Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases

Abstract

SummaryThe use of rocuronium (Org 9426) as a single bolus followed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide-oxygen and halothane. Neuromuscular block was monitored using train-ofif our stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg-'followed by an infusion adjusted manual1.v to maintain the T I , the.first response in the train-of-four, at 10% of control. Following cessation of rocuronium itfusion the patients were either allowed to recover spontaneously I n = 10) or were given neostigmine 50 pg.kg-' or edrophonium I mg.kg-' at 10 or 25% recover), of the T I (n = IOJor each group). Adequate antagonism was dejned as attaining u sustained train-of-four ratio of 0.7. Rocuronium requirements showed marked variation among individual patients but were relatively constant in individual patients. The mean (SD) time to attain stable infusion rates was 17.4 (10.9) min. The mean ( S D ) requirement of rocuronium for steady state 90% block of T, was 572 (190) pg.kg-'.h-' (range 242-1104 pg.kg-'.h-'). The tnean ( S D ) time to attain a train-offour ratio of 0.7 in the group allowed to recover spontaneously was 36. I (7.3) min. Thisinterval was 7.5 (1.9), 9.3 (7.0), 4.6 (1.9) and 1.9 (0.9) min respectively in the groups receiving neostigmine at Ti of 10%.

Rocuronium and Vecuronium Do Not Affect Mandibular Bone Marrow and Masseter Muscular Blood Flow in Rabbits

“…Because rocuronium has a shorter duration of action than vecuronium 29 and is able to be administered by continuous infusion 30 , rocuronium may be useful for oral and maxillofacial surgery.…”

“…In our preliminary study, spontaneous breathing and gross body movement were observed few minutes after the cessation of rocuronium infusion. In a previous study, train of four ratio (TOFR) was reported 80 to 90% when head 30,31 and leg 31 could be continuously lifted for 5 sec in human. When TOFR is more than 80 to 90%, the residual effect of nondepolarizing muscle relaxants is negligible.…”

Cumulation and flexibility with infusions of neuromuscular blocking drugs

“…If the drug is given by incremental topup doses, the duration of each dose is expected to increase with time, and upon termination of anesthesia and surgery, recovery is expected to take longer after prolonged administration. [3][4][5] In practice, however, the increase in vecuronium duration of action of successive top-up doses is small, and recovery is rapid if only moderate blockade (<90%) is maintained. The most likely explanation for this observation is through the concept of context-sensitive half-time.…”

Neostigmine antagonism of rocuronium block during anesthesia with sevoflurance, isoflurane or propofol

“…4 Although there are reports of antagonism of rocuronium block with neostigmine, these have generally examined the influence of the dosage or the timing of administration of the anticholinesterase. [5][6][7] The aim of the present study was to examine the effect of the sevoflurane on the antagonism of rocuronium by neostigmine, and compare it with the effects of isoflurane, and intravenous anesthesia. …”

“…4 Although there are reports of antagonism of rocuronium block with neostigmine, these have generally examined the influence of the dosage or the timing of administration of the anticholinesterase. [5][6][7] The aim of the present study was to examine the effect of the sevoflurane on the antagonism of rocuronium by neostigmine, and compare it with the effects of isoflurane, and intravenous anesthesia. Patients and methods One hundred and twenty three ASA I or II patients (of whom three were replacement patients), aged between 18 and 65 yr, and scheduled to undergo elective body surface or orthopedic surgery lasting longer than 30 min were recruited into the study following their written informed consent and Research Ethics Committee approval.…”