COMPARISON OF NEUROMUSCULAR EFFECTS, EFFICACY AND SAFETY OF ROCURONIUM AND ATRACURIUM IN AMBULATORY ANESTHESIA

Purpose: To compare the neuromuscular effects, efficacy, and safety of equi-effective doses of rocuronium and atracurium in ambulatory femal e patients undergoing surgery. Methods: Forty-one patients undergoing laparoscopic gynaecological surgery were randomized to receive 2 x ED9 0 rocuronium (0.6 mg.kg(-1); n = 20) or atracurium (0.5 mg.kg(-1); n = 21) during intravenous propofol/alfentanil anaesthesia with N2O/O-2 v entilation. Neuromuscular block was measured with a mechanomyogram eli citing a train-of-four (TOF) response at the wrist. Intubation conditi ons 60 sec after administration of muscle relaxant and immediate cardi ovascular disturbances or adverse events during the hospital stay were noted by blinded observers, Results: Compared with atracurium, rocuro nium was associated with a shorter onset time (59.0 +/- 22.2 vs 98.6 /- 41.4 sec: P < 0.001) and clinical duration of action (33.3 +/- 7.1 vs 44.7 +/- 7.2 min; P < 0.001), but longer spontaneous recovery index (9.6 +/- 2.41 vs 6.9 +/- 1.89 min; P = 0.023) and a similar time to s pontaneous recovery to TOF 70%; 53 +/- 6.31 vs 59.2 +/- 7.59 min; P = 0.139). Tracheal intubation was accomplished in < 90 sec in all patien ts receiving rocuronium but in only 14 of 21 patients receiving atracu rium. The incidence of adverse events and the cardiovascular profiles for the two drugs were similar, although one patient receiving atracur ium experienced transient flushing of the head and neck, Conclusion: R ocuronium has minimal side effects, provides conditions more suitable for rapid tracheal intubation, and is associated with a shorter clinic al duration than atracurium, Once begun, the spontaneous recovery prof ile of rocuronium is slightly slower than that of atracurium.