Thenar muscle blood flow and neuromuscular effects of vecuronium in patients receiving balanced or isoflurane anaesthesia |
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Authors: | ABDULATIF, M. HEGAZY, M. |
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Affiliation: | Department of Anaesthesia, Faculty of Medicine, Cairo University Egypt Department of Plastic Surgery, Faculty of Medicine, King Faisal University Saudi Arabia |
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Abstract: | We have tested the hypothesis that isoflurane potentiates non-depolarizingneuromuscular block via an increase in muscle blood flow. Anaesthesiawas induced with thiopentone 45 mg kg1 in 30 adultmale patients of ASA physical status I or II and was maintainedwith 70% nitrous oxide in oxygen supplemented with either abolus dose of fentanyl 4µg kg1 followed by an infusionof 1 7µg kg1 h1 (balanced anaesthesia group,n=15) or 1.1% end-tidal isoflurane (isoflurane group, n=15).Vecuronium 0.1 mg kg1 was given for neuromuscular block.The force of contraction of the adductor pollicis of the thumbin response to ulnar nerve stimulation was recorded. Thenarmuscle blood flow was measured continuously with a laser Dopplerflowmeter. Times required for the first twitch in the train-of-four(T1) to recover to 25%, 75% and 90% of its control value weremean 26.3 (SD 5), 35.3 (10), 43.5 (7) min and 39.2 (15), 53(12.5), 61.2 (10) min in the balanced anaesthesia and isofluranegroups, respectively (P<0.01). Recovery index (time betweenT1 25% and 75%) was prolonged significantly in the isofluranegroup. Administration of thiopentone significantly increasedthenar muscle blood flow from 2.6 (1.9) and 2.2 (1.5) ml min1/100g to 19.2 (14) and 21.7 (16) ml min11100 g in the balancedanaesthesia and isoflurane groups, respectively (P<0.001).The addition of fentanyl (balanced) or isoflurane to the anaestheticmixture produced further increases in thenar muscle blood flowto reach, respectively, 26.2 (16) and 26.8 (13.6) ml min1/1100g during steady state anaesthesia. Thenar muscle blood flowwas comparable in the two groups throughout the study. We concludethat isoflurane prolonged vecuronium-induced neuromuscular block.This prolongation was not related primarily to increase in muscleblood flow. |
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