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Impact of the initial doses of rocuronium and pancuronium on subsequent maintenance for neuromuscular block

Steven E. Kern, PhD^*, Robert J. Fragen, MD, Paul C. Fitzgerald, BSN MS, Michiel van Zeeland, DRMED^* and Joel O. Johnson, MD PhD^*,

^* From the Departments of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah,
Northwestern University Medical School, Chicago, Illinois and
University of Missouri Hospital & Clinics,Columbia, Missouri, USA.

Address correspondence to: Dr. S.E. Kern, Department of Anesthesiology, University of Utah School of Medicine, University of Utah School of Medicine,* 50 N. Medical Drive, Salt Lake City, Utah 84132 USA. E-mail: skern{at}remi.med.utah.edu

Purpose: To determine the impact of the neuromuscular blocking agent given for intubation on the duration of effect of multiple maintenance doses of pancuronium and rocuronium.

Methods: Seventy-eight subjects were randomly assigned to receive one of four dosing combinations for intubation and neuromuscular maintenance: rocuronium for intubation and maintenance, rocuronium for intubation and pancuronium for maintenance, pancuronium for intubation and rocuronium for maintenance, or pancuronium for both. Each time that the first twitch response returned to 25% of the baseline value, the duration of the dose was determined and another maintenance dose was administered. The duration of action of the maintenance doses was compared between the groups.

Results: Twitch suppression from the first maintenance dose was shorter for subjects who received rocuronium for both doses (Group RR) compared with that for subjects that received pancuronium (Groups PR & PP) as their intubation dose ( 17.6 vs 34 & 59.8 min, respectively, P < 0.05). Subjects who received rocuronium followed by pancuronium (Group RP) showed a shorter duration of twitch suppression after the first maintenance dose than the group that received pancuronium for both doses (Group PP) (21.3 vs 59.8 min, P < 0.05). By the third maintenance dose, the influence of the intubating dose on the maintenance dose duration had essentially diminished.

Conclusions: For combinations of rocuronium and pancuronium, the duration of twitch suppression after a maintenance dose is only dependent on the first agent given for the first two maintenance doses administered.