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At least 199 records · Page 11Linked to original sources
PubMed1981

Effect of diazepam on pancuronium-induced neuromuscular blockade maintained by a feedback system.

The possibility of an interaction between diazepam and pancuronium bromide was investigated in six patients undergoing general anaesthesia maintained with fentanyl, droperidol and nitrous oxide. Neuromuscular blockade was controlled using a feedback mechanism which automatically adjusted the rate of injection of pancuronium to maintain between 71.4 and 72.9% blockade. Diazepam 0.14 mg kg-1 i.v. produced blood concentrations within the therapeutic range, but did not produce consistent changes in the level of blockade, pancuronium concentration in the blood or pancuronium consumption measured over 20 min.

Adolescent↗
PubMed1982

Antagonism of pancuronium in renal failure: no recurarization.

Neuromuscular transmission was measured using train-of-four stimulation, during and after anaesthesia, in 20 patients with end-stage renal failure. Neuromuscular blockade was provided with pancuronium in single doses of either 3 or 6 mg per 70 kg, and antagonized at 10% recovery with atropine and neostigmine 2.5 mg per 70 kg. Reversal was followed by progressive recovery of muscle twitch in every patient during the 3 h of the study. Recovery was more rapid after the smaller dose of pancuronium and was inversely correlated with the duration of blockade. It is concluded that, when pancuronium is antagonized with neostigmine in patients with renal failure, neuromuscular transmission recovers without evidence of recurarization. However, when large doses of pancuronium are antagonized with neostigmine 2.5 mg, recovery may be insufficient to ensure normal ventilatory function.

Adult↗
PubMed1982

Clinical studies on Org NC 45: comparison with pancuronium.

Some actions of Org NC 45 have been compared with those of pancuronium in a study on 50 patients anesthetized with nitrous oxide and narcotic supplements. The train-of-four technique was used to assess the recovery of neuromuscular blockade and its antagonism. Org NC 45 was shown to have a duration of action from injection of the intubating dose (0.1 mg kg-1) to the reappearance of the first twitch response of 23.5 +/- 1.1 min; the corresponding time for pancuronium 0.1 mg kg-1 was 50.5 +/- 3.6 min. Recovery time from the initial incremental dose to the reappearance of the first train-of-four response was 11.6 +/- 0.8 min with Org NC 45 and 31 +/- 4.7 min with pancuronium. No evidence of cumulation was seen following several incremental doses of Org NC 45. The rate of onset of paralysis of adductor pollicis was faster with Org NC 45 than with pancuronium, but the difference did not reach statistical significance. Satisfactory spontaneous recovery from Org NC 45 blockade could be achieved without undue delay. Org NC 45 was shown to produce significantly less tachycardia.

Blood Pressure↗
PubMed1982

Onset time and duration of action for atracurium, Org NC45 and pancuronium.

Speed of onset, maximum block, duration of action and 10-25% recovery time for atracurium, Org NC 45 and pancuronium were determined using equipotent doses: 330 micrograms kg-1, 66 micrograms kg-1 and 75 micrograms kg-1 respectively. Vein-to-muscle and artery-to-muscle onset times were measured by use of simultaneous recordings. Mean speeds of onset to 95% twitch depression were: atracurium 2.7 min, Org NC 45 2.8 min and pancuronium 3.6 min. The median value of maximum neuromuscular block exceeded 98.5% for all drugs and the mean durations of action to 25% recovery of control twitch height were: atracurium 27.6 min, Org NC 45 21.9 min and pancuronium 45.1 min. The differences were statistically significant. The recovery period from 10% to 25% twitch response was considerably longer for pancuronium than for the other drugs, which did not differ significantly from each other. We were unable to validate the artery-to-muscle technique in the determination of onset time.

Adult↗
PubMed1984

Comparison between the continuous infusion of vecuronium and the intermittent administration of pancuronium and vecuronium.

The neuromuscular blocking effects of repeated bolus injections of pancuronium, or vecuronium, and of the continuous infusion of vecuronium have been compared in 36 patients by means of evoked twitch tension. Groups I and II received a loading dose (0.075 mg kg-1) of pancuronium or vecuronium, respectively, followed by 0.015-mg kg-1 maintenance doses when twitch tension had recovered to 25% of control. Group III received a 0.075-mg kg-1 loading dose of vecuronium plus a continuous infusion (commenced simultaneously) delivering 0.075 mg kg-1 h-1. With repeated injections of pancuronium (group I) or vecuronium (group II), the durations of blockade to 25% recovery were 64 and 25 min, respectively. Maintenance doses had to be injected every 42 min with pancuronium and every 12 min with vecuronium. The recovery times from 25% to 75% of control twitch tension were 44 v. 12 min. The continuous infusion of vecuronium (group III) produced consistent neuromuscular blockade at an average level of 87% twitch depression. The times from the end of infusion to 25%, and from 25% to 75%, recovery averaged 20 and 26 min, respectively. These values did not correlate with the total dose of vecuronium infused. For clinical practice, the suggested loading dose is 1.5 times the ED90 (= 0.07 mg kg-1) followed by an infusion of the same dose per hour. The infusion should be started within 10 min of the injection of the loading dose.

Adult↗
PubMed1987

Atracurium, vecuronium and pancuronium in end-stage renal failure. Dose-response properties and interactions with azathioprine.

Dose-response relations for atracurium, vecuronium and pancuronium were determined in patients in end-stage renal failure for the initial neuromuscular blockade (using three cumulative doses) and for the maintenance of stable 90% response (during continuous infusion). All measurements were during renal transplant surgery, and the interaction of azathioprine on neuromuscular blockade was estimated. Mean ED95 doses were (microgram kg-1): atracurium 375.6, vecuronium 67.2, pancuronium 86.6; the initial blockade required significantly larger doses than in normal patients (37%, 20% and 45%, respectively, using ED50 values). Mean infusion rates for 90% sustained blockade in renal failure were (microgram kg-1 h-1): atracurium 409.4, vecuronium 78.3, pancuronium 14.2. The atracurium dose was not influenced by renal function, whereas vecuronium and pancuronium requirements were significantly reduced by 23.2% and 61.5%, respectively, compared with normal patients (previous study). Azathioprine was injected at the rate of 1 mg kg-1 min-1 for 3 min at stable 90% neuromuscular blockade with constant-rate infusion of the neuromuscular blocking drug. This produced a relatively small and transient antagonism of blockade--probably of negligible clinical significance.

Adolescent↗
PubMed1988

Comparison of large dose of vecuronium with pancuronium for prolonged neuromuscular blockade.

Dose-duration relationships for vecuronium were determined and the duration of action produced by vecuronium 0.3 mg kg-1 shown to equal that of pancuronium 0.1 mg kg-1. Using these doses, the neuromuscular blocking properties and cardiovascular effects of the two drugs were compared. With large dose administration of vecuronium (0.3 mg kg-1), both the onset time (mean 81 s) and the 25-75% recovery index (mean 13.9 min) were about one-half those associated with pancuronium (mean 168.5 s and 29.3 min, respectively). The duration of action until 25% recovery was similar with both drugs. There was no evidence of cardiovascular instability with the large dose of vecuronium. Heart rate, however, was significantly slower (range 89.7-94.2% of control) 2-20 min after the injection of vecuronium. Vecuronium 0.3 mg kg-1 may have more favourable neuromuscular blocking effects than pancuronium 0.1 mg kg-1 and may be preferable to pancuronium when prolonged neuromuscular blockade is required.

Adolescent↗
PubMed1988

Pipecuronium and pancuronium: comparison of pharmacokinetics and duration of action.

The pharmacokinetics of pipecuronium 0.07 mg kg-1 and pancuronium 0.1 mg kg-1 were compared in 39 ASA class I or II patients. Plasma concentrations of these agents were measured for 6 h following administration, using a sensitive and specific capillary gas chromatographic assay. Concentration v. time data were analysed by non-linear regression and fitted to a two- or three-compartment model as appropriate. Neuromuscular blockade was assessed by measuring the mechanical evoked response of the adductor pollicis muscle to train-of-four stimulation of the ulnar nerve. Pipecuronium had a larger steady-state volume of distribution (Vss) (309 (SD 103) ml kg-1) and greater plasma clearance (Cl) (2.4 (0.6) ml kg-1 min-1) than pancuronium (199 (54) ml kg-1 and 1.5 (0.4) ml kg-1 min-1, respectively). The volumes of the central compartment, distribution and elimination half-lives and mean residence times were similar for both agents and within the range expected for drugs of this type. The durations of action (injection to 25% recovery of twitch tension) of pipecuronium and pancuronium were similar: 98.0 (36.1) min and 117.2 (35.8) min, respectively. We conclude that the time courses of neuromuscular blockade following pipecuronium and pancuronium are similar, despite the differences in Vss and Cl.

Adult↗
PubMed1989

Effects of pipecuronium and pancuronium on the isolated rabbit heart.

We have studied the effects of pipecuronium and pancuronium on myocardial contractility and heart rate in two different animal preparations. Pipecuronium and pancuronium produced no change in isometric contraction of rabbit atria. The chronotropic effects of pipecuronium, pancuronium and vecuronium were investigated using acetylcholine as an agonist in isolated perfused rabbit heart. Pancuronium but not pipecuronium or vecuronium, produced a significant degree of antagonism to the bradycardia produced by acetylcholine.

Androstane-3,17-diol↗
PubMed1991

Priming of pancuronium with magnesium.

Magnesium inhibits the release of acetylcholine from the motor nerve terminal and thus potentiates the action of the non-depolarizing neuromuscular blocking drugs. We have examined the possibility that this effect might enhance the speed of onset of non-depolarizing block with pancuronium. Following the administration of pancuronium 100 micrograms kg-1, 95% depression of thumb twitch occurred in 68.3 (SD 25.9) s in magnesium-pretreated subjects and in 73.7 (19.5) s in a group given a priming dose (10 micrograms kg-1) of pancuronium. Tracheal intubation was performed after 97.8 (22.5) s in the magnesium group and in 121.0 (37.5) s in the control group (ns). It is concluded that pretreatment with magnesium does not usefully increase the speed of onset of action of pancuronium.

Adult↗
PubMed1995

Pancuronium infusion for neuromuscular block in children in the pediatric intensive care unit.

When neuromuscular blockade becomes necessary in the intensive care unit, there are several options available in regard to both the drug and the mode of delivery (continuous versus intermittent administration). Despite extensive experience with intermediate acting drugs such as atracurium or vecuronium, these muscle relaxants are costly and may account for a significant portion of the pharmacy charges. We undertook an open label study to evaluate the efficacy and dosing requirements for a less costly drug, pancuronium. The study group included 25 patients ranging in age from 3 mo to 17 yr and in weight from 3.2 to 68 kg. If the patient had not previously received neuromuscular blocking agents (NMBAs), pancuronium was administered as a bolus dose of 0.1 mg/kg followed by a continuous infusion of 0.05 mg.kg-1.h-1. A nerve stimulator was applied to either the ulnar or peroneal nerve and a standard train-of-four (TOF) was monitored every 2 h. In patients that had previously received other NMBAs, no bolus dose of pancuronium was administered and the infusion was started at 0.05 mg.kg-1.h-1. The pancuronium infusion was increased or decreased by increments of 0.01 mg.kg-1.h-1 to maintain one to two twitches of the TOF. In patients that required an increase in the infusion rate, an additional bolus dose equivalent to the current hourly rate was administered and then followed by the increase in the infusion rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Pancuronium does not decrease oxygen consumption during hypothermic or normothermic cardiopulmonary bypass.

Muscle relaxation reportedly reduces systemic oxygen consumption 30% during hypothermic cardiopulmonary bypass. A potential mechanism is inhibition of hypothermia-induced subclinical muscle tone ("microshivering"). Accordingly, we tested the hypothesis that pancuronium administration would decrease systemic oxygen consumption during hypothermic cardiopulmonary bypass, but not during normothermic bypass. We studied 20 patients undergoing normothermic cardiopulmonary bypass at a nasopharyngeal temperature of 37.6 +/- 0.8 degrees C (mean +/- SD) and 15 patients undergoing hypothermic bypass at a nasopharyngeal temperature of 28.2 +/- 1.2 degrees C. Oxygen consumption during bypass was determined, using the Fick principle, before and after administration of pancuronium 0.15 mg/kg. Morphometric characteristics and anesthetic management were similar in the two groups. Oxygen consumption averaged 93 +/- 28 mL.min-1.m-2 in the normothermic patients and 43 +/- 10 mL.min-1.m-2 in the hypothermic group. Administration of pancuronium decreased oxygen consumption only 2% in the normothermic patients. However, muscle relaxation also decreased oxygen consumption only 2% in the hypothermic patients. We were thus unable to confirm our hypothesis because muscle relaxation induced by administration of pancuronium did not significantly reduce oxygen consumption in either group.

Aged↗
PubMed1975

Neuromuscular effects of enflurane, alone and combined with d-Tubocurarine, pancuronium, and succinylcholine, in man.

The neuromuscular effects of d-tubocurarine (dTc), pacuronium, and succinylcholien (SCh) were studied in 37 unpremedicated adult surgical patients anesthetized with 1.25 MAC enflurance in oxygen. The relaxant doses that produced 50 per cent depression of twitch height (ED50) were 1.57, 0.29, and 4.9 mg/m2 for dTc, pancuronium, and SCh, respectively. These doses are approximately 3.1, 1.7, and 1.0 times less than the amount of dTc, pancuronium, and SCh required to produce 50 per cent depression of twitch height during halothane anesthesia but are the same as ED50 values during isoflurane anesthesia. In eight additional unpremedicated patients anesthesia was maintained at 0.71 MAC enflurane in oxygen (five patients) or 1.67 MAC enflurane in oxygen (three patients). Twitch depression following dTc, 1.5 mg/m2, was related directly to alveolar enflurane concentration. Ability to sustain tetanus decreased progressively with increasing tetanic frequencies and decreased with increasing alveolar enflurane concentrations. The authors concluded that smaller doses of dTc and pancuronium are needed for adequate relaxation during enflurane anesthesia than during equi-MAC halothane anesthesia, and that higher alveolar enflurane concentrations reduce the dose of dTc necessary to produce a given amount of paralysis. Also, neuromuscular effects of enflurane in combination with dTc or pancuronium are not significantly different from those seen suring equi-MAC isoflurane anesthesia.

Anesthesia, Inhalation↗
PubMed1977

Pancuronium-induced neuromuscular blockade, and its antagonism by neostigmine, at 29, 37, and 41 c.

To determine the effects of variations in temperature on the neuromuscular blockade produced by pancuronium, the drug was infused intravenously into 18 cats anesthetized with chloralose and urethane at a constant continuous rate to produce and maintain 90 per cent depression of twitch tension of the anterior tibial muscle following supramaximal stimulation of the peroneal nerve. The mean (+/-SE) infusion rates of pancuronium needed were 0.44 +/- 0.05, 0.99 +/- 0.11, and 1.05 +/- 0.09 microng/kg/min (r = 0.73) at 29, 37, and 41 C, respectively. In contrast, the doses of neostigmine necessary for 50 per cent antagonism of the pancuronium-induced depression of twitch tension were not significantly different at the three temperatures. The time required to achieve peak neostigmine effect was longer at the lowest temperature. The durations of neostigmine action were longer at 29 and 37 than at 41 C. It is concluded that hypothermia augments neuromuscular blockade produced by pancuronium and prolongs the time to peak effect, and possibly the duration of action, but not the dose of neostigmine needed to antagonize the blockade.

Anesthesia, Intravenous↗
PubMed1977

Pancuronium bromide enhances atrioventricular conduction in halothane-anesthetized dogs.

The effect of pancuronium bromide on atrioventricular conduction was studied by His-bundle electrocardiography during atrial pacing at different heart rates in halothane-anesthetized dogs. Pancuronium bromide, 0.1 mg/kg, uniformly enhanced atrioventricular conduction, as evidenced by decreased A-H interval (the time from the onset of the first high-frequency component of atrial depolarization to His deflection). Wenckebach second-degree atrioventricular block appeared in five of 14 animals during atrial pacing with halothane anesthesia. This block was uniformly abolished by pancuronium. The enhancement of atrioventricular conduction may contribute to the development of tachyarrhythmias following administration of pancuronium in certain patients, particularly those who have atrial fibrillation or atrial flutter.

Anesthesia, Inhalation↗
PubMed1981

Disuse atrophy with resistance to pancuronium.

To determine whether disuse atrophy of skeletal muscle results in resistance to pancuronium, the dose response to pancuronium was determined simultaneously in both gastrocnemius muscles of six dogs that had one hind limb immobilized in a plaster cast for one month. Muscle responses were evoked during pentobarbital-nitrous oxide anesthesia by stimulation of the exposed sciatic nerves, using the train-of-four pattern. Muscle subject to disuse atrophy was resistant to pancuronium. The ED50 (dose of pancuronium which causes a 50 per cent depression of twitch tension) was 0.051 mg/kg for casted and 0.027 mg/kg for uncasted limbs for a potency ratio of 1.89. On the basis of these data the author predicts that bedridden or immobilized patients are likely to require greater doses of nondepolarizing relaxants for paralysis.

Animals↗
PubMed1983

Pancuronium, unlike other nondepolarizing relaxants, retains potency at hypothermia.

The authors studied the pharmacodynamics of four nondepolarising relaxants, d-tubocurarine (dTC), pancuronium, metocurine, and gallamine, at 25 degrees C, 31 degrees C, and 37 degrees C. The rat phrenic nerve-hemidiaphragm preparation with vascular perfusion was used for these investigations. For each drug at each temperature, a dose-response curve for twitch depression was constructed. ED50 values were calculated using probit-log dose regression. dTC, metocurine, and gallamine each demonstrated a near twofold increase in ED50 at 25 degrees C compared with 37 degrees C. No such relationship was apparent with pancuronium. In addition, the slopes of the dose-response curves were analyzed for effects due to temperature or drug. Slopes were not influenced by temperature; however, the slopes for metocurine and dTC were lower than those for pancuronium and gallamine. The authors conclude that in the rat, pancuronium retains potency at hypothermia, whereas the other relaxants decrease potency. In addition, metocurine and dTC exhibit less steep dose-response curves under these experimental conditions.

Animals↗
PubMed1983

Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC45) and pancuronium in anesthetized humans.

The pharmacokinetics and pharmacodynamics of vecuronium (25-50 micrograms/kg) and pancuronium (25-50 micrograms/kg) were determined in nine ASA class I or II patients anesthetized with nitrous oxide and halothane. Force of thumb adduction in response to supramaximal stimulation of the ulnar nerve was quantified and recorded. Serum concentrations of the muscle relaxants were determined for eight hours after their administration using a mass spectrometry assay. Data were analyzed by nonlinear regression and fit to a three-compartment pharmacokinetic model and a four-compartment pharmacodynamic model. Vecuronium had a more rapid clearance (5.2 +/- 0.7 ml X kg-1 X min-1; mean +/- SD) and a shorter elimination half-life (71 +/- 20 min) as compared with pancuronium (1.8 +/- 0.4 ml X kg-1 X min-1; 140 +/- 25 min). No other pharmacokinetic differences were found between the drugs. Pharmacodynamic analysis showed that the plasma concentration at steady state which produced a 50% neuromuscular blockade (Cpss 50) was similar for vecuronium and pancuronium. The authors conclude that the drugs are equivalent in their onset and potency; however, the more rapid clearance and shorter elimination half-life for vecuronium provides a kinetic basis for its shorter duration of neuromuscular blockade as compared with pancuronium.

Adult↗