• Yoon Hee Kim, Young Kwon Go, Jung Un Lee, Woo Suk Chung, Yong Sup Shin, Kyu Cheol Han, Ji Eun Shin, and Suk Hoon Lee.
• Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon, 301-721, Korea. yhkim0404@cnu.ac.kr
• J Anesth. 2010 Aug 1;24(4):549-52.

PurposeThis randomized, double-blind, placebo-controlled study was conducted to examine the preventive effect of nafamostat mesilate, a kallikrein inhibitor, on the withdrawal response associated with rocuronium injection.MethodsNinety American Society of Anesthesiology (ASA) physical status I or II patients, aged 18-65 years, were randomly divided into two groups that received either a 1.5-ml solution containing 1.5 mg nafamostat mesilate diluted in a 5% glucose solution or a 1.5-ml 5% glucose solution. Anesthesia was induced by 5 mg/kg 2.5% thiopental. After confirming loss of consciousness, a tourniquet was applied to the mid forearm and tightened to block venous flow. The test solution was then administered, 1 min after which the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Each patient's response to rocuronium injection was graded on a four-point scale in a double-blind manner. Activated coagulation time and plasma potassium concentration were measured before and 5 and 10 min after nafamostat administration.ResultsThe incidence of withdrawal response was 68.9% in the control group and 24.4% in the nafamostat group (P < 0.001). The number of patients showing generalized movement (response 4) with the rocuronium injection was significantly lower in nafamostat group [1 (2.2%)] than the control group [15 (33.3%)], P < 0.001. Five and 10 min after nafamostat administration, measured potassium and activated coagulation time were similar to baseline values.ConclusionPretreatment with 1.5 mg nafamostat mesilate decreased withdrawal response associated with rocuronium injection.

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