Acute desflurane or sevoflurane exposure on a previously stabilized atracurium-induced neuromuscular block.
OBJECTIVE
The aim of this prospective study was to compare the effect of the administration of desflurane or sevoflurane to a fixed neuromuscular block.


METHODS
After written consent, 12 patients were anaesthetized with propofol and sufentanil. Atracurium was administered via a continuous infusion in order to obtain 85% twitch depression of the control value assessed by repeated accelerometric stimulation at the adductor pollicis. Once stabilized over the course of 30 min, propofol was discontinued and either desflurane (n = 6) or sevoflurane (n = 6) was delivered at 1 MAC in a mixture of 50% O(2) in air. Study parameters were the magnitude and the time of twitch height variations. Results are presented in mean +/- SD.


RESULTS
Exposure to halogenated agents led to a significant reduction in twitch height with similar magnitude between the two agents. However, interaction with desflurane showed an initial and transient rise (35 +/- 22%) in twitch height before subsequent depression occurred. The time to reach 50% of the signal depression in the desflurane group was significantly delayed (25 +/- 7 vs. 11 +/- 4 min in the sevoflurane group; P < 0.01).


CONCLUSIONS
On a stable neuromuscular block elicited by continuous infusion of atracurium, the abrupt administration of desflurane or sevoflurane reduces the accelerometric responses of the adductor pollicis in a similar way. This potentiating effect is produced faster after sevoflurane than after desflurane. With desflurane, a biphasic effect (of a transient and moderate increase followed by depression of the signal) was recorded.
Beaussier
M
M
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France. marc.beaussier@sat.ap-hop-paris.fr
Boughaba
A
A
Schiffer
E
E
Debaene
B
B
Lienhart
A
A
d'Hollander
A
A
D000328:Adult; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D001279:Atracurium / Q000494:pharmacology*; D002138:Calibration; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane