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PubMed1996

Effects of mydriatic agents in cockatoos, African gray parrots, and Blue-fronted Amazon parrots.

OBJECTIVE: To compare, in psittacines, the mydriatic effects of several topically applied curariform, sympathomimetic, and parasympatholytic drugs with and without the addition of surface-acting penetrating agents. DESIGN: Prospective, randomized controlled trial. ANIMALS: 10 adult cockatoos (Cacatua sulphurea subspecies), 2 adult African gray parrots (Psittacus erithacus), and 3 adult Blue-fronted Amazon parrots (Amazona aestiva). PROCEDURE: Three curariform drugs (d-tubocurarine, pancuronium, and vecuronium bromide) and 2 autonomic drugs (atropine and phenylephrine hydrochloride) were evaluated. Drugs were tested with and without the addition of a surface-acting penetrating agent, either saponin or benzalkonium chloride. The agent that resulted in the most significant change in pupillary diameter with the fewest systemic side effects in the cockatoos then was evaluated for its effects in the African gray parrots and the Blue-fronted Amazon parrots. During each drug trial, 1 eye was randomly selected to receive the control drug (0.9% NaCl), and the opposite eye was selected to receive the test drug. Each pupil was videotaped 5 (cockatoos only), 15, 30, 45, 60, and 75 minutes after treatment. Pupil diameters were measured by use of a computerized image analysis system. Data for pupil size were analyzed by means of repeated measures ANOVA. RESULTS: Vecuronium without the addition of a surface-acting penetrating agent produced the most consistent and greatest pupillary dilatation in all 3 species with the fewest systemic side effects. CLINICAL IMPLICATIONS: Vecuronium is potentially a clinically useful, topical mydriatic agent for use in avian species. Documented differences in the prevalence of systemic side effects between species suggests that caution should be applied when applying this drug bilaterally.

Animals↗
PubMedDate not supplied

A controller for automatic regulation of induced paralysis during surgery.

This paper presents a strategy for automatic control of induced paralysis using vecuronium bromide during surgery. The controller is self-tuning and adapts to inter-patient and intra-patient response variations while optimizing the output variance and infusion rate. In particular, the controller is capable of accommodating the variations of pure time delays in patient response. The performance of the controller is evaluated using an experimentally derived pharmacokinetic and nonlinear pharmacodynamic model of patient response. The results indicate that the controller provides robust regulation of the paralysis level with no output offset.

Algorithms↗
PubMed1995

Neural control of urethral outlet activity in vivo: role of nitric oxide.

The present study investigated the role of nitric oxide (NO) in the reflex changes in urethral outlet activity during micturition. Isovolumetric bladder contractions, urethral pressure and external urethral sphincter electromyogram (EUS EMG) activity were recorded independently in urethane-anesthetized rats. During reflex bladder contractions, the urethra exhibited reflex responses characterized by an initial decrease in urethral pressure in conjunction with a rise in bladder pressure. This was followed by a period of high frequency oscillations (HFOs) associated with maximal urethral relaxation and burst type EUS EMG activity. Administration of N-nitro-L-arginine (L-NOARG) 10 mg./kg. intravenously, a nitric oxide synthase inhibitor, reversibly decreased the magnitude (62%, p < 0.05) and duration (40%, p < 0.05) of reflex urethral relaxation (N = 7). In 4 additional experiments, L-NOARG (10 to 15 mg./kg. intravenously) completely eliminated reflex urethral relaxation during micturition, and this effect was reversed in all animals by the administration of L-arginine (100 to 150 mg./kg. intravenously). Administration of N-nitro-D-arginine (D-NOARG) (10 to 30 mg./kg. intravenously) had no effect on reflex urethral relaxation. Neuromuscular blockade (vecuronium bromide 5 mg./kg. intravenously) reversibly decreased resting urethral pressure and eliminated the HFOs. The urethral smooth muscle relaxation that remained after neuromuscular blockade was eliminated following administration of L-NOARG (10 mg./kg. intravenously) in 2 of 3 animals. These results suggest that reflex urethral responses during micturition involve changes in both smooth and striated muscle activity, and that the predominant neurotransmitter mechanisms that mediate reflex urethral smooth muscle relaxation involve NO.

Animals↗
PubMed2004

[Anesthetic management for a patient with platypnea-orthodeoxia syndrome].

We experienced anesthetic management for a patient with platypnea-orthodeoxia syndrome. This syndrome is relatively uncommon and accompanies dyspnea and hypoxemia on changing to a sitting or standing from recumbent position. A 75-year-old man with the syndrome underwent atrial septal defect closure on cardiopulmonary bypass. General anesthesia was induced and maintained with midazolam, propofol, fentanyl and vecuronium bromide. During the induction, Spo2 decreased suddenly from 100% to 70%, Spo2, however, recovered to 97% immediately after changing to Trendelenburg position. The perioperative and postoperative course was uneventful, except for hypoxemia during induction. Although the exact mechanisms of platypneaorthodeoxia remains to be solved, right-to-left shunt by an anatomical abnormality and by change of the atrial septum is considered one of the hypoxic mechanisms. We suggest that it is necessary to prevent right-to-left shunt and hypoxemia in anesthetic management of a patient with platypneaorthodeoxia syndrome.

Aged↗
PubMed1990

Observations with norcuron (pharmaceutical works of Gedeon Richter, Budapest, Hungary) injection.

Vecuronium bromide (Norcuron) has been used as an intubation and surgical muscle relaxant besides the use of different types of anaesthesia in the course of 230 gynaecological operations. With a single or repeated drug dose complete muscular relaxation could be assured during operation of 25-60-minute duration. In general the clinical muscle relaxant action lasted for about 30 minutes. Norcuron allowed to perform intubation within 40-120 sec. The drug could be combined with anaesthetics without risk. Cardiovascular unwanted effects or other after-effects did not occur. According to the author-s opinion, as a neuromuscular blocker of a short to medium duration of action, Norcuron is a long-needed drug in Hungarain anaesthesiological practice.

Adult↗
PubMed2006

Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia.

Anastomotic complications after primary repair of congenital esophageal atresia (EA) are recognized and feared complications. A close association exists between anastomotic leakage and the tension of the anastomosis on the suture line. This study aimed to evaluate the efficacy of postoperative elective ventilation support (PEVS) under paralysis with neck flexion after primary repair of EA. Forty-two EA patients; 4 cases with type A and 38 with type C by Gross classification received primary or delayed primary anastomosis between 1979 and 2003. PEVS has been introduced in the postoperative management of all EA cases since 1998. Vecuronium bromide was administered together with fentanyl citrate for five postoperative days. Patients were retrospectively divided into two groups: with or without PEVS management. There was no difference in operation data such as gastrostomy construction, gap between esophageal upper and lower pouch, primary or delayed primary anastomosis. PEVS under paralysis with neck flexion reduced postoperative anastomotic leakages in primary anastomosis with or without a Livaditis procedure. PEVS did not adversely increase anastomotic stricture, atelectasis, severe gastro-esophageal reflux, prolong days on ventilatory support or decrease survival rate. PEVS is an effective management method to decrease anastomotic complications for EA neonates.

Anastomosis, Surgical↗
PubMed1989

Effect of rate of injection on the neuromuscular block produced by vecuronium.

A subparalytic dose (0.015 mg/kg) of vecuronium bromide was administered to matched pairs of patients undergoing routine dental surgery under enflurane-nitrous oxide/oxygen anesthesia either as a rapid bolus injection or as a slow infusion over 5 min. It was demonstrated that bolus injection produced peak plasma levels of drug considerably greater than those following slow infusion. Time to maximum block was more rapid following bolus (368 +/- 84 [SD] sec) than by infusion (615 +/- 88 sec), but the maximum block produced, either demonstrated by the reduction in amplitude of T1 from control or the T1:T4 ratio on the integrated electromyogram (Datex IEMG), was similar in each group irrespective of rate of injection, T1 and T4 referring to the first and last twitch in a train of four series.

Adult↗
PubMed2004

[Effects of modified anaesthesia for patients undergoing brain artery aneurysm repair operation].

55 patients (age 45-63 years old) scheduled for elective brain artery anaeurysm repair operation were randomly divided into two groups: thiopental, atracurium besilate and fentanyl group (group I; n= 27) and propofol, vecuronium bromide and fentanyl in a continuous intravenous administration group (group II; n=28). In group II little changes of arterial blood pressure during the operation were observed. Also the mean time for patient's awaiking was significantly shorter which allowed effective postoperative evaluation of neurological status. In group II only 1 patient required administration of urapidil and in group I 11 ( 40.7%) of patients required lowering blood pressure treatment. There were 7 cases of intra-operative aneurysm ruptures and 5 cases of brain artery embolism not significantly associated with anaesthesia given. It is of a high importance to maintain intraoperatively normal blood pressure, normal blood oxigenation, normal fluid administration and normal blood carbon dioxide levels.

Anesthesia, General↗
PubMed2000

[A senile case of acute necrotizing myopathy presenting prolonged severe muscle paralysis due to high dose glucocorticoid and muscle relaxant].

An 82-year old man was admitted with dyspnea, productive cough and wheezing. In addition to antibiotics (meropenem trihydrate 0.5 g/day), glucocorticoids (hydrocortisone 1.250 mg, methylpredonisolone 4.250 mg) were administered for the severe bronchospasms. Since his respiratory condition deteriorated, he underwent mechanical ventilation using a muscle relaxant (vecuronium bromide, total dose 776 mg) in combination with high dose glucocorticoid. As his pneumonia improved on the 10th hospital day, we started weaning him from the ventilator. However, we were unable to complete weaning from the ventilator because of prolonged quadriplegia and paralysis of the respiratory muscles. A few days later, myoglobinuria appeared. Electrophysiological examinations suggested the involvement of both neuromuscular junctions and muscles. Muscle biopsy showed rhabdomyolysis. Acute necrotizing myopathy was diagnosed due to high doses of glucocorticoid, muscle relaxant, or both. He required about 3 months to be weaned from the mechanical ventilation, and another 3 months to leave the hospital. Based on our experience, we should consider acute myopathy as an adverse effect of glucocorticoids, muscle relaxants or both in elderly patients who require mechanical ventilation.

Acute Disease↗
PubMed1993

[Interaction between vecuronium and pancuronium].

Interaction between vecuronium bromide (VB) and pancuronium bromide (PB) with regard to a change in duration of action was investigated in 32 elective surgical patients divided into four groups. Initial and supplemental drugs were as follow; group I: VB-->VB, group II: PB-->VB, group III: VB-->PB, group IV: PB-->PB. The muscle response was quantified electromyographically. Anesthesia was induced with thiopental. VB or PB 0.08 mg.kg-1 (initial dose) was given to facilitate endotracheal intubation. Anesthesia was maintained with 66% nitrous oxide and 2% sevoflurane in oxygen. Supplemental dose (0.015 mg.kg-1) of the muscle relaxants was administered at 10% recovery of twitch height. Duration of action was defined as the interval between administration and 10% recovery. Duration of action of supplemental doses of VB was significantly longer in group II than in group I. That of PB was significantly shorter in group III than in group IV. Therefore, it should be noticed that duration of action of supplemental relaxant is largely modified by the initial one.

Adult↗
PubMed1993

A versatile, computer-controlled, closed-loop system for continuous infusion of muscle relaxants.

A computer-controlled, closed-loop system for continuous infusion of muscle relaxants that allows the operator to choose either atracurium besylate or vecuronium bromide to provide any desired target level of neuromuscular blockade is described. This new system offers certain advantages over computer-controlled systems described previously for continuous infusion of muscle relaxants--that is, the option to choose either of two muscle relaxants to be infused and the inclusion of monitors to provide feedback about the dosage needed to produce a target level of neuromuscular blockade. The clinical performance of this system was tested in 36 patients who were 18 to 65 years old, were classified in American Society of Anesthesiologists physical status 1 or 2, and were undergoing elective orthopedic, abdominal, or thoracic procedures. In all patients, the control algorithm rapidly induced the target level of neuromuscular blockade and maintained that level of blockade at steady state with minimal oscillation. We conclude that the automatic feedback control system described can induce and precisely maintain any predetermined target level of neuromuscular blockade.

Adolescent↗
PubMed2000

Acute quadriplegic myopathy in a 17-month-old boy.

Acute quadriplegic myopathy is a rare condition associated with the use of nondepolarizing muscle-blocking agents and corticosteroids in the course of severe systemic illness. A 17-month-old boy underwent liver transplantation for fulminant hepatitis. He was intubated for 24 days and treated with vecuronium bromide and high-dose methylprednisolone. The child was weaned from the ventilator and presented extreme weakness in the upper limbs and total paralysis of the lower limbs. Serum creatine kinase level was normal and electromyography showed myopathic abnormalities. Muscle biopsy showed severe type-1 fiber atrophy and selective loss of myosin thick filaments was seen on electron microscopy. Scattered regenerating fetal myosin-positive fibers were present, mu calpain was absent, while m calpain was diffusely expressed. Physical therapy was immediately started and the child recovered even though corticosteroids were not discontinued. The pathogenesis of acute quadriplegic myopathy is still unknown. We suggest that it could be due to abnormal protein turnover in the muscle. Several independent factors, such as corticosteroid treatment, immobilization, or cytokines, could take part in a cascade of events that leads to an excessive yet selective degradation of proteins involving myosin thick filaments and possibly components of sarcolemma, causing muscle inexcitability.

Anti-Inflammatory Agents↗
PubMed1995

A comparison of dynamic and isometric force sensors for train-of-four measurement using submaximal stimulation current.

OBJECTIVE: We studied the accuracy and repeatability of train-of-four (TOF) ratio measurements made from a dynamic piezoelectric sensor that records movement of the thumb in response to ulnar nerve stimulation compared with an isometric mechanomyogram that measures force of contraction of the adductor pollicis. METHODS: The study involved 10 patients whose level of neuromuscular block was held constant with an intravenous (IV) infusion of vecuronium bromide (0.4 to 1.0 micrograms/kg/min) (Organon, West Orange, NJ). The sensors were attached to opposite arms of each patient and simultaneous measurements of TOF ratio were taken at stimulation current levels of 50, 30, and 20 mA. RESULTS: In comparison to the TOF ratio measured at the maximal stimulation current (50 mA), the TOF ratio from the piezo sensor showed a bias and standard deviation of -0.13 +/- 0.24 when the stimulation current was reduced to 30 mA. At 20 mA, the bias and standard deviation was -0.24 +/- 0.28. The TOF ratio from the mechanomyogram showed a bias and standard deviation of 0.01 +/- 0.07 at 30 mA and 0.0 +/- 0.20 at 20 mA when compared with measurements made when the stimulation current was 50 mA. CONCLUSIONS: Both sensors showed diminished repeatability in TOF measurement with decreasing stimulation current. The data indicate that neither sensor is reliable for general monitoring of neuromuscular block at submaximal current levels. However, the individual patient results showed that some patients could be monitored accurately with both sensors, even at the lowest stimulation current levels.

Electric Stimulation↗
PubMed1998

[The relationship between maintenance dose of vecuronium and the recovery time from the muscle relaxation].

We investigated the relationship between maintenance bolus dose of vecuronium bromide (Vb) and the recovery time measured by TOF Guard in patients anesthetized with isoflurane (1.2-2.0%)-N2O-O2 (GOI group, n = 19) and epidural anesthesia (2% mepivacaine) plus isoflurane (0.5%)-N2O-O2 (EPI group, n = 14). In both groups, anesthesia was induced with propofol 2 mg.kg-1 and Vb 0.1 mg.kg-1 and ventilation was controlled to keep end tidal CO2 between 35-40 mmHg. When the muscle relaxation recovered to 25% of train-of four ratio (TOFR), doses of Vb 0.06, 0.04 or 0.02 mg.kg-1 were administered. Recovery time to TOFR 25% at each Vb dose (T 0.06, T 0.04 and T 0.02 respectively) was observed. T 0.02, T 0.04 and T 0.06 in GOI group were 36.7 +/- 3.2, 50.7 +/- 4.3 and 60.7 +/- 5.02 min (mean +/- SE), respectively and those in EPI group were 42.6 +/- 2.53, 52.2 +/- 2.51 and 59.9 +/- 3.22 min, respectively. There were no significant differences in the recovery time between these two groups. In both groups, although the recovery time to TOFR 25% was prolonged significantly in proportion to the increasing doses of Vb, the increase did not correlate with the dose of Vb. We suggest that frequent administration of Vb 0.02 mg.kg-1 decreases the total amount of Vb to keep TOFR within 25%.

Aged↗
PubMed1994

Comparison of haemodynamic effects of rocuronium bromide with those of vecuronium in patients undergoing CABG surgery.

In a double-blind study, cardiovascular parameters (cardiac output, heart rate, systolic and diastolic arterial pressure, pulmonary and systemic vascular resistances) were measured invasively in two groups of patients receiving 3 x ED90 of rocuronium or vecuronium. Measurements were made at 2, 5 and 7 min after administration and 10 and 15 min after subsequent intubation. Systemic vascular resistance mostly increased, sometimes quite markedly, although, because of the variability, rarely statistically significantly. However, heart rate, arterial pressure and cardiac output were not altered to a clinically relevant degree.

Adolescent↗
PubMed1983

[Comparison of the clinical effects of vecuronium and pancuronium bromide in general surgery].

50 patients selected at random were given vecuronium (group A) or pancuronium bromide (group B) at an initial dose of 0.05 mg X kg-1, followed by repeat injections of 0.0125 mg X kg-1. 34 other patients, separated in two groups: group C (vecuronium) and group D (pancuronium), received stronger doses of both drugs: 0.07 mg X kg-1 initially, followed by 0.022 mg X kg-1 repeat injections. The four groups were anaesthetized according to the same protocol; the patients underwent gastrointestinal and gynaecological surgery, lasting 122 +/- 50 min. The results showed that the time of onset and the duration of action of vecuronium were shorter, and that increasing the dose did not increase significantly the duration of action of these repeat doses: time of onset: 104 +/- 42 s (group A), 205 +/- 36 s (group B), 96 +/- 23 s (group C), 255 +/- 36 s (group D); duration of action: 19 +/- 6 min (group A), 36 +/- 6 min (group B), 24 +/- 7 min (group C), 43 +/- 13 min (group D); mean time between doses: 26 +/- 10 min (group A), 55 +/- 5 min (group B), 33 +/- 7 min (group C), 49 +/- 3 min (group D). The degree of muscle relaxation was always satisfactory in the four groups. Decurarization appeared to be particularly sudden with vecuronium. Neither an abnormally prolonged duration of action, nor any haemodynamic effect, nor any signs of histamine release were seen.

Adult↗
PubMed1999

Rapacuronium bromide (Organon Teknika).

Organon Teknika's rapacuronium bromide (Org-9487), the 16-N-allyl, 17-beta-propionate analog of vecuronium bromide, is in phase III clinical trials in the US and Europe for potential use as an anesthetic. It is a steroidal neuromuscular blocking drug characterized by low potency, rapid rate of block development and short time course of neuromuscular blocking action as compared with other non-depolarizing compounds [170210,221422]. A multicenter, randomized, assessor-blind, placebo-controlled, dose-finding study in patients undergoing tracheal intubation showed that the drug produced a dose dependent neuromuscular block. Doses of 1.5 to 2 mg/kg allowed rapid intubation and short duration of action [273336]. Another study showed that the drug does not cause cardiovascular side-effects [273336]. A meeting was held in Europe on 8 February 1999 to brief company employees on the registration and release of rapacuronium [319211] for which the company anticipates a launch in late 1999 [320706]. Organon estimates that the market value of Org-9487 is between dollar 100 m and dollar 250 m a year, each for Europe and the US [221422].

Journal Article↗
PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--5. An anesthetic experience of a pediatric patient with severe epilepsy].

A 6-year-old girl with severe epilepsy received an orthopedic surgery of the right hand under new total intravenous anesthesia with droperidol, fentanyl and ketamine. For the induction of anesthesia, droperidol 0.25 mg.kg-1, fentanyl 5.0 micrograms.kg-1 and ketamine 2.0 mg.kg-1 was administered intravenously. She was intubated and ventilated manually throughout the operative procedure to maintain the end tidal CO2 between 4.5 and 5.5%. For the maintenance of anesthesia, ketamine was given continuously at a rate of 2.0 mg.kg-1.hr-1. Intraoperative muscle relaxation was obtained with vecuronium bromide. The patient recovered from anesthesia uneventfully. The total doses of droperidol, fentanyl, ketamine and vecuronium were 8.75 mg, 1.0 mg, 210 mg and 7.5 mg, respectively. Neither epileptic seizure, nor any other adverse effects with anesthetics was observed during and after anesthesia and surgery. We conclude that this method of anesthesia for epileptic patients may deserve further detailed study.

Anesthesia, Intravenous↗