Comparative study of neuromuscular blocking and hemodynamic effects of rocuronium and cisatracurium under sevoflurane or total intravenous anesthesia.
Neuromuscular blockers (NMB) are important adjuvant to general anesthesia. Rocuronium bromide and cisatracurium besylate are considered relatively recently introduced non-depolarizing muscle relaxants.


OBJECTIVE
This study evaluates the enhancement of cisatracurium and rocuronium-induced neuromuscular block during anesthesia with 1.5 MAC sevoflurane or total i.v. anesthesia (TIVA), hemodynamic effects and side effects.


METHODS
80 patients were randomly allocated into one of four equal Groups to receive either rocuronium (under sevoflurane or propofol TIVA) or cisatracurium (under sevoflurane or propofol TIVA). The NMB effects ofrocuronium and cisatracurium were studied by constructing dose-effect curves. Acceleromyography (TOF-Guard) and train-of-four (TOF) stimulation of the ulnar nerve were used (2 Hz every 15 sec). Cisatracurium and rocuronium were administered in increments until depression of T1/T0 > 95% was reached. Hemodynamic effects of both muscle relaxants together with sevoflurane or propofol were assessed using thoracic bioimpendance.


RESULTS
Depression ofT1/T0 was enhanced under sevoflurane compared to TIVA. ED50 and ED95 values of both drugs were significantly lower under sevoflurane more than TIVA. Recovery index 25-75% and time to a TOF ration of 0.70 were prolonged significantly by sevoflurane compared to TIVA. Hemodynamically, rocuronium and cisatracurium did not exert significant changes, but the interaction of the relaxants and the anesthetic agents resulted in statistically significant decline in some hemodynamic parameters at certain periods which are not clinically significant and required no medications.


CONCLUSIONS
We conclude that the effects of rocuronium and cisatracurium are significantly enhanced during sevoflurane compared with propofol anesthesia and the recovery is lower.
Amin
Ashraf Mounir
AM
Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Mohammad
Mohammad Yosry
MY
Ibrahim
Mona Fathi
MF
D000328:Adult; D000732:Androstanols / Q000494:pharmacology*; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D019148:Neuromuscular Blockade / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol; D012044:Regression Analysis; D000077123:Rocuronium; D000077149:Sevoflurane; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome
D000732:Androstanols; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D000077149:Sevoflurane; C101584:cisatracurium; D000077123:Rocuronium; D015742:Propofol