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Online ISSN 1827-1596
Melloni C. 1, DeVivo P. 2, Launo C. 3, Mastronardi P. 4, Novelli G. P. 5, Romano E. 6, Tomasoni G. 7, Vincenti E. 8
1 Anestesia and Resuscitation Unit City Hospital, Faenza (RA), Italy
2 Anestesia and Resuscitation Unit Casa Sollievo della Sofferenza San Giovanni Rotondo (FG), Italy
3 Department of Anestesia and Resuscitation University of Genoa, Genoa, Italy
4 Department of Anestesia Federico II University, Naples, Italy
5 Division of Anestesia and Resuscitation Careggi Hospital, Florence, Italy
6 Anestesia and Resuscitation Unit Ospedale Maggiore, Trieste, Italy
7 Division of Anestesiology Civil Hospitals, Brescia, Italy
8 Anestesia and Resuscitation Ospedale di Camposanpiero Camposanpiero (PD), Italy
Aim. The aim of this study was to compare the time course characteristics of cisatracurium (C) and vecuronium (V) induced neuromuscular block (NMB) following multiple doses, allowing spontaneous complete recovery (SCRT) and evaluating the influence of age.
Methods. Following institutional approval and signed informed consent, 177 adult ASA 1-2 patients were included in a randomized, double-blind, multicenter study under N20/02/fentanyl/propofol anesthesia. Muscle relaxation was induced with 0.15 mg/kg C or 0.l mg/kg V and was maintained with 0.03 mg/kg of C or 0.02 mg/kg of V injected at T1 25% recovery. Intubating conditions were assessed at 2 min after the initial dose. Time course of NMB was monitored using accelerography (Tofguard) of the adductor pollicis with train-of-four (TOF). Data were analyzed with parametric (Anova) and non parametric statistics (χ2, Kruskal Wallis).
Results. Both drugs offered good/excellent intubating conditions: duration of action of NMB (mean values ± SD, minutes) were: dur25 first dose: V 38.20±13.2 vs C 51.5±11.3 (P<0.02 ); dur25 following repeated boluses (average): V 23.2± 8.6 vs C 28.2±9.5, ns; dur25 last dose: V 25.1±11.5 vs C 31.5±11.4, ns: SCRT following last dose: V 50.2±23.2 vs C 46.4±17.5, ns: t125% to t4/T1 0.80:V 27.1±18.7 vs C 18.8±10.2, ns. Stratifying for age >or< 65 no differences were noted in the intervals studied following C, while all were longer following V. The duration of block of C was longer than V; the SCRT after the final dose of C was shorter than V albeit not significant. There was a clinically significant increase in duration of block and recovery time in elderly patients for V but not for C.
Conclusion. C and V allow predictable NMB duration and spontaneous recovery even if administered in multiple repeated doses; but in elderly patients duration of block and recovery time is longer following V.
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