Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children.

We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Implications: These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration.     

Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children

BACKGROUND: To define the rocuronium doses which would provide 50%, 90%, and 95% probability of 'acceptable' intubation conditions during light sevoflurane anaesthesia, we studied 60 children aged 2-7 years in a prospective, randomised, assessor blinded study. METHODS: After mask ventilation with 1 MAC sevoflurane/N2O for 17+/-1 (x+/-SD) min we administered rocuronium (either 0.15, 0.22, 0.3, 0.5, or 1.0 mg. kg(-1)) or placebo, and quantified the evoked force of the adductor pollicis muscle. Intubation conditions were assessed before and 2 min after injection of the test drug. RESULTS: Intubation conditions were improved significantly with rocuronium and scored 'acceptable' in 70%, 90%, and 100% of the children after injection of rocuronium 0.15, 0.22, and 0.3 mg x kg(-1), respectively. In parallel, twitch tension decreased to 53% (6-100), 26% (11-100), and 11% (0-19) of baseline (median (range)). Recovery of train-of-four ratio to 0.8 was achieved 13 (7-19), 16 (8-28), and 27 (23-44) min after injection of the respective rocuronium doses. Higher rocuronium doses did not further improve intubation conditions but only prolonged time of neuromuscular recovery. Logistic regression analysis revealed that rocuronium 0.11 (CI 0.05-0.16), 0.21 (0.14-0.28), and 0.25 (0.15-0.34) mg x kg(-1) provides a 50%, 90%, and 95% probability of 'acceptable' intubation conditions in children during 1 MAC sevoflurane/N2O anaesthesia, respectively. Furthermore, we calculated that force depression of adductor pollicis muscle to 81% (CI 72-90), 58% (42-74), and 50% (29-71) of baseline is associated with 50%, 90%, and 95% probability of 'acceptable' intubation conditions. CONCLUSIONS: Submaximal depression of muscle force with low dose rocuronium improves intubation conditions in children during light sevoflurane anaesthesia while allowing rapid recovery of neuromuscular function. However, when using low dose rocuronium neuromuscular monitoring may be helpful to detect children with inadequate response to the relaxant so as to avoid an unsuccessful intubation attempt.     

Excitation phenomena during sevoflurane anaesthesia in children

The advantages of rapid induction of and emergence from sevoflurane anaesthesia may be more than offset by the frequent occurrence of agitation during induction and recovery, and a possible epileptogenic effect. The mechanisms and possible strategies to prevent these drawbacks are reviewed, on the basis of the most recent literature.     

Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine

We investigated postoperative residual curarization after administration of either vecuronium or rocuronium with reversal by pyridostigmine in 602 consecutive patients without perioperative neuromuscular monitoring. On arrival in the recovery room, neuromuscular function was assessed both by acceleromyography in a train-of-four (TOF) pattern and also clinically by the ability to sustain a head-lift for >5 s and the tongue-depressor test. Postoperative residual curarization was defined as a TOF ratio <0.7. One fifth of 602 patients (vecuronium, 24.7%; rocuronium, 14.7%) had a TOF <0.7 in the recovery room. There were no significant differences in the TOF ratios between 10 mg and 20 mg of pyridostigmine. The patients with residual block had several associated factors: the absence of perioperative neuromuscular monitoring, the use of pyridostigmine, which is less potent than neostigmine, a larger dose of vecuronium, shorter time from the last neuromuscular blocker to TOF monitoring, or peripheral cooling. We conclude that significant residual neuromuscular block after vecuronium or rocuronium was not eliminated even with reversal by a large dose of pyridostigmine. IMPLICATIONS: Without monitoring, the significant residual neuromuscular block after vecuronium or rocuronium is not eliminated even by reversal with a large dose of pyridostigmine and can still be a problem in the recovery room.     

Cerebral autoregulation in children during sevoflurane anaesthesia

Introduction. Little is known about cerebral autoregulationin children. The aim of this study was to examine cerebral autoregulationin children. Methods. Cerebral autoregulation testing was performed duringless than 1 MAC sevoflurane anaesthesia in children (from 6months to 14 yr) and in adults (18–41 yr). Mean middlecerebral artery flow velocities (V_MCA) were measured using transcranialDoppler ultrasonography. Mean arterial pressure (MAP) was increasedto whichever was greater: 20% above baseline or (i) 80 mm Hgfor less than 9 yr, (ii) 90 mm Hg for 9–14 yr, and (iii)100 mm Hg for adults. Cerebral autoregulation was consideredintact if the autoregulatory index was     

Neuromuscular effects of rocuronium in children during halothane anaesthesia

Rocuronium bromide, a nondepolarizing muscle relaxant has been shown to have a short onset and intermediate duration of action in adults and young children. We evaluated onset time, intubating conditions, as well as duration of action of rocuronium in children ages four to 12 years during nitrous oxide-halothane anaesthesia. Following a stable recording of train-of-four (TOF) impulses at the ulnar nerve, patients were given rocuronium 600 μg˙kg^?1 intravenously. We found that the time to 90% and 100% neuromuscular (N-M) block of the (TOF) was 51 ± 18 s and 66 ± 32 s respectively. Intubation was achieved at 94 ± 31 s and rated as good or excellent in all cases. Time to recovery of N-M transmission to 25%, 75% and 90% of control was 29 ± 8 min, 42 ± 14 min and 46 ± 16 min respectively. Heart rate increased ～12 BPM after drug injection, while the blood pressure remained unchanged. From our data we conclude that, as in other age groups, rocuronium has a rapid onset, intermediate duration of action in children 4–12 years of age, and appears devoid of significant side effects.     

Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia

Purpose

To determine the magnitude of the potentiation of rocuronium by desflurane, isoflurane and sevoflurane 1.5 MAC anaesthesia.

Methods

In a prospective, randomised, study in 80 patients, the cumulative dose-effect curves for rocuronium were determined during anaesthesia with desflurane, sevoflurane and isoflurane (with N₂O 70%, 15 min steady state) or total intravenous anaesthesia (TIVA) using propofol/fentanyl. Neuromuscular block was assessed by acceleromyography (TOF-Guard®) after train-of-four (TOF) stimulation of the ulnar nerve (2Hz every 12sec, 200 μsec duration), Rocuronium was administered in increments of 100 μg·kg^?1 until first twitch (T₁) depression > 95%.

Results

Rocuronium led to more pronounced T₁ depression with desflurane or sevoflurane anaesthesia than with TIVA. The ED₅₀ and ED₉₅ were lower during desflurane (95 ± 25 and 190 ± 80 μg·kg^?1) and sevoflurane (120 ±30 and 210 ± 40 μg·kg^?1) than with TIVA (150 ± 40 and 310 ± 90 μg·kg^?1) (P < .01), while the difference was not significant for isoflurane (130 ± 40 and 250 ± 90 μg·kg^?1). Following equi-effective dosing (T₁ > 95%) the duration to 25% T₁ recovery, recovery index (25/75), and TOF_0.70 was: 13.2 ± 1.8, 12.7 ± 3.4, and 26.9 ± 5.7 min during anaesthesia with desflurane; 15.5 ± 5.0, 11.4 ± 3.8, and 31.0 ± 6.0 min with sevoflurane; 13.9 ± 4.7, 10.7 ± 3.3, and 26.3 ± 8.9 min with isoflurane; and 13.9 ± 3.9, 11.3 ± 5.7, and 27.5 ± 8,2 min with TIVA anaesthesia (P: NS).

Conclusion

Interaction of rocuronium and volatile anaesthetics resulted in augmentation of the intensity of neuromuscular block but did not result in significant effects on duration of or recovery from the block.     

Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children

Background. We studied 120 children aged 2–7 yr in a prospective,randomized, assessor-blinded fashion to define the optimal rocuroniumdose which provides a 95% probability of acceptable intubationconditions (ED_95TI) during inhalation induction with sevoflurane. Methods. After inhalation induction with 8% sevoflurane in 60%nitrous oxide and 40% oxygen, and loss of the eyelash reflex,we administered rocuronium (0.1, 0.15, 0.22, 0.3, or 0.6 mgkg^–1) or placebo. We quantified neuromuscular functionby stimulation of the ulnar nerve at 0.1 Hz to produce contractionof the adductor pollicis muscle using accelerometry. Intubationconditions were assessed 2 min after test drug injection. Theoptimal rocuronium dose was defined as the lowest dose, whichallowed acceptable intubation conditions in 95% of children(ED_95TI). Results. Two minutes after injection of placebo or rocuronium,intubation conditions were acceptable in 35, 45, 80, 90, 95,and 100% of children, respectively. Rocuronium 0.07 [CI 0.02–0.11],0.24 [0.19–0.31], and 0.29 [0.23–0.38] mg kg^–1provided 50, 90, and 95% probability of acceptable intubatingconditions. When thumb acceleration was depressed by 50% ormore, intubating conditions were considered acceptable in 97%of children. Recovery of the train-of-four ratio to 0.8 averaged12 (7), 16 (7), 24 (7), 24 (8), and 50 (22) min after the respectivedose of rocuronium. Conclusions. During inhalation induction with 8% sevofluranein 60% nitrous oxide, rocuronium 0.29 mg kg^–1 (ED₉₅) optimizesintubation conditions for surgery of short duration. Br J Anaesth 2002; 89: 277–81     

Dose–response and time-course of the effect of rocuronium bromide during sevoflurane anaesthesia

To evaluate the influence of sevoflurane on the dose–response relationship and on the time-course of the effect of rocuronium, 60 adult patients undergoing elective plastic surgery were randomly allocated to either the control or the sevoflurane group. Anaesthesia was maintained with 60% nitrous oxide in oxygen and thiopentone in the control group and with 60% nitrous oxide in oxygen and an end-tidal concentration of 1.75% sevoflurane in the sevoflurane group. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s and the percentage depression of the first twitch of the train-of-four was used as the study parameter. The dose–response relationship of rocuronium in the two groups was determined by the cumulative dose–response technique. The dose–response curve of rocuronium in the sevoflurane group was shifted to the left compared to the control group, indicating a potentiation of rocuronium-induced neuromuscular block. The effective doses of rocuronium required to produce 50%, 90% and 95% twitch depression in the sevoflurane group were decreased by 30.5%, 26.7% and 25.2%, respectively, compared to the control group. Following the administration of a total dose of rocuronium of 400 μgkg⁻¹, the duration of action of, and the recovery from, rocuronium were both significantly prolonged by sevoflurane. There were significant differences in the duration of peak effect, clinical duration, recovery index and the total duration of action between the control and the sevoflurane groups.     

Topographic electroencephalogram in children during mask induction of anaesthesia with sevoflurane

Background: Epileptiform patterns, spikes, polyspikes and periodic epileptiform discharges (PED) have been reported in electroencephalograms (EEGs) during anaesthesia induction with sevoflurane in healthy adults and children. Published recordings have been performed with a limited number of channels, and therefore the topographic distributions of these patterns are not known.
Methods: Twenty ASA I children aged 4–10 years undergoing routine operations were anaesthetized with 8% sevoflurane in 50%/50% oxygen and nitrous oxide using mask induction with controlled normoventilation. An EEG was recorded with a full 10–20 electrode system including orbitofrontal and ear electrodes, and a recording band of 0.016–70 Hz. Beat-to-beat heart rate (HR) was calculated off-line.
Results: Nineteen out of 20 children developed multifocal spikes and polyspikes with a maximum over the frontal lobes. Four patients developed suppression, which was almost continuous and lasted several minutes, and thereafter a continuous EEG resumed, a few spikes were seen and then a nonepileptiform pattern. In three children a couple of PED waves were seen at the onset of a continuous EEG. HR increased maximally before the onset of spikes. No motor phenomena were seen.
Conclusion: These recordings confirm the epileptogenic property of sevoflurane in mask induction. The spikes and polyspikes had frontal multifocal maxima and may be missed in recordings from frontopolar electrodes used by depth-of-anaesthesia monitors. PED and burst suppression were synchronous over the whole cortex. Epileptiform activity was indiscernible from epileptiform waveforms without anaesthesia, such as the patterns seen in status epilepticus.     

Comparison of sevoflurane and propofol with rocuronium for modified rapid-sequence induction of anaesthesia

We compared the use of sevoflurane and propofol with three different doses of rocuronium for modified rapid-sequence induction of anaesthesia. One hundred and forty adult patients were randomly allocated to have a rapid-sequence intravenous induction with propofol 2-3 mg.kg-1 (group P) or an inhalational induction with sevoflurane 8% in oxygen, using a vital capacity technique (group S). Following loss of the eyelash reflex, cricoid pressure was applied and 20 patients in each group were administered rocuronium 0.3 (groups P/0.3 and S/0.3), 0.45 (groups P/0.45 and S/0.45) or 0.6 (groups P/0.6 and S/0.6) mg.kg-1. An additional 10 patients in each group received only saline placebo in place of the muscle relaxant (groups P/Saline and S/Saline). Laryngoscopy was started 60 s later and intubating conditions evaluated by a blinded anaesthetist according to a standard scoring system. Intubating conditions were acceptable in one patient and no patient, respectively, following induction with sevoflurane and propofol without the muscle relaxant. The conditions were acceptable in 30, 55 and 90% of subjects with sevoflurane induction, and in 45, 80 and 90% of subjects with propofol induction following 0.3, 0.45 and 0.6 mg.kg-1 of rocuronium, respectively (no significant difference for each dose of rocuronium). The present study shows that intubating conditions during a rapid-sequence induction using rocuronium 0.6 mg.kg-1 following induction of anaesthesia with sevoflurane or propofol are similar.     

Mivacurium-induced neuromuscular blockade during sevoflurane and halothane anaesthesia in children

The neuromuscular blocking effects of mivacurium during sevoflurane or halothane anaesthesia was studied in 38 paediatric patients aged 1–12 yr. All received premedication with midazolam, 0.5 mg · kg⁻¹ po and an inhalational induction with up to 3 MAC of either agent in 70% N₂O and O₂. The ulnar nerve was stimulated at the wrist by a train-of-four stimulus every ten seconds and the force of adduction of the thumb recorded with a Myotrace force transducer. Anaesthesia was maintained with a one MAC end-tidal equivalent of either volatile agent for five minutes before patients received mivacurium (0.2 mg · kg⁻¹) iv. The onset of maximal blockade occurred in 2.4 ± 1.26 (mean ± SD) min with halothane and 1.8 ± 0.54 min with sevoflurane (NS). Four patients failed to achieve 100% block (3 halothane, 1 sevoflurane). The times from injection to 5, 75, and 95% recovery during sevoflurane (9.8 ± 2.6, 19.5 ± 4.4, and 24.2 ± 4.8 min) were greater than during halothane anaesthesia (7.2 ± 2.2, 15.0 ± 4.0, 19.2 ± 4.9 min, respectively (P < 0.005). All patients demonstrated complete spontaneous recovery of neuromuscular function (T₁ > 95%, T₄/T₁ > 75%) during the surgery which lasted 24–63 min. All patients showed clinical signs of full recovery of neuromuscular blockade (i.e., headlift, gag, or cough). Pharmacological reversal was not required. It is concluded that following a single intubating dose of mivacurium, the time to maximum relaxation was not different during halothane and sevoflurane anaesthesia; recovery times to 5, 75 and 95% twitch height were longer during sevoflurane anaesthesia and neuromuscular reversal was not necessary. L’activité neurobloquante du mivacurium pendant l’anesthésie au sévoflurane ou à l’halothane fait l’objet de cette étude réalisée chez 38 enfants de 1 à 12 ans. Tous ont été prémédiqués au midazolam 0,5 mg · kg⁻¹ et l’anesthésie est induite avec un agent volatil jusqu’à MAC 3 de l’un des agents dans du N₂O à 70%. Le nerf cubital était stimulé au poignet au train de quatre aux dix seconds et la force de l’adduction du pouce mesurée avec un transducteur de force Myotrace. L’anesthésie était entretenue avec l’équivalent MAC I d’un des deux agents volatils pendant cinq minutes avant l’administration de mivacurium (0,2 mg · kg⁻¹). Le début du bloc maximum est survenu dans 2,4 ± 1,26 (moyenne ± SD) min avec l’halothane et 1,8 ± 0,54 min avec le sévoflurane (NS). Quatre patients n’ont pas été bloqués à 100% (trois avec l’halothane, un avec le sévoflurane). L’intervalle séparant l’injection à 5; 75, et 95% de la récupération pendant l’anesthésie au sévoflurane (9,8 ± 2,6, 19,5 ± 4,4 et 24,2 ± 4,8 min) a été plus long que pendant l’anesthésie à l’halothane (7,2 ± 2,2, 15,0 ± 4,0, 19,2 ± 4,9 min, respectivement (P < 0,005). An moniteur, chez tous les patients, la fonction neuromusculaire a récupéré spontanément (T₁ > 95%, T₄/T₁ > 75%) au cours de la chirurgie qui a duré de 24–63 min. Tous les patients montraient aussi les signes cliniques d’une récupération complète (par ex., levée de la tête, réflexe pharyngé ou toux). Aucun antagoniste pharmacologique n’a été requis. Il est conclu que le délai jusqu’à la relaxation maximum après une seule dose d’intubation de mivacurium ne diffère pas entre l’anesthésie à l’halothane et l’anesthésie au sévoflurane; les délais de retour à 5, 75 et 95% de la hauteur du twitch sont plus longs pendant l’anesthésie au sévoflurane et il n’est pas nécessaire d’antagoniser le bloc neuromusculaire.

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Supported in part by a grant from Abbott Laboratories, Chicago, Illinois.     

Comparison of rocuronium and vecuronium in paediatric cardiac surgery, using sevoflurane anaesthesia

Aim. The goal was to study the haemodynamic effects and intubating conditions, of rocuronium, vs. vecuronium in paediatric patients undergoing elective cardiac surgery. The haemodymanic effects and intubating conditions, of rocuronium, in children undergoing cardiac surgery, remain incompletely characterised. Methods. A double blind randomised study was conducted in 40 children with congenital heart disease, undergoing open heart surgery. Patients were divided into 2 groups — Group A received rocuronium (0.9 mgkg⁻¹) and Group B, vecuronium (0.2 mgkg⁻¹) (n=20 in each group) Intubating conditions and haemodynamic profile were assessed at 60 seconds and at 90 seconds. Neuromuscular monitoring was established before muscle relaxant administration. Anaesthesia technique standardised with sevoflurane 7–8% in addition, was used in both groups. Results. Compared with vecuronium, rocuronium was associated with shorter onset time (60.2±20.2 vs 88.6±41.2 secs; P<0.001) and clinical duration of action (34.3±8.4 vs 44.7±6.2 min, P<0.001). According to standardised, intubation scores, intubation conditions, at 90 seconds in Group A was 90% and Group B 80%. However at 60 seconds they were 80% and 40% respectively. Haemodynamic stability in both the groups was similar, although one patient in Group B showed transient bradycardia and hypotension. Conclusion. Rocuronium showed better intubating conditions than vecuronium at 60 seconds in paediatric patients undergoing open heart surgery.     

地氟醚对罗库溴铵肌松作用的影响

目的 研究新型吸入药地氟醚对罗库溴铵肌松作用的影响。方法 ２０例ＡＳＡⅠ－Ⅱ病人随机分为两组，每组１０例。两组均采用表麻下慢诱导插管，吸入５０％氧化亚氮及静注芬太尼，羟丁酸钠维持麻醉，对照组静脉注射罗库溴铵０．６ｍｇ．ｋｇ＾－１；地氟醚组在吸入３％地氟醚３０分钟后，静脉注射胃库溴铵０．６ｍｇ．ｋｇ＾－１。     

Early intravenous cannulation in children during sevoflurane induction

BACKGROUND: It has been shown that early placement of an intravenous line in children anesthetized with halothane is equally safe compared with later placement. Whether this is true of sevoflurane is not known. METHODS: Pediatric patients, age 1-18 years, undergoing elective general anesthesia via an inhalation induction were randomized to intravenous placement either 30 or 120 s following loss of lid reflex. Movement on intravenous placement and incidence of laryngospasm were determined. Difficulty with intravenous placement was recorded. RESULTS: Movement on intravenous placement was more prevalent in the early group than in the late group (P < 0.0001). There was no laryngospasm in the late group and eight cases in the early group (P < 0.004). Children who had laryngospasm were older (P < 0.02) and weighed more (P < 0.04). Older children in the early group were more likely to have significant movement. CONCLUSION: Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.     

Reversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesia

BACKGROUND: The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non-depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium-atropine during propofol- versus sevoflurane-based anesthesia. METHODS: Following induction of anesthesia with propofol (2-2.5 mg kg(-1), i.v.) and fentanyl (1-2 microg kg(-1) i.v.), rocuronium 0.6 mg kg(-1) i.v. was administered to facilitate tracheal intubation. Patients were then randomized to receive either a propofol infusion (100 microg kg(-1) min(-1)) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular blockade was monitored using electromyography at the wrist, and reversed with edrophonium 1.0 mg kg(-1) and atropine 0.015 mg kg(-1) when the first twitch hight (T1) of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. Anesthetic maintenance with propofol or sevoflurane was continued following reversal until a TOF ratio of 0.7 was attained. RESULTS: The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol- (39.3+/-14.6 min) and sevoflurane-based (48.1+/-19.7 min) anesthesia. However, the reversal time from 25% T1 to TOF ratio of 0.7 was significantly longer with sevoflurane [Median 2.8 (range 0.5-18.8) min] compared with propofol [1.5 (0.75-3) min] (P<0.05). CONCLUSIONS: We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg(-1) i.v., was similar during both propofol- and sevoflurane-based anesthesia. However, the reversal of rocuronium-induced residual blockade was slower and more variable in the presence of sevoflurane.     

Leucocyte distribution during sevoflurane anaesthesia

We have examined if sevoflurane anaesthesia per se modified the number of circulating leucocytes in humans. Fifty-nine patients undergoing elective surgery were anaesthetized with sevoflurane in oxygen. The inhaled concentration was increased gradually to 5% and maintained for 20 min. Arterial blood samples were obtained before induction of anaesthesia and at 20 min. While the total number of leucocytes remained constant, circulating neutrophils decreased (mean 3370 (SD 1030) mm-3 to 3170 (940) mm-3; P < 0.01) and lymphocytes increased (1870 (520) mm-3 to 2040 (580) mm-3; P < 0.01). We conclude that high concentrations of sevoflurane modified the distribution of leucocytes in anaesthetized patients.      

Low flow desflurane and sevoflurane anaesthesia in children

BACKGROUND AND OBJECTIVE: Low flow desflurane and sevoflurane anaesthesia were administered to children and compared for haemodynamic response, renal and hepatic function, recovery time and postoperative nausea and vomiting. METHODS: Eighty ASA I-II patients aged 5-15 yr were included in the study. Midazolam was given for premedication. Anaesthesia induction was performed with fentanyl, propofol and atracurium. After intubation, the first group received desflurane, oxygen and nitrous oxide at 6 L min(-1) and the second sevoflurane, oxygen and nitrous oxide at 6L min(-1). Ten minutes after induction the flow was decreased to 1 L min(-1) in both groups. Haemodynamic parameters, preoperative and postoperative renal and hepatic function, the times of operation and anaesthesia, and early recovery data were recorded. Modified Aldrete scores were noted at the 10th and 30th minutes postoperatively and postoperative nausea, and vomiting were assessed. RESULTS: There were no significant differences in haemodynamic parameters, renal and hepatic functions, postoperative recovery and postoperative nausea and vomiting between groups. The recovery time was shorter in the desflurane group compared to the sevoflurane group. CONCLUSION: Low flow desflurane and sevoflurane anaesthesia do not adversely affect haemodynamic parameters, hepatic and renal function in children. Desflurane may be preferred when early recovery from anaesthesia is warranted.