A randomized trial to identify optimal precurarizing dose of rocuronium to avoid precurarization-induced...

The aim of this study was to examine the safe precurarizing dose of rocuronium required to avoid neuromuscular block after precurarization.

Twenty-four female patients were randomly allocated into two groups of 12 patients each. General anesthesia was induced and maintained with remifentanil and propofol, and a laryngeal mask was inserted without the aid of a neuromuscular blocking agent. Patients were randomized to receive either 0.03 or 0.06 mg/kg rocuronium as a precurarizing dose. Neuromuscular block was monitored using acceleromyographic train-of-four (TOF) of the adductor pollicis muscle. Three minutes after the precurarization, all patients received suxamethonium 1.5 mg/kg and were graded on severity of fasciculations.

The average TOF ratio was kept above 0.9 even 3 min after precurarization with 0.03 mg/kg rocuronium. In contrast, in patients who received 0.06 mg/kg rocuronium, the ratios significantly decreased to 0.72 (0.14) [mean (SD), P < 0.004] and 0.68 (0.18) (P < 0.006) 2 min and 3 min after the precurarization, respectively. No visible muscle movement was observed following suxamethonium injection, except that one patient who received 0.03 mg/kg rocuronium showed very fine muscle movements of the fingertips.

Rocuronium at 0.06 mg/kg is an overdose for precurarization. The results of the present study demonstrate that a safe and effective precurarizing dose of rocuronium is 0.03 mg/kg.