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Drug transport, viability and morphology of isolated rat hepatocytes preserved for 24 hours in University of Wisconsin solution.

Isolated hepatocytes are a valuable tool to study liver functions. Suitable methods to preserve the isolated cells with good maintenance of viability and functions are crucial to extend experiments with hepatocytes from a single isolation over 2 or more consecutive days. We investigated whether University of Wisconsin (UW) solution, which was designed to preserve organs for transplantation, is also suitable for preservation of isolated rat hepatocytes. Viability, as determined by Trypan blue exclusion and reduction of the tetrazolium 3(4,5-dimethyl-thiazoyl-2-yl)2,5 diphenyltetrazolium bromide to a purple formazan, morphological appearance using electron microscopy, ATP levels and uptake and storage of three model drugs ([3H]vecuronium, [3H]taurocholic acid and [3H]ouabain) were determined directly after isolation and after 22 hr of storage in UW solution at 0-4 degrees. The present study shows that cold storage of rat hepatocytes for 22 hr in UW can be performed without significant loss of viability and with maintenance of proper morphology, cellular ATP and transport functions. In contrast, after storage in Krebs-Henseleit buffer the normal morphology, ATP content and transport functions were strongly affected. These results imply that hepatocytes from a single isolation and stored in UW solution can be used for experiments on 2 consecutive days.

Adenosine Triphosphate↗

The pharmacokinetics of rocuronium bromide in hepatic cirrhosis.

The pharmacokinetics of aminosteroid neuromuscular blocking drugs have been shown to be altered in patients with hepatic cirrhosis. A reduced clearance and prolonged elimination half-life of pancuronium and vecuronium have been demonstrated. Pharmacokinetic studies of the newest aminosteroid neuromuscular blocking agent, rocuronium, performed in a small number of cirrhotic patients, have proved inconclusive, apart from noting a higher central volume of distribution than in healthy patients. This difference may result in a slightly delayed onset of neuromuscular block. Nevertheless, rocuronium, even in cirrhotic patients, has the fastest onset of action of any non-depolarizing neuromuscular blocking agent. Further pharmacokinetic studies are necessary of this drug in hepatic cirrhosis.

Androstanols↗

Comparison of cardiovascular effects of pipecuronium versus vecuronium in patients receiving sufentanil anesthesia for myocardial revascularization.

This study was designed to compare the cardiovascular effects of pipecuronium bromide (PIP) to vecuronium (V) when combined with sufentanil (SF) in patients undergoing coronary artery bypass surgery. Eighty-two patients were studied; 40 were normotensive and 42 had hypertension currently controlled by pharmacological therapy. All patients were randomly assigned to receive either intravenous V, 0.12 mg/kg, or PIP, 0.10 mg/kg. Anesthesia was induced with SF, 6 micrograms/kg, while breathing 100% oxygen. Hemodynamic data including heart rate, mean arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance, and left ventricular stroke work index were collected at five points: prior to induction, 3 and 6 minutes after the complete administration of PIP or V, and 3 and 6 minutes after intubation. There were no statistical differences in hemodynamic changes associated with either PIP or V. In addition, there were no statistical differences in the hemodynamic parameters measured at the five time points between the normotensive and hypertensive patient groups. This study demonstrates that there are no significant hemodynamic changes between SF/PIP and SF/V when used during coronary artery surgery. Due to its associated stable hemodynamics, as well as its long duration of action, PIP could become a commonly used muscle relaxant for anesthesia for cardiac surgery.

Androstane-3,17-diol↗

[Severe anaphylactic reactions after administration of rocuronium].

The authors report four cases of severe anaphylactic reactions (grade III or IV) to rocuronium bromide. In three of them, it was the first contact with a muscle relaxant. In three patients the reaction was mediated by IgE anti-bodies. A cross-reactivity with other muscle relaxants was existing in two cases (suxamethonium, vecuronium and atracurium in one patient, suxamethonium, vecuronium and pancuronium in the other.

Adult↗

Dose-response and time-course of action of rocuronium bromide.

Rocuronium is a new aminosteroidal muscle relaxant, the main feature of which is a low potency compared to other aminosteroidal muscle relaxants. The ED95 is approximately 0.3 mg kg-1, although the estimated potency may vary slightly with different modes of stimulation and under different anaesthetic techniques. The low potency is associated with a rapid onset of effect, a 2-3 x ED95 dose producing the maximum effect in 1-2 min. The duration of action is, however, comparable to other intermediate drugs such as atracurium and vecuronium. The estimated potency is similar in adults and the elderly, although the ED95 may be slightly higher in children. Rocuronium is affected in the same way as vecuronium by the use of volatile anaesthetic agents.

Adolescent↗

Rapacuronium administration to two children with Duchenne's muscular dystrophy.

Children with Duchenne's muscular dystrophy should not be exposed to succinylcholine because of the risk of hyperkalemic cardiac arrest and rhabdomyolysis. This report describes the response to rapacuronium bromide in two patients with Duchenne's muscular dystrophy. Both patients had a recovery index 2 times longer than that reported in children with normal neuromuscular function.

Anesthesia, General↗

[A comparison between neuromuscular blocking effects of pipecuronium and vecuronium; a double blind controlled study in collaboration with 5 departments of anesthesiology].

Neuromuscular blocking effects of pipecuronium bromide 0.04 mg.kg-1 were compared those of vecuronium bromide 0.08 mg.kg-1 in a double blind study. Fifty surgical patients (ASA I or II) were allocated randomly to two groups of each 25 cases and they were anesthetized with nitrous oxide 4 l.min-1, oxygen 2 l.min-1 and isoflurane 1 MAC. Neuromuscular blockade was monitored by using mechanical twitch responses of the thumb to electrical stimulations of the ulnar nerve. Adequate neuromuscular relaxation for surgery of 85.8% to 100% block was obtained by this dose of pipecuronium. The duration of action and recovery time from 75% to 25% block were longer than those produced by twice the dosage of vecuronium (62.3 +/- 37.15 vs. 40.4 +/- 16.09 min, and 48.1 +/- 22.0 vs. 19.9 +/- 10.8 min, P < 0.05). The blocks by both drugs responded to neostigmine. Cardiovascular side effects of the both agents were not found. From these results, it is concluded that pipecuronium is a useful nondepolarizing relaxant with a long duration of action and negligible side effects.

Adult↗

Rapacuronium bromide.

Rapacuronium bromide (Raplon; Organon Inc, West Orange, NJ) is a new, fast-onset, short-duration surgical muscle relaxant. While anesthesia providers are learning how to use this new relaxant, PACU nurses must become aware of the potential problems associated with rapacuronium. This article compares and contrasts the effects of succinylcholine and rapacuronium.

Humans↗

Clinical pharmacokinetics of the newer neuromuscular blocking drugs.

The pharmacokinetics of 6 new neuromuscular blocking drugs are described. These are the aminosteroids pipecuronium bromide, rocuronium bromide and rapacuronium bromide (ORG-9487) and the benzylisoquinolinium diesters doxacurium chloride, mivacurium chloride and cisatracurium besilate. In healthy individuals, these drugs all have similar volumes of distribution. Their pharmacokinetics are influenced little by age or anaesthetic technique, but renal and hepatic disease may significantly alter their distribution and elimination. Pipecuronium resembles pancuronium in its pharmacokinetic and neuromuscular blocking profile, but is devoid of cardiovascular effects. It has a low clearance (0.16 L/h/kg) and long elimination half-life (120 minutes). It is largely eliminated through the kidney. Rocuronium has a similar pharmacokinetic profile to vecuronium but its onset of action is more rapid and duration of action slightly shorter. Its clearance (0.27 L/h/kg) is intermediate between those of pipecuronium and rapacuronium, but its elimination half-life is long (83 minutes). The pharmacokinetics of rocuronium are altered by renal and hepatic disease; the latter probably has the more significant effect. Rapacuronium has a rapid onset, and a bolus dose has a short duration of action. It has a high clearance (0.59 L/h/kg) but a long elimination half-life (112 minutes). Doxacurium has a pharmacokinetic and pharmacodynamic profile similar to pipecuronium. It has a high potency and is devoid of cardiovascular effects. In adults, it has a low clearance (0.15 L/h/kg) and long elimination half-life (87 minutes). Mivacurium is a mixture of 3 stereoisomers. It has a short to intermediate duration of action. It is hydrolysed by plasma cholinesterase. Inherited or acquired alterations in plasma cholinesterase activity are associated with changes in the pharmacokinetics and time course of action of mivacurium. The 2 active isomers (cis-trans and trans-trans) have a high clearance (4.74 L/h/kg) and very short elimination half-lives (approximately 2 minutes). Cisatracurium is the 1R-cis 1'R-cis isomer of atracurium. It has similar pharmacokinetics and pharmacodynamics to atracurium. It is mainly broken down by Hofmann (non-enzymatic) degradation. Cisatracurium has an intermediate clearance (0.3 L/h/kg) and short elimination half-life (26 minutes). Hepatic and renal disease have little effect on its pharmacokinetics.

Aging↗

Neuromuscular and cardiovascular effects of pipecuronium.

Pipecuronium bromide (Arduan) is a bisquaternary, steroid-type neuromuscular blocking agent in clinical use in Eastern Europe. Before its introduction into clinical practice in the USA, in the first phase of this study the neuromuscular potency of pipecuronium was determined under "balanced" and enflurance anaesthesia by the cumulative log dose-response method in 30 patients each. In the second phase the intubation and onset times, clinical duration of the first and repeated doses, spontaneous recovery index, reversibility of its residual neuromuscular effect by an anticholinesterase and its effect on heart rate and blood pressure was compared with the same variables observed in patients, anaesthetized with identical techniques but who had received vecuronium or pancuronium. The neuromuscular potency of pipecuronium was greater under enflurane (ED95 = 23.6 +/- 1.1 micrograms.kg-1 (mean +/- SEM)] than under balanced (ED95 = 35.1 +/- 17 micrograms.kg-1) anaesthesia. Pipecuronium was more potent than vecuronium under both balanced (ED95 = 45.8 micrograms.kg-1) and enflurane anaesthesia (ED95 = 27.4 micrograms.kg-1). Following the administration of 2 x ED95 doses there were no clinically significant differences in the intubation or onset times of pipecuronium, vecuronium and pancuronium. Under balanced anaesthesia the clinical duration of 2 x ED95 dose of pipecuronium (110.5 +/- 0.3 min) or pancuronium (115.8 +/- 8.1 min) were similar and about three times longer than that of vecuronium (36.3 +/- 2.1 min). The recovery indices of pipecuronium (44.5 +/- 8.2 min) and pancuronium (41.3 +/- 4.2 min) were also similar and about three times longer than that of vecuronium (14.3 +/- 1.4 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Inhibition of the plasma cholinesterase variants by pancuronium bromide and some of its analogues.

Pancuronium bromide, a 3,17-diacetoxy-5 alpha-androstane, and three of its analogues, the 17-desoxy, the 3,17-dibutyryloxy and the 16-N-monoquaternary ammonium derivatives have been used as inhibitors of the usual and atypical plasma cholinesterase variants. In all cases the usual enzyme is more sensitive to inhibition by the substituted steroids than the dibucaine resistant enzyme. The relative affinities of the bis-quaternary ammonium compounds for either enzyme is in the order dibutyryloxy derivative > 17-desoxy derivative greater than or equal to pancuronium bromide. The monoquaternary compound has the least affinity of all the inhibitors for the usual enzyme but the greater affinity for the atypical enzyme. These observations show that the bis-quaternary compounds are very powerful differentiators of the variants. The monoquaternary derivative shows less differential inhibition, but provides additional evidence that the usual and dibucaine resistant variants differ in structure at or near their esteratic active site.

Cholinesterase Inhibitors↗

First clinical experiences with ORG NC 45.

The new short-acting steroid muscle relaxant Org NC 45 was tested clinically in 18 patients and compared with a similar application of pancuronium bromide in 22 patients. Onset, duration and slope of recovery were significantly shorter for Org NC 45. No cumulative effects were noticed over several consecutive doses of Org NC 45. No tachycardia or arterial pressure changes were noticed with doses of Org NC 45 up to 130 microgram kg-1, which was three times the 95% blocking dose.

Adult↗

Clinical pharmacology of rapacuronium bromide, a new short-acting neuromuscular blocking agent.

Rapacuronium is a new steroidal, nondepolarizing, neuromuscular blocking agent. It appears to be the least potent of all available nondepolarizing muscle relaxants. Its onset of action resembles that of succinylcholine, and its recovery times are shorter than those of other nondepolarizing agents. The clinical duration of rapacuronium can be shortened significantly with early (2 min) administration of neostigmine, which may be beneficial in patients with difficult airway or failed intubation. Rapacuronium appears to be free of significant cardiovascular complications.

Adult↗

Vaginal physiological changes in a model of sexual arousal in anesthetized rats.

The understanding of the pathophysiology of female sexual dysfunction suffers from the lack of a convenient model for the study of female genital sexual response. In this study, systemic arterial blood pressure (BP) as well as partial oxygen tension, temperature, and blood engorgement of the vagina [using laser-Doppler flowmetry in arbitrary units (AU)] were measured in anesthetized, ovariectomized (1 wk before the start of the experiment) female rats. Vaginal sexual arousal was replicated by electrical stimulation of the pelvic nerve (PNS). PNS induced reproducible increases in the different vaginal parameters (from baseline value, respectively: 16 +/- 10 to 30 +/- 12 mmHg; 34.9 +/- 0.6 to 36 +/- 0.6 degrees C; 450 +/- 196 to 1,500 +/- 360 AU; P < 0.05, paired t-test) and BP (90 +/- 7 to 123 +/- 13 mmHg, P < 0.05, paired t-test). Vaginal vascular resistance was significantly decreased during PNS (from 0.23 +/- 0.15 to 0.08 +/- 0.02 mmHg/AU). Vaginal wall tension was also measured with a force transducer. PNS induced an increase in vaginal wall tension (1.0 +/- 0.2 g), followed by a decrease under the prestimulation value. Intravenous atropine sulfate (1 mg/kg) injection abolished the increase in vaginal wall tension without significantly affecting vaginal vascular resistance. Intravenous vercuronium bromide (2 mg/kg) injection abolished the decrease in vaginal wall tension. Concomitant electrical stimulation of the paravertebral sympathetic chain inhibited vaginal response induced by PNS. Electrical stimulation of the medial preoptic area of the hypothalamus induced a response qualitatively equivalent to PNS with a significant decrease of vaginal vascular resistance. These data support that vaginal contractions involve both smooth and striated muscles and indicate that neural control of vaginal sexual arousal have great similarities in male and female rats.

Anesthesia↗

A comparison of the effects of pancuronium bromide and its monoquaternary analogue, ORG NC 45, on autonomic and somatic neurotransmission in the rat.

1 Potentiation by pancuronium of the effects of adrenergic nerve stimulation, previously shown in cardiovascular tissues, was also found in rat anococcygeus and vas deferens, in vitro or in vivo. 2 In the pithed rat, in the presence of pancuronium, pre-junctional alpha-adrenoceptor-mediated feedback inhibition of cardiac sympathetic transmission was uncovered at relatively low stimulation frequencies by phentolamine or yohimbine. 3 The effects of pancuronium and its mono-quaternary analogue Org NC 45 on autonomic and somatic neuromuscular transmission were compared, in the pithed rat. Org NC 45 was less potent than pancuronium at blocking somatic neuromuscular transmission by a factor of 2.1, at blocking cardiac, parasympathetic transmission by a factor of 538 and at potentiating sympathetic transmission by a factor of 33.

Animals↗

Rapacuronium administration to patients receiving phenytoin or carbamazepine.

Patients receiving anticonvulsants such as phenytoin or carbamazepine may be resistant to neuromuscular blocking agents. The authors report the response to rapacuronium bromide (1.5 mg/kg) in two adult patients; one receiving phenytoin and the other receiving carbamazepine. In both patients, there was a delay in achieving maximum blockade; 100% depression of the first twitch was never achieved in the patient receiving phenytoin. Recovery of neuromuscular function was rapid. In the patient receiving phenytoin and carbamazepine respectively, the clinical duration (time to return of T1% to 25% of baseline) was 5 and 9 minutes, the recovery index (T1 25%-75%) was 4 minutes and 3 minutes, and the time to return of T4/T1 to greater than 0.7 was 15 minutes and 18 minutes 40 seconds. As has been reported with other neuromuscular blocking agents of the aminosteroid class, the clinical duration and the recovery index of rapacuronium are shortened in patients receiving either phenytoin or carbamazepine.

Adult↗