European journal of anaesthesiology. Supplement
-
Eur J Anaesthesiol Suppl · Jan 1994
ReviewInteractions of volatile anaesthetics with rocuronium bromide in perspective.
A review of several publications shows that there is general agreement that inhalational anaesthetic agents potentiate the neuromuscular effects of rocuronium in the same order as other similar agents, namely; enflurane and isoflurane > halothane > intravenous anaesthetics. However, such potentiation is not evident during induction and only becomes significant as anaesthesia becomes more prolonged. It is manifest as a prolongation in the duration of action of maintenance doses and a decrease in the recovery rate. During long-lasting procedures in which enflurane or isoflurane are used, smaller than usual maintenance doses or lower infusion rates should be employed.
-
A computer simulation has been developed based on pharmacodynamic-pharmacokinetic modelling of the effect of neostigmine on rocuronium-induced neuromuscular blockade. The results of a previous study involving 60 patients were used as a test of the model. ⋯ The optimum dose of neostigmine depends on the degree of block at the time of administration: for a more intense block the optimum dose is 80 micrograms kg-1 and for a less intense block is about 30 micrograms kg-1. The pharmacokinetic behaviour rather than the potency of the relaxant determines its reversibility.
-
Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialDose-response relationship of rocuronium bromide during intravenous anaesthesia.
The dose-response relationship and time course of neuromuscular block following bolus injections of rocuronium was determined in four groups of nine patients each under nitrous oxide-narcotic anaesthesia. Each patient received a total of 800 micrograms kg-1 rocuronium in two divided doses, i.e. 120 and 680, 200 and 600, 250 and 550, or 300 and 500 micrograms kg-1. The respective second dose was injected when, following the first dose, the evoked twitch tension had recovered to 95% of its control value. ⋯ The DUR25 ranged between 11 +/- 4 (200 micrograms kg-1) to 14 +/- 3 min (300 micrograms kg-1) following the first and from 30 +/- 6 (500 micrograms kg-1) to 43 +/- 11 min (680 micrograms kg-1) following the second doses. The recovery index following the second doses varied between 14 +/- 5 (500 micrograms kg-1) and 24 +/- 20 min (600 micrograms kg-1), more than twice as long as following the first doses. We conclude that rocuronium is a muscle relaxant of low potency with an intermediate duration of action.
-
Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Clinical TrialEvaluation of the onset and intubation conditions of rocuronium bromide.
Rocuronium 0.6, 0.75, or 0.9 mg kg-1, was given after supramaximal train-of-four stimulation of the ulnar nerve, measuring the compound action potential of the hypothenar muscles, Intubation conditions, onset time, recovery to 25% and recovery index of the three doses of rocuronium bromide were determined in 60 ASA I or II consenting patients, who were receiving propofol, alfentanil and N2O/O2 for ophthalmic surgery. Intubation conditions were randomly assessed either 45 s or 60 s after injection. In general, intubation conditions were excellent or good; in only three patients were poor conditions obtained, always at 45 s. ⋯ No difference could be shown between the three dose groups. The onset time was longer (P < 0.01) in the 0.6 mg kg-1 group, compared to that in the 0.9 mg kg-1 group. The recovery to 25% and spontaneous recovery index were shorter in the 0.6 mg kg-1 group (P < 0.01).
-
Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Clinical TrialQuantitation of the interaction of rocuronium bromide with etomidate, fentanyl, midazolam, propofol, thiopentone, and isoflurane using closed-loop feedback control of infusion of rocuronium.
Sixty patients were randomly assigned to one of six groups (n = 10 in each case) in which anaesthesia was induced and maintained with etomidate, fentanyl, midazolam, propofol or with thiopentone and N2O, or isoflurane and N2O. After obtaining control measurements, rocuronium 0.6 mg kg-1 was given for intubation followed by an infusion, controlled by closed-loop feedback at 90% block. ⋯ The intravenous agents did not interact with recuronium to any clinically significant degree. Isoflurane reduced the requirements by 35-40%.