Wpływ sewofluranu na ustępowanie zwiotczenia wywołanego przez miwakurium u dzieci^*)

Bogumiła Wołoszczuk-Gębicka¹, Elżbieta Wyska²

Summary
Background. Sevoflurane may markedly prolong the neuromuscular block caused by mivacurium, and the block may not be completely reversed without discontinuation of sevoflurane. We assessed the clinical course of mivacurium NMT block, comparing sevoflurane with opioid-based anaesthesia. Methods. 24 ASA 1 and 2 children (aged 3-11 years) were randomly allocated to receive 1 MAC nitrous oxide-sevoflurane, (SEVO group, n=12) or nitrous oxide-fentanyl (FENT group, n=12). An intubating dose of mivacurium, 0.2 mg kg^-1 was given, and when T1 returned to 5%, muscle relaxation was maintained by continuous infusion of mivacurium, adjusted in a closed loop to maintain a stable 90-99% block. The ulnar nerve was stimulated at the wrist with train-of-four (TOF, 2 Hz repeated every 20s), and electromyographic response was recorded from the adductor pollicis brevis. Results. The results of the study indicated that RF_25-75 was significantly longer in the SEVO group (8.8±3.4 vs. 6.1±2.2, p=0.036). However, the maximum time from discontinuation of mivacurium infusion to the time when an endotracheal tube could be safely removed (train-of four ratio TR>80%) was insignificantly longer in the SEVO group and never exceeded 30 minutes. Moreover, RF_25-75, which describes an early phase of the recovery of neuromuscular transmission, correlated with the mivacurium requirement (R² =0.19). Conclusion. Monitoring of neuromuscular transmission during mivacurium infusion and during the recovery phase should be mandatory, because of the large interpatient variability in drug response.

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