Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-20T04:40:17.579Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of neuromuscular and haemodynamic effects of cisatracurium and vecuronium under sevoflurane–remifentanil anaesthesia in elderly patients

Published online by Cambridge University Press:  28 January 2005

G. T. Keleş ,
A. Yentür ,
Z. Çavuş  and
M. Sakarya
G. T. Keleş
Affiliation:
University of Celal Bayar, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Manisa, Turkey
A. Yentür
Affiliation:
University of Celal Bayar, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Manisa, Turkey
Z. Çavuş
Affiliation:
University of Celal Bayar, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Manisa, Turkey
M. Sakarya
Affiliation:
University of Celal Bayar, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Manisa, Turkey
Get access

Abstract

Summary

Background and objective: Neuromuscular block times, quality of muscle relaxation for tracheal tube insertion, and the haemodynamic effects after cisatracurium and vecuronium under sevoflurane–remifentanil anaesthesia were compared in elderly patients.

Methods: The study was performed in 40 patients over 65 yr of age. Anaesthesia was induced with thiopental, and maintained with sevoflurane in N2O/O2 and remifentanil. Cisatracurium 0.15 mg kg−1 or vecuronium 0.1 mg kg−1 were administered after induction. Intubation was attempted when neuromuscular block was 95%. Onset time, clinical duration of action, recovery index, spontaneous recovery time and tracheal intubation conditions were assessed. Haemodynamic parameters were also monitored.

Results: The average ages of the patients were 72.5 ± 5.1 and 73.6 ± 6.3 in the cisatracurium and vecuronium groups, respectively. Onset time was significantly shorter after vecuronium, 158 ± 34 s vs. 200 ± 50 s, respectively. Recovery index was significantly shorter after cisatracurium, 19.5 ± 7.5 s vs. 33.7 ± 18.6 s (P < 0.05). Clinical duration and spontaneous recovery time were similar in both groups as well as haemodynamic variables.

Conclusions: In elderly patients, vecuronium has a faster onset time while cisatracurium has a shorter recovery index under sevoflurane–remifentanil anaesthesia.

Keywords

NEUROMUSCULAR BLOCKING AGENTS, vecuronium, cisatracurium, action duration, recoveryANAESTHESIA GENERAL, remifentanil, thiopental, sevofluraneAGED
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 11 , November 2004 , pp. 877 - 881
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth 2001; 87: 608–624.Google Scholar
Delbono O. Neural control of aging skeletal muscle. Aging Cell 2003; 2: 21–29.Google Scholar
Vandervoort AA. Aging of the human neuromuscular system. Muscle Nerve 2002; 25: 17–25.Google Scholar
Viby-Mogensen J, Engbaek J, Eriksson LI, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.Google Scholar
Kelly E, Lien CA, Savarese JJ, et al. Depression of neuromuscular function in a patient during desflurane anesthesia. Anesth Analg 1993; 76: 868–871.Google Scholar
Miller RD, Way WL, Dolan WM, et al. The dependence of pancuronium- and d-tubocurarine-induced neuromuscular blockades on alveolar concentrations of halothane and forane. Anesthesiology 1972; 37: 573–575.Google Scholar
Miller RD, Crique M, Eger EI. Duration of halothane anesthesia and neuromuscular blockade with d-tubocurarine. Anesthesiology 1976; 44: 206–208.Google Scholar
Vanlinthout LE, Booij LH, van Egmond J, Robertson EN. Effects of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium. Br J Anaesth 1996; 76: 389–395.Google Scholar
Miller RD, Rupp SM, Fisher DM, Cronnelly R, Fahey MR, Sohn YJ. Clinical pharmacology of vecuronium and atracurium. Anaesthesiology 1984; 61: 444–453.Google Scholar
Cannon JE, Fahey MR, Castagnoli KP, et al. Continuous infusion of vecuronium: the effect of anesthetics agents. Anesthesiology 1987; 67: 503–506.Google Scholar
Shanks CA, Fragen RJ, Ling D. Continuous intravenous infusion of rocuronium (ORG 9426) in patients receiving balanced, enflurane, or isoflurane anesthesia. Anesthesiology 1993; 78: 649–654.Google Scholar
Doherty TJ. Aging and sarcopenia. J Appl Physiol 2003; 95: 1717–1727.Google Scholar
Naguib M, Flood P, McArdle JJ, Brenner HR. Advances in neurobiology of the neuromuscular junction: implications for the anesthesiologist. Anesthesiology 2002; 96: 202–231.Google Scholar
De Wolf AM, Freeman JA, Scott VL, et al. Pharmacokinetics and pharmacodynamics of cisatracurium in patients with end-stage liver disease undergoing liver transplantation. Br J Anaesth 1996; 76: 624–628.Google Scholar
Ornstein E, Lien CA, Matteo RS, et al. Pharmacodynamics and pharmacokinetics of cisatracurium in geriatric surgical patients. Anesthesiology 1996; 84: 520–525.Google Scholar
Sorooshran SS, Stafford MA, Eastwood NB, et al. Pharmacokinetics and pharmacodynamics of cisatracurium in young and elderly adult patients. Anesthesiology 1996; 84: 1083–1091.Google Scholar
Boyd AH, Eastwood NB, Parker CJR, et al. Pharmacodynamics of the 1 R cis-1′R cis isomer of atracurium (51W89) in health and chronic renal failure. Br J Anaesth 1995; 74: 400–404.Google Scholar
Kitajima T, Ishii K, Ogata H. Edrophonium as an antagonist of vecuronium-induced neuromuscular block in the elderly. Anaesthesia 1995; 50: 359–361.Google Scholar
Pühringer FK, Heier T, Dodgson M, et al. Double-blind comparison of the variability in spontaneous recovery of cisatracurium and vecuronium induced neuromuscular block in adult and elderly patients. Acta Anaesthesiol Scand 2002; 46: 364–371.Google Scholar
Lien CA, Matteo RS, Ornstein E, Schwartz AE, Diaz J. Distribution, elimination, and action of vecuronium in the elderly. Anesth Analg 1991; 73: 39–42.Google Scholar
Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology 2003; 98: 1042–1048.Google Scholar