Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000500001
Brazilian Journal of Anesthesiology
Scientific Article

Influência do sevoflurano e do isoflurano na recuperação do bloqueio neuromuscular produzido pelo cisatracúrio

The influence of sevoflurane and isoflurane on the recovery from cisatracurium-induced neuromuscular block

Angélica de Fátima de Assunção Braga; Franklin Sarmento da Silva Braga; Glória Maria Braga Potério; Eugesse Cremonesi; Gislaine Mauro

http://dx.doi.org/10.1590/S0034-70942002000500001 Braz J Anesthesiol, vol.52, n5, p.517-524, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os efeitos dos agentes bloqueadores neuromusculares sobre a junção neuromuscular são aumentados pelos anestésicos voláteis. O objetivo deste estudo foi avaliar a influência do sevoflurano e do isoflurano na recuperação do bloqueio neuromuscular produzido pelo cisatracúrio. MÉTODO: Foram estudados 90 pacientes, estado físico ASA I e II, submetidos à cirurgias eletivas sob anestesia geral, distribuídos em três grupos: Grupo I (sevoflurano), Grupo II (isoflurano) e Grupo III (propofol). Todos os pacientes receberam como medicação pré-anestésica, midazolam (0,1 mg.kg-1) por via muscular, 30 minutos antes da cirurgia. A indução anestésica foi obtida com alfentanil (50 µg.kg-1), propofol (2,5 mg.kg-1) e cisatracúrio (0,15 mg.kg-1). Os pacientes foram ventilados com oxigênio a 100% sob máscara até o desaparecimento das quatro respostas a SQE, quando foram realizadas as manobras de laringoscopia e intubação traqueal. Os agente voláteis para a manutenção da anestesia foram introduzidos logo após a intubação traqueal e empregados nas concentrações de 2% e 1%, respectivamente para o sevoflurano e isoflurano, e o propofol em infusão contínua (7 a 10 mg.kg-1.h-1). Em todos os pacientes empregou-se a mistura de oxigênio e óxido nitroso a 50%. A função neuromuscular foi monitorizada por aceleromiografia do músculo adutor do polegar, empregando-se a SQE a cada 15 segundos. Foram avaliados: a duração clínica do bloqueio neuromuscular (T1(25%)) e o índice de recuperação (IR= T1(25-75%)). RESULTADOS: Os tempos médios e desvios padrão para a duração clínica (T1(25%)) e índice de recuperação (IR = T1(25-75%)) foram respectivamente: Grupo I (66,2 ± 13,42 min e 23,6 ± 5,02 min), Grupo II (54,4 ± 6,58 min e 14,9 ± 3,82 min) e Grupo III (47,2 ± 7,43 min e 16,2 ± 2,93 min). Em relação à duração clínica houve diferença significante entre os grupos I e II, I e III, e II e III. Para o índice de recuperação houve diferença significante entre o grupo I e os demais grupos. CONCLUSÕES: A recuperação do bloqueio neuromuscular produzido pelo cisatracúrio foi mais lenta durante a anestesia com os agentes voláteis do que com o propofol, sendo o efeito mais pronunciado com o sevoflurano.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, ANESTÉSICOS, BLOQUEADORES NEUROMUSCULARES, BLOQUEADORES NEUROMUSCULARES, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The effects of neuromuscular blockers on the neuromuscular junction are potentiated by volatile anesthetics. This study aimed at evaluating the influence of sevoflurane and isoflurane on the recovery of cisatracurium- induced neuromuscular block. METHODS: Ninety ASA I and II patients undergoing elective surgeries under general anesthesia were included in this study. Patients were allocated in three groups: Group I (sevoflurane), Group II (isoflurane) and Group III (propofol). All patients were premedicated with intramuscular midazolam (0.1 mg.kg-1) 30 min before surgery. Anesthesia was induced with alfentanil (50 µg.kg-1), propofol (2.5 mg.kg-1) and cisatracurium (0.15 mg.kg-1). Patients were then ventilated under mask with 100% O2 until disappearance of all TOF responses when laryngoscopy and tracheal intubation were performed. Volatile agents for anesthetic maintenance were introduced immediately after tracheal intubation in 2% and 1% concentrations, respectively, for sevoflurane and isoflurane, as well as the propofol continuous infusion (7 to 10 mg.kg-1.h-1) for Group III. All patients received a 50% mixture of O2 and N2O. Neuromuscular function was monitored by adductor pollicis muscle acceleromyography with TOF stimulation at 15-second intervals. Clinical duration of neuromuscular block (T1(25%)) and recovery index (RI=T1(25-75%)) were evaluated. RESULTS: Mean time and standard deviation for clinical duration (T1(25%)) and recovery index (RI=T1(25-75%)) were respectively: Group I (66.2 ± 13.42 min and 23.6 ± 5.02 min), Group II (54.4 ± 6.58 min and 14.9 ± 3.82 min) and Group III (47.2 ± 7.43 min and 16.2 ± 2.93 min). There were significant differences in clinical duration between Groups I and II, I and III and II and III. There was a significant difference in recovery index between Group I and the other groups. CONCLUSIONS: The recovery from cisatracurium-induced neuromuscular block was longer during anesthesia with volatile agents as compared to propofol. The most pronounced effect was observed with sevoflurane.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETICS, MONITORING, NEUROMUSCULAR BLOCKERS, NEUROMUSCULAR BLOCKERS

Referencias

Rupp SM, Miller RD, Gencarelli PJ. Vecuronium: induced neuromuscular blockade during enflurane, isoflurane, and halothane anesthesia in humans. Anesthesiology. 1984;60:102-105.

Vanlinthout LEH, Booij LHDJ, van Egmond J. Effect of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium. Br J Anaesth. 1996;76:389-395.

Suzuki T, Iwasaki K, Fukano N. Duration of exposure to sevoflurane effects dose-response relationship of vecuronium. Br J Anaesth. 2000;85:732-734.

Xue FS, Liao X, Tong SY. Dose-response and time-course of the effect of rocuronium bromide during sevoflurane anaesthesia. Anaesthesia. 1998;53:25-30.

Wulf H, Ledowski T, Linstedt U. Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia. Can J Anaesth. 1998;45:526-532.

Withington DE, Donati F, Bevan DR. Potentiation of atracurium neuromuscular blockade by enflurane: time-course of effect. Anesth Analg. 1991;72:469-473.

Ortiz JR, Percaz JA. Efecto de la técnica anestésica sobre la recuperación del bloqueo neuromuscular por cisatracurio. Rev Esp Anestesiol Reanim. 2001;48:117-121.

Braga AFA, Potério GMP, Braga FSS. Influência do sevoflurano e do isoflurano na duração do bloqueio neuromuscular produzido pelo rocurônio. Rev Bras Anestesiol. 2001;51:2-9.

Miller RD, Way WL, Dolan WM. Comparative neuromuscular effects of pancuronium, gallamine and succinylcholine during forane and halothane anesthesia in man. Anesthesiology. 1971;35:509-514.

Agoston S. Interactions of volatile anaesthetics with rocuronium bromide in perspective. Eur J Anaesth. 1994;11(^s9):107-111.

Yasuda N, Lockhart SH, Eger EI II. Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth Analg. 1991;72:316-324.

Yasuda N, Lockhart SH, Eger EI II. Kinetics of desflurane, isoflurane, and halothane in humans. Anesthesiology. 1991;74:489-498.

Wulf H, Kahl M, Ledowski T. Argumentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia. Br J Anaesth. 1998;80:308-312.

Mallampati SR, Gatt SP, Gugino LD. A clinical sign to predict difficult tracheal intubation: a prospective study. Can J Anaesth. 1985;32:429-434.

Oris B, Crul JF, Vandermeersch E. Muscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia. Anesth Analg. 1993;77:570-573.

Shanks CA, Fragen RJ, Ling D. Continuous intravenous infusion balanced, enflurane, or isoflurane anesthesia. Anesthesiology. 1993;78:649-651.

Hemmerling TM, Shuettler J, Schwilden H. Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol. Can J Anaesth. 2001;48:532-537.

Pollard BJ. Interactions Involving Relaxants, em: Pollard BJ - Applied Neuromuscular Pharmacology. 1994:202-228.

Vitez TS, Miller RD, Eger EI II. Comparison in vitro of isoflurane and halothane potentiation of d-tubocurarine and succinylcholine neuromuscular blockades. Anesthesiology. 1974;41:53-56.

Waud BE, Waud DR. The effects of diethyl ether, enflurane and isoflurane at the neuromuscular junction. Anesthesiology. 1975;42:275-280.

Waud BE. Decrease in dose requirements of d-tubocurarine by volatile anesthetics. Anesthesiology. 1979;51:298-302.

Brett RS, Dilger JP, Yland KF. Isoflurane causes "flickering" of the acetylcholine receptor channel: observations using the patch clamp. Anesthesiology. 1988;69:161-170.

Lowry DW, Mirakhur RK, Carroll MT. Potency and time course of mivacurium block during sevoflurane, isoflurane and intravenous anesthesia. Can J Anaesth. 1999;46:29-33.

Driessen JJ, Crul JF, Jansen R. Isoflurane and neuromuscular blocking drugs. Anaesth Int Care. 1986;182:76-82.

Cannon JF, Fahey MR, Castagnoli KP. Continuous infusion of vecuronium: the effect of anesthetic agents. Anesthesiology. 1987;67:503-506.

Shanks CA. Pharmacokinetics of the nondepolarizing neuromuscular relaxants applied to the calculation of bolus and infusion dosage regimens. Anesthesiology. 1986;64:72-86.

Hunter JM. New neuromuscular blocking drugs. N England J Med. 1995;332:1691-1699.

Fisher DM, Rosen JI. A pharmacokinetic explanation for increasing recovery time following larger or repeated doses of nondepolarizing muscle relaxants. Anesthesiology. 1986;65:286-291.

Ginsberg B, Glass PS, Quill T. Onset and duration of neuromuscular blockade following high-dose vecuronium administration. Anesthesiology. 1989;71:201-205.

Bock M, Klippel K, Nitsche B. Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia. Br J Anaesth. 2000;84:43-47.

Belmont MR, Lien CA, Quessy S. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology. 1995;82:1139-1145.

Lepage JY, Malinovsky JM, Malinge M. Pharmacodynamic dose response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2-opioid anesthesia. Anesth Analg. 1996;83:823-829.

Carpenter RL, Eger EI II, Johnson BH. Pharmacokinetics of inhaled anesthetics in humans: Measurements during and after the simultaneous administration of enflurane, isoflurane, methoxyflurane and nitrous oxide. Anesth Analg. 1986;65:575-582.

Wright PMC, Hart P, Lau M. The magnitude and time course of vecuronium potentiation by desflurane versus isoflurane. Anesthesiology. 1995;82:404-411.

Gill SS, Bevan DR, Donati F. Edrophonium antagonism of atracurium during enflurane anaesthesia. Br J Anaesth. 1990;64:300-305.

Baurain MJ, d’Hollander AA, Melot C. Effects of residual concentrations of isoflurane on the reversal of vecuronium-induced neuromuscular blockade. Anesthesiology. 1991;74:474-478.

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