Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction:
Of the volatile anaesthetic agents, desflurane causes the greatest degree of potentiation of the
neuromuscular blocking drugs (NMB). The purpose of this study was to determine whether
desflurane prolongs the effects of 3xED95 doses of rocuronium and cisatracurium to the same
degree. The two NMB represent potent and less potent classes respectively.
Methods:
Informed, written consent was obtained from 63 adult patients scheduled for routine surgery.
They were randomly allocated to one of four groups to receive either desflurane-sufentanil
(end-tidal partial pressure 4.0 kPa) or propofol-sufentanil anaesthesia and either rocuronium
(0.9mg/kg) or cisatracurium (0.15mg/kg). All patients received a target-controlled sufentanil
infusion (0.5 ng/ml). Neuromuscular blockade was recorded using accelerometry (TOFGUARD
®, Organon) while patients recovered spontaneously to a Train-of-Four ratio of 0.9
(TOFR0.9). Data were analysed using one- and two-way analysis of variance. The main
effects were the types of anaesthetic and NMB on indices of recovery.
Results:
Compared with propofol-sufentanil anaesthesia, mean times to recovery to T125% and
TOFR0.9, were prolonged by desflurane-sufentanil (p<0.01). There were no interactions. Mean prolongation of time to TOFR0.9 was 41 min (SD 36) for cisatracurium and 26.6 min
(SD 39) for rocuronium.
Discussion:
Whereas previous studies did not reveal prolongation of the duration of action of rocuronium
by desflurane, we demonstrated a statistically significant prolongation of the spontaneous
recovery times of both rocuronium and cisatracurium by desflurane. From the data we could
not conclude that there was a difference between the two NMB. A power study revealed that
in order to detect a difference between times to recovery to TOF0.9, a sample size of 101
subjects per group would be required.
Conclusion:
Desflurane prolongs the mean time to spontaneous recovery from neuromuscular blockade
after 3xED95 doses of both cisatracurium (a potent NMB) and rocuronium (a less potent
NMB). There was wide inter-individual variation in times to spontaneous recovery. Any
difference in the mean prolongations between the different types of NMB is unlikely to be of
clinical importance. / AFRIKAANSE OPSOMMING: Inleiding
Van al die vlugtige narkosemiddels veroorsaak desfluraan die grootste mate van potensiasie
van die neuromuskulêre blokkeermiddels. Die doel van hierdie studie was om vas te stel of
desfluraan wel die effek van driedubbel die ED95 dosis van rokuronium en cisatrakurium tot
dieselfde mate sal verleng.
Metodiek
Geskrewe ingeligte toestemming is verkry van 63 pasiënte wat voorgedoen het vir roetiene
chirurgiese prosedures. Pasiënte is lukraak in een van vier groepe ingedeel om of desfluraansufentaniel
(eind-gety parsieële druk 4.0 kPa) of propofol-sufentaniel narkose en of
rokuronium (0.9 mg/kg) of cisatrakurium (0.15 mg/kg) te ontvang. Alle pasiënte het 'n
teiken-beheerde sufentaniel infusie (0.5 ng/ml). Neuromuskulêre blokkade is waargeneem
met behulp van aksellerometrie (TOF-GUARD, Organon) terwyl pasiënte spontaan herstel
het tot “reeks-van-vier” verhouding (Engels “Train-of-four” ratio) 0.9 (TOFR0.9). Data
analise is gedoen met behulp van een- en tweerigting analise van variansie.
Resultate
Desfluraan-sufentaniel het die gemiddelde hersteltyd tot T125% en TOFR0.9 verleng in
vergelyking met propofol-sufentaniel. Geen interaksies is waargeneem nie. Gemiddelde verlenging van TOFR0.9 vir cisatrakurium was 41 minute (standaardafwyking 36) en vir
rokuronium 26.6 minute (standaardafwyking 39).
Bespreking
Vorige studies kon nie vasstel of desfluraan die werkingsduur van rokuronium verleng nie.
Ons het in hierdie studie vasgestel dat desfluraan wel 'n statisties beduidende verlenging in
die hersteltyd van beide rokuronium en cisatrakurium veroorsaak. Ons kon egter nie 'n
verskil tussen die twee neuromuskulêre agente aandui nie. 'n onderskeidingsvermoëstudie
het getoon dat ten minste 101 pasiënte per groep benodig sou word om 'n beduidende verskil
tussen die hersteltye tot TOFR0.9 te verkry.
Gevolgtrekking
Desfluraan verleng die gemiddelde hersteltyd tot spontane herstel van neuromuskulêre
blokkade na driedubbele ED95 dosisse van beide cisatrakurium en rokuronium. Daar was
egter groot interindividuele variasie ten opsigte van spontane hersteltyd. Enige verskille in
die gemiddelde verlenging is onwaarskynlik van kliniese belang.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/85643 |
| Date | 12 1900 |
| Creators | Scheepers, Pamela Anne |
| Contributors | Coetzee, Johan Francois, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anaesthesiology and Critical Care. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 61 p. : ill. |
| Rights | Stellenbosch University |
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