Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-26T19:09:57.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Acute desflurane or sevoflurane exposure on a previously stabilized atracurium-induced neuromuscular block

Published online by Cambridge University Press:  24 May 2006

M. Beaussier ,
A. Boughaba ,
E. Schiffer ,
B. Debaene ,
A. Lienhart  and
A. d'Hollander
M. Beaussier
Affiliation:
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France
A. Boughaba
Affiliation:
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France
E. Schiffer
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, Poitiers, France
B. Debaene
Affiliation:
Hôpital Cantonal Universitaire, Department of Anaesthesia and Intensive Care, Genève, Switzerland
A. Lienhart
Affiliation:
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France
A. d'Hollander
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, Poitiers, France
Get access

Abstract

Summary

Background and objective: The aim of this prospective study was to compare the effect of the administration of desflurane or sevoflurane to a fixed neuromuscular block. Methods: After written consent, 12 patients were anaesthetized with propofol and sufentanil. Atracurium was administered via a continuous infusion in order to obtain 85% twitch depression of the control value assessed by repeated accelerometric stimulation at the adductor pollicis. Once stabilized over the course of 30 min, propofol was discontinued and either desflurane (n = 6) or sevoflurane (n = 6) was delivered at 1 MAC in a mixture of 50% O2 in air. Study parameters were the magnitude and the time of twitch height variations. Results are presented in mean ± SD. Result: Exposure to halogenated agents led to a significant reduction in twitch height with similar magnitude between the two agents. However, interaction with desflurane showed an initial and transient rise (35 ± 22%) in twitch height before subsequent depression occurred. The time to reach 50% of the signal depression in the desflurane group was significantly delayed (25 ± 7 vs. 11 ± 4 min in the sevoflurane group; P < 0.01). Conclusions: On a stable neuromuscular block elicited by continuous infusion of atracurium, the abrupt administration of desflurane or sevoflurane reduces the accelerometric responses of the adductor pollicis in a similar way. This potentiating effect is produced faster after sevoflurane than after desflurane. With desflurane, a biphasic effect (of a transient and moderate increase followed by depression of the signal) was recorded.

Keywords

ANAESTHETICS INHALATION, desflurane, sevofluraneNEUROMUSCULAR NON-DEPOLARIZING AGENTS, atracuriumMONITORING INTRAOPERATIVE, neuromuscular functionDRUG INTERACTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 9 , September 2006 , pp. 755 - 759
Copyright
2006 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

Eger II E, Eisenkraft J, Weiskopf R. Neuromuscular effects of inhaled anesthetics. In: Eger IIE, ed. The Pharmacology of Inhaled Anesthetics. Sponsored by the Danmiller Memorial Educational Foundation, Educational Grant from Baxter Healthcare Corporation, 2003: 133–145.
Baurain M, d'Hollander A, Melot C, Dernovoi B, Barvais L. Effects of residual concentrations of isoflurane on the reversal of vecuronium-induced neuromuscular blockade. Anesthesiology 1991; 74: 474–478.Google Scholar
Cannon J, Fahey M, Castagnoli Ket al. Continuous infusion of vecuronium: the effect of anesthetic agents. Anesthesiology 1987; 67: 503–506.Google Scholar
Meretoja O, Wirtavuori K, Taivainen T, Olkkola K. Time course of potentiation of mivacurium by halothane and isoflurane in children. Br J Anaesth 1996; 76: 235–238.Google Scholar
Yasuda N, Targ A, Eger II E. Solubility of I-653, sevoflurane, isoflurane, and halothane in human tissues. Anesth Analg 1989; 69: 370–373.Google Scholar
Viby-Mogensen J, Engbaek J, Eriksson Let al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.Google Scholar
Vanlinthout L, Booij L, van Egmond J, Robertson E. Effect 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
Wulf H, Kahl M, Ledowski T. Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia. Br J Anaesth 1998; 80: 308–312.Google Scholar
Hemmerling T, Schuettler J, Schwilden H. Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol. Can J Anesth 2001; 48: 532–537.Google Scholar
Wright P, Hart P, Lau Met al. The magnitude and time course of vecuronium potentiation by desflurane versus isoflurane. Anesthesiology 1995; 82: 404–411.Google Scholar
Yasuda N, Lockhart S, Eger II Eet al. Kinetics of desflurane, isoflurane, and halothane in humans. Anesthesiology 1991; 74: 489–498.Google Scholar
Violet J, Downie D, Nakisa R, Lieb W, Franks N. Differential sensitivities of mammalian neuronal and muscle nicotinic acetylcholine receptors to general anesthetics. Anesthesiology 1997; 86: 866–874.Google Scholar
Paul M, Fokt R, Kindler C, Dipp N, Yost C. Characterization of the interactions between volatile anesthetics and neuromuscular blockers at the muscle nicotinic acetylcholine receptor. Anesth Analg 2002; 95: 362–367.Google Scholar
Parker C, Hunter J, Snowdon S. Effect of age, sex and anaesthetic technique on pharmacokinetics of atracurium. Br J Anaesth 1992; 69: 439–443.Google Scholar