Influência da freqüência de estímulos na instalação do bloqueio neuromuscular produzido pelo rocurônio e pancurônio: avaliação pelo método acelerográfico
Influence of stimulation frequency on rocuronium and pancuronium-induced neuromuscular block onset. Acceleromyography evaluation
Derli da Conceição Munhóz; Angélica de Fátima de Assunção Braga; Glória Maria Braga Potério
Resumo
Palavras-chave
Abstract
BACKGROUND AND OBJECTIVES: Factors associated to patients and neuromuscular blockers (NMB), as well as others inherent to neuromuscular function monitoring, may affect neuromuscular block onset. This study aimed at the influence of two different stimulation frequencies on rocuronium and pancuronium-induced neuromuscular block.
METHODS: Participated in this study 120 patients, physical status ASA I and II, submitted to elective procedures under general anesthesia, who were randomly allocated in two groups, according to the stimulation frequency employed to monitor neuromuscular block: Group I - 0.1 Hz (n = 60) and Group II - 1 Hz (n = 60). Two subgroups were formed within each group (n = 30), according to the neuromuscular blocker: Subgroup P (pancuronium) and Subgroup R (rocuronium). Patients were premedicated with muscular midazolam (0.1 mg.kg-1), 30 minutes before surgery. Anesthesia was induced with propofol (2.5 mg.kg-1) preceded by alfentanil (50 µg.kg-1) and followed by pancuronium or rocuronium. Patients were ventilated under mask with 100% oxygen until 75% or more decrease in adductor pollicis muscle response, when laryngoscopy and tracheal intubation were performed. Neuromuscular function was monitored by acceleration transducer. The following parameters were evaluated: pancuronium and rocuronium onset time; time for complete block and tracheal intubation conditions.
RESULTS: Mean times (seconds) for pancuronium-induced neuromuscular block onset and for complete neuromuscular block were: Group I (159.33 ± 35,22 and 222 ± 46.56) and Group II (77.83 ± 9.52 and 105.96 ± 15.58); rocuronium-induced values were: Group I (83 ± 17.25 and 125.33 ± 20.12) and Group II (48.96 ± 10.16 and 59.83 ± 10.36) with statistical difference between groups. Tracheal intubation conditions were satisfactory in 117 patients (97.5%) and unsatisfactory in 3 (2.5%).
CONCLUSIONS: Rocuronium and pancuronium-induced neuromuscular block onset and time required for complete adductor pollicis muscle neuromuscular block are shorter when higher stimulation frequencies are applied.
Keywords
Referências
McCoy EP, Mirakhur RK, Connolly FM. The influence of the duration of control stimulation on the onset and recovery of neuromuscular block. Anesth Analg. 1995;80:364-367.
Feldman SA, Khaw K. The effect of dose and the rate of stimulation on the action of rocuronium. Eur J Anaesth. 1995;12:15-17.
Donati F, Plaud B, Meistelman C. A method to measure elicited contraction of laryngeal adductor muscles during anesthesia. Anesthesiology. 1991;74:827-832.
Donati F. Onset of action of relaxants. Can J Anaesth. 1988;35:S52-S58.
Bowman WC, Rodger IW, Houston J. Structure action relationships among some desacetoxy analogues of pancuronium and vecuronium in the anesthetized cat. Anesthesiology. 1988;69:57-62.
Mallampati SR, Gatt SP, 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.
Bell PF, Gibson FM, Mirakhur RK. Comparison of single twitch and train-of-four modes of stimulation for measurement of non-depolarizing neuromuscular block. Br J Anaesth. 1988;60:343P.
Cooper RA, Mirakhur RK, Elliott P. Estimation of the potency of ORG 9426 using two different modes of nerve stimulation. Can J Anaesth. 1992;39:139-142.
Maddineni VR, Mirakhur RK, Cooper R. Potency estimation of mivacurium: comparison of two different modes of nerve stimulation. Br J Anaesth. 1993;70:694-695.
Viby-Mogensen J, Engbaek J, Eriksson LI. Good Clinical Research Practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59-74.
Hans P, Dewé W, Albert A. Onset time on neuromuscular block and intubating conditions: influence of different stimulation patterns. Acta Anaesthesiol Belg. 1997;48:15-21.
De Mey JC, De Laat M. Factors influencing the profile of onset of relaxation. Acta Anaesthesiol Belg. 1997;48:7-10.
Goat VA, Yeung ML, Blakeney C. The effect of blood flow upon the activity of gallamine triethiodide. Br J Anaesth. 1976;48:69-73.
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.
Chauvin M, Lebreault C, Duvaldestin P. The neuromuscular blocking effect of vecuronium on the human diaphragm. Anesth Analg. 1987;66:117-122.
Pansard JL, Chauvin M, Lebreault C. Effect of an intubating dose of succinylcholine and atracurium on the diaphragm and adductor pollicis muscle in humans. Anesthesiology. 1987;67:326-330.
Girling KJ, Mahajan RP. The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry. Anesth Analg. 1996;82:1257-1260.
Galindo A. Procaine, pentobarbital and halothane: effects at the mammalian myoneural junction. J Pharmacol Exp Ther. 1971;177:360-368.
Smith CE, Donati F, Bevan DR. Differential effects of pancuronium on masseter and adductor pollicis muscles in humans. Anesthesiology. 1989;71:57-61.
Carnie JC, Street MK, Kumar B. Emergency intubation on the trachea facilitated by suxamethonium. Br J Anaesth. 1986;58:498-501.
Huizinga AC, Vandenbrom RH, Wierda JM. Intubating conditions and onset time of neuromuscular block of ORG 9426 (rocuronium), a new nondepolarizing neuromuscular blocking agent: a comparison with suxamethonium. Acta Anaesthesiol Scand. 1992;36:463-468.
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.
McCourt KC, Salmela L, Mirakhur RK. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998;53:867-871.
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-S81.
McKeating K, Bali IM, Dundee JW. The effects of thiopentone and propofol on upper airway integrity. Anaesthesia. 1988;43:638-640.
Braga A FA, Potério GMB, Braga FSS et al. Intubação traqueal sem relaxantes musculares, utilizando propofol como agente de indução. Rev Bras Anestesiol. 1991;41(^s13):CBA130.
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.
Braga AFA, Braga FSS, Potério GMB. The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children. Eur J Anaesth. 2001;18:384-388.
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.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email