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BJA Advance Access originally published online on November 21, 2008
British Journal of Anaesthesia 2009 102(1):55-60; doi:10.1093/bja/aen332
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Onset and effectiveness of rocuronium for rapid onset of paralysis in patients with major burns: priming or large bolus

T.-H. Han1,* and J. A. J. Martyn2

1 The Department of Anesthesia, 5937 JPP, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
2 The Department of Anesthesiology and Critical Care, Harvard Medical School, Massachusetts General Hospital and Shriners Hospital for Children, Boston, MA 02114, USA

* Corresponding author. E-mail: anthony-han{at}uiowa.edu

Background: Burn injury leads to resistance to the effects of non-depolarizing muscle relaxants. We tested the hypothesis that a larger bolus dose is as effective as priming for rapid onset of paralysis after burns.

Methods: Ninety adults, aged 18–59 yr with 40 (2)% [mean (SE)] burn and 30 (2) days after injury, received rocuronium as a priming dose followed by bolus (0.06+0.94 mg kg–1), or single bolus of either 1.0 or 1.5 mg kg–1. Sixty-one non-burned, receiving 1.0 mg kg–1 as a primed (0.06+0.94 mg kg–1) or full bolus dose, served as controls. Acceleromyography measured the onset times.

Results: Priming when compared with 1.0 mg kg–1 bolus in burned patients shortened the time to first appearance of twitch depression (30 vs 45 s, P<0.05) and time to maximum twitch inhibition (135 vs 210 s, P<0.05). The onset times between priming and higher bolus dose (1.5 mg kg–1) were not different (30 vs 30 s for first twitch depression and 135 vs 135 s for maximal depression, respectively). The onset times in controls, however, were significantly (P<0.05) faster than burns both for priming and for full bolus (15 and 15 s, respectively, for first twitch depression and 75 and 75 s for maximal depression). Priming caused respiratory distress in 10% of patients in both groups. Intubating conditions in burns were significantly better with 1.5 mg kg–1 than with priming or full 1.0 mg kg–1 bolus.

Conclusions: A dose of 1.5 mg kg–1 not only produces an initial onset of paralysis as early as 30 s, which we speculate could be a reasonable onset time for relief of laryngospasm, but also has an onset as fast as priming with superior intubating conditions and no respiratory side-effects.

Keywords: burns; neuromuscular block, rocuronium


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E-letters:

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The onset of rocuronium in patients with major burn
MOHAMMAD EL-ORBANY, et al.
British Journal of Anaesthesia, 10 Jan 2009 [Full text]
Response Letter to Editor
Tae-Hyung Han
British Journal of Anaesthesia, 17 Jan 2009 [Full text]

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