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Canadian Journal of Anesthesia, Vol 29, 59-64, Copyright © 1982 by Canadian Anesthesiologists' Society

Effect of Enflurane and Fentanyl on the Clinical Characteristics of Long-Term Succinylcholine Infusion

F. DONATI 1 and D. R. BEVAN 1

1 Department of Anaesthesia, Royal Victoria Hospital & McGill University, 687 Pine Avenue West, Montreal, Quebec

The characteristics of the neuromuscular block produced by prolonged succinylcholine infusion were compared in 40 patients anaesthetized with either nitrous oxide with enflurane (1-2 per cent inspired) or nitrous oxide and fentanyl. Neuromuscular transmission was monitored using train-of-four stimulation and the infusion rate was adjusted to keep the first twitch at 10-15 per cent of its control value.

Initially, all patients exhibited a depolarizing-type block all twitches of the trainof- four being roughly the same size, and the infusion rates were similar in the enflurane (54 µg·kg-1/min) and the fentanyl (58 µg·kg-1/min) groups. Tachyphylaxis developed later in both groups and correlated well with the onset of phase II block (dual block). This occurred sooner and at a lower cumulative dose in the enflurane group. Fourth to first twitch ratios decreased to 50, 25 and 0 per cent in 31, 46 and 59 minutes in the enflurane group, at cumulative succinylcholine doses of 2.2, 3.2 and 4.2 mg·kg-1 respectively. Corresponding figures for the fentanyl group were 52, 73 and 86 minutes, with doses of 3.4, 5.0 and 5.9 mg·kg-1. Infusion rates increased markedly after establishment of dual block, but were similar with enflurane (0.99 mg·kg-1/min) and fentanyl (1.12 mg·kg-1/min). Ten minutes after stopping the infusion fourth to first twitch ratios failed to reach 50 per cent in most patients given enflurane who had received more than 6 mg·kg-1 succinylcholine over more than 90 minutes. Corresponding figures for fentanyl patients were 13 mg·kg-1 and 150 minutes. The block in all 15 patients (9 enflurane, 6 fentanyl) who did not recover spontaneously was successfully antagonized with atropine and neostigmine.

Key Words: NEUROMUSCULAR RELAXANTS, succinylcholine • PHARMACOLOGY, Drug Interaction, succinylcholine, enflurane, fentanyl






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Copyright © 1982 by the Canadian Anesthesiologists' Society.