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Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia

Un bloc neuromusculaire avec du vécuronium réduit l’index des potentiels évoqués auditifs d’extraction rapide pendant l’anesthésie en état d’équilibre

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Abstract

Purpose

During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (A-line ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon.

Methods

Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (FETISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg·kg−1, 0.1 mg·kg−1, 0.2 mg·kg−1 or saline was administered in a randomized, double-blind design. The AAI and bispectral index (Blhx) were monitored throughout the study and analyzed off-line.

Results

Blhx was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg·kg−1 did not differ significantly from the corresponding mean recorded from 15 min to 20 min after FETISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg·kg−1 or 0.2 mg·kg−1, AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017).

Conclusions

Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while Blhx is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation.

Résumé

Objectif

Pendant le monitorage clinique, le vécuronium a semblé réduire, jusqu’à un certain point, l’index des potentiels évoqués d’extraction rapide (A-line ARX index ou AAI). Nous avons voulu analyser ce phénomène par une étude prospective et randomisée.

Méthode

Quarante patients adultes devant subir une opération réglée ont participé à l’étude. Après l’intubation endotrachéale, l’anesthésie a été maintenue avec une concentration d’isoflurane téléexpiratoire (FETISO) de 1,0% pendant 20 min, puis une dose de 10 mL de vécuronium, à 0,05 mg·kg−1, 0,1 mg·kg−1 ou 0,2 mg·kg−1, ou de soluté physiologique, a été administrée de façon randomisée et en double aveugle. L’AAI et l’index bispectral (Bihx) ont été enregistrés tout au long de l’étude et analysé en différé.

Résultats

Le Bihx n’était pas modifié après l’administration de solution saline ou de vécuronium. La moyenne des valeurs centrales d’AAI (par patient), notée de deux à dix minutes après l’administration de solution salée ou de 0,05 mg·kg−1 de vécuronium, ne différait pas de façon significative de la moyenne correspondante notée de 15 à 20 min après le maintien de la FETISO à 1,0 % (P = 0,678; 0,169), même si après l’administration de 0,1 mg·kg−1 ou de 0,2 mg·kg−1, l’AAI a été réduit de 18,3, 18,0 à 14,8, 13,4 (P = 0,016, 0,017).

Conclusion

Le bloc neuromusculaire avec du vécuronium réduit l’AAI pendant l’anesthésie en état d’équilibre sans stimuli chirurgical, mais le Bihx n’est pas modifié. Les valeurs seuil de l’AAI des événements chirurgicaux doivent être déterminées selon le niveau de bloc neuromusculaire pendant le monitorage de la profondeur de l’anesthésie/sédation.

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Author information

Correspondence to Sheng-Jin Ge.

Additional information

This work was attributed to the Department of Anesthesiology, Shanghai First People’s Hospital.

Financial support was received from the Department of Anesthesiology, Shanghai First People’s Hospital.

There are no commercial or non-commercial affiliations that are or may be perceived to be a conflict of interest with this work.

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Ge, S., Zhuang, X., He, R. et al. Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia. Can J Anesth 50, 1017–1022 (2003). https://doi.org/10.1007/BF03018365

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Keywords

  • Vecuronium
  • Neuromuscular Blockade
  • Neuromuscular Block
  • Mivacurium
  • Bispectral Index