Neuromuscular Effects of Rocuronium During Sevoflurane, Isoflurane, and Intravenous Anesthesia

Lowry, D; Mirakhur, R. K.; McCarthy, Gerald; Carroll, M T; McCourt, K. C.

doi:10.1097/00000539-199810000-00036

Cited by 82 publications

(91 citation statements)

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“…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. 4 The greater effect of sevoflurane compared with isoflurane would, from the results of our study, appear to be present during the reversal of block as well indicating that sevoflurane may have inherently greater potentiating effect on muscle relaxants such as rocuronium. In our study, both sevoflurane and isoflurane were administered for similar average times (longer than those reported by others for equilibration between blood and muscle compartments), yet the reversal was slower in those receiving sevoflurane.…”

Section: Discussionmentioning

confidence: 58%

“…[1][2][3] It has also been shown that sevoflurane anesthesia potentiates the effect of rocuronium compared with isoflurane and propofol 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.…”

mentioning

confidence: 99%

“…The end-tidal concentration of the volatile agents was monitored using a respiratory gas monitor and adjusted to 1.5 MAC adjusted for age and concomitant use of nitrous oxide (1.5-1.8% sevoflurane, 0.8-1.0% isoflurane) as described previously. 4 Patients whose anesthesia was maintained with iv propofol received a standard propofol infusion at 6-12 mg·kg -1 ·hr -1 . Further doses of propofol or fentanyl were administered as required.…”

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confidence: 99%

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

Reid

Breslin

Mirakhur

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To examine the influence of continuing administration of sevoflurane or isoflurane during reversal of rocuronium induced neuromuscular block with neostigmine.Methods: One hundred and twenty patients, divided into three equal groups, were randomly allocated to maintenance of anesthesia with sevoflurane, isoflurane or propofol. Neuromuscular block was induced with rocuronium and monitored using train-of-four (TOF) stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. Neostigmine was administered when the first response in TOF had recovered to 25%. At this time the volatile agent administration was stopped or propofol dosage reduced in half the patients in each group (n = 20 in each group). The times to attain TOF ratio of 0.8, and the number of patients attaining this end point within 15 min were recorded.Results: The times (mean ± SD) to recovery of the TOF ratio to 0.8 were 12.0 ± 5.5 and 6.8 ± 2.3 min in the sevoflurane continued and sevoflurane stopped groups, 9.0 ± 8.3 and 5.5 ± 3.0 min in the isoflurane continued and isoflurane stopped groups, and 5.2 ± 2.8 and 4.7 ±1.5 min in the propofol continued and propofol stopped groups (P < 0.5-01). Only 9 and 15 patients in the sevoflurane and isoflurane continued groups respectively had attained a TOF ratio of 0.8 within 15 min (P < 0.001 for sevoflurane).Conclusions: The continued administration of sevoflurane, and to a smaller extent isoflurane, results in delay in attaining adequate antagonism of rocuronium induced neuromuscular block. REVIOUS studies have shown that antagonism of block with relaxants such as vecuronium is impeded in the presence of potent volatile agents such as sevoflurane and isoflurane. [1][2][3] It has also been shown that sevoflurane anesthesia potentiates the effect of rocuronium compared with isoflurane and propofol 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.

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Section: Discussionmentioning

confidence: 58%

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confidence: 99%

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confidence: 99%

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

Reid

Breslin

Mirakhur

et al. 2001

Can J Anesth/J Can Anesth

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“…The use of Succinylcholine in this situation is controversial, and its use has been criticised in anaesthesia for the critically Case reports Anaesthesia, 2000, 55, 469±474 ........................................................................................................................................................................................................................................... obstructed airway [11]. However, in this child, signi®-cant obstruction had been excluded and we wished to prevent any movement of the neck associated with coughing.…”

Section: Discussionmentioning

confidence: 99%

“…We avoided using volatile anaesthetics in this patient because of the risk of precipitating either a hypermetabolic state resembling malignant hyperthermia, as can occur in myopathies such as Duchenne's muscular dystrophy [8], or an actual malignant hyperthermia crisis itself [9]. Volatile anaesthetic agents are also known to augment neuromuscular blockade [10,11]. Their residual effects may also persist into the early postoperative period, further impairing muscle function.…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal abscess presenting with upper airway obstruction and atlanto‐axial subluxation in a small infant

Brookes¹,

Moriarty

2000

Anaesthesia

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SummaryWe describe an infant who presented with a combination of upper airway obstruction and atlantoaxial subluxation, secondary to a pharyngeal abscess resulting from cosmetic ear piercing. This combination posed a number of dif®culties for the anaesthetist and a detailed plan was formulated to prepare the child for anaesthesia.Keywords Complications: pharyngeal abscess; atlanto-axial subluxation. Intubation: tracheal; dif®cult. Anaesthesia: paediatric. Parapharyngeal abscess is rare in the early infant period and the association of subluxation of the cervical spine with pharyngeal abscess is rare at any age [1].This combination of conditions poses a number of problems for the anaesthetist; the possibility of dif®cult intubation, worsened by the inability to¯ex or extend the cervical spine, the presence of atlanto-axial subluxation and the potential of damage to the spinal cord, and the age of the child, which would make awake ®breoptic intubation extremely dif®cult. Case historyThree weeks after cosmetic piercing of both ear lobes, a 6-month-old 8.8 kg baby was admitted to a local hospital with a 3-week history of swelling of the right side of his neck, pyrexia and malaise. He was transferred to The Birmingham Children's Hospital when he developed an expiratory wheeze, inspiratory stridor and intercostal recession, requiring supplementary oxygen therapy.On examination, the infant was apyrexial and there was a tender cystic mass measuring 7 cm in diameter in the right lateral cervical area (Fig. 1). The inspiratory stridor and intercostal recession were minimal at rest and he did not require supplementary oxygen. The patient preferred to have his head positioned looking to the left, although he would move it into the neutral position. Investigations revealed a reactive leucocytosis (white cell count 54.41 0 9 .l À1 ). A chest radiograph indicated changes consistent with bronchiolitis and a lateral X-ray of the cervical spine demonstrated a large parapharyngeal mass associated with gross atlanto-axial subluxation.An ultrasound of the neck con®rmed the large pharyngeal mass (6.8´4.5´4.9 cm), suggestive of suppurative lymphadenitis. An examination by a neurosurgeon did not show any neurological signs, and a magnetic resonance imaging (MRI) scan was requested to look for compression of the spinal cord. A consultant ear nose and throat (ENT) surgeon requested general anaesthesia to drain the mass.At a pre-operative visit we con®rmed the absence of neurological signs, and the child's ability to move his head into the neutral position spontaneously. Although his stridor, while present at rest, was minimal, we felt that an MRI scan was necessary before attempting tracheal intubation, to establish the degree of laryngeal or tracheal compression by the mass. The child was therefore sedated with chloral hydrate and transferred to the MRI suite, accompanied by two anaesthetists.During the MRI scan the child was monitored with pulse oximetry, noninvasive blood pressure and electrocardiograph. The scan proceeded uneventfull...

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Effects of sevoflurane and adenosine receptor antagonist on the sugammadex‐induced recovery from rocuronium‐induced neuromuscular blockade in rodent phrenic nerve–hemidiaphragm tissue specimens

Kim

Choi

Park

et al. 2021

Pharmacology Res & Perspec

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Sevoflurane affects on the A1 receptor in the central nervous system and potentiates the action of neuromuscular blocking agents. In the present study, we investigated whether sevoflurane (SEVO) has the ability to potentiate the neuromuscular blocking effect of rocuronium and if the specific antagonist of adenosine receptor (SLV320) can reverse this effect. In this study, phrenic nerve–hemidiaphragm tissue specimens were obtained from 40 Sprague–Dawley (SD) rats. The specimens were immersed in an organ bath filled with Krebs buffer and stimulated by a train‐of‐four (TOF) pattern using indirect supramaximal stimulation at 20 s intervals. The specimens were randomly allocated to control, 2‐chloroadenosine (CADO), SEVO, or SLV320 + SEVO groups. In the CADO and SLV320 + SEVO groups, CADO and SLV320 were added to the organ bath from the start to a concentration of 10 μM and 10 nM, respectively. We then proceeded with rocuronium‐induced blockade of >95% depression of the first twitch tension of TOF (T1) and TOF ratio (TOFR). In the SEVO and SLV320 + SEVO groups, SEVO was added to the Krebs buffer solution to concentration of 400–500 μM for 10 min. Sugammadex‐induced T1 and TOFR recovery was monitored for 30 min until >95% of T1 and >0.9 of TOFR were confirmed, and the recovery pattern was compared by plotting these data. T1 recovery in the SEVO and CADO groups was significantly delayed compared with the control and SLV320 + SEVO groups (p < .05). In conclusion, sevoflurane affects on the A1 receptor at the neuromuscular junction and delays sugammadex‐induced recovery from neuromuscular blockade.

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Neuromuscular Effects of Rocuronium During Sevoflurane, Isoflurane, and Intravenous Anesthesia

Abstract: In routine clinical use, the effects of rocuronium are enhanced by sevoflurane, in comparison with isoflurane and propofol anesthesia, and the recovery is slower. Particular attention should be paid to monitoring of neuromuscular block during sevoflurane anesthesia.

Cited by 82 publications

References 20 publications

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

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

Pharyngeal abscess presenting with upper airway obstruction and atlanto‐axial subluxation in a small infant

Effects of sevoflurane and adenosine receptor antagonist on the sugammadex‐induced recovery from rocuronium‐induced neuromuscular blockade in rodent phrenic nerve–hemidiaphragm tissue specimens

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