Dose-response and concentration-response relation of rocuronium infusion during propofol-nitrous oxide and isoflurane-nitrous oxide anaesthesia

Abstract

The dose-response and concentration-response relation of rocuronium infusion was studied in 20 adult surgical patients during propofol-nitrous oxide and isoflurane (1 MAC) -nitrous oxide anaesthesia. Neuromuscular block was kept constant, initially at 90% and then at 50% with a closed-loop feedback controller. At 90% block the steady-state infusion of rocuronium was 0.55 ± 0.16 mg kg⁻¹ h⁻¹ and the corresponding concentration 1714 ± 281 ng mL⁻¹ in patients receiving propofol. At 50% block the corresponding infusion rate was 0.27 ± 0.11 mg kg⁻¹ h⁻¹ and the concentration 1077 ± 244 ng mL⁻¹, respectively. At 50% block isoflurane reduced the rate of infusion by 52% (P < 0.005) and the concentration by 59% (P < 0.001); at 90% block both the mean infusion rate and the concentration of rocuronium were reduced by 35% (P <0.005). The mean rocuronium clearance at 50% block was unaffected by the type of anaesthesia; it was 4.1 ± 1.6 and 4.9 ± 2.7 mL kg⁻¹ min⁻¹ in the groups receiving propofol and isoflurane anaesthesia, respectively. We conclude that isoflurane reduces the infusion requirements of rocuronium by changing the pharmacodynamic behaviour.