Quantitation of the Effect of Nitrous Oxide on Rocuronium Infusion Requirements Using Closed-loop Feedback Control

Illman, Hanna; Antila, Heikki; Olkkola, Klaus T.

doi:10.1097/aln.0b013e318164cacb

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…Like our former study on rocuronium [7] but unlike previous studies using bolus techniques, we used a closed-loop feedback control method of administering cisatracurium to produce and maintain a relatively constant neuromuscular block of 90%. It was thus possible to quantitate any interaction between cisatracurium and nitrous oxide during maintenance of anesthesia with longer exposure to nitrous oxide and with minimal disturbance of the clinical routine.…”

Section: Discussionmentioning

confidence: 99%

“…Because the mechanism of action of nitrous oxide on muscle relaxants is unknown and because it is controversial whether there is an interaction between nitrous oxide and muscle relaxants, we found it important to repeat our previous study [7] using cisatracurium, a muscle relaxant with a different chemical structure and elimination kinetics. Cisatracurium, as opposed to the aminosteroid relaxant rocuronium, is a benzyl isoquinoline compound with a novel pharmacokinetic profile since its elimination kinetics is essentially independent of liver and renal function [8].…”

Section: Introductionmentioning

confidence: 94%

“…Whether this interaction is due to an alteration in pharmacokinetics or pharmacodynamics remains, however, completely unknown. Evidence from one study on the infusion requirements of rocuronium during nitrous oxide demonstrated that nitrous oxide does not affect rocuronium in a clinically significant degree [7]. Thus, different study methodology appears to give different results on the interaction between nitrous oxide and rocuronium.…”

Section: Introductionmentioning

confidence: 99%

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Effect of nitrous oxide on cisatracurium infusion demands: a randomized controlled trial

2010

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BackgroundRecent studies have questioned our previous understanding on the effect of nitrous oxide on muscle relaxants, since nitrous oxide has been shown to potentiate the action of bolus doses of mivacurium, rocuronium and vecuronium. This study was aimed to investigate the possible effect of nitrous oxide on the infusion requirements of cisatracurium.Methods70 ASA physical status I-III patients aged 18-75 years were enrolled in this randomized trial. The patients were undergoing elective surgery requiring general anesthesia with a duration of at least 90 minutes. Patients were randomized to receive propofol and remifentanil by target controlled infusion in combination with either a mixture of oxygen and nitrous oxide (Nitrous oxide/TIVA group) or oxygen in air (Air/TIVA group). A 0.1 mg/kg initial bolus of cisatracurium was administered before tracheal intubation, followed by a closed-loop computer controlled infusion of cisatracurium to produce and maintain a 90% neuromuscular block. Cumulative dose requirements of cisatracurium during the 90-min study period after bolus administration were measured and the asymptotic steady state rate of infusion to produce a constant 90% block was determined by applying nonlinear curve fitting to the data on the cumulative dose requirement during the study period.ResultsController performance, i.e. the ability of the controller to maintain neuromuscular block constant at the setpoint and patient characteristics were similar in both groups. The administration of nitrous oxide did not affect cisatracurium infusion requirements. The mean steady-state rates of infusion were 0.072 +/- 0.018 and 0.066 +/- 0.017 mg * kg-1 * h-1 in Air/TIVA and Nitrous oxide/TIVA groups, respectively.ConclusionsNitrous oxide does not affect the infusion requirements of cisatracurium.Trial registrationClinicalTrials.gov NCT01152905; European Clinical Trials Database at http://eudract.emea.eu.int/2006-006037-41.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Effect of nitrous oxide on cisatracurium infusion demands: a randomized controlled trial

2010

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“…They used a relaxograph neuromuscular transmission monitor (Datex, Helsinki, Finland) as the input, a model-driven closed-loop feedback system running on a Compaq portable 386 computer (Houston, Texas, USA) as the controller, and an infusion pump (Fresenius Infusomat CP; Bad Homburg, Germany) as the output. They showed good success with this system and a rapid return to neuromuscular function at the end of the surgical case [28].…”

Section: Nondepolarizing Muscle Blocking Agentsmentioning

confidence: 98%

“…Illman et al [28] used a CLS to dose rocuronium to maintain a 90% muscle blockade. They used a relaxograph neuromuscular transmission monitor (Datex, Helsinki, Finland) as the input, a model-driven closed-loop feedback system running on a Compaq portable 386 computer (Houston, Texas, USA) as the controller, and an infusion pump (Fresenius Infusomat CP; Bad Homburg, Germany) as the output.…”

Section: Nondepolarizing Muscle Blocking Agentsmentioning

confidence: 99%