Abstract
Purpose
To compare the neuromuscular effects, efficacy, and safety of equi-effective doses of rocuronium and atracurium in ambulatory female patients undergoing surgery.
Methods
Forty-one patients undergoing laparoscopic gynaecological surgery were randomized to receive 2 × ED90 rocuronium (0.6 mg·kg−1; n = 20) or atracurium (0.5 mg·kg−1; n = 21) during intravenous propofol/alfentanil anaesthesia with N2O/O2 ventilation. Neuromuscular block was measured with a mechanomyogram eliciting a train-of-four (TOF) response at the wrist. Intubation conditions 60 sec after administration of muscle relaxant and immediate cardiovascular disturbances or adverse events during the hospital stay were noted by blinded observers.
Results
Compared with atracurium, rocuronium was associated with a shorter onset time (59.0 ± 22.2vs 98.6 ± 41.4 sec;P < 0.001) and clinical duration of action (33.3 ± 7.1vs 44.7 ± 7.2 min;P < 0.001), but longer spontaneous recovery index (9.6 ± 2.41vs 6.9 ± 1.89 min;P = 0.023) and a similar time to spontaneous recovery to TOF 70%; 53 ± 6.31vs 59.2 ± 7.59 min;P =0.139). Tracheal intubation was accomplished in < 90 sec in all patients receiving rocuronium but in only 14 of 21 patients receiving atracurium. The incidence of adverse events and the cardiovascular profiles for the two drugs were similar, although one patient receiving atracurium experienced transient flushing of the head and neck.
Conclusion
Rocuronium has minimal side effects, provides conditions more suitable for rapid tracheal intubation, and is associated with a shorter clinical duration than atracurium. Once begun, the spontaneous recovery profile of rocuronium is slightly slower than that of atracurium.
Résumé
Objectif p]Comparer les effets neuromusculaires, l’efficacité et la sécurité de doses à effet équivalent de rocuronium et d’atracurium chez des patientes devant subir une chirurgie ambulatoire.
Méthode
Quarante-deux patientes réparties au hasard et devant subir une laparoscopie gynécologique ont reçu 2 × ED90 de rocuronium (0,6 mg·kg−1; n = 20) ou d’atracurium (0,5 mg·kg−1; n = 21) pour une anesthésie intraveineuse avec propofol et alfentanil sous ventilation avec N2O et O2. Le blocage neuromusculaire a été mesuré à l’aide d’un mécanomyogramme enregistrant, au poignet, une réponse en train-de-quatre (TDQ). Pendant le séjour à l’hôpital, des observateurs impartiaux ont noté l’état de l’intubation 60 s après l’administration du relaxant musculaire, et les perturbations cardiovasculaires ou les réactions indésirables immédiatement après leur survenue.
Résultats
Comparé à l’atracurium, le rocuronium a été associé à une induction plus courte (59,0 ± 22,2vs 98,6 ± 41,4 s;P < 0,001) et à une action clinique plus brève (33,3 ± 7, 1vs 44,7 ± 7,2 min;P < 0,001), mais à un index de récupération spontanée plus long (9,6 ± 2,41vs 6,9 ± 1,89 min;P = 0,023) et à une durée similaire de récupération spontanée au TDQ 70 % (53 ± 6,31vs 59,2 ± 7,59 min;P = 0,139). L’intubation endotrachéale a eu lieu en moins de 90 s chez toutes les patientes qui ont reçu du rocuronium mais chez seulement 14 des 21 patientes ayant reçu de l’atracurium. Lincidence de réactions indésirables et les profils cardiovasculaires ont été semblables avec les deux médicaments, quoiqu’une patiente ayant reçu de l’atracurium ait manifesté des bouffées vasomotrices à la tête et au cou.
Conclusion
Le rocuronium présente moins d’effets secondaires, permet une intubation endotrachéale plus rapide et est associé à un effet clinique plus court que l’atracurium. Une fois amorcée, la récupération spontanée est légèrement plus lente qu’avec l’atracurium.
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Whalley, D.G., Maurer, W.G., Knapik, A.L. et al. Comparison of neuromuscular effects, efficacy and safety of rocuronium and atracurium in ambulatory anaesthesia. Can J Anaesth 45, 954–959 (1998). https://doi.org/10.1007/BF03012303
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DOI: https://doi.org/10.1007/BF03012303