| Rocuronium bromide, being a new nondepolarising muscle relaxant, having arapid onset and intermediate action time, has been thought to be the most idealmuscle relaxant used in anesthesia maintenance up to now, and can substitutesuccinylcholine in tracheal intubation. Sevoflurane has a low blood-gas coefficientand rapid induction and recovery, which has been used in clinical practiceincreasingly. The diabetes mellitus, because of its pathophysiologic changes, has ainfluence on pharmacokinetics and pharmacodynamics of the anesthetics, and theprevious studies have shown that recovery from neuromuscular blockade is delayedin diabetic patients.Objective1. to evaluate the influence of sevoflurane anesthesia on the rocuronium-inducedneuromuscular blockade in healthy adult patients. 2. to evaluate the influence ofdiabetes mellitus on the rocuronium-induced neuromuscular blockade under totalintravenous anesthesia. 3. to evaluate the influence of sevoflurane on therocuronium-induced neuromuscular blockade in patients with diabetes mellitus.Methods30 diabetic patients were assigned to diabetes mellitus(DM)-totalⅳanesthesia(PD)group(n=15);or DM-sevoflurane (SD)group(n=15).Thirty healthypatients were divided into control-total iv anesthesia(PN) group(n=15) orcontrol-sevoflurane(SN) group(n=15).In the PN or PD groups,anesthesia wasmaintained with propofol and fentanyl, and in SN or SD groups, anesthesia wasmaintained with an end-tidal concentration of 1.71％sevoflurane and fentanyl. Afterreceiving rocuronium 0.6mg/kg, neuromuscular function was assessed byaccelerograph TOF-Watch ?SX with train-of-four(TOF) stimulation at the wrist. Wemeasured the onset time, the maximal depression of the first twitch(T1) of the TOF,the recovery times of T1,T2,T3,and T4. times of T1 return to 5％, 10％, 25％, 75％,recovery index, and the value of T1/T0 and TOF ratio every 10min fromadministration to 120min after receiving rocuronium.Results The characteristics of patients did not differ among the four groups, the onsettime in the PN group was longer than in the SD group(P＜0.05). Time fromrocuronium administration to the return of T1 did not differ among the fourgroups, however, times to the return of T2,T3 and T4 in the PD and SD groups werelonger than in the PN and SN groups(P＜0.05).Times for recovery of the T1 to5％,10％,25％in the SN and SD group were longer than in the PN group.Therecovery time of T1 to 75％in the PD, SN and SD groups were longer than in the PNgroup, and in the SD group was longer than in the PD group(P＜0.05).The recoveryindex in the SD group was longer than in the PN,PD and SN groups(P＜0.05).Thevalue of T1/T0 in the SD group was less than in the PN and PD groups 60 to 120minafter receiving rocuronium(P＜0.05), T1/T0 in the SN group was less than in the PNgroup 80 to 120min after receiving rocuronium(P＜0.05).TOF ratio in the SD groupwas less than in the PN,PD and SN groups 70 to 120min, 70 to 120rain,80 to120min after receiving rocuronium, respectively(P＜0.05).Conclusion1. Diabetic patients exhibit damage of the motor nerve and skeletal muscle,recovery from neuromuscular block caused by rocuronium is delay as comparedwith that in healthy patients. 2. Sevoflurane can potentiate the neuromuscularblocking effects of rocuronium compared with propofol. 3. Under sevofluraneanesthesia,the dose of rocuronium should be reduced in patients with diabetesmellitus. 4 For the patients with diabetes mellitus, the aneathesists should take careof the residual paralysis caused by neuromuscular relaxants.
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