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AMBULATORY ANESTHESIA

Spontaneous Recovery Profile of Rapacuronium During Desflurane, Sevoflurane, or Propofol Anesthesia for Outpatient Laparoscopy

Tian J. Zhou, MD^*, Margarita Coloma, MD^*, Paul F. White, PhD^*, Jun Tang, MD, FANZCA, MD, Tom Webb, MD, John E. Forestner, MD^*, Nancy B. Greilich, MD^*, and Larry L. Duffy, MD^*

Departments of Anesthesiology and Pain Management, *University of Texas Southwestern Medical Center at Dallas, Texas; and Cedars Sinai Medical Center in Los Angeles, California

Address correspondence to Paul F. White, PhD, MD, FANZCA, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, F2.208, Dallas, TX 75235-9068. Address e-mail to paul.white{at}email .swmed.edu.

We evaluated the spontaneous recovery characteristics of rapacuronium during desflurane-, sevoflurane-, or propofol-based anesthesia in 51 consenting women undergoing laparoscopic tubal ligation procedures. After the induction of the anesthesia with standardized doses of propofol and fentanyl, 1.5 mg/kg IV rapacuronium was administered to facilitate tracheal intubation. Patients were randomized to receive either 1 minimum alveolar anesthetic concentration of desflurane, 1 minimum alveolar concentration of sevoflurane, or 100 µg · kg^-1 · min^-1 propofol infusion in combination with 66% nitrous oxide in oxygen for maintenance of anesthesia. Neuromuscular blockade was monitored at the wrist by using electromyography. The degree of maximum blockade and the times for first twitch recovery (T₁) to 5%, 25%, 50%, 75%, and 90%, as well as the recovery index, were similar in all three anesthetic groups. However, recovery times for the train-of-four ratio to achieve 0.7 and 0.8 were significantly longer with desflurane (44.4 ± 18.9 and 53.5 ± 22.4 min) and sevoflurane (44.8 ± 15.1 and 53.2 ± 15.8 min) compared with propofol (31.8 ± 5.3 and 36.5 ± 6.5 min). Eight patients (16%) required a maintenance dose of 0.5 mg/kg rapacuronium and reversal of rapacuronium residual block occurred in three (6%) patients. We conclude that spontaneous recovery after an intubating dose of 1.5 mg/kg rapacuronium was significantly prolonged by both desflurane and sevoflurane compared with propofol-based anesthesia. Routine monitoring of neuromuscular activity is recommended even when a single bolus dose of rapacuronium is administered during ambulatory anesthesia.

Implications: When administered for laparoscopic surgery, the duration of action of an intubating dose of rapacuronium was prolonged 40%–50% by desflurane and sevoflurane, respectively, (versus propofol). Monitoring recovery of neuromuscular blockade produced by rapacuronium is particularly important when desflurane or sevoflurane is administered to ensure that an adequate recovery (train-of-four 0.8) is achieved by the end of anesthesia.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999