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PubMed1990

[Vecuronium bromide in pediatric anesthesia].

Ninety patients were included in a study to assess the clinical characteristics of vecuronium bromide used in children. The myorelaxant was administered to all patients using different routes. The use of vecuronium at a dose approximately equal to 1ED95 was characterised by a duration of action sufficient to allow its use in short operations; on the other hand, it also produced a long induction-intubation interval and not optimal conditions in which to perform intubation. Conditions for intubation improved during induction via inhalation and there was a reduced induction-intubation interval compared to intravenous induction using the same dose of vecuronium. A further reduction in intubation time was obtained by increasing the dose from 50 to 150 micrograms/kg-1 together with an increased clinical duration of action. The "priming principle" technique also allowed intubation time to be shortened without variations in the duration of action provided a full dose of vecuronium, 100 micrograms/kg-1, was used. However, this was also associated with a notable incidence of adverse reactions. Of the various combinations examined, the most advantageous association of pre-dose and interval between doses was the association of a pre-dose of 10 micrograms/kg-1 and an interval of 4 min between doses. Lower doses countered the advantages of priming, whereas higher doses resulted in an increased number of adverse reactions without producing notable changes in the intubation time.

Adolescent↗
PubMed1986

Hepatobiliary disposition of vecuronium bromide in man.

The plasma and bile concentrations, the biliary excretion and the neuromuscular blocking effect of vecuronium bromide were studied during surgery in 13 patients who had received 150 micrograms kg-1 i.v. The amount of vecuronium in liver biopsies taken after i.v injection was measured in a separate group of six patients. Vecuronium appeared early in the bile, in concentrations that were 30-50 times greater than those in the plasma. On the basis of the measured amount of vecuronium excreted in the bile, together with the accepted average daily bile flow, it was estimated that more than 40% of vecuronium was excreted in the bile in 24 h. Liver biopsies indicated that the liver may contain more than 50% of the i.v. dose 30 min after injection. The large distribution of vecuronium into the liver may account for the initial rapid decline in vecuronium plasma concentration and its relatively short duration of action. In this study, neuromuscular blockade was prolonged, possibly as a result of interference, by surgical manipulation, with the rapid hepatic uptake of vecuronium.

Adult↗
PubMed1986

Disposition and urinary excretion of vecuronium bromide in anesthetized patients with normal renal function or renal failure.

The effect and plasma concentrations of vecuronium bromide were measured in normal patients after an intravenous dose of 50, 100, or 150 micrograms/kg and in patients with renal failure after 50 or 100 micrograms/kg. Urinary excretion of vecuronium was studied in normal patients after the 150 micrograms/kg dose. Pharmacokinetic parameters of patients with or without renal failure were similar. No metabolites of vecuronium were found in the plasma. Twenty percent of vecuronium was excreted unchanged in the urine; 5% as the 3-hydroxy derivative. No other metabolites of vecuronium were found in the urine. Increasing doses of vecuronium shortened the onset, but prolonged the duration of action and the recovery rate, to a similar extent in patients with or without renal failure. It was concluded that the disposition of vecuronium was best described by a three compartment model. Both the disposition and the effect of vecuronium are only marginally disturbed by renal failure.

Adult↗
PubMedDate not supplied

The effect of d-tubocurarine priming on an ED95 dose of vecuronium bromide.

STUDY OBJECTIVE: To examine how priming with ED10 d-tubocurarine prior to the administration of ED95 vecuronium bromide affects onset and duration of neuromuscular blockade. DESIGN: Prospective, randomized, observer-blinded study. SETTING: Operating room at a university cancer center. PATIENTS: 40 ASA physical status I and II patients undergoing ambulatory surgical procedures. INTERVENTIONS: Patients were randomized to one of two groups. Group 1 patients received d-tubocurarine 50 micrograms/kg intravenously (IV), followed by vecuronium 60 micrograms/kg IV. Group 2 patients received vecuronium 60 micrograms/kg IV without priming. All patients received a total IV anesthetic consisting of alfentanil and propofol for induction of anesthesia and propofol alone for maintenance of anesthesia. MEASUREMENTS AND MAIN RESULTS: Onset of muscle relaxation was determined with an electromyograph (Datex Relaxograph), documenting time to 80% depression of the first twitch in a train-of-four (T(1)80%), percent depression of T1 at 60 and 90 seconds (T(1)60 and T(1)90, respectively), T4:T1 ratio at 90 seconds, and time to achieve maximal blockade (Bmax). Recovery was evaluated by measuring the time required for return of T1 to 25% of the baseline value. Intubating conditions were assessed at 90 seconds after vecuronium administration and graded on a 1 (jaw tight, impossible to intubate) to 4 (jaw relaxed, vocal cords immobile) scale. All criteria measuring onset of neuromuscular blockade (i.e., T(1)80%, T(1)60, T(1)90, T4:T1, and Bmax) were significantly shorter (p < 0.05) in patients who received d-tubocurarine. Recovery was similar in both groups. Intubation scores were significantly better 90 seconds after priming (p < 0.05). CONCLUSIONS: These results indicate that crossover dosing of nondepolarizing muscle relaxants may have synergistic effects. Priming with ED10 d-tubocurarine prior to an ED95 dose of vecuronium shortens the time to 80% T1 depression and produces satisfactory intubating conditions at 90 seconds, without prolonging the duration of the Therefore, d-tubocurarine is an attractive drug for priming vecuronium in short operative procedures that require muscle relaxation.

Adult↗
PubMedDate not supplied

An artificial neural network-based controller for the control of induced paralysis using vecuronium bromide.

This study presents an artificial neural network-based controller for regulating the level of induced paralysis during surgery using vecuronium bromide. The controller uses the myogram of a rapid muscle contractions (called twitch) to generate the appropriate infusion rate. The controller is self-adjusting and can accommodate inter- and intrapatient drug response variations. It also withstands changes in the pure time delay and nonlinear pharmacokinetic parameters of the response. Another feature of the controller is that it does not depend on a priori knowledge of the patient response model. Computer simulations using pharmacokinetic and pharmacodynamic models showed negligible steady-state error and maximum percent undershoot averaged to 6.24%. The average infusion rate for 90% paralysis was 1.22 (microg x kg(-1) x min[-1]).

Computer Simulation↗
PubMed1985

Interactions between calcium entry blockers and vecuronium bromide in anaesthetized cats.

Possible interactions between three calcium entry blocking agents (nifedipine, verapamil and bepridil) and the non-depolarizing neuromuscular blocking agent, vecuronium bromide, were investigated in chloralose-anaesthetized cats. In i.v. doses which caused decreases in arterial pressure, the calcium entry blockers did not affect indirectly-elicited twitches of tibialis muscle, but did potentiate the effects of vecuronium. No such potentiation of vecuronium was observed with the vasodilator drug, sodium nitroprusside. Experiments using close-arterial injections of acetylcholine suggested that the probable site of interaction is on the postsynaptic muscle membrane and probably involves blockade of calcium channels in skeletal muscle.

Acetylcholine↗
PubMed1989

[Vecuronium bromide and succinylcholine procedures in medial relaxation. A comparison of electromyography and clinical findings].

UNLABELLED: Clinical and electromyographic effects of either succinylcholine (Suc) or vecuronium bromide (VEC) were compared during induction and maintenance of neuromuscular blockade for pelvic laparoscopy. METHODS: Forty ASA class I and II patients (pat.) were studied under general anesthesia with thiopental, enflurane, and nitrous oxide. Group VEC-pat. (n = 20) received 0.015 mg/kg body wt. VEC as priming and 5 min later 0.085 mg/kg as intubation doses. Repetitive doses of 0.01 mg/kg were injected to maintain twitch depression (T1%) less than or equal to 15%. Neuromuscular block was reversed with atropine and pyridostigmine (0.01 resp. 0.1 mg/kg). In group Suc-pat. relaxation was induced with 1.5 mg/kg Suc 5 min after pretreatment with 2 mg alcuronium. Relaxation (10% less than or equal to T1% less than or equal to 15%) was prolonged using a Suc infusion. Neuromuscular blockade was assessed electromyographically (Relaxograph, Datex) using train-of-four (TOF) stimulation (2 Hz for 2 s). Intubation conditions were scored according to Fahey et al. RESULTS: Pretreatment with 0.015 mg/kg VEC compared to 2 mg alcuronium led to a more pronounced decline in T1% and TOF-ratio (P less than 0.001). The time interval between injection of the intubation dose and complete relaxation (T1% less than or equal to 5%) was shorter in group Suc- than in VEC-pat. (P less than 0.001). Suc provides better intubation conditions than VEC (P less than 0.05). Recovery from muscle relaxation was faster in Suc- than in VEC-pat. (P less than 0.001). During Suc infusion in 8 patients a phase-II block (TOF ratio less than or equal to 30%) was observed. DISCUSSION: Postoperative problems are often related to an unrecognized after effects of relaxants. Suc infusion leads to a remarkable number of phase-II blocks, whereas VEC can be antagonized promptly.

Anesthesia↗
PubMed1985

[Interaction of the calcium antagonists nifedipine and nisoldipine with the nondepolarizing muscle relaxant vecuronium bromide in an vivo rat preparation].

The interaction of two orally administered Ca-channel blockers, the dihydropyridines nisoldipine and nifedipine, with the non-depolarizing muscle relaxant, vecuronium bromide, was tested in the indirectly stimulated tibialis anterior muscle of anesthetized and ventilated Sprague-Dawley rats. In both the nisoldipine and the nifedipine group, depression of twitch tension and duration of vecuronium-induced neuromuscular blockade was potentiated when compared with a control group. The possible clinical relevance of these findings is discussed.

Animals↗
PubMed1988

Uptake and excretion of vecuronium bromide and pancuronium bromide in the isolated perfused rat liver.

Using the isolated perfused rat liver preparation, the disappearance from the perfusate and the excretion in the bile of vecuronium bromide and pancuronium bromide and their metabolites were followed for 2 h after the addition of 1 mg of either drug to the perfusate. In addition, the rate of change of the hepatic content of these two compounds was calculated by serially subtracting the amount of the compound and the metabolites in the bile and in the perfusate from the dose of drug added to the perfusate. It was found that, whereas the concentration of pancuronium in the perfusate declined slowly and monoexponentially, vercuronium concentration in the perfusate declined rapidly in a biexponential manner. No metabolites of either drug were detected in the perfusate. Approximately 40% of the injected dose of vecuronium was excreted in the bile as unchanged vecuronium and another 30% as the 3-hydroxy metabolite. No other metabolites of vecuronium were found in the bile. In total only about 7% of pancuronium (unchanged) was collected in the bile by the end of the experiment. It is concluded that, in comparison to pancuronium, the rat liver takes up large amounts of vecuronium rapidly, half of which is eliminated as unchanged vecuronium and half as the 3-hydroxy derivative. A small amount of vecuronium or its 3-hydroxy metabolite is returned to the perfusate from the liver. Some possible mechanisms underlying these differences are discussed.

Animals↗
PubMedDate not supplied

Intubating conditions with propofol under muscle relaxation with vecuronium bromide. A time-related comparison with thiopental.

In the present study a comparison has been made between intubating condition obtainable after anesthesia induction with Thiopental or Propofol, using Vecuronium Bromide to achieve muscle relaxation. Data were collected about hemodynamic parameters, vocal cords position, coughing or bucking, and involuntary movements. Three-hundred patients, males and females, ASA classes I and II, not premedicated, were included in the study; they all had to undergo surgery requiring tracheal intubation. The patients were divided in six different groups, and in each of them intubation was performed at different times from injection of inducing agents (2-2, 30-3-4-5-6 minutes). Overall results show a lack of satisfying intubating conditions on the extreme of selected times (2 and 5-6 minutes), with no significant difference between Thiopental and Propofol, except for a minimal unlike behaviour in hemodynamics. Therefore, on the basis of our data, as far as intubating conditions are considered, we can conclude that there is no reason to prefer one of the two inducing agents.

Adolescent↗
PubMed1991

Changes in the plasma histamine concentration after the administration of vecuronium bromide.

Clinical symptoms of anaphylactoid reaction to muscle relaxants vary from localized flush to cardiovascular collapse. Vecuronium bromide is reported to have very little histamine releasing property. However, there are some reports of anaphylaxis or anaphylactoid reaction to vecuronium. We studied plasma histamine concentration after the intravenous injection of vecuronium to confirm the histamine release. Twenty patients were randomly allocated to one of two groups, each group comprising of 10 patients: one group was to receive vecuronium 0.1 mg.kg(-1) and the other 0.2 mg.kg(-1) using the priming principle. Blood samples were taken prior to and 1, 3, 5, 8 and 13 min after the administration of vecuronium. The plasma histamine concentration was measured by radioimmunoassay with monoclonal antibody. There were no significant changes in plasma histamine concentration over 13 min after the administration of vecuronium compared with the baseline value. There were also no significant differences between these two groups. We concluded that vecuronium up to 0.2 mg.kg(-1) did not change the plasma histamine concentration in the patients having no previous history of allergy or atopic tendencies.

Clinical Trial↗
PubMed1990

[Use of vecuronium bromide for anesthesia for renal transplantation].

We used vecuronium on 7 patients for renal transplants and recorded the muscle relaxant effect using an Anesthesia and Brain Monitor; we also compared them with patients with normal renal function. Results show that there were no significant differences between renal transplant patients and patients with normal renal functions in regard to the time of appearance of effect, duration of effect and recovery rate but the effect was somewhat prolonged in the renal transplant patients. Therefore, although vecuronium is said to be a muscle relaxant with little renal dependency, and it is used on renal transplant patients with renal insufficiency, the possibility of a prolonged effect must be considered. It is important to monitor continuously by a muscle relaxant monitor, grasp adequately the conditions of muscle relaxation, and observe carefully the postoperative respiratory conditions.

Adult↗
PubMed1986

Effects of vecuronium bromide on intracranial pressure and cerebral perfusion pressure. A preliminary report.

The effects of vecuronium 0.1 mg kg-1 on intracranial pressure, heart rate and arterial pressure were evaluated in 20 anaesthetized patients with intracranial tumours undergoing neurosurgery. Apart from a slight decrease in intracranial pressure (-4.9%; ns) which was most probably the result of a concomitant decrease (-14.9%) in central venous pressure, vecuronium 0.1 mg kg-1 was without effect on either cerebral or systemic haemodynamics.

Anesthesia, General↗
PubMed1989

[Use of vecuronium bromide and atracurium besylate in continuous intravenous infusion in urologic surgery].

The effects of continuous i.v. infusion of atracurium and vecuronium monitored by TOF supplied by an ABM monitor have been compared in 60 patients subdivided into four groups and submitted to anaesthesia with isoflurane for urological surgery interventions. Groups A and V received respectively an initial bolus of 0.5 mg/kg atracurium and of 0.08 mg/kg vecuronium followed immediately by continuous i.v. infusion of 5.5 micrograms/kg/min. Atracurium or 0.9 micrograms/kg/min of vecuronium; recovery of neuromuscular function happened spontaneously. Groups A' and V' differed by virtue of the use of 0.04 mg/kg prostigmin in the recovery phase. Average consumption of atracurium and vecuronium were respectively 5.1 +/- 1.75 micrograms/kg/min (2.6-9.03) and 0.75 +/- 0.20 micrograms/kg/min (0.5-1.2) in groups A-A' and V-V'. In groups A and V Recovery time 25-75" of T1 and TR presented a statistically significant difference (p less than 0.05) in favour of atracurium. In groups A' and V' the same parameters presented a statistically non-significant difference (p greater than 0.05). The ratio TI/TR does not vary to a statistically significant extent in the 4 groups. The number of infusion rate variations needed to maintain stable neuromuscular block was lower in the atracurium groups.

Adult↗
PubMedDate not supplied

[Onset time and duration of action of neuromuscular block induced by increasing doses of vecuronium bromide].

The authors determined the onset time and the duration of action of neuromuscular blockade by a 100-150 micrograms.kg-1 vecuronium random administration in 30 ASA I and ASA II patients during urological surgery. Neuromuscular blockade was evaluated by the electromyographic response to stimulation of the ulnar nerve train of four. The time from vecuronium administration to complete abolition of twitch response (T1 = 0%) did not change significantly, in spite of 50% increased dose of neuromuscular relaxant. The duration of action of neuromuscular blockade, that is the time from T1 = 0% to T1 = 25%, increased from 38.2 +/- 7.5 min to 52.5 +/- 19.8 min by the increasing of neuromuscular relaxant dose (p < or = 0.018). Vecuronium increased doses did not shorten significantly the onset time.

Adult↗
PubMed1985

Effects of hepatic uptake of vecuronium bromide and its putative metabolites on their neuromuscular blocking actions in the cat.

The neuromuscular blocking effects of equipotent doses of the three putative metabolites of vecuronium (3-hydroxy vecuronium, 17-hydroxy vecuronium and 3,17-dihydroxy vecuronium) were compared with those of an equipotent dose of vecuronium. Results obtained with the liver excluded from the circulation and after intraportal injection were compared with those following i.v. injection, in the cat. Following injection i.v., and with the liver excluded from the systemic circulation, there was a marked prolongation of duration of action (which averaged 100%) with all four compounds. After intraportal injection the only significant results were shortening of the duration of action and a decrease in the maximum blockade achieved with the 3-hydroxy metabolite. It is concluded that, in the cat, the hepatic removal of these compounds from the circulation is a major determinant of their duration of action. This process seems to be of importance for all four compounds, although the 3-hydroxy derivative appeared the most sensitive.

Animals↗