Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy

Abstract

The onset and time course of action of rocuronium in normal children and children receiving anticonvulsant drugs for prolonged periods was characterized. A single bolus dose of 0.6 mg.kg-1 rocuronium was administered i.v. to seven nonepileptic patients on no medication, and eight patients on chronic anticonvulsant therapy consisting of either phenytoin, carbamazepine, or both who were age and weight matched. Neuromuscular transmission was monitored by the evoked compound electromyography of the thenar muscles using train of four stimulation every 20 s. Recovery times of the first twitch to 10%, 25%, 50%, 75% and 100% of baseline values and recovery index were obtained. The onset times were 1.05+/-0.5 and 1.41+/-0.5 min for the control and anticonvulsant groups respectively and were not significantly different. Children receiving chronic anticonvulsant therapy had significantly shorter recovery index than the control group (control 10.4+/-5.1 min, anticonvulsant 4.8+/-1.7 min, P<0.05). Furthermore, the duration of recovery to 10%, 50%, 75% and 100% of baseline T1 values was less in the anticonvulsant drug group. Our data confirm resistance to rocuronium in children on chronic anticonvulsant drugs.

Anaesthetic management of children with tuberous sclerosis

“…The requirements for opioids and muscle relaxants may be increased secondary to chronic anticonvulsant treatment (21–23). Motor weakness may change the clinical response to neuromuscular blocking agents as well as its assessment by a peripheral nerve stimulator.…”

Antiepileptic drugs and anesthesia

“…The total propofol dose was significantly lower when the patient was taking an antiepileptic (5.7 ± 1.51 mg·kg −1 ·h −1 ) compared to patients not on antiepileptics (6.8±1.27 mg·kg −1 ·h −1 ) ( P < 0.0001) . Phenytoin and carbamazepine used chronically increase hepatic clearance of rocuronium, pancuronium, vecuronium, and cisatracurium, and decrease their duration of action . However, acute administration of phenytoin potentiates the effect of rocuronium .…”

Interaction of rocuronium with human liver cytochromes P450

“…On the contrary, drugs known as inducers of CYP enzymes, e.g. carbamazepine or phenytoin, appear to cause a decrease of the effect of rocuronium (15). In general, the key for understanding drug interactions may often be a dependence of drug (e.g.…”