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Equi-lasting doses of rocuronium, compared to mivacurium, result in improved neuromuscular blockade in patients undergoing gynecological laparoscopy

Des doses de durée équivalente de rocuronium, comparé au mivacurium, améliorent la curarisation chez des patientes qui subissent une laparoscopie gynécologique

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Abstract

Purpose

To compare equi-lasting doses of a short-acting (mivacurium) to an intermediate-acting (rocuronium) neuromuscular relaxant, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic alterations, adverse events and costs, in patients undergoing laparoscopic gynecological surgery.

Methods

Sixty patients were randomly allocated to receive either 0.2 mg·kg−1 (3 × ED95) mivacurium or 0.5 mg·kg−1 (1.7 × ED95) rocuronium, under propofol/fentanyl anesthesia. TI, first twitch of the train-of-four (TOF) and TOF ratio (T4:TI) were used to evaluate neuromuscular block using the Relaxometer® mechanomyograph. The trachea was intubated when TI was maximally suppressed. Neuromuscular block was maintained at 25% TI with equi-lasting doses of 0.075 mg·kg−1 mivacurium or 0. 15 mg·kg−1 rocuronium.

Results

Mean (min) ± SD mivacurium onset time (1.9 ± 0.4) was longer than that of rocuronium (1.3 ± 0.3). This did not yield a statistical difference in intubating conditions between the two groups. Interval 25–75% TI recovery and time to 0.8 TOF recovery were prolonged following rocuronium (11.9 ± 3.9, 52.6 ± 15.5 respectively) compared to mivacurium (6.7 ± 2.3, 39.2 ± 8. 1 respectively). More patients, 22/30, required mivacurium maintenance doses compared to 14/30 patients in the rocuronium group. Arterial blood pressure declined and 13/30 patients manifested erythema following mivacurium administration. The acquisition costs of rocuronium (6.93 Euro/patient) were 23% lower compared to mivacurium (8.96 Euro/patient).

Conclusion

Equi-lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with erythema, compared to mivacurium.

Résumé

Objectif

Comparer des doses de durée équivalente d’un myorelaxant à action brève, le mivacurium à celles d’un myorelaxant à effet intermédiaire, le rocuronium, quant aux conditions de l’intubation, l’efficacité, le nombre de doses de maintien, les changements hémodynamiques, les incidents et le coût, chez des patientes qui subissent une laparoscopie gynécologique.

Méthode

Soixante patientes ont été réparties au hasard et ont reçu, soit 0,2 mg·kg−1 (3 × ED95) de mivacurium, soit 0,5 mg·kg−1 (1,7 × ED95) de rocuronium, sous une anesthésie au propofol et au fentanyl. TI, première stimulation d’un train-de-quatre (TDQ) et le ratio du TDQ (T4: TI) ont permis d’évaluer la curarisation avec un relaxomécanomyographe. L’intubation a été réalisée après la suppression maximale de TI. La curarisation a été maintenue à 25 % de TI par des doses de durée équivalente de 0,075 mg·kg−1 de mivacurium ou de 0,15 mg·kg−1 de rocuronium.

Résultats

Le délai d’installation moyen (min) [± l’écart type] du mivacurium (1,9 ± 0,4) a été plus long que celui du rocuronium (1,3 ± 0,3). Ce résultat ne fournit pas de différence statistique intergroupe. La récupération dans l’intervalle 25–75 % TI et le temps nécessaire à la récupération à 0,8 du TDQ se sont prolongés avec le rocuronium (11,9 ± 3,9, 52,6 ± 15,5 respectivement) comparé au mivacurium (6,7 ± 2,3, 39,2 ± 8,1 respectivement). Un plus grand nombre de patientes, 22/30, ont eu besoin de doses de maintien de mivacurium, comparativement à 14/30 patientes ayant reçu du rocuronium. La tension artérielle a baissé et 13/30 patientes ontmanifesté de l’érythème à la suite de l’administration de mivacurium. Le coût d’achat du rocuronium (6,93 Euros/patiente) a été de 23 % plus bas que celui du mivacurium (8,96 Euros/patiente).

Conclusion

Des doses de durée équivalente de rocuronium, comparé au mivacurium, ont permis une intubation plus précoce, amélioré la stabilité hémodynamique, exigé des doses de maintien moins fréquentes et n’ont pas été associées à un érythème.

References

  1. 1

    Diefenbach C, Mellinghoff H, Lynch J, Buzello W. Mivacurium: dose-response relationship and administration by repeated injection or infusion. Anesth Analg 1992; 74: 420–3.

  2. 2

    Foldes FF, Nagashima H, Nguyen HD, Schiller WS, Mason MM, Ohta Y. The neuromuscular effects of ORG 9426 in patients receiving balanced anesthesia. Anesthesiology 1991; 75: 191–6.

  3. 3

    Viby-Mogensen J, Engbaek, Eriksson I, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.

  4. 4

    Moher D, Schulz KF, Altman DG, for the CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallelgroup randomised trials. Lancet 2001; 357: 1191–4.

  5. 5

    Rowaan CJ, Vandenbrom RHG, Wierda JMKH. The relaxometer: a complete and comprehensive computer-controlled neuromuscular transmission measurement system developed for clinical research on muscle relaxants. J Clin Monit 1993; 9: 38–44.

  6. 6

    Caldwell JE, Heier F, Kitts JB, Lynam DP, Fahey MR, Miller RD Comparison of the neuromuscular block induced by mivacurium, suxamethonium or atracurium during nitrous oxide-fentanyl anaesthesia. Br J Anaesth 1989; 63: 393–9.

  7. 7

    Wierda JMKH, De Wit APM, Kuizenga K, Agoston S. Clinical observations on the neuromuscular blocking action of ORG 9426, a new steroidal non-depolarizing agent. Br J Anaesth. 1990; 64: 521–3.

  8. 8

    Agoston S. Onset time and evaluation of intubating conditions: rocuronium in perspective. Eur J Anaesthesiol 1995; 12(Suppl. 11): 31–7.

  9. 9

    Lnmbnlk LM, De Wit APM, Wierda JMKH, Hennis PJ Agoston S. Dose-response relationship and time course of action of Org 9426. A new muscle relaxant of intermediate duration evaluated under various anaesthetic techniques. Anaesthesia 1991; 46: 907–11.

  10. 10

    Ding Y, Fredman B, White PF Use of mivacurium during laparoscopic surgery: effect of reversal drugs on postoperative recovery. Anesth Analg 1994; 78: 450–4.

  11. 11

    Løvstad RZ, Thagaard KS, Berner NS, Raeder JC Neostigmine 50 μg kg−1 with glycopyrrolate increases postoperative nausea in women after laparoscopic gynaecological surgery. Acta Anaesthesiol Scand 2001; 45: 495–500.

  12. 12

    Fang J, Joshi GP, White PF. Comparison of rocuronium and mivacurium to succinylcholine during outpatient laparoscopic surgery. Anesth Analg 1996; 82: 994–8.

  13. 13

    Goldhill DR, Whitehead JP, Emmott RS, Griffith AP, Bracey BJ, Flynn PJ. Neuromuscular and clinical effects of mivacurium chloride in healthy adult patients during 1090 nitrous oxide-enflurane anaesthesia. Br J Anaesth 1991; 67: 289–95.

  14. 14

    Maddineni VR, Mirakhur RK, McCoy EP, Fee JPH, Clarke RSJ. Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium. Anaesthesia 1993; 48: 940–5.

  15. 15

    Savarese JJ, Ali HH, Basta SJ, et al. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U). Anesthesiology 1988; 68: 723–32.

  16. 16

    Meistelman C, Plaud B, Donati F. Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth 1992; 39: 665–9.

  17. 17

    Choi WW, Mehta MP, Murray DJ, et al. Neuromuscular and cardiovascular effects of mivacurium chloride in surgical patients receiving nitrous oxide-narcotic or nitrous oxide-isoflurane anaesthesia. Can J Anaesth 1989; 36: 641–50.

  18. 18

    Savarese JJ, Ali HH, Basta SJ, et al. The cardiovascular effects of mivacurium chloride (BW B1090U) in patients receiving nitrous oxideopiate-barbiturate anesthesia. Anesthesiology 1989; 70: 386–94.

  19. 19

    McCoy EP, Maddineni VR, Elliott P, Mirakhur RK, Carson IW, Cooper RA Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium. Can J Anaesth 1993; 40: 703–8.

  20. 20

    Levy JH, Davis GK, Duggan J, Szlam F. Determination of the haemodynamics and histamine release of rocuronium (Org 9426) when administered in increased doses under N2O/O2-sufentanil anesthesia. Anesth Analg 1994; 78: 318–21.

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Correspondence to Ashraf A. Dahaba.

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Dahaba, A.A., Schweitzer, E., Fitzgerald, R.D. et al. Equi-lasting doses of rocuronium, compared to mivacurium, result in improved neuromuscular blockade in patients undergoing gynecological laparoscopy. Can J Anesth 48, 1084–1090 (2001). https://doi.org/10.1007/BF03020374

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Keywords

  • Rocuronium
  • Neuromuscular Blockade
  • Neuromuscular Block
  • Mivacurium
  • Adductor Pollicis