Reversal of rapacuronium block during propofol versus sevoflurane anesthesia

Tian J. Zhou, Jun Tang, Paul F. White, Girish P. Joshi, Ronald Wender, Mark T. Murphy, Jen W. Chiu, Tom Webb

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

We studied the antagonism of rapacuronium with edrophonium-atropine during propofol- or sevoflurane-based anesthesia in 60 healthy outpatients. After the induction of anesthesia with standardized doses of propofol and fentanyl, rapacuronium 1.5 mg/kg was administered to facilitate tracheal intubation. Patients were randomized to receive either a propofol infusion (100 μg · kg-1 · min-1) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular block was monitored by using electromyography at the wrist and reversed with edrophonium 1.0 mg/kg and atropine 0.015 mg/kg when the first twitch (T1) response of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol (13.1 ± 3.6 min) and sevoflurane (13.7 ± 4.4 min) anesthesia. The time from 25% T1 recovery to TOF ratio of 0.8 was also similar with propofol (3.4 ± 2.1 min) and sevoflurane (5.9 ± 8.7 min) (P > 0.05). Although none of the patients in the propofol group required more than 9 min to achieve a TOF ratio of 0.8, two patients receiving sevoflurane required 31 min and 37 min. Adequate antagonism of rapacuronium block with edrophonium can be achieved within 10 min during propofol anesthesia. However, more prolonged recovery may occur in the presence of sevoflurane. Implications: We studied the reversal of rapacuronium-induced block with edrophonium and found that the residual rapacuronium block can be readily antagonized during propofol-based anesthesia. However, reversal of rapacuronium appears to be less predictable during sevoflurane-based anesthesia.

Original languageEnglish (US)
Pages (from-to)689-693
Number of pages5
JournalAnesthesia and Analgesia
Volume90
Issue number3
StatePublished - 2000

Fingerprint

Propofol
Anesthesia
Edrophonium
Atropine
Delayed Emergence from Anesthesia
Neuromuscular Blockade
rapacuronium
sevoflurane
Nitrous Oxide
Electromyography
Fentanyl
Wrist
Intubation
Outpatients
Maintenance

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Zhou, T. J., Tang, J., White, P. F., Joshi, G. P., Wender, R., Murphy, M. T., ... Webb, T. (2000). Reversal of rapacuronium block during propofol versus sevoflurane anesthesia. Anesthesia and Analgesia, 90(3), 689-693.

Reversal of rapacuronium block during propofol versus sevoflurane anesthesia. / Zhou, Tian J.; Tang, Jun; White, Paul F.; Joshi, Girish P.; Wender, Ronald; Murphy, Mark T.; Chiu, Jen W.; Webb, Tom.

In: Anesthesia and Analgesia, Vol. 90, No. 3, 2000, p. 689-693.

Research output: Contribution to journalArticle

Zhou, TJ, Tang, J, White, PF, Joshi, GP, Wender, R, Murphy, MT, Chiu, JW & Webb, T 2000, 'Reversal of rapacuronium block during propofol versus sevoflurane anesthesia', Anesthesia and Analgesia, vol. 90, no. 3, pp. 689-693.
Zhou TJ, Tang J, White PF, Joshi GP, Wender R, Murphy MT et al. Reversal of rapacuronium block during propofol versus sevoflurane anesthesia. Anesthesia and Analgesia. 2000;90(3):689-693.
Zhou, Tian J. ; Tang, Jun ; White, Paul F. ; Joshi, Girish P. ; Wender, Ronald ; Murphy, Mark T. ; Chiu, Jen W. ; Webb, Tom. / Reversal of rapacuronium block during propofol versus sevoflurane anesthesia. In: Anesthesia and Analgesia. 2000 ; Vol. 90, No. 3. pp. 689-693.
@article{040408828d2a41e3b622ae709b68bee0,
title = "Reversal of rapacuronium block during propofol versus sevoflurane anesthesia",
abstract = "We studied the antagonism of rapacuronium with edrophonium-atropine during propofol- or sevoflurane-based anesthesia in 60 healthy outpatients. After the induction of anesthesia with standardized doses of propofol and fentanyl, rapacuronium 1.5 mg/kg was administered to facilitate tracheal intubation. Patients were randomized to receive either a propofol infusion (100 μg · kg-1 · min-1) or sevoflurane (1.0{\%}, end-tidal) in combination with nitrous oxide 66{\%} for maintenance of anesthesia. Neuromuscular block was monitored by using electromyography at the wrist and reversed with edrophonium 1.0 mg/kg and atropine 0.015 mg/kg when the first twitch (T1) response of the train-of-four (TOF) stimulation recovered to 25{\%} of the baseline value. The clinical duration of action (i.e., time to 25{\%} T1 recovery) was similar during both propofol (13.1 ± 3.6 min) and sevoflurane (13.7 ± 4.4 min) anesthesia. The time from 25{\%} T1 recovery to TOF ratio of 0.8 was also similar with propofol (3.4 ± 2.1 min) and sevoflurane (5.9 ± 8.7 min) (P > 0.05). Although none of the patients in the propofol group required more than 9 min to achieve a TOF ratio of 0.8, two patients receiving sevoflurane required 31 min and 37 min. Adequate antagonism of rapacuronium block with edrophonium can be achieved within 10 min during propofol anesthesia. However, more prolonged recovery may occur in the presence of sevoflurane. Implications: We studied the reversal of rapacuronium-induced block with edrophonium and found that the residual rapacuronium block can be readily antagonized during propofol-based anesthesia. However, reversal of rapacuronium appears to be less predictable during sevoflurane-based anesthesia.",
author = "Zhou, {Tian J.} and Jun Tang and White, {Paul F.} and Joshi, {Girish P.} and Ronald Wender and Murphy, {Mark T.} and Chiu, {Jen W.} and Tom Webb",
year = "2000",
language = "English (US)",
volume = "90",
pages = "689--693",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Reversal of rapacuronium block during propofol versus sevoflurane anesthesia

AU - Zhou, Tian J.

AU - Tang, Jun

AU - White, Paul F.

AU - Joshi, Girish P.

AU - Wender, Ronald

AU - Murphy, Mark T.

AU - Chiu, Jen W.

AU - Webb, Tom

PY - 2000

Y1 - 2000

N2 - We studied the antagonism of rapacuronium with edrophonium-atropine during propofol- or sevoflurane-based anesthesia in 60 healthy outpatients. After the induction of anesthesia with standardized doses of propofol and fentanyl, rapacuronium 1.5 mg/kg was administered to facilitate tracheal intubation. Patients were randomized to receive either a propofol infusion (100 μg · kg-1 · min-1) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular block was monitored by using electromyography at the wrist and reversed with edrophonium 1.0 mg/kg and atropine 0.015 mg/kg when the first twitch (T1) response of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol (13.1 ± 3.6 min) and sevoflurane (13.7 ± 4.4 min) anesthesia. The time from 25% T1 recovery to TOF ratio of 0.8 was also similar with propofol (3.4 ± 2.1 min) and sevoflurane (5.9 ± 8.7 min) (P > 0.05). Although none of the patients in the propofol group required more than 9 min to achieve a TOF ratio of 0.8, two patients receiving sevoflurane required 31 min and 37 min. Adequate antagonism of rapacuronium block with edrophonium can be achieved within 10 min during propofol anesthesia. However, more prolonged recovery may occur in the presence of sevoflurane. Implications: We studied the reversal of rapacuronium-induced block with edrophonium and found that the residual rapacuronium block can be readily antagonized during propofol-based anesthesia. However, reversal of rapacuronium appears to be less predictable during sevoflurane-based anesthesia.

AB - We studied the antagonism of rapacuronium with edrophonium-atropine during propofol- or sevoflurane-based anesthesia in 60 healthy outpatients. After the induction of anesthesia with standardized doses of propofol and fentanyl, rapacuronium 1.5 mg/kg was administered to facilitate tracheal intubation. Patients were randomized to receive either a propofol infusion (100 μg · kg-1 · min-1) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular block was monitored by using electromyography at the wrist and reversed with edrophonium 1.0 mg/kg and atropine 0.015 mg/kg when the first twitch (T1) response of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol (13.1 ± 3.6 min) and sevoflurane (13.7 ± 4.4 min) anesthesia. The time from 25% T1 recovery to TOF ratio of 0.8 was also similar with propofol (3.4 ± 2.1 min) and sevoflurane (5.9 ± 8.7 min) (P > 0.05). Although none of the patients in the propofol group required more than 9 min to achieve a TOF ratio of 0.8, two patients receiving sevoflurane required 31 min and 37 min. Adequate antagonism of rapacuronium block with edrophonium can be achieved within 10 min during propofol anesthesia. However, more prolonged recovery may occur in the presence of sevoflurane. Implications: We studied the reversal of rapacuronium-induced block with edrophonium and found that the residual rapacuronium block can be readily antagonized during propofol-based anesthesia. However, reversal of rapacuronium appears to be less predictable during sevoflurane-based anesthesia.

UR - http://www.scopus.com/inward/record.url?scp=0034048934&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034048934&partnerID=8YFLogxK

M3 - Article

C2 - 10702458

AN - SCOPUS:0034048934

VL - 90

SP - 689

EP - 693

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 3

ER -