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At least 163 records · Page 9Linked to original sources
PubMed1986

Intubating conditions following pre-induction priming with alcuronium.

Three priming doses of alcuronium have been investigated and, using a logistic transformation technique, the priming dose required to produce adequate intubating conditions in 99% of patients at 60 seconds following the second dose of alcuronium has been deduced. This dose, 106.5 micrograms/kg is extremely high and may be unsafe if used, since 30% of our patients complained of side effects when given a priming dose of only 50 micrograms/kg.

Adult↗
PubMed1987

Anaphylactoid reaction to alcuronium.

A 67-year-old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. In vitro testing showed a highly specific sensitivity to alcuronium with minimal cross-reactivity. Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.

Aged↗
PubMed1987

Prolonged paralysis following an infusion of alcuronium in a patient with renal dysfunction.

The case is described of a patient who underwent artificial ventilation in an intensive therapy unit and received an infusion of alcuronium 10 mg/hour for more than 4 days, in the presence of significant renal (and later, some degree of hepatic) impairment. Prolonged and profound neuromuscular block persisted despite haemodialysis (5 hours on each of 3 days) followed by 72 hours of continuous haemofiltration; it appeared to resolve only after plasma exchange (4 litres). The total of persistent block, for 9 days after the infusion had been stopped, is thought to be the longest period ever reported after administration of alcuronium. Neuromuscular block was monitored throughout this period using the train-of-four twitch technique. The potentiating effects of concurrent aminoglycoside therapy and hepatic dysfunction on the degree of paralysis are discussed.

Alcuronium↗
PubMed1987

Liver tumours and muscle relaxants. Electromyographic studies in children.

Electromyographic studies of the onset of action of tubocurarine or alcuronium were performed on eight occasions in five patients who had liver masses. There was a slow onset of action and an increased dose requirement in those with malignant disease. Normal responses were found in a patient with benign nodular hyperplasia and in another where the malignant tumour was successfully treated with chemotherapy.

Alcuronium↗
PubMed1988

Recovery of neuromuscular function and postoperative morbidity following blockade by atracurium, alcuronium and vecuronium.

Recovery of neuromuscular function and postoperative morbidity were studied in 51 fit female patients who had nonemergency gynaecological laparoscopy as inpatients. They were allocated randomly to one of three groups to receive either atracurium 0.31 mg/kg, alcuronium 0.25 mg/kg, or vecuronium 0.06 mg/kg as part of an otherwise standard anaesthetic technique. There were neither differences in intubation conditions nor in the occurrence of postoperative diplopia whichever muscle relaxant was used. Deficits in grip strength and expiratory force were seen at one hour after reversal with atropine 1.2 mg and neostigmine 2.5 mg in all patients, deficits which persisted for 3 hours in those who received alcuronium. The recovery of inspiratory force was slower and less complete at up to 3 hours in those who received alcuronium and there was a high incidence of minor postoperative morbidity at up to 24 hours in each of the three groups. The only statistical difference in symptomatic morbidity was an increase in muscle weakness in those who received alcuronium compared with atracurium at 3 hours after laparoscopy. Only 25%, 20% and 31% of the patients who received atracurium, alcuronium and vecuronium respectively said that they would have liked to be day stay patients.

Adult↗
PubMed1988

Recurarisation following a suxamethonium-alcuronium sequence in patients with atypical cholinesterase.

Alcuronium 10 mg was administered to maintain muscle relaxation in two patients before recovery from suxamethonium neuromuscular blockade to facilitate tracheal intubation. This sequence resulted in a markedly prolonged block which could not be antagonised adequately by neostigmine 0.05 mg/kg; initial antagonism was followed rapidly by prolonged recurarisation. Estimation of plasma cholinesterase activity revealed that the two patients were homozygous for the atypical and silent genes. respectively.

Adult↗
PubMed1983

Alcuronium kinetics in patients undergoing cardiopulmonary bypass surgery.

1 The disposition of alcuronium was investigated in 10 patients undergoing surgery involving cardiopulmonary bypass (CPB) and compared with results from a group of non-cardiac patients studied previously. 2 After intravenous administration of a combined bolus and infusion dosage regimen, plasma concentrations fell in a bi-exponential fashion to a mean value of 0.55 micrograms/ml immediately before the start of extracorporeal circulation. 3 During CPB an apparent steady-state of alcuronium was reached immediately after commencement of CPB, however plasma concentrations were some 50% higher than those noted prior to commencement of CPB and those predicted using previous pharmacokinetic data from normal surgical patients. 4 Once CPB was completed and the alcuronium infusion terminated, post-infusion alcuronium plasma concentrations again appeared to decline bi-exponentially with time. 5 Of the pharmacokinetic parameters which were calculated model-independently, the apparent volume of distribution (Vss) was unchanged (329 vs 313 ml/kg) and the elimination half-life (t1/2,z) (532 vs 199 min) was prolonged and the plasma clearance (CL) (0.8 vs 1.34 ml min-1kg-1) markedly reduced in these patients compared to non-cardiac surgical patients. 6 As a result of these changes in alcuronium concentration during CPB and the diminished elimination of alcuronium following CPB, a closer monitoring of neuromuscular function may be necessary in cardiac patients undergoing CPB.

Adult↗
PubMed1979

Studies on muscle relaxants during haemodialysis.

Signs of neuromuscular block were evident more than 20 hours after the administration of alcuronium to an anuric patient. Complete recovery occurred during haemodialysis. We therefore decided to study the dialysance of three radioactive non-depolarising relaxants during haemodialysis of four patients with chronic renal failure. Although dimethyl tubocurarine and alcuronium were equal as regards dialysance, the concentration of the former, in plasma, falls faster than does alcuronium. It is believed that a larger volume of distribution occurs with dimethyl tubocurarine. In spite of the fact that the dialysance of muscle relaxants is small, haemodialysis might lower the concentration of these substances in the plasma to a level below the critical point which produces paralysis.

Acute Kidney Injury↗
PubMed1981

Haemodynamic responses to antagonism of pancuronium and alcuronium block.

Using non-invasive methods, haemodynamic responses to antagonism of pancuronium (Pc) and alcuronium (Ac) block were compared in patients anaesthetized with thiopental-N2O-fentanyl and undergoing minor surgery. Neuromuscular block (90%) was maintained with Pc in 10 patients and Ac in 10 patients. After surgery, atropine 0.015 mg kg-1 and neostigmine 0.03 mg kg-1 (AN) were given simultaneously. The rate of reversal of the block was equal in the two groups. Between 4 and 16 min after AN, the decrease of heart rate (HR) was more pronounced in patients who had received Pc. The mean of the lowest HR was 43.2 beats min-1 in the Pc group, compared with 62.0 beats min-1 in the Ac group. The bradycardia was associated with a moderate decrease in arterial pressure in patients treated with Pc. However, due to an increase in stroke volume, mean cardiac output (CO) was not lower in the Pc group. Some patients treated with Pc developed a temporary nodal rhythm after AN and this was associated with a considerable decrease in CO. It is concluded that, in spite of marked bradycardia during antagonism of Pc block, circulation is well maintained, provided that sinus rhythm is present.

Adult↗
PubMed1981

Onset time for alcuronium and pancuronium after cremophor-containing anaesthetics.

Cremophor is a nonionic, surface-acting agent, previously shown to bind to proteins and biological membranes. The compound is used as a solvent for certain anaesthetics. The effects of this surfactant on the onset times for alcuronium and pancuronium were investigated. Both artery-to-muscle (A-M) and vein-to-muscle (V-M) onset times were determined after cremophor- and non-cremophor-containing induction agents. Circulatory effects of the surfactant were investigated by measuring the blood velocity of the brachial artery using pulsed Doppler ultrasound. A significant reduction in both A-M and V-M onset time was found for pancuronium after cremophor-containing anaesthetics. However, no difference was found for the onset times for alcuronium in the two induction groups. In contrast to alcuronium, there was no significant difference between A-M and V-M onset times for pancuronium. Arterial blood velocity was found to be practically the same after cremophor and non-cremophor induction agents. The possible of a stronger affinity of pancuronium than alcuronium to intravascular binding sites is suggested. Cremophor might, due to its protein and membrane effects, interfere with pancuronium association to these sites.

Adult↗
PubMed1983

Five non-depolarizing muscle relaxants in precurarization.

Five different non-depolarizing muscle relaxants and a control solution of saline were studied as precurarization agents. Two hundred and twenty-two surgical patients (ASA I-II) were allocated in a double-blind fashion to one of the following groups: d-tubocurarine 0.05 mg/kg, alcuronium 0.03 mg/kg, pancuronium 0.01 mg/kg, gallamine 0.25 mg/kg, ORG NC-45 (vecuronium) 0.01 mg/kg and saline solution 0.005 ml/kg. Pretreatment was performed 4 min before administering a 1.5 mg/kg bolus of succinylcholine (SCh). Fasciculations, intubation conditions, duration of neuromuscular blockade after SCh, serum potassium changes and postoperative myalgias (in 60 patients) were recorded. All the drugs studied prevented fasciculations significantly (P less than 0.05) more than in the control group. d-Tubocurarine and alcuronium were superior to the others in this respect. Intubation conditions were best in the control and pancuronium groups, but there was no significant difference between the pancuronium and d-tubocurarine or between the d-tubocurarine and alcuronium groups. Pancuronium pretreatment prolonged the SCh block significantly, whereas other agents shortened the duration of the SCh block. The antagonism of the SCh block apparently also affected intubation conditions, although intubation remained satisfactory. A statistically significant rise in serum potassium level was measured only in the control and pancuronium groups. In the control and pancuronium groups, four patients out of 10 had postoperative myalgias, whereas in the other groups only one or none out of 10 had them (0/10 vs. 4/10; 0.10 greater than P greater than 0.05). In conclusion, d-tubocurarine and alcuronium seem to have advantages over pancuronium, ORG NC-45 and gallamine for precurarization.

Adolescent↗
PubMed1985

Circulatory effects of pancuronium and alcuronium in patients with coronary artery stenosis.

Heart rate and systemic arterial blood pressure were recorded during induction of anaesthesia up to 9 min after endotracheal intubation in 92 patients scheduled for coronary artery bypass surgery, in order to study to what degree the circulatory response to induction of anaesthesia and intubation was modified by different relaxants. Pancuronium (pancuronium bromide) 0.1 mg X kg b.w.-1 and alcuronium (diallyl-nortoxiferine) 0.25 mg X kg b.w.-1 were randomly studied in 36 patients during induction with high-dose fentanyl and in 36 patients induced with thiopentone, diazepam, fentanyl and nitrous oxide. In patients given high-dose fentanyl anaesthesia, systolic blood pressure before, during and after intubation was significantly lower with alcuronium (P less than 0.01). The same difference between alcuronium and pancuronium was observed in balanced anaesthesia before endotracheal intubation. Induction of anaesthesia and intubation were followed by a moderate increase in heart rate, irrespective of the type of anaesthesia and relaxant. Subsequently, 20 patients (10 with high-dose fentanyl and 10 with balanced anaesthesia) were studied. They received pancuronium 0.05 mg X kg b.w.-1 + alcuronium 0.125 mg X kg b.w.-1. This mixture of relaxants produced an intermediate blood pressure response.

Adjuvants, Anesthesia↗
PubMed1988

Optimal time interval between pretreatment with alcuronium and suxamethonium during anaesthetic induction.

Alcuronium 0.03 mg/kg was studied in a double-blind randomized fashion as a pretreatment before suxamethonium using different time intervals between the administration of the drugs in 78 patients (ASA I-II) undergoing otolaryngological surgery. Alcuronium was given 1, 2 or 3 min before suxamethonium 1.5 mg/kg. The control group received saline as a pretreatment and suxamethonium 1 mg/kg. Anaesthesia was induced with thiopental 5.5 mg/kg over 60 s. Muscle fasciculations, intubating conditions, cardiovascular responses to endotracheal intubation and duration of neuromuscular block were assessed. Muscle fasciculations were statistically and similarly inhibited (P less than 0.01) at all time intervals between alcuronium and suxamethonium. Intubating conditions were worse (P less than 0.05) in the 3-min group than in the other groups. Cardiovascular responses to endotracheal intubation were similar in all groups. The neuromuscular block after suxamethonium was significantly shorter (P less than 0.05) in the 2- and 3-min groups than in the other groups. In conclusion, from the clinical point of view the 1-min time interval between alcuronium and suxamethonium is optimal since muscle fasciculations are inhibited and intubating conditions are satisfactory.

Adult↗
PubMed1989

Comparison of thumb acceleration and thenar EMG in a pharmacodynamic study of alcuronium.

We compared thumb acceleration (Acc) and thenar electromyography (EMG) techniques by evaluating the neuromuscular blocking properties of alcuronium in 14 ASA physical status I patients. The dose-response curves determined by the two techniques were parallel but the EMG-curve was shifted 25% to the right (P less than 0.001). Acc reflected 8-11% greater neuromuscular block than simultaneous EMG in every patients (P less than 0.05). Concurrently, the duration of greater than 90% neuromuscular block maintained by alcuronium 280 micrograms/kg was significantly longer when measured by the Acc transducer (30 vs. 19 min, P less than 0.001). Although the TOF ratios were in good correlation (r2 = 0.82), clinically significant differences existed between the two simultaneous techniques. The results underline the importance of the method of assessment of neuromuscular transmission when evaluating the action of neuromuscular blocking drugs.

Acceleration↗
PubMed1990

Effects of precurarisation on suxamethonium-induced postoperative myalgia during the first trimester of pregnancy.

Two hundred and fifty women undergoing termination of pregnancy during the first trimester under general anaesthesia were studied to determine the effects of precurarisation on suxamethonium-induced postoperative myalgia and on the need for postoperative analgesics after suxamethonium. Either alcuronium (0.03 mg/kg), atracurium (0.04 mg/kg), tubocurarine (0.05 mg/kg), vecuronium (0.01 mg/kg) or saline was administered in a double-blind manner 4 min before giving suxamethonium. An additional 50 patients were studied who received isoflurane rather than precurarisation and suxamethonium. Every pretreatment prevented fasciculations better than did saline (P less than 0.001). In the saline group, 92% of patients had fasciculations and in the other groups this ranged from 8 to 32%, respectively. On the first postoperative day, 76% of the patients in the saline group had myalgia while myalgia was manifested in 28, 54 and 34% of patients given alcuronium, tubocurarine or vecuronium, respectively (P less than 0.05). Atracurium failed in this effect with 62% having myalgia. In the isoflurane group, none of the patients complained of myalgia on the first postoperative morning. The need for analgesics was less (P less than 0.005) in the isoflurane group (8%) and in the pretreatment groups (18-27%) than in the saline group (42%). It is concluded that precurarisation with tubocurarine, vecuronium or, most effectively, with alcuronium but not with atracurium decreases suxamethonium-induced postoperative myalgia and seems to be necessary also during the first trimester of pregnancy.

Abortion, Induced↗