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Is rocuronium an exception to the relation between onset and offset? A comparison with pipecuronium

Published online by Cambridge University Press:  04 August 2006

A. J. England ,
K. Panikkar ,
I. Redai ,
E. Haxby ,
S. Gopinath  and
S. A. Feldman
A. J. England
Affiliation:
The John Hammond Department of Anaesthesia, East Surrey Hospital, Canada Avenue, Redhill, UK
K. Panikkar
Affiliation:
Magill Department of Anaesthetics, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
I. Redai
Affiliation:
Magill Department of Anaesthetics, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
E. Haxby
Affiliation:
Magill Department of Anaesthetics, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
S. Gopinath
Affiliation:
Magill Department of Anaesthetics, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
S. A. Feldman
Affiliation:
Magill Department of Anaesthetics, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK
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Abstract

A general relation between the rate of onset and rate of recovery from non-depolarizing blockade has been demonstrated, with recovery consistently about ten times slower than onset. This observation has led to the suggestion that non-depolarizing agents share a common mechanism of action. Rocuronium, a recently introduced steroidal non-depolarizing agent, is claimed to have a very rapid onset but an intermediate duration and appears to test this hypothesis. To investigate this paradox we have calculated the rates of onset and recovery of rocuronium using the isolated human forearm and compared them with those of pipecuronium. The mean ratio of recovery time/onset time for rocuronium was 31.3, which is significantly greater than that for pipecuronium, 11.6 (P < 0.01). Whilst pipecuronium conforms to the same general relation between onset and offset described previously for other non-depolarizing agents, rocuronium appears to have a disproportionately rapid rate of onset for its rate of recovery. This suggests that onset, recovery, or both onset and recovery, from rocuronium blockade occur in a different manner to that of other non-depolarizing agents.

Keywords

neuromuscular blockadeonset timeoffset timeneuromuscular blocking drugspipecuroniumrocuronium
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 13 , Issue 4 , April 1996 , pp. 385 - 388
Copyright
1996 European Society of Anaesthesiology

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