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GENERAL ARTICLES

An Alternate Method for Estimating the Dose-Response Relationships of Neuromuscular Blocking Drugs

Aaron F. Kopman, MD^*, Monika M. Klewicka, BA, and George G. Neuman, MD^*

*Department of Clinical Anesthesiology, New York Medical College, Valhalla; and Department of Anesthesiology, St. Vincent’s Hospital, New York, New York

Address correspondence and reprint requests to Aaron F. Kopman, MD, Department of Anesthesiology, Room NR 408, St. Vincent’s Hospital and Medical Center, 170 W. 12th St., New York, NY 10011. Address e-mail to AKopman{at}interport.net

Slopes of the dose-response relationships for all available neuromuscular blocking drugs appear to be essentially parallel and to approximate a log-dose/logit value of 4.75. We tested the possibility of estimating both 50% effective dose (ED₅₀) and 95% effective dose (ED₉₅) values from a single dose-response data point when that slope is postulated. We compared the ED₅₀ and ED₉₅ values of rocuronium and succinylcholine calculated by using traditional log-dose/logit regression analysis with the same values obtained by averaging individual estimates of potency as determined by using the Hill equation. After the induction of anesthesia (propofol/alfentanil), tracheal intubation was accomplished without the administration of neuromuscular blocking drugs. Anesthesia was maintained with nitrous oxide and propofol. The evoked electromyographic response to 0.10-Hz single stimuli was continuously recorded. After baseline stabilization, a single IV bolus of succinylcholine (0.08–0.26 mg/kg, n = 50) or rocuronium (0.13–0.30 mg/kg, n = 40) was administered and the peak effect noted. By using log-dose/logit regression analysis, we calculated ED₅₀ and ED₉₅ values for rocuronium of 0.17 and 0.33 mg/kg and 0.14 and 0.27 mg/kg for succinylcholine. When potency was calculated from the Hill equation, the resultant ED₅₀ and ED₉₅ values did not differ by more than ±4% from those obtained by using regression analysis. Averaging of single-dose estimates of neuromuscular potency provides a useful adjunct and reasonable alternative to conventional regression analysis.

Implications: Averaging of single-dose estimates of neuromuscular potency provides a useful adjunct and reasonable alternative to conventional regression analysis.

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