Rocuronium pharmacokinetics and pharmacodynamics in the adductor pollicis and masseter muscles.

BACKGROUND: The aim of this study was to characterize the dose-effect relationship of rocuronium at the adductor pollicis and masseter muscles. METHODS: Ten, ASA I, adult patients, received a bolus dose of rocuronium 0.3 mg/kg during propofol based anesthesia. Train-of-four (TOF) was simultaneously monitored at the masseter and the adductor pollicis muscles until recovery. Rocuronium arterial serum concentrations were measured during 120 min. The first twitch of the TOF response was used to characterize the time-effect profile of both muscles using pharmacokinetic-pharmacodynamic analysis in NONMEM. A decrease in NONMEM objective function (∆OFV) of 3.84 points for an added parameter was considered significant at the 0.05 level. RESULTS: Onset time at the masseter (mean ± SD, 1.5 ± 0.9 min) was faster than at the adductor pollicis (2.7 ± 1.4 min, P < 0.05). Recovery, measured as the time to TOF ratio = 0.9 was similar between muscles 29.9 ± 6.7 (adductor pollicis) vs. 29.3 ± 8.1 (masseter). (P = 0.77). The estimated pharmacodynamic parameters [mean (95% CI)] of the adductor pollicis muscle and the masseter muscle were; plasma effect-site equilibration half-time (teq) 3.25 (2.34, 3.69) min vs. 2.86 (1.83, 3.29) min, (∆OFV 383.665); Ce50 of 1.24 (1.13, 1.56) mg/l vs. 1.19 (1.00, 1.21) mg/l, (∆OFV 184.284); Hill coefficient of 3.97 (3.82, 5.62) vs. 4.68 (3.83, 5.71), (∆OFV 78.906). CONCLUSIONS: We found that the masseter muscle has faster onset of blockade and similar recovery profile than adductor pollicis muscle. These findings were best, explained by a faster plasma effect-site equilibration of the masseter muscle to rocuronium.

Effect site concentrations of propofol producing hypnosis in children and adults: comparison using the bispectral index.

BACKGROUND: No study has determined the concentration of propofol producing a degree of hypnosis compatible with anaesthesia in children. As a result, concentrations determined in adults are recommended for children. As this can result in an inadequate depth of anaesthesia, we determined the predicted effect site concentration (C(e)) of propofol necessary to obtain a bispectral index (BIS) of 50 in 50% (EC(e50)) of children and adults. METHODS: Twenty adults (aged 33-44 years) and 20 children (aged 3-11 years) undergoing surgery under general anaesthesia were studied. All were monitored with a BIS monitor, and a target controlled infusion of propofol aiming for a constant C(e) value was started. After 10 min, patients were evaluated using a sedation scale, and the last 5 min was used to determine the mean BIS for this C(e) value. The C(e) value of propofol was defined using the up-and-down method of Dixon and Massey. The first patient in each group received C(e)= 6 microg/ml; thereafter, it was modified in 0.5 microg/ml decrements/increments with positive or negative responses, respectively. A positive response was BIS < 50 and a negative response was BIS > or = 50. The EC(e50) value was compared using unpaired Student's t-test. The prediction probability (P(K)) was used to study the association between BIS and the sedation score. RESULTS: The mean EC(e50) (95% confidence interval) values were 3.75 microg/ml (2.97-4.75 microg/ml) in adults and 3.65 microg/ml (3.36-3.96 microg/ml) in children (not significant). All patients with BIS < 50 were unarousable with tactile stimulation. The P(K) value was 0.99 in both groups. CONCLUSIONS: The predicted C(e) value of propofol resulting in BIS = 50 was similar in adults and children aged 3-11 years. The predicted C(e) value of propofol producing hypnosis in adults also seems to be useful in this paediatric population.