Dose–response and time‐course of the effect of rocuronium bromide during sevoflurane anaesthesia

Abstract

To evaluate the influence of sevoflurane on the dose-response relationship and on the time-course of the effect of rocuronium, 60 adult patients undergoing elective plastic surgery were randomly allocated to either the control or the sevoflurane group. Anaesthesia was maintained with 60% nitrous oxide in oxygen and thiopentone in the control group and with 60% nitrous oxide in oxygen and an end-tidal concentration of 1.75% sevoflurane in the sevoflurane group. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12s and the percentage depression of the first twitch of the train-of-four was used as the study parameter. The dose-response relationship of rocuronium in the two groups was determined by the cumulative dose-response technique. The dose-response curve of rocuronium in the sevoflurane group was shifted to the left compared to the control group, indicating a potentiation of rocuronium-induced neuromuscular block. The effective doses of rocuronium required to produce 50%, 90% and 95% twitch depression in the sevoflurane group were decreased by 30.5%, 26.7% and 25.2%, respectively, compared to the control group. Following the administration of a total dose of rocuronium of 400 micrograms.kg-1, the duration of action of, and the recovery from, rocuronium were both significantly prolonged by sevoflurane. There were significant differences in the duration of peak effect, clinical duration, recovery index and the total duration of action between the control and the sevoflurane groups.

Comparison of the effects of neuroleptanesthesia and enflurane or sevoflurane anesthesia on neuromuscular blockade by rocuronium

“…Many studies have demonstrated that with different muscle relaxants, volatile anesthetics do not alter the dose requirements for endotracheal intubation and anesthesia induction and the resulting onset time, but may prolong the clinical duration and recovery times [1,2,6,11,[17][18][19]. In daily practice, muscle relaxants are administered before or simultaneously with the start of inhalation anesthetics.…”

“…It has been reported that muscle paralysis by rocuronium (Org 9426) is potentiated during enflurane anesthesia as compared with TIVA or balanced anesthesia [6,7]. Sevoflurane, a widely used volatile anesthetic agent possessing rapid and smooth induction and recovery characteristics, has been demonstrated to potentiate vecuronium-and rocuronium-induced neuromuscular blockade compared with balanced anesthesia using propofol or midazolam [8][9][10][11]. Not only was the neuromuscular blocking action of rocuronium significantly potentiated, but also the duration of action of, and the recovery from, rocuronium were significantly prolonged by sevoflurane [12].…”

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

“…[14][15][16] This may be the reason why in a recent study there was no marked prolongation in average reversal time of rapacuronium during sevoflurane compared to propofol anesthesia as the reversal was carried out within only about 15 min of relaxant and anesthetic administration. 1 7 These results are at variance with the findings of Lowry et al who showed a more marked effect of sevoflurane on rocuronium block during spontaneous recovery even after shorter periods of volatile agent administration.…”

The effects of general anaesthesia on memory in children

“…Accidental disconnections have been reported with this device, with the manufacturers describing their intent to improve product instructions to prevent further disconnection [1][2][3]. However, despite there having been two previous reports of blockage [4,5] in addition to the defect described above, it is unclear whether the manufacturer's have investigated these problems further.…”

“…Fifth, was there any consideration for the potential prolongation of the duration of rocuronium due to the associated sevoflurane anaesthesia? [3] And finally, was there any correlation between the whole duration of the exposure to anaesthesia and the reported memory changes? The Epifuse connector comprises a standard Luer lock port and an elastomeric tube that 'locks' around an inserted epidural catheter end (Fig.…”