response relation ships for edrophonium and neostigmine as antagonists of atracurium and vecuronium neuromuscular blockade. Anesthesiology 1989; 71: 37–43.

    Article  CAS  PubMed  Google Scholar 

  7. Kopman AK. Recovery times following edrophonium and neostigmine reversal of pancuronium, atracurium, and vecuronium steady-state infusions. Anesthesiology 1986; 65: 572–8.

    Article  CAS  PubMed  Google Scholar 

  8. Wachtel RE. Comparison of anticholinesterases and their effects on acctylcholine-activated ion channels. Anesthesiology 1990; 72: 496–503.

    Article  CAS  PubMed  Google Scholar 

  9. Gill SS, Bevan DR, Donati F. Edrophonium antagonism of atracurium during enflurane anaesthesia. Br J Anaesth 1990; 64: 300–5.

    Article  CAS  PubMed  Google Scholar 

  10. Cronnelly R, Morris RB, Miller RD. Edrophonium: dura tion of action and atropine requirement in humans during halothane anesthesia. Anesthesiology 1982; 57: 261–6.

    Article  CAS  PubMed  Google Scholar 

  11. Katoh T, Suguro Y, Kimura T, Ikeda K. Cerebral awaken ing concentration of sevoflurane and isoflurane predicted during slow and fast alveolar washout. Anesth Analg 1993; 77: 1012–7.

    Article  CAS  PubMed  Google Scholar 

  12. Cannon JE, Fahey MR, Castagnoli KP, et al. Continuous infusion of vecuronium: the effect of anesthetic agents. Anesthesiology 1987; 67: 503–6.

    Article  CAS  PubMed  Google Scholar 

  13. Morita T, Tsukagoshi H, Sugaya T, Yoshikawa D, Fujita T. The effects sevoflurane are similar to those of isoflurane on the neuromuscular block produced by vecuronium. Br J Anaesth 1994; 72: 465–7.

    Article  CAS  PubMed  Google Scholar 

  14. Tai K, Suzuki H, Itagaki T, et al. Influence of sevoflurane on neuromuscular blocking effects of vecuronium and pancuronium. (Japanese) Masui 1987; 36: 227–32.

    CAS  PubMed  Google Scholar 

  15. Yost CS, Maestrone E. Clinical concentrations of edropho nium enhance desensitization of the nicotinic acetylcholine receptor. Anesth Analg 1994; 78: 520–6.

    Article  CAS  PubMed  Google Scholar 

  16. Brett RS, Dilger JP, Yland KF. Isoflurane causes “flicker ing” of the acetylcholine receptor channel: observations using the patch clamp. Anesthesiology 1988; 69: 161–70.

    Article  CAS  PubMed  Google Scholar 

  17. Kopman AF. Tactile evaluation of train-of-four count as an indicator of reliability of antagonism of vecuronium- or atracurium-induced neuromuscular blockade. Anesthesio logy 1991; 75: 588–93.

    Article  CAS  Google Scholar 

  18. Salib YM, Donati F, Bevan DR. Edrophonium antagonism of vecuronium at varying degrees of fourth twitch recov ery. Can J Anaesth 1993; 40: 839–43.

    Article  CAS  PubMed  Google Scholar 

  19. Beemer GH, Goonetilleke PH, Bjorksten AR. The maxi mum depth of an atracurium neuromuscular block antago nized by edrophonium to effect adequate recovery. Anesthesiology 1995; 82: 852–8

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Reanimatology, Gunma University School of Medicine and Hospital, 3-39-22 Showa-machi, Maebashi, 371, Gunma, Japan

    Toshihiro Morita, Dai Kurosaki, Hiroshi Tsukagoshi, Takeo Sugaya, Shigeru Saito, Hironobu Sato & Tatsusi Fujita

Authors
  1. Toshihiro Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dai Kurosaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Tsukagoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeo Sugaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shigeru Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hironobu Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tatsusi Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toshihiro Morita.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morita, T., Kurosaki, D., Tsukagoshi, H. et al. Sevoflurane and isoflurane impair edrophonium reversal of vecuronium-induced neuromuscular block. Can J Anaesth 43, 799–805 (1996). https://doi.org/10.1007/BF03013032

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03013032

Key words

Search

Navigation