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Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium

Published online by Cambridge University Press:  01 July 2008

M. Adamus ,
T. Gabrhelik  and
O. Marek
M. Adamus*
Affiliation:
Palacký University, University Hospital and Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Olomouc, Czech Republic
T. Gabrhelik
Affiliation:
Palacký University, University Hospital and Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Olomouc, Czech Republic
O. Marek
Affiliation:
Palacký University, University Hospital and Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Olomouc, Czech Republic
*
Correspondence to: Milan Adamus, Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine, Palacký University, 772 00 Olomouc, Czech Republic. E-mail: milan.adamus@seznam.cz; Tel: +420 608 570801; Fax: +420 585 852524
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Summary

Background and objective

There is increasing evidence of gender differences in the pharmacokinetics and pharmacodynamics of aminosteroid neuromuscular blocking agents. Compared to males, females are more susceptible, requiring approximately 30% less rocuronium to achieve the same degree of neuromuscular block. However, little information is available whether this difference is applicable to modern benzylisoquinolines (cisatracurium).

Methods

In all, 848 patients (423 males, 425 females) undergoing general surgery under total intravenous anaesthesia with muscle relaxation, tracheal intubation and mechanical ventilation were studied. Patients were randomized to receive a single bolus dose of cisatracurium (0.1 mg kg−1, 221 males and 199 females) or rocuronium (0.6 mg kg−1, 202 males and 226 females). The onset time for 95% depression of T1, clinical duration until 25% recovery and recovery index (T1 from 25% to 75%) were determined with an NMT electromyographic module of the Datex-Ohmeda S/5 Anaesthesia Monitor. The data for male and female groups were compared with appropriate statistical tests (unpaired t-test, Mann–Whitney rank sum test and Fisher’s exact test).

Results

In both groups (cisatracurium and rocuronium), males were significantly taller (P < 0.001) and heavier (P < 0.001) than females, but the body mass index was comparable. For rocuronium, the onset time was shorter 91.7 ± 14.3 s vs. 108.0 ± 14.6 s (P < 0.001) and the clinical duration was increased in females 43.3 ± 7.8 min vs. 31.3 ± 5.5 min (P < 0.001). In the cisatracurium group, both onset times (248.9 ± 60.7 s for males vs. 253.4 ± 70.9 s for females) and clinical duration (42.6 ± 6.9 min for males vs. 43.1 ± 6.9 min for females) were similar. The recovery index was identical for males and females in both groups.

Conclusions

Females were more sensitive than males to a single bolus dose of rocuronium. Under the study conditions described, the onset time was shorter and the clinical duration was increased in female patients. This suggests that the routine dose of rocuronium should be reduced in females compared to males. On the contrary, we could demonstrate no gender differences in the onset time or clinical duration of cisatracurium.

Keywords

ANAESTHESIA GENERAL, total intravenous anaesthesia, target-controlled infusionNEUROMUSCULAR BLOCKADE, monitoring, electromyographyNEUROMUSCULAR BLOCKING AGENT, cisatracurium, rocuronium, onset, recoveryGENDER AND SEX ISSUE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 7 , July 2008 , pp. 589 - 595
Copyright
copyright © European Society of Anaesthesiology 2008

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References

1.Pleym, H, Spigset, O, Kharasch, ED, Dale, O. Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol Scand 2003; 47: 241–259.CrossRefGoogle ScholarPubMed
2.Xue, FS, Tong, SY, Liao, X, Liu, JH, An, G, Luo, LK. Dose-response and time course of effect of rocuronium in male and female anesthetized patients. Anesth Analg 1997; 85: 667–671.CrossRefGoogle ScholarPubMed
3.Mencke, T, Soltesz, S, Grundmann, U et al. Time course of neuromuscular blockade after rocuronium. A comparison between women and men. Anaesthesist 2000; 49: 609–612.CrossRefGoogle ScholarPubMed
4.Mencke, T, Schreiber, JU, Knoll, H, Werth, M, Grundmann, U, Rensing, H. Influence of gender on the intubation conditions with rocuronium. Anaesthesist 2005; 54: 884–888.CrossRefGoogle ScholarPubMed
5.Mallampati, SR, Gatt, SP, Gugino, LD et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–434.CrossRefGoogle ScholarPubMed
6. References and formulas used by the Body Surface Area Calculator. Formula for Body Mass Index. Formulas for Body Surface Area [on line, cited 2007 May 15]. Available from http://www.halls.md/body-surface-area/refs.htm.Google Scholar
7.Servin, F, Cazalaa, JB, Levron, JC. Propofol, Sufentanil, Remifentanil in TCI. Bibliographical study of anesthetic agents used in the Base Primea®, Fresenius Vial. Le Grand Chemin, Brezins, France: Fresenius Vial, 2003: 64p.Google Scholar
8.Schnider, TW, Minto, CF, Gambus, PL et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: 1170–1182.CrossRefGoogle ScholarPubMed
9.Gepts, E, Shafer, SL, Camu, F et al. Linearity of pharmacokinetics and model estimation of sufentanil. Anesthesiology 1995; 83: 1194–1204.CrossRefGoogle ScholarPubMed
10.Viby-Mogensen, J, Engbaek, J, Eriksson, LI, Gramstad, L, Jensen, E, Jensen, FS. Good Clinical Research Practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.CrossRefGoogle ScholarPubMed
11.Viby-Mogensen, J, Ostergaard, D, Donati, F, Fisher, D, Hunter, J, Kampmann, JP. Pharmacokinetic studies of neuromuscular blocking agents: Good Clinical Research Practice (GCRP). Acta Anaesthesiol Scand 2000; 44: 1169–1190.CrossRefGoogle ScholarPubMed
12.Adamus, M, Belohlavek, R. Automatic control of neuromuscular block during long-lasting neurosurgical interventions. Cesk Slov Neurol N 2006; 69: 447–451.Google Scholar
13.Adamus, M, Belohlavek, R, Koutna, J, Vujcikova, M, Janaskova, E. Cisatracurium vs. Rocuronium: a prospective, comparative, randomized study in adult patients under total intravenous anaesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2006; 150: 333–338.CrossRefGoogle ScholarPubMed
14.Mencke, T, Beerhalter, U, Fuchs-Buder, T. Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients. Acta Anaesthesiol Scand 2001; 45: 1002–1005.CrossRefGoogle ScholarPubMed
15.Mencke, T, Schreiber, JU, Knoll, H et al. Women report more pain on injection of a precurarization dose of rocuronium: a randomized, prospective, placebo-controlled trial. Acta Anaesthesiol Scand 2004; 48: 1245–1248.CrossRefGoogle ScholarPubMed
16.Houghton, IT, Aun, CS, Oh, TE. Vecuronium: an anthropometric comparison. Anaesthesia 1992; 47: 741–746.CrossRefGoogle ScholarPubMed
17.Semple, P, Hope, DA, Clyburn, P, Rodbert, A. Relative potency of vecuronium in male and female patients in Britain and Australia. Br J Anaesth 1994; 72: 190–194.CrossRefGoogle ScholarPubMed
18.Xue, F, Liao, X, Liu, J et al. Dose-response curve and time-course of effect of vecuronium in male and female patients. Br J Anaesth 1998; 80: 720–724.CrossRefGoogle ScholarPubMed
19.Xue, FS, An, G, Liao, X, Zou, Q, Luo, LK. The pharmacokinetics of vecuronium in male and female patients. Anesth Analg 1998; 86: 1322–1327.CrossRefGoogle ScholarPubMed
20.Parker, CJ, Hunter, JM, Snowdon, SL. Effect of age, sex and anaesthetic technique on the pharmacokinetics of atracurium. Br J Anaesth 1992; 69: 439–443.CrossRefGoogle ScholarPubMed
21.Xue, FS, Zhang, YM, Liao, X, Liu, JH, An, G. Influences of age and gender on dose response and time course of effect of atracurium in anesthetized adult patients. J Clin Anesth 1999; 11: 397–405.CrossRefGoogle ScholarPubMed
22.Schmith, VD, Fiedler-Kelly, J, Phillips, L, Grasela, TH Jr. Prospective use of population pharmacokinetics/pharmacodynamics in the development of cisatracurium. Pharm Res 1997; 14: 91–97.CrossRefGoogle ScholarPubMed
23.Hans, P, Welter, P, Dewandre, PY, Brichant, JF, Bonhomme, V. Recovery from neuromuscular block after an intubation dose of cisatracurium and rocuronium in lumbar disc surgery. Acta Anaesthesiol Belg 2004; 55: 129–133.Google ScholarPubMed
24.Melloni, C, Devivo, P, Launo, C, Mastronardi, P, Novelli, GP, Romano, E. Cisatracurium versus vecuronium: a comparative, double blind, randomized, multicenter study in adult patients under propofol/fentanyl/N2O anesthesia. Minerva Anestesiol 2006; 72: 299–308.Google ScholarPubMed
25.Baillard, C, Gehan, G, Reboul-Marty, J, Larmignat, P, Samama, CM, Cupa, M. Residual curarization in the recovery room after vecuronium. Br J Anaesth 2000; 84: 394–395.CrossRefGoogle ScholarPubMed
26.Cammu, G, de Baerdemaeker, L, den Blauwen, N, de Mey, JC, Struys, M, Mortier, E. Postoperative residual curarization with cisatracurium and rocuronium infusions. Eur J Anaesthesiol 2002; 19: 129–134.CrossRefGoogle ScholarPubMed
27.Beaussier, M, Boughaba, MA. Residual neuromuscular blockade. Ann Fr Anesth Reanim 2005; 24: 1266–1274.CrossRefGoogle ScholarPubMed
28.Viby-Mogensen, J. Postoperative residual curarization and evidence-based anaesthesia. Br J Anaesth 2000; 84: 301–303.CrossRefGoogle ScholarPubMed
29.Alkhazrajy, W, Khorasanee, AD, Russell, WJ. Muscle weakness after muscle relaxants: an audit of clinical practice. Anaesth Intensive Care 2004; 32: 256–259.CrossRefGoogle ScholarPubMed
30.Berg, H, Roed, J, Viby-Mogensen, J et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand 1997; 41: 1095–1103.CrossRefGoogle Scholar