Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol
作者:Thomas M. Hemmerling、Juergen Schuettler、Helmut Schwilden
DOI:10.1007/bf03016828
日期:2001.6
Purpose: The present study investigated the interaction between the cumulative dose requirements of cisatracurium and anesthesia with isoflurane, sevoflurane, desflurane or propofol using closed-loop feedback control.Methods: Fifty-six patients (18-85 yr, vitrectomies of more than one hour) were studied. In the volatile anesthetics groups, anesthesia was maintained by 1.3 MAC of isoflurane, sevoflurane or desflurane; in the propofol group, anesthesia was maintained by a continuous infusion of 6-8 mg(.)kg(-1) hr(-1) propofol. After bolus application of 0.1 mg(.)kg(-1) cisatracurium, a T1%-level of 10% of control level (train-of-four stimulation every 20 sec) was maintained using closed-loop feedback controlled infusion of cisatracurium. The effective therapeutic infusion rate (ETI) was estimated from the asymptotic steady-state infusion rate I-ss. The I-SS was derived from fitting an asymptotic line to the measured cumulative dose requirement curve. The ETI of the different groups was compared using Kruskal-Wallis- test, followed by rank sum test, corrected for the number of comparisons, P <0.05 was regarded as showing significant difference.Results: ETI in the isoflurane group was 35.6 +/- 8.6 mug(.)m(-2) min(-1), in the sevoflurane group 36.4-+/- 11.9 mug m(-2) min(-1), in the desflurane group 23.8 +/- 6.3 mug(.)m(-2) min(-1). The ETI of the volatile anesthetic groups were all significantly lower than the ETI in the propofol group at 61.7 +/- 25.3 mug(.)m(-2)min(-1) (P <0.002). The ETI in the desflurane group was significantly lower than in all other groups (P <0.02).Conclusion: In comparison to propofol, isoflurane, sevoflurane and desflurane reduce the cumulative dose requirements of cisatracurium to maintain a 90% neuromuscular blockade by 42%, 41% and 60%, respectively.