Does discontinuation of desflurane at the time of neostigmine administration speed recovery from cisatracurium block compared to that with a propofol-based technique?
BACKGROUND
Volatile anaesthetics are known to influence the effect of neostigmine as an antagonist of neuromuscular block. The aim of the present study was to investigate whether discontinuation of desflurane at the time of neostigmine administration shortens reversal time from cisatracurium block, compared to that with a propofol-based anaesthesia.


METHODS
Ten volunteers were studied twice. For one study, anaesthesia was induced with alfentanil and propofol and maintained with nitrous oxide 70% and propofol 150 microg. kg-1. min-1. For the other study, experimental conditions were replicated except that desflurane 6% was administered and the dose of propofol was only 50 microg. kg-1. min-1. The evoked mechanical response of the adductor pollicis to train-of-four (TOF) stimulation was recorded. Neuromuscular block was induced with cisatracurium 0.2 mg. kg-1. When the magnitude of the first TOF response (T1) had recovered to 10%, the block was antagonized with neostigmine 70 microg. kg-1. At this time, propofol was decreased to 50 microg. kg-1. min-1, or the desflurane was discontinued.


RESULTS
There were no significant differences between the two techniques of anaesthesia in the rate of neostigmine-induced recovery of the TOF ratio. The times (mean+/-SD) to achieve TOF ratios of 0.7, 0.8, and 0.9 were (propofol first, desflurane second) 6.1+/-2.2 and 6.5+/-1.6 min; 10.4+/-4.2 and 9.6+/-2.7 min; 17.1+/-6.9 and 21.0+/-13.0 min, respectively.


CONCLUSIONS
Discontinuing desflurane does not speed neostigmine-induced recovery from cisatracurium neuromuscular block, when compared to that during propofol-based anaesthesia.
Kirkegaard-Nielsen
H
H
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA. hanskirkegaard@dadlnet.dk
Caldwell
J E
JE
Abengochea
A
A
Berry
P D
PD
Heier
T
T
D000328:Adult; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000031:analogs & derivatives; D002800:Cholinesterase Inhibitors; D000077335:Desflurane; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D009388:Neostigmine; D003473:Neuromuscular Nondepolarizing Agents; D015742:Propofol
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D009388:Neostigmine; D000077335:Desflurane; D007530:Isoflurane; C101584:cisatracurium; D015742:Propofol