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BJA Advance Access published online on January 16, 2007
British Journal of Anaesthesia, doi:10.1093/bja/ael362
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Influence of acute normovolaemic haemodilution on the dose–response relationship and time course of action of cisatracurium besylate

A. A. Dahaba1,*, G. Wang2, X. Xu2, X. Liu2, X. Wu2, H. Bornemann1 and H. Metzler1

1 Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
2 Department of Anaesthesiology, Peking University First Hospital, Beijing, People's Republic of China

* Corresponding author: Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria. E-mail: ashraf.dahaba{at}meduni-graz.at

BACKGROUND: Acute normovolaemic haemodilution (ANH) is an efficacious blood conservation strategy aiming at avoiding allogeneic blood transfusion. ANH was shown to increase the potency of vecuronium, atracurium, and rocuronium. The aim of our study was to investigate whether cisatracurium potency is altered with ANH.

METHODS: Using the Relaxometer mechanomyograph, we compared cisatracurium dose–response relationship and time course of action in 60 patients randomly allocated to the ANH or control groups. Patients in each group were randomly allocated to receive one of three cisatracurium doses (30, 40, 50 µg kg–1) followed by a second supplemental dose to reach a total of 100 µg kg–1.

RESULTS: ANH did not result in a significant shift in cisatracurium log dose–probit dose–response curve. There was no significant difference in mean (95% confidence intervals) ED50, ED90, and ED95 (effective doses required for 50, 90, and 95% first twitch depression) between the ANH group [29.5 (27–32), 50.4 (47.4–53.4), 58.7 (55.3–62) µg kg–1] and the control group [28.2 (25.3–31), 47.6 (44.9–50.3), 55.3 (52.5–58.1) µg kg–1], whereas there was no difference in mean (SD) Dur25 and Dur0.8 (time until 25% first twitch and 0.8 train-of-four ratio recoveries) between the ANH group [40.8 (5.9), 64.7 (8.4) min] and the control group [42.2 (7.6), 66.5 (10.7) min].

CONCLUSIONS: Our results demonstrated that unlike other previously reported neuromuscular blocking drugs, ANH did not alter cisatracurium potency. Thus, cisatracurium would be the neuromuscular blocking drug of choice in patients who undergo surgery with ANH, as no dose adjustments are required.

Keywords: monitoring; neuromuscular block; neuromuscular blocking agent


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