title: Influence of hypnotics on cisatracurium-induced neuromuscular block. Use of acceleromyograhpy.
abstract: OBJECTIVE
  Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB). The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade.
  
  
  METHODS
  We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol) and GII (etomidate). Patients received intramuscular (IM) midazolam (0.1mg.kg(-1)) as premedication and we performed induction with propofol (2.5mg.kg(-1)) or etomidate (0.3mg.kg(1)), preceded by fentanyl (250mg) and followed by cisatracurium (0.1mg.kg(-1)). The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions.
  
  
  RESULTS
  The mean time and standard deviations of cisatracurium onset were: GI (86.6±14.3s) and GII (116.9±11.6s), with a significant difference (p<0, 0001). Intubation conditions were acceptable in 100% of GI and 53.3% of GII patients (p<0.0001).
  
  
  CONCLUSIONS
  Induction of neuromuscular blockade with cisatracurium was faster, with better intubation conditions in patients receiving propofol compared to those receiving etomidate, without hemodynamic repercussions.
authors.affiliation: Associate Professor, Department of Anesthesiology, Universidade Estadual de Campinas (Unicamp) Medical School, Campinas, SP, Brazil.
authors.forename: Angélica de Fátima
authors.initials: Ade F
authors.lastname: de Assunção Braga
authors.forename: Franklin Sarmento
authors.initials: FS
authors.lastname: da Silva Braga
authors.forename: Glória Maria
authors.initials: GM
authors.lastname: Braga Potério
authors.forename: José Aristeu
authors.initials: JA
authors.lastname: Fachini Frias
authors.forename: Fernanda Maria
authors.initials: FM
authors.lastname: Silva Pedro
authors.forename: Derli Conceição
authors.initials: DC
authors.lastname: Munhoz
mesh_terms: D000328:Adult; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D004347:Drug Interactions; D005045:Etomidate / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D009213:Myography / Q000379:methods; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology*
chemical_list: D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium; D015742:Propofol; D005045:Etomidate