rocuronium and Cerebrovascular-Disorders

Many anti-epileptics cause resistance to non-depolarizing neuromuscular blocking agents, but this has not been reported for valproic acid (VPA). We hypothesized that VPA would increase the rocuronium requirement and that magnesium sulphate (MgSO(4)) may reduce this increase.. Fifty-five patients undergoing cerebrovascular surgeries were studied. Subjects were allocated into three groups at a 1:1:1 ratio: Groups VM, VC, and C. Groups VM and VC were given VPA premedication; Group C was not. A rocuronium injection (0.6 mg kg(-1) i.v.) was administered to Group VM, followed by MgSO(4) as a 50 mg kg(-1) i.v. bolus and 15 mg kg(-1) h(-1) infusion. The same volume of 0.9% saline was administered to the other groups. Supplementary rocuronium (0.15 mg kg(-1)) was given whenever the train-of-four count reached 2. Rocuronium requirements (primary outcome), mean arterial pressure (MAP), heart rate (HR), nausea, vomiting, shivering, and use of anti-emetics and nicardipine were compared.. Group VC showed the highest rocuronium requirement [mg kg(-1) h(-1): 0.47 (0.08) vs 0.33 (0.12) (Group C), 0.31 (0.07) (Group VM); P<0.001]. MAP, intraoperative HR, nausea, vomiting, shivering, and use of anti-emetics and nicardipine were not significantly different among the groups. Postoperative HR was lower in Group VM than in Group VC.. VPA increased the rocuronium requirement, and MgSO(4) infusion attenuated this increase.

Topics: Adolescent; Adult; Aged; Androstanols; Anticonvulsants; Blood Pressure; Cerebrovascular Disorders; Craniotomy; Double-Blind Method; Drug Interactions; Female; Heart Rate; Humans; Magnesium Sulfate; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Rocuronium; Valproic Acid

Impaired cerebrovascular reactivity (CVR) is an important prognostic marker of stroke. Most measures of CVR lack (1) a reproducible vasoactive stimulus and (2) a high time and spatial resolution measure of cerebral blood flow (CBF), particularly for mechanically ventilated patients. The aim of our study was to investigate the feasibility of measuring CVR using sequential gas delivery circuit and gas blender for precise targeting of end-tidal PCO. Four patients with known moyamoya disease requiring preoperative CVR measurements under general anesthesia were studied. All patients had standard anesthesia induction and maintenance with intravenous propofol and rocuronium. Patients were intubated and manually ventilated with a self-inflating bag connected to a sequential breathing circuit. A computer-controlled gas blender supplied the gas mixture in proportions to attain target PetCO. CVR studies were successfully performed on all patients, and the CVR values were lower in both gray and white matter bilaterally when compared with healthy volunteers. In addition, CVR maps in 3 patients showed intracerebral steal phenomenon in spite of having had cerebral revascularization procedures, indicating that they are still at risk of cerebral ischemia.. BOLD-MRI CVR studies are feasible in mechanically ventilated patients anesthetized with propofol.

Topics: Administration, Intravenous; Adolescent; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Biomarkers; Cerebral Arteries; Cerebrovascular Circulation; Cerebrovascular Disorders; Feasibility Studies; Female; Humans; Hypercapnia; Image Interpretation, Computer-Assisted; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Moyamoya Disease; Neuromuscular Nondepolarizing Agents; Oxygen; Perfusion Imaging; Pilot Projects; Predictive Value of Tests; Propofol; Respiration, Artificial; Rocuronium; Young Adult