Priming with rocuronium or vecuronium prevents remifentanil-mediated muscle rigidity and difficult ventilation.
OBJECTIVE
The aim of this study was to test our hypothesis that priming with rocuronium would prevent muscle rigidity and difficult ventilation due to remifentanil administration.


METHODS
One hundred patients, American Society of Anesthesiologists (ASA) status I or II, were recruited into the study, and randomly allocated to one of four protocols (n = 25 each). Remifentanil was administered at 0.2 microg.kg(-1).min(-1) in group A and at 0.7 microg.kg(-1).min(-1) in groups B, C, and D. Priming with vecuronium (0.02 mg.kg(-1)) or rocuronium (0.06 mg.kg(-1)) was performed at the same time as the infusion of remifentanil in groups C and D, respectively. Anesthesia was induced with 1 mg.kg(-1)propofol 2 min after the start of remifentanil infusion. After the patient had lost consciousness, the anesthesiologist performed mask ventilation, and watched for the presence of muscle rigidity. Ventilation and rigidity were evaluated using a scoring system.


RESULTS
Of the 100 patients, 9 were excluded; the number of patients in group A was 24, while groups B and D had 22 patients each, and group C had 23 patients. A lower dose of remifentanil (group A) or priming with vecuronium or rocuronium (groups C, D) significantly reduced the incidence of some difficulty with ventilation (P = 0.0010, P = 0.0053, and P = 0.021, respectively, vs group B). Of the patients in group B, 10 (45.5%) developed some difficulty with ventilation, and ventilation was impossible in 2 of them. On the other hand, 1 (4.1%) of the patients in group A, 2 (8.7%) in group C, and 3 (13.6%) in group D developed some difficulty with ventilation.


CONCLUSIONS
The present study showed that priming with rocuronium or vecuronium reduced the incidence of difficult ventilation by avoiding the muscle rigidity caused by remifentanil.
Nakada
Junya
J
Department of Anesthesiology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
Nishira
Masao
M
Hosoda
Renko
R
Funaki
Kazumi
K
Takahashi
Shyunsaku
S
Matsura
Tatsuya
T
Inagaki
Yoshimi
Y
D000368:Aged; D000732:Androstanols; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000139:chemically induced* / Q000517:prevention & control*; D003473:Neuromuscular Nondepolarizing Agents; D010100:Oxygen / Q000097:blood; D010880:Piperidines / Q000009:adverse effects*; D000077208:Remifentanil; D012121:Respiration, Artificial; D000077123:Rocuronium; D014673:Vecuronium Bromide
D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D014673:Vecuronium Bromide; D000077208:Remifentanil; D010100:Oxygen; D000077123:Rocuronium
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