Quantitative assessment of residual antidepolarizing block. II.
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RX 72601, a new and potent anticholinesterase, has been evaluated for its ability to reverse the neuromuscular blockade induced by non-depolarizing muscle relaxants. In rats RX 72601 10 mug/kg i.v. proved effective in reversing the effects of alcuronium gallamine, pancuronium or tubocurarine and the drug exhibited a wide margin of safety. RX 72601 proved equally effective in reversing the effects of tubocurarine in both cats and baboons. In dogs and cats, effective anti-curare doses had little action on the cardiovascular or respiratory systems. Overall the results obtained indicate that RX 72601 may be a safe antagonist of non-depolarizing muscle relaxants and that it will be possible to use RX 72601 without prior administration of atropine.
The relationship between alcuronium requirements and the plasma concentration of albumin and total globulin was investigated in 50 adult patients undergoing elective upper abdominal surgery. No significant correlation was obtained with the plasma proteins (g/100 ml plasma). A significant positive correlation between alcuronium requirements and plasma albumin X (1-PCV), especially in anaemic patients, was found. This relationship tended to decrease with time.
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Intraocular pressure remained stable when either pancuronium or alcuronium was used to produce muscle relaxation, suggesting that alcuronium may be a reasonable alternative to pancuronium for routine surgery of the open eye, particularly in elderly patients with limited cardiac reserve.
The relative potency, time-course of action and cardiovascular effects of Org NC 45, a new non-depolarizing neuromuscular blocking agent, have been compared with those of pancuronium, alcuronium and tubocurarine in 64 anaesthetized patients. The relative potency (ED50) to Org NC 45 was 1.74, 3.69 and 8.57 respectively. In doses which caused useful surgical relaxation, duration of action of Org NC 45 was 34%, 39% and 26% that of pancuronium, alcuroniuym and tubocurarine. After administration of repeated doses no cumulation was seen for Org NC 45. The new drug was free from any effect on arterial pressure and heart rate.
The interactions between tubocurarine, pancuronium and alcuronium on neuromuscular transmission have been studied in an isolated neuromuscular preparation (the rat phrenic nerve-hemidiaphragm). Mixtures of tubocurarine and pancuronium, and tubocurarine and alcuronium were found to have a more potent effect than the additive effects of the individual agents when given alone, that is, mixtures were synergistic. Mixtures of alcuronium and pancuronium did not exhibit this phenomenon. Possible mechanisms for these findings are discussed.
The changes in the plasma concentrations of noradrenaline, adrenaline and dopamine, during tracheal intubation, were studied in 17 patients. Nine patients received pancuronium and eight alcuronium to produce neuromuscular blockade. In the patients receiving pancuronium, intubation of the trachea was accompanied by an increase in mean arterial pressure, and in the plasma concentrations of noradrenaline and adrenaline. In the alcuronium group, there were no significant changes in the plasma concentrations of any catecholamine, nor any change in mean arterial pressure in response to intubation of the trachea.
The reversal of alcuronium by edrophonium 1 mg kg-1 or neostigmine 35.7 micrograms kg-1 was compared in 23 patients undergoing elective ophthalmic surgery. Neuromuscular transmission was assessed by measuring the force of contraction of the adductor pollicis muscle in response to train-of-four supramaximal stimuli (2 Hz, 0.2 ms duration) delivered via surface electrodes to the ulnar nerve every 10 s. Anaesthesia was induced and maintained with Althesin, and patients were ventilated to normocarbia with 67% nitrous oxide in oxygen. Neuromuscular blockade was induced with alcuronium 0.2-0.3 mg kg-1 and antagonism was attempted when the train-of-four ratio had recovered spontaneously to 0.1. Recovery of the first contraction response of the train-of-four and of fade were more rapid after edrophonium. Although most patients were monitored for at least 30 min no re-curarization was seen. Comparison of the relative rates of recovery of the first contraction, and the response to train-of-four stimuli, suggests that edrophonium has a greater prejunctional effect than neostigmine.