{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:44:57Z","timestamp":1760060697621,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:00:00Z","timestamp":1757721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: There is little data available in infants on the extent to which inhalational anesthetics prolong the effects of neuromuscular blocking agents compared with intravenous agents. Here, we assessed the differences between the neuromuscular blocking effects (duration and recovery time) of a single dose of rocuronium during propofol vs. sevoflurane anesthesia. Methods: The prospective study enrolled 20 infants (4\u201312 months of age) scheduled for craniosynostosis surgery, randomly assigned to receive general anesthesia maintenance with sevoflurane or propofol. All patients received 0.6 mg\/kg rocuronium as a single bolus dose to facilitate tracheal intubation and surgery. Primary study endpoint was the clinical duration of rocuronium, from administration until spontaneous recovery to a train-of-four ratio (TOFR) &gt; 0.90. Secondary endpoints were times for reappearance of the first, second, third, and fourth twitches of the TOF (T1, T2, T3 and T4, respectively) in the two patient groups. Results: There were no differences in the infants\u2019 age (sevoflurane maintenance: 5.8 \u00b1 2.4 months; propofol maintenance: 6.7 \u00b1 3.1 months, p = 0.47) or weight (sevoflurane: 7722 \u00b1 1644 g; propofol: 7433 \u00b1 1782 g, p = 0.71). Rocuronium onset time was 101.0 \u00b1 55.0 s in the sevoflurane group and 83.4 \u00b1 47.9 s in the propofol group (p = 0.46). Total duration of anesthesia was comparable in the sevoflurane (122.0 \u00b1 23.8 min) and propofol (107.7 \u00b1 25.2 min, p = 0.18) groups. Rocuronium recovery to TOFR &gt; 0.9 required 136 min (CI: 123.7\u2013149.5 min) in the sevoflurane group and 61.5 min (CI: 58.0\u2013101.0 min) in the propofol group (p &lt; 0.001). Conclusions: In infants, sevoflurane maintenance enhances the neuromuscular blocking effect of a single, 0.6 mg\/kg BW dose of rocuronium as compared to propofol maintenance. After discontinuation of sevoflurane, additional time is necessary to reach the acceptable TOFR &gt;0.9 needed before tracheal extubation. The present study further underscores the importance of objective (quantitative) neuromuscular monitoring in infants to guide intraoperative management and prevent residual neuromuscular block.<\/jats:p>","DOI":"10.3390\/jcm14186459","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T11:51:43Z","timestamp":1757937103000},"page":"6459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time Course of a Single, 0.6 mg\/kg Dose of Rocuronium Neuromuscular Block During Sevoflurane or Propofol Anesthesia in Infants\u2014A Prospective, Randomized Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2541-9740","authenticated-orcid":false,"given":"B\u00e9la","family":"F\u00fclesdi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary"},{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e9ter","family":"Luter\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary"},{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mena","family":"Boktor","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary"},{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2899-8648","authenticated-orcid":false,"given":"L\u00e1szl\u00f3","family":"Asztalos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary"},{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gy\u00f6rgy","family":"Nagy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary"},{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2607-2590","authenticated-orcid":false,"given":"Sorin J.","family":"Brull","sequence":"additional","affiliation":[{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"},{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, 4500 San Pablo Rd., Jacksonville, FL 32066, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8610-6344","authenticated-orcid":false,"given":"Csilla","family":"Moln\u00e1r","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary"},{"name":"Ed\u00f6m\u00e9r Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/EJA.0000000000001928","article-title":"Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines","volume":"41","author":"Disma","year":"2024","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/pan.13806","article-title":"Neuromuscular-blocking agents for tracheal intubation in pediatric patients (0\u201312 years): A systematic review and meta-analysis","volume":"30","author":"Vanlinthout","year":"2020","journal-title":"Paediatr. Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/ALN.0000000000004379","article-title":"2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade","volume":"138","author":"Thilen","year":"2023","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/EJA.0000000000001769","article-title":"Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care","volume":"40","author":"Romero","year":"2023","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/aas.13478","article-title":"Effects of high neuromuscular blocking agent dose on post-operative respiratory complications in infants and children","volume":"64","author":"Scheffenbichler","year":"2020","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1213\/ANE.0000000000005386","article-title":"A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade","volume":"132","author":"Faulk","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1213\/00000539-199309000-00024","article-title":"Muscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia","volume":"77","author":"Oris","year":"1993","journal-title":"Anesth. Analg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1213\/00000539-199810000-00036","article-title":"Neuromuscular effects of rocuronium during sevoflurane, isoflurane, and intravenous anesthesia","volume":"87","author":"Lowry","year":"1998","journal-title":"Anesth Analg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1034\/j.1399-6576.2001.450112.x","article-title":"The influence of halothane, isoflurane and sevoflurane on rocuronium infusion in children","volume":"45","author":"Lapczynski","year":"2001","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1213\/00000539-199310000-00010","article-title":"Clinical pharmacology of mivacurium in pediatric patients less than off years old during nitrous oxide-halothane anesthesia","volume":"77","author":"Woelfel","year":"1993","journal-title":"Anesth. Analg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1177\/0310057X9001800403","article-title":"Neuromuscular blocking agents in paediatric patients: Influence of age on the response","volume":"18","author":"Meretoja","year":"1990","journal-title":"Anaesth. Intensive Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/bja\/52.2.205","article-title":"Maturation of neuromuscular transmission in the infant","volume":"52","author":"Goudsouzian","year":"1980","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/bja\/77.3.335","article-title":"Intubating conditions and time course of rocuronium-induced neuromuscular block in children","volume":"77","author":"Tassonyi","year":"1996","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1046\/j.1460-9592.2003.01216.x","article-title":"Neuromuscular recovery following rocuronium bromide single dose in infants","volume":"14","author":"Rapp","year":"2004","journal-title":"Paediatr. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1213\/00000539-199608000-00020","article-title":"Intubating conditions and onset of action after rocuronium, vecuronium, and atracurium in young children","volume":"83","author":"Scheiber","year":"1996","journal-title":"Anesth Analg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/bja\/78.6.690","article-title":"Pharmacokinetics and pharmacokinetic-dynamic modelling of rocuronium in infants and children","volume":"78","author":"Wierda","year":"1997","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/j.1460-9592.2006.02181.x","article-title":"Sevoflurane increases fade of neuromuscular response to TOF stimulation following rocuronium administration in children. A PK\/PD analysis","volume":"17","author":"Wyska","year":"2007","journal-title":"Paediatr. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"378","DOI":"10.4103\/sja.sja_160_23","article-title":"Intraoperative electromyographic monitoring in children using a novel pediatric sensor","volume":"17","author":"Kalsotra","year":"2023","journal-title":"Saudi J. Anaesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/mus.28445","article-title":"Function of the Normal Neuromuscular Junction in Young Children","volume":"72","author":"Nagy","year":"2025","journal-title":"Muscle Nerve"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6459\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:45:06Z","timestamp":1760035506000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,13]]},"references-count":19,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186459"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186459","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,13]]}}}