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PubMed1993

Potentiation of pancuronium and vecuronium neuromuscular blockade by intravenous salbutamol.

Three doses of salbutamol 125 micrograms iv were given, over 3.5 hr, to a 28-yr-old healthy, previously non-asthmatic man during thiopentone-O2/N2O-isoflurane anaesthesia for treatment and prophylaxis of bronchospasm. Force of contraction of the adductor pollicis was measured before and after the last two injections. Initially, the patient was given pancuronium, 5 mg. Salbutamol, 125 micrograms iv, was given when T1 blockade was 45%. Blockade increased to 66% over five minutes and returned to 45% after 18 min. Vecuronium was subsequently used to maintain relaxation. At the end of surgery, salbutamol was followed by an increase in T1 blockade, from 66% to 86%, over five minutes which returned to 66% after ten minutes. It is concluded that intravenous salbutamol potentiates the neuromuscular blocking effect of nondepolarizing muscle relaxants.

Adult↗
PubMed1983

ORG NC45 for short intra-abdominal operations: a comparison with succinylcholine.

ORG NC45 was compared with succinylcholine to produce muscle relaxation for short, intra-abdominal operations in 40 patients during nitrous oxide-oxygen-enflurane anaesthesia. Intubating conditions after ORG NC45, 100 micrograms/kg, were similar to those after succinylcholine 1 mg/kg, although this was achieved at a mean time of 229.9 +/- 10.8 sec compared with 129.8 +/- 14.2 sec after succinylcholine. Muscle relaxation during surgery, mean duration 32.5 minutes, was provided in the succinylcholine group with an infusion and in the ORG NC45 group by repeated boluses, 10 micrograms/kg, which were required in four patients. At the end of surgery ORG NC45 was antagonized with atropine, 17 micrograms/kg, and neostigmine, 36 micrograms/kg, which were repeated in two patients. Postoperative recovery of neuromuscular function was indistinguishable between the two groups. We conclude that ORG NC45 is a suitable relaxant for short, intra-abdominal operations if sufficient time, three to four minutes, is allowed to produce good intubating conditions.

Adult↗
PubMed1984

Vecuronium in renal failure.

Neuromuscular blockade during surgery was provided with vecuronium in 24 adult patients in end-stage renal failure and in 21 normal patients who served as controls. Dose response curves were constructed which showed that the effective doses required to produce 50, 90 and 95 per cent neuromuscular blockade in patients with renal failure were 27.5, 43 and 49 micrograms X kg-1 respectively. These were not significantly different from the doses of 31, 49 and 57 micrograms X kg-1 in the normal patients. Repeated small doses of 0.01 mg X kg-1 had a significantly longer duration of action and were associated with some cumulation in the renal failure group. Recovery from the block occurred rapidly after neostigmine, was no different in renal failure and was not associated with recurarization. It is concluded that, when given to subjects in renal failure, vecuronium offers advantages over established agents such as shorter duration of action and easy reversibility.

Adult↗
PubMed1994

Succinylcholine and vecuronium blockade of the diaphragm, laryngeal and limb muscles in the anaesthetized goat.

The purpose of the study was to compare the response of the cricoarytenoideus dorsalis muscle (CD) to neuromuscular blocking drugs with those of the thyroarytenoideus (TA), diaphragm (DI) and ulnaris lateralis (UL) muscles. Evoked electromyographic response to indirect supramaximal stimulation at 1 Hz was monitored in ten adult goats under thiopentone-halothane anaesthesia. The onset time and duration of neuromuscular blockade after intravenous administration of 500 micrograms.kg-1 of succinylcholine or 4 micrograms.kg-1 of vecuronium were determined. Times to 100% paralysis in CD, TA, DI and UL after succinylcholine were (mean +/- SD) 39 +/- 11, 39 +/- 11, 42 +/- 8 and 57 +/- 8 seconds, respectively; the corresponding times for vecuronium were 5.6 +/- 2.3, 4.6 +/- 1.7, 6.0 +/- 1.9 and 9.6 +/- 1.7 min. The order of recovery to 25% spontaneous EMG activity was TA, CD, DI and UL after succinylcholine (durations: 9.7 +/- 3.6, 11.0 +/- 3.0, 15.3 +/- 1.3 and 22.0 +/- 1.2 min, respectively) but DI, CD, TA and UL after vecuronium (durations: 31.9 +/- 18.6, 35.2 +/- 19.5, 47.1 +/- 19.9 and 71.7 +/- 16.1 minutes, respectively). Thus, as in the diaphragm and thyroarytenoideus muscles, onset time and duration of succinylcholine or vecuronium blockade were shorter in the abductor muscle of the glottis, cricoarytenoideus dorsalis, than in the limb muscle.

Action Potentials↗
PubMed1993

Assessment of double-burst monitoring at 10 mA above threshold current.

We compared fade measurements in response to double-burst stimulation (DBS) at 10 mA above the threshold for the second response (D2) to that for DBS at 60 mA in order to determine the utility of low-current DBS testing. In 20 healthy adults undergoing general endotracheal anesthesia with isoflurane 0.5-1% end-tidal, a vecuronium infusion (0.25-1.5 micrograms.kg-1 x min-1) was delivered until a stable train-of-four (TOF) response to ulnar nerve stimulation was documented with an adductor pollicis force transducer. Then DBS responses were recorded, and the D2/D1 ratios were determined at 60 mA and at 10 mA above the D2 threshold current (TS + 10 mA). The mean difference (bias) between D2/D1 /TS+10 mA and D2/D1 / 60 mA was -0.02 (P < 0.05); the 95% limits of agreement were from -0.12 to +0.08. The bias and limits of agreement were similar to those for T4/T1 of train-of-four. A strong correlation was noted between the degrees of fade determined at the low and high currents (r = 0.95). We conclude that, although stimulation at 10 mA above the D2 threshold is associated with a slight negative bias, it is virtually interchangeable with testing at higher current in the clinical setting. This technique thus may be used effectively to monitor neuromuscular fade in settings where neurostimulation with low current is deemed desirable.

Adult↗
PubMed1993

Pharmacodynamics of vecuronium in patients with and without renal failure: a meta-analysis.

Eight trials comparing the effects of vecuronium in patients with either normal renal function or renal failure were subjected to a meta-analysis. Vecuronium doses were similar in the different trials, identical in the two patient groups of any given trial, and ranged from 0.05 to 0.14 mg.kg-1. Neuromuscular blockade was assessed by TOF or single twitch stimulation, and recorded by either mechanomyography or electromyography. Indices of blockade included onset time (from injection to maximal twitch depression), duration of action (from injection to recovery to 25% of control twitch) and 25-75% recovery index. Statistical analysis used Hedges method: effect size and variance were calculated for each relevant outcome, then the global effect size was estimated by pooling the effect sizes of each trial. Three separate meta-analyses were conducted. No differences were found either in onset time, or in recovery index between the two groups, whereas the duration of action was longer in the renal failure group. It is concluded that renal function is likely involved in the pharmacokinetic parameters of vecuronium.

Adult↗
PubMed1993

Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium.

Haemodynamic variables were measured following administration of rocuronium 0.6 mg.kg-1 or vecuronium 0.08 mg.kg-1 (approximately equivalent to 2 x ED95 doses) in patients anaesthetized with fentanyl 50 micrograms.kg-1 and scheduled to undergo elective coronary artery bypass grafting. There were increases in stroke volume index (+15%) and cardiac index (+11%), and a decrease in pulmonary capillary wedge pressure (-25%) following administration of rocuronium (P < 0.05). The changes in heart rate (+7%), mean arterial pressure (-5%), systemic vascular resistance (-12%) and other measured or derived indices were insignificant. In comparison the administration of vecuronium was associated with decreases in heart rate (-7%), mean pulmonary artery pressure (-17%), central venous pressure (-15%) and the rate-pressure product (-9%) (P < 0.05). The changes in mean arterial pressure (-7%), cardiac index (-6%) and systemic vascular resistance (-8%) following vecuronium were insignificant. There were no differences in any of the variables between rocuronium and vecuronium. The absolute values of all variables were, however, within acceptable clinical limits. There was no evidence of histamine release in any patient. The present study shows that rocuronium 0.6 mg.kg-1 is associated with changes of only small magnitude in haemodynamic variables.

Androstanols↗
PubMed1994

Anaesthesia and the Sturge-Weber syndrome.

We report a series of 13 patients with Sturge-Weber syndrome anaesthetised on 17 occasions. Anaesthesia management varied depending on the clinical manifestations which ranged from localized, superficial skin lesions to extensive systemic involvement. These patients tolerate anaesthesia well but anaesthetic management includes evaluation for associated anomalies. Difficulty with intubation may occur due to angiomas of the mouth and upper airway. Anaesthesia should be planned to avoid trauma to the haemangiomata and increases in intraocular and intracranial pressure.

Adolescent↗
PubMed1994

Waiting time after non-depolarizing relaxants alter muscle fasciculation response to succinylcholine.

The purpose of the study was to determine the effect of nondepolarizing muscle relaxants and waiting time on muscle fasciculations after succinylcholine in anaesthetized patients. Adult men and women, 60-80 kg, received pretreatment doses of atracurium 5 mg (n = 160), pancuronium 1 mg (n = 123), d-tubocurarine 3 mg (n = 97), or vecuronium 1 mg (n = 62). Waiting times between pretreatment and succinylcholine, 100 mg, ranged between 0.6 and 5 min. Data points (presence or absence of fasciculations and waiting time) were entered for each patient. Waiting time response curves were obtained between the logit transformation of the probability of no fasciculations and the log waiting time for each drug. Statistical differences between wait time response curves were determined by non-overlapping of the associated 95% confidence intervals. The frequency of muscle fasciculations was reduced with increased waiting time for all nondepolarizers tested. Following wait times of three, four and five minutes, the probability of not fasciculating was greatest with d-tubocurarine (90, 97 and 99%, respectively) and atracurium (89, 93 and 96%). Corresponding values for pancuronium were 70, 82 and 88% and for vecuronium were 74, 82 and 86%. Waiting times to prevent fasciculations in 80% and 90% of patients were shorter with d-tubocurarine (2.46 and 3.02 min, respectively) or atracurium (2.16 and 3.24 min) than pancuronium (3.77 and 5.35 min) or vecuronium (3.73 and 6.36 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Preliminary investigations of the clinical pharmacology of three short-acting non-depolarizing neuromuscular blocking agents, Org 9453, Org 9489 and Org 9487.

Three muscle relaxants, Org 9453, Org 9489 and Org 9487, short-acting in animals, were investigated to establish their profiles in humans. Potency, time course of action, and pharmacokinetic behaviour were studied in 90 healthy patients during fentanyl/halothane/N2O anaesthesia. Neuromuscular function was monitored mechanomyographically. Plasma and urine concentrations (three patients per compound) were measured by HPLC, and these data were analyzed by iterative linear least square regression analysis. The ED90 values for Org 9453, Org 9489 and Org 9487 were 1.4, 0.45 and 1.15 mg.kg-1 respectively. The onset times of Org 9453 (1.5 mg.kg-1, 1.1 X ED90), Org 9489 (0.9 mg.kg-1, 2 X ED90) and Org 9487 (1.5 mg.kg-1, 1.3 X ED90) were 1.2, 1.6 and 1.5 min, and the durations until 25% twitch recovery were 8.6, 22.0 and 8.9 min, respectively. Clearances of these doses were 6.9, 5.8, and 11.1 ml.kg-1.min-1, and mean residence times 26, 79, and 41 min, respectively. Mean renal excretion (parent compound and metabolites) within 24 hr amounted to 5, 11.3 and 12.2% respectively. No side effects other than a moderate short-lasting decrease of blood pressure and a concomittant increase in heart rate were noted. It is concluded that Org 9453 and Org 9487 are short-acting muscle relaxants in humans.

Adolescent↗
PubMed1987

Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with aortic valve disease.

To compare haemodynamic responses associated with equipotent doses of neuromuscular blockers and high-dose fentanyl (50 micrograms.kg-1), 40 patients with aortic valve stenosis (AS) and 20 patients with aortic insufficiency (AI) were randomized to four study groups to receive the following: (1) pancuronium 0.12 mg.kg-1, (2) vecuronium 0.12 mg.kg-1, (3) atracurium 0.4 mg.kg-1, or (4) pancuronium-metocurine mixture (0.4 mg + 1.6 mg/ml): 1 ml/10 kg). Neuromuscular blockers were injected at the same time with the fentanyl; haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation. In patients with AS, pancuronium increased heart rate more than vecuronium or atracurium; heart rates were also higher with the pancuronium-metocurine mixture than with vecuronium. Although there were no ECG signs of ischaemia, one patient given pancuronium developed severe hypotension associated with tachycardia. Reductions in SVR after atracurium allowed small but significant (p less than 0.01) decreases in MAP which were well tolerated; one patient, however, did develop severe hypotension. Intubation resulted in significant (p less than 0.01) increases in MAP in the pancuronium-metocurine mixture group. Vecuronium permitted the most stable overall haemodynamic course at all measurement times. In contrast, patients with AI showed stable haemodynamics after vecuronium, pancuronium and the pancuronium-metocurine mixture; one patient became tachycardic following vecuronium. Atracurium caused unexplained elevations in diastolic and mean arterial pressures which were significant when compared to vecuronium (p less than 0.01). These results in increases in PCWP; mean PA pressures and CVP were also increased. These effects of atracurium inpatients with Al need further evaluation.

Aged↗
PubMed1988

Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation.

Results of a series of controlled, randomized, double-blind trials investigating intubation conditions with priming sequences of nondepolarizing relaxants are reported. In Phase I of the study the groups received: Group A, tubocurarine (DTC) 3 mg + succinylcholine 1.5 mg.kg-1, Group B, atracurium 0.05 mg.kg-1 + 0.35 mg.kg-1, Group C, vecuronium, 0.01 mg.kg-1 + 0.07 mg.kg-1; in Phase II: Group D, no relaxant, Group E, DTC 0.05 mg.kg-1 + vecuronium 0.07 mg.kg-1, Group F, vecuronium 0.01 mg.kg-1 + vecuronium 0.12 mg.kg-1; in Phase III, Group G, DTC 3 mg + succinylcholine 1.5 mg.kg-1, Group H, vecuronium 0.01 mg.kg-1 + 0.09 mg.kg-1, Group I vecuronium 0.1 mg.kg-1 as a single bolus. Intubation conditions were assessed at 60 seconds. A seven-minute priming interval was used in Phase I and II and a four-minute interval was used in Phase III. Priming produced significantly better intubating conditions than an equivalent single bolus; however, intubating conditions with priming did not appear to match the uniformly excellent conditions produced by succinylcholine. The data suggest that a four-minute priming interval is as effective as a seven-minute interval. The results of this study differed substantially from previous unblinded studies; therefore, it is suggested that a randomized, double-blind design with simultaneous succinylcholine controls be considered a prerequisite for future studies of intubation conditions.

Atracurium↗
PubMed1988

A comparative evaluation of intubating doses of atracurium, d-tubocurarine, pancuronium and vecuronium in children.

To determine the onset and recovery times and haemodynamic effects of intubating doses of atracurium (0.4 mg.kg-1), d-tubocurarine (0.8 mg.kg-1), pancuronium (0.12 mg.kg-1), and vecuronium (0.07 mg.kg-1), sixty-seven children aged one to eight years were studied under halothane and nitrous oxide anaesthesia. The time to maximum twitch depression and the time to recovery to T1/Tc 25 per cent were recorded with an integrated evoked EMG recorder. The heart rate and systolic blood pressure were recorded for five minutes after drug administration and prior to intubation. There was no difference in onset times between drugs. The recovery time to T1/Tc 25 per cent following vecuronium (25.5 +/- 6.3 min) was shorter than following atracurium (37.5 +/- 7.0 min). Recovery times for d-tubocurarine and pancuronium were greater than sixty minutes. Elevation of heart rate occurred after administration of pancuronium (+29.8 per cent to +38.6 per cent) and d-tubocurarine (+31 per cent to +34.9 per cent), but no change was observed after atracurium or vecuronium. Elevation of blood pressure was greatest following pancuronium (+10.8 to +14.8 per cent). No significant change was observed following atracurium or vecuronium. A transient lowering of blood pressure (-9.3 per cent) occurred following d-tubocurarine.

Atracurium↗
PubMed1995

It is not necessary to administer more than 10 micrograms.kg-1 of atropine to older children before succinylcholine.

It is common practice at the Hospital for Sick Children, Toronto, to administer atropine 20 micrograms.kg-1 prior to succinylcholine in infants and children. It is unclear whether "prophylactic" administration of this dose of atropine to older children (6-16 yr) is necessary. This study was designed to compare the changes in heart rate, rhythm and mean arterial pressure after administration of either atropine 10 or 20 micrograms.kg-1 with succinylcholine or vecuronium (control group) to older children anaesthetized with thiopentone. Thirty-six ASA I or II patients (6-16 yr) were studied. Anaesthesia was induced with thiopentone 5 mg.kg-1. Patients were randomly assigned to receive: (a) atropine 10 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 12), (b) atropine 20 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 13) or (c) vecuronium 0.1 mg.kg-1 (n = 11) to facilitate tracheal intubation. Heart rate and rhythm were recorded continuously using a computerised analogue interface whereas blood pressure was monitored non-invasively before induction of anaesthesia, immediately before and at one and three minutes after laryngoscopy. No difference was observed between patients who received atropine 10 or 20 micrograms.kg-1 prior to succinylcholine. No episode of sinus bradycardia occurred. Premature atrial contractions were observed in two patients (one succinylcholine/atropine 20 micrograms.kg-1, one vecuronium). Administration of atropine 20 micrograms.kg-1 prior to succinylcholine provides no advantage over atropine 10 micrograms.kg-1 in older children in terms of cardiovascular stability.

Adolescent↗
PubMed1988

Atracurium versus vecuronium: a comparison of recovery in outpatient arthroscopy.

Atracurium 0.5 mg.kg-1 and vecuronium 0.1 mg.kg-1 were compared as neuromuscular relaxants for outpatient arthroscopy of the knee under general anaesthesia. In 40 unpremedicated patients divided at random into two groups, anaesthesia was induced with methohexitone, atracurium (Group A) or vecuronium (Group B), three per cent isoflurane prior to intubation and 0.9 per cent during maintenance with nitrous oxide 66 per cent in oxygen. Neuromuscular function was recorded by a Datex Relaxograph. Recovery was assessed by the time the patients took to open their eyes, to be able to answer five questions correctly, the time to recovery of ocular balance (Maddox Wing test) and by comparing pre- and postoperative performance of a paper and pencil test (the p-deletion test). Recovery tests showed no significant differences between groups. After three hours all the patients were fit for discharge. The patients were interviewed one month after the procedure. All were satisfied with their anaesthetic. "Full recovery" took 1.5 days with a range of 1 h-7 days. The only significant difference (p less than 0.01) between the groups was the need for pharmacological reversal of residual paralysis. In a procedure with a mean duration of 45.6 minutes, and using isoflurane, all but one patient (95 per cent) in the atracurium group required neostigmine versus nine patients in the vecuronium group (45 per cent).

Adolescent↗
PubMed1995

Nondepolarizing neuromuscular blocking drugs and train-of-four fade.

The aim of this study was to examine differences in prejunctional effects of different relaxants by measuring the train-of-four (TOF) fade during the onset and recovery of neuromuscular block. The relaxants studied were atracurium (225 micrograms.kg-1), mivacurium (65 micrograms.kg-1) rocuronium (300 micrograms.kg-1) and vecuronium (40 micrograms.kg-1). The TOF ratios were measured at approximate heights of T1 (first response in the TOF) of 90, 75, 50, and 25%. The TOF fade (as shown by lower TOF ratios) increased with a decrease in the T1 during onset of neuromuscular block. Although there was a slightly greater fade with atracurium and rocuronium during the onset of block, the differences among the relaxants were insignificant. It is concluded that the relative prejunctional effects of these relaxants are similar.

Adult↗
PubMed1986

Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with coronary artery disease.

To compare haemodynamic responses associated with equipotent doses of muscle relaxants and high dose fentanyl (50 micrograms X kg-1), 40 non-hypertensive patients who were receiving beta adrenergic and calcium channel blocker therapy and undergoing coronary bypass surgery were randomized to four study groups receiving the following: (1) atracurium: 0.4 mg X kg-1, (2) pancuronium: 0.12 mg X kg-1, (3) vecuronium: 0.12 mg X kg-1, or (4) pancuronium-metocurine mixture: (0.4 mg + 1.6 mg X ml-1):1 ml/10 kg. Neuromuscular blockers were injected with fetanyl at induction. Haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation. Pancuronium was the only drug associated with significant increases in HR; no other significant changes occurred within each group when compared to their respective baseline haemodynamics. HR increased more after induction with pancuronium when compared to atracurium (23 vs. 4 per cent, p less than 0.05) and to vecuronium (23 vs. 2 per cent, p less than 0.05), and when compared to vecuronium after intubation (29 vs. 7 per cent, p less than 0.05). The pancuronium-metocurine mixture caused tachycardia which was less than, though not significantly different than with pancuronium; however, HR returned to baseline by five minutes with the mixture, but remained elevated with pancuronium (3 vs. 18 per cent, p less than 0.05). SVR fell more on induction with atracurium when compared to vecuronium (-18 vs. 1 per cent, p less than 0.05). These changes in HR or SVR were not accompanied by ECG signs of ischaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗