BJA Advance Access originally published online on March 18, 2005
British Journal of Anaesthesia 2005 94(6):742-747; doi:10.1093/bja/aei120
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Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia
Department of Anaesthesiology, University Hospital, CHUV BH-10, 1011 Lausanne, Switzerland
* Corresponding author: E-mail: Lennart.Magnusson{at}chuv.hospvd.ch
Background. Conflicting effects of neuromuscular blocking drugs and anticholinesterases on depth of anaesthesia have been reported. Therefore we evaluated the effect of atracurium and neostigmine on bispectral index (BIS) and middle-latency auditory evoked potentials (AAI).
Methods. We studied 40 patients (ASA I–II) aged 18–69 yr. General anaesthesia consisted of propofol and remifentanil by target-controlled infusion and neuromuscular function was monitored by electromyography. When BIS reached stable values, patients were randomly assigned to one of two groups. Group 1 received atracurium 0.4 mg kg–1 and, 5 min later, the same volume of NaCl 0.9%; group 2 received saline first and then atracurium. When the first twitch of a train of four reached 10% of control intensity, patients were again randomized: one group (N) received neostigmine 0.04 mg kg–1 and glycopyrrolate 0.01 mg kg–1, and the control group (G) received only glycopyrrolate.
Results. Injection of atracurium or NaCl 0.9% had no effect on BIS or AAI. After neostigmine–glycopyrrolate, BIS and AAI increased significantly (mean maximal change of BIS 7.1 [SD 7.5], P<0.001; mean maximal change of AAI 9.7 [10.5], P<0.001). When glycopyrrolate was injected alone BIS and AAI also increased (mean maximal change of BIS 2.2 [3.4], P=0.008; mean maximal change of AAI 3.5 [5.7], P=0.012), but this increase was significantly less than in group N (P=0.012 for BIS; P=0.027 for AAI).
Conclusion. These data suggest that neostigmine alters the state of propofol–remifentanil anaesthesia and may enhance recovery.
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