title: Recovery from neuromuscular block after an intubation dose of cisatracurium and rocuronium in lumbar disc surgery.
abstract: OBJECTIVE
  Residual muscle paralysis remains a concern for anaesthesiologists. This study investigated the recovery from neuromuscular block (NMB) after an intubation dose of cisatracurium (C) or rocuronium (R) in 32 patients undergoing lumbar disc surgery.
  
  
  METHODS
  Anaesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in nitrous oxide/oxygen. Patients were randomised to receive twice the ED95 of either cisatracurium (GC) or rocuronium (GR) before tracheal intubation. After placement in prone position, neuromuscular transmission was monitored at the wrist by accelerometry. NMB was antagonised when the TOF ratio (TOFR) was < 0.75 at muscle closure. The time from muscle relaxant to muscle closure, and to TOFR of 0.25 and of 0.50 were recorded. Data were analysed using Student's t-tests, chi-squared tests and two-way mixed-designed ANOVA's. The prediction probability (Pk) of the times from muscle relaxant to muscle closure, and to TOFR of 0.25 for the necessity to antagonize NMB was calculated in both groups. P < 0.05 was considered statistically significant.
  
  
  RESULTS
  NMB was antagonized in 8 (GC) and 6 (GR) patients, respectively. The time from muscle relaxant to muscle closure was shorter in patients whose NMB was antagonized. The Pk of this time was significant in GC (0.85) but not in GR (0.69). In GR contrarily to GC, the times to a TOFR of 0.25 and 0.50 were longer in patients whose NMB was antagonized. The Pk of the time to TOFR of 0.25 was significant in GR (0.95) but not in GC (0.64).
  
  
  CONCLUSIONS
  A single dose of cisatracurium or rocuronium may be associated to some degree of NMB at the end of lumbar surgery, depending on the duration of surgery and on the duration of action of the muscle relaxant which is more variable for rocuronium than for cisatracurium.
authors.affiliation: University Department of Anaesthesia & ICM, CHR de la Citadelle, University Hospital, Liege, Belgium. pol.hans@chu.ulg.ac.be
authors.forename: P
authors.initials: P
authors.lastname: Hans
authors.forename: Ph
authors.initials: P
authors.lastname: Welter
authors.forename: P Y
authors.initials: PY
authors.lastname: Dewandre
authors.forename: J F
authors.initials: JF
authors.lastname: Brichant
authors.forename: V
authors.initials: V
authors.lastname: Bonhomme
mesh_terms: D000328:Adult; D000732:Androstanols / Q000009:adverse effects*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D001279:Atracurium / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007442:Intubation, Intratracheal; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D011292:Premedication; D011446:Prospective Studies; D000077123:Rocuronium; D009435:Synaptic Transmission / Q000187:drug effects
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D000077123:Rocuronium