This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hemmerling, T. M. Articles by Schwilden, H. Search for Related Content PubMed PubMed Citation Articles by Hemmerling, T. M. Articles by Schwilden, H.

Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol

[Le desflurane, comparé à l'isoflurane, au sévoflurane ou au propofol, réduit davantage la vitesse de perfusion thérapeutique utile (PTU) du cisatracurium]

From the Department of Anesthesiology, University of Erlangen-Nuremberg Germany.

Present correspondence address: Dr. Thomas M Hemmerling, Department of Anesthesiology, University of Montreal, CHUM - Hôtel-Dieu, 3840, rue Saint-Urbain, Montreal, Quebec H2W 1T8, Canada. Phone: 514-843-2611, ext. 4570; Fax: 514-843-2690; E-mail: thomashemmerling{at}hotmail.com

Purpose: The present study investigated the interaction between the cumulative dose requirements of cisatracurium and anesthesia with isoflurane, sevoflurane, desflurane or propofol using closed-loop feedback control.

Methods: Fifty-six patients (18–85 yr, vitrectomies of more than one hour) were studied. In the volatile anesthetics groups, anesthesia was maintained by 1.3 MAC of isoflurane, sevoflurane or desflurane; in the propofol group, anesthesia was maintained by a continuous infusion of 6–8 mg•kg^–1•hr^–1 propofol. After bolus application of 0.1 mg•kg^–1 cisatracurium, a T1%-level of 10% of control level (train-of-four stimulation every 20 sec) was maintained using closed-loop feedback controlled infusion of cisatracurium. The effective therapeutic infusion rate (ETI) was estimated from the asymptotic steady-state infusion rate I_ss. The I_ss was derived from fitting an asymptotic line to the measured cumulative dose requirement curve. The ETI of the different groups was compared using Kruskal-Wallis- test, followed by rank sum test, corrected for the number of comparisons, P <0.05 was regarded as showing significant difference.

Results: ETI in the isoflurane group was 35.6 ± 8.6 µg•m^–2•min^–1, in the sevoflurane group 36.4-± 11.9 µg m^–2•min^–1, in the desflurane group 23.8 ± 6.3 µg•m^–2•min^–1. The ETI of the volatile anesthetic groups were all significantly lower than the ETI in the propofol group at 61.7 ± 25.3 µg•m^–2•min^–1 (P <0.002). The ETI in the desflurane group was significantly lower than in all other groups (P <0.02).

Conclusion: In comparison to propofol, isoflurane, sevoflurane and desflurane reduce the cumulative dose requirements of cisatracurium to maintain a 90% neuromuscular blockade by 42%, 41% and 60%, respectively.

This article has been cited by other articles:

				S. Deschamps, G. Trager, P. A. Mathieu, and T. M. Hemmerling The staircase phenomenon at the corrugator supercilii muscle in comparison with the hand muscles Br. J. Anaesth., September 1, 2005; 95(3): 372 - 376. [Abstract] [Full Text] [PDF]

				J. E. Squires Artificial Blood Science, February 8, 2002; 295(5557): 1002 - 1005. [Abstract] [Full Text] [PDF]