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American Journal of Critical Care. 2009;18: 439-445 doi:10.4037/ajcc2009883
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Clinical Predictors of Duration of Action of Cisatracurium and Rocuronium Administered Long-Term

By Philipp Fassbender, MD, Götz Geldner, MD, Manfred Blobner, MD, Rainer Hofmockel, MD, Christopher Rex, MD, Shiva Gautam, PhD, Atul Malhotra, MD and Matthias Eikermann, MD. Philipp Fassbender is a resident in anesthesiology at Universität Duisburg-Essen and Universitätsklinikum Essen, Germany. Götz Geldner is an anesthesiologist at Klinikum Ludwigsburg and Philipps-Universität, Marburg, Germany. Manfred Blobner is an anesthesiologist at Klinikum rechts der Isar and Technische Universität München, Munich, Germany. Rainer Hofmockel is an anesthesiologist at Universitätsklinikum Rostock, Germany. Christopher Rex is an anesthesiologist at Klinikum am Steinenberg, Reutlingen, Germany. Shiva Gautam is a statistician at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Atul Malhotra is a pulmonary intensivist at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. Matthias Eikermann is an anesthesiologist and intensivist at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Corresponding author: Philipp Fassbender, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122 Essen, Germany (e-mail: philipp.fassbender{at}uk-essen.de).

Background The duration of action of neuromuscular blocking drugs (NBDs) varies between individuals and even within individuals in different settings.

Objectives To define predictors of variance in duration of action of rocuronium and cisatracurium administered long-term.

Methods A prospective, double-blind, multicenter trial that included 113 patients scheduled for major abdominal surgery and postoperative admission to the intensive care unit. Patients received repetitive (median, 7) equipotent doses of rocuronium or cisatracurium to maintain deep relaxation (twitch height of the adductor pollicis muscle <25% of baseline). Effects of weight, age, sex, American Society of Anesthesiologists risk score, lowest core temperature, duration of NBD administration, and tobacco smoking history on duration of action of cisatracurium and rocuronium were determined via multiple regression analysis.

Results Only duration of NBD administration was predictive of the duration of action of rocuronium. The predicted increase in time to recovery of the train-of-4 ratio to 0.9 (duration TOF 0.9) per hour of continuous NBD treatment was 12.4 minutes. In contrast, only lowest core body temperature was predictive of cisatracurium’s duration of action, and the predicted increase in duration TOF 0.9 per degree Celsius decrease was 9.8 min.

Conclusion Duration of NBD treatment is strongly predictive of the duration of action of rocuronium, and body temperature is predictive of the duration of action of cisatracurium. These data may help decrease the incidence of drug-induced muscle weakness in recovery rooms and surgical intensive care units, particularly if neuromuscular transmission monitoring is not available.






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Copyright © 2009 by the American Association of Critical-Care Nurses.