Sevoflurane Rocuronium

In addition to the medicines mentioned above, a number of opiate- and non-opiate-based analgesics, including COX-2 inhibitors, anaesthetics (e.g. propofol, desflurane, sevoflurane, ropivacaine, levobupivacaine and remifentanil), neuromuscular blockers (e.g. rocuronium bromid, zemuron, cisatracuiium, doxacurium. 

The block of rocuronium is reversed with neostigmine 35-50 pg-kg-1 provided some spontaneous recovery has taken place. The reversal may be slowed in the presence of agents like sevoflurane, however discontinuation of sevoflurane before neostigmine administration results in fairly prompt recovery. 

Both desflurane and sevoflurane significantly increase the neuromuscular blocking effects of rocuronium compared with isoflurane or propofol (20,21). 

Lowry DW, Mirakhur RK, Carrol MT. Time course of action of rocuronium during sevoflurane, isoflurane or i.v. anaesthesia. Br J Anaesth 1998 80 544. 

Wulf H, Ledowski T, Linstedt U, Proppe D, Sitzlack D. Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia. Can J Anaesth 1998 45(6) 526-32. 

Both desflurane and sevoflurane significantly increase the neuromuscular blocking effects of rocuronium compared with isoflurane or propofol (41,42). The effective doses of rocuronium for 50% depression of single twitch height were 95,120,130, and 150 pg/kg for desflurane, sevoflurane, isoflurane, and propofol respectively. There were no differences in recovery profiles between the four drugs using equieffective doses. Desflurane, sevoflurane, and to a lesser extent isoflurane, also potentiated the neuromuscular blocking effect of cisatracurium by 30% compared with propofol (43,44). 

Reid JE, Breslin DS, Mirakhur RK, Hayes AH. Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane, isoflurane or propofol. Can JAnaesth (2001) 48, 351-5. 

The inhalational anaesthetics increase the effects of the neuromuscular blockers to differing extents, but nitrous oxide appears not to interact significantly. Ketamine has been reported to potentiate the effects of atracurium. Propofol does not appear to interact with mivacurium or vecuronium. Xenon is reported not to interact with mivacurium or rocuronium, and has less effect than sevoflurane on vecuronium neuromuscular blockade. Bradycardia has been seen in patients given vecuronium with eto-midate or thiopental. Propofol can cause serious bradycardia if it is given with suxamethonium (succinylcholine) without adequate antimuscarinic premedication, and asystole has been seen when fentanyl, propofol and suxamethonium were given sequentially. 

Xenon is reported not to prolong the neuromuscular blocking effects of rocuronium.It is also reported to have less effect on recovery from vecuronium-induced neuromuscular block than sevoflurane. Xenon is also reported not to affect the onset time, duration and recovery from mi-vacurium. ... 

Bock M, Klippel K, Nitsche B, Bach A, Martin E, Motsch J. Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaes-diesia. BrJ Anaesth (2000) 84, 43-7. 

In a double-blind, multicenter, randomized study in 20 ASA I-III patients aged 18-69 years and scheduled for elective surgery lasting at least 120 minutes, anesthesia was induced with remifentanil and rocuronium and maintained with sevoflurane or propofol remifentanil was used for... 

Duvaldestin P, Kuizenga K, Saldien V, Claudius C, Servin F, Klein J, Debaene B, Heeringa M. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg 2010 110(1) 74-82. 

A 35-year-old woman, scheduled for an emergency cesarean section, was anesthetized with propofol 2 mg/kg and rocuronium 0.9 mg/kg and maintained with sevoflurane. About 15 minutes before the end of the operation she became tachycardic, difficult to ventilate, and hypoxic despite 70% oxygen. After a second dose of propofol for reintubation, she again became hypotensive and profoundly hypoxic and required inotropic support. Pulmonary edema was diagnosed. Afterwards, a skin test showed a strong weal and flare reaction to propofol. 

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