Effects of single‐shot and steady‐state propofol anaesthesia on rocuronium dose–response relationship: a randomised trial

Stäuble, Christiane G.; Stäuble, Roland B.; Schaller, Stefan J.; Unterbuchner, Christoph; Fink, Heidrun; Blobner, Manfred

doi:10.1111/aas.12523

Cited by 11 publications

(10 citation statements)

References 32 publications

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“…Intravenous anesthetics have no direct interaction with neuromuscular blockers, but etomidate (which has fewer cardiovascular effects) and ketamine (which acts on GABA receptors) may have indirect effects [ 72 73 ]. A single bolus dose of intravenous anesthetic (e.g., propofol) can decrease blood pressure and cardiac output, delaying the onset of action of NMBDs, but it also decreases muscle tone, which can accelerate the onset of action [ 74 ].…”

Section: Factors That Affect Muscle Contractilitymentioning

confidence: 99%

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Kim

Sung

Yang

2017

Korean J Anesthesiol

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Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action. Factors that affect the onset time include the potency of the NMBDs, the rate of NMBDs reaching the effect site, the onset time by dose control, metabolism and elimination of NMBDs, buffered diffusion to the effect site, nicotinic acetylcholine receptor subunit affinity, drugs that affect acetylcholine (ACh) production and release at the neuromuscular junction, drugs that inhibit plasma cholinesterase, presynaptic receptors responsible for ACh release at the neuromuscular junction, anesthetics or drugs that affect muscle contractility, site and methods for monitoring neuromuscular function, individual variability, and coexisting disease. NMBDs with rapid onset without major adverse events are expected in the next few years, and the development of lower potency NMBDs will continue. Anesthesiologists should be aware of the use of NMBDs in the management of anesthesia. The choice of NMBD and determination of the appropriate dosage to modulate neuromuscular blockade characteristics such as onset time and duration of neuromuscular blockade should be considered along with factors that affect the effects of the NMBDs. In this review, we discuss the factors that affect the onset time of NMBDs.

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Section: Factors That Affect Muscle Contractilitymentioning

confidence: 99%

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Kim

Sung

Yang

2017

Korean J Anesthesiol

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“…Similar results have been reported in other literature. A single shot of propofol and rocuronium shows that the potency of rocuronium is significantly enhanced after propofol infusion for 30 min compared with 2 min of propofol; this finding indicates that propofol can increase the affinity of rocuronium for the receptor under steady-state conditions [27]. Meanwhile, a randomized double-blinded trial found no statistically significant difference in the doses of propofol required for inducing anesthesia, regardless of whether the drug was administered as a freshly prepared propofol/lidocaine 10 : 1 mixture or as a separate injection after a dose of lidocaine [28].…”

Section: Discussionmentioning

confidence: 93%

Nanoformulation of Premixing Propofol Lipid Emulsion and Fentanyl Citrate and Their Effects on Acute Toxicity, Sedation, and Analgesia

Gao

Sha

Liu

et al. 2016

Journal of Nanomaterials

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To illustrate the effects of premixing propofol lipid emulsion (PLE) and fentanyl citrate (FC) on acute toxicity, sedation, and analgesia, sixty female mice were randomly assigned to individual and premixed groups. The median lethal dose (LD50), median effective dose (ED50) of loss of righting reflex, and ED50of tail flick test in both groups were determined using the up and down procedure (FC : PLE = 1 μg : 2 mg). PLE was immediately administered to the mice from the individual group via the tail vein after injecting FC. By contrast, FC was mixed with PLE before injection from the premixed group. No significant differences in LD50, histopathological examination, and ED50sedation value were found between the groups. However, ED50of analgesia in the premixed group decreased to half of that in the individual group. Transmission electron microscopic observation revealed ~10 nm fusiform particles at the juncture of 200–300 nm particles in the mixture of PLE and FC compared with the single PLE and its mixture with saline, which may be attributed to the structure of FC. In conclusion, premixing PLE and FC enhanced synergic analgesia twofold but did not influence toxicity and sedation compared with individual injections.

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“…However, the histamine levels were not measured in the present study, and no significant differences were observed in the number of dogs administered glycopyrrolate, atropine and vasopressor and inotropic drugs between groups. Regardless of the cause, arterial hypotension could have led to a potential decrease in blood pH due to tissue hypoperfusion, which could have slowed down the pH-dependent Hofmann degradation of cis-atracurium 22 27–29. In this case, more cis-atracurium would be available to shorten the NMB onset in dogs administered fentanyl and lidocaine.…”

Section: Discussionmentioning

confidence: 99%

“…Potential electrolytes and acid-base alterations could not be excluded because they were not assessed in the present study. A longer NMB effect associated with hypotension could not be ruled out in dogs administered lidocaine 22 28 29. Finally, a potential haemodilution associated with an increased infusion rate of fluids could have prolonged the duration of action of NMB agents in the control group 46…”

Section: Discussionmentioning

confidence: 99%

Onset and duration of cis‐atracurium neuromuscular block during fentanyl and lidocaine infusions in isoflurane‐anaesthetised dogs

Ida¹,

Van-Wijnsberghe²,

Tutunaru³

et al. 2020

Veterinary Record

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BackgroundThis retrospective study assessed the onset and duration of the neuromuscular block (NMB) induced by cis-atracurium 0.15 mg/kg intravenously with and without fentanyl or lidocaine infusions in 45 isoflurane-anaesthetised dogs.MethodsDogs with neuromuscular function assessed by a calibrated train-of-four (TOF) monitor with stimulation (every 13 s) of the peroneal nerve were included. The onset and duration of the NMB were defined as the time from cis-atracurium administration until TOF=0 and the time during TOF=0 display, respectively.ResultsThe NMB onset was shorter during fentanyl (mean±sd) (1.9±0.7 minutes; P=0.0042) and lidocaine (2.0±0.7 minutes; P=0.0154) compared with control (2.9±0.8 minutes). The NMB duration was shorter in the fentanyl (27.5±7.3 minutes; P=0.0491), but not in the lidocaine group (32.3±6.9 minutes; P=0.0790), compared with control (33.7±9.1 minutes). The NMB onset was poorly but significantly correlated with the dose of fentanyl and lidocaine administered before cis-atracurium (r=−0.3396; P=0.0225). The fentanyl and lidocaine groups received more crystalloid and colloid boluses than the control.ConclusionsFentanyl and lidocaine shortened the NMB onset and the former decreased the NMB duration. Further prospective studies are required to clarify whether this was associated with an indirect decrease in blood pressure or a direct interaction between cis-atracurium and fentanyl and lidocaine.

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Effects of single‐shot and steady‐state propofol anaesthesia on rocuronium dose–response relationship: a randomised trial

Cited by 11 publications

References 32 publications

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Nanoformulation of Premixing Propofol Lipid Emulsion and Fentanyl Citrate and Their Effects on Acute Toxicity, Sedation, and Analgesia

Onset and duration of cis‐atracurium neuromuscular block during fentanyl and lidocaine infusions in isoflurane‐anaesthetised dogs

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