Influence of sevoflurane on antagonism effect of small dose neostigmine against rocuronium-induced residual neuromuscular blockade

Objective To compare the antagonistic effect of small dose neostigmine on rocuronium-induced residual neuromuscular blockade during anesthesia maintenance using propofol and sevoflurane.Methods Sixty elective surgery patients were randomly divided into 4 groups:propofol infusion was used to maintain anesthesia without(group Pc)and with(group Pn)antagonism for residual neuromuscular blockade of rocuronium;sevoflurane inhalation was used to maintain anesthesia without(group Sc)and with(group Sn)antagonism of rocuronium.Patients were induced and intubated with midazolam,fentanyl,propofol and 0.6 mg/kg rocuronium in all the 4 groups.Bolus 0.15 mg/kg rocuronium was injected when required during surgery.Propofol was infused at a rate of 4-10 mg·kg-1·h-1 in groups Pc and Pn,and sevoflurane was inhaled at 1-1.5 MAC in groups Sc and Sn.The train-of-four ratio(TOFR)was monitored by acceleromyography.Neostigmine(20 μg/kg)and atropine(10 μg/kg)were administrated when TOFR reached 0.7 postoperatively in group Pn and group Sn.In group Pc and group Sc,neuromuscular function was allowed to recover spontaneously.The interval of TOFR recovery from 0.7 to 0.9,bradycardia and postoperative nausea and vomiting in 6 h and 24 h were observed and documented.Results The intervals of TOFR recovery from 0.7 to 0.9 in group Pc,Pn,Sc and Sn were(13.3±4.5)min,(2.9±0.9)min,(16.6±5.3)min and(4.2±2.1)min,respectively.The interval of recovery in group Sc was significantly longer than that in group Pc(P0.05).The intervals of recovery in groups Pn,Sn were significantly shorter than those in groups Pc and Sc,respectively(both P0.01).No bradycardia was found in the four groups,and there was no significant difference in the incidence of postoperative nausea and vomiting at 6 h and 24 h after operation in the 4 groups(all P0.05).Conclusions Antagonism of rocuronium-induced residual neuromuscular blockade with small dose neostigmine(20 μg/kg)leads to a better reversal of neuromuscular blockade without increasing the adverse events.Small dose of neostigmine is more suitable to antagonize residual neuromuscular blockade with sevoflurane anesthesia.