Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-26T13:36:15.171Z Has data issue: false hasContentIssue false
  • English
  • Français

Muscle relaxants in neurosurgical anaesthesia: a critical appraisal

Published online by Cambridge University Press:  12 July 2005

P. Hans  and
V. Bonhomme
P. Hans
Affiliation:
Liege University Hospital, University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Liege, Belgium
V. Bonhomme
Affiliation:
Liege University Hospital, University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Liege, Belgium
Get access

Abstract

Summary

The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of neurosurgery including the advent of new surgical techniques, the evolution of anaesthesia having the benefit of new drugs and devices, and the rationale for using muscle relaxants balanced against their potential side-effects and possible pharmacodynamic alterations in neurosurgical patients.

Keywords

ANAESTHESIA, GENERAL anaesthesia, inhalationNEUROMUSCULAR BLOCKING AGENTSSPECIALTIES, SURGICAL, neurosurgery
Type
Review
Information
European Journal of Anaesthesiology , Volume 20 , Issue 8 , September 2003 , pp. 600 - 605
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Durieux M. Changes in neurosurgery: implications for neuroanaesthesia. Cur Opin Anaesthesiol 2001; 14: 467–468.Google Scholar
Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg 1998; 86: 45–49.Google Scholar
Adams DC, Emerson RG, Heyer EJ, et al. Monitoring of intraoperative motor-evoked potentials under conditions of controlled neuromuscular blockade. Anesth Analg 1993; 77: 913–918.Google Scholar
Sloan TB, Erian R. Effect of vecuronium-induced neuromuscular blockade on cortical motor evoked potentials. Anesthesiology 1993; 78: 966–973.Google Scholar
Sloan TB, Erian R. Effect of atracurium-induced neuromuscular block on cortical motor-evoked potentials. Anesth Analg 1993; 76: 979–984.Google Scholar
Maertens de Noordhout A, Born JD, Hans P, Remacle JM, Delwaide PJ. Intraoperative localisation of the primary motor cortex using single electrical stimuli. J Neurol Neurosurg Psychiatry 1996; 60: 442–444.Google Scholar
Lennon RL, Hosking MP, Daube JR, Welna JO. Effect of partial neuromuscular blockade on intraoperative electromyography in patients undergoing resection of acoustic neuromas. Anesth Analg 1992; 75: 729–733.Google Scholar
Chan KL, Chan MTV, Gin T, Lam MK, Tong M. Is low level neuromuscular block compatible with intraoperative facial nerve monitoring? J Neurosurg Anesth 2001; 13: 375.Google Scholar
Modica PA, Tempelhoff R. Intracranial pressure during induction of anaesthesia and tracheal intubation with etomidate-induced EEG burst suppression. Can J Anaesth 1992; 39: 236–241.Google Scholar
Lanier WL, Albrecht RF II, Laizzo PA. Divergence of intracranial and central venous pressures in lightly anesthetized, tracheally intubated dogs that move in response to a noxious stimulus. Anesthesiology 1996; 84: 605–613.Google Scholar
Matteo RS, Pua EK, Khambatta HJ, Spector S. Cerebrospinal fluid levels of d-tubocurarine in man. Anesthesiology 1977; 46: 396–399.Google Scholar
Segredo V, Matthay MA, Sharma ML, Gruenke LD, Caldwell JE, Miller RD. Prolonged neuromuscular blockade after long-term administration of vecuronium in two critically ill patients. Anesthesiology 1990; 72: 566–570.Google Scholar
Eddleston JM, Harper NJ, Pollard BJ, Edwards D, Gwinnutt CL. Concentrations of atracurium and laudanosine in cerebrospinal fluid and plasma during intracranial surgery. Br J Anaesth 1989; 63: 525–530.Google Scholar
Fahey MR, Canfell PC, Taboada T, Hosobuchi Y, Miller RD. Cerebrospinal fluid concentrations of laudanosine after administration of atracurium. Br J Anaesth 1990; 64: 105–106.Google Scholar
Tassonyi E, Fuchs-Buder T, Chiodini FC, et al. Cerebrospinal fluid concentrations of atracurium in neurosurgical patients. Br J Anaesth 1997; 78: A246.Google Scholar
Dasheiff RM. d-Tubocurarine causes neuronal death when injected direcly into rat brain. Exp Neurol 1985; 89: 172–188.Google Scholar
Goonewardene TW, Sentheshanmuganathan S, Kamalanathan S, Kanagasunderam R. Accidental subarachnoid injection of gallamine. A case report. Br J Anaesth 1975; 47: 889–893.Google Scholar
Mesry S, Baradaran J. Accidental intrathecal injection of gallamine triethiodide. Anaesthesia 1974; 29: 301–304.Google Scholar
Peduto VA, Gungui P, Di Martino MR, Napoleone M. Accidental subarachnoid injection of pancuronium. Anesth Analg 1989; 69: 516–517.Google Scholar
Szenohradszky J, Trevor AJ, Bickler P, et al. Central nervous system effects of intrathecal muscle relaxants in rats. Anesth Analg 1993; 76: 1304–1309.Google Scholar
Cardone C, Szenohradszky J, Yost S, Bickler PE. Activation of brain acetylcholine receptors by neuromuscular blocking drugs. A possible mechanism of neurotoxicity. Anesthesiology 1994; 80: 1155–1161.Google Scholar
Chiodini FC, Tassonyi E, Fuchs-Buder T, Fathi M, Bertrand D, Muller D. Effects of neuromuscular blocking agents on excitatory transmission and gamma-aminobutyric acidA-mediated inhibition in the rat hippocampal slice. Anesthesiology 1998; 88: 1003–1013.Google Scholar
Chiodini F, Charpantier E, Muller D, Tassonyi E, Fuchs-Buder T, Bertrand D. Blockade and activation of the human neuronal nicotinic acetylcholine receptors by atracurium and laudanosine. Anesthesiology 2001; 94: 643–651.Google Scholar
Martyn JA, White DA, Gronert GA, Jaffe RS, Ward JM. Up-and-down regulation of skeletal muscle acetylcholine receptors. Effects on neuromuscular blockers. Anesthesiology 1992; 76: 822–843.Google Scholar
Raines A, Standaert FG. Pre- and postjunctional effects of diphenylhydantoin at the cat soleus neuromuscular junction. J Pharmacol Exp Ther 1966; 153: 361–366.Google Scholar
Melton AT, Antognini JF, Gronert GA. Prolonged duration of succinylcholine in patients receiving anticonvulsants: evidence for mild up-regulation of acetylcholine receptors? Can J Anaesth 1993; 40: 939–942.Google Scholar
Kuntzman R. Drugs and enzyme induction. Annu Rev Pharmacol 1969; 9: 21–36.Google Scholar
Nation RL, Evans AM, Milne RW. Pharmacokinetic drug interactions with phenytoin (Part II). Clin Pharmacokinet 1990; 18: 131–150.Google Scholar
Abramson FP, Lutz MP. The effects of phenytoin dosage on the induction of alpha 1-acid glycoprotein and antipyrine clearance in the dog. Eur J Drug Metab Pharmacokinet 1986; 11: 135–143.Google Scholar
Kim CS, Arnold FJ, Itani MS, Martyn JA. Decreased sensitivity to metocurine during long-term phenytoin therapy may be attributable to protein binding and acetylcholine receptor changes. Anesthesiology 1992; 77: 500–506.Google Scholar
Alderdice MT, Trommer BA. Differential effects of the anticonvulsants phenobarbital, ethosuximide and carbamazepine on neuromuscular transmission. J Pharmacol Exp Ther 1980; 215: 92–96.Google Scholar
Gage PW, Lonergan M, Torda TA. Presynaptic and post-synaptic depressant effects of phenytoin sodium at the neuromuscular junction. Br J Pharmacol 1980; 69: 119–121.Google Scholar
Platt PR, Thackray NM. Phenytoin-induced resistance to vecuronium. Anaesth Intensive Care 1993; 21: 185–191.Google Scholar
Kremer JM, Wilting J, Janssen LH. Drug binding to human alpha-1-acid glycoprotein in health and disease. Pharmacol Rev 1988; 40: 1–47.Google Scholar
Garcia E, Calvo R, Rodriguez-Sasiain JM, Jimenez R, Troconiz IF, Suarez E. Resistance to atracurium in rats with experimental inflammation: role of protein binding. Acta Anaesthesiol Scand 1995; 39: 1019–1023.Google Scholar
Alloul K, Whalley DG, Shutway F, Ebrahim Z, Varin F. Pharmacokinetic origin of carbamazepine-induced resistance to vecuronium neuromuscular blockade in anesthetized patients. Anesthesiology 1996; 84: 330–339.Google Scholar
Hans P, Ledoux D, Bonhomme V, Brichant JF. Effect of plasma anticonvulsant level on pipecuronium-induced neuromuscular blockade: preliminary results. J Neurosurg Anesthesiol 1995; 7: 254–258.Google Scholar
Lanier WL, Iaizzo PA, Milde JH. Cerebral function and muscle afferent activity following intravenous succinylcholine in dogs anesthetized with halothane: the effects of pretreatment with a defasciculating dose of pancuronium. Anesthesiology 1989; 71: 87–95.Google Scholar
Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology 1981; 55: 578–581.Google Scholar
Minton MD, Grosslight K, Stirt JA, Bedford RF. Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade. Anesthesiology 1986; 65: 165–169.Google Scholar
Stirt JA, Grosslight KR, Bedford RF, Vollmer D. ‘Defasciculation’ with metocurine prevents succinylcholine-induced increases in intracranial pressure. Anesthesiology 1987; 67: 50–53.Google Scholar
Kovarik WD, Mayberg TS, Lam AM, Mathisen TL, Winn HR. Succinylcholine does not change intracranial pressure, cerebral blood flow velocity, or the electroencephalogram in patients with neurologic injury. Anesth Analg 1994; 78: 469–473.Google Scholar
Brown MM, Parr MJ, Manara AR. The effect of suxamethonium on intracranial pressure and cerebral perfusion pressure in patients with severe head injuries following blunt trauma. Eur J Anaesthesiol 1996; 13: 474–477.Google Scholar
Burney RG, Winn R. Increased cerbrospinal fluid pressure during laryngoscopy and intubation for induction of anesthesia. Anesth Analg 1975; 54: 687–690.Google Scholar
Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 1975; 43: 89–99.Google Scholar
John DA, Tobey RE, Homer LD, Rice CL. Onset of succinylcholine-induced hyperkalemia following denervation. Anesthesiology 1976; 45: 294–299.Google Scholar
Gronert GA. Cardiac arrest after succinylcholine: mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology 2001; 94: 523–529.Google Scholar
Schramm WM, Papousek A, Michalek-Sauberer A, Czech T, Illievich U. The cerebral and cardiovascular effects of cisatracurium and atracurium in neurosurgical patients. Anesth Analg 1998; 86: 123–127.Google Scholar
Schramm WM, Strasser K, Bartunek A, Gilly H, Spiss CK. Effects of rocuronium and vecuronium on intracranial pressure, mean arterial pressure and heart rate in neurosurgical patients. Br J Anaesth 1996; 77: 607–611.Google Scholar
Ornstein E, Matteo RS, Young WL, Diaz J. Resistance to metocurine-induced neuromuscular blockade in patients receiving phenytoin. Anesthesiology 1985; 63: 294–298.Google Scholar
Hickey DR, Sangwan S, Bevan JC. Phenytoin-induced resistance to pancuronium. Use of atracurium infusion in management of a neurosurgical patient. Anaesthesia 1988; 43: 757–759.Google Scholar
Ornstein E, Matteo RS, Schwartz AE, Silverberg PA, Young WL, Diaz J. The effect of phenytoin on the magnitude and duration of neuromuscular block following atracurium or vecuronium. Anesthesiology 1987; 67: 191–196.Google Scholar
Whalley DG, Ebrahim Z. Influence of carbamazepine on the dose–response relationship of vecuronium. Br J Anaesth 1994; 72: 125–126.Google Scholar
Ornstein E, Matteo RS, Weinstein JA, Halevy JD, Young WL, Abou-Donia MM. Accelerated recovery from doxacurium-induced neuromuscular blockade in patients receiving chronic anticonvulsant therapy. J Clin Anesth 1991; 3: 108–111.Google Scholar
Jellish WS, Modica PA, Tempelhoff R. Accelerated recovery from pipecuronium in patients treated with chronic anticonvulsant therapy. J Clin Anesth 1993; 5: 105–108.Google Scholar
Driessen JJ, Robertson EN, Booij LH, Vree TB. Accelerated recovery and disposition from rocuronium in an end-stage renal failure patient on chronic anticonvulsant therapy with sodium valproate and primidone. Br J Anaesth 1998; 80: 386–388.Google Scholar
Spacek A, Nickl S, Neiger FX, et al. Augmentation of the rocuronium-induced neuromuscular block by the acutely administered phenytoin. Anesthesiology 1999; 90: 1551–1555.Google Scholar
Soriano SG, Kaus SJ, Sullivan LJ, Martyn JA. Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy. Paediatr Anaesth 2000; 10: 133–136.Google Scholar
Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, Perez-Ayala M. Rocuronium-induced neuromuscular blockade is affected by chronic phenytoin therapy. J Neurosurg Anesthesiol 2001; 13: 79–82.Google Scholar
Tempelhoff R, Modica PA, Jellish WS, Spitznagel EL. Resistance to atracurium-induced neuromuscular blockade in patients with intractable seizure disorders treated with anticonvulsants. Anesth Analg 1990; 71: 665–669.Google Scholar
Spacek A, Neiger FX, Spiss CK, Kress HG. Atracurium-induced neuromuscular block is not affected by chronic anticonvulsant therapy with carbamazepine. Acta Anaesthesiol Scand 1997; 41: 1308–1311.Google Scholar
Koenig MH, Edwards LT. Cisatracurium-induced neuromuscular blockade in anticonvulsant treated neurosurgical patients. J Neurosurg Anesthesiol 2000; 12: 314–318.Google Scholar