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At least 145 records · Page 8Linked to original sources
PubMed1984

Use of alcuronium in patients undergoing renal transplantation.

Alcuronium 0.16 mg kg-1 was used to provide neuromuscular blockade in patients with chronic renal failure undergoing renal transplantation. Relaxation was found to be adequate for intubation and surgery. There were minimal alterations to cardiovascular variables. The dose required was small, and complete reversal occurred with neostigmine. Although the number of patients is small, the drug may be of value as an alternative to tubocurarine or pancuronium in such patients.

Adolescent↗
PubMed1984

Pharmacokinetics of alcuronium in elderly patients undergoing total hip replacement or aortic reconstructive surgery.

The pharmacokinetic behaviour of alcuronium was studied in three patients undergoing resection of an aortic aneurysm, and in another two patients undergoing total hip replacement (group I). A control group of five elderly patients undergoing relatively minor surgery was included (group II). In group I patients, the values of the pharmacokinetic parameters such as plasma clearance, elimination half-life and the apparent volume of distribution of the drug were found to be comparable to those obtained in normal young patients in previous studies. The group II patients, however, were found to have a prolonged elimination half-life as a result of reduced plasma clearance, possibly an age-related effect. The differences between these two groups of patients may be explained by the differences in the extent of haemorrhage and fluid replacement or changes in blood circulation, or both. However, alcuronium must still be used cautiously in both groups of patients, especially in the light of a recent finding that patients undergoing aortic reconstructive surgery have a high frequency of functional renal failure after operation.

Aged↗
PubMed1985

A comparison of atracurium and alcuronium during halothane anaesthesia by measurement of the train-of-four response of the adductor pollicis muscle and clinical observation.

Atracurium and alcuronium have been compared during halothane anaesthesia, by measurement of the mechanical response of the adductor pollicis muscles to train-of-four stimulation and by clinical observation. Atracurium appeared significantly shorter-acting than alcuronium. However, results suggested that the action of alcuronium may not be of "medium duration". A comparison of three indices of muscle twitch response to the train-of-four nerve stimulation, seemed to indicate that the D'/D ratio gave the best overall index of neuromuscular blockade in this study.

Adult↗
PubMed1986

Evoked electromyographic and mechanical responses of the adductor pollicis compared during the onset of neuromuscular blockade by atracurium or alcuronium, and during antagonism by neostigmine.

The effects of atracurium and alcuronium on the evoked mechanical and electromyographic responses of the adductor pollicis were investigated in 30 adult patients. The ulnar nerve was stimulated with trains of four supramaximal pulses of 0.2 ms duration and a frequency of 2 Hz at intervals of 20 s. The mechanical response was measured using a strain gauge force transducer and the evoked compound action potential (ECAP) was recorded simultaneously using a Medelec MS91 electromyography system. Depression of the electromyographic and mechanical responses, caused by atracurium, was similar during onset and antagonism of blockade. During onset of blockade by alcuronium, the mechanical response was depressed to a significantly greater extent compared with the ECAP. This difference was not observed during antagonism with neostigmine. The rates of onset of atracurium and alcuronium were generally similar, but the rate of onset of mechanical fade was greater in the alcuronium group. There was no significant quantitative difference between the rates of antagonism of alcuronium and atracurium when assessed by the mechanical first response ratio. Electromyographic first response and electromyographic and mechanical train-of-four ratios recovered more rapidly in the atracurium group. These findings suggest that the differences between mechanical and electromyographic measurements of neuromuscular blockade are drug-specific and are more pronounced during the onset of blockade than during its antagonism by neostigmine.

Adult↗
PubMed1986

Priming and the onset of neuromuscular blockade with alcuronium.

"Priming" with alcuronium has been studied in 72 female patients. Blockade of single twitch responses of the adductor pollicis by alcuronium 0.15, 0.2 or 0.3 mg kg-1 could be accelerated by priming with a suitable priming portion of the total dose. Giving alcuronium 0.04 mg kg-1 30 s after the induction of anaesthesia, followed by the balance 4 min later, resulted in more rapid neuromuscular blockade than giving the total dose at 4.5 min after induction. There was some suggestion of an increase in maximal twitch depression, but this could not be demonstrated confidently. The effect of increasing the priming portion was tested for the 0.3 mg kg-1 total dose, but any priming effect was attenuated. The mechanism of priming is not obvious. Occupation of "spare receptors" does not explain all of the features of priming.

Adult↗
PubMed1986

Recovery of respiration following neuromuscular blockade with atracurium and alcuronium.

Eleven fit unpremedicated patients took part in the study. Group I (five patients) received atracurium 0.3 mg kg-1 and group II (six patients) received alcuronium 0.2 mg kg-1. The simultaneous recovery of respiration, judged by serial measurements of the tidal volume and blood-gas values, and peripheral neuromuscular function, judged by the response of the adductor pollicis muscle, were studied. Anaesthesia was maintained with 66% nitrous oxide in oxygen, supplemented by 0.5% halothane. The tetanic response reappeared 17.6 +/- 0.92 min (group I) and 19.2 +/- 2.6 min (group II) after the administration of the drug, and spontaneous breathing at 24.0 +/- 2.08 min (group I) and 23.6 +/- 2.1 min (group II). Adequate recovery of respiratory muscle function was present in group I within 15 min of the onset of spontaneous respiration, whereas in group II this recovery took 30 min. At this time there was marked peripheral neuromuscular blockade with the peak tetanic height value less than 25% of control in both groups. It was concluded that recovery of the respiratory muscles from neuromuscular block by atracurium and alcuronium occurred more rapidly than the recovery of the small muscles of the hand, but that adequate tidal volume, in the absence of other clinical signs, should not be regarded as a reliable indication of complete return of neuromuscular function.

Adolescent↗
PubMed1987

Recovery of respiration after neuromuscular blockade with alcuronium.

Alcuronium 0.2 mg kg-1 was given to six patients to investigate the simultaneous recovery of breathing and peripheral neuromuscular function. Anaesthesia was maintained with 66% nitrous oxide in oxygen supplemented with 0.5% halothane, and the patients were ventilated to normocarbia. Patients were disconnected from the ventilator after the reappearance of the tetanic response. This response returned at a mean time of 19.2 min after the injection of alcuronium and oxygenation was maintained thereafter by means of apnoeic diffusion. Spontaneous breathing returned at a mean time of 23.6 min after the injection of alcuronium. Sixty minutes after the administration of alcuronium, respiratory exchange was judged adequate, and at that time neuromuscular function was still markedly depressed with a tetanic height less than 25% of control. It was concluded that, because of the slow recovery of neuromuscular function, alcuronium should be reserved for the longer surgical procedure.

Adolescent↗
PubMed1987

Potentiation of the neuromuscular blockade produced by alcuronium with halothane, enflurane and isoflurane.

The potentiation of alcuronium by halothane, enflurane and isoflurane was investigated using electromyography. In the first study, cumulative dose-response curves were constructed in four groups of 10 patients anaesthetized with one of the inhalation agents and nitrous oxide, or with fentanyl and droperidol (control). All three agents reduced the ED50 of alcuronium; the effect was marked with isoflurane (P less than 0.005) but less so with halothane (P less than 0.05) and enflurane (ns). In the second part of the investigation, designed primarily to test the duration of action of alcuronium with each agent, a single bolus dose of alcuronium 0.2 mg kg-1 was given to four similar groups (n = 5). The duration of action was significantly prolonged by enflurane (P less than 0.01) and isoflurane (P less than 0.05), but not by halothane. The possible reasons for this are discussed.

Action Potentials↗
PubMed1988

Adverse reactions to atracurium and alcuronium. A prospective surveillance study.

A multicentre prospective surveillance study was undertaken to compare the incidence and severity of adverse reactions attributed to atracurium and alcuronium. Clinical manifestations were used by the anaesthetist to diagnose an adverse reaction (a cutaneous reaction, a greater than 20% change in arterial pressure or heart rate, and bronchospasm). Of the 1956 patients receiving atracurium, 10.1% had adverse reactions compared with 17.9% of the 1425 patients receiving alcuronium (P less than 0.001). There were no longterm sequelae. The atracurium group had a markedly lower incidence of hypotension (3.4% v. 13.7%; P less than 0.0001), but a higher incidence of cutaneous reactions (4.6% v. 2.3%; P less than 0.005) which were not associated with other adverse reactions. There was a low incidence of bronchospasm in both groups (0.2% v. 0.1%).

Adult↗
PubMed1984

Comparison of atracurium and alcuronium in day-case gynaecological surgery.

Alcuronium and atracurium were used on a randomised basis as part of the anaesthetic technique for out-patient gynaecological laparoscopy. Conditions for intubation and relaxation were similar but there was a marked decrease in the incidence of minor postoperative sequelae in the atracurium group.

Alcuronium↗