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Neuromuscular Effects of Rocuronium on the Diaphragm and Adductor Pollicis Muscles in Anesthetized Patients

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Abstract

Methods:

The forces generated by the diaphragm and the adductor pollicis during supramaximal single-twitch stimulation of the phrenic and ulnar nerves, respectively, were studied during thiopental, fentanyl, and nitrous oxide-oxygen anesthesia. In 6 patients, cumulative doses of 0.15, 0.25, 0.35, 0.45, and 0.60 mg kg-1 rocuronium were given over a 9-min period. The doses for 50% (ED50) and 95% (ED95) depression of twitch height were calculated. In another 12 patients, the times for maximal effect and 10%, 25%, 50%, 75%, and 90% recovery of the twitch height were calculated after a bolus dose of 0.60 mg kg-1 rocuronium.

Results:

ED50 and ED95 were higher for the diaphragm (0.26 ± 0.07 and 0.50 ± 0.20 mng·kg-1, respectively) than for the adductor pollicis (0.14 ± 0.05 and 0.24 ± 0.04 mg·kg-1). Rocuronium 0.60 mg·kg-1 produced 100% paralysis of the adductor pollicis in all patients and of the diaphragm in 9 of 12 patients. The onset time for muscle relaxation after 0.6 mg·kg-1 rocuronium was shorter for the adductor pollicis than for the diaphragm (80 ± 20 vs. 120 ± 62 s). Times for 10%, 25% 75% and 90% recovery of twitch height were 34 ± 10, 40 ± 13, 56 ± 20, and 64 ± 21 mln, respectively, for the adductor pollicis, and significantly shorter for the diaphragm: 17 ± 10, 23 ± 9, 33 ± 13, and 35 ± 10 min, respectively.

Conclusions:

The diaphragm is more resistant than the adductor pollicis to rocuronium, as shown by greater ED50and ED95, and faster recovery of the twitch height. The intubatlng dose of 0.60 mg·kg-1 is close to the ED95 of 0.50 mg·kg-1 for the diaphragm.

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