title: Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium.
abstract: BACKGROUND
  Rocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium.
  
  
  METHODS
  A total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 µg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation.
  
  
  RESULTS
  Incidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups.
  
  
  CONCLUSIONS
  It seems that remifentanil (1 µg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea.
authors.forename: Hye Ji
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea.
authors.forename: Hyo Sung
authors.initials: HS
authors.lastname: Bae
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Sang Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Keum Young
authors.initials: KY
authors.lastname: So
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Kyung Jun
authors.initials: KJ
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Jong Dal
authors.initials: JD
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: An
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, Gwangju, Korea.
authors.forename: Hong Chan
authors.initials: HC
authors.lastname: Park
keywords: Ketamine; Lidocaine; Pain; Remifentanil; Rocuronium