Pharmacodynamic interactions between cisatracurium and rocuronium.
The onset and duration of maintenance doses of neuromuscular blocking drugs may be influenced by the original neuromuscular blocking drug used. We assessed the effect of the interaction between steroidal and benzo-isoquinolinium compounds on the clinical duration of maintenance doses of cisatracurium. Sixty adult patients undergoing anesthesia with isoflurane, nitrous oxide, and oxygen were randomized to receive the following: Group I = rocuronium 0.6 mg/kg followed by cisatracurium 0.03 mg/kg when the first twitch in the train-of-four (TOF) recovered to 25%, Group II = cisatracurium 0.15 mg/kg followed by cisatracurium 0.03 mg/kg, and Group III = rocuronium 0.6 mg/kg followed by rocuronium 0.15 mg/kg. Neuromuscular blockade was monitored using acceleromyography (TOF-Guard, Boxtel, The Netherlands). The clinical duration (mean +/- SD) of the first 2 maintenance doses was 41 +/- 10, 31 +/- 7++, and 25 +/- 8++ min, and 39 +/- 11, 30 +/- 6+, 29 +/- 9* min in Groups I-III, respectively (*P < 0.05, +P < 0.01, ++P < 0.001; Group I versus II and III). Thus, the clinical duration of the first two maintenance doses of cisatracurium was prolonged when administered after rocuronium.


CONCLUSIONS
We assessed the clinical effect of administering cisatracurium after an intubating dose of rocuronium in 60 patients undergoing isoflurane/nitrous oxide and oxygen anesthesia. The clinical duration of the first two maintenance doses of cisatracurium administered after rocuronium was significantly prolonged. This supports the contention that combinations of structurally dissimilar neuromuscular blocking drugs result in a synergistic effect.
Breslin
Dara S
DS
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Jiao
Kuiran
K
Habib
Ashraf S
AS
Schultz
John
J
Gan
Tong J
TJ
D000368:Aged; D000732:Androstanols / Q000009:adverse effects*; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001279:Atracurium / Q000009:adverse effects* / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D004338:Drug Combinations; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D009609:Nitrous Oxide; D011446:Prospective Studies; D000077123:Rocuronium
D000732:Androstanols; D018685:Anesthetics, Inhalation; D004338:Drug Combinations; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D007530:Isoflurane; D009609:Nitrous Oxide; C101584:cisatracurium; D000077123:Rocuronium