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Nicorandil accelerates recovery of neuromuscular block caused by vecuronium

Yuhji Saitoh, MD^*,, Koh Kaneda, MD^,, Yoshitaka Fujii, MD^, and Tsutomu Oshima, MD^,

^* Fukushima, Toride Kyodo General Hospital,
Ibaraki, Department of Anesthesiology, Institute of Clinical Medicine,
University of Tsukuba, Ibaraki, and the Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine,
Gifu, Japan.
From the Department of Anesthesiology, Fukushima Medical University School of Medicine,

Address correspondence to: Dr. Yuhji Saitoh, Department of Anesthesiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan. Phone: 81-24-548-2111; Fax: 81-24-548-0828; E-mail: ys{at}m6.people.or.jp

Purpose: To examine the effect of nicorandil, a K_ATP channel agonist, on neuromuscular block caused by vecuronium in patients anesthetized with nitrous oxide, oxygen, isoflurane, and fentanyl.

Methods: Sixty adult patients were allocated to four groups of 15: nicorandil-post-tetanic count (N-PTC), nicorandil-train-of-four (N-TOF), control-post-tetanic count (C-PTC) or control-train-of-four (C-TOF) group. In the N-PTC and N-TOF groups, 0.1 mg•kg^–1 nicorandil was given as a bolus followed by an infusion at 1 µg•kg^–1•min^–1. Two minutes after the bolus, 0.1 mg•kg^–1 vecuronium was administered. In the C-PTC or C-TOF group normal saline was given instead of nicorandil. PTC and TOF responses were measured mechanically using a force displacement transducer.

Results: Time from the administration of vecuronium to the onset of neuromuscular block in the N-PTC or N-TOF group did not differ from that in the C-PTC or C-TOF group (241 ± 33 vs 225 ± 32 sec, mean ± SD). Times from vecuronium injection to the return of PTC in the N-PTC and C-PTC groups, and those of T1, T2, T3, and T4 (first, second, third, and fourth stimulation of TOF) in the N-TOF and C-TOF groups did not differ. Recoveries of PTC in the N-PTC and C-PTC groups followed similar time course. T1/control twitch height and TOF ratio (T4/T1) in the N-TOF group were higher than those in the C-TOF group 80-120 min and 100-120 min after administration of vecuronium, respectively.

Conclusion: Nicorandil accelerates recovery of neuromuscular block caused by vecuronium.