Potentiation of Atracurium Neuromuscular Blockade by Enflurane: Time‐Course of Effect

This study was designed to determine the time required for potentiation of atracurium neuromuscular blockade after the introduction of enflurane. Ten ASA physical status I and II adults anesthetized with thiopental, nitrous oxide, and alfentanil were given 0.4 mg/kg atracurium besylate. The force of contraction of the adductor pollicis muscle in response to train-of‐four stimulation of the ulnar nerve was recorded. When the first twitch (T1) of the train‐of‐four recovered to 10% of control, an atracurium infusion was started and adjusted to keep the level of blockade constant. After 15 min of stable blockade, 1.6%-1.7% end‐tidal enflurane was started and maintained for up to 2 h. Venous blood samples were drawn and plasma atracurium concentrations were measured 15 min before and 0, 5, 10,15, 30, 45, 60, 90, and 120 min after the introduction of enflurane. Atracurium plasma concentrations were 730 ± 127 (SEM) ng/mL at time 0. During the first 30 min, no significant decrease in plasma levels occurred; but at 45 min, concentrations were only 67% ± 8% of their initial value (P<0.01) and 48% k 2% at 120 min (P<0.01). This suggests that the interaction between enflurane and atracurium is time‐dependent. Clinically, the interaction between atracurium and enflurane is negligible during procedures of less than 45 min.