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Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases
Author(s) -
McCOY E.P.,
MIRAKHUR R.K.,
MADDINENI V.R.,
LOAN P.B.,
CONNOLLY F.
Publication year - 1994
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1994.tb04308.x
Subject(s) - medicine , rocuronium , anesthesia , administration (probate law) , intubation , law , political science
Summary 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 T 1 , 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 50μg.kg ‐1 or edrophonium 1 mg.kg ‐1 at 10 or 25% recovery of the T 1 (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 T 1 was 572 (190) μg.kg ‐1 .h ‐1 (range 242–1104 μg.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 T 1 of 10%, edrophonium at T 1 of 10%, neostigmine at T 1 of 25% and edrophonium at T 1 of 25%. The antagonism was significantly faster in those reversed at 25% (p < 0.05). Three patients in the group receiving edrophonium at T 1 of 10% and one in the group receiving neostigmine at T 1 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.