European journal of anaesthesiology. Supplement
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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.
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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.
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Eur J Anaesthesiol Suppl · Jan 1994
Pharmacokinetics and pharmacodynamics of rocuronium bromide in adult patients.
In seven patients (M/F: 4:3) rocuronium 0.6 mg kg-1 was given after the induction of anaesthesia with propofol, and during maintenance with N2O/O2, halothane 0.5% and alfentanil 60-90 micrograms kg-1 h-1. Intubation conditions were scored at 60 s and lag time, onset time, maximal block achieved, recovery to 25% of T1, and Recovery Index, were measured using a Relaxograph. ⋯ Mean clearance was 5.2 ml kg-1 min-1, the terminal half-life was 69 min and distribution volume at steady state was 0.22 litre kg-1. Cumulative urinary excretion was around 18% within 24 h.
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Eur J Anaesthesiol Suppl · Jan 1994
Time course of action and recovery of rocuronium bromide in children during halothane anaesthesia--a preliminary report.
In this preliminary study, two groups of 15 patients, aged 1-4 years and 5-10 years respectively, received one of four doses of rocuronium (0.12, 0.17, 0.22 or 0.27 mg kg-1) and when block was maximal a supplementary dose to bring them all to a total of 0.5 mg kg-1. In half the patients, the block was reversed with atropine and neostigmine at a T1 recovery of 25%. The remainder were allowed to recover spontaneously. ⋯ Mean spontaneous recovery time from T1 25% to a train-of-four ratio of 0.7 was about 11 min. Neostigmine doubled the rate of recovery. There was a moderate increase in heart rate in the younger age range.
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Eur J Anaesthesiol Suppl · Jan 1994
Pharmacodynamics and pharmacokinetics of rocuronium following continuous infusion in patients during intravenous anaesthesia.
After an initial bolus dose (0.6 mg kg-1), 10 patients received a continuous infusion of rocuronium, initially at 0.5 mg kg-1h-1, and then adjusted to maintain 90% twitch depression. Blood samples were analysed for 420 min after switching off the infusion. The dose required to maintain the block was 595 +/- 146 micrograms kg-1h-1, 7-9 times that reported for vecuronium under similar conditions. The pharmacokinetic parameters (volume of distribution at steady state, 309 +/- 80 ml kg-1, plasma clearance 4.5 +/- 1.96 ml kg-1 min-1, and elimination half-life 107 +/- 37 min) were similar to those previously reported after a large single bolus.