title: Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol-based anaesthesia.
abstract: We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of rapacuronium. Eighty ASA I-III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5-2.5 mg kg-1 and fentanyl 1-2 micrograms kg-1, followed by a bolus of rapacuronium 1.5 mg kg-1. The patients were randomized to receive either desflurane (2-4% end-tidal, ET), sevoflurane (0.75-1.5% ET), isoflurane (0.4-0.8% ET), or a propofol infusion (75-150 micrograms kg-1 min-1) for maintenance of anaesthesia in combination with nitrous oxide (60-70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard accelerometer) returned to 5%, an infusion of rapacuronium was started at 3 mg kg-1 h-1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg-1 h-1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
authors.affiliation: Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: W
authors.initials: W
authors.lastname: Fu
authors.forename: K W
authors.initials: KW
authors.lastname: Klein
authors.forename: P F
authors.initials: PF
authors.lastname: White
authors.forename: J W
authors.initials: JW
authors.lastname: Chiu
authors.forename: H J
authors.initials: HJ
authors.lastname: Lemmens
authors.forename: D G
authors.initials: DG
authors.lastname: Whalley
authors.forename: D R
authors.initials: DR
authors.lastname: Drover
authors.forename: C P
authors.initials: CP
authors.lastname: Greenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000077335:Desflurane; D004357:Drug Synergism; D004576:Electromyography; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077149:Sevoflurane; D013997:Time Factors; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D014673:Vecuronium Bromide; D000077335:Desflurane; D007530:Isoflurane; C082938:rapacuronium; D015742:Propofol