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Acute desflurane or sevoflurane exposure on a previously stabilized atracurium-induced neuromuscular block

Published online by Cambridge University Press:  24 May 2006

M. Beaussier ,
A. Boughaba ,
E. Schiffer ,
B. Debaene ,
A. Lienhart  and
A. d'Hollander
M. Beaussier
Affiliation:
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France
A. Boughaba
Affiliation:
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France
E. Schiffer
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, Poitiers, France
B. Debaene
Affiliation:
Hôpital Cantonal Universitaire, Department of Anaesthesia and Intensive Care, Genève, Switzerland
A. Lienhart
Affiliation:
St-Antoine Hospital, Department of Anaesthesia and Intensive Care, Paris, France
A. d'Hollander
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, Poitiers, France
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Abstract

Summary

Background and objective: The aim of this prospective study was to compare the effect of the administration of desflurane or sevoflurane to a fixed neuromuscular block. Methods: After written consent, 12 patients were anaesthetized with propofol and sufentanil. Atracurium was administered via a continuous infusion in order to obtain 85% twitch depression of the control value assessed by repeated accelerometric stimulation at the adductor pollicis. Once stabilized over the course of 30 min, propofol was discontinued and either desflurane (n = 6) or sevoflurane (n = 6) was delivered at 1 MAC in a mixture of 50% O2 in air. Study parameters were the magnitude and the time of twitch height variations. Results are presented in mean ± SD. Result: Exposure to halogenated agents led to a significant reduction in twitch height with similar magnitude between the two agents. However, interaction with desflurane showed an initial and transient rise (35 ± 22%) in twitch height before subsequent depression occurred. The time to reach 50% of the signal depression in the desflurane group was significantly delayed (25 ± 7 vs. 11 ± 4 min in the sevoflurane group; P < 0.01). Conclusions: On a stable neuromuscular block elicited by continuous infusion of atracurium, the abrupt administration of desflurane or sevoflurane reduces the accelerometric responses of the adductor pollicis in a similar way. This potentiating effect is produced faster after sevoflurane than after desflurane. With desflurane, a biphasic effect (of a transient and moderate increase followed by depression of the signal) was recorded.

Keywords

ANAESTHETICS INHALATION, desflurane, sevofluraneNEUROMUSCULAR NON-DEPOLARIZING AGENTS, atracuriumMONITORING INTRAOPERATIVE, neuromuscular functionDRUG INTERACTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 9 , September 2006 , pp. 755 - 759
Copyright
2006 European Society of Anaesthesiology

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