Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand 2005 Mar;49(3):312-5
Date
03/09/2005Pubmed ID
15752394DOI
10.1111/j.1399-6576.2005.00634.xScopus ID
2-s2.0-15944398333 (requires institutional sign-in at Scopus site) 74 CitationsAbstract
BACKGROUND: Steroid-based, non-depolarizing neuromuscular-blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ-dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a duration of action not altered by ageing. The objective of the study was to determine if elderly patients had less variability in duration of action with 2 x ED95 of cisatracurium compared to equipotent doses of rocuronium or vecuronium.
METHODS: Informed consent was obtained from 66 elderly patients with normal renal and liver function. Preoperative midazolam (1 mg) was given IV. The anaesthestic induction was with 5 mg kg(-1) thiopental and 2 microg kg(-1) fentanyl. The patients received 0.6 mg kg(-1) rocuronium, 0.1 mg kg(-1) vecuronium or 0.1 mg kg(-1) cisatracurium. Anaesthetic maintenance was with sevoflurane in oxygen/nitrous oxide. Neuromuscular-blocking duration of action was defined as the return of T1 twitch height to 25% of control. Variability was determined by subtracting the actual duration of action from the mean duration of action for each drug.
RESULTS: The durations of action (range, min) were: cisatracurium, 37-81; vecuronium, 35-137; and rocuronium, 33-119. The median of the variability of duration was significantly less with cisatracurium (7 min) compared to vecuronium (18 min) and rocuronium (18 min) (P < 0.05).
CONCLUSION: When used with sevoflurane/N(2)O, there was a two-fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium.
Author List
Arain SR, Kern S, Ficke DJ, Ebert TJAuthor
Thomas J. Ebert MD, PhD Adjunct Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAging
Analysis of Variance
Androstanols
Atracurium
Dose-Response Relationship, Drug
Female
Humans
Male
Neuromuscular Blocking Agents
Neuromuscular Nondepolarizing Agents
Time Factors
Vecuronium Bromide