Effects of Rocuronium on Ischemia-reperfusion Injury and Intracellular ATP Consumption: A Randomized Controlled Trial

Muscle relaxants reduce "total" oxygen consumption, and 1.2 mg/kg of rocuronium has been shown to attenuate ischemia-reperfusion injury (IRI). Therefore, we herein investigated whether 0.9 mg/kg of rocuronium reduced "local" oxygen consumption and IRI indirectly by measuring changes in hypoxanthine (HPX), an indicator of intracellular adenosine triphosphate (ATP) consumption, and malondialdehyde (MDA), an indicator of IRI, respectively.

This study was designed as a randomized controlled trial. Female patients aged 50-79 years old who were scheduled for elective knee arthroplasty under general anesthesia were recruited. After the collection of pre-ischemia blood samples, 0.9 mg/kg of rocuronium was administered to patients in group R and a placebo to those in group C 3 minutes before tourniquet inflation. Five minutes after tourniquet deflation, post-ischemia blood samples were collected. The primary outcome was the change in the concentration of MDA (Δ MDA) after ischemia.

Medians [interquartile ranges] for Δ MDA (μmol/L) in group R (n = 19) and group C (n = 18) were -0.47 [-1.25 to 0.13] and -0.58 [-0.67 to -0.28], respectively, with no significant difference (p = 0.796). Means ± standard deviations for Δ HPX (μmol/L) were 1.09 ± 0.70 and 1.71 ± 1.09 in groups R and C, respectively, and the difference between the groups was significant (p = 0.046).

We were unable to confirm that 0.9 mg/kg of rocuronium attenuates IRI or postoperative quadriceps muscle weakness. While the present results suggest that rocuronium reduced intracellular ATP consumption, no clinically beneficial effects were observed.