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Priming with rocuronium or vecuronium prevents remifentanil-mediated muscle rigidity and difficult ventilation

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Abstract

Purpose

The aim of this study was to test our hypothesis that priming with rocuronium would prevent muscle rigidity and difficult ventilation due to remifentanil administration.

Methods

One hundred patients, American Society of Anesthesiologists (ASA) status I or II, were recruited into the study, and randomly allocated to one of four protocols (n = 25 each). Remifentanil was administered at 0.2 μg·kg−1·min−1 in group A and at 0.7 μg·kg−1·min−1 in groups B, C, and D. Priming with vecuronium (0.02 mg·kg−1) or rocuronium (0.06 mg·kg−1) was performed at the same time as the infusion of remifentanil in groups C and D, respectively. Anesthesia was induced with 1 mg·kg−1propofol 2 min after the start of remifentanil infusion. After the patient had lost consciousness, the anesthesiologist performed mask ventilation, and watched for the presence of muscle rigidity. Ventilation and rigidity were evaluated using a scoring system.

Results

Of the 100 patients, 9 were excluded; the number of patients in group A was 24, while groups B and D had 22 patients each, and group C had 23 patients. A lower dose of remifentanil (group A) or priming with vecuronium or rocuronium (groups C, D) significantly reduced the incidence of some difficulty with ventilation (P = 0.0010, P = 0.0053, and P = 0.021, respectively, vs group B). Of the patients in group B, 10 (45.5%) developed some difficulty with ventilation, and ventilation was impossible in 2 of them. On the other hand, 1 (4.1%) of the patients in group A, 2 (8.7%) in group C, and 3 (13.6%) in group D developed some difficulty with ventilation.

Conclusion

The present study showed that priming with rocuronium or vecuronium reduced the incidence of difficult ventilation by avoiding the muscle rigidity caused by remifentanil.

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Authors and Affiliations

  1. Department of Anesthesiology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Junya Nakada, Masao Nishira & Renko Hosoda

  2. Department of Anesthesiology and Critical Care Medicine, Tottori University Faculty of Medicine, Yonago, Japan

    Kazumi Funaki, Shyunsaku Takahashi & Yoshimi Inagaki

  3. Division of Medical Biochemistry, Tottori University Faculty of Medicine, Yonago, Japan

    Tatsuya Matsura

Authors
  1. Junya Nakada
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  2. Masao Nishira
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  3. Renko Hosoda
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  4. Kazumi Funaki
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  5. Shyunsaku Takahashi
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  6. Tatsuya Matsura
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  7. Yoshimi Inagaki
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Nakada, J., Nishira, M., Hosoda, R. et al. Priming with rocuronium or vecuronium prevents remifentanil-mediated muscle rigidity and difficult ventilation. J Anesth 23, 323–328 (2009). https://doi.org/10.1007/s00540-009-0769-9

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  • DOI: https://doi.org/10.1007/s00540-009-0769-9

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