Korean J Anesthesiol.  2014 Sep;67(3):175-180. 10.4097/kjae.2014.67.3.175.

Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium

• Jung KT
• Kim HJ
• Bae HS
• Lee HY
• Kim SH
• So KY
• Lim KJ
• Yu BS
• Jung JD
• An TH
• Park HC

• KMID: 1966751
• DOI: http://doi.org/10.4097/kjae.2014.67.3.175

Abstract

BACKGROUND
Rocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium.
METHODS
A total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 microg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation.
RESULTS
Incidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups.
CONCLUSIONS
It seems that remifentanil (1 microg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.

Keyword

Ketamine; Lidocaine; Pain; Remifentanil; Rocuronium

MeSH Terms

Blood Pressure
Heart Rate
Hemodynamics
Humans
Incidence
Intubation, Intratracheal
Ketamine*
Lidocaine*
Ketamine
Lidocaine