Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000600003
Brazilian Journal of Anesthesiology
Scientific Article

Influência do propofol e do etomidato no bloqueio neuromuscular produzido pelo rocurônio: avaliação pela aceleromiografia

Influence of propofol and etomidate on rocuronium-induced euromuscular block: evaluation with acceleromyography

Derli Conceição Munhoz; Angélica de Fátima de Assunção Braga; Glória Maria Braga Potério

http://dx.doi.org/10.1590/S0034-70942002000600003 Braz J Anesthesiol, vol.52, n6, p.673-680, 2002
PDF
Downloads: 0
Views: 1161

Resumo

JUSTIFICATIVA E OBJETIVOS: Alguns hipnóticos podem interagir com os bloqueadores neuromusculares (BNM) potencializando seus efeitos. O objetivo deste estudo foi avaliar a influência do propofol e do etomidato sobre o bloqueio neuromuscular produzido pelo rocurônio. MÉTODO: Foram incluídos no estudo 60 pacientes, estado físico ASA I e II, submetidos a cirurgias eletivas sob anestesia geral, distribuídos aleatoriamente em dois grupos de acordo com o hipnótico empregado: Grupo I (propofol) e Grupo II (etomidato). Todos os pacientes receberam midazolam (0,1 mg.kg-1) por via muscular como medicação pré-anestésica, 30 minutos antes da cirurgia. A indução anestésica foi obtida com propofol (2,5 mg.kg-1) ou etomidato (0,3 mg.kg-1) precedido de alfentanil (50 µg.kg-1) e seguido de rocurônio (0,6 mg.kg-1). Os pacientes foram ventilados sob máscara com oxigênio a 100% até a obtenção de redução de 75% ou mais na amplitude da resposta do músculo adutor do polegar, quando foram realizadas as manobras de laringoscopia e intubação traqueal. A função neuromuscular foi monitorizada com aceleromiografia. Foram avaliados: tempo de início de ação do rocurônio (T1 <= 25%); tempo para instalação do bloqueio neuromuscular total; grau de bloqueio neuromuscular no momento da intubação traqueal; condições de intubação traqueal e repercussões hemodinâmicas. RESULTADOS: Os tempos de início de ação e instalação de bloqueio neuromuscular total (segundos) produzido pelo rocurônio foram: Grupo I (48,20 ± 10,85 s e 58,87 ± 10,73 s) e Grupo II (51,20 ± 13,80 s e 64,27 ± 18,55 s). O grau de bloqueio neuromuscular no momento da intubação traqueal foi: Grupo I (77,50%) e Grupo II (76,96%). As condições de intubação traqueal foram satisfatórias em 100% dos pacientes do Grupo I e em 83,33% no Grupo II. Nos dois grupos, após a injeção do hipnótico, observou-se diminuição significativa da pressão arterial média seguida de elevação. CONCLUSÕES: O propofol e o etomidato comportaram-se de maneira semelhante em relação à instalação do bloqueio neuromuscular e às condições de intubação traqueal produzidos pelo rocurônio.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, BLOQUEADORES NEUROMUSCULARES, HIPNÓTICOS, HIPNÓTICOS, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Some hypnotics may interact with neuromuscular blockers and potentiate their effects. This study aimed at evaluating the influence of propofol and etomidate on rocuronium-induced neuromuscular block. METHODS: Participated in this study 60 patients, physical status ASA I and II, scheduled for elective surgeries under general anesthesia, who were randomly distributed in two groups according to the hypnotic drug: Group I (propofol) and Group II (etomidate). All patients were premedicated with intramuscular midazolam (0.1 mg.kg-1), 30 minutes before surgery. Anesthesia was induced with propofol (2.5 mg.kg-1) or etomidate (0.3 mg.kg-1) preceded by alfentanil (50 µg.kg-1) and followed by rocuronium (0.6 mg.kg-1). Patients were ventilated under mask with 100% oxygen until achieving a decrease of 75% or more in the adductor pollicis muscle response amplitude. Neuromuscular function was monitored by accelerometry. The following parameters were evaluated: rocuronium onset (T1 <= 25%); time for complete neuromuscular block; neuromuscular block degree at tracheal intubation; tracheal intubation conditions and hemodynamic effects. RESULTS: Complete rocuronium-induced neuromuscular block onset times (in seconds) were: Group I (48.20 ± 10.85 s and 58.87 ± 10.73 s) and Group II (51.20 ± 13.80 s and 64.27 ± 18.55 s). Neuromuscular block degree at tracheal intubation was: Group I (77.50%) and Group II (76.96%). Tracheal intubation conditions were satisfactory in 100% of Group I patients and in 83.33% of Group II patients. There has been a significant decrease in mean blood pressure, followed by an increase after hypnotic injection, in both groups. CONCLUSIONS: Propofol and etomidate had a similar behavior regarding time for rocuronium-induced neuromuscular block and tracheal intubation conditions.

Keywords

HYPNOTICS, HYPNOTICS, MEASUREMENT TECHNIQUES, NEUROMUSCULAR BLOCKERS, NEUROMUSCULAR BLOCKERS

References

Mirakhur RK. Dose-response and time-course of action of rocuronium bromide. Eur J Anaesthesiol. 1995;12(^s11):23-25.

Theroux MC, Zgnoev M, Brandom BW. Comparison of rapid endotracheal intubations using succinylcholine, mivacurium and vecuronium to combinations of mivacurium and vecuronium. Anesth Analg. 1994;78.

Glass PSA, WIilson W, Mace JA. Is the priming principle effective and safe?. Anesth Analg. 1989;68:127-134.

Braga AFA, Potério GMB. Emprego do pancurônio e alcurônio em doses fracionadas na obtenção de relaxamento muscular para intubação traqueal. Rev Bras Anestesiol. 1993;43(^s17).

Muir AW, Anderson KA, Pow E. Interaction between rocuronium bromide and some drugs, used during anaesthesia. Eur J Anaesthesiol. 1994;11(^s9):93-98.

Gill RS, Scott RPF. Etomidate short the onset time of neuromuscular block. Br J Anaesth. 1992;69:444-446.

Dilger JP, Liu Y, Vidal AM. Interactions of general anaesthetics with single acetylcholine receptor channels. Eur J Anaesthesiol. 1995;12:31-39.

Abdel-Zaher AO, Askar FG. The myoneural effects of propofol emulsion (Diprivan) on the nerve-muscle preparations of rats. Pharmacol Res. 1997;36:323-332.

Braga AFA, Potério GMB, Braga FSS. Intubação traqueal sem relaxantes musculares, utilizando propofol como agente de indução. Rev Bras Anestesiol. 1991;41(^s13).

Braga AFA, Braga FSB, Potério GMB. The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children. Eur J Anaesthesiol. 2001;18:384-388.

Mallampati SR, Gatt , Gugino LD. A clinical sign to predict difficult tracheal intubation: a prospective study. Can J Anaesth. 1985;32:429-434.

Helbo-Hansen S, Ravlo O, Trap-Andersen S. The influence of alfentanil on the intubating conditions after priming with vecuronium. Acta Anaesthesiol Scand. 1988;32:41-44.

Curran MJ, Donati F, Bevan DR. Onset and recovery of atracurium and suxamethonium-induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation. Br J Anaesth. 1987;59:989-994.

Girling KJ, Mahajan RP. The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry. Anesth Analg. 1996;82:1257-1260.

McCoy EP, Mirakhur RK, Maddineni VR. Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia. Br J Anaesth. 1995;76:29-33.

Saxena PR, Dhasmana KM, Prakash O. A comparison of systemic and regional haemodynamic effects of d-tubocurarine, pancuronium and vecuronium. Anesthesiology. 1983;59:102-108.

Ali HH, Savarese JJ. Monitoring of neuromuscular function. Anesthesiology. 1976;45:216-249.

De Mey JC, De Baerdemaeker L, De Laat M. The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium. Eur J Anaesthesiol. 1999;16:387-389.

Bali IM, Dundeee JW. Effect of I.V. induction regimens on endotracheal intubation with alcuronium and atracurium. Br J Anaesth. 1985;57:830-831.

Fuchs-Buder T, Sparr HJ, Ziegenfuss T. Thiopental or etomidate for rapid sequence induction with rocuronium. Br J Anaesth. 1998;80:504-506.

Skinner HJ, Biswas A, Mahajan RP. Evaluation of intubating conditions with rocuronium and either propofol or etomidate for rapid sequence induction. Anaesthesia. 1998;53:702-710.

Keaveny JP, Knell PJ. Intubation under induction doses of propofol. Anaesthesia. 1988;43(S80-81).

McKeating K, Bali IM, Dundee JW. The effects of thiopentone and propofol on upper airway integrity. Anaesthesia. 1988;43:638-640.

Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg. 1992;75:788-793.

Dobson AP, McCluskey A, Meakin G. Effective time to satisfactory intubation conditions after administration of rocuronium in adults: Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia. Anaesthesia. 1999;54:172-197.

Sparr HJ, Luger TJ, Heidegger T. Comparison of intubating conditions after rocuronium and suxamethonium following "rapid-sequence induction" with thiopentone in elective cases. Acta Anaesthesiol Scand. 1996;40:425-430.

Acalovschi I, Bodolea C, Cristea T. Induction with propofol does not improve the intubating conditions of rocuronium. Eur J Anaesthesiol. 1997;14(13^s16).

Crul JF, Vanbelleghem V, Buyse L. Rocuronium with alfentanil and propofol allows intubation with 45 seconds. Eur J Anaesthesiol. 1995;12(^s11):111-112.

Cantineau JP, Porte F, d´Honneur G. Neuromuscular effect of rocuronium on the diaphragm and adductor pollicis muscles in anesthetized patients. Anesthesiology. 1994;81:585-590.

Guidon-Attali C, Morillac F, Quilichini D. Propofol as the main anaesthetic agent in dental surgery. Acta Anaesthesiol Scand. 1990;34:397-399.

5dd57a450e88254f0ac8fca7 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections