Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol-based anaesthesia

Br J Anaesth. 2000 Aug;85(2):302-5. doi: 10.1093/bja/85.2.302.

Abstract

We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of rapacuronium. Eighty ASA I-III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5-2.5 mg kg-1 and fentanyl 1-2 micrograms kg-1, followed by a bolus of rapacuronium 1.5 mg kg-1. The patients were randomized to receive either desflurane (2-4% end-tidal, ET), sevoflurane (0.75-1.5% ET), isoflurane (0.4-0.8% ET), or a propofol infusion (75-150 micrograms kg-1 min-1) for maintenance of anaesthesia in combination with nitrous oxide (60-70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard accelerometer) returned to 5%, an infusion of rapacuronium was started at 3 mg kg-1 h-1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg-1 h-1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anesthesia Recovery Period
  • Anesthetics, Inhalation / administration & dosage*
  • Anesthetics, Intravenous / administration & dosage*
  • Desflurane
  • Drug Synergism
  • Electromyography
  • Female
  • Humans
  • Infusions, Intravenous
  • Isoflurane / administration & dosage
  • Isoflurane / analogs & derivatives
  • Male
  • Methyl Ethers / administration & dosage
  • Middle Aged
  • Neuromuscular Nondepolarizing Agents / administration & dosage*
  • Propofol / administration & dosage*
  • Sevoflurane
  • Time Factors
  • Vecuronium Bromide / administration & dosage
  • Vecuronium Bromide / analogs & derivatives*

Substances

  • Anesthetics, Inhalation
  • Anesthetics, Intravenous
  • Methyl Ethers
  • Neuromuscular Nondepolarizing Agents
  • Sevoflurane
  • Vecuronium Bromide
  • Desflurane
  • Isoflurane
  • rapacuronium
  • Propofol