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GENERAL ARTICLES

Recovery from Neuromuscular Blockade After Either Bolus and Prolonged Infusions of Cisatracurium or Rocuronium Using Either Isoflurane or Propofol-Based Anesthetics

Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois

Address correspondence and reprint requests to W. Scott Jellish, MD, PhD, Department of Anesthesiology, Loyola University Medical Center, 2160 South First Ave., Maywood, IL 60153. Address e-mail to wjellis{at}luc.edu

We examined the recovery characteristics of cisatracurium or rocuronium after bolus or prolonged infusion under either isoflurane or propofol anesthesia. Sixty patients undergoing neurosurgical procedures of at least 5 h were randomized to receive either isoflurane with fentanyl (Groups 1and 2) or propofol and fentanyl (Groups 3 and 4) as their anesthetic. Groups 1 and 3 received cisatracurium 0.2 mg/kg IV bolus, spontaneously recovered, after which time an infusion was begun. Groups 2 and 4 received rocuronium 0.6 mg/kg IV, spontaneously recovered, and an infusion was begun. Before the end of surgery, the infusion was stopped and recovery of first twitch (T₁), recovery index, clinical duration, and train-of-four (TOF) recovery was recorded and compared among groups by using appropriate statistical methods. Clinical duration was shorter for rocuronium compared with cisatracurium using either anesthetic. Cisatracurium T₁ 75% recovery after the infusion was shorter with propofol compared with isoflurane. Cisatracurium TOF 75% recovery was similar after either bolus or infusion, but rocuronium TOF 75% recovery after the infusion was delayed. Infusion rates decreased for cisatracurium but remained relatively constant for rocuronium regardless of the anesthetic used. Isoflurane enhances the effect of both muscle relaxants but prolonged cisatracurium recovery more than rocuronium. Of the two muscle relaxants studied, rocuronium’s recovery was most affected by length of the infusion. Cisatracurium may be a more desired muscle relaxant for prolonged procedures because recovery was least affected by prolonged infusion.

Implications: This study describes the effect of different anesthetic techniques on the recovery of two different muscle relaxants, cisatracurium and rocuronium, when administered as either a single bolus or prolonged infusion during neurosurgery. This study demonstrates the feasibility of using these relaxants for these prolonged procedures.

This article has been cited by other articles:

				O. Kunitz, J.-H. Baumert, K. Hecker, T. Beeker, M. Coburn, A. Zuhlsdorff, and R. Rossaint Xenon Does Not Prolong Neuromuscular Block of Rocuronium Anesth. Analg., November 1, 2004; 99(5): 1398 - 1401. [Abstract] [Full Text] [PDF]

				K. S. Kim, M. A. Cheong, H. J. Lee, and J. M. Lee Tactile Assessment for the Reversibility of Rocuronium-Induced Neuromuscular Blockade During Propofol or Sevoflurane Anesthesia Anesth. Analg., October 1, 2004; 99(4): 1080 - 1085. [Abstract] [Full Text] [PDF]

				D. S. Breslin, K. Jiao, A. S. Habib, J. Schultz, and T. J. Gan Pharmacodynamic Interactions Between Cisatracurium and Rocuronium Anesth. Analg., January 1, 2004; 98(1): 107 - 110. [Abstract] [Full Text] [PDF]

				A. Amann, J. Rieder, M. Fleischer, P. Niedermuller, G. Hoffmann, A. Amberger, C. Marth, V. Nigrovic, and F. Puhringer The Influence of Atracurium, Cisatracurium, and Mivacurium on the Proliferation of Two Human Cell Lines In Vitro Anesth. Analg., September 1, 2001; 93(3): 690 - 696. [Abstract] [Full Text] [PDF]

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