title: Priming with rocuronium or vecuronium prevents remifentanil-mediated muscle rigidity and difficult ventilation.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Nakada
authors.forename: Masao
authors.initials: M
authors.lastname: Nishira
authors.forename: Renko
authors.initials: R
authors.lastname: Hosoda
authors.forename: Kazumi
authors.initials: K
authors.lastname: Funaki
authors.forename: Shyunsaku
authors.initials: S
authors.lastname: Takahashi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Matsura
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Inagaki
mesh_terms: 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
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D014673:Vecuronium Bromide; D000077208:Remifentanil; D010100:Oxygen; D000077123:Rocuronium
references.citation: Expert Opin Drug Saf. 2005 Jul;4(4):643-51
references.pmid: 16011444
references.citation: J Clin Anesth. 2006 Feb;18(1):34-40
references.pmid: 16517330
references.citation: Anesth Analg. 1985 Jan;64(1):48-53
references.pmid: 2981489
references.citation: Can Respir J. 2006 May-Jun;13(4):203-10
references.pmid: 16779465
references.citation: J Anesth. 2007;21(4):510-2
references.pmid: 18008122
references.citation: Anesth Analg. 1995 Mar;80(3):538-42
references.pmid: 7864421
references.citation: J Cardiothorac Vasc Anesth. 2003 Feb;17(1):60-8
references.pmid: 12635062
references.citation: Br J Anaesth. 2000 Jan;84(1):106-7
references.pmid: 10740559
references.citation: Anesthesiology. 1986 Apr;64(4):440-6
references.pmid: 3008595
references.citation: Eur J Anaesthesiol Suppl. 1995 Sep;11:69-72
references.pmid: 8557010
references.citation: Acta Anaesthesiol Scand. 1989 Jan;33(1):1-5
references.pmid: 2644747
references.citation: Anesthesiology. 1996 Apr;84(4):812-20
references.pmid: 8638835
references.citation: Anesth Analg. 1996 Sep;83(3):629-32
references.pmid: 8780294
references.citation: Anesth Analg. 2002 Nov;95(5):1305-7, table of contents
references.pmid: 12401616
references.citation: J Cardiothorac Vasc Anesth. 2007 Feb;21(1):35-40
references.pmid: 17289477
references.citation: Eur J Anaesthesiol. 2002 Jul;19(7):517-21
references.pmid: 12113615
references.citation: Anesth Analg. 1997 Sep;85(3):663-6
references.pmid: 9296427
references.citation: Med Sci Monit. 2006 Aug;12(8):PI33-8
references.pmid: 16865075
references.citation: Anesthesiology. 1996 Sep;85(3):574-83
references.pmid: 8853088
references.citation: Anesthesiology. 1997 Sep;87(3):533-41
references.pmid: 9316957
references.citation: J Clin Anesth. 1997 May;9(3):204-7
references.pmid: 9172027
references.citation: Anaesthesia. 1999 Nov;54(11):1037-40
references.pmid: 10540091
references.citation: Br J Anaesth. 1996 Mar;76(3):341-3
references.pmid: 8785129
references.citation: Anesthesiology. 1997 Nov;87(5):1070-4
references.pmid: 9366458
references.citation: J Clin Anesth. 2007 Sep;19(6):413-7
references.pmid: 17967668