Smoking does not alter the dose-requirements and the pharmacodynamics of rocuronium

Abstract

Purpose: Controversial data about the effect of smoking on the dose-requirements and the pharamcodynamics of rocuronium have been reported recently. This study was conducted to evaluate the dose-requirements and the pharmacodynamics of rocuronium in smokers using target controlled infusion. Methods:The dose-requirements of rocuronium for 60 min relaxation, using target controlled infusion, given under intravenous anaesthesia with propofol, fentanyl and nitrous oxide was studied in 37 smokers and 37 nonsmokers. Initially 450 µg·kg -1 rocuronium were administered, neuromuscular effects were quantified by recording the single twitch response of the adductor pollicis muscle after ulnar nerve stimulation using a force transducer, and the neuromuscular block was kept at 80% by target controlled infusion throughout the procedure.Results: The dose-requirements for one hour relaxation were 867 ± 116 µg·kg -1 ·hr -1 for smokers (S) and 839 ± 149 µg·kg -1 ·hr -1 for non-smokers (NS). The duration to 10% and the spontaneous recovery from 25% to 75% of the control twitch response also showed no differences between S (17.2 ± 3.4 min, 10.6 ± 0.9 min ) and NS (18.9 ± 4.3 min, 10.9 ± 3.2 min), as well as maximum block, onset time and infusion rate. Conclusion:Smoking does not alter the dose-requirements for rocuronium and no effects on the onset time, degree of block, time to maximum block, duration 10% and spontaneous recovery index were observed.Objectif : Des données controversées au sujet de l'effet du tabagisme sur les doses nécessaires de rocuronium et sur sa pharmacodynamie ont été publiées récemment. La présente étude a été menée pour évaluer les doses efficaces de rocuronium et sa pharmacodynamie chez des fumeurs en utilisant une perfusion cible contrôlée.Méthode : Les doses de rocuronium nécessaires pour provoquer un relâchement musculaire de 60 min ont été étudiées chez 37 fumeurs et 37 non fumeurs, à l'aide d'une perfusion cible contrôlée. Elles ont été administrées sous anesthésie intraveineuse avec du propofol, du fentanyl et du protoxyde d'azote. On a d'abord administré 450 µg·kg -1 de rocuronium, puis on a quantifié les effets neuromusculaires en enregistrant les contractions uniques de l'adducteur du pouce après la stimulation du nerf cubital à l'aide d'un transducteur de force. Le blocage neuromusculaire a été maintenu à 80 % par la perfusion cible contrôlée tout au long de l'intervention.Résultats : Les doses requises pour assurer une heure de myorelaxation ont été de 867 ± 116 µg·kg -1 ·h -1 chez les fumeurs (F) et de 839 ± 149 µg·kg -1 ·h -1 chez les non fumeurs (NF), P : NS. Le temps d'atteindre 10 % du bloc et la récupération spontanée de 25 % à 75 % des réponses par contractions contrôlées n'ont pas présenté de différences entre les patients du groupe F (17,2 ± 3,4 min, 10,6 ± 0,9 min ) et ceux du groupe NF (18,9 ± 4,3 min, 10,9 ± 3,2 min). Aucune différence n'est apparue pour le temps nécessaire à l'obtention du bloc maximal, le délai d'installation du bloc et le débit de la perfusion.Conclusion : L'habi...

Clinical Predictors of Duration of Action of Cisatracurium and Rocuronium Administered Long-Term

“…Rautoma and Svartling 25 reported a significantly increased requirement for rocuronium in smokers, and Reisli et al 24 reported a significantly longer dur 25 in children with a history of exposure to secondhand smoke than in children without such exposure. Pühringer et al, 26 however, did not find any differences between tobacco smokers and nonsmokers in rocuronium's onset time, peak neuromuscular blockade, and duration of action. Our findings indicate that tobacco smoking history is not an independent predictor of the duration of action of rocuronium, suggesting that the reported association between smoking and increased duration of action of rocuronium 24,25 is not causative.…”

“…[24][25][26] Variables that correlated significantly (P = .15) with the mean dur 25 were included in our multiple regression analysis model, and an association of variables with the dur 25 of the respective NBD was assumed at a significance level of less than .05.…”

“…Both of these NBDs are often used in anesthesia and intensive care medicine. 4 On the basis of published data, we thought that weight, 15,16 age, 17 sex, 18 American Society of Anesthesiologists (ASA) risk score, 19 blood loss (suggesting instability of cardiac output), 20,21 lowest core body temperature, 22 duration of NBD administration, 23 and tobacco smoking history [24][25][26] might contribute to the variance in the mean duration of action of cisatracurium and rocuronium.…”

Effect of Smoking on Reversing Neuromuscular Block

“…Pühringer et al (16) found that smoking does not change the dose requirement or the pharmacodynamics of rocuronium. Salihoğlu et al (17) discovered a decrease of 25% in the neuromuscular effect of rocuronium, starting time and recovery time in smokers compared with non-smokers.…”

The effect of environmental tobacco smoke on the dose requirements of rocuronium in children

“…In addition, nicotine may influence the action of NMBAs at the nicotinic acetylcholine receptors of the neuromuscular junction (5). Recent studies report controversial data about the effects of smoking on the dose requirements of nondepolarizing NMBAs in adults (6–8). Some authors have suggested that nonsmokers are more sensitive to vecuronium than smokers (6) and smoking increases the requirement for rocuronium (7), but others have suggested that smoking does not alter rocuronium‐induced neuromuscular block (NMB) (8).…”