European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Jan 1994
Dose-response relationship and time course of action of rocuronium bromide in perspective.
The available evidence indicates that rocuronium is one of the least potent non-depolarizing muscle relaxants, having a clinical duration, recovery index and reversal time similar to those of atracurium and vecuronium. The onset time, however, is significantly shorter than that of currently used non-depolarizing muscle relaxants. ⋯ There is no difference in potency of rocuronium between adult and elderly patients, but it is not clear yet whether the potency differs between adults and neonates, infants or children. The onset time, duration of action, and recovery index are prolonged in elderly patients and the onset time, duration of action, and recovery index are longer in infants than in children.
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Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Clinical TrialEvaluation of the onset and intubation conditions of rocuronium bromide.
Rocuronium 0.6, 0.75, or 0.9 mg kg-1, was given after supramaximal train-of-four stimulation of the ulnar nerve, measuring the compound action potential of the hypothenar muscles, Intubation conditions, onset time, recovery to 25% and recovery index of the three doses of rocuronium bromide were determined in 60 ASA I or II consenting patients, who were receiving propofol, alfentanil and N2O/O2 for ophthalmic surgery. Intubation conditions were randomly assessed either 45 s or 60 s after injection. In general, intubation conditions were excellent or good; in only three patients were poor conditions obtained, always at 45 s. ⋯ No difference could be shown between the three dose groups. The onset time was longer (P < 0.01) in the 0.6 mg kg-1 group, compared to that in the 0.9 mg kg-1 group. The recovery to 25% and spontaneous recovery index were shorter in the 0.6 mg kg-1 group (P < 0.01).
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Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Clinical TrialQuantitation of the interaction of rocuronium bromide with etomidate, fentanyl, midazolam, propofol, thiopentone, and isoflurane using closed-loop feedback control of infusion of rocuronium.
Sixty patients were randomly assigned to one of six groups (n = 10 in each case) in which anaesthesia was induced and maintained with etomidate, fentanyl, midazolam, propofol or with thiopentone and N2O, or isoflurane and N2O. After obtaining control measurements, rocuronium 0.6 mg kg-1 was given for intubation followed by an infusion, controlled by closed-loop feedback at 90% block. ⋯ The intravenous agents did not interact with recuronium to any clinically significant degree. Isoflurane reduced the requirements by 35-40%.
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Many factors influence the minimum time required to achieve an easy and successful tracheal intubation after a non-depolarizing relaxant. The ideal study design has never been achieved in practice: an overall picture of the efficacy of rocuronium depends on careful interpretation of studies with different methodologies, which have usually compared the new drug with vecuronium or suxamethonium, currently the best alternatives. ⋯ Although some studies have produced evidence that rocuronium can produce smooth easy intubation conditions in 60 s, 90 s would appear to be closer to the time when excellent conditions can be guaranteed. Whether this is an acceptable alternative to the 45 s or so needed after suxamethonium is a matter of clinical judgement which only testing in practice will answer.
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Eur J Anaesthesiol Suppl · Jan 1994
Safety aspects of non-depolarizing neuromuscular blocking agents with special reference to rocuronium bromide.
The safety of neuromuscular relaxants can be assessed according to their cardiovascular and autonomic effects, their liability to release histamine, their tendency to cause anaphylactic/anaphylactoid reactions, their effect on cholinesterase, on intra-ocular and intracranial pressure, their tendency to cumulation and their reversibility. Any adverse effects of metabolites are also potential problems. Against these standards, rocuronium may have some mild vagolytic activity. Apart from that, its safety profile is indistinguishable from that of vecuronium.