Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane, isoflurane or propofol.
OBJECTIVE
To examine the influence of continuing administration of sevoflurane or isoflurane during reversal of rocuronium induced neuromuscular block with neostigmine.


METHODS
One hundred and twenty patients, divided into three equal groups, were randomly allocated to maintenance of anesthesia with sevoflurane, isoflurane or propofol. Neuromuscular block was induced with rocuronium and monitored using train-of-four (TOF) stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. Neostigmine was administered when the first response in TOF had recovered to 25%. At this time the volatile agent administration was stopped or propofol dosage reduced in half the patients in each group (n = 20 in each group). The times to attain TOF ratio of 0.8, and the number of patients attaining this end point within 15 min were recorded.


RESULTS
The times (mean +/- SD) to recovery of the TOF ratio to 0.8 were 12.0 +/- 5.5 and 6.8 +/- 2.3 min in the sevoflurane continued and sevoflurane stopped groups, 9.0 +/- 8.3 and 5.5 +/- 3.0 min in the isoflurane continued and isoflurane stopped groups, and 5.2 +/- 2.8 and 4.7 +/- 1.5 min in the propofol continued and propofol stopped groups (P < 0.5-01). Only 9 and 15 patients in the sevoflurane and isoflurane continued groups respectively had attained a TOF ratio of 0.8 within 15 min (P < 0.001 for sevoflurane).


CONCLUSIONS
The continued administration of sevoflurane, and to a smaller extent isoflurane, results in delay in attaining adequate antagonism of rocuronium induced neuromuscular block.
Reid
J E
JE
Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, N. Ireland, UK.
Breslin
D S
DS
Mirakhur
R K
RK
Hayes
A H
AH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors*; D000777:Anesthetics / Q000494:pharmacology*; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000494:pharmacology*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D009388:Neostigmine / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D015742:Propofol / Q000494:pharmacology*; D000077123:Rocuronium; D000077149:Sevoflurane; D013997:Time Factors
D000732:Androstanols; D000777:Anesthetics; D002800:Cholinesterase Inhibitors; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D009388:Neostigmine; D007530:Isoflurane; D000077123:Rocuronium; D015742:Propofol