The influence of the duration of isoflurane anaesthesia on neuromuscular effects of mivacurium.

Abstract

The pharmacodynamic profile of muscle relaxants is usually changed by volatile anaesthetics. These changes seem to be time-dependent, even though few data are available to substantiate this. We studied neuromuscular effects of a single dose of mivacurium (0.2 mg.kg-1) during short and intermediate duration of isoflurane anaesthesia. Forty-five children 1-10 years of age were randomized to receive 1.5% end-tidal concentration of isoflurane in N2O/O2 for 10 or 30 min (groups Iso-10 and Iso-30, respectively) or to receive nitrous oxide in oxygen for 10 min (Group N2O) before 0.2 mg.kg-1 of mivacurium was given. Neuromuscular response was recorded by adductor pollicis electromyogram. The onset time of mivacurium was shorter in Group Iso-30, 1.7 (1.0-2.3) min than in Group Iso-10, 2.3 (1.7-3.3) min or Group N2O, 2.3 (1.7-3.3) min (median with 10-90% percentiles) (P < 0.05). In Group Iso-30 the recovery time of the first EMG response was significantly longer than in groups Iso-10 and N2O (P < 0.0001). Groups Iso-10 and N2O did not differ from each other. Our results indicate that the duration of a constant concentration of isoflurane anaesthesia influences significantly the pharmacodynamics of mivacurium. The duration of a volatile anaesthesia is critical when potentiation of NMB is evaluated or compared in neuromuscular studies.