title: Oral mucosal injection of a local anesthetic solution containing epinephrine enhances muscle relaxant effects of rocuronium.
abstract: The purpose of this study was to examine how submucosal injection of a clinically relevant dose of a lidocaine hydrochloride solution containing epinephrine affects the muscle relaxant effects of rocuronium bromide. Sixteen patients scheduled for orthognathic surgery participated in this study. All patients were induced with fentanyl citrate, a target-controlled infusion of propofol and rocuronium bromide. Anesthesia was maintained by total intravenous anesthesia. After nasotracheal intubation, an infusion of rocuronium bromide was started at 7 µg/kg/min, and the infusion rate was then adjusted to maintain a train of four (TOF) ratio at 10 to 15%. The TOF ratio just prior to oral mucosal injection of a 1% lidocaine hydrochloride solution containing 10 µg/mL epinephrine (LE) was taken as the baseline. TOF ratio was observed for 20 minutes, with 1-minute intervals following the start of injection. Mean epinephrine dose was 85.6 ± 18.6 µg and mean infusion rate of rocuronium bromide was 6.3 ± 1.6 µg/kg/min. TOF ratio began to decrease 2 minutes after the injection of LE, reached the minimum value at 3.1 ± 3.6% 12 minutes after the injection, and then began to recover. We conclude that oral mucosal injection of LE enhances the muscle relaxant effects of rocuronium bromide.
authors.affiliation: Department of Dental Anesthesiology, Tokyo Dental College, Chiba, Japan. asakoninomiya@tdc.ac.jp
authors.forename: Asako
authors.initials: A
authors.lastname: Ninomiya
authors.forename: Yui
authors.initials: Y
authors.lastname: Terakawa
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ichinohe
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kaneko
mesh_terms: D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000494:pharmacology / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental; D000771:Anesthesia, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000494:pharmacology; D004357:Drug Synergism; D004558:Electric Stimulation / Q000295:instrumentation; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D005385:Fingers / Q000294:innervation; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D009061:Mouth Mucosa; D009119:Muscle Contraction / Q000187:drug effects; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000077123:Rocuronium; D013997:Time Factors; D014459:Ulnar Nerve / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000494:pharmacology; D055815:Young Adult
chemical_list: D000732:Androstanols; D000779:Anesthetics, Local; D003473:Neuromuscular Nondepolarizing Agents; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D000077123:Rocuronium; D004837:Epinephrine