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ANESTHETIC PHARMACOLOGY

The Effect of Adenosine Triphosphate on Vecuronium-Induced Neuromuscular Block

Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan.

Address correspondence and reprint requests to Keiichi Nitahara, MD, Department of Anesthesiology, Fukuoka University School of Medicine, 7–45–1, Nanakuma, Jonan-ku, Fukuoka 814–0180, Japan. Address e-mail to nitahara{at}fukuoka-u.ac.jp

Continuous IV adenosine triphosphate administration has been used during surgery in the expectation of analgesic and vasodilative effects. Because adenosine triphosphate inhibits neuromuscular transmission, we investigated whether the neuromuscular effect of vecuronium was enhanced by IV adenosine triphosphate in 29 patients randomly given either continuous IV adenosine triphosphate 0.1 mg · kg^–1 · min^–1 or 0.9% NaCl when undergoing elective minor surgery. Anesthesia was induced and maintained with propofol. Neuromuscular monitoring was recorded from the adductor pollicis muscle using electromyography with train-of-four stimulation of the ulnar nerve. Vecuronium 25, 30, or 40 µg/kg was given and lag time, onset time, and maximum block were recorded. ED₅₀ and ED₉₅ values for each group were derived from least squares linear regression analysis. ED₅₀ and ED₉₅ values were 29 µg/kg and 44 µg/kg, respectively, for the adenosine triphosphate group and 26 µg/kg and 46 µg/kg, respectively, for the controls. Differences in lag time, onset time, and neuromuscular responses between the two groups were not statistically significant. A significantly larger number of patients in the adenosine triphosphate group showed hypotension (systolic blood pressure <80 mm Hg). Our results demonstrated that adenosine triphosphate 0.1 mg · kg^–1 · min^–1 did not enhance the neuromuscular block induced by vecuronium.

IMPLICATIONS: In contrast to animal studies, this randomized-controlled study in humans demonstrated that adenosine triphosphate (ATP) 0.1 mg · kg^–1 · min^–1 did not enhance the neuromuscular block induced by vecuronium and, indeed, contributed to an increased incidence of hypotension. These findings suggest possible advantages and limitations of intraoperative use of ATP.