title: Effect of maintenance bolus on the recovery profile of a short-acting nondepolarizing muscle relaxant.
abstract: OBJECTIVE
  To evaluate the effect of different maintenance boluses of a short-acting nondepolarizing neuromuscular blocking drug on its spontaneous recovery profile during anesthesia.
  
  
  METHODS
  Prospective, randomized, double-blind, dose-ranging study.
  
  
  METHODS
  University-based medical center.
  
  
  METHODS
  69 ASA physical status I and II consenting adult outpatients undergoing general anesthesia with an anticipated duration of at least 2 hours.
  
  
  METHODS
  Patients were randomized to one of three study groups. Following induction of anesthesia with propofol and fentanyl, rapacuronium 1.5 mg x kg(-1) intravenously (i.v.), was administered to facilitate tracheal intubation. Anesthesia was maintained with desflurane 4% end-tidal in combination with nitrous oxide 67% in oxygen. When the first twitch (T(1)) in the train-of-four (TOF) returned to 25% of its baseline value, a maintenance dose of rapacuronium 0.25 mg x kg(-1) i.v. (Group 1), 0.5 mg. kg(-1) i.v. (Group 2), or 0.75 mg. kg(-1) i.v. (Group 3) was administered. The time course of neuromuscular block was monitored at the wrist using standard electromyography.
  
  
  RESULTS
  The times for recovery of the T(1) to 25% of the baseline value following different maintenance doses of rapacuronium were only 6.3 +/- 2.2, 7.5 +/- 2.3, and 9.6 +/- 2.5 minutes, in Groups 1, 2 and 3, respectively. However, the times for the TOF ratio to return to 0.7 were 44 +/- 15, 53 +/- 20, and 66 +/- 30 minutes in Groups 1, 2, and 3, respectively. Although recovery times were significantly longer after rapacuronium 0.75 mg x kg(-1) i.v. (Group 3), there were no significant differences in any of the recovery variables between Groups 1 and 2.
  
  
  CONCLUSIONS
  Spontaneous recovery of the T(1) to 25% of the baseline value occurred 6 to 10 minutes after a maintenance bolus dose of rapacuronium 0.25 to 0.75 mg x kg(-1) i.v. However, recovery to a TOF>0.7 required 44 to 66 minutes during desflurane anesthesia.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9068, USA.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Tang
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Wender
authors.forename: Alexander
authors.initials: A
authors.lastname: Sloninsky
authors.forename: Robert
authors.initials: R
authors.lastname: Naruse
authors.forename: Robert
authors.initials: R
authors.lastname: Kariger
authors.forename: Tom
authors.initials: T
authors.lastname: Webb
authors.forename: Eve
authors.initials: E
authors.lastname: Norel
mesh_terms: D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D000077335:Desflurane; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D011446:Prospective Studies; D013997:Time Factors; D014673:Vecuronium Bromide / Q000031:analogs & derivatives* / Q000494:pharmacology*
chemical_list: D018685:Anesthetics, Inhalation; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D000077335:Desflurane; D007530:Isoflurane; C082938:rapacuronium