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PubMed2001

Intubating conditions after three different doses of rocuronium in the elderly.

This randomized controlled trial study evaluated the intubating conditions at 1 minute after 0.3, 0.6 and 0.9 mg/kg of rocuronium in 60 Thai elderly patients who enrolled for elective surgery under general anesthesia with fentanyl, thiopental and halothane at King Chulalongkorn Memorial Hospital. Excellent or good conditions were observed in 50 per cent (p<0.05) at rocuronium 0.3 mg/kg, compared with 95 and 85 per cent at 0.6 and 0.9 mg/kg of rocuronium, respectively but the excellent conditions were 5 (p<0.05), 30 and 45 per cent from each dose. Therefore, rocuronium 0.6 or 0.9 mg/kg should be adequate for intubation in elective, elderly patients but was inadequate for emergency case. In addition, rocuronium 0.3 mg/kg is insufficient for intubation at 1 minute in this age group. No serious side effects of the drug nor complications were found in this study.

Aged↗
PubMed2003

Closed-circuit anesthesia prolongs the neuromuscular blockade of rocuronium.

BACKGROUND: Volatile anesthetics are known to potentiate the neuromuscular blocking effect of nondepolarizing muscle relaxants. The influences of anesthetic techniques, closed-circuit anesthesia (CCA) and high flow semi-closed anesthesia (SCA), on the neuromuscular blockade of rocuronium has not yet been studied in detail. This study was purposed to compare the effects of isoflurane conveyed in minimal flow (CCA) and in high flow (SCA) on the neuromuscular blockade of rocuronium. METHODS: Fifty females scheduled for elective laparoscopic gynecological surgery were enrolled for study and randomly assigned to receive either CCA (n = 25) or SCA (n = 25). Anesthesia was induced with fentanyl 2 micrograms/kg, thiopental 5 mg/kg and rocuronium 0.6 mg/kg. Two percent isoflurane in high O2 flow (3 l/min) was given for 10 min to all patients initially to wash isoflurane in the functional residual capacity of both lungs and the breathing circuit. After the wash in, for CCA group, the O2 flow was reduced to 300 ml/min with isoflurane vaporizer setting adjusted to 3-5% for anesthesia maintenance, while for SCA group, anesthesia was maintained with 1.5-2% isoflurane in 3 l/min O2 flow throughout the surgery. Electromyogram was used to determine neuromuscular blockade. Rocuronium (0.15 mg/kg) was given to maintain muscle relaxation when T1 reached 25% of control. We maintained the anesthetic depth until the recordings of T1 twitch response which reached 75% was completed. Onset time, duration, recovery index and intubating conditions were recorded. The hemodynamic parameters and the inhaled/exhaled concentrations were also measured every 15 min after skin incision in both groups. RESULTS: The onset time and intubating conditions were similar in both groups. In comparison with SCA group, longer clinical durations (54.1 +/- 14.4 vs. 45.4 +/- 9.2 min, P < 0.05), longer durations of maintained dose (41.1 +/- 11.1 vs. 30.2 +/- 8.6 min, P < 0.01) and longer recovery index (34.2 +/- 10.7 vs. 20.9 +/- 5.4 min, P < 0.0001) were observed in CCA group. CONCLUSIONS: We conclude that CCA may further prolong the neuromuscular blocking effect of rocuronium than SCA.

Adolescent↗
PubMed2004

The effect of ephedrine on the onset time of rocuronium in Thai patients.

UNLABELLED: The aim of this study was to determine the effect of ephedrine on the onset time of rocuronium. The study population was 60 ASA physical status 1 and 2 patients, aged 15-60 years scheduled for elective surgery under general anesthesia at Ramathibodi Hospital. The patients were randomly assigned into 2 groups. Group I (ephedrine group), ephedrine 70 microg/kg was given 1 minute before induction and group II (control group), saline was given instead of ephedrine and midazolam 7.5 mg was given orally 30-60 minutes before the induction. Anesthesia was induced with fentanyl 1 microg/kg and sodium thiopentone 3-5 mg/kg. The patient was intubated with 0.9 mg/kg of rocuronium. The intubation time (from rocuronium administration to the time of intubation) was predetermined by the Dixon's up and down method (with 5 seconds as a step size) for each patient and started at 60 seconds for the first patient in each group. The intubation time in the ephedrine group (39.41 +/- 4.64 seconds) was significantly different from the control group (59.17 +/- 9.00 seconds); p-value < 0.01. The hemodynamics were similar in both groups. CONCLUSION: Intravenous ephedrine shortened the onset time of rocuronium with no significant adverse hemodynamic effects. As an alternative to suxamethonium for rapid intubation, the authors recommend the use of ephedrine 70 microg/kg at one minute before induction followed by 0.9 mg/kg of rocuronium intravenously in healthy patients. The intubation could be achieved at 40 seconds after the administration.

Adolescent↗
PubMed2004

[Precurarization with rocuronium prevents fasciculations and biochemical changes after succinylcholine administration].

OBJECTIVE: To determine the efficacy of rocuronium to prevent fasciculations and biochemical changes after succinylcholine administration. PATIENTS AND METHODS: Prospective, randomized double-blind trial enrolling 60 ASA I-II patients scheduled for elective surgery under general anesthesia. The patients were assigned to 2 groups to receive either 0.06 mg x Kg(-1) of rocuronium or physiological saline solution 90 seconds before administration of 1.5 mg x Kg(-1) of succinylcholine. The incidence and severity of fasciculations and serum concentrations of potassium before anesthesia and 3, 5, and 20 minutes after succinylcholine administration were recorded. Other serum concentrations recorded were myoglobin, creatinine phosphokinase and lactate before anesthesia and 20 minutes after succinylcholine administration. RESULTS: The increases in potassium levels at 3 and 5 minutes (0.3 +/- 0.3 and 0.2 +/- 0.4 mmol x L(-1)) and in myoglobin levels at 20 minutes (38.9 +/- 31.7 ng x mL(-1)) were attenuated by precurarization with rocuronium. The incidence of fasciculations was significantly lower (p<0.001) and their severity significantly less (p<0.001) in patients who received rocuronium before administration of succinylcholine. CONCLUSIONS: Precurarization with rocuronium 90 seconds before succinylcholine administration reduces the incidence and severity of fasciculations and prevents increases in serum potassium and myoglobin concentrations.

Adolescent↗
PubMed2004

[Fentanyl or remifentanil to potentiate a single dose of rocuronium in patients anesthetized with propofol with evaluation by accelerometry].

OBJECTIVE: To compare the increase in potency of a single dose of rocuronium during anesthesia with propofol combined with either fentanyl or remifentanil. PATIENTS AND METHODS: Forty patients scheduled for plastic surgery were distributed in 2 groups of 20 according to the opioid drug assigned: fentanyl or remifentanil. Induction with propofol was accomplished by computer-controlled infusion, with response measured in the adductor pollicis muscle. After calibration, a dose of 0.6 mg/Kg of rocuronium was infused. Anesthesia was maintained with propofol, oxygen in air, and an equipotent dose of either fentanyl or remifentanil, which was modified to maintain heart rate and systolic arterial pressure within 30% above or below baseline levels. Patient characteristics recorded were age, sex, height, weight, ASA class, type of surgery, and the propofol and opioid doses consumed. Intubation conditions and time to onset of action of rocuronium (T1), of recovery of the first response in a train of four (RT1), and of recovery of 25% of the first response or clinical duration. RESULTS: The groups were statistically similar in terms of demographic variables, type of surgery, propofol and opioid consumption, intubation conditions, and rocuronium T1 and RT1. Clinical duration of anesthesia was longer (p<0.05) in the remifentanil group (33.1 +/- 10 minutes) than in the fentanyl group (27.1 +/- 7.4 minutes). CONCLUSIONS: Remifentanil administered in combination with propofol for anesthesia does not affect time of onset of a single dose of 0.6 mg/Kg dose of rocuronium, but clinical duration of anesthesia is longer with remifentanil and propofol than with the fentanyl and propofol combination. The surgical and intubation conditions achieved with both combinations are adequate and similar.

Adjuvants, Anesthesia↗
PubMedDate not supplied

[Rocuronium: onset time or speed of action?].

OBJECTIVE: Rocuronium has been said to have an initially rapid onset of action followed by a slower final approach to maximum effect, the supporting data showing only that time to 75% of blockade is more rapid. Expressions of velocity are derived from basic measures such as length and time. The aim of our study was to confirm the onset characteristics of rocuronium by using appropriate expressions of velocity. PATIENTS AND METHODS: After consenting, 25 adults scheduled for elective surgery were anesthetized, using a bolus dose of rocuronium of 400 microg Kg(-1) for relaxation. Electromyography was used to determine maximal effect, time to reach 80% of a full neuromuscular block, onset time, the time interval between these two points, and the differential blockade produced during each period. Velocity for each period was calculated as the ratio between the percentage of block produced per amount of time elapsed (%/s) during each respective period. The ratio between time and blockade (s/%) was also calculated. RESULTS: More blockade was produced per second (velocity) during the initial period of activity (0.55%/s) than during the final period (0.109%/s). The average velocity during the onset period overall (0.33%/s) lay between those two figures. Rocuronium requires less time (acting fast) to achieve an initial effect (1.95 s/%) than it does to reach the final effect (10.8 s/%). The ratio of early to late speed of onset was 5.8 +/- 3.5. CONCLUSION: Using appropriate expressions and calculations, we can unequivocally conclude that rocuronium has a biphasic onset that is initially rapid and then slower. The rate of action is nearly 6 times faster at the beginning.

Androstanols↗
PubMed2005

Similar preoperative hemodynamic response to pancuronium and rocuronium in high-risk cardiac surgical patients.

AIM: Rocuronium may be a good alternative to pancuronium in cardiac surgical patients. We evaluate the hemodynamic response to rocuronium and pancuronium administered to cardiac surgical patients. METHODS: A single-blind, randomized clinical trial was carried out at the National Institute of Cardiology in Mexico. Twenty-two patients older than 18 years, NYHA class III-IV, and scheduled to undergo an elective cardiovascular surgical procedure were enrolled. Patients were randomly allocated to receive an i.v. bolus dose of either pancuronium 100 microg/kg or rocuronium 600 microg/kg. Peripheral arterial (radial) and venous cannulations and insertion of a multi-lumen pulmonary artery flotation catheter through the right internal jugular vein were carried out under local anesthesia. Anesthetic induction with an i.v. bolus dose of fentanyl 700 microg and diazepam 20 mg was performed and thereafter the neuromuscular blocking agent was administered. Ventilation with O2 100% was performed until a TOF < or =5% was observed and tracheal intubation was performed. After intubation, patients were maintained with O2 10 mL/kg administered by means of a pulmonary ventilator at a pressure of 20-25 cm H2O. The basal, pre-laryngoscopy, post-intubation, and pre-operative recording of a set of cardiovascular parameters were obtained. RESULTS: No differences (P>0.05) in the hemodynamic response were observed between pancuronium and rocuronium nor during the different evaluation times in each group. CONCLUSIONS: Rocuronium can be a safe alternative to pancuronium for patients requiring cardiac surgical procedures.

Adult↗
PubMed1994

A comparison of rocuronium and vecuronium: the pharmacodynamic, cardiovascular and intra-ocular effects.

The aim of this study was to compare, in 30 patients, the pharmacodynamics of equipotent intubating doses of rocuronium and vecuronium and to compare their effects on heart rate, arterial pressure and intra-ocular pressure under steady state propofol anaesthesia. Baseline readings of heart rate and arterial pressure, using a Dinamap, and intra-ocular pressure, using a Tonopen, were made after induction of anaesthesia. The effects of the administration of the relaxants on these parameters were measured, recorded and compared. Rocuronium had a faster onset time than vecuronium, but had a similar duration of action. Vecuronium had no significant cardiovascular effects. Rocuronium caused a rise in mean arterial pressure (10-15%) and a slight rise in heart rate (5-10%). Both vecuronium and rocuronium caused similar falls in intra-ocular pressure. With its rapid onset time and lack of intra-ocular pressure effects, rocuronium is perhaps the relaxant of choice in patients with penetrating eye injuries requiring emergency endotracheal anaesthesia where a longer-acting relaxant is not contraindicated.

Adolescent↗
PubMed1994

Rapid-sequence orotracheal intubation with rocuronium: a randomized double-blind comparison with suxamethonium--preliminary communication.

Eighty ASA I-III patients were randomly assigned to four groups. Group I patients received rocuronium 0.6 mg kg-1 immediately prior to thiopentone, while patients in group II received the same dose immediately after the induction agent. In groups III and IV a priming dose of rocuronium 0.04 mg kg-1 was administered prior to induction. Group III patients received rocuronium immediately prior to thiopentone. In group IV, suxamethonium 1.5 mg kg-1 was administered immediately after thiopentone. Intubation conditions were scored by a blinded investigator. An intubation time of > 60 s was defined as a failure. All patients could be intubated within 60 s. Priming with rocuronium did not improve intubation conditions. Total intubation scores > 6 occurred significantly more often in group II (P < 0.01 vs. all other groups). A single bolus dose of rocuronium 0.6 mg kg-1 (2 x ED95) administered immediately prior to thiopentone 6 mg kg-1 offers the same intubation conditions as suxamethonium 1.5 mg kg-1.

Adult↗
PubMed1995

Rocuronium- and mivacurium-induced neuromuscular block and intubating conditions: a comparison with vecuronium.

The time-course of action after an initial 2 x ED90 dose and after maintenance doses of 0.5 x ED90, and intubating conditions at 90 s after a 2 x ED90 dose following rocuronium, vecuronium and mivacurium were evaluated in anaesthetized adult patients. Neuromuscular measurements were performed with mechanomyography. Rocuronium produced a significantly deeper neuromuscular block at 90 s (mean and (standard deviation)) (91 (11%), compared to vecuronium (61 (22%)%) and mivacurium (58 (23)%). The onset time following rocuronium (172 (71)s) was significantly shorter than that following mivacurium (229 (60)s). At 90 s, intubating conditions were significantly better in the rocuronium group than in the vecuronium or mivacurium group. Mivacurium offered a significantly faster recovery of neuromuscular block following the 2 x ED90 dose and following an average of 45 min of clinical muscle relaxation (single twitch response < or = 25%) compared to rocuronium and vecuronium: clinical duration 13 (4), 28 (9) and 33 (9) min, respectively, and recovery time from 25 to 75% recovery of the single twitch response: 6 (2), 11 (4) and 14 (7) min, respectively.

Adolescent↗
PubMed2002

Preferences of Mexican anesthesiologists for vecuronium, rocuronium, or other neuromuscular blocking agents: a survey.

BACKGROUND: Several neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. The present study was performed in order to identify preferences and behaviors of anesthesiologists for using vecuronium, rocuronium or other NMB agents in their clinical practice. MATERIAL AND METHODS: The cross-sectional survey was applied at the Updated Course of the Colegio Mexicano de Anestesiología performed last year. Of 989, 282 (28.5%) surveys were returned. RESULTS: Most anesthesiologists were working at both public and private hospitals, performed anesthetic procedures for hospitalized and ambulatory patients, and anesthetized children as well as adults. Respondents did not consider mechanomyography as the gold standard method for neuromuscular monitoring. The T25 was not recognized as a pharmacodynamic parameter that represents the clinical duration of the neuromuscular block. Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling. Rocuronium was preferred for emergency surgery in patients with full stomach only. Almost all of anesthesiologists that conserve the unused drug did it without refrigeration and more than 30% conserve the unused drug in one syringe for further use. CONCLUSION: Vecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs. Storage of unused drugs without refrigeration in a single syringe for purpose of future use in several patients represented a dangerous common practice.

Journal Article↗
PubMed1993

Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium.

Haemodynamic variables were measured following administration of rocuronium 0.6 mg.kg-1 or vecuronium 0.08 mg.kg-1 (approximately equivalent to 2 x ED95 doses) in patients anaesthetized with fentanyl 50 micrograms.kg-1 and scheduled to undergo elective coronary artery bypass grafting. There were increases in stroke volume index (+15%) and cardiac index (+11%), and a decrease in pulmonary capillary wedge pressure (-25%) following administration of rocuronium (P < 0.05). The changes in heart rate (+7%), mean arterial pressure (-5%), systemic vascular resistance (-12%) and other measured or derived indices were insignificant. In comparison the administration of vecuronium was associated with decreases in heart rate (-7%), mean pulmonary artery pressure (-17%), central venous pressure (-15%) and the rate-pressure product (-9%) (P < 0.05). The changes in mean arterial pressure (-7%), cardiac index (-6%) and systemic vascular resistance (-8%) following vecuronium were insignificant. There were no differences in any of the variables between rocuronium and vecuronium. The absolute values of all variables were, however, within acceptable clinical limits. There was no evidence of histamine release in any patient. The present study shows that rocuronium 0.6 mg.kg-1 is associated with changes of only small magnitude in haemodynamic variables.

Androstanols↗
PubMed1993

Pharmacodynamic behaviour of rocuronium in the elderly.

This study compared the potency and time course of action of rocuronium (ORG 9426) in elderly and young patients during nitrous oxide-opioid anaesthesia. One hundred ASA physical status I-II patients (60, aged 65-80 yr, and 40, aged 20-45 yr) were studied by measuring the force of contraction of the adductor pollicis in response to train-of-four stimulation of the ulnar nerve. After induction of anaesthesia with thiopentone and maintenance with N2O/O2 and fentanyl, rocuronium 120, 160, 200, or 240 micrograms.kg-1 was administered to determine dose-response curves. When maximum block had been obtained, further rocuronium to a total of 300 micrograms.kg-1 was given. Additional doses of 100 micrograms.kg-1 were administered when the first twitch height (T1) had recovered to 25% control. At the end of surgery neuromuscular blockade was allowed, whenever possible, to recover spontaneously until T1 was 90% of control before administration of neostigmine. There was no difference in the potency of rocuronium in the elderly and the younger patients. The ED50 was 196 +/- 8 (SEE for the mean) in elderly, vs 215 +/- 17 micrograms.kg-1 in young patients (NS). When individual cumulative dose-response curves were constructed, the ED50 was 203 +/- 7 (SEM) and 201 +/- 10 micrograms.kg-1 in the elderly and the young respectively (NS). However, the onset of maximum neuromuscular block was slower in the elderly 3.7 +/- 1.1 (SD) vs 3.1 +/- 0.9 min, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia.

PURPOSE: To determine which non-depolarizing relaxant among d-tubocurarine, vecuronium, atracurium, mivacurium and rocuronium prevented muscular fasciculations and myalgia following succinylcholine. METHODS: In this double blind randomized study, 120 female patients scheduled for laparoscopic procedures were studied. They were divided into six groups of 20 according to the non-depolarizing pretreatment used: NaCl 0.9% (control), 0.05 mg.kg-1 d-tubocurarine, 0.01 mg.kg-1 vecuronium, 0.05 mg.kg-1 atracurium, 0.02 mg.kg-1 mivacurium and 0.06 mg.kg-1 rocuronium. Four minutes after the pretreatment, 1.5 mg.kg-1 succinylcholine was injected. Side effects of the pretreatment, the presence and magnitude of fasciculations, the ease of tracheal intubation, myalgia 1, 24 and 48 hr after surgery were observed. A Puritan Bennett Datex 221 NMT Relaxograph monitor was used to evaluate the neuromuscular block. RESULTS: Muscle fasciculations were observed in 19 of the 20 patients in the control group and in 3 of the 20 patients in the rocuronium group, the best of the pretreatments in that aspect. Four patients in the mivacurium group were unable to sustain more than four seconds head-lift after pretreatment (P < 0.05). Tracheal intubation conditions were better and the onset of block was faster and longer after succinylcholine in the control group (P < 0.05). Myalgias were present in 71% of the patients 24 hr postoperatively and the frequency was not different among the groups. CONCLUSION: Among the pretreatments tested, 0.06 mg.kg-1 rocuronium was the best to prevent muscular fasciculations following succinylcholine injection. In the population studied, pretreatment did not prevent postoperative myalgia. Succinylcholine 1.5 mg.kg-1 was more effective without a non-depolarizing pretreatment.

Adult↗
PubMed1997

Comparison of rocuronium and d-tubocurarine for prevention of succinylcholine-induced fasciculations and myalgia.

PURPOSE: We compared d-tubocurarine and rocuronium for the prevention of succinylcholine-induced fasciculations and postoperative myalgia (POM) and evaluated the influence of both drugs on the speed of onset and recovery of succinylcholine. METHODS: Seventy-five women undergoing surgery of short duration were studied. They were randomized to one of three groups: group SAL received normal saline followed three minutes later by 1.0 mg.kg-1 succinylcholine; group ROC received 0.05 mg.kg-1 rocuronium + 1.5 mg.kg-1 succinylcholine; group DTC received 0.05 mg.kg-1 d-tubocurarine + 1.5 mg.kg-1 succinylcholine. Single-twitch stimulation was applied to the ulnar nerve every 10 sec and the EMG response of the adductor pollicis was recorded. Fasciculations were assessed by a blinded observer on a scale of 0-3. Patients were asked 24 and 48 hr later to rate POM using a scale of 0-10. RESULTS: The interval needed for twitch height to decrease to 10% of initial value after succinylcholine was longer in group ROC (58 +/- 20 sec) (mean +/- SD) compared with group SAL (44 +/- 13 sec) (P < 0.05). Recovery to 20% occurred faster in group ROC (324 +/- 83 sec) than in groups SAL (456 +/- 103 sec) and DTC (450 +/-132 sec) (P < 0.05). Fasciculations were more intense in groups SAL than in groups ROC and DTC (P < 0.001). Patients rated POM as less intense 24hr postoperatively only in group ROC (1.2 +/- 2.4) compared with group SAL (3.3 +/- 3.5) (P < 0.05). CONCLUSION: Rocuronium prevents succinylcholine-induced fasciculations and POM. Rocuronium also delays the onset of succinylcholine and shortens its duration compared with d-tubocurarine.

Adolescent↗
PubMedDate not supplied

Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient.

PURPOSE: To report a case of reduced duration of action of rocuronium in a patient with normocalcemic hyperparathyroidism (HPT). CLINICAL FEATURES: A 56-yr-old patient with primary HPT, who had had surgical resection of three and a half parathyroid glands nine months previously, was referred to our institution for further investigation of a persistent increase in parathyroid hormone. Preoperatively, the patient had a normal serum ionized and total calcium. The patient was diagnosed with a persistent parathyroid adenoma and was scheduled for an elective parathyroidectomy. General anesthesia was induced with iv propofol, fentanyl and succinylcholine. Intraoperatively, anesthesia was maintained with nitrous oxide in oxygen, and isoflurane. Neuromuscular blockade was attained using incremental doses of rocuronium. The average duration of 0.15 mg x kg(-1) incremental doses of rocuronium was 5.9 min (expected: 13-18 min), and that of 0.2 mg x kg(-1) was ten minutes (expected: 19-23 min). CONCLUSION: Primary HPT even in the absence of hypercalcemia may result in resistance to competitive blockade by rocuronium. It suggests that primary HPT may cause acetylcholine receptor up-regulation resulting in hyposensitivity to non-depolarizing muscle relaxants.

Androstanols↗
PubMed2003

Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium.

PURPOSE: To examine the efficacy of antagonism of rapacuronium-, mivacurium-, rocuronium- and cisatracurium-induced neuromuscular block at the laryngeal adductors (LA). METHODS: One hundred four patients were randomly assigned to one of eight study groups. They either received rapacuronium 1.5 mg x kg(-1), mivacurium 0.25 mg x kg(-1), rocuronium 0.9 mg x kg(-1) or cisatracurium 0.15 mg x kg(-1). Patients in each treatment group either received edrophonium (0.5 mg x kg(-1)) at 10% recovery of the first twitch (T1) of train-of-four (TOF) at the LA or were allowed to recover spontaneously from neuromuscular block. The effect of antagonism on speed of recovery of neuromuscular function at the LA was evaluated. RESULTS: The time to recovery to a TOF ratio of 0.9 at the LA, when compared to the spontaneous recovery group, was significantly shortened by the administration of edrophonium in patients receiving rapacuronium [19.2 +/- 7.8 vs 26.2 +/- 4.9 (mean +/- SD) min], rocuronium (24.7 +/- 14.3 vs 44.4 +/- 13.0 min) and cisatracurium (24.2 +/- 5.7 vs 35.1 +/- 7.6 min). Edrophonium administration did not shorten complete recovery from mivacurium-induced block (15.7 +/- 8.0 vs 17.6 +/- 6.1 min). CONCLUSION: Recovery from rapacuronium-, rocuronium- or cisatracurium- induced neuromuscular block to a TOF ratio of 0.9 as measured at the LA was shortened by the administration of edrophonium, when compared to spontaneous recovery.

Adolescent↗
PubMed2000

Tracheal intubation after induction of anesthesia in children with propofol--remifentanil or propofol-rocuronium.

PURPOSE: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil. METHODS: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 microgxkg(-1) remifentanil (Re2 or Re4); 2 microgxkg(-1) remifentanil and 0.2 mgxkg(-1) rocuronium (Re2-Ro0.2); 0.4 mgxkg(-1) rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mgxkg(-1) propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation. RESULTS: In all children intubation was successful. Overall intubating conditions were better (P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. CONCLUSION: The best intubating conditions were produced by the combination of 4 microgxkg(-1) remifentanil and 3.5 mgxkg(-1) propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.

Androstanols↗