After repeated rocuronium administration there is wide inter-patient variability in the time to recover muscle function.

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• D M Maybauer, G Geldner, M Blobner, F Pühringer, R Hofmockel, C Rex, H F Wulf, L Eberhart, C Arndt, and M Eikermann.
• Klinik für Anästhesiologie und Intensivmedizin, Philipps-Universität Marburg, Germany.
• Anaesthesia. 2007 Jan 1;62(1):12-7.

AbstractIn a randomised, controlled, double-blind, multicentre trial in 338 patients, we assessed the incidence of residual paralysis following administration of cisatracurium or rocuronium. The incidence at the end of surgery was significantly lower in patients treated with rocuronium (62 of 142 patients, 44%) than in those given cisatracurium (99 of 175 patients, 57%) (p < 0.05). In contrast, with rocuronium the mean (SD) time between skin closure and extubation was 28 (28) min vs 18 (19) min for cisatracurium, and the duration 0.9 (time from administration of last top-up dose to recovery of the train-of-four ratio to 0.9) was significantly longer and more variable for rocuronium than for cisatracurium. Thus, after repeated administration, the duration and variability of duration of action are greater with rocuronium compared with cisatracurium. These pharmacodynamic differences do not necessarily translate into a higher incidence of residual paralysis, because clinicians compensate for the longer duration of action and variability of rocuronium by terminating administration of the neuromuscular blocking earlier.

This article appears in the collection: Neuromuscular myths: the lies we tell ourselves.

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