Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia

Abstract

INTERNPurpose: To determine the magnitude of the potentiation of rocuronium by desflurane, isotlurane and sevotturane 1.5 MAC anaesthesia. Methods: In a prospective, randomised, study in 80 patients, the cumulative dose-effect curves for rocuronium were determined during anaesthesia with desflurane, sevoflurane and isoflurane (with N20 700/6, I 5 min steady state) or total intravenous anaesthesia (-i-lVA) using propofol/fentanyl. Neuromuscular block was assessed by acceleromyography CTOF-Guarcl| after t~in-of-four (-I-OF) stimulation of the ulnar nerve (2Hz every 12sec, 200 /.tsec duration), Rocuronium was administered in increments of 100/.tg'kg -~ until first twitch (TI) depression > 95%, Results: Rocuronium led to more pronounced T I depression with destturane or sevoflurane anaesthesia than with TIVA. The EDs0 and EDg.were lower during desflurane (95 _ 25 and 190 + 80 h,g'kg -t) and sevoflurane (120 _+ 30 and 210 _+ 40 pg-kg z~) than with TIVA (I 50 _+ 40 and 310 -+ 90 pg-kg -I) (P < .01), while the difference was not significant for isoflurane (I 30 + 40 and 250 + 90pg'kg-I), Following equi-effective dosing (T~ > 95%) the duration to 25% T recovery, recovery index (25/75), and TOF070 was: 13.2 ___ 1.8, 12.7 _+ 3.4, and 26.9 + 5.7 min during anaesthesia with desflurane; 5.5 +_ 5.0, I 1.4 _ 3.8, ai~d 31.0 _+ 6.0 min with sevoflurane; 13.9 + 4.7, 10.7 _ 3,3, and 26.3 +_ 8.9 min with isoflurane; and 13.9 -+ ,3.9, I 1,3 _+ 5.7, and 27.5 +-8.2 min with TIVA anaesthesia (P: NS). Conclusion: Interaction of rocuronium and volatile anaesthetics resulted in augmentation of the intensity of neuromuscular block but did not result in significant effects on duration of or recovery from the block. ', 13,9 +__ 4,7', I0,7 +--3,3 et 26,3 +_ 8,9 min avec l'isoflurane; enfin, 13,9 ---3,9; 11,3 __. 5,7 et 27,5 ---8,2 rain avec I'AEI (P: NS). Conclusion : l'interaction du rocuronium et des anesth~siques volatils a provoquE l'augmentation de l'intensitE . du bloc neuromusculaire mais n'a pas eu d'effet significatif sur la dur& du bloc ou sur la rEcupEration qui a suivi.

Effective method of continuous rocuronium administration based on effect-site concentrations using a pharmacokinetic/pharmacodynamic model during propofol–remifentanil anesthesia

“…Therefore, the anesthetic agents administered in our study did not influence the effects of rocuronium. In contrast, inhaled anesthetics, such as sevoflurane, isoflurane, and desflurane, can potentiate the neuromuscular blocking effects of rocuronium, which would decrease the continuous rocuronium infusion dose requirements [23,24]. Further research is needed to investigate whether the our method, as described herein, is effective under conditions of inhaled anesthesia.…”

Reversal effect of sugammadex in isoflurane, sevoflurane, and desflurane induced anesthesia: a randomized-controlled clinical study

“…In a study on the effects of isoflurane and desflurane on the neuromuscular blocker effects of rocuronium, Wulf et al [6] found more pronounced TOF T1 depression with desflurane or sevoflurane but did not find any difference in the duration of the block or recovery from block. Basic Clin Sci 2013; 2: 57-64…”

“…It is a known fact that inhalation anesthesia produces some neuromuscular relaxation even though not as high as the one with neuromuscular blocker drugs [6,7]. Various studies have been undertaken thinking that volatile anesthetics may be influencing the relaxation effect of neuromuscular blocker drugs when used together and it has been found that several volatile anesthetics affect neuromuscular blocker drugs and that there is no significant difference among these effects [7,8].…”

Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos

“…Some authors have found a prolonged T in adults with rocuronium and sevoflurane as compared to isoflurane (26.3 and 14.7 minutes, respectively) 28 . The slower recovery time observed by some authors may be due to lower rocuronium doses or the association of intravenous anesthetics 20,34,35 . Rocuronium recovery time of 19.7 minutes found in our study was not different from that obtained for atracurium, which was 13.1 minutes.…”

“…A different study has shown a 70% decrease in mivacurium dose in children anesthetized with isoflurane as compared to those anesthetized with halothane 23 . A period of 30 to 45 minutes is taken into account when studying the influence of volatile anesthetics on neuromuscular blockers, that is, enough time for its diffusion in the muscle compartment and to establish a balance among inhaled alveolar, plasma and muscular concentrations 28,[33][34][35] . Sevoflurane was the volatile anesthetic drug used in this study and was administered for more than 30 to 45 minutes.…”