Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia.

We have evaluated the enhancement of cisatracurium-induced neuromuscular block by potent inhalation anaesthetic agents, by constructing dose-effect curves for cisatracurium in 84 patients during anaesthesia with 1.5 MAC (70% nitrous oxide) desflurane, sevoflurane, isoflurane or total i.v. anaesthesia (TIVA). Acceleromyography (TOF-Guard) and train-of-four (TOF) stimulation of the ulnar nerve were used (2 Hz every 12 s). Cisatracurium was administered in increments of 15 micrograms kg-1 until depression of T1/T0 > 95% was reached. ANOVA was used for statistical analysis (alpha = 0.05, beta = 0.2). Depression of T1/T0 during potent inhalation anaesthesia was enhanced compared with TIVA. ED50 and ED95 values of cisatracurium were 15 (SD 5) and 34 (10) micrograms kg-1 for desflurane; 15 (4) and 32 (7) micrograms kg-1 for sevoflurane; and 15 (5) and 33 (9) micrograms kg-1 for isoflurane. These were significantly lower than the values for TIVA (21 (4) and 51 (13) micrograms kg-1) (P < 0.01 in each case). After equi-effective dosing, times to T1/T0 = 25% were similar in all groups (19 (7), 19 (5), 20 (5) vs 16 (4) min). Recovery index25-75% and time to a TOF ration of 0.70 were prolonged significantly by desflurane and sevoflurane compared with TIVA (18 (5), 19 (8) vs 12 (4) min and 43 (11), 44 (10) vs 35 (5) min, respectively), whereas the difference was not significant for isoflurane (14 (6) and 41 (7) min).

[1]  J. Hendrickx,et al.  Uptake of Desflurane and Isoflurane During Closed-Circuit Anesthesia with Spontaneous and Controlled Mechanical Ventilation , 1997, Anesthesia and analgesia.

[2]  T. Taivainen,et al.  Time course of potentiation of mivacurium by halothane and isoflurane in children. , 1997, British journal of anaesthesia.

[3]  R. Mirakhur,et al.  Potency and time course of action of rocuronium during desflurane and isoflurane anaesthesia. , 1996, British journal of anaesthesia.

[4]  M. Pinaud,et al.  Pharmacodynamic Dose-Response and Safety Study of Cisatracurium (51W89) in Adult Surgical Patients During N2 O-O2-Opioid Anesthesia , 1996, Anesthesia and analgesia.

[5]  R. Mahajan,et al.  The Effect of Stabilization on the Onset of Neuromuscular Block When Assessed Using Accelerometry , 1996, Anesthesia and analgesia.

[6]  E. Ornstein,et al.  Pharmacokinetics, pharmacodynamics and safety of cisatracurium in elderly patients , 1996 .

[7]  K. Olkkola,et al.  Quantifying the effect of isoflurane on mivacurium infusion requirements. , 1996, Anaesthesia.

[8]  L. Skovgaard,et al.  Good Clinical Research Practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents , 1996, Acta anaesthesiologica Scandinavica.

[9]  J. Hunter,et al.  Pharmacokinetics of 1R-cis 1'R-cis atracurium besylate (51W89) and plasma laudanosine concentrations in health and chronic renal failure. , 1995, British journal of anaesthesia.

[10]  C. Lien,et al.  The Clinical Neuromuscular Pharmacology of 51W89 in Patients Receiving Nitrous Oxide/Opioid/Barbiturate Anesthesia , 1995, Anesthesiology.

[11]  J. Hunter,et al.  Pharmacodynamics of the 1R cis-1'R cis isomer of atracurium (51W89) in health and chronic renal failure. , 1995, British journal of anaesthesia.

[12]  T. Taivainen,et al.  Pharmacodynamic effects of 51W89, an isomer of atracurium, in children during halothane anaesthesia. , 1995, British journal of anaesthesia.

[13]  A. Muir,et al.  Interaction between rocuronium bromide and some drugs used during anaesthesia. , 1994, European journal of anaesthesiology. Supplement.

[14]  J H Proost,et al.  Pharmacokinetics and pharmacokinetic/dynamic relationship of rocuronium bromide in humans. , 1994, European journal of anaesthesiology. Supplement.

[15]  S. Ágoston.  Interactions of volatile anaesthetics with rocuronium bromide in perspective. , 1994, European journal of anaesthesiology. Supplement.

[16]  C. Shanks,et al.  Continuous Intravenous Infusion of Rocuronium (ORG 9426) in Patients Receiving Balanced, Enflurane, or Isoflurane Anesthesia , 1993, Anesthesiology.

[17]  E. Eger,et al.  Solubility of I-653, sevoflurane, isoflurane, and halothane in human tissues. , 1989, Anesthesia and analgesia.

[18]  E. Eger,et al.  Partition coefficients for sevoflurane in human blood, saline, and olive oil. , 1987, Anesthesia and analgesia.

[19]  J. Egmond,et al.  Isoflurane and Neuromuscular Blocking Drugs , 1986 .

[20]  R. Miller,et al.  Vecuronium‐induced Neuromuscular Blockade during Enflurane, Isoflurane, and Halothane Anesthesia in Humans , 1984, Anesthesiology.

[21]  H. H. Ali,et al.  Human dose-response curves for neuromuscular blocking drugs: a comparison of two methods of construction and analysis. , 1980, Anesthesiology.

[22]  E. Eger,et al.  Comparative Neuromuscular Effects of Forane and Halothane Alone and in Combination with d‐Tubocurarine in Man , 1971, Anesthesiology.