Neuromuscular effect of dexmedetomidine on sevoflurane: an open-label, dose-escalation clinical trial

BACKGROUND: Sevoflurane presents reliable central neuromuscular effects. However, little knowledge is available regarding the interaction between sevoflurane and demedetomidine. We evaluated the neuromuscular effect of dexmedetomidine on sevoflurane in patients with normal neuromuscular transmission and calculated the 50% effective concentration (EC50). METHODS: One-hundred and forty-four ASA grade I similar to II patients with normal neuromuscular transmission, aged 20 similar to 60 years old, undergoing lower limbs surgery were enrolled in this open-label, dose-escalation clinical trial. Patients were randomly assigned into 12 groups. Each patient received intravenous 0, 0.5, or 1.0 mu g/kg dexmedetomidine 15 min after inhaling 0.7, 1.0, 1.4, or 2.0 MAC sevoflurane. Neuromuscular monitoring was recorded from the adductor pollicis muscle by using acceleromyography with train-of-four (TOF) stimulation of the ulnar nerve (2 Hz every 20 s). TOF ratio was recorded before inhaling sevoflurane, 15 min after keeping constant at target MAC of sevo.urane, 30 min after receiving target dose of dexmedetomidine, and 15 min after sevoflurane washing out. RESULTS: Sevo.urane produced a concentration-dependent decrease in TOF ratio. Mean TOF ratio in 0.7, 1.0, 1.4, and 2.0 MAC groups was 97.9%, 94.9%, 84.7%, and 77.2%, respectively. Neuromuscular EC50 of sevo.urane was 1.31 MAC (95% CI: 1.236 similar to 1.388 MAC). Intravenous 0.5 and 1.0 mu g/kg dexmedetomidine decreased 3.1% (EC50: 1.27 MAC [95% CI: 1.206 similar to 1.327 MAC]) and 10.7% (EC50: 1.17 MAC [ 95% CI: 1.122 similar to 1.217 MAC]) of neuromuscular EC50, respectively. CONCLUSIONS: Sevo.urane has a concentration-dependent central neuromuscular effect in patients with normal neuromuscular transmission. Intravenous dexmedetomidine dose-dependently decreases the neuromuscular EC50 of sevoflurane.