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

Area of Science:

• Anesthesiology
• Surgical Research
• Biomedical Engineering

Background:

• Muscle relaxants can decrease total oxygen consumption.
• Rocuronium (1.2 mg/kg) has previously shown potential to reduce ischemia-reperfusion injury (IRI).
• Investigating lower doses (0.9 mg/kg) for local effects is warranted.

Purpose of the Study:

• To determine if 0.9 mg/kg rocuronium reduces local oxygen consumption and IRI.
• To assess changes in hypoxanthine (HPX) as an indicator of ATP consumption.
• To measure malondialdehyde (MDA) as an indicator of IRI.

Main Methods:

• Randomized controlled trial in female patients (50-79 years) undergoing knee arthroplasty.
• Rocuronium (0.9 mg/kg) or placebo administered 3 minutes before tourniquet inflation.
• Blood samples collected pre-ischemia and post-ischemia to measure MDA and HPX changes.

Main Results:

• No significant difference in Δ MDA (IRI marker) between rocuronium and placebo groups (p = 0.796).
• Significant reduction in Δ HPX (ATP consumption marker) in the rocuronium group compared to placebo (p = 0.046).
• The study did not confirm attenuation of IRI or muscle weakness.

Conclusions:

• 0.9 mg/kg rocuronium did not attenuate IRI or postoperative muscle weakness in this patient cohort.
• Results suggest rocuronium may reduce intracellular ATP consumption.
• No clinically significant beneficial effects were observed with this dose.