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Most anesthetics are known to decrease the dose of neuromuscular blocking agent (NMBA) required for intubation and prolong the duration of action. Which of the following is known to have the GREATEST potentiation of NMBA at equipotent dosing (1.5 MAC)?
A. Desflurane
B. Sevoflurane
C. Isoflurane
D. Halothane
E. Nitrous-opioid
F. Propofol (TIVA)
Answer
The answer is A. All anesthetic agents potentiate NMBA. From least to greatest, the potentiation effect is propofol, nitrous-opioid, halothane, isoflurane, sevoflurane, and desflurane. The effect is dependent on the duration of anesthesia and relative amount of agent. This effect may be from a central effect on motor neurons, inhibition of the ACh receptor or an increased affinity at the receptor site.
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