Neuromuscular Blocking Agents Clinical Trial
Official title:
Effect of Nitrous Oxide on Cisatracurium Infusion Demands. A Randomized Controlled Trial.
Background: Recent studies have questioned our previous understanding on the effect of
nitrous oxide on muscle relaxants, since nitrous oxide has been shown to potentiate the
action of bolus doses of mivacurium, rocuronium and vecuronium. This study was aimed to
investigate the possible effect of nitrous oxide on the infusion requirements of
cisatracurium.
Methods: 70 ASA physical status I-III patients aged 18-75 years were enrolled in this
randomized trial. The patients were undergoing elective surgery requiring general anesthesia
with a duration of at least 90 minutes. Patients were randomized to receive propofol and
remifentanil by target controlled infusion in combination with either a mixture of oxygen
and nitrous oxide (Nitrous oxide/TIVA group) or oxygen in air (Air/TIVA group). A 0.1 mg/kg
initial bolus of cisatracurium was administered before tracheal intubation, followed by a
closed-loop computer controlled infusion of cisatracurium to produce and maintain a 90%
neuromuscular block. Cumulative dose requirements of cisatracurium during the 90-min study
period after bolus administration were measured and the asymptotic steady state rate of
infusion to produce a constant 90% block was determined by applying nonlinear curve fitting
to the data on the cumulative dose requirement during the study period.
Results: Controller performance, i.e. the ability of the controller to maintain
neuromuscular block constant at the setpoint and patient characteristics were similar in
both groups. The administration of nitrous oxide did not affect cisatracurium infusion
requirements. The mean steady-state rates of infusion were 0.072 +/- 0.018 and 0.066 +/-
0.017 mg * kg-1 * h-1 in Air/TIVA and Nitrous oxide/TIVA groups, respectively.
Conclusions: Nitrous oxide does not affect the infusion requirements of cisatracurium.
n/a
Observational Model: Case Control, Time Perspective: Prospective
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