| Partâ… Comparative study of neuromuscular blocking effects of cisatracurium under sevoflurane or propfolBackgronud:Neuromuscular blockers(NMB) are important adjuvant to general anesthesia,cisatracurium is considered relatively recently introduced non-depolarizing muscle relaxants.Objectives:This study evaluates the enhancement of cisatracurium-induced neuromuscular block during anesthesia with sevoflurane or propofol.Methods:Sixty ASA classâ… orâ…¡patients,aged 20 to 59 years old,scheduled for ENT(ears,nose,throat) surgery were randomly allocated into one of four equal Groups to receive either 0.1 mg/kg cisatracurium under sevoflurane(SA) or propofol TIVA(PA) or 0.15mg/kg cisatracurium under sevoflurane(SB) or propofol TIVA(PB).Keep the bispectral index between 40 and 50 during maintenance of anesthesia.Thumb adductorius contractile response was monitored with TOF stimulation.Results:1.There were no difference between group PA(4.6min ) and SA(3.5min); group PB(2.7min) and SB(2.5min) in the onset time(P＞0.05).The onset time was significantly shorter in group PB than PA(40%),group SB than SA(30%) (P＜0.05).2.The no response time was prolonged by 62%in group SA(31.8min) compared with PA(19.6min),and 26%in group SB(43.5min )compared with PB(34.5min) (P＜0.05).The no response time was prolonged by 76%in group PB compared with PA,and 37%in group SB compared with SA(P＜0.05).The time of T1 recovering 25%of the control value(T25) was prolonged by 45% in group SA(48.5min) compared with PA(33.5min),and 29%in group SB (59.1min) compared with PB(45.8min)(P＜0.05).T25 was prolonged by 37% in group PB compared with PA,and 22%in group SB compared with SA(P＜0.05).3.The time of T1 recovering 95%of the control value(T95)was prolonged by 47%in group SA(70.2min) compared with PA(47.7min),and 36%in group SB (83.3min) compared with PB(61.1min)(P＜0.05).T95 was prolonged by 28% in group PB compared with PA,and 19%in group SB compared with SA (P＜0.05).The recovery index(RI) was prolonged by 33%in group SA(13min) compared with PA(9.8min),and 48%in group SB(15.2min) compared with PB(10.3min) (P＜0.05).There were no difference between group PA and PB;group SA and SB in RI(P＞0.05).Conclusion:During sevofiurane compared with propofol TIVA,the neuromuscular block effect of cisatracurium is enhanced and the clinical duration of cisatracurium is significantly longer,but the onset times is similar. With the increasing of dose of cisatracurium,the neuromuscular block effect is enhanced too,and there was a faster onset,but the recovery index is similar. Partâ…¡Pharmacodynamic interactions between cisatracurium and rocuroniumBackgronud:The onset and duration of maintenance doses of neuromuscular blocker may be influenced by the original neuromuscular blocker used.Objectives:This study evaluates the effect of the interaction between cisatracurium and rocuronium when administered the maintenance doses of cisatracurium after rocuronium under total intravenous anesthesia.Methods:Forty-eight ASA classâ… orâ…¡patients,aged 20 to 59 years old, scheduled for ENT(ears,nose,throat) surgery undergoing total intravenous anesthesia anesthesia with propofol by TCI and fentanyl were randomized to receive the following:Groupâ… A=rocuronium 0.6mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 25%;Groupâ… B=rocuronium 0.6 mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 75%;Groupâ…¡A= cisatracurium 0.1mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 25%;Groupâ…¡B=cisatracurium 0.1mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 75%.Keep the bispectral index between 40 and 50 during maintenance of anesthesia.Thumb adductorius contractile response was monitored with TOF stimulation.Results:1.After administered the maintenance doses of cisatracurium when T1 recovered to 25%or 75%,compared with groupâ…¡A(5.3%),the minimum value of T1 in groupâ… A(0.6%) was significantly smaller;compared with groupâ…¡B(12.6%), the minimum value of T1 in groupâ… B(2.9%) was significantly smaller too (P＜0.05).The minimum value of T1 was significantly smaller in groupâ… A thanâ… B, groupâ…¡A thanâ…¡B(P＜0.05).2.After administered the maintenance doses of cisatracurium when T1 recovered to 25%or 75%,the time of T1 recovering 25%of the control value(T25) was prolonged by 39%in groupâ… A(22.8min) compared withâ…¡A(16.4min),and 40% in groupâ… B(16.2min) compared withâ…¡B(11.6min)(P＜0.05).T25 was prolonged by 41%in groupâ… A compared withâ… B,and groupâ…¡A compared withâ…¡B(P＜0.05).3.After administered the maintenance doses of cisatracurium when T1 recovered to 25%or 75%,the time of T1 recovering 95%of the control value(T95) was prolonged by 22%in groupâ… A(37.7min) compared withâ…¡A(30.9min),and 18% in groupâ… B(30.5min) compared withâ…¡B(25.9min )(P＜0.05).T95 was prolonged by 24%in groupâ… A compared withâ… B,and 19%in groupâ…¡A compared withâ…¡B (P＜0.05)4.After administered the maintenance doses of cisatracurium when T1 recovered to 25%or 75%,there were no difference between groupâ… A(9.7min ) andâ…¡A (9.7min),groupâ… B(10.4min) andâ…¡B(10.2min),groupâ… A andâ… B,groupâ…¡A andâ…¡B in the recovery index(P＞0.05).Conclusion:When administered the maintenance doses of cisatracurium after rocuronium,the maximum block degree was enhanced and the clinical duration was prolonged.Administered the maintenance doses of cisatracurium when T1 recovered to 25%compared with T1 recovered to 75%,the maximum block degree was enhanced and the clinical duration was prolonged too.But in our study,the recovery index is similar in all groups.
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