Molar Potency Is Predictive of the Speed of Onset of Neuromuscular Block for Agents of Intermediate, Short, and Ultrashort Duration 

1999 ◽  
Vol 90 (2) ◽  
pp. 425-431 ◽  
Author(s):  
Aaron F. Kopman ◽  
Monica M. Klewicka ◽  
David J. Kopman ◽  
George G. Neuman
Keyword(s):  
Short Duration ◽  
Neuromuscular Block ◽  
Onset Time ◽  
Inverse Correlation ◽  
Peak Effect ◽  
American Society ◽  
The Times ◽  
Long Acting ◽  
End Tidal ◽  
Speed Of Onset

Background The times to peak effect of rocuronium, vecuronium, cisatracurium, mivacurium, and succinylcholine were evaluated to confirm that the correlation between potency and onset time observed for long-acting relaxants also held for drugs of intermediate and short duration. Methods The authors recruited 99 patients classified as American Society of Anesthesiologists physical status score 1 or 2 for the study. After anesthesia was induced, tracheal intubation was accomplished without relaxants. Anesthesia was maintained with nitrous oxide and 3% or 4% end-tidal desflurane plus intravenous narcotic supplementation. The evoked electromyographic response to single stimuli administered at 0.10 Hz was recorded continuously. Drug doses were selected to produce approximately 95% twitch depression. If peak twitch depression did not fall in the range of 90% to 98%, the patient was excluded from the study. The time to 50% to 90% of peak effect was plotted as a function of the administered dose. Results There was no difference in the onset profiles of mivacurium and vecuronium, or in the time to 50% of peak effect between succinylcholine and rocuronium. For all other parameters, onset times ranked as follows: succinylcholine < rocuronium < vecuronium-mivacurium < cisatracurium (P < 0.05). When the log of the ED95 in micromoles per kilogram for all five drugs was plotted against the log of onset time to 50% peak effect, the R2 value for the best fit line was more than 0.98. Conclusions The inverse correlation between the molar potency and speed of onset previously described for agents of long duration also applies to nondepolarizing agents of intermediate and short duration. The onset time of succinylcholine also appears to be compatible with this relation.

The Dynamic Relationship between End-tidal Sevoflurane and Isoflurane Concentrations and Bispectral Index and Spectral Edge Frequency of the Electroencephalogram 

1999 ◽  
Vol 90 (5) ◽  
pp. 1345-1353 ◽  
Author(s):  
Erik Olofsen ◽  
Albert Dahan
Keyword(s):  
Bispectral Index ◽  
Effect Compartment ◽  
Spectral Edge Frequency ◽  
Spectral Edge ◽  
Emax Model ◽  
Dynamic Relationship ◽  
Ic50 Values ◽  
American Society ◽  
End Tidal ◽  
Speed Of Onset

Background Inhalational anesthetics produce dose-dependent effects on electroencephalogram-derived parameters, such as 95% spectral edge frequency (SEF) and bispectral index (BIS). The authors analyzed the relationship between end-tidal sevoflurane and isoflurane concentrations (FET) and BIS and SEF and determined the speed of onset and offset of effect (t1/2k(e0)). Methods Twenty-four patients with American Society of Anesthesiologists physical status I or II were randomly assigned to receive anesthesia with sevoflurane or isoflurane. Several transitions between 0.5 and 1.5 minimum alveolar concentration were performed. BIS and SEF data were analyzed with a combination of an effect compartment and an inhibitory sigmoid Emax model, characterized by t1/2k(e0), the concentration at which 50% depression of the electroencephalogram parameters occurred (IC50), and shape parameters. Parameter values estimated are mean +/- SD. Results The model adequately described the FET-BIS relationship. Values for t1/2k(e0), derived from the BIS data, were 3.5 +/- 2.0 and 3.2 +/- 0.7 min for sevoflurane and isoflurane, respectively (NS). Equivalent values derived from SEF were 3.1 +/- 2.4 min (sevoflurane) and 2.3 +/- 1.2 min (isoflurane; NS). Values of t1/2k(e0) derived from the SEF were smaller than those from BIS (P < 0.05). IC50 values derived from the BIS were 1.14 +/- 0.31% (sevoflurane) and 0.60 +/- 0.11% (isoflurane; P < 0.05). Conclusions The speed of onset and offset of anesthetic effect did not differ between isoflurane and sevoflurane; isoflurane was approximately twice as potent as sevoflurane. The greater values of t1/2k(e0) derived from the BIS data compared with those derived from the SEF data may be related to computational and physiologic delays.

scholarly journals Neuromuscular block in patients 80 years and older: a prospective, controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Denis Schmartz ◽  
Raouf Sghaier ◽  
Paul Bernard ◽  
Jean François Fils ◽  
Thomas Fuchs-Buder
Keyword(s):  
Time Course ◽  
Neuromuscular Block ◽  
Demographic Data ◽  
Onset Time ◽  
Rapid Onset ◽  
Controlled Study ◽  
Younger Adults ◽  
Number Of Patients ◽  
Long Acting ◽  
Prospective Controlled Study

Abstract Background An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults. Methods Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined. Results Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P < 0.001 and the clinical duration was 52 [48–69.5] min and 36 [34–41] min, respectively, P < 0.001. Duration to 90% recovery of baseline was 77.5 [71–88.5] min and duration to 100% recovery of baseline was 91.2 [82.2–98] min in patients ≥ 80 years and the corresponding values in the patients 20–50 years old were 53.5 [49–55.5] min and 59.5 [56.5–70.25] min, respectively, P < 0.001. Conclusion Compared to younger adults rocuronium shifted in patients ≥ 80 years from a rapid onset, intermediate acting compound to a slower onset, long-acting compound. Trial registration ClinicalTrials.gov identifier: NCT03551652 (29/05/2018).

scholarly journals Optimal neuromuscular blocking effects of remifentanil during tracheal intubation under general anesthesia

2018 ◽  
Vol 46 (8) ◽  
pp. 3097-3103 ◽  
Author(s):  
So Young Kwon ◽  
Si Wook Chung ◽  
Jin Deok Joo
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Neuromuscular Block ◽  
Onset Time ◽  
Neuromuscular Blocking ◽  
Blocking Effects ◽  
Train Of Four ◽  
The Times ◽  
Time Required ◽  
Retrospective Comparative Study

Objective This study was performed to determine the effect of the remifentanil dose on the onset time of rocuronium with electromyography. Methods This retrospective comparative study included 75 patients undergoing general anesthesia for elective surgery. Patients received lidocaine (40 mg) and propofol (2 mg/kg) followed by rocuronium (0.6 mg/kg) with either saline infusion (Group S), remifentanil at 0.5 µg/kg/minute (Group R 0.5), or remifentanil at 1.0 µg/kg/minute (Group R 1.0). Neuromuscular block was monitored by train-of-four (TOF) electromyography, and the times taken to reach TOF 0 and TOF ratio (TOFR) 25% were recorded. Results The times taken to reach TOF 0 and TOFR 25% were significantly higher in Groups R 0.5 and R 1.0 than in Group S. The time taken to reach TOF 0 was 130.0 ± 6.4 s in Group S, 142.6 ± 6.0 s in Group R 0.5, and 183.0 ± 11.6 s in Group R 1.0. The time taken to reach TOFR 25% was also higher in Groups R 0.5 and R 1.0 than in Group S. Conclusions As the remifentanil dose increases, the intubation time required to reach TOF 0 also increases. Remifentanil has an effect on the onset of rocuronium.

Mivacurium Neuromuscular Block at the Adductor Muscles of the Larynx and Adductor Pollicis in Humans

1996 ◽  
Vol 85 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Benoit Plaud ◽  
Bertrand Debaene ◽  
Frank Lequeau ◽  
Claude Meistelman ◽  
Francois Donati
Keyword(s):  
Neuromuscular Block ◽  
Onset Time ◽  
Pressure Change ◽  
Peak Effect ◽  
Adductor Pollicis ◽  
Vocal Cords ◽  
Laryngeal Muscles ◽  
Time To Peak ◽  
Adductor Muscles ◽  
Train Of Four

Background Laryngeal muscles must be paralyzed for tracheal intubation. Time to peak effect (onset time) is shorter and intensity of blockade is less at laryngeal muscles compared with the adductor pollicis. The authors' aim in this study was to determine the neuromuscular effects of mivacurium at the laryngeal adductor muscles and the adductor pollicis. Methods In 22 adults, anesthesia was induced and maintained with propofol and alfentanil. The force of contraction of the adductor pollicis was recorded, and the laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords after train-of-four stimulation. Mivacurium (0.07 mg.kg-1 or 0.14 mg.kg-1) was given intravenously (10s). Results With 0.07 mg.kg-1 mivacurium, onset time was 151 +/- 40 s(mean +/- SD) at the larynx and 241 +/- 79 s at the adductor pollicis, respectively (P &lt; 0.005). Maximum block was 78 +/- 18% and 95 +/- 8%, respectively (P &lt; 0.002), and time to 90% recovery was 11.1 +/- 2.9 min and 23.3 +/- 7.6 min, respectively (P &lt; 0.001). With 0.14 mg.kg-1 mivacurium, onset time also was more rapid at the vocal cords (137 +/- 20 s) than at the adductor pollicis (201 +/- 59 s, P &lt; 0.01). Maximum block was 90 +/- 7% and 99 +/- 1% (P &lt; 0.005), and time to 90% recovery was 16.4 +/- 4.9 min and 27.4 +/- 7.8 min, respectively (P &lt; 0.01). Conclusions With mivacurium, onset and recovery are faster at the laryngeal muscles, but block is less intense than at the adductor pollicis. A dose greater than 0.14 mg.kg-1 mivacurium is necessary to ensure complete relaxation at the vocal cords.

An alveolar pCO2 control system: its use to magnify respiratory depression by meperidine

1960 ◽  
Vol 15 (1) ◽  
pp. 43-48 ◽  
Author(s):  
C. J. Lambertsen ◽  
H. Wendel
Keyword(s):  
Control System ◽  
Experimental Situation ◽  
Onset Time ◽  
Normal Subjects ◽  
Peak Effect ◽  
Minute Volume ◽  
Arterial Blood ◽  
Significant Difference ◽  
End Tidal ◽  
Normal Men

A system was devised combining means of a) automatic sampling of end-tidal gas, b) rapid analysis of samples gas for Co2 concentration and c) manual or automatic modification of per cent Co2 in succeeding inspirations to permit maintenance of alveolar pCo2 at desired levels above the Co2 tension natural for a particular experimental situation. By imposing a fixed, elevated alveolar pCo2 upon a subject, effects of drugs or physiological stresses upon Co2-sensitive functions can be evaluated, unmasked by the compensatory alterations of alveolar and arterial pCo2 which normally result from changes in alveolar ventilation or metabolism. Validation of alveolar pCo2 control in 16 normal subjects, using arterial pCo2 as a reference standard, revealed no significant difference between the imposed end-tidal pCo2 and the pCo2 of arterial blood. Use of the pCo2 control system to evaluate the dynamics of meperidine effect on respiration in normal men indicated sufficient magnification of the effect of meperidine on respiratory minute volume to permit use of the method for comparative studies of rate of onset, time of peak effect and rate of disappearance of the action of meperidine on respiration. Submitted on July 9, 1959

Augmentation of the Rocuronium-induced Neuromuscular Block by the Acutely Administered Phenytoin

1999 ◽  
Vol 90 (6) ◽  
pp. 1551-1555. ◽  
Author(s):  
Anna Spacek ◽  
Stephan Nickl ◽  
Franz X. Neiger ◽  
Vladimir Nigrovic ◽  
Odo-Winfried Ullrich ◽  
...  
Keyword(s):  
Plasma Proteins ◽  
Neuromuscular Block ◽  
Plasma Concentrations ◽  
Acute Administration ◽  
Arterial Blood ◽  
Evoked Electromyography ◽  
American Society ◽  
Neuromuscular Transmission Monitor ◽  
End Tidal ◽  
American Society Of Anesthesiologists

Background The effects of an acute administration of phenytoin on the magnitude of the rocuronium-induced neuromuscular block were evaluated. Methods Twenty patients (classified as American Society of Anesthesiologists physical status I or II) scheduled for craniotomy were studied: 15 received phenytoin during operation (10 mg/kg), and the others served as controls. Anesthesia was induced with thiopental and fentanyl and maintained with nitrous oxide (65%) in oxygen and end-tidal isoflurane (1%). The ulnar nerve was stimulated supramaximally and the evoked electromyography was recorded using a neuromuscular transmission monitor. Continuous infusion of rocuronium maintained the neuromuscular block with first twitch (T1) between 10 and 15% for 45 min before the start of an infusion of either phenytoin or NaCl 0.9%. Twitch recordings continued for 60 min thereafter. Arterial blood samples were collected at the predefined time points (four measurements before and four after the start of the infusion) to determine the concentrations of phenytoin and rocuronium and the percentage of rocuronium bound to plasma proteins. Results The first twitch produced by an infusion of rocuronium remained constant during the 15 min before and the 60 min after the start of the saline infusion. After the phenytoin infusion, the twitch decreased progressively, but the plasma concentrations and the protein-bound fraction of rocuronium did not change. Conclusion Phenytoin acutely augments the neuromuscular block produced by rocuronium without altering its plasma concentration or its binding to plasma proteins.

Residual Neuromuscular Block in HIV-Infected Young Patients: A Prospective Observational Study

2021 ◽  
Author(s):  
Ruixue hou ◽  
Liangyu wu ◽  
Yadong liu ◽  
Fangfang miao ◽  
Cheng yin ◽  
...  
Keyword(s):  
Reaction Time ◽  
Neuromuscular Block ◽  
Young Patients ◽  
Onset Time ◽  
Pulmonary Complications ◽  
Infected Group ◽  
Normal Group ◽  
Postanesthesia Care Unit ◽  
Residual Neuromuscular Blockade ◽  
Train Of Four

Abstract Objectives: Avoidance of residual neuromuscular blockade (RNMB) is crucial to decrease anesthesia-related pulmonary complications. At present, no data are available for HIV-infected patients about the occurrence of RNMB. In this trial, we aim to investigate the incidence of RNMB in such patients. Methods: Data were prospectively collected on 45 normal and 45 HIV-infected patients (18-65 yr). The train-of-four stimulation (TOF-Watch SX) was used to evaluate the level of neuromuscular block from the induction of anesthesia to back to the postanesthesia care unit (PACU) by an assessor, but blind to the anesthesiologist. Primary endpoint was the presence of RNMB at PACU admission, defined as a train-of-four (TOF) ratio < 0.9. The onset time (from application of cisatracurium to maximum depression of T1), no reaction time (from zero of T1 to non-zero), and clinical duration (from application to 25% recovery of T1) were determined for each patient. Results: The incidence of RNMB was 37.5% in HIV- infected patients and 32.5% in normal patients (difference, 5%; 99% CI, −16% to 26 1%; p=0.815). The onset time was no different between two groups (4.05±0.88 min in HIV-infected group vs. 3.85±1.08 min in normal group (p=0.37)). The no reaction time was also similarly between two groups ( 49.83±3.81min in HIV-infected group vs. 48.98±5.12min in normal group (p=0.40)). The clinical duration was 53.78±3.05 min and 52.40±5.02 min in HIV-infected group and normal group, respectively (p=0.14). Conclusion: The odds of RNMB were not significantly different in HIV-infected young patients compared to normal persons.

Effect of Fresh Gas Flow on Isoflurane Concentrations during Low-flow Anaesthesia

2005 ◽  
Vol 33 (5) ◽  
pp. 513-519 ◽  
Author(s):  
J-Y Park ◽  
J-H Kim ◽  
W-Y Kim ◽  
M-S Chang ◽  
J-Y Kim ◽  
...  
Keyword(s):  
Gas Flow ◽  
Low Flow ◽  
Physical Status ◽  
Closed Circle ◽  
Haemodynamic Changes ◽  
Low Flow Anaesthesia ◽  
Baseline Values ◽  
American Society ◽  
End Tidal ◽  
Closed Circle System

The effect of fresh gas flow (FGF) on isoflurane concentrations at given vaporizer settings during low-flow anaesthesia was investigated. Ninety patients (American Society of Anaesthesiologists physical status I or II) were randomly allocated to three groups (FGF 1 l/min, FGF 2 l/min and FGF 4 l/min). Anaesthesia was maintained for 10 min with vaporizer setting isoflurane 2 vol% and FGF 4 l/min for full-tissue anaesthetic uptake in a semi-closed circle system. Low-flow anaesthesia was maintained for 20 min with end-tidal isoflurane 1.5 vol% and FGF 2 l/min. FGF was then changed to FGF 1 l/min, FGF 2 l/min or FGF 4 l/min. Measurements during the 20-min period showed that inspired and end-tidal isoflurane concentrations decreased in the FGF 1-l/min group but increased in the FGF 4-l/min group compared with baseline values. No haemodynamic changes were observed. Monitoring of anaesthetic concentrations and appropriate control of vaporizer settings are necessary during low-flow anaesthesia.

scholarly journals Characteristics of neuromuscular block after administration of rocuronium bromide in patients with end-stage renal failure

2011 ◽  
Vol 139 (11-12) ◽  
pp. 765-771
Author(s):  
Nevena Kalezic ◽  
Biljana Krivic ◽  
Vladan Zivaljevic ◽  
Djordje Ugrinovic ◽  
Dijana Jovanovic ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Normal Renal Function ◽  
Neuromuscular Block ◽  
Onset Time ◽  
Cumulative Effect ◽  
Control Group ◽  
Rocuronium Bromide ◽  
Duration Time ◽  
Development Duration

Introduction. Anaesthesia affects kidney function by reducing the renal blood flow and glomerular filtration rate. As chronic renal failure (CRF) significantly influences drug metabolism and elimination, we studied the effects of rocuronium bromide (RB) in patients with CRF. Objective. The aim of the study was to examine whether, when using RB in patients with CFR, there are differences regarding the onset time of neuromuscular block (NMB) development, duration time, speed of recovery and cumulative effects of RB. Methods. Prospective study included 60 patients who underwent urologic surgery procedures. The patients were divided into 3 groups: the first group (G1) - 20 patients with CRF and residual dieresis, the second group (G2) - 20 patients with CRF and without dieresis, and third group (G3) - 20 patients with normal renal function (control group). During surgery RB was administrated for muscle paralysis in all patients. Train-of-four (TOF) Guard acceleromyography was used for NMB monitoring. Results. Onset time in three groups was 132.3 s; 139.5 s and 113.2 s (r<0.01). Duration of intubation dose was the same in G1 and G2 (28.9 minutes), while in the third group it was 27.2 minutes (r>0.05). The number of RB repeated doses was 3-8, 3-7 and 4-8 (r>0.05). The duration time until spontaneous recovery was 31.8, 31.6 and 29.8 minutes (r>0.01). The recovery index was 16.8, 16.7 and 10.6 minutes (r<0.001). The duration time from the last dose of RB to extubation was 74.5, 74.8 and 58.9 minutes (r<0.001). Conclusion. In patients with CRF the cumulative effect of the drug was registered, with a prolonged recovery time from NMB in relation to the patients with normal renal function.

scholarly journals A randomized trial evaluating the safety profile of sugammadex in high surgical risk ASA physical class 3 or 4 participants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
W. Joseph Herring ◽  
Yuki Mukai ◽  
Aobo Wang ◽  
Jeannine Lutkiewicz ◽  
John F. Lombard ◽  
...  
Keyword(s):  
Sinus Tachycardia ◽  
Sinus Bradycardia ◽  
Neuromuscular Block ◽  
Tolerability Profile ◽  
Double Blind ◽  
Link Type ◽  
Cardiac Arrythmias ◽  
Deep Neuromuscular Block ◽  
American Society ◽  
The Impact

Abstract Background The aim of this randomized, double-blind trial was to evaluate the safety and tolerability profile, including cardiac safety, of sugammadex-mediated recovery from neuromuscular block in participants undergoing surgery who met the American Society of Anesthesiologists (ASA) Physical Class 3 or 4 criteria. Specifically, this study assessed the impact of sugammadex on cardiac adverse events (AEs) and other prespecified AEs of clinical interest. Methods Participants meeting ASA Class 3 and 4 criteria were stratified by ASA Class and NMBA (rocuronium or vecuronium) then randomized to one of the following: 1) Moderate neuromuscular block, sugammadex 2 mg/kg; 2) Moderate neuromuscular block, neostigmine and glycopyrrolate (neostigmine/glycopyrrolate); 3) Deep neuromuscular block, sugammadex 4 mg/kg; 4) Deep neuromuscular block, sugammadex 16 mg/kg (rocuronium only). Primary endpoints included incidences of treatment-emergent (TE) sinus bradycardia, TE sinus tachycardia and other TE cardiac arrhythmias. Results Of 344 participants randomized, 331 received treatment (61% male, BMI 28.5 ± 5.3 kg/m2, age 69 ± 11 years). Incidence of TE sinus bradycardia was significantly lower in the sugammadex 2 mg/kg group vs neostigmine/glycopyrrolate. The incidence of TE sinus tachycardia was significantly lower in the sugammadex 2 and 4 mg/kg groups vs neostigmine/glycopyrrolate. No significant differences in other TE cardiac arrythmias were seen between sugammadex groups and neostigmine/glycopyrrolate. There were no cases of adjudicated anaphylaxis or hypersensitivity reactions in this study. Conclusions Compared with neostigmine/glycopyrrolate, incidence of TE sinus bradycardia was significantly lower with sugammadex 2 mg/kg and incidence of TE sinus tachycardia was significantly lower with sugammadex 2 mg/kg and 4 mg/kg. These results support the safety of sugammadex for reversing rocuronium- or vecuronium-induced moderate and deep neuromuscular block in ASA Class 3 or 4 participants. Trial registration ClinicalTrials.gov Identifier: NCT03346057.

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