Infusion requirements and reversibility of rocuronium at the corrugator supercilii and adductor pollicis muscles

Acta Anaesthesiol Scand. 2009 Nov;53(10):1336-40. doi: 10.1111/j.1399-6576.2009.02073.x. Epub 2009 Jul 22.


Background: The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM).

Methods: We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0-1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced and maintained at T1 of 10% of the control at the CSM or APM for 120 min. Immediately after rocuronium infusion was discontinued, the time required for 0.04 mg/kg neostigmine-facilitated recovery to a TOF ratio of 0.9 was recorded.

Results: Rocuronium infusion dose after a lapse of 120 min was significantly larger in the CSM than in the APM [7.1 (2.3) vs. 4.7 (2.6) microg/kg/min; P=0.001]. The time for facilitated recovery was shorter in the CSM than in the APM [11.4 (3.8) vs. 16.2 (6.0) min; P=0.016].

Conclusion: A larger rocuronium infusion dose was required to maintain a constant neuromuscular block at the CSM. Neostigmine-mediated reversal was faster at the CSM.

Publication types

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

MeSH terms

  • Adult
  • Androstanols / administration & dosage*
  • Androstanols / antagonists & inhibitors
  • Androstanols / pharmacokinetics
  • Cholinesterase Inhibitors / administration & dosage
  • Dose-Response Relationship, Drug
  • Facial Muscles / innervation*
  • Facial Nerve / drug effects
  • Female
  • Humans
  • Infusions, Intravenous
  • Middle Aged
  • Myography / methods
  • Neostigmine / administration & dosage
  • Neuromuscular Blockade* / instrumentation
  • Neuromuscular Blockade* / methods
  • Neuromuscular Nondepolarizing Agents / administration & dosage*
  • Neuromuscular Nondepolarizing Agents / antagonists & inhibitors
  • Neuromuscular Nondepolarizing Agents / pharmacology
  • Rocuronium
  • Thumb / innervation*
  • Transcutaneous Electric Nerve Stimulation
  • Treatment Outcome
  • Ulnar Nerve / drug effects
  • Young Adult


  • Androstanols
  • Cholinesterase Inhibitors
  • Neuromuscular Nondepolarizing Agents
  • Neostigmine
  • Rocuronium