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PubMed1999

Intramuscular rocuronium in infants and children: a multicenter study to evaluate tracheal intubating conditions, onset, and duration of action.

BACKGROUND: This multicenter, assessor-blinded, randomized study was done to confirm and extend a pilot study showing that intramuscular rocuronium can provide adequate tracheal intubating conditions in infants (2.5 min) and children (3 min) during halothane anesthesia. METHODS: Thirty-eight infants (age range, 3-12 months) and 38 children (age range, 1 to 5 yr) classified as American Society of Anesthesiologists physical status 1 and 2 were evaluated at four investigational sites. Anesthesia was maintained with halothane and oxygen (1% end-tidal concentration if <2.5 yr; 0.80% end-tidal concentration if >2.5 yr) for 5 min. One half of the patients received 0.45 mg/kg intravenous rocuronium. The others received 1 mg/kg (infants) or 1.8 mg/kg (children) of intramuscular rocuronium into the deltoid muscle. Intubating conditions and mechanomyographic responses to ulnar nerve stimulation were assessed. RESULTS: The conditions for tracheal intubation at 2.5 and 3 min in infants and children, respectively, were inadequate in a high percentage of patients in the intramuscular group. Nine of 16 infants and 10 of 17 children had adequate or better intubating conditions at 3.5 and 4 min, respectively, after intramuscular rocuronium. Better-than-adequate intubating conditions were achieved in 14 of 15 infants and 16 of 17 children given intravenous rocuronium. Intramuscular rocuronium provided > or =98% blockade in 7.4+/-3.4 min (in infants) and 8+/-6.3 min (in children). Twenty-five percent recovery occurred in 79+/-26 min (in infants) and in 86+/-22 min (in children). CONCLUSIONS: Intramuscular rocuronium, in the doses and conditions tested, does not consistently provide satisfactory tracheal intubating conditions in infants and children and is not an adequate alternative to intramuscular succinylcholine when rapid intubation is necessary.

Androstanols↗
PubMed2001

Recirculatory pharmacokinetics and pharmacodynamics of rocuronium in patients: the influence of cardiac output.

BACKGROUND: Recirculatory models are capable of accurately describing first-pass pharmacokinetics and the influence of cardiac output (CO), which is important for drugs with a fast onset of effect. The influence of CO on pharmacokinetic and pharmacodynamic parameters of rocuronium in patients was evaluated using a recirculatory pharmacokinetic model. METHODS: Fifteen patients were included to study rocuronium pharmacokinetics and pharmacodynamics. Bolus doses of rocuronium (0.35 mg/kg) and indocyanine green (25 mg) were injected simultaneously via a peripheral intravenous catheter. Blood samples were taken for 240 min from the radial artery. The force of contraction of the adductor pollicis after a train-of-four at 2 Hz every 12 s was measured. Arterial concentration-time curves of rocuronium and indocyanine green were analyzed using a recirculatory model. Pharmacodynamics were described using a sigmoid maximum effect (Emax) model. RESULTS: The CO of the patients varied from 2.43 to 5.59 l/min. Total distribution volume of rocuronium was 17.3 +/- 4.8 l (mean +/- SD). The CO showed a correlation with the fast tissue clearance (Cl(T_f); r2 = 0.51), with the slow tissue clearance (Cl(T_s); r2 = 0.31) and with the mean transit times of rocuronium except for the mean transit time of the slow tissue compartment. The blood-effect site equilibration constant (k(e0)) was strongly correlated with CO (r2 = 0.70). CONCLUSIONS: Cardiac output influences the pharmacokinetics, including k(e0), for rocuronium in patients. For drugs with a fast onset of effect, a recirculatory model, which includes CO, can give a good description of the relation between concentration and effect, in contrast to a conventional compartmental pharmacokinetic model.

Adult↗
PubMed1997

Dose-response relationship and effective time to satisfactory intubation conditions after rocuronium in children.

We assessed the neuromuscular blocking effects of, and intubation conditions following, rocuronium in 81 children aged 2-12 years. The study was conducted in three parts. Parts 1 and 2 were undertaken during anaesthesia with thiopentone, alfentanil and nitrous oxide. Neuromuscular blockade was evaluated by recording the force of contraction of the adductor pollicis in response to train-of-four stimulation at 2 Hz repeated every 10s. In Part 1 the potency of rocuronium was determined in 15 children using a single dose-response technique; in Part 2 onset and recovery times were determined in six children following rocuronium 0.6 mg.kg-1. In Part 3 of the study, intubation conditions were assessed in five groups of 12 children whose tracheas were intubated 30, 40, 50, 60 and 70s after rocuronium 0.6 mg.kg-1 during anaesthesia with thiopentone. The times to satisfactory intubation conditions in 50% and 90% of children were determined by probit analysis. The effective doses of rocuronium to produce 50% and 95% twitch depression were 151 micrograms.kg-1 (95% confidence intervals: 129-173 micrograms.kg-1) and 331 micrograms.kg-1 (95% confidence intervals: 249-543 micrograms.kg-1), respectively. The mean times (SD) to 90% and 100% depression of control twitch following rocuronium 0.6 mg.kg-1 were 42 (11.8) s and 60.3 (19.3) s, respectively. The times to 5%, 25%, 75% and 90% recovery were 20.5 (3.1) min, 26.1 (4.1) min, 35.1 (5.4) min, and 39.5 (6.4) min, respectively. Intubation conditions were satisfactory in 4/12 children at 30 s, 6/12 at 40 s, 8/12 at 50 s, 11/12 at 60 s and 12/12 at 70 s. The times to satisfactory intubation conditions in 50% and 90% of children after rocuronium 0.6 mg.kg-1 were 38 s (95% confidence intervals: 30-44 s) and 61 s (95% confidence intervals: 55-70 s), respectively.

Androstanols↗
PubMed1998

Dose-response and time-course of the effect of rocuronium bromide during sevoflurane anaesthesia.

To evaluate the influence of sevoflurane on the dose-response relationship and on the time-course of the effect of rocuronium, 60 adult patients undergoing elective plastic surgery were randomly allocated to either the control or the sevoflurane group. Anaesthesia was maintained with 60% nitrous oxide in oxygen and thiopentone in the control group and with 60% nitrous oxide in oxygen and an end-tidal concentration of 1.75% sevoflurane in the sevoflurane group. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12s and the percentage depression of the first twitch of the train-of-four was used as the study parameter. The dose-response relationship of rocuronium in the two groups was determined by the cumulative dose-response technique. The dose-response curve of rocuronium in the sevoflurane group was shifted to the left compared to the control group, indicating a potentiation of rocuronium-induced neuromuscular block. The effective doses of rocuronium required to produce 50%, 90% and 95% twitch depression in the sevoflurane group were decreased by 30.5%, 26.7% and 25.2%, respectively, compared to the control group. Following the administration of a total dose of rocuronium of 400 micrograms.kg-1, the duration of action of, and the recovery from, rocuronium were both significantly prolonged by sevoflurane. There were significant differences in the duration of peak effect, clinical duration, recovery index and the total duration of action between the control and the sevoflurane groups.

Adolescent↗
PubMed2006

Effects of SZ1677, a new non-depolarizing steroidal neuromuscular blocking drug, and rocuronium on two laryngeal muscles and the anterior tibial muscle in guinea pigs.

BACKGROUND: SZ1677 is a new neuromuscular blocking drug structurally related to rocuronium. We compared the effect of an ED(90) of SZ1677 (25 microg/kg) with that of rocuronium (100 microg/kg) in guinea pig laryngeal and peripheral muscles. METHODS: Electromyography was used to quantify neuromuscular blockade at the posterior cricoarytenoid muscle, the thyroarytenoid muscle and the anterior tibial muscle after SZ1677 (n = 10) and rocuronium (n = 9). RESULTS: Maximum neuromuscular blockade was similar after SZ1677 and rocuronium (83 +/- 11% vs. 89 +/- 11%; thyroarytenoid muscle: 91 +/- 8% vs. 97 +/- 3%; anterior tibial muscle: 91 +/- 15% vs. 96 +/- 3%, respectively). Onset time of neuromuscular blockade at the laryngeal muscles was similar for the two neuromuscular blocking drugs; it was shorter at the thyroarytenoid muscle (67 +/- 32 s vs. 42 +/- 40 s) than at the posterior cricoarytenoid muscle (101 +/- 26 s vs. 102 +/- 108 s). Onset time at the anterior tibial muscle was longer after SZ1677 (114 +/- 34 s) than after rocuronium (68 +/- 46 s); P < 0.05. Neuromuscular recovery was faster after SZ1677 (interval 25%-75%: posterior cricoarytenoid muscle: 222 +/- 66 s; thyroarytenoid muscle: 192 +/- 92 s; tibial muscle 149 +/- 55 s) than after rocuronium (450 +/- 148 and 464 +/- 183 s, 292 +/- 86 s, respectively); P < 0.05. CONCLUSIONS: In guinea pigs, SZ1677 offers a rapid onset of neuromuscular blockade at a laryngeal adductor muscle with a shorter duration than rocuronium. Regardless of the drug used, the course of neuromuscular blockade differs not only between peripheral muscles and the larynx but also between antagonistic laryngeal muscles. The differences seem to be species specific.

Androstanes↗
PubMedDate not supplied

Meta-analysis of the differences in the time to onset of action between rocuronium and vecuronium.

1. The aim of the present study was to conduct a meta-analysis of the magnitude of differences in the onset of action (T(max)) between rocuronium and vecuronium. 2. A search was made in PubMed, EMBASE Drugs and Pharmacology, Cochrane Controlled Trials Register and Cochrane Database on Systematic Reviews. Studies comparing the T(max) at the adductor policies between rocuronium and vecuronium administered as an intravenous bolus were included in the study. Twenty-nine effect sizes obtained from 21 studies were included. 3. The result of the meta-analysis of differences was -57.9 s (95% confidence interval -71.4 to -44.3 s), favouring rocuronium over vecuronium. The smallest difference in T(max) between these neuromuscular-blocking agents was observed in children (-19.1 s). The difference in T(max) between rocuronium and vecuronium in female patients was -38.7 s. The difference in T(max) between rocuronium and vecuronium measured by electromyography was approximately 50% shorter than that determined by acceleromyography or mechanomyography. In a subanalysis between rocuronium 600 mg/kg versus vecuronium 100 mg/kg, the difference in T(max) between them was very similar to that obtained in the general meta-analysis. 4. According to subanalyses of patient age and sex, drug dose and neuromuscular monitoring systems, the T(max) of rocuronium was approximately 20-70 s faster than that of vecuronium.

Adult↗
PubMed2003

[Ephedrine shortens the onset of action of rocuronium but not atracurium].

HYPOTHESIS: Ephedrine increases blood flow to muscles and may shorten the onset of action of rocuronium and atracurium. MATERIAL AND METHODS: A prospective study of 80 ASA I-III patients undergoing surgery under general anesthesia and randomized to 4 groups: ephedrine-rocuronium, placebo-rocuronium, ephedrine-atracurium and placebo-atracurium. Atracurium or rocuronium was administered at a dose of 0.04 mg.Kg-1. We monitored neuromuscular function by acceleromyography, ECG and pulse oxymetry, arterial blood pressure (ABP) using an intra-arterial catheter (AT), heart rate (HR) and carbon dioxide pressure. Patient characteristics, time to onset, duration and recovery from the neuromuscular block were recorded. HR and ABP were measured at baseline, 3 minutes after ephedrine dosing, 1 minute after induction, immediately after intubation and 5, 10 and 20 minutes after intubation. RESULTS: Patient characteristics were similar in all groups. The time to onset of neuromuscular block was significantly shorter in the rocuronium and rocuronium-ephedrine groups than in the atracurium groups. Duration and recovery were similar in all groups. Patients premedicated with ephedrine experienced a significant increase in HR for 20 minutes. The only complications were 2 cases of self-limiting sinus tachycardia of less than 130 beats.min-1 in the ephedrine group. CONCLUSIONS: Premeditation with 10 mg of ephedrine decreases the time until onset of action of rocuronium but does not affect the timing of atracurium.

Adult↗
PubMedDate not supplied

Atracurium, cisatracurium, vecuronium and rocuronium in patients with renal failure.

AIM: The cumulative index, the recovery, the onset and the duration of action, of atracurium, cisatracurium, vecuronium and rocuronium in uremic patients undergoing kidney transplantation compared to healthy patients undergoing general surgery were studied. METHODS: In all patients (64 uremic vs 62 "healthy" patients) after anesthesia induction, atracurium 0.5 mgxkg(-1) or cisatracurium 0.15 mgxkg(-1) or vecuronium 0.1 mgxkg(-1) or rocuronium 0.6 mgxkg(-1) were administered, and at the end of surgery when T1 reached 25% neostigmine 0.05 mgxkg(-1) was given. Neuro-muscu-lar transmission was monitored by accelerometry (TOF-GUARD, Organon). RESULTS: Cumulative index of vecuronium (1.3+/-0.1 vs 1.06+/-0.11, p<0.001) and rocuronium (1.45+/-0.18 vs 1.04+/-0.16, p<0.001), recovery index (time of T1 25-75) of atracurium (14.2+/-5 vs 9+/-4, p<0.005), cisatracurium (18.7+/-3 vs 9.1, p<0.001), vecuronium (18.5+/-3 vs 12.5+/-3, p<0.001) and rocuronium (18+/-6 vs 11+/-4, p<0.001) and interval T1 25% to TOF 0.8 of cisatracurium (20.5+/-1.2 vs 16+/-2.1, p<0.001) and vecuronium (27+/-6.3 vs 20+/-3.3, p<0.001) were longer in uremic patients. The onset time and the duration of action of atracurium, cisatracurium, vecuronium and rocuronium were similar in all groups compared to controls one. CONCLUSION: In patients with renal failure the use of atracurium, cisatracurium, vecuronium and rocuronium is suitable and predictable in terms of onset, and duration of action. Care has to be taken to vecuronium and rocuronium cumulative index. Neuromuscular trasmission has to be always monitored.

Adult↗
PubMed2004

Recovery of neuromuscular function after a combination of mivacurium and rocuronium.

PURPOSE: The present study was undertaken to evaluate onset, and early and late recovery of neuromuscular block after a combination of mivacurium (M) and rocuronium (R). METHODS: In this controlled, randomized study, 45 consenting ASA I-II patients were assigned to one of three treatment groups: 2.ED95 R alone (2R); 2.ED95 R plus 1.ED95 M (2R1M). or 2.ED95 R plus 2.ED95 M (2R2M). Neuromuscular monitoring of the ulnar nerve consisted of surface electrode stimulation and force transduction of the adductor pollicis muscle. Stable baseline stimulation (1 Hz, square-wave, supramaximal current) was established prior to relaxant administration and continued until 95 percent twitch height depression (onset). Thereafter, train-of-four stimulation every 10 seconds was used to record recovery data until 95 percent recovery (T(95%)). Data were analyzed using grouped t-tests, ANOVA, and Newman-Keuls multiple comparison tests. Significance was defined at the p < 0.05 level. RESULTS: The addition of mivacurium to rocuronium did not accelerate onset of block. The combination prolonged the clinical duration (time to 5 percent recovery, T(5%)), but did not affect subsequent recovery parameters: T(5%) in the 2R1M and 2R2M groups were 100 percent and 118 percent longer than in the 2R group, respectively (p < 0.05) the T(5-25%) (early recovery) and T(25-75%) (linear recovery) indexes were similar in all three groups. CONCLUSIONS: The present study did not note an acceleration of block onset when mivacurium was added to rocuronium. The findings suggest that the addition of mivacurium (1-2.ED95) to rocuronium (2.ED95) prolongs the clinical duration of the longer-acting agent, rocuronium, but has no effect on the early or linear recovery indexes of rocuronium. Thus, although clinical duration is prolonged, recovery from the combination regimens proceeds as if no mivacurium had been added to rocuronium.

Adolescent↗
PubMed1995

Cross-reactivity of rocuronium with other neuromuscular blocking agents.

The cross-reactivity of rocuronium with other neuromuscular blocking agents (NMBAs) was studied in 31 patients known to be allergic to a muscle relaxant. Tests for diagnosing cross-reactivity were skin tests (prick tests and intradermal tests: IDTs), detection by RAST assay of IgEs against the quaternary ammonium group (QAS-RIA: quaternary ammonium sepharose radio-immuno-assay), QAS-RIA inhibition test to detect IgE specificity, and leucocyte histamine release test (LHRT). Skin tests were performed with rocuronium, suxamethonium, gallamine, vecuronium, pancuronium, atracurium. The threshold for cross-reactivity was 10(-1) with all the NMBAs except for atracurium (10(-2)). The inhibition test and LHRT were performed with rocuronium and the NMBA responsible for the shock. Ten volunteers made up the control group for prick tests, QAS-RIA, LHRT. Cross-reactivity was found in 30 patients out of 31. Rocuronium did not cross-react in 10 patients out of 31. They had negative cutaneous tests and negative LHRTs. In one of the five patients allergic to all the NMBAs available, rocuronium was the only one which did not cross-react. In those 10 patients, rocuronium may be safely used for subsequent anaesthesia. In terms of allergy, rocuronium appeared to be very close to the other steroidal NMBAs.

Adult↗
PubMed1996

[Effect of rocuronium in sufentanil/isoflurane and sufentanil/propofol anesthesia].

It is a well-known fact that the duration of the effect of non-depolarizing neuromuscular blocking agents is influenced by other anaesthetics. Etomidate, propofol and nitrous oxide have no influence on the duration of effect of rocuronium, but a prolongation of the rocuronium effect under the influence of isoflurane has been described. In this study, we investigated the onset time, duration of effect and recovery index of rocuronium in isoflurane/N2O/sufentanil anaesthesia compared with these parameters in propofol/N2O/sufentanil anaesthesia. Forty patients (10 men and 30 women aged 47.5 +/- 13.0 years, ASA 1-2) were included in the investigation. Anaesthesia was induced by intravenous application of 20 mg etomidate, 0.15-0.2 micrograms/kg sufentanil and 0.9 mg/kg rocuronium. In 20 patients, anaesthesia was supplemented with 0.3-0.8 Vol.% (endexpiratory) isoflurane in a mixture of 30% O2 and 70% N2O (group A). In another 20 patients breathing 30% O2 and 70% N2O propofol (2-6 mg/kg/h) was infused continuously (group B). Onset time, duration of action and recovery index of rocuronium were measured with a nerve stimulator (train-of-four mode). The patients were intubated 60 seconds after completing the rocuronium injection and the intubation conditions were estimated clinically. The onset time amounted to 47.6 +/- 17.8 seconds (group A) and 58.1 +/- 13.6 seconds (group B). In group A, a mean duration of action of 54.3 +/- 13.8 minutes and in group B a mean duration of action of 53.9 +/- 18.9 minutes were measured. The recovery index amounted to 21.2 +/- 10.6 minutes in group A and 17.6 +/- 5.8 minutes in group B. The differences in onset time and recovery times were not significant. Significant changes in arterial blood pressure or heart rate were not observed. The intubation conditions after 60 seconds were excellent in 34 patients (85%) and good in 6 patients (15%). It can be concluded that in comparison with anesthesia maintained by propofol/sufentanil and nitrous oxide/oxygen, the relatively low but necessary supplementation with isoflurane instead of propofol does not lead to a clinically relevant amplification of the relaxing effect of rocuronium.

Adjuvants, Anesthesia↗
PubMed1996

Continuous infusion of rocuronium in a paediatric intensive care unit.

PURPOSE: To evaluate prospectively the efficacy and dose requirements of rocuronium administered by continuous infusion for neuromuscular blockade in a paediatric ICU population. METHODS: Neuromuscular function was monitored by train-of-four (TOF) stimulation of the ulnar or peroneal nerve. Rocuronium was administered as a bolus dose (0.6 mg.kg-1) followed by a continuous infusion starting at 0.6 mg.kg-1.hr-1. The infusion was increased or decreased by 0.1 mg.kg-1.hr-1 to maintain one visible twitch of the TOF. All patients also received a benzodiazepine or a barbiturate infusion. RESULTS: The study population included 20 patients (12 boys, eight girls) ranging in age from two months to 16 yr and in weight from 3.6 to 64 kg. The duration of the rocuronium infusion varied from 26 to 172 hr for a total of 1492 hr in the 20 patients. The rocuronium infusion requirements for day 1 varied from 0.3 to 0.8 mg.kg-1.hr-1 (0.76 +/- 0.3 mg.kg-1.hr-1). When considering all patients and all patient days, the rocuronium infusion rate required to maintain one twitch of the TOF varied from 0.3 to 2.2 mg.kg-1.hr-1 (mean for all patient days = 0.95 +/- 0.4 mg.kg-1.hr-1). The infusion requirements were 0.5 to 0.8 mg.kg-1.hr-1 in 45 of the 64 patient days (70%) and 0.3 to 1.0 mg.kg-1.hr-1 in 58 of the 64 patient days (90%). No problems with the infusion were noted. CONCLUSIONS: Continuous infusion of rocuronium can be used to provide neuromuscular blockade in the paediatric ICU patient. Due to the variability in infusion requirements, monitoring of neuromuscular function is suggested.

Adolescent↗
PubMed1998

Increased sensitivity to rocuronium and atracurium in mitochondrial myopathy.

PURPOSE: To describe the prolonged effect of the intermediate-acting, non-depolarising neuromuscular blocking agents rocuronium and atracurium in a 29-yr-old apparently healthy woman. CLINICAL FEATURES: Because of abdominal pain the patient was scheduled for explorative laparoscopic pelvic examination. General anaesthesia was induced with fentanyl, midazolam and propofol. Muscle relaxation was achieved with 0.6 mg.kg-1 rocuronium. Anaesthesia was maintained with nitrous oxide and propofol. Two Hz train-of-four stimulation every 15 sec evoked no twitch responses until 60 min after rocuronium. Further relaxation was achieved with 0.075 mg.kg-1 atracurium after which twitch responses recurred after 45 min. Fifteen minutes later neuromuscular blockade was successfully reversed with atropine and neostigmine. The postanaesthetic course was uneventful. Because of the increased sensitivity to rocuronium and atracurium the patient was re-evaluated postoperatively. History revealed occasional double vision, fatigue, muscle cramps, stiffness and myoglobinuria. Clinical neurological examination showed ptosis, tremor, ataxia and bradydiadochokinesia. A standardised lactate stress testing on a bicycle was pathological and, after muscle biopsy, the diagnosis of mitochondrial myopathy was established. CONCLUSION: An increased sensitivity to rocuronium and atracurium may occur in patients with mitochondrial myopathy. In these patients appropriate dosing of muscle relaxants and adequate monitoring of the neuromuscular blockade are required. If an increased sensitivity to rocuronium and atracurium occurs in an apparently healthy subject, further neurological investigations should follow.

Adult↗
PubMed1998

Comparison of neuromuscular effects, efficacy and safety of rocuronium and atracurium in ambulatory anaesthesia.

PURPOSE: To compare the neuromuscular effects, efficacy, and safety of equi-effective doses of rocuronium and atracurium in ambulatory female patients undergoing surgery. METHODS: Forty-one patients undergoing laparoscopic gynaecological surgery were randomized to receive 2 X ED90 rocuronium (0.6 mg.kg-1; n = 20) or atracurium (0.5 mg.kg-1; n = 21) during intravenous propofol/alfentanil anaesthesia with N2O/O2 ventilation. Neuromuscular block was measured with a mechanomyogram eliciting a train-of-four (TOF) response at the wrist. Intubation conditions 60 sec after administration of muscle relaxant and immediate cardiovascular disturbances or adverse events during the hospital stay were noted by blinded observers. RESULTS: Compared with atracurium, rocuronium was associated with a shorter onset time (59.0 +/- 22.2 vs 98.6 +/- 41.4 sec; P < 0.001) and clinical duration of action (33.3 +/- 7.1 vs 44.7 +/- 7.2 min; P < 0.001), but longer spontaneous recovery index (9.6 +/- 2.41 vs 6.9 +/- 1.89 min; P = 0.023) and a similar time to spontaneous recovery to TOF 70%; 53 +/- 6.31 vs 59.2 +/- 7.59 min; P = 0.139). Tracheal intubation was accomplished in < 90 sec in all patients receiving rocuronium but in only 14 of 21 patients receiving atracurium. The incidence of adverse events and the cardiovascular profiles for the two drugs were similar, although one patient receiving atracurium experienced transient flushing of the head and neck. CONCLUSION: Rocuronium has minimal side effects, provides conditions more suitable for rapid tracheal intubation, and is associated with a shorter clinical duration than atracurium. Once begun, the spontaneous recovery profile of rocuronium is slightly slower than that of atracurium.

Adolescent↗
PubMed1998

A rapid precurarization technique using rocuronium.

PURPOSE: To evaluate a rapid and time-saving precurarization technique using rocuronium to prevent succinylcholine-induced myalgia. METHOD: In a prospective, double blind randomized study, 42 ASA 1-2 patients were assigned to one of three pretreatment groups: 0.01 ml.kg-1 normal saline, 0.1 mg.kg-1 atracurium, and 0.1 mg.kg-1 rocuronium. Anaesthesia commenced with 1.5 micrograms.kg-1 fentanyl and 0.5 mg.kg-1 lidocaine at time zero. Pretreatment was administered 60 sec later, followed by 2.5 mg.kg-1 propofol. At 90 sec, 1.5 mg.kg-1 succinylcholine was injected and 30 sec later, the trachea was intubated and the ease of intubation was graded. The patient was observed for the presence and severity of fasciculations. Myalgias were recorded on postoperative days 1, 2 and 7. RESULTS: The incidence of fasciculations in the rocuronium group (21.4%) was lower (P < 0.001) than atracurium (78.5%) or placebo (92.8%) groups. On postoperative day 1, the incidence of postoperative myalgia in the rocuronium group (14.2%) was less than the placebo group (78.2%; P < 0.002) and atracurium group (85.7%; P < 0.001). The incidence of myalgia in the rocuronium group (7.1%) was lower than in the placebo group (78.5%; P < 0.001) but not different from the atracurium group (42.8%; P = 0.077) on postoperative day 2. On postoperative day 7, there was no difference among the three groups. Fasciculations were related to postoperative myalgia. There was no difference in intubating conditions among the three groups. CONCLUSION: Rocuronium pretreatment given just before induction of anaesthesia with propofol reduces fasciculations and succinylcholine-induced myalgia.

Adult↗
PubMed1997

Rocuronium prevents succinylcholine-induced fasciculations.

PURPOSE: The aim of this study was to assess the effect of rocuronium pretreatment at 3 and 1.5 min before succinylcholine administration on fasciculations, neuromuscular blockade and intubating conditions. METHODS: Sixty ASA I or II adults scheduled for elective surgery were anaesthetised with midazolam, fentanyl, propofol, N2O and isoflurane. They were randomised in a double blind manner into three groups: group ROC-3 min (n = 22) received 0.05 mg.kg-1 rocuronium, 3 min before 2 mg.kg-1 succinylcholine; group ROC-1.5 min (n = 20) received 0.05 mg.kg-1 rocuronium 1.5 min before 2 mg.kg-1 succinylcholine; and group NO ROC (n = 18) had no rocuronium before injection of 2 mg.kg-1 succinylcholine. Fasciculations and intubating conditions were evaluated by the same physician who was unaware of the randomisation. Neuromuscular block was measured at the adductor pollicis with an accelerometer. RESULTS: The incidence of fasciculations was lower in the ROC-3 min (9%) and ROC-1.5 min (30%) groups than in the NO ROC group (83%; P < 0.001). The intensity of fasciculations was also less in both pretreatment groups. No statistical difference was noted between pretreatment at 3 and 1.5 min. Intubating conditions, onset time and duration of succinylcholine blockade were comparable in all three groups. CONCLUSION: The incidence and severity of succinylcholine fasciculations can be reduced by giving 0.05 mg.kg-1 rocuronium either 1.5 min or 3 min before succinylcholine. The effects of 2 mg.kg-1 succinylcholine with rocuronium pretreatment, and 1 mg.kg-1 succinylcholine, without pretreatment, are similar with respect to intubating conditions, onset of paralysis and duration of blockade.

Adolescent↗
PubMed1997

Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium.

PURPOSE: To evaluate the tracheal intubating conditions and neuromuscular blocking characteristics of divided dose mivacurium or single dose rocuronium. METHODS: Thirty-two patients undergoing elective surgery were studied. Anaesthesia was with propofol 2 mg.kg-1, followed by an infusion of 150 micrograms.kg-1.min.1. Patients were randomized to receive either mivacurium-0.15 mg.kg-1 followed 30 sec later by 0.1 mg.kg-1, or rocuronium- 0.9 mg.kg-1, followed 30 sec later by placebo. Tracheal intubating conditions were assessed 90 sec after the initial dose of relaxant by an anaesthetists who was unaware of patient group. The electromyographic (EMG) response of the first dorsal interosseus muscle to ulnar nerve train-of-four was measured. RESULTS: Successful tracheal intubation was performed in all patients after both mivacurium and rocuronium. Intubating conditions (jaw relaxation, open visible vocal cords) were judged to be good-excellent in all but one patient before insertion of the tracheal tube. However, patients receiving mivacurium were more likely to experience coughing and bucking after tracheal tube insertion (10/16 patients) than those receiving rocuronium (3/16 patients, P < 0.05). No patient in the rocuronium group experienced moderately vigorous coughing and bucking after insertion of the tracheal tube vs six patients in the mivacurium group (P < 0.05). Time to 10 and 25% recovery of neuromuscular function was faster (P < 0.05) after divided dose mivacurium (20 +/- 1 and 23 +/- 1 min, respectively) than after rocuronium (45 +/- 5 and 57 +/- 8 min, respectively). CONCLUSION: The results suggest that, during conditions of the study, divided dose mivacurium is not recommended for a 90-sec tracheal intubation in patients where moderate coughing and bucking is deemed unacceptable.

Adult↗
PubMed2002

Rocuronium pharmacokinetic-pharmacodynamic relationship under stable propofol or isoflurane anesthesia.

PURPOSE: To compare the pharmacokinetics, pharmacodynamics and the concentration-effect relationship of rocuronium in patients under stable propofol or isoflurane anesthesia. METHODS: Ten patients were randomized to receive fentanyl, propofol and nitrous oxide (60%) or fentanyl, thiopental, isoflurane (1.2% end-tidal concentration) and nitrous oxide (60%). To obtain good intubation conditions and maintain adequate muscle relaxation during surgery, patients received two bolus doses of rocuronium: 0.5 mg x kg(-1) (1.7 x ED95) at induction followed one hour later by 0.3 mg x kg(-1) (1 x ED95). Arterial blood samples were obtained over six hours after the second bolus dose. Plasma concentrations of rocuronium were measured using high pressure liquid chromatography. Muscle twitch tension was monitored by mechanomyography for the two doses. Pharmacokinetic and pharmacodynamic parameters were determined. RESULTS: No differences in rocuronium pharmacokinetic parameters were observed between both groups. After the second bolus, clinical duration was 20 +/- 6 min in the propofol group vs 39 +/- 8 min in the isoflurane group (P <0.05). The effect compartment concentration corresponding to 50% block, EC50, was higher under propofol anesthesia: 1008 vs 592 microg x L(-1) (P <0.05). CONCLUSION: Rocuronium body disposition is similar under stable propofol or isoflurane anesthesia. In contrast to isoflurane, propofol does not prolong the neuromuscular block. Therefore, the potentiating effect of isoflurane is of pharmacodynamic origin only, as explained by an increased sensitivity at the neuromuscular junction. In contrast with isoflurane anesthesia where the dose of rocuronium has to be decreased under stable conditions, no dose adjustment is required under propofol anesthesia.

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