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Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases.
Anaesthesia. 1994 Nov; 49(11):940-5.A

Abstract

The use of rocuronium (Org 9426) as a single bolus followed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide-oxygen and halothane. Neuromuscular block was monitored using train-of-four stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg-1 followed by an infusion adjusted manually to maintain the T1, the first response in the train-of-four, at 10% of control. Following cessation of rocuronium infusion the patients were either allowed to recover spontaneously (n = 10) or were given neostigmine 50 micrograms.kg-1 or edrophonium 1 mg.kg-1 at 10 or 25% recovery of the T1 (n = 10 for each group). Adequate antagonism was defined as attaining a sustained train-of-four ratio of 0.7. Rocuronium requirements showed marked variation among individual patients but were relatively constant in individual patients. The mean (SD) time to attain stable infusion rates was 17.4 (10.9) min. The mean (SD) requirement of rocuronium for steady state 90% block of T1 was 572 (190) micrograms.kg-1.h-1 (range 242-1104 micrograms.kg-1.h-1). The mean (SD) time to attain a train-of-four ratio of 0.7 in the group allowed to recover spontaneously was 36.1 (7.3) min. This interval was 7.5 (1.9), 9.3 (7.0), 4.6 (1.9) and 1.9 (0.9) min respectively in the groups receiving neostigmine at T1 of 10%, edrophonium at T1 of 10%, neostigmine at T1 of 25% and edrophonium at T1 of 25%. The antagonism was significantly faster in those reversed at 25% (p < 0.05). Three patients in the group receiving edrophonium at T1 of 10% and one in the group receiving neostigmine at T1 of 25% failed to attain a train-of-four ratio of 0.7. It is concluded that rocuronium can be administered as a continuous infusion for stable neuromuscular block. Neostigmine may be a more reliable antagonist of deep block, whereas edrophonium is advantageous when there is a greater spontaneous recovery.

Authors+Show Affiliations

Department of Anaesthetics, Queen's University of Belfast, Northern Ireland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7802236

Citation

McCoy, E P., et al. "Administration of Rocuronium (Org 9426) By Continuous Infusion and Its Reversibility With Anticholinesterases." Anaesthesia, vol. 49, no. 11, 1994, pp. 940-5.
McCoy EP, Mirakhur RK, Maddineni VR, et al. Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases. Anaesthesia. 1994;49(11):940-5.
McCoy, E. P., Mirakhur, R. K., Maddineni, V. R., Loan, P. B., & Connolly, F. (1994). Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases. Anaesthesia, 49(11), 940-5.
McCoy EP, et al. Administration of Rocuronium (Org 9426) By Continuous Infusion and Its Reversibility With Anticholinesterases. Anaesthesia. 1994;49(11):940-5. PubMed PMID: 7802236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases. AU - McCoy,E P, AU - Mirakhur,R K, AU - Maddineni,V R, AU - Loan,P B, AU - Connolly,F, PY - 1994/11/1/pubmed PY - 1994/11/1/medline PY - 1994/11/1/entrez SP - 940 EP - 5 JF - Anaesthesia JO - Anaesthesia VL - 49 IS - 11 N2 - The use of rocuronium (Org 9426) as a single bolus followed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide-oxygen and halothane. Neuromuscular block was monitored using train-of-four stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg-1 followed by an infusion adjusted manually to maintain the T1, the first response in the train-of-four, at 10% of control. Following cessation of rocuronium infusion the patients were either allowed to recover spontaneously (n = 10) or were given neostigmine 50 micrograms.kg-1 or edrophonium 1 mg.kg-1 at 10 or 25% recovery of the T1 (n = 10 for each group). Adequate antagonism was defined as attaining a sustained train-of-four ratio of 0.7. Rocuronium requirements showed marked variation among individual patients but were relatively constant in individual patients. The mean (SD) time to attain stable infusion rates was 17.4 (10.9) min. The mean (SD) requirement of rocuronium for steady state 90% block of T1 was 572 (190) micrograms.kg-1.h-1 (range 242-1104 micrograms.kg-1.h-1). The mean (SD) time to attain a train-of-four ratio of 0.7 in the group allowed to recover spontaneously was 36.1 (7.3) min. This interval was 7.5 (1.9), 9.3 (7.0), 4.6 (1.9) and 1.9 (0.9) min respectively in the groups receiving neostigmine at T1 of 10%, edrophonium at T1 of 10%, neostigmine at T1 of 25% and edrophonium at T1 of 25%. The antagonism was significantly faster in those reversed at 25% (p < 0.05). Three patients in the group receiving edrophonium at T1 of 10% and one in the group receiving neostigmine at T1 of 25% failed to attain a train-of-four ratio of 0.7. It is concluded that rocuronium can be administered as a continuous infusion for stable neuromuscular block. Neostigmine may be a more reliable antagonist of deep block, whereas edrophonium is advantageous when there is a greater spontaneous recovery. SN - 0003-2409 UR - https://www.unboundmedicine.com/medline/citation/7802236/Administration_of_rocuronium__Org_9426__by_continuous_infusion_and_its_reversibility_with_anticholinesterases_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0003-2409&amp;date=1994&amp;volume=49&amp;issue=11&amp;spage=940 DB - PRIME DP - Unbound Medicine ER -