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Neuromuscular block and relative concentrations of mivacurium isomers under isoflurane versus propofol anaesthesia

Published online by Cambridge University Press:  11 July 2005

T. Ledowski ,
H. Wulf ,
K. Ahrens ,
M. Weindlmayr-Goettel ,
H.-G. Kress ,
G. Geldner  and
J. Scholz
T. Ledowski
Affiliation:
Hospital of the Christian-Albrechts-University, Department of Anaesthesiology and Intensive Care Medicine, Kiel, Germany
H. Wulf
Affiliation:
Hospital of the Philipps-University, Department of Anaesthesiology and Intensive Care Medicine, Marburg, Germany
K. Ahrens
Affiliation:
Hospital of the Philipps-University, Department of Anaesthesiology and Intensive Care Medicine, Marburg, Germany
M. Weindlmayr-Goettel
Affiliation:
University of Vienna, Department B of Anaesthesiology and General Intensive Care Medicine, Allgemeines Krankenhaus, Austria
H.-G. Kress
Affiliation:
University of Vienna, Department B of Anaesthesiology and General Intensive Care Medicine, Allgemeines Krankenhaus, Austria
G. Geldner
Affiliation:
Hospital of the Philipps-University, Department of Anaesthesiology and Intensive Care Medicine, Marburg, Germany
J. Scholz
Affiliation:
Hospital of the Christian-Albrechts-University, Department of Anaesthesiology and Intensive Care Medicine, Kiel, Germany
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Extract

Summary

Background and objective: The augmentation of the effect of neuromuscular blocking drugs with volatile anaesthetics is well documented, but the mechanism remains unclear. The pharmacological interaction and relative plasma concentrations of mivacurium isomers were investigated during either propofol- or isoflurane-maintained anaesthesia.

Methods: Forty-four patients were randomly assigned to one of two groups: isoflurane or propofol. All patients received an initial dose of mivacurium 0.1 mg kg−1. After recovery of the first twitch (T1) response measured by acceleromyography to 5%, a T1 depression of 90–99% was maintained by infusion. After a steady state was reached, blood samples were taken after 10 and 30 min for analysis of mivacurium isomers. Recovery times for T1 to 25/50/75/90% (TW25–90), train-of-four ratio 25/70% and recovery index (time TW25–75) were recorded after stop of infusion.

Results: In the isoflurane group, lower infusion rates were needed (3.0 ± 1.6 versus 3.6 ± 1.6 μg kg−1 min−1) and there was a slower recovery (significant for train-of-four ratio 70%: 21.9 versus 17.9 min). The plasma concentrations of mivacurium and its trans–trans isomer (in percentage of the total) were significantly higher in the isoflurane group (10 min: 52.6 versus 25.8%; 30 min: 49.6 versus 23.2%).

Conclusions: For mivacurium, the phenomenon of ‘potentiation’ of the effect of muscle relaxants by volatile anaesthetics could be due to an increase in the plasma concentration of the potent trans–trans isomer.

Keywords

ANAESTHETICS, INHALATIONCHEMISTRY, ORGANIC, isomerismDRUG INTERACTIONSMETABOLISM, pharmacokineticsNEUROMUSCULAR NON-DEPOLARIZING AGENTS, mivacurium
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 10 , November 2003 , pp. 821 - 825
Copyright
© 2003 European Society of Anaesthesiology

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