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ANESTHETIC PHARMACOLOGY

Neuromuscular Pharmacodynamics of Rocuronium in Patients with Major Burns

TaeHyung Han, MD PhD, FAAFP^*, HyeongSeok Kim, MD^*, JiYoung Bae, MD^*, KwangMin Kim, MD PhD^*, and J. A. Jeevendra Martyn, MD FRCA, FCCM

*Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University, School of Medicine, Seoul, Korea; and Department of Anesthesiology and Critical Care, Harvard Medical School, Massachusetts General Hospital, and Shriners Hospital for Children, Boston, Massachusetts

Address correspondence and reprint requests to TaeHyung Han, MD, PhD, FAAFP, Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University, School of Medicine, 94-200 Yongdungpo-Dong, Yongdungpo-Ku, Seoul, Korea 150-719. Address e-mail to athan{at}unitel.co.kr

Rocuronium, which has a short onset time and is free of hyperkalemic effects, could be considered for rapid-sequence induction of anesthesia in patients with burns. In this study, we assessed the neuromuscular pharmacodynamics of rocuronium in patients with major burns. Adults aged 18–59 yr who had a major burn injury (n = 56) and a control group of 44 nonburned patients were included. Rocuronium was used at 3 times (0.9 mg/kg) or 4 times (1.2 mg/kg) the 95% effective dose. Anesthesia consisted of propofol and fentanyl with nitrous oxide and oxygen. Neuromuscular block was monitored with an acceleromyograph by using train-of-four stimulation. The onset time to 95% neuromuscular block was prolonged in burned compared with nonburned patients (115 ± 58 s versus 68 ± 16 s for 0.9 mg/kg; 86 ± 20 s versus 57 ± 11 s for 1.2 mg/kg). Dose escalation shortened the onset time, prolonged the duration of action, and improved intubating conditions in burned patients. All recovery profiles were significantly shorter in burned versus nonburned groups with both doses. Resistance to the neuromuscular effects of rocuronium was partially overcome by increasing the dose. A dose up to 1.2 mg/kg provides good tracheal intubating conditions after major burns.

IMPLICATIONS: After major burn injury, the response to nondepolarizing neuromuscular blocking drugs is unpredictable but usually demonstrates resistance. This study documents that a 1.2 mg/kg dose of rocuronium provides good intubating conditions with a faster onset time compared with a dose of 0.9 mg/kg.

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