Recovery from Rocuronium-induced Neuromuscular Blockade during Sevoflurane or Propofol Anesthesia in Pediatric Patients

Kang, Sin Young; Kim, Chi Hyo; Han, Jong In; Lee, Guie Yong

Abstract

BACKGROUND: Potent inhalation anesthetics potentiate the neuromuscular blocking effects of non-depolarizing muscle relaxants. Therefore, sevoflurane may increase the safety margin at the end of anesthesia by reducing the muscle relaxant dose requirements. We studied the recovery from rocuronium-induced neuromuscular blockade during sevoflurane- versus propofol-based anesthesia in children.
METHODS
Fifty pediatric patients were randomly allocated to maintenance of anesthesia with sevoflurane (n = 25) or propofol (n = 25). Neuromuscular block was maintained with rocuronium and monitored by acceleromyography (TOF-Watch?) using train-of-four (TOF) stimulation every 12 seconds. Anesthetic agent administration was gradually reduced and then stopped toward the end of procedure. At the end of surgery, neostigmine 0.04 mg/kg was administered. Time of tracheal extubation, time of arrival in PACU, amount of rocuronium given were recorded.
RESULTS
TOF ratio at the end of surgery was greater in sevoflurane group (73.0 +/- 30.0) than in propofol group (50.0 +/- 37.1)(P < 0.05). The dose of rocuronium administered as supplemental increments in sevoflurane group was significantly smaller than that in propofol group (0.9 +/- 1.6 vs 2.8 +/- 2.4microgram/kg/min)(P < 0.05). Time to extubation (7.3 +/- 2.0 vs 9.0 +/- 2.6 min), and time to arrival in PACU (11.5 +/- 2.9 vs 13.9 +/- 2.6 min) from end of surgery were shorter in sevoflurane group than in propofol group (P < 0.05).
CONCLUSIONS
These results support the postulate that the potentiation of neuromuscular block by sevoflurane may provide additional safety for pediatric patients by reducing the muscle relaxant dose requirements.