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[Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial].
Rev Esp Anestesiol Reanim. 2007 Aug-Sep; 54(7):399-404.RE

Abstract

OBJECTIVES

To compare the time-course of neuromuscular blockade with rocuronium or cisatracurium during intravenous anesthesia, in terms of both the time to spontaneous recovery or time to reversal after administration of neostigmine.

MATERIAL AND METHODS

Patients classified as ASA 1-2 were randomized to receive blinded administration of a single injection of twice the 95% effective dose of rocuronium or cisatracurium for general anesthesia, and then neostigmine plus atropine at recovery of the first train-of-4 (TOF) twitch at 5% or 25%, or normal saline solution as placebo at recovery of the first TOF twitch at 25%. The neuromuscular blockade was monitored by acceleromyography. Intergroup comparisons were carried out by Student t test and analysis of variance.

RESULTS

Sixty patients were enrolled. Mean (SD) time to onset was faster with rocuronium at (1.04 [0.32] minutes) compared with cisatracurium at (2.58 [0.81] minutes) and duration was shorter: time to the first twich at 5% was 30 (6.4) minutes with rocuronium and 38.1 (9.7) minutes with cisatracurium. The total duration of blockade (time to the 80% TOF ratio) was also shorter with rocuronium when the neuromuscular blockade was reversed, but there were no differences in the time to block reversal when neostigmine was not used: 62 (18.9) minutes to recovery from the rocuronium blockade vs 66.96 (15.9) minutes to recover from a cisatracurium blockade. A high percentage of patients had less than an 80% TOF ratio at 60 and 90 minutes of administration of the neuromuscular blockerswhen reversal was not used (patients receiving rocuronium, 60% at 60 minutes, and 20% at 90 minutes; patients receiving cisatracurium, 80% at 60 minutes, and 40% at 90 minutes).

CONCLUSION

Not antagonizing a rocuronium- or cisatracurium-induced neuromuscular blockade in surgical procedures lasting less than 90 minutes can lead to a high percentaje of residual blockade (TOF ratio <80%).

Authors+Show Affiliations

Servicio de Anestesiología, Hospital Arnau de Vilanova, Valencia. jabama16@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

spa

PubMed ID

17953333

Citation

Barrio, J, et al. "[Influence of Neostigmine On the Course of Neuromuscular Blockade With Rocuronium or Cisatracurium: a Randomized, Double-blind Trial]." Revista Espanola De Anestesiologia Y Reanimacion, vol. 54, no. 7, 2007, pp. 399-404.
Barrio J, San Miguel G, García V, et al. [Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial]. Rev Esp Anestesiol Reanim. 2007;54(7):399-404.
Barrio, J., San Miguel, G., García, V., & Pelegrín, F. (2007). [Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial]. Revista Espanola De Anestesiologia Y Reanimacion, 54(7), 399-404.
Barrio J, et al. [Influence of Neostigmine On the Course of Neuromuscular Blockade With Rocuronium or Cisatracurium: a Randomized, Double-blind Trial]. Rev Esp Anestesiol Reanim. 2007 Aug-Sep;54(7):399-404. PubMed PMID: 17953333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial]. AU - Barrio,J, AU - San Miguel,G, AU - García,V, AU - Pelegrín,F, PY - 2007/10/24/pubmed PY - 2007/12/21/medline PY - 2007/10/24/entrez SP - 399 EP - 404 JF - Revista espanola de anestesiologia y reanimacion JO - Rev Esp Anestesiol Reanim VL - 54 IS - 7 N2 - OBJECTIVES: To compare the time-course of neuromuscular blockade with rocuronium or cisatracurium during intravenous anesthesia, in terms of both the time to spontaneous recovery or time to reversal after administration of neostigmine. MATERIAL AND METHODS: Patients classified as ASA 1-2 were randomized to receive blinded administration of a single injection of twice the 95% effective dose of rocuronium or cisatracurium for general anesthesia, and then neostigmine plus atropine at recovery of the first train-of-4 (TOF) twitch at 5% or 25%, or normal saline solution as placebo at recovery of the first TOF twitch at 25%. The neuromuscular blockade was monitored by acceleromyography. Intergroup comparisons were carried out by Student t test and analysis of variance. RESULTS: Sixty patients were enrolled. Mean (SD) time to onset was faster with rocuronium at (1.04 [0.32] minutes) compared with cisatracurium at (2.58 [0.81] minutes) and duration was shorter: time to the first twich at 5% was 30 (6.4) minutes with rocuronium and 38.1 (9.7) minutes with cisatracurium. The total duration of blockade (time to the 80% TOF ratio) was also shorter with rocuronium when the neuromuscular blockade was reversed, but there were no differences in the time to block reversal when neostigmine was not used: 62 (18.9) minutes to recovery from the rocuronium blockade vs 66.96 (15.9) minutes to recover from a cisatracurium blockade. A high percentage of patients had less than an 80% TOF ratio at 60 and 90 minutes of administration of the neuromuscular blockerswhen reversal was not used (patients receiving rocuronium, 60% at 60 minutes, and 20% at 90 minutes; patients receiving cisatracurium, 80% at 60 minutes, and 40% at 90 minutes). CONCLUSION: Not antagonizing a rocuronium- or cisatracurium-induced neuromuscular blockade in surgical procedures lasting less than 90 minutes can lead to a high percentaje of residual blockade (TOF ratio <80%). SN - 0034-9356 UR - https://www.unboundmedicine.com/medline/citation/17953333/[Influence_of_neostigmine_on_the_course_of_neuromuscular_blockade_with_rocuronium_or_cisatracurium:_a_randomized_double_blind_trial]_ DB - PRIME DP - Unbound Medicine ER -