Abstract
The effects of rocuronium, 0.25 or 0.5 mg · kg, were measured simultaneously on the adductor muscles of the larynx and adductor pollicis in 14 adult patients. Anaesthesia was induced and maintained with propofol and fentanyl. Tracheal intubation was performed without muscle relaxants. The recurrent laryngeal and ulnar nerves were both stimulated supramaximally, at the notch of the thyroid cartilage and at the wrist respectively, using train-of-four stimulation. The laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords. Onset time, intensity of blockade and duration of action were less at the larynx than at the adductor pollicis. After rocuronium, 0.25 mg · kg−1, the onset time (interval between injection and maximal TI blockade) was 1.6 ± 0.1 min and 3.0 ± 0.3 min (mean ± SEM) at the laryngeal muscles and adductor pollicis, respectively (P < 0.01 between muscles). Maximum blockade was 37 ± 8% and 69 ± 8%, respectively (P < 0.05), and time to 90% TI recovery was 7 ± 1 min and 20 ± 4 min, respectively (P < 0.05). With 0.5 mg· kg−1, the onset time was also more rapid at the vocal cords (1.4 ± 0.1 min) than at the adductor pollicis (2.4 ± 0.2 min, P < 0.001). Maximum blockade was 77 ± 5% and 98 ± 1 %, respectively (P < 0.01), and time to 90% TI recovery was 22 ± 3 min and 37 ± 4 min, respectively (P < 0.01). It is concluded that with rocuronium onset and recovery are faster at the laryngeal adductor muscles, but blockade is less intense than at the adductor pollicis. These findings are similar to the observations made previously with vecuronium, except that rocuronium had a faster onset at both muscles.
Résumé
Le but de cette étude était de mesurer chez 14 sujets adultes l’effet du rocuronium, 0.25 ou 0.5 mg · kg−1, à la fois sur les muscles adducteurs du larynx et sur l’adducteur du pouce. L’induction et l’entretien de l’anesthésie se sont effectés à l’aide de propofol et de fentanyl. On n’a pas utilisé de curare pour l’intubation trachéale. On a appliqué une stimulation supramaximale en train-de-quatre à l’échancrure du cartilage thyroïde, pour le nerf récurrent laryngé, et au poignet, pour le nerf cubital. La contraction des muscles laryngés produisait un changement de pression dans le ballonnet de la sonde trachéale, placé entre les cordes vocales. Le temps d’installation, le bloc maximum et la durée d’action étaient moindres au niveau du larynx qu’à l’adducteur du pouce. Après injection de 0.25 mg · kg−1 de rocuronium, le temps d’installation (intervalle entre l’injection et bloc maximum de TI) etait de 1.6 ± 0.1 et de 3.0 ± 0.3 min (moyenne ± écart type de la moyenne) pour les muscles laryngés et l’adducteur du pouce, respectivement (P<0,01 entre les muscles). Le bloc maximum se situait à 37 ± 8 et 69 ± 8%, respectivement (P < 0,05), et on comptait 7 ± 1 et 20 ± 4 min respectivement (P < 0,05) jusqu’ à un retour de TI à 90%. Avec une dose de 0.5 mg · kg−1, le temps d’installation était aussi plus court pour les cordes vocales (1.4 ± 0.1 min) que pour l’adducteur du pouce (2.4 ± 0.2 min, P < 0.001). On retrouvrait un bloc maximum de 77 ± 5 et 98 ± 1%, respectivement, et une durée d’action jusqu’á une récupération de TI à 90% de 22 ± 3 et 37 ± 4 min respectivement (P < 0,01). On en conclut que le rocuronium agit plus rapidement au niveau des muscles adducteurs du larynx, mais que le bloc neuromusculaire est moins intense qu’au niveau de l’adducteur de pouce. Ces résultats sont comparables à ceux obtenus avec le vècuronium, sauf que le rocuronium agit plus rapidement au niveau des deux muscles.
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Meistelman, C., Plaud, B. & Donati, F. Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth 39, 665–669 (1992). https://doi.org/10.1007/BF03008227
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DOI: https://doi.org/10.1007/BF03008227