Comparative study of neuromuscular blocking and hemodynamic effects of rocuronium and cisatracurium under sevoflurane or total intravenous anesthesia

Neuromuscular blockers [NMB] are important adjuvant to general anesthesia, rocuronium bromide and cisatracurium besylate are considered relatively recently introduced non-depolarizing muscle relaxants. This study evaluates the enhancement of cisatracurium and rocuronium -induced neuromuscular block during anesthesia with 1.5 MAC sevoflurane or total i.v. anesthesia [TIVA], hemodynamic effects and side effects. 80 patients were randomly allocated into one of four equal groups to receive either rocuronium [under sevoflurane or propofol TIVA] or cisatracurium [under sevoflurane or propofol TIVA]. The NMB effects of rocuronium and cisatracurium were studied by constructing dose-effect curves. Acceleromyography [TOF-Guard] and train-of-four [TOF] stimulation of the ulnar nerve were used [2Hz every 15sec.]. Cisatracurium and rocuronium were administered in increments until depression of T[1]/T[0]>95% was reached. Hemodynamic effects of both muscle relaxants together with sevoflurane or propofol were assessed using thoracic bioimpedance. Depression of T[1]/T[0] was enhanced under sevoflurane compared to TIVA. ED[50] and ED[95] values of both drugs were significantly lower under sevoflurane more than TIVA. Recovery index 25-75% and time to a TOF ration of 0.70 were prolonged significantly by sevoflurane compared to TIVA. Hemodynamically, rocuronium and cisatracurium did not exert significant changes, but the interaction of the relaxants and the anesthetic agents resulted in statistically significant decline in some hemodynamic parameters at certain periods which are not clinically significant and required no medications. We conclude that the effects of rocuronium and cisatracurium are significantly enhanced during sevoflurane compared with propofol anesthesia and the recovery is slower

role of magnesium sulphate as an adjuvant to propofol sedation in ICU patients, a comparative study

The aim of this study was to determine the effect of the concomitant use of magnesium sulphate infusion together with propofol continuous infusion used for sedation of the ICU patients on the total propofol consumption and on the patients' hemodynamics. Thirty mechanically ventilated ICU patients were randomly divided into two equal groups and allocated to receive either magnesium sulphate or placebo together with profolol continuous infusion. Hemodynamic monitoring included heart rate and invasive blood pressure measurements. Biochemical parameters included serum Na+, K+, Ca++. Mg++, total bilirubin and creatinine, and finally total propofol consumption in 24 hours. The use of magnesium sulphate continuous infusion significantly reduced total propofol consumption in group 2 [p<0.05]. This reduction was observed correlating with significant progressive rise of serum Mg++ [p<0.05]. No significant differences were detected in patients' hemodynamics or other biochemical parameters between both groups after the use of magnesium sulphate. The results indicate that the concomitant use of magnesium sulphate with propofol continuous sedation in ICU patients significantly reduced total propofol consumption with no significant derangements of the patients' hemodynamics or chemistry