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BJA Advance Access published online on January 22, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh062
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted October 20, 2003

Short Communication

Concentration of rocuronium in cerebrospinal fluid of patients undergoing cerebral aneurysm clipping{dagger}

T. Fuchs-Buder 1*, M. Strowitzki 2, K. Rentsch 3, J. U. Schreiber 1, S. Philipp-Osterman 1, S. Kleinschmidt 1

1 Department of Anaesthesia and Critical Care, University of Saarland, Homburg/Saar, Germany
2 Department of Neurosurgery, University of Saarland, Homburg/Saar, Germany
3 Institute for Clinical Chemistry University Hospital of Zurich, Switzerland

* To whom correspondence should be addressed. E-mail: t.fuchs-buder{at}chu-nancy.fr.


  Abstract

Background. This study assessed the concentration of rocuronium in the cerebrospinal fluid (CSF) of patients undergoing cerebral aneurysm clipping, and investigated whether the mode of administration (single bolus vs continuous infusion) influenced the CSF concentration.

Methods. Twenty patients with subarachnoid haemorrhage were randomly allocated to receive a bolus dose (bolus group), or a bolus followed by a continuous infusion of rocuronium (infusion group) (n=10 for each group). Arterial blood and ventricular CSF were sampled 2 h after the rocuronium bolus. Samples were analysed by liquid chromatography electrospray ionization-tandem mass spectrometry.

Results. Rocuronium could be detected in all the CSF samples. The mean (range) CSF concentration was 2.2 (0.9-4.6) ng ml-1 in the bolus group and 12.4 (2.4-34.6) ng ml-1 in the infusion group; P<0.01.

Conclusions. This study demonstrated that rocuronium, normally not considered to cross the blood-brain barrier, is regularly found in the CSF of patients undergoing cerebral clipping; continuous infusion of the drug led to higher plasma and CSF concentrations than after a single bolus dose.

Br J Anaesth 2004

Keywords: Keywords: blood-brain barrier, mass spectrometry high pressure liquid chromatography; neuromuscular blocking agents, rocuronium; surgery, cerebrovascular


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