Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia

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Serval ID
serval:BIB_5B05B1AC5000
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia
Journal
British Journal of Anaesthesia
Author(s)
Vasella  F. C., Frascarolo  P., Spahn  D. R., Magnusson  L.
ISSN
0007-0912 (Print)
Publication state
Published
Issued date
06/2005
Volume
94
Number
6
Pages
742-7
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial --- Old month value: Jun
Abstract
BACKGROUND: Conflicting effects of neuromuscular blocking drugs and anticholinesterases on depth of anaesthesia have been reported. Therefore we evaluated the effect of atracurium and neostigmine on bispectral index (BIS) and middle-latency auditory evoked potentials (AAI). METHODS: We studied 40 patients (ASA I-II) aged 18-69 yr. General anaesthesia consisted of propofol and remifentanil by target-controlled infusion and neuromuscular function was monitored by electromyography. When BIS reached stable values, patients were randomly assigned to one of two groups. Group 1 received atracurium 0.4 mg kg(-1) and, 5 min later, the same volume of NaCl 0.9%; group 2 received saline first and then atracurium. When the first twitch of a train of four reached 10% of control intensity, patients were again randomized: one group (N) received neostigmine 0.04 mg kg(-1) and glycopyrrolate 0.01 mg kg(-1), and the control group (G) received only glycopyrrolate. RESULTS: Injection of atracurium or NaCl 0.9% had no effect on BIS or AAI. After neostigmine-glycopyrrolate, BIS and AAI increased significantly (mean maximal change of BIS 7.1 [SD 7.5], P<0.001; mean maximal change of AAI 9.7 [10.5], P<0.001). When glycopyrrolate was injected alone BIS and AAI also increased (mean maximal change of BIS 2.2 [3.4], P=0.008; mean maximal change of AAI 3.5 [5.7], P=0.012), but this increase was significantly less than in group N (P=0.012 for BIS; P=0.027 for AAI). CONCLUSION: These data suggest that neostigmine alters the state of propofol-remifentanil anaesthesia and may enhance recovery.
Keywords
Adult Aged Anesthetics, Combined/pharmacology Anesthetics, Intravenous/*pharmacology Atracurium/pharmacology Blood Pressure/drug effects Cholinesterase Inhibitors/*pharmacology Double-Blind Method Drug Interactions Electroencephalography/drug effects Evoked Potentials, Auditory/*drug effects Female Heart Rate/drug effects Humans Male Middle Aged Monitoring, Intraoperative/methods Muscle Relaxation/*drug effects Neostigmine/pharmacology *Neuromuscular Blockade Neuromuscular Nondepolarizing Agents/pharmacology Piperidines/pharmacology Propofol/pharmacology Prospective Studies
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 11:52
Last modification date
01/10/2019 7:18
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