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Drug‐administration sequence of target‐controlled propofol and remifentanil influences the onset of rocuronium. A double‐blind, randomized trial
Author(s) -
NA H. S.,
HWANG J. W.,
PARK S. H.,
OH A. Y.,
PARK H. P.,
JEON Y. T.,
DO S. H.
Publication year - 2012
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2012.02648.x
Subject(s) - rocuronium , remifentanil , medicine , propofol , anesthesia
Background Remifentanil is known to cause bradycardia and hypotension, as well as the decreases of cardiac output ( CO ). We hypothesized that hemodynamic suppression by remifentanil would affect the onset time of rocuronium. This study investigated whether the onset of rocuronium was influenced by the drug‐administration sequence during induction of anesthesia with target‐controlled infusion of propofol and remifentanil. Methods Healthy adult patients ( n = 126) undergoing elective surgery under general anesthesia were randomized into two groups according to drug‐administration sequence. In R emi‐ P ro‐ R ocu group ( n = 62), remifentanil was infused first, followed by propofol. Then, rocuronium was administered lastly. In P ro‐ R ocu‐ R emi group ( n = 64), propofol, rocuronium, and remifentanil were given in that order. As a primary outcome, the onset time of rocuronium was measured. Mean arterial pressure ( MAP ), heart rate ( HR ), CO , and stroke volume were recorded before anesthesia ( T 1), at injection of rocuronium ( T 2), immediately before and after intubation ( T 3 and T 4). Results In R emi‐ P ro‐ R oc group, the onset of rocuronium was delayed significantly compared with P ro‐ R ocu‐ R emi group [median (interquartile range); 130 (105–150) vs. 90 (71–100) s, P < 0.001]. At the time of rocuronium injection ( T 2), MAP , HR , and CO were significantly lower in R emi‐ P ro‐ R ocu group than P ro‐ R ocu‐ R emi group ( P < 0.001). Conclusion The onset time of rocuronium is prolonged significantly by early administration of remifentanil during target‐controlled infusion of propofol and remifentanil, and it may be due to the decreased CO caused by remifentanil.