Tactile TOF count as a predictive factor for the efficacy of neostigmine reversal of rocuronium-Induced blockade during propofol or sevoflurane anesthesia

ABSTRACT

This study was done to determine whether train-of-four [TOF] count is a good predictor to the efficacy of neostigmine administration for reversal of rocuronium-induced blockade during propofol or sevoflurane anaesthesia, and to follow subsequent recovery until the TOF reached 0.9. One-hundred-twenty patients, divided into eight equal groups, were randomly allocated to maintenance of anaesthesia with propofol or sevoflurane. The tactile response of the adductor pollicis to TOF stimulation was evaluated on one arm, and the mecha-nomyographic response was recorded on the other Neuromuscular block was induced with rocuronium 0.6 mg.kg[-1] and maintained with rocuronium to 15% of the control first twitch in TOF, neostigmine 0.07mg.Kg[-1] was administered on reappearance of the first [Group I], second [Group II], third [Group III], or fourth [Group IV] tactile TOF-response in each anaesthesia. The times from administration of neostigmine until the ratio recovered to 0.7, 0.8 and 0.9 were recorded. The times [[median [range]] to TOF ratio - 0.9 were 8.2 [4.5-17.3], 7.8 [3.6-11.9], 5.6 [1.8-9.1], and 4.4 [1.1-7.6] min in Groups I-IV during propofol anaesthesia, respectively, and 24.6 [8.1-66.3], 22.8 [7.6-51.1], 15.4 [7.1-39.7], and 9.1 [4.9-22.3] minutes in corresponding groups during sevoflurane anaesthesia, respectively, [p<0.05]. We recommend more than 2 TOF responses with propofol anaesthesia and 4 TOF responses with sevoflurane anaesthesia for adequate reversal within 10 and 15 minutes, respectively. The more tactile TOF responses present at the time of reversal achieved greater adequate recovery