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Effect of levetiracetam on rocuronium duration in patients undergoing cerebrovascular surgery
Anesth Pain Med 2018;13(4):409-14
Published online October 31, 2018
© 2018 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Young-Jae Jeon and Mi-hyun Kim
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Mi-hyun Kim, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: 82-2-2258-2236
Fax: 82-2-537-1951
Received January 8, 2018; Revised July 1, 2018; Accepted July 3, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background:It has long been held that antiepileptics reduce the duration of action, and increase the requirement for, neuromuscular blocking agents. However, levetiracetam, a relatively novel antiepileptic agent, possesses different pharmacokinetic properties to other, conventional antiepileptics, such that its effect on neuromuscular blocking agents might also differ. The purpose of this retrospective study is to investigate the effect of levetiracetam on the clinical duration of rocuronium.
Methods:In this study, the duration of neuromuscular blockade induced by rocuronium was compared between control and levetiracetam-receiving groups. The data were retrieved from one of our previous studies.
Results:The control and levetiracetam groups comprised 16 and 13 patients, respectively, all of whom underwent cerebrovascular surgery. Subjects received supplementary rocuronium (0.15 mg/kg) whenever the train-of-four count reached 2 during surgery. The interval between supplementary rocuronium (0.15 mg/kg) injections was significantly longer in the levetiracetam vs. control group (50 and 39 minutes, respectively; P = 0.036).
Conclusions:The present results challenge the convention that antiepileptics decrease the duration of action of neuromuscular blockers, thereby alerting clinicians to the possibility of prolonged neuromuscular blockade in patients taking levetiracetam. Anesthetic management should encompass careful neuromuscular monitoring in such patients.
Key Words : Anticonvulsants; Neuromuscular blockade; Neuromuscular nondepolarizing agents.

October 2018, 13 (4)
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