Spontaneous recovery profile of rapacuronium during desflurane, sevoflurane, or propofol anesthesia for outpatient laparoscopy

We evaluated the spontaneous recovery characteristics of rapacuronium durin g desflurane-, sevoflurane, or propofol-based anesthesia in 51 consenting w omen undergoing laparoscopic tubal ligation procedures. After the induction of the anesthesia with standardized doses of propofol and fentanyl, 1.5 mg /kg IV rapacuronium was administered to facilitate tracheal intubation. Pat ients were randomized to receive either 1 minimum alveolar anesthetic conce ntration of desflurane, 1 minimum alveolar concentration of sevoflurane, or 100 mu g . kg(-1) . min(-1) propofol infusion in combination with 66% nitr ous oxide in oxygen for maintenance of anesthesia. Neuromuscular blockade w as monitored at the wrist by using electromyography. The degree of maximum blockade and the times for first twitch recovery (T-1) to 5%, 25%, 50%, 75% , and 90%, as well as the recovery index, were similar in all three anesthe tic groups. However, recovery times for the train-of-four ratio to achieve 0.7 and 0.8 were significantly longer with desflurane (44.4 +/- 18.9 and 53 .5 +/- 22.4 min) and sevoflurane (44.8 +/- 15.1 and 53.2 +/- 15.8 min) comp ared with propofol (31.8 +/- 5.3 and 36.5 +/- 6.5 min). Eight patients (16% ) required a maintenance dose of 0.5 mg/kg rapacuronium and reversal of rap acuronium residual block occurred in three (6%) patients. We conclude that spontaneous recovery after an intubating dose of 1.5 mg/kg rapacuronium was significantly prolonged by both desflurane and sevoflurane compared with p ropofol-based anesthesia. Routine monitoring of neuromuscular activity is r ecommended even when a single bolus dose of rapacuronium is administered du ring ambulatory anesthesia.