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Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium

Published online by Cambridge University Press:  01 July 2008

M. Adamus ,
T. Gabrhelik  and
O. Marek
M. Adamus*
Affiliation:
Palacký University, University Hospital and Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Olomouc, Czech Republic
T. Gabrhelik
Affiliation:
Palacký University, University Hospital and Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Olomouc, Czech Republic
O. Marek
Affiliation:
Palacký University, University Hospital and Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Olomouc, Czech Republic
*
Correspondence to: Milan Adamus, Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine, Palacký University, 772 00 Olomouc, Czech Republic. E-mail: [email protected]; Tel: +420 608 570801; Fax: +420 585 852524
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Summary

Background and objective

There is increasing evidence of gender differences in the pharmacokinetics and pharmacodynamics of aminosteroid neuromuscular blocking agents. Compared to males, females are more susceptible, requiring approximately 30% less rocuronium to achieve the same degree of neuromuscular block. However, little information is available whether this difference is applicable to modern benzylisoquinolines (cisatracurium).

Methods

In all, 848 patients (423 males, 425 females) undergoing general surgery under total intravenous anaesthesia with muscle relaxation, tracheal intubation and mechanical ventilation were studied. Patients were randomized to receive a single bolus dose of cisatracurium (0.1 mg kg−1, 221 males and 199 females) or rocuronium (0.6 mg kg−1, 202 males and 226 females). The onset time for 95% depression of T1, clinical duration until 25% recovery and recovery index (T1 from 25% to 75%) were determined with an NMT electromyographic module of the Datex-Ohmeda S/5 Anaesthesia Monitor. The data for male and female groups were compared with appropriate statistical tests (unpaired t-test, Mann–Whitney rank sum test and Fisher’s exact test).

Results

In both groups (cisatracurium and rocuronium), males were significantly taller (P < 0.001) and heavier (P < 0.001) than females, but the body mass index was comparable. For rocuronium, the onset time was shorter 91.7 ± 14.3 s vs. 108.0 ± 14.6 s (P < 0.001) and the clinical duration was increased in females 43.3 ± 7.8 min vs. 31.3 ± 5.5 min (P < 0.001). In the cisatracurium group, both onset times (248.9 ± 60.7 s for males vs. 253.4 ± 70.9 s for females) and clinical duration (42.6 ± 6.9 min for males vs. 43.1 ± 6.9 min for females) were similar. The recovery index was identical for males and females in both groups.

Conclusions

Females were more sensitive than males to a single bolus dose of rocuronium. Under the study conditions described, the onset time was shorter and the clinical duration was increased in female patients. This suggests that the routine dose of rocuronium should be reduced in females compared to males. On the contrary, we could demonstrate no gender differences in the onset time or clinical duration of cisatracurium.

Keywords

ANAESTHESIA GENERAL, total intravenous anaesthesia, target-controlled infusionNEUROMUSCULAR BLOCKADE, monitoring, electromyographyNEUROMUSCULAR BLOCKING AGENT, cisatracurium, rocuronium, onset, recoveryGENDER AND SEX ISSUE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 7 , July 2008 , pp. 589 - 595
Copyright
copyright © European Society of Anaesthesiology 2008

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