Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans

Abstract

The effects of rocuronium, 0.25 or 0.5 mg · kg, were measured simultaneously on the adductor muscles of the larynx and adductor pollicis in 14 adult patients. Anaesthesia was induced and maintained with propofol and fentanyl. Tracheal intubation was performed without muscle relaxants. The recurrent laryngeal and ulnar nerves were both stimulated supramaximally, at the notch of the thyroid cartilage and at the wrist respectively, using train-of-four stimulation. The laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords. Onset time, intensity of blockade and duration of action were less at the larynx than at the adductor pollicis. After rocuronium, 0.25 mg · kg-1, the onset time (interval between injection and maximal TI blockade) was 1.6 ± 0.1 min and 3.0 ± 0.3 min (mean ± SEM) at the laryngeal muscles and adductor pollicis, respectively (P < 0.01 between muscles). Maximum blockade was 37 ± 8% and 69 ± 8%, respectively (P < 0.05), and time to 90% TI recovery was 7 ± 1 min and 20 ± 4 min, respectively (P < 0.05). With 0.5 mg· kg-1, the onset time was also more rapid at the vocal cords (1.4 ± 0.1 min) than at the adductor pollicis (2.4 ± 0.2 min, P < 0.001). Maximum blockade was 77 ± 5% and 98 ± 1 %, respectively (P < 0.01), and time to 90% TI recovery was 22 ± 3 min and 37 ± 4 min, respectively (P < 0.01). It is concluded that with rocuronium onset and recovery are faster at the laryngeal adductor muscles, but blockade is less intense than at the adductor pollicis. These findings are similar to the observations made previously with vecuronium, except that rocuronium had a faster onset at both muscles. © 1992 Canadian Anesthesiologists.