FN Thomson Reuters Web of Science™ VR 1.0 PT J AU Barrio, J SanMiguel, G Asensio, I Molina, I Lopez, F Garcia, V AF Barrio, J SanMiguel, G Asensio, I Molina, I Lopez, F Garcia, V TI Time course and train-of-four fade of mivacurium block during sevoflurane and intravenous anaesthesia SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blocking agents, mivacurium; anaesthetics, inhalation; sevoflurane; anaesthetics, intravenous, propofol; pharmacology, drug interactions; receptors, nicotinic acetylcholine ID NICOTINIC ACETYLCHOLINE-RECEPTORS; GATED ION CHANNELS; VOLATILE ANESTHETICS; GENERAL-ANESTHETICS; ISOFLURANE; PROPOFOL; HALOTHANE; SYNAPSES; CHILDREN AB Background and objective: Volatile anaesthetics inhibit nicotinic acetylcholine receptors at clinically relevant concentrations with higher affinity for the neuronal nicotinic receptor. The inhibitory effects of propofol on nicotinic receptors have only been documented at supraclinical concentrations. The aim of this study was to determine recovery properties and train-of-four (TOF) fade of mivacurium during sevoflurane and propofol anaesthesia, in order to examine any differences both in the enhancement of the neuromuscular block (postjunctional effects) and in TOF fade (prejunctional effects). Methods: Twenty ASA I-II adult patients were randomly allocated to maintenance of anaesthesia with sevoflurane (end-tidal concentration 2%) or propofol. Neuromuscular block was assessed by acceleromyography and a single dose of mivacurium (0.15 mg kg(-1)) was administered (in the sevoflurane group after 30 min of exposure to sevoflurane). We measured time for recovery of the first twitch of the TOF (T 1) from 25-75%, time from 25 96 recovery of T1 to achieving a TOF ratio (TOFR) of 0.8, TOFR at 50%, 75% and 90% recovery of T1, and height of T1 at: TOFR of 0.7 and 0.9. Data were tested using t-test for independent samples. Results: Recovery times (mean (95976 confidence interval, Q) of mivacurium in the sevoflurane group (T1 25-75%, 11.3 (8.1-14.5) min; T1 25%-TOFR0.8, 19.1 (15.7-22.5) min) were significantly longer (P < 0.05) than in the propofol group (T1 25-75%, 6.5 (5.2-7.7) min; T1 25%-TOFR0.8, 11.3 (7.8-10.3) min). No differences were found in the relations between TOFR and T1 or vice versa, between the groups. Conclusions: Recover. times after a single dose of mivacurium were prolonged by sevoflurane compared with propofol but no differences in TOF fade were observed between the two anaesthetics. C1 Hosp Arnau Vilanova, Dept Anaesthesiol, Valencia, Spain. RP Barrio, J (reprint author), C Reina Dona Germana 1, Valencia 46005, Spain. EM jabama16@hotmail.com NR 22 TC 0 Z9 0 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD APR PY 2005 VL 22 IS 4 BP 303 EP 306 DI 10.1017/S0265021505000517 PG 4 WC Anesthesiology SC Anesthesiology GA 932DY UT WOS:000229535600011 ER PT J AU Kopman, AF Chin, WA Moe, J AF Kopman, AF Chin, WA Moe, J TI Dose-response relationship of rocuronium: A comparison of electromyographic vs. acceleromyographic-derived values SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE acceleromyography; dose-response; electromyography; neuromuscular monitoring; rocuronium ID NEUROMUSCULAR BLOCKADE; MUSCLE PARALYSIS; MYOGRAPH-2000; ANESTHESIA; CHILDREN AB Background: Acceleromyography (AMG) is being employed with increasing frequency as a research tool. However, there is almost no information available regarding the accuracy of values for drug potency obtained using AMG. This study was an attempt to determine if AMG-derived ED50/95 values are interchangeable with those measured with a more traditional neuromuscular monitor. Methods: Thirty adult patients were studied. Anesthesia was induced and maintained with N20, propofol, and supplementation opioid. Tracheal intubation was accomplished without muscle relaxants. Simultaneous ipsilateral AMG and EMG responses to 0.10 Hz stimulation was recorded. Following instrument calibrations, a single dose of rocuronium was administered. The first patient received a bolus of 0.17 mg kg(-1) of rocuronium. Using the Hill equation with a postulated slope of 4.50, the ED50 was calculated. The second subject received a dose which approximated the calculated ED50 for patient no. 1. Successive subjects were given a dose based on the running average of the estimated ED50. Results: The AMG-derived ED50/95 values for rocuronium (0.163 +/- 0.055 and 0.314 +/- 0.105 mg mg(-1)) were virtually identical to those established using EMG (0.159 +/- 0.043 and 0.306 +/- 0.084 mg kg(-1)). While mean peak twitch depression (DeltaT1) was the same in both groups for individual subjects DeltaT1 differed by +/- 20% (95% confidence interval). Discussion: Acceleromyography-derived twitch heights for individual patients are not necessarily interchangeable with information obtained using electromyography. Nevertheless, acceleromyography appears to be a valid methodology for determining the drug potency when a population rather than an individual subject is being studied. C1 St Vincents Hosp Manhattan, Dept Anesthesiol, New York, NY 10011 USA. New York Med Coll, Valhalla, NY 10595 USA. RP Kopman, AF (reprint author), St Vincents Hosp Manhattan, Dept Anesthesiol, Room NR 408, New York, NY 10011 USA. EM akopman@nyc.rr.com NR 18 TC 4 Z9 5 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAR PY 2005 VL 49 IS 3 BP 323 EP 327 DI 10.1111/j.1399-6576.2004.00641.x PG 5 WC Anesthesiology SC Anesthesiology GA 902WI UT WOS:000227387000010 ER PT J AU Gatke, MR Viby-Mogensen, J Ostergaard, D Bundgaard, JR AF Gatke, MR Viby-Mogensen, J Ostergaard, D Bundgaard, JR TI Response to mivacurium in patients carrying the K variant in the butyrylcholinesterase gene SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 23-27, 2004 CL Las Vegas, NV SP Amer Soc Anesthesiologists ID PROLONGED NEUROMUSCULAR BLOCK; PLASMA CHOLINESTERASE ACTIVITY; PHENOTYPICALLY NORMAL-PATIENTS; HUMAN SERUM CHOLINESTERASE; IDENTIFICATION; POPULATION; PARALYSIS; FREQUENCY; MUTATION AB Background: Mivacurium is hydrolyzed by the butyrylcholinesterase enzyme, and patients with hereditary changes of the enzyme often have prolonged duration of action of mivacurium. In this study, the authors investigated the significance of the most commonly occurring variant, the Kalow (K) variant, established using DNA analysis, for the response to mivacurium. Methods. A total of 58 patients carrying either the wild-type butyrylcholinesterase or different combinations of the atypical (A) variant and the K variant were included. Patients who were homozygous for the A variant were given 0.03 mg/kg mivacurium. All other patients received 0.2 mg/kg mivacurium. The neuromuscular block was measured using train-of-four nerve stimulation and mechanomyography. Genotyping was performed with complete nucleotide sequencing. Results: Heterozygosity of the K variant prolonged the time to train-of-four 0.70 from 26.6 to 34.5 min (30%; not significant) as compared with the wild type. Heterozygosity of the K variant linked to the A variant prolonged the corresponding time from 32 to 42.7 min (33%; P = 0.03) as compared with patients who were heterozygous, for solely an A allele. For eight patients who were homozygous for both the A and K variants, the time to 25% recovery was 78-89 min as compared with 44-57 min in patients who were homozygous for the A variant or had only one linked K variant. Conclusion: The K variant prolongs the duration of action of mivacurium. The current results indicate that the effect is modest when the K variant occurs heterozygously with the wild type or the A variant but is marked in patients who are homozygous for both the A and K variants. C1 Copenhagen Univ Hosp, Rigshosp, Dept Anesthesia & Intens Care 4231, Danish Cholinesterase Res Unit, DK-2100 Copenhagen, Denmark. Copenhagen Univ Hosp, Rigshosp, Dept Clin Biochem, Danish Cholinesterase Res Unit, DK-2100 Copenhagen, Denmark. Herlev Univ Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark. RP Gatke, MR (reprint author), Copenhagen Univ Hosp, Rigshosp, Dept Anesthesia & Intens Care 4231, Danish Cholinesterase Res Unit, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. EM mgatke@rh.dk NR 32 TC 6 Z9 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 2005 VL 102 IS 3 BP 503 EP 508 PG 6 WC Anesthesiology SC Anesthesiology GA 901IW UT WOS:000227277200004 ER PT J AU El Ayass, N Hendrickx, P AF El Ayass, N Hendrickx, P TI Decreased mivacurium infusion rate and delayed neuromuscular recovery after metoclopramide: a randomized double blind-placebo-controlled study SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular nondepolarizing agents, mivacurium, monitoring, recovery; metoclopramide; pseudocholinesterase, inhibition, drug interaction ID PLASMA CHOLINESTERASE ACTIVITY; BLOCK AB Background and objective: Metoclopramide is an antiemetic drug which inhibits plasma cholinesterase activity. We have compared the mivacurium infusion requirements and neuromuscular recovery after administration of metoclopramide to a group of adults compared to a control group. Methods: Forty-five patients were randomized into three groups. Two groups received either 10 or 20 mg of intravenous (i.v.) metoclopramide and the third group received i.v. saline. Metoclopramide and saline were given 5 min before i.v. induction of anaesthesia. Plasma cholinesterase activity was measured before induction and 30 min after metoclopramide or saline injection. Neuromuscular block was monitored by accelerography using single and train-of-four (TOF) stimulation. The mivacurium intubation dose was followed by an infusion titrated every 5 min to maintain 95% block until the end of surgery when the infusion was stopped. Recovery from mivacurium was then monitored until complete. Results: Mivacurium. infusion rates were significantly lower in the metoclopramide groups. After 45 min of infusion, the infusion rates were 1.82 +/- 0.8 and 2.1 +/- 1 μ g kg(-1) min(-1) in the 20 and 10 mg metoclopramide groups, respectively, and 6.8. +/- 2.7 in the saline group.. Time to recovery of TOF to greater than 90% was significantly prolonged in both metoclopramide groups compared to the saline, group: 33.2 +/- 7.2 and 29.5 +/- 10.3 min in the metoclopramide 20 and 10 mg groups, respectively, compared to 22 +/- 3.9 in the saline group (P < 0.001 for the 20 mg group compared to control). Conclusion: Metoclopramide enhances the effect of a mivacurium infusion. C1 Hosp Braine LAlleud, Dept Anesthesiol, Waterloo, Belgium. RP El Ayass, N (reprint author), 106 Kuitegemstr, B-2890 St Amands, Waterloo, Belgium. EM Nizar725@hotmail.com NR 11 TC 0 Z9 0 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD MAR PY 2005 VL 22 IS 3 BP 197 EP 201 PG 5 WC Anesthesiology SC Anesthesiology GA 922VV UT WOS:000228868900006 ER PT J AU Caron, MJ Girard, F Girard, DC Boudreault, D Brais, B Nassif, E Chouinard, P Ruel, M Duranceau, A AF Caron, MJ Girard, F Girard, DC Boudreault, D Brais, B Nassif, E Chouinard, P Ruel, M Duranceau, A TI Cisatracurium pharmacodynamics in patients with oculopharyngeal muscular dystrophy SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKADE; ANESTHETIC MANAGEMENT; NEMALINE MYOPATHY; FEMALE-PATIENTS; VECURONIUM AB The pharmacodynamics of muscle relaxants in patients with oculopharyngeal muscular dystrophy (OPMD) have never been studied. We designed this study to compare the pharmacodynamics of cisatracurium in OPMD patients versus a control group. Forty patients were enrolled: 20 OPMD patients requiring general anesthesia for cricopharyngeal myotomy and 20 age-matched controls undergoing an operation of similar duration and expected blood loss. Anesthesia was standardized, and both groups received a bolus of cisatracurium 0.1 mg/kg. Onset time, time to 10% T1 recovery, and the intervals 10%, 25% and 25%-75% were calculated for both groups. A subgroup analysis was performed in patients with a more severe form of OPMD. Demographic and intraoperative data were similar. Onset time was significantly longer in OPMD patients compared with the control group (4.6 +/- 1.5 min versus 3.4 +/- 1.0 min; P = 0.001). There was no difference in recovery times or indices between groups, regardless of the severity of the disease. In conclusion, there was no difference in the duration of a cisatracurium-induced neuromuscular block between OPMD patients and a control group. A delayed onset of action of the drug may occur. C1 CHUM, Notre Dame Hosp, Dept Anesthesiol, Montreal, PQ H2L 4M1, Canada. CHUM, Notre Dame Hosp, Dept Med, Montreal, PQ H2L 4M1, Canada. CHUM, Notre Dame Hosp, Dept Surg, Montreal, PQ H2L 4M1, Canada. RP Girard, F (reprint author), CHUM, Notre Dame Hosp, Dept Anesthesiol, 1560 Sherbrooke E, Montreal, PQ H2L 4M1, Canada. EM francois.girard.chum@ssss.gouv.qc.ca NR 21 TC 2 Z9 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 2005 VL 100 IS 2 BP 393 EP 397 DI 10.1213/01.ANE.0000140783.39597.FD PG 5 WC Anesthesiology SC Anesthesiology GA 891FP UT WOS:000226567000017 ER PT J AU Richard, A Girard, F Girard, DC Boudreault, D Chouinard, P Moumdjian, R Bouthilier, A Ruel, M Couture, J Varin, F AF Richard, A Girard, F Girard, DC Boudreault, D Chouinard, P Moumdjian, R Bouthilier, A Ruel, M Couture, J Varin, F TI Cisatracurium-induced neuromuscular blockade is affected by chronic phenytoin or carbamazepine treatment in neurosurgical patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID OPIOID BARBITURATE ANESTHESIA; RESEARCH PRACTICE GCRP; BLOCKING-AGENTS; INDUCED RESISTANCE; DRUG-METABOLISM; PROTEIN-BINDING; ATRACURIUM; PHARMACOKINETICS; PHARMACODYNAMICS; ANTICONVULSANTS AB The effect of chronic anticonvulsant therapy (CAT) on the maintenance and recovery profiles of cisatracurium-induced neuromuscular blockade has not been adequately studied. In this study, we compared the pharmacokinetics and pharmacodynamics of cisatracurium after a prolonged infusion in patients with or without CAT. Thirty patients undergoing intracranial surgery were enrolled in the study: 15 patients under CAT (carbamazepine and phenytoin, Group A) and 15 controls receiving no anticonvulsant therapy (Group C). Anesthesia was standardized and both groups received a bolus of cisatracurium followed by an infusion to maintain a 95% twitch depression. A steady-state was obtained and the infusion was kept constant for 2 additional hours. Neuromuscular blockade was then allowed to spontaneously recover. Blood samples were taken for measurement of cisatracurium plasma concentration during the steady-state period (Cp(ss)95) and at various times during recovery. Demographic and intraoperative data were similar. CAT resulted in faster 25% and 75% recovery of the first twitch. The rate of infusion of cisatracurium needed to maintain a 95% twitch depression at steady-state was 44% faster in Group A (P < 0.001). The clearance of cisatracurium was significantly faster in Group A when compared with Group C (7.12 &PLUSMN; 1.87 versus 5.72 &PLUSMN; 0.70 L . kg(-1) . min(-1), P = 0.01). The Cp(ss)95 was also significantly larger in Group A (191 &PLUSMN; 45 versus 159 &PLUSMN; 36 ng/mL, P = 0.04). In addition, patients receiving CAT had a 20% increase in the clearance of cisatracurium that, in turn, resulted in a faster recovery of neuromuscular blockade after an infusion of the drug. Also, patients under CAT had a 20% increase in their Cp(ss)95, indicating an increased resistance to the effect of cisatracurium. C1 CHUM, Hop Notre Dame, Dept Anesthesiol, Montreal, PQ H2L 4M1, Canada. CHUM, Hop Notre Dame, Div Neurosurg, Montreal, PQ H2L 4M1, Canada. Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. RP Girard, F (reprint author), CHUM, Hop Notre Dame, Dept Anesthesiol, 1560 Sherbrooke E, Montreal, PQ H2L 4M1, Canada. EM francois.girard.chum@ssss.gouv.qc.ca NR 31 TC 5 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 2005 VL 100 IS 2 BP 538 EP 544 DI 10.1213/01.ANE.0000143333.84988.50 PG 7 WC Anesthesiology SC Anesthesiology GA 891FP UT WOS:000226567000042 ER PT J AU Kopman, AF Kopman, DJ Ng, J Zank, LM AF Kopman, AF Kopman, DJ Ng, J Zank, LM TI Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE acceleromyography; rocuronium; cisatracurium; neostigmine; reversal; antagonism ID POSTOPERATIVE RESIDUAL CURARIZATION; QUANTITATIVE ASSESSMENT; TRAIN-OF-4 COUNT; NEOSTIGMINE; ATRACURIUM; HUMANS; VECURONIUM; REVERSAL; RECOVERY; PANCURONIUM AB Study Objective: The purpose of this study is to determine the incidence of significant (train-of-four [TOF] ratio < 0.70), but clinically undetectable (TOF ratio > 0.40), residual neuromuscular block after neostigmine antagonism of profound cisatracurium (CIS) or rocuronium (ROC) block. Design: Prospective, randomized, open-label study. Setting: University hospital. Patients: Forty ASA physical status I and II undergoing elective surgical procedures. Interventions: Anesthesia was induced with propofol 1.5 to 2.5 mg/kg IV plus fentanyl 2 to 4 mu g/kg and maintained with N2O/desflurane plus narcotic supplementation. The electromyographic response of the adductor pollicis was recorded. Train-of-four stimulation was given every 20 seconds. Twitch height (T1) and TOF fade ratio were continuously recorded. In group 1 (n = 20), neuromuscular block was induced with CIS 0.10 mg/kg, and T1 was maintained at 5% of control by a constant infusion of CIS until the end of surgery. One minute after the termination of the infusion, neostigmine 0.05 mg/kg was administered. T1 and TOF values were monitored continuously for the next 20 minutes. Group 2 (n 20) is identical to group I except that the initial drug was ROC 0.60 mg/kg, and paralysis was maintained with an infusion of ROC. Measurements and Main Results: There were no significant differences in the recovery patterns of CIS vs ROC. The duration (bolus to end of infusion) in both groups averaged 2.7 hours, and the mean cumulative dose of relaxant approximated 4 x the ED95. T I at the time of reversal was 6% (4%-10%) of control. Mean TOF ratios at 10, 15, and 20 minutes were 0.55, 0.71, and 0.0.81, respectively. Return to a TOF ratio > 0.40 was always achieved in 15 minutes or less. However, at 20 minutes postreversal, 5 of 40 subjects had TOF ratios < 0.70 and only 11 individuals had recovered to a TOF ratio of 0.90 or greater. Conclusions: Most clinicians cannot detect tactile fade once the TOF ratio exceeds 0.40. When reversing profound block, an objective monitor of neuromuscular function is required if the extent of residual block is to be assessed with any confidence. (c) 2005 Elsevier Inc. All rights reserved. C1 New York Med Coll, Dept Anesthesiol, Valhalla, NY 10595 USA. New York Presbyterian Hosp, Dept Anesthesiol, New York, NY USA. RP Kopman, AF (reprint author), St Vincents Hosp Manhattan, Dept Anesthesiol, New York, NY 10011 USA. EM akopman@svcmcny.org NR 28 TC 19 Z9 21 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD FEB PY 2005 VL 17 IS 1 BP 30 EP 35 DI 10.1016/j.jclinane.2004.03.009 PG 6 WC Anesthesiology SC Anesthesiology GA 906JM UT WOS:000227637000007 ER PT J AU Nava-Ocampo, AA Velazquez-Armenta, Y Moyao-Garcia, D Antonio-Ocampo, A Salmeron, J AF Nava-Ocampo, AA Velazquez-Armenta, Y Moyao-Garcia, D Antonio-Ocampo, A Salmeron, J TI Variable designs of clinical trials of neuromuscular blocking agents: an example of studies comparing rocuronium and vecuronium SO MEDICAL SCIENCE MONITOR LA English DT Article DE neuromuscular nondepolarizing agents; drug utilization review ID TRAIN-OF-4 FADE; ISOFLURANE ANESTHESIA; PLASMA-CONCENTRATIONS; ENFLURANE ANESTHESIA; INFORMED-CONSENT; ADULT PATIENTS; ONSET; ATRACURIUM; MIVACURIUM; CHILDREN AB Background: Published clinical trials on neuromuscular blocking (NMB) agents are being reported with large variations in their protocols and conflicting results may emerge from these differences. Because they have been compared in several clinical trials, the study was focused on rocuronium and vecuronium in order to evaluate whether these NMB agents were compared under homogeneous conditions. Material/Methods: A search was made in PubMed, Embase Drugs and Pharmacology, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Studies on the neuromuscular response at the adductor pollicis to air i.v. bolus dose of rocuronium or vecuronium in humans were included. Quality of all reports was assessed by means of the 3-item Jadad et al. scale. Twenty-five studies met our inclusion criteria and all were retrieved. Results: Randomization was performed in 21 (80.8%) studies. Blinding procedure for drug administration was mentioned in only one study without clarifying the procedure. Induction was most commonly performed with thiopental, followed by propofol. Two studies were performed in children and two in elderly patients. Withdrawals or dropouts were not mentioned in any paper. Electromyography and mechanomyography were the most common monitoring procedures. The time to maximal response, the maximum effect and the time to reach 25% recovery of neuromuscular function were the most used pharmacodynamic parameters. Conclusions: Clinical trials on neuromuscular blocking agents, e.g. vecuronium versus rocuronium, are being performed with large variability and without following established guidelines. C1 Hosp Infant Mexico Federico Gomez, Dept Clin Pharmacol, Mexico City 06720, DF, Mexico. Hosp Infantil Mexico Dr Federico Gomez, Dept Anesthesia & Resp Therapy, Mexico City, DF, Mexico. Hosp Especialdades, Dept Teaching & Med Educ, Ctr Med Nacl Siglo XXI, IMSS, Mexico City, DF, Mexico. Hosp Gen Reg 1, Hlth Serv Res Unit, IMSS, Cuernavaca, Morelos, Mexico. RP Nava-Ocampo, AA (reprint author), Hosp Infant Mexico Federico Gomez, Dept Clin Pharmacol, Dr Marquez 162,Colonia Doctores, Mexico City 06720, DF, Mexico. EM navaocampo_aa@yahoo.com RI Nava-Ocampo, Alejandro/K-3850-2012 NR 46 TC 0 Z9 0 PU INT SCIENTIFIC LITERATURE, INC PI ALBERTSON PA 1125 WILLIS AVE, ALBERTSON, NY 11507 USA SN 1234-1010 J9 MED SCI MONITOR JI Med. Sci. Monitor PD FEB PY 2005 VL 11 IS 2 BP PI22 EP PI30 PG 9 WC Medicine, Research & Experimental SC Research & Experimental Medicine GA 897UA UT WOS:000227029700020 ER PT J AU Gibson, JK Haire, RG AF Gibson, JK Haire, RG TI Activation of pentamethylcyclopentadiene by Bk+, Cf+ and Es+ ions in the gas phase: Probing electronic structures of transcurium actinides SO ORGANOMETALLICS LA English DT Article ID HYDROCARBON ACTIVATION; LANTHANIDE CATIONS; ORGANOMETALLIC CHEMISTRY; METAL; REACTIVITY; COMPLEXES; URANIUM; CALIFORNIUM; CHARACTER; ENERGIES AB Reactions of monopositive actinide ions, An(+), and lanthanide ions, Ln(+), with 1,2,3,4,5-pentamethylcyclopentadiene, HCp*, were studied by mass spectrometry. This was the first study of the M+/HCp* reaction for M+ = Cm+, Cf+, and Es+; results for M+ = Am+, Bk+, Pr+, Eu+, and Tm+ are compared with those from previous studies. Different product distributions for the present experiments versus previous results for the same reactions are traced to a pressure effect whereby higher reactant pressures favor certain reaction channels. Each of the eight metal ions, M+, reacted with HCp* to produce [MCp*](+) (+ H), as well as additional products. Both Cf+ and Es+ have previously been found to be inert toward most alkenes, but efficiently reacted with HCp* to induce (1) H-loss and [AnCp*](+); (2) H-2-loss and [AnC(5)(CH3)(4)(CH2)](+); and (3) CH3-loss and [AnC(5)(CH3)(4)H](+) (An = Cf, Es). These are the first organoeinsteinium complexes derived from activation of an organic substrate. The exhibited types of reactivity, i.e., product distributions, for the studied ions correlate with the energies to excite the ground-state atomic ions to configurations with two non-f valence electrons. It is concluded that the unidentified lowest-lying [Rn]5f(5)6d7s configuration of Cf+ is similar to2.5 eV above the [Rn]5P(5)7s ground-state configuration. Secondary products included [MCP*(2)](+) (M = Am, Cm, Bk, Cf, Es, Tm, and Pr), the compositions of which correspond to the metallocene sandwich complexes. C1 Oak Ridge Natl Lab, Div Chem Sci, Oak Ridge, TN 37831 USA. RP Gibson, JK (reprint author), Oak Ridge Natl Lab, Div Chem Sci, Oak Ridge, TN 37831 USA. EM gibsonjk@ornl.gov NR 37 TC 5 Z9 5 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0276-7333 J9 ORGANOMETALLICS JI Organometallics PD JAN 3 PY 2005 VL 24 IS 1 BP 119 EP 126 DI 10.1021/om049387v PG 8 WC Chemistry, Inorganic & Nuclear; Chemistry, Organic SC Chemistry GA 884GK UT WOS:000226072600019 ER PT J AU Nitahara, K Shono, S Hamada, T Higuchi, H Sakuragi, T Higa, K AF Nitahara, K Shono, S Hamada, T Higuchi, H Sakuragi, T Higa, K TI The effect of adenosine triphosphate on vecuronium-induced neuromuscular block SO ANESTHESIA AND ANALGESIA LA English DT Article ID ATP; INHIBITION; METABOLISM; RECEPTORS; INFUSION; JUNCTION; AGENTS; MOUSE; PAIN AB Continuous IV adenosine triphosphate administration has been used during surgery in the expectation of analgesic and vasodilative effects. Because adenosine triphosphate inhibits neuromuscular transmission, we investigated whether the neuromuscular effect of vecuronium was enhanced by IV adenosine triphosphate in 29 patients randomly given either continuous IV adenosine triphosphate 0.1 mg (.) kg(-1) (.) min(-1) or 0.9% NaCl when undergoing elective minor surgery. Anesthesia was induced and maintained with propofol. Neuromuscular monitoring was recorded from the adductor pollicis muscle using electromyography with train-of-four stimulation of the ulnar nerve. Vecuronium 25, 30, or 40 mug/kg was given and lag time, onset time, and maximum block were recorded. ED50 and ED95 values for each group were derived from least squares linear regression analysis. ED50 and ED95 values were 29 mug/kg and 44 mug/kg, respectively, for the adenosine triphosphate group and 26 mug/kg and 46 mug/kg, respectively, for the controls. Differences in lag time, onset time, and neuromuscular responses between the two groups were not statistically significant. A significantly larger number of patients in the adenosine triphosphate group showed hypotension (systolic blood pressure <80 mm Hg). Our results demonstrated that adenosine triphosphate 0.1 mg (.) kg(-1) (.) min(-1) did not enhance the neuromuscular block induced by vecuronium. C1 Fukuoka Univ, Sch Med, Dept Anesthesiol, Jonan Ku, Fukuoka 8140180, Japan. RP Nitahara, K (reprint author), Fukuoka Univ, Sch Med, Dept Anesthesiol, Jonan Ku, 7-45-1,Nanakuma, Fukuoka 8140180, Japan. EM nitahara@fukuoka-u.ac.jp NR 25 TC 0 Z9 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2005 VL 100 IS 1 BP 116 EP 119 DI 10.1213/01.ANE.0000140248.20142.4A PG 4 WC Anesthesiology SC Anesthesiology GA 881MG UT WOS:000225871000023 ER PT J AU Jooste, E Zhang, Y Emala, CW AF Jooste, E Zhang, Y Emala, CW TI Rapacuronium preferentially antagonizes the function of M2 versus M3 muscarinic receptors in guinea pig airway smooth muscle SO ANESTHESIOLOGY LA English DT Article ID PULMONARY PARASYMPATHETIC NERVES; MUSCARINIC RECEPTOR SUBTYPES; HISTAMINE-RELEASE; GENERAL-ANESTHESIA; D-TUBOCURARINE; PHARMACOKINETICS; BRONCHOSPASM; CHILDREN; TRACHEA; LUNG AB Background: Rapacuronium, a nondepolarizing muscle relaxant that was proposed as a replacement for succinylcholine for rapid intubation, was withdrawn from clinical use as a result of fatal bronchospasm, but the mechanism of this effect is not known. Preferential antagonism of presynaptic M2 muscarinic receptors versus postsynpatic M3 muscarinic receptors can facilitate bronchoconstriction. The authors questioned whether rapacuronium preferentially antagonized M2 versus M3 muscarinic receptors in intact airway. Methods: Guinea pig tracheal rings were suspended in organ baths and muscle relaxants' antagonism of prejunctional M2 muscarinic autoreceptors was evaluated by augmentation of muscle contraction elicited by electrical field stimulation. Muscle relaxants' antagonism of postjunctional M3 muscarinic receptors was assessed by attenuation of muscle contraction elicited by acetylcholine. Results: Rapacuronium displayed a 50-fold higher affinity for antagonism of the M2 versus M3 muscarinic receptor. Moreover, its affinity for the M2 but not the M3 receptor was within concentrations achieved clinically. in addition, rapacuronium caused an increase in baseline tone of airway smooth muscle that was antagonized by atropine but not by previous depletion of nonadrenergic noncholinergic neurotransmitters or by inhibitors of histamine receptors, tachykinin receptors, leukotriene receptors, or calcium channels. Conclusion: These findings are consistent with the hypothesis that rapacuronium may precipitate bronchoconstriction by selective antagonism of the M2 muscarinic receptor on parasympathetic nerves, enhancing acetylcholine release to act upon unopposed M3 muscarinic receptors on airway muscle. An additional mechanism of rapacuronium-induced bronchoconstriction is suggested by increases in baseline muscle tension. C1 Columbia Univ, Coll Phys & Surg, Dept Anesthesiol, New York, NY 10032 USA. RP Emala, CW (reprint author), Columbia Univ, Coll Phys & Surg, Dept Anesthesiol, 630 W 168th St P&S Box 46, New York, NY 10032 USA. EM cwe5@columbia.edu NR 41 TC 25 Z9 26 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2005 VL 102 IS 1 BP 117 EP 124 DI 10.1097/00000542-200501000-00020 PG 8 WC Anesthesiology SC Anesthesiology GA 885IZ UT WOS:000226151600019 ER PT J AU Ezzine, S Varin, F AF Ezzine, S Varin, F TI Interstitial muscle concentrations of rocuronium under steady-state conditions in anaesthetized dogs: actual versus predicted values SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE pharmacokinetics,rocuronium; pharmacology, rocuronium; model, dog ID MICRODIALYSIS; PLASMA; PHARMACODYNAMICS; PHARMACOKINETICS; HUMANS; TISSUE; FLUID; RATS AB Introduction. The objective of this study was to compare rocuronium effect (C-e) and peripheral (C-2) compartment concentrations predicted by pharmacokinetic-pharmacodynamic (PK-PD) modelling with those measured in plasma (C-p) and in the interstitial fluid of muscle tissue (C-ISF,C-u) by microdialysis in anaesthetized dogs. Methods. After approval by the Animal Care Committee, eight adult male dogs with a body weight ranging from 7 to 18 kg were anaesthetized with pentobarbital. Each dog received a 2-min rocuronium infusion of 0.15 mg kg(-1) min(-1) followed by a 118-min infusion of 60 mug kg(-1) min(-1) via the right jugular vein. Arteriovenous gradient across the hindlimb was measured at 40, 60, 100 and 120 min. Three microdialysis samples were collected at 40-min intervals. Once the infusion stopped, arterial samples were collected every 2 min for the first 10 min and every 20 min for the next 120 min. Neuromuscular function was monitored using train-of-four stimulation until full recovery. Dogs were then killed and a biopsy of muscle tissue was performed (C-m). Results. At steady state, the mean C-ISF,C-u value was 1353 ng ml(-1). After correction for the unbound fraction in plasma, the mean C-e,C-corr and C-2,C-corr were 1681 and 1481 ng ml(-1), respectively. At the terminal sampling point, C-m was 10-fold higher than C-p. Conclusion. Unbound concentration of rocuronium measured in the muscle interstitial fluid under steady-state conditions confirms that parametric PK-PD modelling gives reliable estimates of effect site concentrations. Rocuronium accumulates in muscle tissue, probably by non-specific protein binding in the interstitial space. C1 Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. RP Varin, F (reprint author), Univ Montreal, Fac Pharm, 2900 Edouard Montpetit,CP 6128,Succursale Ctr Vil, Montreal, PQ H3C 3J7, Canada. EM france.varin@umontreal.ca NR 21 TC 10 Z9 10 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JAN PY 2005 VL 94 IS 1 BP 49 EP 56 DI 10.1093/bja/aei005 PG 8 WC Anesthesiology SC Anesthesiology GA 889AK UT WOS:000226415700009 ER PT J AU Robertson, EN Driessen, JJ Booij, LHDJ AF Robertson, EN Driessen, JJ Booij, LHDJ TI Pharmacokinetics and pharmacodynamics of rocuronium in patients with and without renal failure SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular non-depolarizing agents, rocuronium; kidney failure, chronic; pharmacokinetics, rocuronium, metabolites ID TIME-COURSE; BROMIDE ORG-9426; ANESTHESIA; HALOTHANE AB Background and objective: This study clarifies 1 the relationship between the neuromuscular blocking effects of rocuronium 0.6 mg kg(-1) and its pharmacokinetics in patients with renal failure. Methods: Seventeen healthy patients and 17 patients with renal failure were studied under propofol anaesthesia in this prospective open label study. Rocuronium 0.6 mg kg(-1) was given after induction of anaesthesia. The train-of-four mechano-myographic response of the thumb to supramaximal stimulation of the ulnar nerve at 2 Hz every 12 s was measured. Venous blood samples (4 mL) were obtained at 0, 2, 4, 7, 10, 15, 20, 30, 60, 120, 180, 240 and 360 min after relaxant administration. Samples were centrifuged, separated and stored at -20 degrees C until plasma levels of rocuronium and its metabolites were measured. Two- and three-exponential equations were used to describe the pharmacokinetic data in each group and these were compared to each other using the Wilcoxon signed rank sum test as was the pharmacodynamic data. P < 0.05 was significant. Results: Onset of block was similar in both groups. Clinical duration and the time to recovery of the train-of-four to 7096 were prolonged in the renal failure group compared to control; 49 vs. 32 min (P < 0.004, 95% confidential interval 17, difference 5-28) and 88 vs. 55 min (P < 0.001, 95% confidential interval 33, difference 17-50), respectively. Clearance of rocuronium was reduced by 39% in the renal failure patients compared to control, with an 84% increase in the mean residence time. The volume of distribution was unaffected by renal failure. Conclusions: The duration of action of a bolus dose of 0.6 mg kg(-1) rocuronium is increased significantly in patients with end-stage renal failure compared to healthy controls. This increase may be due to a decreased clearance of rocuronium, the disease process causing the renal failure and/or the medication which patients with renal failure need in their treatment. C1 Univ Med Ctr, Dept Anesthesiol, NL-6500 HB Nijmegen, Netherlands. RP Robertson, EN (reprint author), Univ Med Ctr, Dept Anesthesiol, Postbus 9101, NL-6500 HB Nijmegen, Netherlands. EM e.robertson@anes.umcn.nl NR 16 TC 27 Z9 28 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 2005 VL 22 IS 1 BP 4 EP 10 DI 10.1017/S0265021505000025 PG 7 WC Anesthesiology SC Anesthesiology GA 932DS UT WOS:000229535000002 ER PT J AU Driessen, JJ Robertson, EN Booij, LHDJ AF Driessen, JJ Robertson, EN Booij, LHDJ TI Acceleromyography in neonates and small infants: baseline calibration and recovery of the responses after neuromuscular blockade with rocuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blockade, monitoring, acceleromyography; neuromuscular blocking agents, rocuronium; infant, newborn ID BLOCKING-AGENTS; STIMULATION; ACCELERATION; TRAIN-OF-4; ANESTHESIA; CHILDREN; NERVE AB Background: We have evaluated the use of the TOF-Guard(R) (TOF, train-of-four) acceleromyographic thumb responses to ulnar nerve stimulation in neonates and infants and the return of the responses after neuromuscular blockade. Methods: Baseline acceleromyographic recording of thumb adduction to ulnar nerve stimulation during volatile anaesthesia was performed in 22 babies aged less than 30 weeks. At the start of stimulation the automatic set-up procedure of the TOF-Guard(R) was used to see if a 100% control twitch height could be achieved. Irrespective of the ability to achieve a 100% control twitch height, TOF stimulation was used thereafter. When no automatic 100% control twitch could be reached, the transducer signal gain factor was set manually to obtain a 100% value. In 14 of the 22 children the recovery after neuromuscular blockade with rocuronium 0.3 mg kg(-1) was recorded. Results: In nine of 22 patients a 100% baseline twitch height was obtained with the automatic set-up. In the other 13 babies the TOF-Guard(R) display indicated that the transducer signal was too low. The mean time to recovery of control twitch to 75% of baseline after rocuronium 0.3 mg kg(-1) was 51 min (SD = 21) and the time to recovery of the TOF ratio to 70% was 49 min (SD = 19). The mean final twitch height and TOF after recover), from rocuronium blockade were 101176 (SD = 15) and 92% (SD = 12), respectively. Conclusion: The recovery of the responses after neuromuscular blockade to near baseline values shows that acceleromyography can be used to measure neuromuscular block and recovery in neonates and infants. C1 Univ Med Ctr Nijmegen, Dept Anesthesiol, NL-6500 HB Nijmegen, Netherlands. RP Driessen, JJ (reprint author), Univ Med Ctr Nijmegen, Dept Anesthesiol, Postbus 9101, NL-6500 HB Nijmegen, Netherlands. EM JJ.Driessen@anes.umcn.nl NR 15 TC 8 Z9 8 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 2005 VL 22 IS 1 BP 11 EP 15 DI 10.1017/S0265021505000037 PG 5 WC Anesthesiology SC Anesthesiology GA 932DS UT WOS:000229535000003 ER PT J AU Rieder, J Lirk, P Bodrogi, E Sawires, M Gruber, G Hoffmann, G AF Rieder, J Lirk, P Bodrogi, E Sawires, M Gruber, G Hoffmann, G TI Cisatracurium, but not mivacurium, induces apoptosis in human umbilical vein endothelial cells in vitro SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT 10th ESA Congress CY MAY 06-JUN 10, 2002 CL Nice, FRANCE SP ESA DE neuromuscular blocking agents, cisatracurium, mivacurium; breakdown products; glutathione; endothelial cells, human umbilical venous; oxidative stress; apoptosis ID MOUSE LYMPHOMA-CELLS; ATRACURIUM TOXICITY; RAT-LIVER; LAUDANOSINE; PHARMACOKINETICS; METHACRYLATE; GENOTOXICITY; ACRYLATE AB Background and objective: Cisatracurium is an intermediate acting, non-depolarizing neuromuscular blocking agent. Previous reports have indicated a growth-inhibitory effect of the isoforms cisatracurium and atracurium on two human cell lines in vitro. These effects were ascribed to oxidative stress elicited by acrylate esters formed during cisatracurium breakdown. Oxidative stress is a potent precipitator of apoptosis. Therefore, the aim of the present study was to investigate whether the growth-inhibitory effects of cisatracurium could be explained by initiation of apoptosis. Methods: Human umbilical vein endothelial cells were incubated with cisatracurium at concentrations of 0.96, 3.2, 9.6, 3 2 and 96 mu mol for 24 h. DNA fragmentation was measured using the Cell Death Detection ELISA Plus assay (Roche Diagnostics, Mannheim, Germany). Results: There was a dose dependency of cisatracurium with respect to the rate of apoptosis in human umbilical vein endothelial cells. Programmed cell death could be demonstrated at concentrations encountered in human plasma after single-bolus injections of cisatracurium. Apoptosis was attenuated by the concomitant administration of glutathione. Conclusions: These findings strongly support the hypothesis that acrylate esters, breakdown products of cisatracurium, induce oxidative stress and, subsequently, apoptosis. C1 Leopold Franzens Univ Innsbruck, Dept Anesthesiol & Crit Care Med, A-6020 Innsbruck, Austria. RP Rieder, J (reprint author), Leopold Franzens Univ Innsbruck, Dept Anesthesiol & Crit Care Med, Anichstr 35, A-6020 Innsbruck, Austria. EM Josef.Rieder@uibk.ac.at RI Hoffmann, Georg/B-9201-2013 NR 19 TC 0 Z9 0 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 2005 VL 22 IS 1 BP 16 EP 19 PG 4 WC Anesthesiology SC Anesthesiology GA 932DS UT WOS:000229535000004 ER PT J AU Hattori, H Saitoh, Y Nakajma, H Sanbe, N Akatu, M Murakawa, M AF Hattori, H Saitoh, Y Nakajma, H Sanbe, N Akatu, M Murakawa, M TI Gabexate mesilate hastens recovery from vecuronium-induced neuromuscular blockade SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE pharmacology, drug interactions; protease inhibitors, gabexate mesilate; neuromuscular blocking agents, vecuronium, recovery ID PROTEASE INHIBITOR; ISCHEMIA/REPERFUSION INJURY; LIVER; PHARMACODYNAMICS; PHARMACOKINETICS; CISATRACURIUM; ATRACURIUM; INFUSION; RATS AB Background and objective: To test the hypothesis that gabexate mesilate, a protease inihibitor, hastens recovery from neuromuscular blockade, we examined the effect of gabexate mesilate on the recovery of vecuronium-induced neuromuscular blockade in anaesthetized patients in a double-blind, randomized fashion. Methods: Thirty adult patients were divided into two groups of 15. In the gabexate mesilate group, immediately after administration of vecuronium 0.1 mg kg(-1), a continuous infusion of gabexate mesilate was started at a speed of 1.5 mg kg(-1) h(-1). In the control group, normal saline was administered instead of gabexate mesilate. Times to the return of T-1, T-2, T-3 or T-4 (first, second, third and fourth response of train-of-four (TOF)), times to the recovery of T-1/control to 0.25 (T25) or 0.5 (T50), recovery of T-1/control or TOF ratio (T-4/T-1) were compared between the two groups. Results: Times to the returns of T-1, T-2, T-3 and T-4 in the gabexate mesilate group were significantly shorter than in the control group (19.4 +/- 6.8 vs. 25.7 +/- 7.2 min for T-1; mean +/- SD, P = 0.020). Times to T25 and T50 were significantly shorter in the gabexate mesilate group than in the control group (34.0 +/- 9.9 vs. 51.3 +/- 10.2 min for T25, P < 0.001). T-1/control and TOF ratio in the gabexate mesilate group were significantly higher than in the control group 40-80 min and 40-120 min after administration of vecuronium, respectively (P < 0.05). Conclusion: Gabexate mesilate hastens recovery from neuromuscular block in anaesthetized patients receiving vecuronium. C1 Fukushima Med Univ Sch Med, Dept Anesthesiol, Fukushima 9601295, Japan. RP Hattori, H (reprint author), Fukushima Med Univ Sch Med, Dept Anesthesiol, Hikarigaoka 1, Fukushima 9601295, Japan. EM hattori@sb.dcns.ne.jp NR 21 TC 0 Z9 0 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 2005 VL 22 IS 1 BP 20 EP 24 PG 5 WC Anesthesiology SC Anesthesiology GA 932DS UT WOS:000229535000005 ER PT J AU Cammu, G Boussemaere, V Foubert, L Hendrickx, J Coddens, J Deloof, T AF Cammu, G Boussemaere, V Foubert, L Hendrickx, J Coddens, J Deloof, T TI Large bolus dose vs. continuous infusion of cisatracurium during hypothermic cardiopulmonary bypass surgery SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blocking agents, cisatracurium; cardiopulmonary bypass; hypothermia ID ROCURONIUM; PHARMACOKINETICS; ATRACURIUM; DRUGS AB Background and objective: We investigated whether a high bolus dose of cisatracurium (8 X ED95) given at induction can provide muscle relaxation for the major part of a cardiac procedure with hypothermic cardiopulmonary bypass, avoid important postoperative residual curarization and cause no waste of product. Methods: Twenty patients were randomly assigned either to Group 1 (n = 10) or Group 2 (n = 10). Those in Group 1 were given cisatracurium in a high bolus dose (0.4 mg kg(-1)). Those in Group 2 received cisatracurium 0.1 mg kg(-1) at induction followed after 30 min by a continuous infusion of cisatracurium. As an escape medication In case of patient movement, a bolus dose of cisatracurium 0.03 mg kg(-1) was given. Results: In Group 1 (large cisatracurium bolus dose), the clinical duration of effect (until T-1/T-0 = 25%) was 110 min. Six of 10 patients in Group 1 required additional boluses of cisatracurium intraoperatively. Four of these six had received an additional bolus near the end of surgery and had a train-of-four (TOF) ratio = 0 at the end. The other four patients in Group 1 had a final TOF ratio >0.9. In Group 2 (continuous cisatracurium infusion), only two patients had a TOF ratio >0.9 at the end of surgery, no patient moved and none received additional boluses. The total amount of cisatracurium used in the bolus and infusion Groups was 34.5 +/- 7.8 and 21.3 +/- 5.7 mg, respectively (P = 0.0004). Conclusions: For continued neuromuscular block during hypothermic cardiac surgery, a high bolus dose of cisatracurium appears to be safe, although it is not an alternative to a continuous infusion, as its neuromuscular blockade does not cover the intraoperative period and a high incidence of movements occurs. In the patients who received a high bolus dose of cisatracurium, postoperative residual curarization appeared after additional boluses had been given. The consumption of cisatracurium by high bolus was significantly greater than with continuous infusion. C1 OLV Clin, Dept Anaesthesia & Crit Care Med, B-9300 Aalst, Belgium. RP Cammu, G (reprint author), OLV Clin, Dept Anaesthesia & Crit Care Med, Moorselbaan 164, B-9300 Aalst, Belgium. EM Guy.Cammu@olvz-aalst.be NR 10 TC 2 Z9 9 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 2005 VL 22 IS 1 BP 25 EP 29 DI 10.1017/S0265021505000062 PG 5 WC Anesthesiology SC Anesthesiology GA 932DS UT WOS:000229535000006 ER PT J AU Salem, AA Barsoum, BN El Said, DM AF Salem, AA Barsoum, BN El Said, DM TI Rapid determination of gallamine triethiodide (Flaxedil (R)) and pancuronium bromide (Pavulon (R)) in pharmaceutical and urine matrices by means of modified-carbon-paste ion-selective electrodes SO HELVETICA CHIMICA ACTA LA English DT Article ID PERFORMANCE LIQUID-CHROMATOGRAPHY; QUATERNARY AMMONIUM-COMPOUNDS; THIN-LAYER CHROMATOGRAPHY; POTENTIOMETRIC DETERMINATION; MASS-SPECTROMETRY; MUSCLE; VECURONIUM; SAMPLES; PLASMA; SERUM AB A new analytical method for the determination of gallamine triethiodide (Flaxedil (R); 1) and pancuronium bromide (Pavulon (R); 2), two muscle relaxants used in surgical operations and in pain relief, has been developed. Our approach relies on rapid, precise, and sensitive potentiometric sensors based on modified-carbon-paste ionselective electrodes (CP-ISEs). Linear calibration graphs in the working ranges of ca. 4.5-892 and 7.3-733 mu g/ ml (in H2O, pH 7.0, T= 25 degrees) were established for I and 2, respectively; and Nernst slopes corresponding to three-or two-electrons transfers, respectively, were obtained. The method works best in a pH range of 7-9. Average relative errors of 2.12 and 2.14%, with average standard deviations of 1.98-2.47 and 2.64-3.45, respectively, were obtained for urine samples of 1 and 2. The corresponding relative errors for the pharmaceutical samples were 1.59 and 1.64%, with standard deviations of 0.54-1.34 and 0.52-1.67, respectively. Statistical Student and F tests were applied to the data, and satisfactory results were obtained. C1 UAE Univ, Fac Sci, Dept Chem, Al Ain, U Arab Emirates. Cairo Univ, Fac Sci, Dept Chem, Giza, Egypt. RP Salem, AA (reprint author), UAE Univ, Fac Sci, Dept Chem, Al Ain, U Arab Emirates. EM Asalem@uaeu.ac.ae NR 26 TC 5 Z9 5 PU WILEY-V C H VERLAG GMBH PI WEINHEIM PA PO BOX 10 11 61, D-69451 WEINHEIM, GERMANY SN 0018-019X J9 HELV CHIM ACTA JI Helv. Chim. Acta PY 2005 VL 88 IS 4 BP 861 EP 872 DI 10.1002/hlca.200590064 PG 12 WC Chemistry, Multidisciplinary SC Chemistry GA 921KF UT WOS:000228762400015 ER PT J AU Andresen, BD Alcaraz, A Grant, PM AF Andresen, BD Alcaraz, A Grant, PM TI Pancuronium bromide (Pavulon) isolation and identification in aged autopsy tissues and fluids SO JOURNAL OF FORENSIC SCIENCES LA English DT Article DE forensic science; aged exhumation tissues; Pancuronium bromide (Pavulon); gas chromatography-mass spectrometry (GC/MS); solid-phase extraction (SPE); liquid chromatography-electrospray ionization mass spectrometry (mu HPLC-ESI-MS/MS) ID CHROMATOGRAPHY; QUANTITATION; PLASMA; SERUM AB The isolation and detection of pancuronium bromide was developed for aged autopsy samples to identify and confirm this compound in questioned tissue samples. A novel protocol was optimized for the isolation of the target drug in highly decomposed tissues. Solid-phase extraction (SPE) cartridges containing styrene-divinylbenzene were investigated. This polymer retained quaternary drugs and facilitated sequential elution upon washing with commonly available solvents. The semi-purified SPE samples were prescreened by pyrolysis GC-MS. A candidate specimen was then confirmed by microbore high-performance liquid chromatography/electrospray-ionization/mass spectrometry (muHPLC-ESI-MS/MS) with a triple-quadrupole mass spectrometer. The developed procedures provided a qualitative or semiquantitative (at best) basis for the investigation of difficult cases involving overdoses of polar drugs. C1 Forens Sci Ctr, Livermore, CA 94550 USA. RP Grant, PM (reprint author), Forens Sci Ctr, LLNL,L-231, Livermore, CA 94550 USA. EM patgrant@llnl.gov NR 16 TC 6 Z9 7 PU AMER SOC TESTING MATERIALS PI W CONSHOHOCKEN PA 100 BARR HARBOR DR, W CONSHOHOCKEN, PA 19428-2959 USA SN 0022-1198 J9 J FORENSIC SCI JI J. Forensic Sci. PD JAN PY 2005 VL 50 IS 1 BP 196 EP 203 PG 8 WC Medicine, Legal SC Legal Medicine GA 885WG UT WOS:000226187400030 ER PT J AU Andresen, BD Alcaraz, A Grant, PM AF Andresen, BD Alcaraz, A Grant, PM TI The application of pancuronium bromide (Pavulon) forensic analyses to tissue samples from an "Angel of death" investigation SO JOURNAL OF FORENSIC SCIENCES LA English DT Article DE forensic science; aged exhumation tissues; pancuronium bromide (Pavulon); GC/MS; solid-phase extraction (SPE); liquid chromatography-electrospray mass spectrometry (HPLC-ES-MS/MS); Angel of Death AB The case report of a serial killer who worked at several hospitals as a respiratory therapist is presented. The suspect was initially labeled a benevolent Angel of Death who ended the suffering of elderly patients through mercy killing. However, his subsequently declared motive for homicide was very different from other similar cases in medical settings. The application of new analysis techniques for the detection of pancuronium bromide in a series of aged exhumation tissues gave positive results and led to the resultant conviction of the therapist. C1 LLNL, Forens Sci Ctr, Livermore, CA 94550 USA. RP Grant, PM (reprint author), LLNL, Forens Sci Ctr, L-231, Livermore, CA 94550 USA. EM patgrant@llnl.gov NR 8 TC 4 Z9 4 PU AMER SOC TESTING MATERIALS PI W CONSHOHOCKEN PA 100 BARR HARBOR DR, W CONSHOHOCKEN, PA 19428-2959 USA SN 0022-1198 J9 J FORENSIC SCI JI J. Forensic Sci. PD JAN PY 2005 VL 50 IS 1 BP 215 EP 219 PG 5 WC Medicine, Legal SC Legal Medicine GA 885WG UT WOS:000226187400033 ER PT J AU Cooper, A Nutley, M MacLean, EJ Cameron, K Fielding, L Mestres, J Palin, R AF Cooper, A Nutley, M MacLean, EJ Cameron, K Fielding, L Mestres, J Palin, R TI Mutual induced fit in cyclodextrin-rocuronium complexes SO ORGANIC & BIOMOLECULAR CHEMISTRY LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENT; MOLECULAR-MECHANICS; CRYSTAL-STRUCTURE; CONFORMATIONAL EQUILIBRIA; GAMMA-CYCLODEXTRIN; AMINO STEROIDS; BENZENE DIMER; PANCURONIUM; REVERSAL; BROMIDE AB The binding of rocuronium bromide to 6-perdeoxy-6-per(4-carboxyphenyl) thio-γ-cyclodextrin sodium salt, displays biphasic behaviour characteristic of the formation of a binary and 2 : 1 ternary guest-host complex in aqueous solution. Thermodynamic and structural data on this sequential complexation process can be rationalised within a single model involving switching of the conformational equilibria of both the rocuronium bromide and cyclodextrin molecules. Isothermal titration calorimetry (ITC), NMR and. fluorescence experiments in solution, together with X-ray crystallography and molecular modelling, suggest that in order to induce encapsulation both rocuronium bromide and the modified cyclodextrin undergo conformational changes. Ring A of rocuronium bromide `switches' from the more sterically encumbered chair to the sterically less demanding twist-boat, whilst the modified cyclodextrin "opens" its cavity to allow the steroid to enter. The recognition and mutual induced fit between cyclodextrin and steroid represents a classic example of dynamic host-guest chemistry. C1 Organon Res, Dept Chem, Newhouse ML1 5SH, Scotland. Univ Glasgow, Dept Chem, Glasgow G12 8QQ, Lanark, Scotland. CCLRC, Daresbury Lab, Warrington WA4 4AD, Cheshire, England. RP Palin, R (reprint author), Organon Res, Dept Chem, Newhouse ML1 5SH, Scotland. EM r.palin@organon.co.uk RI Mestres, Jordi/B-3673-2009; Cooper, Alan/F-7813-2011 OI Cooper, Alan/0000-0001-6709-7343 NR 40 TC 11 Z9 11 PU ROYAL SOC CHEMISTRY PI CAMBRIDGE PA THOMAS GRAHAM HOUSE, SCIENCE PARK, MILTON RD, CAMBRIDGE CB4 0WF, CAMBS, ENGLAND SN 1477-0520 J9 ORG BIOMOL CHEM JI Org. Biomol. Chem. PY 2005 VL 3 IS 10 BP 1863 EP 1871 DI 10.1039/b415903a PG 9 WC Chemistry, Organic SC Chemistry GA 925QI UT WOS:000229067300010 ER PT J AU Myasoedov, BF Maryutina, TA Litvina, MN Malikov, DA Kulyako, YM Spivakov, BY Hill, C Adnet, JM Lecomte, M Madic, C AF Myasoedov, BF Maryutina, TA Litvina, MN Malikov, DA Kulyako, YM Spivakov, BY Hill, C Adnet, JM Lecomte, M Madic, C TI Americium(III)/curium(III) separation by countercurrent chromatography using malonamide extractants SO RADIOCHIMICA ACTA LA English DT Article DE radionuclide separations; purification; countercurrent chromatography; malonamide extractants; resolution ID TRUEX PROCESS; ELEMENTS; SOLVENT; WASTE AB The separation of Am(III) and Cm(III) by countercurrent chromatography (CCC) was achieved using the liquid phase systems "diamide-hydrogenated tetrapropylene (TPH)-HNO(3)" following the optimisation of: (i) the compositions of the mobile (HNO(3) concentration) and the stationary (nature of the diamide and its concentration in TPH) phases, (ii) column length and (iii) operating parameters of the CCC (flow rate of the mobile phase and rotation speed of the coil column). The following diamide extractants have been studied: (i) N,N'-dimethyl-N,N-dibutyltetradecylmalonamide (DMDB-TDMA), (ii) N,N'-dimethyl-N,N'-dioctylhexyl-ethoxymalonamide (DMDOHEMA) and (iii) N,N'-dimethyl-N,N'-dibutyldodecylethoxymalonamide (DMDBDDEMA). It is shown that these diamides can be used for the separation of Am(III) and Cm(III) by CCC. Increasing the column length leads to an increase of the stationary phase retention on the column while improving the Am/Cm separation. Increasing the speed of rotation of the centrifuge from 660 to 950 rpm also results in increasing the stationary phase retention but does not influence the resolution of the Am/Cm separation. Decreasing the flow rate of the mobile phase from 1.0 to 0.5 mL/min leads to a better resolution of Am and Cm separation. The best Am/Cm separation was achieved with systems based on DMDBDDEMA and DMDOHEMA in TPH using a two-layer coil column and an isocratic elution mode. The application of CCC makes it possible to separate the elements within 100 min: the Cm fraction contains 99.5% of Cm(III) and 0.6% of Am(III) inventories and the Am fraction contains 99.4% of Am(III) and 0.5% of Cm(III). C1 CEA, DEN, VRH, DRCP,SCPS, F-30207 Bagnols Sur Ceze, France. CEA, DEN, DDIN, F-91191 Gif Sur Yvette, France. Russian Acad Sci, VI Vernadskii Inst Geochem & Analyt Chem, Moscow, Russia. RP Hill, C (reprint author), CEA, DEN, VRH, DRCP,SCPS, BP 17171, F-30207 Bagnols Sur Ceze, France. EM clement.hill@cea.fr NR 27 TC 5 Z9 5 PU OLDENBOURG VERLAG PI MUNICH PA LEKTORAT MINT, POSTFACH 80 13 60, D-81613 MUNICH, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 2005 VL 93 IS 1 BP 9 EP 15 DI 10.1524/ract.93.1.9.58300 PG 7 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 898RM UT WOS:000227093900002 ER PT J AU Salminen, S Paatero, J Jaakkola, T Lehto, J AF Salminen, S Paatero, J Jaakkola, T Lehto, J TI Americium and curium deposition in Finland from the Chernobyl accident SO RADIOCHIMICA ACTA LA English DT Article DE americium; curium; Chernobyl; deposition; peat ID GLOBAL FALLOUT; PLUTONIUM; ELEMENTS; SAMPLES; URANIUM; ALPHA; SPECTROMETRY; PARTICLES; CLADONIA; RATIOS AB Am-241 and Cm-244 were analysed from peat samples collected in Finland immediately after the Chernobyl accident. The separation method included co-precipitation, anion exchange and extraction chromatography. Activities of Am-241 and Cm-244 were measured by alpha spectrometry. The activity of Chernobyl-derived Am-241 varied between 0.0115 and 9.32Bq/m(2) and that of Cm-244 from < 0.002 to 1.97 Bq/m(2) (reference date 1.5.1986). The origin of Am-241 in Finland is predominantly from atmospheric nuclear tests. However, the geographical distribution of Chernobyl-americium is uneven and depending on a location even 100% of Am-241 in peat originated from the Chernobyl accident. The deposition pattern of Chernobyl-derived Am-241 and Cm-244 resembles that of other refractory nuclides, such as Zr-95, Ce-141 and (239,240) Pu. C1 Univ Helsinki, Lab Radiochem, FIN-00014 Helsinki, Finland. Finnish Meteorol Inst, Air Qual Res, FIN-00101 Helsinki, Finland. RP Salminen, S (reprint author), Univ Helsinki, Lab Radiochem, POB 55, FIN-00014 Helsinki, Finland. EM susanna.salminen@helsinki.fi NR 34 TC 12 Z9 13 PU OLDENBOURG VERLAG PI MUNICH PA LEKTORAT MINT, POSTFACH 80 13 60, D-81613 MUNICH, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 2005 VL 93 IS 12 BP 771 EP 779 DI 10.1524/ract.2005.93.12.771 PG 9 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 000RK UT WOS:000234479900007 ER PT J AU Nishi, M Itoh, H Tsubokawa, T Taniguchi, T Yamamoto, K AF Nishi, M Itoh, H Tsubokawa, T Taniguchi, T Yamamoto, K TI Effective doses of vecuronium in a patient with myotonic dystrophy SO ANAESTHESIA LA English DT Article DE myotonic dystrophy; vecuronium ID ADDUCTOR POLLICIS MUSCLES; ORBICULARIS OCULI; NEUROMUSCULAR BLOCKADE; CORRUGATOR SUPERCILII; ATRACURIUM; DIAPHRAGM AB Of the forms of muscular dystrophy, myotonic dystrophy has the greatest systemic involvement. Although most patients with myotonic dystrophy show normal sensitivity to non-depolarising neuromuscular blocking drugs, some have been reported to show greatly increased sensitivity to these drugs, and little is known about the sensitivity of different muscles. We compared effective doses of vecuronium in a patient with myotonic dystrophy at the orbicularis oculi, adductor pollicis and flexor hallucis brevis muscles during total intravenous anaesthesia. The calculated ED50 for the orbicularis oculi (7.77 mug.kg(-1) (95% CI 3.10-16.8 mug.kg(-1))) was lower than for the adductor pollicis (25.3 mug.kg(-1) (95% CI 20.7-43.3 mug.kg(-1))) and flexor hallucis brevis muscles (29.5 mug.kg(-1) (95% CI 11.0-85.6 mug.kg(-1); p < 0.01)). The ED90 was also lower for the orbicularis oculi (35.7 mug.kg(-1) (95% CI 14.8-66.5 mug.kg(-1))) than for the other muscles (51.8 mug.kg(-1) (95% CI 29.3-145.0 mug.kg(-1)) and 50.6 mug.kg(-1) (95% CI 5.29-642.0 mug.kg(-1)), respectively) (p < 0.01)). C1 Kanazawa Univ, Grad Sch Med Sci, Dept Emergency & Crit Care Med, Kanazawa, Ishikawa 9208641, Japan. Kanazawa Univ, Grad Sch Med Sci, Dept Anaesthesiol & Intens Care Med, Kanazawa, Ishikawa 9208641, Japan. RP Nishi, M (reprint author), Kanazawa Univ, Grad Sch Med Sci, Dept Anaesthesiol & Intens Care Med, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan. EM masatosi@anaesth.m.kanazawa-u.ac.jp NR 9 TC 7 Z9 8 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD DEC PY 2004 VL 59 IS 12 BP 1216 EP 1218 DI 10.1111/j.1365-2044.2004.03926.x PG 3 WC Anesthesiology SC Anesthesiology GA 872HC UT WOS:000225197300013 ER PT J AU Agarwal, A Pandey, R Dhiraaj, S Singh, PK Raza, M Pandey, CK Gupta, D Choudhury, A Singh, U AF Agarwal, A Pandey, R Dhiraaj, S Singh, PK Raza, M Pandey, CK Gupta, D Choudhury, A Singh, U TI The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANESTHETIC REQUIREMENTS; LOCAL-ANESTHETICS; SKIN INCISION; BLOCK; CONSCIOUSNESS; ALFENTANIL; LIGNOCAINE AB The growing interest in combining local and general anesthesia has led to studies investigating possible interactions between general anesthesia and local anesthetics administered via spinal, epidural, IV, or IM routes. However, no study has evaluated the effect of local anesthetics on all three components of balanced anesthesia, i.e., hypnosis, analgesia, and muscle relaxation. In this prospective, randomized, double-blind study, we investigated the effect of epidural bupivacaine on the dose requirement of propofol (as evaluated by using the bispectral index [BIS]), fentanyl, and vecuronium for general anesthesia. This study consisted of 30 adults, ASA physical status I and 11, undergoing Whipple's pancreaticoduodenectomy for periampullary carcinoma lasting >4 h. An epidural catheter was placed between T9-10. Depending on the group allocation, 10 mL of the study drug was administered as a bolus followed by an infusion at 6 mL/h via the epidural catheter. Patients were divided into 2 groups of 15 each. Patients in the control group received epidural normal saline whereas those in the bupivacaine group received epidural bupivacaine 0.1%. Induction of anesthesia was performed with IV fentanyl 2 mug/kg and propofol titrated to achieve BIS between 40-50. Endotracheal intubation was facilitated by the IV administration of vecuronium 0.1 mg/kg and patient's lungs were ventilated with 66% nitrous oxide in oxygen. After intubation, infusion of propofol 1% was titrated to maintain BIS between 40-50. Inadequate analgesia was defined as an increase in systolic blood pressure and/or heart rate by >20% of baseline values in response to surgical stimulus and was treated with bolus fentanyl 0.5 mug/kg. Neuromuscular monitoring was used to assess the need for additional doses of vecuronium. Data were analyzed by using the Student's t-test and P less than or equal to0.05 was considered significant. The requirement of propofol for induction and maintenance of anesthesia in the bupivacaine group was 1.3 +/- 0.3 mg/kg and 2.4 +/- 0.9 mg . kg(-1) . h(-1), respectively, compared with 2.4 +/- 0.6 mg/kg and 4.4 +/- 1.6 mg . kg(-1) . h(-1) observed in the control group (P <0.05). Significant reduction was also observed in the requirement of vecuronium and fentanyl during maintenance in the bupivacaine group (P <0.05). We conclude that epidural bupivacaine given before induction of anesthesia reduces the requirement of propofol, fentanyl, and vecuronium during general anesthesia. C1 Sanjay Gandhi Postgrad Inst Med Sci, Dept Anesthesia, Lucknow 226014, Uttar Pradesh, India. Sanjay Gandhi Postgrad Inst Med Sci, Dept Biostat, Lucknow 226014, Uttar Pradesh, India. RP Agarwal, A (reprint author), Sanjay Gandhi Postgrad Inst Med Sci, Dept Anesthesia, Type 4-48, Lucknow 226014, Uttar Pradesh, India. EM aagarwal@sgpgi.ac.in NR 23 TC 17 Z9 22 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 2004 VL 99 IS 6 BP 1684 EP 1688 DI 10.1213/01.ANE.0000136422.70531.5A PG 5 WC Anesthesiology SC Anesthesiology GA 874HN UT WOS:000225341600020 ER PT J AU Herweling, A Latorre, F Herwig, A Horstick, G Kempski, O Gervais, HW AF Herweling, A Latorre, F Herwig, A Horstick, G Kempski, O Gervais, HW TI The hemodynamic effects of ephedrine on the onset time of rocuronium in pigs SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCK; CARDIAC-OUTPUT; VECURONIUM; ESMOLOL AB Several studies have found a correlation between the onset time of muscle relaxants, cardiac index, and muscle blood flow. Ephedrine increases these hemodynamic variables and shortens onset time of rocuronium in humans. Our aim in this animal study was to determine the effect of ephedrine on the onset time of rocuronium, cardiac index, and muscle blood flow after administration of thiopental. At predefined measuring points, mean arterial blood pressure and cardiac index were measured invasively and onset time was determined mechanomyographically. Twenty-four pigs were randomly assigned to three groups. Group I received etomiclate and subsequently rocuronium (2 X 95% effective dose). Instead of etomidate, Group II received thiopental. In Group III, ephedrine 100 mug/kg was given before thiopental; additionally, muscle blood flow was measured (fluorescent microspheres). Although there were differences in hemodynamics between Groups I and II, this was not reflected in different onset times of rocuronium. In Group III, ephedrine compensated the thiopental-induced decrease of mean arterial blood pressure, cardiac index, and muscle blood flow, but no significant shortening of onset time (Group I: 74 +/- 21 s; Group II: 71 +/- 24; Group III: 69 +/- 22 s) was found. Our results demonstrated that ephedrinerelated increases in cardiac index and blood flow did not shorten onset time of rocuronium in healthy pigs. C1 Univ Mainz, Dept Anesthesiol, D-55131 Mainz, Germany. Univ Mainz, Med Clin 2, D-55131 Mainz, Germany. Univ Mainz, Inst Neurosurg Pathophysiol, D-55131 Mainz, Germany. RP Herweling, A (reprint author), Univ Mainz, Dept Anesthesiol, Langenbeckstr 1, D-55131 Mainz, Germany. EM herweling@uni-mainz.de NR 17 TC 1 Z9 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 2004 VL 99 IS 6 BP 1703 EP 1707 DI 10.1213/01.ANE.0000136846.86357.B9 PG 5 WC Anesthesiology SC Anesthesiology GA 874HN UT WOS:000225341600024 ER PT J AU Ikemba, CM Su, JT Stayer, SA Miller-Hance, WC Eidem, BW Bezold, LI Hall, SR Havemann, LM Andropoulos, DB AF Ikemba, CM Su, JT Stayer, SA Miller-Hance, WC Eidem, BW Bezold, LI Hall, SR Havemann, LM Andropoulos, DB TI Myocardial performance index with sevoflurane-pancuronium versus fentanyl-midazolam-pancuronium in infants with a functional single ventricle SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT World Congress of Anesthesiologists Meeting CY APR 24, 2004 CL Paris, FRANCE ID CONGENITAL HEART-DISEASE; SYSTEMIC BLOOD-FLOW; QUANTITATIVE ASSESSMENT; HEALTHY-CHILDREN; TISSUE DOPPLER; NORMAL VALUES; VELOCITIES; PHARMACOKINETICS; HALOTHANE; ECHOCARDIOGRAPHY AB Background: Patients with congenital heart disease characterized by a functional single ventricle make up an increasing number of patients presenting for cardiac or noncardiac surgery. Conventional echocardiographic methods to measure left ventricular function, ie., ejection fraction, are invalid in these patients because of altered ventricular geometry. Two recently described Doppler echocardiographic modalities, the myocardial performance index and Doppler tissue imaging, can be applied to single-ventricle patients because they are independent of ventricular geometry. This study assessed the changes in myocardial performance index and Doppler tissue imaging in response to two anesthetic regimens, fentanyl-midazolam pancuronium and sevoflurane-pancuronium. Methods: Thirty patients aged 4-12 months with a functional single ventricle were randomized to receive fentanyl-midazolam or sevoflurane. Myocardial performance index and Doppler tissue imaging were measured by transthoracic echocardiography at baseline and two clinically relevant dose levels. Results: Sixteen patients receiving sevoflurane and 14 receiving fentanyl-midazolam were studied. Myocardial performance index was unchanged from baseline with either agent (fentanyl-midazolam: 0.50 +/- 15 baseline vs. 0.51 +/- 0.15 at dose 2; sevoflurane: 0.42 +/- 0.14 baseline vs. 0.46 +/- 0.09 at dose 2). Doppler tissue imaging S (systolic)- and E (early diastolic) wave velocities in the lateral ventricular walls at the level of the atrioventricular valve annulus were unchanged in the sevoflurane group; however, both Doppler tissue imaging S- and E-wave velocities were decreased significantly from baseline at dose 1 and dose 2 with fentanyl-midazolam, consistent with decreased longitudinal systolic and diastolic ventricular function. Conclusions: Myocardial performance index, a global measurement of combined systolic and diastolic ventricular function, is not affected by commonly used doses of fentanyl-midazolam or sevoflurane in infants with a functional single ventricle. C1 Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA. Texas Childrens Hosp, Pediat Cardiol Sect, Houston, TX 77030 USA. Baylor Coll Med, Dept Anesthesiol, Houston, TX 77030 USA. RP Andropoulos, DB (reprint author), Texas Childrens Hosp, Div Pediat Cardiovasc Anesthesiol, 621 Fannin,WT19345H, Houston, TX 77030 USA. EM dra@bcm.tmc.edu NR 45 TC 17 Z9 18 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 2004 VL 101 IS 6 BP 1298 EP 1305 PG 8 WC Anesthesiology SC Anesthesiology GA 874WD UT WOS:000225380200008 ER PT J AU Mencke, T Schreiber, JU Knoll, H Stracke, C Kleinschmidt, S Rensing, H Silomon, M AF Mencke, T Schreiber, JU Knoll, H Stracke, C Kleinschmidt, S Rensing, H Silomon, M TI Women report more pain on injection of a precurarization dose of rocuronium: A randomized, prospective, placebo-controlled trial SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE gender; injection; neuromuscular-blocking drugs; pain perception; pain; rocuronium; sex ID SPONTANEOUS MOVEMENTS; PREVENTION; LIDOCAINE; ANALGESIA; FENTANYL; BROMIDE; GENDER; FEMALE AB Background: The purpose of this study was to investigate whether gender influences the perception of pain on injection of rocuronium. Methods: In this prospective, placebo-controlled trial 120 patients were randomized into four groups to receive rocuronium 0.03 mg kg(-1) (40 female and 40 male patients) or saline (20 female and 20 male patients). The incidence and severity of the injection pain after administration of the study drug was compared between female and male patients using a numerical rating scale (0-10). Signs of local irritation, i.e. erythema and thrombophlebitis, were assessed up to 48 h after surgery. Results: In 26 (32.5%) of the 80 patients receiving rocuronium, pain on injection was observed. This occurred significantly more frequently in the female compared with male patients: 18 (45%) vs. eight (20%), respectively (P = 0.032). The severity was more pronounced in the women than in the men (P = 0.020). The incidence of the rocuronium-associated pain was significantly increased compared with the Saline groups (P < 0.001). After surgery no patient complained of any residual pain and no local signs were observed in any patient during the study period. Conclusions: Women experienced more pain on injection of rocuronium than men, moreover this is an additional evidence for gender-related differences in pain perception. When rocuronium is used as a precurarization agent, an analgesic pretreatment (e.g. opioids) should be considered, especially for female patients. C1 Univ Saarland, Dept Anaesthesia & Intens Care Med, D-66421 Homburg, Germany. RP Mencke, T (reprint author), Univ Saarland, Dept Anaesthesia & Intens Care Med, D-66421 Homburg, Germany. EM thomas.mencke@uniklinik-saarland.de RI Schreiber, Jan-Uwe/B-1340-2012 NR 18 TC 12 Z9 13 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD NOV PY 2004 VL 48 IS 10 BP 1245 EP 1248 DI 10.1111/j.1399-6576.2004.00506.x PG 4 WC Anesthesiology SC Anesthesiology GA 865TW UT WOS:000224727100005 ER PT J AU Karanovic, N Jukic, M Carev, M Kardum, G Dogas, Z AF Karanovic, N Jukic, M Carev, M Kardum, G Dogas, Z TI Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE halothane; inhalational anesthesia; muscle relaxants; oculocardiac reflex; pediatric anesthesia; rocuronium; squint surgery; strabismus; succinylcholine ID STRABISMUS SURGERY; ANESTHESIA; DRUGS AB Background: The oculocardiac reflex (OCR) may be activated during squint surgery. The aim of this study was to test whether rocuronium 0.4 mg kg(-1) could reduce the frequency of OCR, and also whether a single dose of succinylcholine 1 mg kg(-1) could affect the frequency of OCR during anesthesia with halothane in a nitrous oxide/oxygen mixture. Methods: A total of 161 ASA I children, 3-10 years old, undergoing elective surgery of the medial rectus muscle (MRM) were randomly assigned to three groups. Group R (n = 51), received 0.4 mg kg(-1) of rocuronium intravenously before endotracheal intubation. Group S (n = 58) received 1 mg kg(-1) of succinylcholine. Group C (controls, n = 52) received no relaxant. Oculocardiac reflex was defined as a reduction in heart rate (HR) >= 15% and/or the appearance of any other arrhythmias, during manipulation of the MRM. Analysis of variance (ANOVA), chi-squared, Kruskal-Wallis, and Student's t-tests were used for statistical analysis; P< 0.05 was considered statistically significant. Results: In group R, OCR occurred in 15/51 (29%) of children, in group S in 31/58 (53%), and in group C in 23/52 (44%) (chi(2) = 6.46, P = 0.049). In group R, the incidence of arrhythmias such as nodal rhythms, supraventricular and ventricular premature beats was 6%, compared with 22% in group S and 19% in group C (chi(2) = 6.01, P = 0.040). However, there was no reduction in the occurrence of bradycardia (chi(2) = 0.16, P = 0.924)., Conclusion: Rocuronium reduced the frequency of OCR, mainly by reducing the incidence of supraventricular and ventricular premature beats. C1 Univ Split Med Sch, Dept Neurosci, Split 21000, Croatia. Univ Hosp Split, Dept Anesthesiol & Intens Care, Split, Croatia. RP Dogas, Z (reprint author), Univ Split Med Sch, Dept Neurosci, Soltanska 2, Split 21000, Croatia. EM zdogas@bsb.mefst NR 20 TC 8 Z9 14 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD NOV PY 2004 VL 48 IS 10 BP 1301 EP 1305 DI 10.1111/j.1399-6576.2004.00523.x PG 5 WC Anesthesiology SC Anesthesiology GA 865TW UT WOS:000224727100014 ER PT J AU Kunitz, O Baumert, JH Hecker, K Beeker, T Coburn, M Zuhlsdorff, A Rossaint, R AF Kunitz, O Baumert, JH Hecker, K Beeker, T Coburn, M Zuhlsdorff, A Rossaint, R TI Xenon does not prolong neuromuscular block of rocuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID SEVOFLURANE ANESTHESIA; VOLATILE ANESTHETICS; HUMAN-TISSUES; ISOFLURANE; SOLUBILITY; RECOVERY; POTENCY; HUMANS AB With the exception of xenon, the interaction between muscle relaxants and inhaled anesthetics is known. We therefore compared the pharmacodynamics of rocuronium during xenon anesthesia versus a total IV anesthesia with propofol. Anesthesia was induced with propofol and remifentanil in both the xenon and propofol groups (each n = 20). The xenon group received xenon via face mask until an end-expiratory concentration of 60% was maintained for 1 min. Meanwhile, the acceleromyograph (TOF-Watch SX(R)) was calibrated and a frequent train-of-four stimulation of the musculus adductor pollicis was started. After stabilization of the signal for 5 min, a single bolus of 0.6 mg/kg rocuronium was injected. Anesthesia was maintained with xenon and remifentanil (xenon group) or with propofol and remifentanil (propofol group). There were no significant differences between the groups concerning the onset time (xenon group 125 +/- 33 and propofol group 144 +/- 43 s), duration (xenon group 33.2 +/- 10.8 and propofol group 32.6 +/- 8.4 min), recovery index (xenon group 9.4 +/- 6.6 and propofol group 8.4 +/- 5.3 min), and clinical recovery (xenon group 18.0 +/- 10.2 and propofol group 17.1 +/- 8.5 min). We conclude that the neuromuscular blocking effects of rocuronium are not different when given during propofol versus xenon anesthesia. C1 Univ Hosp, Rhein Westfal TH Aachen, Dept Anesthesiol, D-52074 Aachen, Germany. RP Kunitz, O (reprint author), Univ Hosp, Rhein Westfal TH Aachen, Dept Anesthesiol, Pauwelsstr 30, D-52074 Aachen, Germany. EM okunitz@ukaachen.de NR 21 TC 8 Z9 13 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 2004 VL 99 IS 5 BP 1398 EP 1401 DI 10.1213/01.ANE.0000132970.64413.E7 PG 4 WC Anesthesiology SC Anesthesiology GA 865ED UT WOS:000224684400022 ER PT J AU Dueck, MH Paul, M Sagawe, P Oberthuer, A Wedekind, C Boerner, U AF Dueck, MH Paul, M Sagawe, P Oberthuer, A Wedekind, C Boerner, U TI Different F-wave recovery after neuromuscular blockade with pancuronium and mivacurium SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT 9th Annual Meeting of the European-Society-of-Anaesthesiologists CY APR 07-10, 2001 CL GOTHENBURG, SWEDEN SP European Soc Anaesthesiologists ID BLOCKING-AGENTS; ATRACURIUM; HUMANS; TUBOCURARINE; VOLUNTEERS; RESPONSES; SYSTEM AB We performed this study to assess the recovery period after neuromuscular blockade by electromyographic F-wave analysis, a method that supplies more information about more proximal parts of the motor system than conventionally used methods, e.g., mechanomyography (MMG). In 20 neurosurgical ASA physical status I or II patients anesthesia was induced and maintained with IV fentanyl and midazolam. Patients were randomly assigned to receive either 0.25 mg/kg mivacurium (NW group, n = 10) or 0.1 mg/kg pancuronium (PC group, n = 10) intraoperatively. MMG monitoring of the adductor pollicis muscle was performed continuously. F waves were recorded at the abductor pollicis muscle of the contralateral hand at train-of-four (TOF) ratios of 0.1, 0.25,0.5, 0.7,0.75,0.8,0.85,0.9, and 0.95. Recovery of F-wave amplitudes after neuromuscular blockade with pancuronium was significantly slower compared with mivacurium (P = 0.004) during the clinically important recovery period defined by MMG TOF ratios from 0.7 to 0.95. This electrophysiologic finding suggests a differential recovery of the motor system after administration of pancuronium and mivacurium not detected by MMG. C1 Univ Cologne, Dept Anesthesiol, D-50924 Cologne, Germany. RP Dueck, MH (reprint author), Univ Cologne, Dept Anesthesiol, Joseph Stelzmann Str 9, D-50924 Cologne, Germany. EM m.dueck@uni-koeln.de NR 21 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 2004 VL 99 IS 5 BP 1402 EP 1407 DI 10.1213/01.ANE.0000135407.11545.36 PG 6 WC Anesthesiology SC Anesthesiology GA 865ED UT WOS:000224684400023 ER PT J AU Reich, DL Hollinger, I Harrington, DJ Seiden, HS Chakravorti, S Cook, DR AF Reich, DL Hollinger, I Harrington, DJ Seiden, HS Chakravorti, S Cook, DR TI Comparison of cisatracurium and vecuronium by infusion in neonates and small infants after congenital heart surgery SO ANESTHESIOLOGY LA English DT Article ID CRITICALLY-ILL PATIENTS; RENAL-FAILURE; ATRACURIUM BESYLATE; PHARMACOKINETICS; PHARMACODYNAMICS; LAUDANOSINE; RECOVERY; 51W89; REQUIREMENTS; UNIT AB Background: Neonates and infants often require extended periods of mechanical ventilation facilitated by sedation and neuromuscular blockade. Methods: Twenty-three patients aged younger than 2 yr were randomly assigned to receive either cisatracurium or vecuronium infusions postoperatively in a double-blinded fashion after undergoing congenital heart surgery. The infusion was titrated to maintain one twitch of a train-of-four. The times to fun spontaneous recovery of train-of-four without fade, extubation, intensive care unit discharge, and hospital discharge were documented after drug discontinuation. Sparse sampling after termination of the infusion and a one-compartment model were used for pharmacokinetic analysis. The Mann-Whitney U test and Student I test were used to compare data between groups. Results: There were no significant differences between groups with respect to demographic data or duration of postoperative neuromuscular blockade infusion. The median recovery time for train-of-four for cisatracurium (30 min) was less than that for vecuronium (180 min) (P < 0.05). Three patients in the vecuronium group had prolonged train-of-four recovery: Two had long elimination half-lives for vecuronium, and one had a high concentration of 3-OH vecuronium. There were no differences in extubation times, intensive care unit stays, or hospital stays between groups. Conclusions: Our results parallel data from adults demonstrating a markedly shorter recovery of neuromuscular transmission after cisatracurium compared with vecuronium. Decreased clearance of vecuronium and the accumulation of 3-OH vecuronium may contribute to prolonged spontaneous recovery times. Cisatracurium is associated with faster spontaneous recovery of neuromuscular function compared with vecuronium but not with any differences in intermediate outcome measures in neonates and infants. C1 Mt Sinai Sch Med, Dept Anesthesiol, New York, NY USA. Mt Sinai Sch Med, Dept Pediat, New York, NY USA. Childrens Hosp Pittsburgh, Pittsburgh, PA 15213 USA. Duke Univ, Med Ctr, Durham, NC 27706 USA. RP Reich, DL (reprint author), Mt Sinai Med Ctr, Dept Anesthesiol, Box 1010,1 Gustave L Levy Pl, New York, NY 10029 USA. EM david.reich@msnyuhealth.org NR 24 TC 4 Z9 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 2004 VL 101 IS 5 BP 1122 EP 1127 DI 10.1097/00000542-200411000-00011 PG 6 WC Anesthesiology SC Anesthesiology GA 865XX UT WOS:000224738600010 ER PT J AU Keles, GT Yentur, A Cavus, Z Sakarya, M AF Keles, GT Yentur, A Cavus, Z Sakarya, M TI Assessment of neuromuscular and haemodynamic effects of cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia in elderly patients SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blocking agents; vecuronium; cisatracurium; action duration; recovery; anaesthesia general; remifentanil; thiopental; sevoflurane; aged ID D-TUBOCURARINE; PHARMACODYNAMICS; PHARMACOKINETICS; ATRACURIUM; BLOCK; PANCURONIUM; ISOFLURANE; HALOTHANE; DURATION; INFUSION AB Background and objective: Neuromuscular block times, quality of muscle relaxation for tracheal tube insertion, and the haemodynamic effects after cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia were compared in elderly patients. Methods: The study was performed in 40 patients over 65 yr of age. Anaesthesia was induced with thiopental, and maintained with sevoflurane in N2O/O-2 and remifentanil. Cisatracurium 0.15 mg kg(-1) or vecuronium 0.1 mg kg(-1) were administered after induction. Intubation was attempted when neuromuscular block was 95%. Onset time, clinical duration of action, recovery index, spontaneous recovery time and tracheal intubation conditions were assessed. Haemodynamic parameters were also monitored. Results: The average ages of the patients were 72.5 +/- 5.1 and 73.6 +/- 6.3 in the cisatracurium and vecuronium groups, respectively. Onset time was significantly shorter after vecuronium, 158 +/- 34 s vs. 200 +/- 50 s, respectively. Recovery index was significantly shorter after cisatracurium, 19.5 +/- 7.5 s vs. 33.7 +/- 18.6 s (P < 0.05). Clinical duration and spontaneous recovery time were similar in both groups as well as haemodynamic variables. Conclusions: In elderly patients, vecuronium has a faster onset time while cisatracurium has a shorter recovery index under sevoflurane-remifentanil anaesthesia. C1 Univ Celal Bayar, Fac Med, Dept Anaesthesiol & Reanimat, TR-45000 Manisa, Turkey. RP Keles, GT (reprint author), Univ Celal Bayar, Fac Med, Dept Anaesthesiol & Reanimat, TR-45000 Manisa, Turkey. EM gonul.keles@bayar.edu.tr NR 21 TC 3 Z9 5 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD NOV PY 2004 VL 21 IS 11 BP 877 EP 881 DI 10.1017/S0265021504000225 PG 5 WC Anesthesiology SC Anesthesiology GA 894TF UT WOS:000226813800008 ER PT J AU Schiere, S Proost, JH Roggeveld, J Wierda, M AF Schiere, S Proost, JH Roggeveld, J Wierda, M TI An interstitial compartment is necessary to link the pharmacokinetics and pharmacodynamics of mivacurium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 14-18, 2000 CL SAN FRANCISCO, CA SP Amer Soc Anesthesiologists DE neuromuscular non-depolarizing agents; mivacurium; pharmacology; pharmacokinetics; pharmacodynamics; cholinesterases; pharmacokinetics ID PLASMA CHOLINESTERASE ACTIVITY; NEUROMUSCULAR BLOCKING-AGENTS; TIME-COURSE; ONSET TIME; MODEL; DRUGS; PHARMACOLOGY; METABOLITES; ANESTHESIA; VECURONIUM AB Background and objective: The time course of action of mivacurium does not correlate with its rapid breakdown by plasma cholinesterase. Pharmacokinetic-pharmacodynamic (PK-PD) modelling was applied to obtain more insight in the concentration-effect relationship. Methods: Fourteen patients between 25 and 55 yr, undergoing non-major surgery, American Society of Anesthesiologists Grade I-II, were included. All patients received thiopentone/fentanyl/isoflurane/oxygen/nitrous oxide anaesthesia. Neuromuscular block was monitored mechanomyographically using single twitch stimulation (0.1 Hz). Mivacurium was administered as a short-term infusion, mean (standard deviation) duration 4.7 (1.0) min and dose 145 (33) mug kg(-1). Arterial blood samples were obtained, and plasma was analysed using high performance liquid chromatography. PK-PD modelling was performed using an iterative Bayesian two-stage approach, assuming that the trans-trans and cis-trans isomers are equally potent. Results: A PK-PD model with an effect compartment linked to plasma did not fit to the data satisfactorily. A model using an interstitial space compartment between plasma and effect compartment fitted significantly better. Parameters (mean (percentage coefficient of variation)) of the best fitting model were: k(ip) 0.374 min(-1) (46%), k(ei) 0.151 min(-1) (36%), EC50 98 mug L-1 (29%) and gamma 3.7 (22%). Conclusions: The PK-PD behaviour of mivacurium could be described using a model with an interstitial space compartment interposed between plasma and effect compartment. This model shows that the time course of mivacurium is mainly governed by the concentration decline in this interposed compartment and only indirectly related to the rapid plasma clearance. C1 Univ Groningen Hosp, Dept Anesthesiol, Res Grp Expt Anesthesiol & Clin Pharmacol, NL-9700 RB Groningen, Netherlands. RP Wierda, M (reprint author), Univ Groningen Hosp, Dept Anesthesiol, Res Grp Expt Anesthesiol & Clin Pharmacol, POB 30-001, NL-9700 RB Groningen, Netherlands. EM j.m.k.h.wierda@anest.azg.nl NR 30 TC 2 Z9 2 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD NOV PY 2004 VL 21 IS 11 BP 882 EP 891 PG 10 WC Anesthesiology SC Anesthesiology GA 894TF UT WOS:000226813800009 ER PT J AU Takenaka, Y Ozaki, T Ohnuki, T AF Takenaka, Y Ozaki, T Ohnuki, T TI Influence of ionic strength on curium(III) and europium(III) sorption on Halomonas elongata SO JOURNAL OF NUCLEAR SCIENCE AND TECHNOLOGY LA English DT Article DE ionic strength; bacteria; curium(III); europium(III); adsorption; Halomonas elongata; cell surface; hydrophobicity ID HALOPHILIC BACTERIUM; CELL-WALL; ACID; PH C1 Japan Atom Energy Res Inst, Adv Sci Res Ctr, Naka, Ibaraki 3191195, Japan. Hiroshima Univ, Grad Sch Biosphere Sci, Higashihiroshima, Hiroshima 7398528, Japan. RP Ohnuki, T (reprint author), Japan Atom Energy Res Inst, Adv Sci Res Ctr, Naka, Ibaraki 3191195, Japan. EM ohnuki@sparclt.tokai.jaeri.go.jp NR 10 TC 1 Z9 1 PU ATOMIC ENERGY SOC JAPAN PI TOKYO PA 1-1-13 SHIMBASHI MINATO-KU, TOKYO, 105, JAPAN SN 0022-3131 J9 J NUCL SCI TECHNOL JI J. Nucl. Sci. Technol. PD NOV PY 2004 VL 41 IS 11 BP 1125 EP 1127 DI 10.3327/jnst.41.1125 PG 3 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 886QP UT WOS:000226243700014 ER PT J AU Oh, AY Kim, SD Kim, CS AF Oh, AY Kim, SD Kim, CS TI Early and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE anaesthetics, inhalation; sevoflurane; cholinesterase inhibitor; pyridostigmine; neuromuscular blocking agents; rocuronium ID INDUCED NEUROMUSCULAR BLOCK; PEDIATRIC-PATIENTS; DOSE-RESPONSE; NEOSTIGMINE; EDROPHONIUM; ADULTS; ANTAGONISTS; VECURONIUM; ATRACURIUM; PANCURONIUM AB This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T-1) recovery; or at a 25% twitch height (T-25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch(R), rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1+/-0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T-25) was 40.1+/-8.8 min and the recovery index (time between T-25 and T-75) 19.9+/-9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T-1 or T-25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium. C1 Seoul Natl Univ, Coll Med, Dept Anesthesiol & Pain Med, Seoul 110744, South Korea. Seoul Natl Univ, Childrens Hosp, Dept Anesthesiol & Pain Med, Seoul 110744, South Korea. RP Oh, AY (reprint author), Seoul Natl Univ, Coll Med, Dept Anesthesiol & Pain Med, 28 Yeongun Dong, Seoul 110744, South Korea. RI Oh, Ah-Young/J-5541-2012 NR 21 TC 0 Z9 1 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD OCT PY 2004 VL 32 IS 5 BP 649 EP 652 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 865ND UT WOS:000224708900006 ER PT J AU Kim, KS Cheong, MA Lee, HJ Lee, JM AF Kim, KS Cheong, MA Lee, HJ Lee, JM TI Tactile assessment for the reversibility of rocuronium-induced neuromuscular blockage during propofol or sevoflurane anesthesia SO ANESTHESIA AND ANALGESIA LA English DT Article ID ISOFLURANE ANESTHESIA; ANTAGONISM; RECOVERY; CISATRACURIUM; TUBOCURARINE; NEOSTIGMINE; VOLUNTEERS; PARALYSIS; REVERSAL; HUMANS AB We sought to determine whether tactile train-of-four (TOF) count can predict the efficacy of neostigmine administration for rocuronium-induced blockade during propofol or sevoflurane anesthesia, and to follow subsequent recovery until the TOF ratio reached 0.9. One-hundred-sixty patients, divided into eight equal groups, were randomly allocated to maintenance of anesthesia with propofol or sevoflurane. The tactile response of the adductor pollicis to TOF stimulation was evaluated on one arm, and the mechanomyographic response was recorded on the other. Neuromuscular block was induced with rocuronium 0.6 mg/kg and maintained with rocuronium to 15% of the control first twitch in TOR Neostigmine 0.07 mg/kg was administered on reappearance of the first (Group I), second (Group II), third (Group III), or fourth (Group IV) tactile TOF response in each anesthesia. At this time, sevoflurane or the propofol dosage was reduced in each group (n = 20 in each group). The times from administration of neostigmine until the TOF ratio recovered to 0.7,0.8, and 0.9 were recorded. The times [median (range)] to TOF ratio = 0.9 were 8.6 (4.7-18.9), 7.5 (3.4-9.8), 5.4 (1.6-8.6), and 4.7 (1.3-7.2) min in Groups I-IV during propofol anesthesia, respectively, and 28.6 (8.8-75.8), 22.6 (8.3-57.4), 15.6 (7.3-43.9), and 9.7 (5.1-26.4) min in corresponding groups during sevoflurane anesthesia, respectively (P < 0.0001). We recommend more than 2 TOF responses with propofol anesthesia and 4 TOF responses with sevoflurane anesthesia for adequate reversal within 10 and 15 min, respectively. The more tactile TOF responses present at the time of reversal achieved greater adequate recovery; however, tactile TOF responses are not a completely reliable predictor within a reasonable time period. C1 Hanyang Univ Hosp, Dept Anesthesiol, Seoul 133792, South Korea. RP Kim, KS (reprint author), Hanyang Univ Hosp, Dept Anesthesiol, 17 Haengdangdong, Seoul 133792, South Korea. EM kimks@hanyang.ac.kr NR 21 TC 17 Z9 18 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 2004 VL 99 IS 4 BP 1080 EP 1085 DI 10.1213/01.ane.0000130616.57678.80 PG 6 WC Anesthesiology SC Anesthesiology GA 856IW UT WOS:000224039900023 ER PT J AU Leykin, Y Pellis, T Lucca, M Lomangino, G Marzano, B Gullo, A AF Leykin, Y Pellis, T Lucca, M Lomangino, G Marzano, B Gullo, A TI The pharmacodynamic effects of rocuronium when dosed according to real body weight or ideal body weight in morbidly obese patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID PHARMACOKINETICS; BROMIDE AB We investigated the pharmacodynamic effects of rocuronium on morbidly obese patients. Twelve morbidly obese female patients (body mass index >40 kg/m(2)) admitted for laparoscopic gastric banding were randomized into two groups. Group 1 (n = 6) received 0.6 mg/kg of rocuronium based on real body weight, whereas Group 2 (n = 6) received 0.6 mg/kg of rocuronium based on ideal body weight. In a control group of six normal-weight female patients admitted for laparoscopic surgery, rocuronium was dosed on the basis of their real body weight. Neuromuscular transmission was monitored by using acceleromyography of the adductor pollicis; anesthesia was induced and maintained with remifentanil and propofol. The onset time tended to be shorter in Group 1 and the control group compared with Group 2, but this did not achieve statistical significance. Duration of action to 25% of twitch tension was more than double in Group 1 (55 min) compared with the other two groups (22 and 25 min; P < 0.001). Duration of action was similar between Group 2 and control. Recovery index tended to be longer in Group 1, but without a significant difference. In conclusion, in morbidly obese patients, the duration of action of rocuronium is significantly prolonged when it is dosed according to real body weight. Therefore, the dosage should be assessed on the basis of ideal rather than on real body weight in clinical practice. C1 Santa Maria Angeli Hosp, Dept Anesthesia Pain Perioperat Med & Intens Care, I-33170 Pordenone, Italy. Univ Trieste, Sch Med, Dept Perioperat Med Intens Care & Emergency, Trieste, Italy. Santa Maria Angeli Hosp, Dept Surg, Pordenone, Italy. RP Leykin, Y (reprint author), Santa Maria Angeli Hosp, Dept Anesthesia & Intens Care, Via Montereale 24, I-33170 Pordenone, Italy. EM Yigal.Leykin@aopn.fvg.it NR 15 TC 31 Z9 34 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 2004 VL 99 IS 4 BP 1086 EP 1089 DI 10.1213/01.ane.0000120081.99080.c2 PG 4 WC Anesthesiology SC Anesthesiology GA 856IW UT WOS:000224039900024 ER PT J AU Leykin, Y Pellis, T Lucca, M Lomangino, G Marzano, B Gullo, A AF Leykin, Y Pellis, T Lucca, M Lomangino, G Marzano, B Gullo, A TI The effects of cisatracurium on morbidly obese women SO ANESTHESIA AND ANALGESIA LA English DT Article ID ROCURONIUM BROMIDE; RENAL-FAILURE; PHARMACOKINETICS; ATRACURIUM; PHARMACODYNAMICS; INTUBATION; ANESTHESIA; VECURONIUM; DURATION; PATIENT AB There is conflicting evidence on the duration of action of atracurium in obese patients. Cisatracurium is one of the stereoisomers of atracurium. We investigated the neuromuscular effects of cisatracurium in morbidly obese patients. Twenty obese female patients (body mass index >40) were randomized in two groups. Group I (n = 10) received 0.2 mg/kg of cisatracurium. on the basis of real body weight (RBW), whereas in Group II (n = 10) the dose was calculated on ideal body weight (IBW). In a control group of 10 normal weight female patients (body mass index 20-24), the dose of cisatracurium was based on RBW. Neuromuscular transmission was monitored using acceleromyography of the adductor pollicis, and anesthesia was induced and maintained with remifentanil and propofol. Onset time was comparable between Group I and the control group (132 s versus 135 s; P = ns). The duration 25% was longer in Group I than in the control group (74.6 min versus 59.1 min; P = 0.01) and in the control group compared with Group 11 (45.0 min; P = 0.016). In conclusion, the duration of action of cisatracurium was prolonged in morbidly obese patients when dosed according to RBW compared with a control group of normal weight patients. Duration was also prolonged in the control group patients compared with morbidly obese patients to whom the drug was administered on the basis of IBW. C1 Santa Marie Angeli Hosp, Dept Anesthesia Pain Perioperat Med & Intens Care, I-33170 Pordenone, Italy. Santa Marie Angeli Hosp, Dept Surg, I-33170 Pordenone, Italy. Univ Trieste, Sch Med, Dept Perioperat Med Intens Care & Emergency, Trieste, Italy. RP Leykin, Y (reprint author), Santa Marie Angeli Hosp, Dept Anesthesia & Intens Care, Via Montereale 24, I-33170 Pordenone, Italy. EM yigal.leykin@aopn.fvg.it NR 28 TC 21 Z9 28 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 2004 VL 99 IS 4 BP 1090 EP 1094 DI 10.1213/01.ane.0000132781.62934.37 PG 5 WC Anesthesiology SC Anesthesiology GA 856IW UT WOS:000224039900025 ER PT J AU Baumann, MH McAlpin, BW Brown, K Patel, P Ahmad, I Stewart, R Petrini, M AF Baumann, MH McAlpin, BW Brown, K Patel, P Ahmad, I Stewart, R Petrini, M TI A prospective randomized comparison of train-of-four monitoring and clinical assessment during continuous ICU cisatracurium paralysis SO CHEST LA English DT Article DE intensive care; monitoring; neuromuscular blockade; paralysis; train-of-four ID NEUROMUSCULAR BLOCKING-AGENTS; INTENSIVE-CARE UNIT; PERIPHERAL-NERVE STIMULATION; CRITICALLY-ILL PATIENTS; BLOCKADE; VECURONIUM; PATIENT AB Study purpose: Train-of-four (TOF) monitoring is often recommended during the continuous use of neuromuscular blockade (NMB) [paralysis] in the ICU. Prior study results are conflicting regarding the benefits of TOF monitoring. Design: Thirty patients in the medical ICU were randomized to TOF monitoring (n = 16) or to clinical assessment (n = 14) during continuous cisatracurium infusion. TOF monitoring was done at least every 4 h, with the goal being maintenance of one to two twitches. Statistical analysis was performed by two-tailed, unpaired t test (with Bonferroni correction for multiple comparisons), X-2, and Fisher exact test, with p < 0.05 considered significant. Given a power of 80%, and the variance seen in the two groups, we estimate that the sample size used is sufficient to detect a change of greater than or equal to 60 min between groups for recovery time. Results: The mean recovery time after cessation of paralytics was no different between TOF and clinical assessment (45 +/- 7 min vs 38 +/- 10 min, respectively [mean SEMI). No differences were noted for mean APACHE (acute physiology and chronic health evaluation) II entry scores, glomerular filtration rates, or use of corticosteroids. No significant differences were noted between TOF monitoring and clinical assessment in mean total paralysis time (4,118 +/- 1,012 min vs 3,188 +/- 705 min, respectively), mean total cisatracurium dose (920 +/- 325 mg vs 715 +/- 167 mg), or dosage (2.3 +/- 0.2 mug/kg/min vs 2.9 +/- 0.2 mug/kg/min). Conclusions: TOF monitoring does not lead to improved recovery time or lower cisatracurium dosing compared with monitoring by clinical assessment. We conclude that TOF monitoring is unnecessary, and careful titration of the neuromuscular blocking agent by clinical assessment alone is sufficient in patients undergoing continuous cisatracurium NMB. C1 Univ Mississippi, Med Ctr, Div Pulm & Crit Care Med, Jackson, MS 39216 USA. RP Baumann, MH (reprint author), Univ Mississippi, Med Ctr, Div Pulm & Crit Care Med, 2500 N State St, Jackson, MS 39216 USA. EM mbaumann@medicine.unsmed.edu NR 16 TC 11 Z9 12 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD OCT PY 2004 VL 126 IS 4 BP 1267 EP 1273 DI 10.1378/chest.126.4.1267 PG 7 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 864ZY UT WOS:000224673100043 ER PT J AU Maidatsi, RG Zaralidou, AT Gorgias, NK Amaniti, EN Karakoulas, KA Giala, MM AF Maidatsi, RG Zaralidou, AT Gorgias, NK Amaniti, EN Karakoulas, KA Giala, MM TI Rocuronium duration of action under sevoflurane, desflurane or propofol anaesthesia SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE anaesthetics inhalation; sevoflurane; desflurane; anaesthetics intravenous; propofol; neuromuscular blocking agents; rocuronium; monitoring; duration of action ID MINIMUM ALVEOLAR CONCENTRATION; TIME-COURSE; NEUROMUSCULAR BLOCKADE; ISOFLURANE ANESTHESIA; ADDUCTOR POLLICIS; VECURONIUM; POTENTIATION; HALOTHANE; ORG-9426; POTENCY AB Background and objective: We conducted a prospective randomized study to evaluate whether the duration of action of a single bolus dose of rocuronium is influenced by maintenance of anaesthesia with sevoflurane, desflurane or propofol infusion. Methods: Fifty-seven ASA I-II patients undergoing elective abdominal surgery were enrolled in this study. Anaesthesia was induced with thiopental 3-5 mg kg(-1) or propofol 2.5 mg kg(-1) and fentanyl 5 mug kg(-1) and tracheal intubation was facilitated with rocuronium 0.9 mg kg(-1). Thereafter patients were randomly allocated to three different groups to receive sevoflurane, desflurane or propofol for maintenance of anaesthesia. Recovery of neuromuscular function was monitored by single twitch stimulation of the ulnar nerve and by recording the adductor pollicis response using accelerometry. Intergroup recovery times to 5% of control value of single twitch were analysed using analysis of variance with Bonferroni correction. Results: The mean (95176 confidence interval) recovery time to 5916 of control value of single twitch during desflurane anaesthesia was 90.18 (86.11-94.25) min. Significantly shorter recovery times were observed during sevoflurane or propofol anaesthesia, 58.86 (54.73-62.99) min and 51.11 (45.47-56.74) min, respectively (P < 0.001). There were also significant differences in the recovery time between groups receiving desflurane vs. sevoflurane (P < 0.001) and desflurane vs. propofol (P < 0.001). Conclusions: Desflurane anaesthesia significantly prolongs the duration of action of rocuronium at 0.9 mg kg(-1) single bolus dose, compared to sevoflurane or propofol anaesthesia maintenance regimens. C1 AHEPA Univ Hosp, Dept Anesthesiol, Thessaloniki 54632, Greece. St Demetrios Gen Hosp, Dept Anaesthesiol, Thessaloniki, Greece. RP Maidatsi, RG (reprint author), AHEPA Univ Hosp, Dept Anesthesiol, Sachini 30, Thessaloniki 54632, Greece. EM mpanagio@panafonet.gr NR 17 TC 0 Z9 0 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD OCT PY 2004 VL 21 IS 10 BP 781 EP 786 PG 6 WC Anesthesiology SC Anesthesiology GA 885ZI UT WOS:000226195500005 ER PT J AU Delogu, G Antonelli, A Signore, M Marcucci, L Petrinelli, P Tellan, G Antonucci, A Elli, R AF Delogu, G Antonelli, A Signore, M Marcucci, L Petrinelli, P Tellan, G Antonucci, A Elli, R TI Chromosome instability in T-cells cultured in the presence of pancuronium or fentanyl SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE apoptosis; fentanyl; genomic instability; pancuronium; telomeric association; chromosome instability ID TELOMERIC ASSOCIATIONS; IN-VITRO; APOPTOSIS; STABILITY; LEUKEMIA; BLOOD; DEATH AB Background: Genomic instability is recognized as a cause of cellular apoptosis and certain drugs that exhibit a proapoptotic effect are also able to induce chromosome damage. Since we found in recent experiments that drugs such as pancuronium and fentanyl exerted an apoptogenic effect on T cells, we studied the capacity of those agents to promote chromosome instability, i.e. chromosome aberrations (CA) and telomeric associations (tas) in peripheral blood lymphocytes. Methods: Lymphocytes from healthy donors were cultured with pancuronium or fentanyl, using two different concentrations for each drug: 20 and 200 ng/ml for pancuronium and 10 and 30 ng/ml for fentanyl, respectively. Cells were exposed to each concentration of these drugs either for 24 or 48 h. The higher concentration chosen was the same at which we detected the proapoptotic effect in our previous works. Cytogenetic analysis was performed by means of a standard technique and chromosome aberrations or telomeric associations were blindly evaluated by two independent observers. Results: The chromosome aberrations we observed in treated cells were not significantly different from control lymphocytes. However, an unusual rate of telomeric associations (P < 0.001) was detected in cells exposed to both pancuronium and fentanyl, at each concentration tested and at each exposure time of the study. Conclusions: Fentanyl and pancuronium do not have a direct clastogenic effect on T cultures, but at the same concentrations at which we demonstrated their apoptogenic power, these drugs are able to increase genomic instability through inducing an elevated rate of telomeric associations. Such a capacity could exploit in peripheral T cells the same mitochondrion-mediated signal pathway of apoptosis death. C1 Univ Roma La Sapienza, Dept Anesthesia & Intens Care, Rome, Italy. Univ Roma La Sapienza, Dept Cellular Biotechnol & Hematol, Rome, Italy. Ist Super Sanita, Dept Hematol Oncol & Mol Med, Rome, Italy. RP Delogu, G (reprint author), Policlin Umberto 1, Dept Anesthesia & Intens Care, I-00161 Rome, Italy. EM giovanna.delogu@uniroma1.it NR 23 TC 2 Z9 2 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD SEP PY 2004 VL 48 IS 8 BP 968 EP 972 DI 10.1111/j.1399-6576.2004.00453.x PG 5 WC Anesthesiology SC Anesthesiology GA 847FT UT WOS:000223378800006 ER PT J AU Tuncali, B Karci, A Tuncah, BE Mavioglu, O Guner, CG Ayhan, S Elar, Z AF Tuncali, B Karci, A Tuncah, BE Mavioglu, O Guner, CG Ayhan, S Elar, Z TI Dilution of rocuronium to 0.5 mg/mL with 0.9% NaCl eliminates the pain during intravenous injection in awake patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID BROMIDE; LIDOCAINE AB In a randomized, double-blinded, controlled study, we evaluated the effect of diluting rocuronium 10 mg/mL to 1 or 0.5 mg/mL with 0.9% NaCl on the pain associated with IV administration of rocuronium with small doses given before succinylcholine or nondepolarizing agent administration. One hundred fifty patients undergoing surgical procedures that required general anesthesia were randomized into three groups. Group 1 received rocuronium 10 mg/mL. Groups 2 and 3 received I and 0.5 mg/mL of rocuronium, respectively. Patient demographics, pain scores, osmolality, and the pH of the solutions were recorded. Group 1 had the most intense and frequent pain response. Eighty percent of patients in this group reported pain on injection. In Group 2, the incidence and intensity of pain were significantly less when compared with those of Group 1. In this group, 38% of patients reported pain during injection. In Group 3, none of the patients experienced pain on injection. The pH values and osmolalities of study solutions were not significantly different among groups. In conclusion, in awake patients, dilution of rocuronium. 10 mg/mL at small doses given before succinylcholine or nondepolarizing agent administration of 0.06 mg/kg to 0.5 mg/mL with 0.9% NaCl is a simple and cost-effective strategy for preventing pain during IV rocuronium injection. C1 Dokuz Eylul Univ, Dept Anesthesiol & Reanimat, Izmir, Turkey. RP Tuncali, B (reprint author), Sumbul Sok,42-11 Narlidere, Izmir, Turkey. EM bahattin.tuncali@deu.edu.tr NR 18 TC 12 Z9 15 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 2004 VL 99 IS 3 BP 740 EP 743 DI 10.1213/01.ANE.0000130005.94395.B2 PG 4 WC Anesthesiology SC Anesthesiology GA 847XC UT WOS:000223430300020 ER PT J AU Robertson, EN Driessen, JJ Booij, LHDJ AF Robertson, EN Driessen, JJ Booij, LHDJ TI Suxamethonium administration prolongs the duration of action of subsequent rocuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular agents, rocuronium, suxamethonium, onset, recovery; intraocular pressure; drug interactions; cardiovascular physiology, heart rate, blood pressure ID RAPID-SEQUENCE INDUCTION; INTUBATING CONDITIONS; SUCCINYLCHOLINE; ORG-9426; SURGERY AB Background and aim: Rocuronium may be given to patients for intubation and also after they have received suxamethonium for intubation. The neuromuscular profile of rocuronium given after recovery from suxamethonium may not be identical to that when rocuronium has been given alone. The neuromuscular effects of suxamethonium and rocuronium, and their effects on intraocular pressure (TOP), heart rate (HR) and arterial pressure were also recorded. Methods: Thirty patients were randomly allocated to receive either 0.6 mg kg(-1) rocuronium (n = 15) or 1 mg kg(-1) suxamethonium (n = 15) for intubation. Anaesthesia was first induced using propofol 2.5 mg kg(-1) and fentanyl 2 mug kg(-1) and maintained with propofol 6-12 mg kg(-1) h(-1). The response of the thumb to supra-maximal train-of-four (TOF) ulnar nerve stimulation at the wrist was measured using a mechanomyograph. In the suxamethonium group, when the first twitch of the TOF had recovered to 90%, rocuronium 0.6 mg kg(-1) was administered. Before administration of relaxant, baseline readings of HR, arterial pressure and TOP were measured until stable, then the appropriate relaxant administered. Thereafter, all readings were repeated at 30, 90, 150, 210 and 270 s. Tracheal intubation was performed 300 s after the intubating dose and all recordings repeated 30 s later. Mechanomyographic monitoring was continued until 70% TOF recovery. Results: Suxamethonium had a more rapid onset than rocuronium (49 s vs. 74 s, P < 0.0001). The onset time of rocuronium after suxamethonium was significantly reduced (56 s) and the time to recover to a TOF of 70% following rocuronium was increased by previous suxamethonium administration (47 vs. 58 min, P < 0.05). Suxamethonium caused a marked rise in TOP (>30%) and HR (>10%) while rocuronium had little effect on either. Conclusion: Previous suxamethonium administration decreases the onset time and increases the duration of action of rocuronium. Unlike suxamethonium, rocuronium has few cardiovascular effects and causes little change in TOP. C1 Univ Med Ctr, Dept Anesthesiol, NL-6500 HB Nijmegen, Netherlands. RP Robertson, EN (reprint author), Univ Med Ctr, Dept Anesthesiol, Postbus 9101, NL-6500 HB Nijmegen, Netherlands. EM e.robertson@anes.umcn.nl NR 13 TC 2 Z9 2 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD SEP PY 2004 VL 21 IS 9 BP 734 EP 737 DI 10.1017/S0265021504009111 PG 4 WC Anesthesiology SC Anesthesiology GA 876SJ UT WOS:000225517500011 ER PT J AU Hiernaut, JP Ronchi, C AF Hiernaut, JP Ronchi, C TI Curium vaporization from (CM,Pu)(2)O-3 and from irradiated oxide fuel: Mass spectrometric measurement SO JOURNAL OF NUCLEAR MATERIALS LA English DT Article AB The equilibrium vapour pressure over a mixed curium oxide of type (Cm-244(0.76), Pu-240(1.24))O-3 was measured by Knudsen-effusion experiments. Plutonium was formed in the samples during 25 years decay of curium in an initial Cm2O3 sintered pellet. The same measurements were repeated on seven reactor-irradiated UO2 and MOX samples to obtain the vaporization enthalpy of curium present in typical spent nuclear fuel. The samples were annealed in a tungsten Knudsen cell up to 2800 K and the effusion rates of the different vapour components were analyzed on line by a quadrupole mass spectrometer. The vapour pressures of the curium-bearing species were accurately measured and the results compared with published data obtained under different conditions. The obtained results show that CmO(g) is the only effective vapour species and the measured equilibrium pressure confirms the trend observed in the actinide oxides that the high temperature volatility is more pronounced in compounds where the cation can easily attain a higher oxidation state than that of the condensed phase. (C) 2004 Elsevier B.V. All rights reserved. C1 European Commiss, Joint Res Ctr, Inst Transuranium Elements, D-76125 Karlsruhe, Germany. RP Ronchi, C (reprint author), European Commiss, Joint Res Ctr, Inst Transuranium Elements, POB 2340, D-76125 Karlsruhe, Germany. EM ronchi@itu.fzk.de NR 6 TC 8 Z9 8 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0022-3115 J9 J NUCL MATER JI J. Nucl. Mater. PD SEP 1 PY 2004 VL 334 IS 2-3 BP 133 EP 138 DI 10.1016/j.jnucmat.2004.05.009 PG 6 WC Materials Science, Multidisciplinary; Nuclear Science & Technology; Mining & Mineral Processing SC Materials Science; Nuclear Science & Technology; Mining & Mineral Processing GA 853RH UT WOS:000223844600007 ER PT J AU Osaka, M Koyama, S Mitsugashira, T AF Osaka, M Koyama, S Mitsugashira, T TI Analysis of curium in mixed oxide fuel irradiated in the experimental fast reactor JOYO for the evaluation of its transmutation behavior SO JOURNAL OF NUCLEAR SCIENCE AND TECHNOLOGY LA English DT Article DE curium; chemical analysis; irradiated fuel; MOX fuel; transmutation behavior; fast reactor; anion-exchange; methanol system AB Curium isotopes generated in the MOX fuel irradiated in the experimental fast reactor JOYO were analyzed by applying a sophisticated radiochemical technique. Curium was isolated from the irradiated MOX fuel by anion-exchange chromatography using a mixed medium of nitric acid and methanol. The isotopic ratio of curium and its content were determined by thermal ionization mass spectroscopy and alpha-spectrometry, respectively. The curium content was less than 0.004 at% even at high burnup of 120 GWd/t, which is much smaller than that of PWR-MOX at 60 GWd/t. On the basis of present analytical results, the transmutation behavior of curium isotopes in a fast reactor was discussed from various viewpoints. Transmutation rates of curium isotopes were estimated; the rate for (246)cm, which is known to be a key nuclide in the transmutation of curium, was larger than the previously reported value. It was concluded from these evaluations that the fast reactor was suitable for the incineration of curium. C1 Japan Nucl Cycle Dev Inst, Ibaraki 3111393, Japan. Tohoku Univ, Ibaraki 3111393, Japan. RP Osaka, M (reprint author), Japan Nucl Cycle Dev Inst, O-Arai-Machi, Ibaraki 3111393, Japan. EM osaka@oec.jnc.go.jp NR 16 TC 3 Z9 3 PU ATOMIC ENERGY SOC JAPAN PI TOKYO PA 1-1-13 SHIMBASHI MINATO-KU, TOKYO, 105, JAPAN SN 0022-3131 J9 J NUCL SCI TECHNOL JI J. Nucl. Sci. Technol. PD SEP PY 2004 VL 41 IS 9 BP 907 EP 914 DI 10.3327/jnst.41.907 PG 8 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 872YJ UT WOS:000225245100005 ER PT J AU Saitoh, Y Hattori, H Sanbe, N Nakajima, H Akatu, M Murakawa, M AF Saitoh, Y Hattori, H Sanbe, N Nakajima, H Akatu, M Murakawa, M TI Reversal of vecuronium with neostigmine in patients with diabetes mellitus SO ANAESTHESIA LA English DT Article DE neuromuscular blocking agents, vecuronium; anticholinesterase drugs, neostigmine; monitoring, intra-operative; diabetes mellitus ID INDUCED NEUROMUSCULAR BLOCK; NERVE CONDUCTION VELOCITY; POSTTETANIC TWITCH; ATRACURIUM; ANTAGONISM; NEUROPATHY; ISOFLURANE; ANESTHESIA; RECOVERY; ROCURONIUM AB Reversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 mug.kg(-1) and atropine 20 mug.kg(-1) were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033). C1 Saitama Med Sch, Dept Anaesthesiol, Saitama, Japan. Fukushima Med Univ, Sch Med, Dept Anaesthesiol, Fukushima, Japan. RP Saitoh, Y (reprint author), Saitama Med Sch, Dept Anaesthesiol, Saitama, Japan. EM ysys@r5.dion.ne.jp NR 32 TC 3 Z9 3 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD AUG PY 2004 VL 59 IS 8 BP 750 EP 754 DI 10.1111/j.1365-2044.2004.03833.x PG 5 WC Anesthesiology SC Anesthesiology GA 839RE UT WOS:000222801500004 ER PT J AU Han, TH Kim, H Bae, J Kim, K Martyn, JAJ AF Han, TH Kim, H Bae, J Kim, K Martyn, JAJ TI Neuromuscular pharmacodynamics of rocuronium in patients with major burns SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT 11th Annual Meeting of the European-Society-of-Anaesthesiologists CY MAY 31-JUN 03, 2003 CL GLASGOW, SCOTLAND SP European Soc Anaesthesiologists ID NICOTINIC ACETYLCHOLINE-RECEPTORS; RAPID-SEQUENCE INDUCTION; THERMAL-INJURY; CLINICAL-PHARMACOLOGY; TRACHEAL INTUBATION; MUSCLE MEMBRANE; D-TUBOCURARINE; DOSE-RESPONSE; SUCCINYLCHOLINE; PHARMACOKINETICS AB Rocuronium, which has a short onset time and is free of hyperkalemic effects, could be considered for rapid-sequence induction of anesthesia in patients with burns. In this study, we assessed the neuromuscular pharmacodynamics of rocuronium in patients with major burns. Adults aged 18-59 yr who had a major burn injury (n = 56) and a control group of 44 nonburned patients were included. Rocuronium was used at 3 times (0.9 mg/kg) or 4 times (1.2 mg/kg) the 95% effective dose. Anesthesia consisted of propofol and fentanyl with nitrous oxide and oxygen. Neuromuscular block was monitored with an acceleromyograph by using train-of-four stimulation. The onset time to 95% neuromuscular block was prolonged in burned compared with nonburned patients (115 +/- 58 s versus 68 +/- 16 s for 0.9 mg/kg; 86 +/- 20 s versus 57 +/- 11 s for 1.2 mg/kg). Dose escalation shortened the onset time, prolonged the duration of action, and improved intubating conditions in burned patients. All recovery profiles were significantly shorter in burned versus nonburned groups with both doses. Resistance to the neuromuscular effects of rocuronium was partially overcome by increasing the dose. A dose up to 1.2 mg/kg provides good tracheal intubating conditions after major burns. C1 Hallym Univ, Hangang Sacred Heart Hosp, Dept Anesthesiol & Pain Med, Sch Med, Seoul 150719, South Korea. Harvard Univ, Sch Med, Massachusetts Gen Hosp, Dept Anesthesiol & Crit Care, Boston, MA 02115 USA. Shriners Hosp Children, Boston, MA USA. RP Han, TH (reprint author), Hallym Univ, Hangang Sacred Heart Hosp, Dept Anesthesiol & Pain Med, Sch Med, 94-200 Yongdungpo Dong, Seoul 150719, South Korea. EM athan@unitel.co.kr NR 37 TC 15 Z9 16 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2004 VL 99 IS 2 BP 386 EP 392 PG 7 WC Anesthesiology SC Anesthesiology GA 840YS UT WOS:000222897100016 ER PT J AU Yang, H Choi, PTL McChesney, J Buckley, N AF Yang, H Choi, PTL McChesney, J Buckley, N TI Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID OMITTING NITROUS-OXIDE; POSTOPERATIVE NAUSEA; TRACHEAL INTUBATION; MUSCLE-RELAXANTS; GYNECOLOGICAL SURGERY; GENERAL-ANESTHESIA; METAANALYSIS; CHOLECYSTECTOMY; PREVENTION; SATISFACTION AB Purpose: To compare sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction with regards to the frequency of moderate to severe postoperative nausea and vomiting (PONV) in the first 24 hr after laparoscopic day surgery. Methods: After informed consent, 156 ASA physical status class I to III patients undergoing laparoscopic cholecystectomy or tubal ligation were randomized to either induction with sevoflurane 8%, N2O 67% and iv remifentanil 1 to 1.5 mug(.)kg(-1) or induction with iv fentanyl 2 to 3 mug(.)kg(-1), propofol 2 mg(.)kg(-1), and rocuronium 0.3 to 0.5 mg(.)kg(-1). All patients received iv ketorolac 0.5 mg(.)kg(-1) at induction and sevoflurane-N2O maintenance anesthesia with rocuronium as needed. PONV was treated with iv ondansetron, droperidol, or dimenhydrinate; postoperative pain was treated with opioid analgesics. Patients were followed for 24 hr with regards to PONV and pain. Intubating conditions, induction and emergence times, time to achieve fast-track discharge criteria, and drug costs were measured. Results: No differences were seen between the two groups in their frequencies of 24-hr moderate to severe PONV and postoperative pain, or in their intubating conditions, induction and emergence times, and time to achieve fast-track discharge criteria. Patients undergoing sevoflurane-remifentanil induction received more morphine (11 mg vs 8 mg; P < 0.001) in the postanesthetic care unit. Sevoflurane-remifentanil induction resulted in similar anesthetic and total drug costs for both procedures. Conclusion: We did not demonstrate any difference in PONV, pain, or anesthetic/recovery times or costs between the sevoflurane and propofol groups. Sevoflurane-remifentanil induction is a feasible technique for anesthetic induction. C1 McMaster Univ, Dept Anaesthesia, Hamilton Hlth Sci, Hamilton, ON L8N 3Z5, Canada. McMaster Univ, St Josephs Healthcare, Hamilton, ON L8N 3Z5, Canada. McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada. RP Buckley, N (reprint author), McMaster Univ, Dept Anaesthesia, Hamilton Hlth Sci, 1200 Main St W,Room HSC2UI, Hamilton, ON L8N 3Z5, Canada. EM buckleyn@mcmaster.ca NR 32 TC 9 Z9 11 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD AUG-SEP PY 2004 VL 51 IS 7 BP 660 EP 667 PG 8 WC Anesthesiology SC Anesthesiology GA 856KR UT WOS:000224044600004 ER PT J AU Greene, SA Benson, GJ Tranquilli, WJ Grimm, KA AF Greene, SA Benson, GJ Tranquilli, WJ Grimm, KA TI Effect of isoflurane, atracurium, fentanyl, and noxious stimulation on bispectral index in pigs SO COMPARATIVE MEDICINE LA English DT Article ID NITROUS-OXIDE; ALVEOLAR CONCENTRATION; ANESTHETIC DEPTH; SUS-SCROFA; SWINE; ELECTROENCEPHALOGRAM; SEVOFLURANE; SEDATION; PROPOFOL; POTENCY AB The study reported here was done to determine the relationship between anesthesia depth and bispectral index (BIS) in stimulated pigs. lsoflurane minimal alveolar concentration (MAC) was determined using the tail-clamp method in 16 Yorkshire/Landrace-cross pigs with mean +/- SEM weight of 27.7 +/- 1.76 kg. One week later, BIS, ECG, heart rate, arterial blood pressure, esophageal temperature, end-tidal CO2 tension and isoflurane concentration, arterial pH, PaO2, PaCO2, plasma bicarbonate concentration, and base excess were determined at each of five isoflurane MAC-multiples: 0.8, 1.0, 1.3, 1.6, and 2.0. Six treatments were studied: isoflurane; isoflurane and atracurium; isoflurane, atracurium, and fentanyl; isoflurane with noxious stimulation; isoflurane and atracurium with noxious stimulation; and isoflurane, atracurium, and fentanyl with noxious stimulation. The noxious stimulus during BIS measurement was the same as that for MAC determination. Each pig was studied three times (n = 8), and order of MAC-multiples and treatments was randomized. Data were evaluated by use of general linear model analysis of variance and linear regression analysis, with statistical significance set at P < 0.05. Significant differences in BIS values were identified between MAC-multiples within each treatment and between treatment 3 compared with treatments 2 and 4. Significant differences also were observed within and between treatments for heart rate, arterial blood pressure, and PaO2. Use of BIS appears reliable for identification of light versus deep anesthesia, but is of limited use for discrimination between isoflurane MAC-multiples of 1 and 1.6. We conclude that, compared with other treatments, atracurium. and noxious stimulation had no significant effect on BIS. C1 Univ Illinois, Coll Vet Med, Dept Vet Clin Med, Urbana, IL 61802 USA. RP Greene, SA (reprint author), Washington State Univ, Coll Vet Med, Dept Vet Clin Sci, Pullman, WA 99164 USA. NR 27 TC 13 Z9 13 PU AMER ASSOC LABORATORY ANIMAL SCIENCE PI MEMPHIS PA 9190 CRESTWYN HILLS DR, MEMPHIS, TN 38125 USA SN 1532-0820 J9 COMPARATIVE MED JI Comparative Med. PD AUG PY 2004 VL 54 IS 4 BP 397 EP 403 PG 7 WC Veterinary Sciences; Zoology SC Veterinary Sciences; Zoology GA 847LD UT WOS:000223393100007 ER PT J AU Stumpf, T Tits, J Walther, C Wieland, E Fanghanel, T AF Stumpf, T Tits, J Walther, C Wieland, E Fanghanel, T TI Uptake of trivalent actinides (curium(III)) by hardened cement paste: a time-resolved laser fluorescence spectroscopy study SO JOURNAL OF COLLOID AND INTERFACE SCIENCE LA English DT Article DE curium; cement; CSH; sorption; surface complexation; incorporation; TRLFS; LIBD ID CONCENTRATED ELECTROLYTE-SOLUTIONS; BREAKDOWN DETECTION; GAMMA-ALUMINA; CM(III); SORPTION; THERMODYNAMICS; LUMINESCENCE; COMPLEXATION; SPECIATION; ELEMENTS AB The curium(III) interaction with cement was investigated using time-resolved laser fluorescence spectroscopy at trace concentrations. Four different Cm(III) species were identified: a nonfluorescing species which corresponds to curium hydroxide real colloids, which were characterized in detail by laser-induced breakdown detection (LIBD), a fluorescing Cm(III)/portlandite sorption species, and two fluorescing Cm(III)/calcium silicate hydrate (CSH) species. From the fluorescence emission lifetimes it is predicted that the two fluorescing Cm(III)/CSH species have one to two and no water molecules, respectively, left in their first coordination sphere, suggesting that these species are incorporated into the CSH structure. (C) 2004 Elsevier Inc. All rights reserved. C1 Forschungszentrum Karlsruhe, Inst Nukl Entsorgung, D-76021 Karlsruhe, Germany. Paul Scherrer Inst, Waste Management Lab, CH-5232 Villigen, Switzerland. RP Stumpf, T (reprint author), Forschungszentrum Karlsruhe, Inst Nukl Entsorgung, POB 3640, D-76021 Karlsruhe, Germany. EM thorsten.stumpf@ine.fzk.de NR 31 TC 17 Z9 17 PU ACADEMIC PRESS INC ELSEVIER SCIENCE PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0021-9797 J9 J COLLOID INTERF SCI JI J. Colloid Interface Sci. PD AUG 1 PY 2004 VL 276 IS 1 BP 118 EP 124 DI 10.1016/j.jcis.2004.03.014 PG 7 WC Chemistry, Physical SC Chemistry GA 836EI UT WOS:000222537800016 ER PT J AU Oztekin, S Hepaguslar, H Kilercik, H Kar, AA Boyaci, F Elar, Z AF Oztekin, S Hepaguslar, H Kilercik, H Kar, AA Boyaci, F Elar, Z TI Low doses of rocuronium during remifentanil-propofol-based anesthesia in children: comparison of intubating conditions SO PEDIATRIC ANESTHESIA LA English DT Article; Proceedings Paper CT Euroanaesthesia 2003 Meeting CY MAY 31-JUN 03, 2003 CL GLASGOW, SCOTLAND DE anaesthetics; propofol; opioids; remifentanil; neuromuscular nondepolarizing agents rocuronium; intubation ID NEUROMUSCULAR BLOCKING-AGENTS; TRACHEAL INTUBATION; MUSCLE-RELAXANTS; ALFENTANIL; INDUCTION; SURGERY; SEVOFLURANE AB Background: In this prospective double-blind study, intubation conditions were compared at 90 s following two different low doses of rocuronium during remifentanil and propofol anesthesia in children undergoing ambulatory procedures. Methods: Forty-four children (ASA I-II, aged 3-12 years) undergoing day case ENT surgery were premedicated with midazolam 0.5 mg(.)kg(-1). Following atropine 10 mug(.)kg(-1), remifentanil infusion 0.5 mug(.)kg(-1.)min(-1) was started. After 60 s, anesthesia was induced with propofol 2.5 mg(.)kg(-1). Immediately after a bolus dose of propofol, the children received rocuronium doses of 0.15 mg(.)kg(-1) (group I, n = 22) or 0.3 mg(.)kg(-1) (group II, n = 22) in a randomized manner, after which an infusion of propofol 6 mg-kg(-1) h(-1) was added to the infusion of remifentanil 0.5 mug(.)kg(-1) min(-1) for maintenance of anesthesia. Intubating conditions were evaluated 90 s after rocuronium administration applying the Copenhagen Scoring System which included components of laryngoscopy, vocal cord movement and reaction to intubation. Hemodynamic values were recorded at predetermined time intervals. Results: Excellent, good and poor intubation conditions were 18.2, 40.9 and 40.9% in group I and 40.9, 54.5 and 4.5% in group II. Clinically acceptable intubating conditions (excellent and good) were significantly higher in group II (95.5%) than in group I (59.1%) (P = 0.004). Mean values of heart rate and blood pressure did not differ significantly between groups. No children required any intervention for hemodynamic instability and/or muscle rigidity. Conclusions: The results suggest that 0.3 mg(.)kg(-1) of rocuronium may be a better low dose than 0.15 mg(.)kg(-1) of rocuronium for clinically acceptable intubating conditions in pediatric ambulatory surgery during remifentanil-propofol-based anesthesia at the doses used in the study. C1 Dokuz Eylul Univ, Dept Anaesthesiol, Izmir, Turkey. RP Oztekin, S (reprint author), 114 Sok 50, TR-35040 Izmir, Turkey. EM sermin.oztekin@deu.edu.tr NR 27 TC 2 Z9 2 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PEDIATR ANESTH JI Pediatr. Anesth. PD AUG PY 2004 VL 14 IS 8 BP 636 EP 641 DI 10.1111/j.1460-9592.2004.01273.x PG 6 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 845GI UT WOS:000223228500004 ER PT J AU Lirk, P Longato, S Rieder, J Klimaschewski, L AF Lirk, P Longato, S Rieder, J Klimaschewski, L TI Cisatracurium, but not mivacurium, inhibits survival and axonal growth of neonatal and adult rat peripheral neurons in vitro SO NEUROSCIENCE LETTERS LA English DT Article DE anaesthesia; neuromuscular blocking drug; cisatracurium; superior cervical ganglion; dorsal root ganglion; survival; axon growth ID SYMPATHETIC NEURONS; PC12 CELLS; ATRACURIUM; DEGRADATION; NEUROTOXICITY; HYDROLYSIS; APOPTOSIS; GALANIN AB Cisatracurium and mivacurium are widely used neuromuscular blocking drugs. Previous reports have indicated growth-inhibitory effects of cisatracurium. but not mivacurium, on two human cell lines in vitro. These effects were ascribed to oxidative stress elicited by acrylate esters formed during cisatracurium breakdown. The aim of the present study was to investigate whether these agents would possibly interfere with the peripheral nervous system. Survival and axonal growth of rat primary neurons obtained from the superior cervical sympathetic ganglion (SCG) or from the adult dorsal root ganglion (DRG) were investigated after treatment with cisatracurium or mivacurium at concentrations from 1 to 10 muM for 24 h. Cisatracurium, but not mivacurium, significantly decreased neuronal survival in a dose-dependent manner, and axonal length was considerably reduced by cisatracurium as compared to controls. It is concluded that high concentrations of cisatracurium are potentially neurotoxic. (C) 2004 Elsevier Ireland Ltd. All rights reserved. C1 Med Univ Innsbruck, Dept Anat Histol & Embryol, A-6020 Innsbruck, Austria. Med Univ Innsbruck, Dept Anesthesiol & Crit Care Med, A-6020 Innsbruck, Austria. RP Klimaschewski, L (reprint author), Med Univ Innsbruck, Dept Anat Histol & Embryol, Muellerstr 59, A-6020 Innsbruck, Austria. EM lars.klimaschewski@uibk.ac.at NR 16 TC 1 Z9 2 PU ELSEVIER SCI IRELAND LTD PI CLARE PA CUSTOMER RELATIONS MANAGER, BAY 15, SHANNON INDUSTRIAL ESTATE CO, CLARE, IRELAND SN 0304-3940 J9 NEUROSCI LETT JI Neurosci. Lett. PD JUL 22 PY 2004 VL 365 IS 2 BP 153 EP 155 DI 10.1016/j.neulet.2004.04.073 PG 3 WC Neurosciences SC Neurosciences & Neurology GA 840OR UT WOS:000222869300017 ER PT J AU Kala, M Lechowicz, W AF Kala, M Lechowicz, W TI Instability of pancuronium in postmortem blood and liver taken after a fatal intramuscular Pavulon injection SO FORENSIC SCIENCE INTERNATIONAL LA English DT Article; Proceedings Paper CT 41th Annual Meeting of the International-Association-of-Forensic-Toxicologists (TIAFT 2003) CY NOV 16, 2003 CL Melbourne, AUSTRALIA SP Int Assoc Forens Toxicologists DE pancuronium; analysis; stability; LC-MS ID PERFORMANCE LIQUID-CHROMATOGRAPHY; QUATERNARY AMMONIUM-COMPOUNDS; IONIZATION MASS-SPECTROMETRY; NITROGEN MUSCLE-RELAXANTS; HUMAN PLASMA; SCREENING-PROCEDURE; BIOLOGICAL-FLUIDS; SUCCINYLCHOLINE; TISSUES; QUANTITATION AB The present study was designed to determine the stability of pancuronium in postmortem blood and liver during storage. Results were obtained using the method by Kerskes et al. [C.H.M. Kerskes, K.J. Lusthof, P.G.M. Zweipfenning, J.P. Franke, The detection and identification of quaternary nitrogen muscle relaxants in biological fluids and tissues by ion-trap LC-ESI-MS, J. Anal. Toxicol. 26 (2002) 29-34.], modified and validated in our laboratory. Target analytes were isolated after enzymatic hydrolysis followed by solid phase extraction (BondElut C18 column). Internal standardisation was carried out using laudanosine and the target ions were monitored by LC-ESI-MS (monitoring ions m/z 358 for IS and 286 for pancuronium). Materials were taken from a 46-year-old woman, who had been found dead. A syringe (2 ml) and an empty ampoule of Pavulon (4 mg/2 mL) were found in her hand. The residual volume of fluid in the syringe was 0.7 ml. An autopsy was performed six days after death. It revealed a needle mark on the left thigh. Postmortem materials (muscle from the injection site, blood and liver) and the syringe with fluid were stored for four months in a freezer at -20 degreesC. The initial pancuronium concentrations were 81 ng/mL in blood and 532 ng/g in liver. The analyte was stable when stored at -20 degreesC in blood even up to seven months. In liver samples its concentrations were variable. Pancuronium in blood stored at 20 degreesC underwent degradation very rapidly. After three months of storage these blood samples had concentrations not greater about 10% of the initial value. The degradation patterns of pancuronium depended on temperature and the biological matrix. (C) 2004 Elsevier Ireland Ltd. All rights reserved. C1 Inst Forens Res, PL-31033 Krakow, Poland. RP Kala, M (reprint author), Inst Forens Res, Westerplatte 9, PL-31033 Krakow, Poland. EM mkala@ies.krakow.pl NR 20 TC 8 Z9 8 PU ELSEVIER SCI IRELAND LTD PI CLARE PA CUSTOMER RELATIONS MANAGER, BAY 15, SHANNON INDUSTRIAL ESTATE CO, CLARE, IRELAND SN 0379-0738 J9 FORENSIC SCI INT JI Forensic Sci.Int. PD JUL 16 PY 2004 VL 143 IS 2-3 BP 191 EP 198 DI 10.1016/j.forsciint.2004.03.030 PG 8 WC Medicine, Legal SC Legal Medicine GA 840ER UT WOS:000222840500018 ER PT J AU Nascimento, DC Serra, CSM Oliveira, AC AF Nascimento, DC Serra, CSM Oliveira, AC TI Cellular mechanisms of atracurium-induced tetanic fade in the isolated rat muscle SO BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY LA English DT Article ID NEUROMUSCULAR-TRANSMISSION; ACETYLCHOLINE TRANSPORT; DIAPHRAGM PREPARATION; TRANSMITTER; BLOCKADE; RELEASE; FROG; STIMULATION; PANCURONIUM; POTENTIALS AB Although atracurium is a widely used neuromuscular blocker, we still lack knowledge regarding some of its cellular mechanisms of action. Thus, similar to other clinically used blockers atracurium induces, both in vivo and in vitro, fade of the tetanic contraction. However, the cellular mechanisms underlying this tetanic fade have never been systematically studied. In the present work these mechanisms were investigated in vitro. A sciatic nerve extensor digitorum longus muscle preparation of the rat was used. A combination of myographical and electrophysiological techniques was employed. Indirect twitches were evoked at 0.1 Hz and tetanic contractions at 50 Hz. Trains of end-plate potentials were evoked at a frequency of 50 Hz. The electrophysiological variables used in the analysis of the trains of end-plate potentials were: peak amplitude of the first end-plate potential in the train, peak amplitude of plateau end-plate potentials in the train, tetanic run-down of the end-plate potentials' train, quantal content of first and plateau end-plate potentials in the train, quantal size. In the myographical study atracurium, at a concentration of 2.4 muM, induced a complete fade of the tetanic contraction while only slightly affected the twitch. In the electrophysiological study atracurium, at the same 2.4 muM concentration, significantly decreased the amplitude of both first end-plate potentials in the train (control: 14.4 mV; atracurium: 3.2 mV) and plateau end-plate potentials (control: 10.8 mV, atracurium: 2.4 mV) and reinforced the tetanic run-down of the train of end-plate potentials, evaluated as the percent loss in amplitude of plateau end-plate potentials compared to first end-plate potentials in the trains (control: 25.2%; atracurium: 33.2%). Atracurium also significantly decreased the quantal content of first end-plate potentials in the train (control: 231; atracurium: 68), the quantal content of plateau end-plate potentials (control: 159; atracurium: 42) and the quantal size (control: 0.119 mV; atracurium: 0.075 mV). In relative terms the decrease in quantal content was about twice as large as the decrease in quantal size. This indicates that the fade of the tetanic contraction induced by atracurium (2.4 muM) is due to both pre- and postsynaptic blocking effects, the presynaptic one being stronger. C1 Univ Sao Paulo, Inst Biomed Sci, Dept Pharmacol, BR-05508900 Sao Paulo, Brazil. RP Oliveira, AC (reprint author), Univ Sao Paulo, Inst Biomed Sci, Dept Pharmacol, Avenida Lineu Prestes 1524, BR-05508900 Sao Paulo, Brazil. EM acolivei@icb.usp.br NR 32 TC 3 Z9 3 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 1742-7835 J9 BASIC CLIN PHARMACOL JI Basic Clin. Pharmacol. Toxicol. PD JUL PY 2004 VL 95 IS 1 BP 9 EP 14 PG 6 WC Pharmacology & Pharmacy; Toxicology SC Pharmacology & Pharmacy; Toxicology GA 841IR UT WOS:000222924000003 ER PT J AU Kirov, K Motamed, C Decailliot, F Behforouz, N Duvaldestin, P AF Kirov, K Motamed, C Decailliot, F Behforouz, N Duvaldestin, P TI Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and the adductor pollicis SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE atracurium; cisatracurium; larynx; electromyography ID INTUBATING CONDITIONS; MUSCLES; VECURONIUM; HUMANS; AGENTS; ANESTHESIA; HISTAMINE; 51W89; ONSET AB Background: Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this alone would be the greatest advantage in replacing atracurium for the facilitation of tracheal intubation. On the other hand, 2 ED95 doses of cisatracurium (100 mug/kg) do not yield satisfactory intubating conditions such as those seen with equipotent doses of atracurium and therefore the recommended intubating dose of cisatracurium is 3 ED95. To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium directly at the larynx adductors in humans. Methods: The study was conducted in 54 patients (ASA class I or II) undergoing peripheral surgery requiring general anesthesia. Cisatracurium 25-150 mug/kg or atracurium 120-500 mug/kg intravenous (i.v.) boluses doses were administered during anesthesia with propofol, nitrous oxide, oxygen and fentanyl. Neuromuscular block was measured by electromyography (single twitch stimulation every 10 s) at the larynx and the adductor pollicis. The dose-response effect measured at both muscles included maximum neuromuscular blockade achieved (Emax), the time to maximum depression of twitch height (onset) and time to spontaneous recovery of the twitch height to 25%, 75% and 90% (T25, T75, T90) of control value. Result: The onset at the larynx was of 196 +/- 28 s after the 100 mug/kg cisatracurium dose compared with 140 +/- 14 s after the 500 mug/kg atracurium dose (P < 0.05). Emax at the larynx was 92 +/- 1% and 98 +/- 1% after 100 mug/kg cisatracurium and 500 mug/kg atracurium, respectively (P < 0.05). The time to onset of maximum suppression Emax = 100 +/- 0% after a 150 mug/kg cisatracurium dose was 148 +/- 29 s. At the larynx, the ED50 was 25 mug/kg for cisatracurium and 180 mug/kg for atracurium and the ED95 was 87 mug/kg for cisatracurium compared with 400 mug/kg for atracurium. Conclusion: The slow onset time at the laryngeal muscles after cisatracurium can be explained by the higher potency as compared with atracurium. C1 Univ Paris 12, Hop Henri Mondor, Dept Anesthesia, Serv Anesthesie Reanimat, F-94010 Creteil, France. RP Duvaldestin, P (reprint author), Univ Paris 12, Hop Henri Mondor, Dept Anesthesia, Serv Anesthesie Reanimat, AP HP, F-94010 Creteil, France. EM philippe.duvaldestin@hmn.ap-hop-paris.fr NR 18 TC 7 Z9 16 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2004 VL 48 IS 5 BP 577 EP 581 DI 10.1111/j.1399-6576.2004.00378.x PG 5 WC Anesthesiology SC Anesthesiology GA 814MI UT WOS:000220978400005 ER PT J AU Kutepov, AL Kutepova, SG AF Kutepov, A. L. Kutepova, S. G. TI First-principles study of electronic and magnetic structure of alpha-Pu, delta-Pu, americium, and curium SO JOURNAL OF MAGNETISM AND MAGNETIC MATERIALS LA English DT Article DE actinides; ground state properties AB The ab initio study of electronic and magnetic structure has been carried out for alpha-Pu, delta-Pu, Am, and Cm. The effect of taking the spin polarization into account on the calculated ground state properties of the given actinides has been studied. (C) 2003 Elsevier B. V. All rights reserved. C1 Inst Tech Phys, Snezhinsk 456770, Chelyabinsk, Russia. RP Kutepov, AL (reprint author), Inst Tech Phys, Vasiliev St 13,POB 245, Snezhinsk 456770, Chelyabinsk, Russia. EM a.l.kutepov@vniitf.ru NR 10 TC 17 Z9 17 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0304-8853 J9 J MAGN MAGN MATER JI J. Magn. Magn. Mater. PD MAY PY 2004 VL 272 SU 1 BP E329 EP E330 DI 10.1016/j.jmmm.2003.12.706 PG 2 WC Materials Science, Multidisciplinary; Physics, Condensed Matter SC Materials Science; Physics GA V42WI UT WOS:000202897200144 ER PT J AU Gerasimov, AS Kiselev, GV Myrtsymova, LA Zaritskaya, TS AF Gerasimov, AS Kiselev, GV Myrtsymova, LA Zaritskaya, TS TI Cyclic mode of neptunium, americium and curium transmutation in heavy-water reactor SO NUCLEAR ENGINEERING AND DESIGN LA English DT Article; Proceedings Paper CT 11th International Conference on Nuclear Energy (ICONE-11) CY APR 20-23, 2003 CL Tokyo, JAPAN SP Japan Soc Mech Engineers, Amer Soc Mech Engineers AB Characteristics of process of transmutation of neptunium, americium and curium from spent nuclear fuel in heavy-water reactor during first 10 lifetimes and at transition to equilibrium mode are calculated. During transmutation, dangerous nuclides, first of all, Cm-244 and Pu-238 are accumulated. They cause an increase of radiotoxicity. At first 10 cycles of transmutation, the radiotoxicity is increased by 8.7 times in comparison with radiotoxicity of initial load of transmuted actinides. Heavy-water reactor with thermal power of 1000 MW can transmute neptunium, americium and curium extracted from 3.7 VVER-1000 type reactors. It means, that the required power of transmutation reactor makes about 8% of thermal power of VVER-1000 type reactors. (C) 2004 Elsevier B.V. All rights reserved. C1 Inst Theoret & Expt Phys, Moscow 117259, Russia. RP Gerasimov, AS (reprint author), Inst Theoret & Expt Phys, 25 B Cheremushkinskaya, Moscow 117259, Russia. EM geras@vitep1.itep.ru NR 3 TC 0 Z9 0 PU ELSEVIER SCIENCE SA PI LAUSANNE PA PO BOX 564, 1001 LAUSANNE, SWITZERLAND SN 0029-5493 J9 NUCL ENG DES JI Nucl. Eng. Des. PD MAY PY 2004 VL 230 IS 1-3 BP 327 EP 331 DI 10.1016/j.nucengdes.2003.11.026 PG 5 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 822TH UT WOS:000221562700023 ER PT J AU Dhonneur, G Combes, X Chassard, D Merle, JC AF Dhonneur, G Combes, X Chassard, D Merle, JC TI Skin sensitivity to rocuronium and vecuronium: A randomized controlled prick-testing study in healthy volunteers SO ANESTHESIA AND ANALGESIA LA English DT Article ID FLARE RESPONSES; ANAPHYLACTOID REACTIONS; ANESTHESIA; HUMANS; WHEAL AB Prick tests are frequently used for the authentication of neuromuscular blocking drugs (NMBDs) as causative drugs for anaphylactic reactions during anesthesia. Unfortunately, the actual threshold concentration for skin testing remains debatable for most NMBDs. We studied the flare and wheal responses to prick tests with rocuronium. and vecuronium. Thirty healthy, nonatopic, anesthesia-naive male and female volunteers (14 men and 16 women) from 18 to 40 yr of age were assigned randomly to receive a total of 10 prick tests-4 ascending dilutions (1:1000, 1:100, 1:10, and 1) of rocuronium and vecuronium. and 2 controls- on both forearms. An assessor blinded to the assignment monitored systemic and skin responses to NMBDs and measured wheal and flare surfaces immediately after and 15 min after prick tests. None of the volunteers experienced any immediate systemic or cutaneous responses to rocuronium or vecuronium. Although a dilution of 1:1000 of both NMBDs failed to promote any skin response at 15 min, 50% and 40% of the subjects had a positive skin reaction to undiluted rocuronium and vecuronium, respectively. We demonstrated a sex effect related to smaller threshold concentration-induced cutaneous reactions in female volunteers to both muscle relaxants. Our observation questions the reliability of prick testing with undiluted solutions of rocuronium and vecuronium for the diagnosis of allergy. C1 Univ Hosp & Paris 12 Val De Marne, Sch Med, Dept Anesthesia & Crit Care Med, Creteil, France. CEPHAC ASTER Inst, Clin Res Org, Paris, France. RP Dhonneur, G (reprint author), CHU Henri Mondor, Dept Anesthesie & Reanimat, F-94000 Creteil, France. EM gilles.dhonneur@hmn.ap-hop-paris.fr NR 19 TC 38 Z9 41 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 2004 VL 98 IS 4 BP 986 EP 989 DI 10.1213/01.ANE.0000111206 PG 4 WC Anesthesiology SC Anesthesiology GA 807HD UT WOS:000220491700020 ER PT J AU Savarese, JJ Belmont, MR Hashim, MA Mook, RA Boros, EE Samano, V Patel, SS Feldman, PL Schultz, JAI McNulty, M Spitzer, T Cohn, DL Morgan, P Wastila, WB AF Savarese, JJ Belmont, MR Hashim, MA Mook, RA Boros, EE Samano, V Patel, SS Feldman, PL Schultz, JAI McNulty, M Spitzer, T Cohn, DL Morgan, P Wastila, WB TI Preclinical pharmacology of GW280430A (AV430A) in the rhesus monkey and in the cat - A comparison with mivacurium SO ANESTHESIOLOGY LA English DT Article ID CLINICAL NEUROMUSCULAR PHARMACOLOGY; OPIOID BARBITURATE ANESTHESIA; STEROIDAL MUSCLE-RELAXANT; BLOCKING-AGENT; RAPACURONIUM BROMIDE; RENAL-FAILURE; ATRACURIUM; PHARMACOKINETICS; PANCURONIUM; CISATRACURIUM AB Background: No replacement for succinylcholinc is yet available. GW280430A (AV430A) is a representative of a new class of nondepolarizing neuromuscular blocking drugs called asymmetric mixed-onium chlorofumarates. it undergoes rapid degradation in plasma by chemical hydrolysis and inactivation by cysteine adduction, resulting in a very short duration of effect. The neuromuscular, cardiovascular, and autonomic pharmacology of GW280430A is compared herein with that of mivacurium. Methods: Adult male rhesus monkeys and adult male cats were anesthetized with nitrous oxide-oxygen-halothane and chloralose-pentobarbital, respectively. The neuromuscular blocking properties of GW280430A and mivacurium were compared at a stimulation rate of 0.15 Hz in the extensor digitorum of the foot (monkey) and the tibialis anterior (cat). Sympathetic responses were assayed in the cat in the nictitating membrane preparation, and vagal effects were evaluated in the cat via observation of bradycardic responses after stimulation of the cervical right vagus nerve. Results: GW280430A and mivacurium were equipotent in the monkey (ED95 was 0.06 mg/kg in each case). GW280430A was half as potent as mivacurium in the cat. The total duration of action of GW280430A was less than half that of mivacurium. in the monkey; recovery slopes were more than twice as rapid. The 25-75% recovery index of GW280430A did not vary significantly after various bolus doses or infusions, averaging 1.4-1.8 min in the monkey, significantly shorter than the same time interval (4.8-5.7 min) for mivacurium. Dose ratios for autonomic versus neuromuscular blocking properties in the cat were greater than 25 for both GW280430A and mivacurium. The ratio ED Hist:ED95 Neuromuscular Block in the monkey was significantly greater (approximately 53 vs. 13) for GW280430A, indicating approximately four times less relative prominence of the side effects of skin flushing and decrease of blood pressure, which are associated with release of histamine. Conclusions: These experiments show a much shorter neuromuscular blocking effect and much-reduced side effects in the case of GW280430A vis-d-vis mivacurium. These results, together with the novel chemical degradation of GW28o430A, suggest further evaluation in human subjects. C1 Cornell Univ, Weill Med Coll, Dept Anesthesiol, New York, NY 10021 USA. New York Presbyterian Hosp, New York, NY USA. Glaxo Wellcome Labs, Dept Chem, Res Triangle Pk, NC USA. Glaxo Wellcome Labs, Dept Pharmacol, Res Triangle Pk, NC USA. RP Savarese, JJ (reprint author), Cornell Univ, Weill Med Coll, Dept Anesthesiol, New York Weill Cornell Campus,525 E 68th St, New York, NY 10021 USA. EM jjsavare@med.cornell.edu NR 37 TC 21 Z9 21 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 2004 VL 100 IS 4 BP 835 EP 845 DI 10.1097/00000542-200404000-00013 PG 11 WC Anesthesiology SC Anesthesiology GA 806LZ UT WOS:000220436700012 ER PT J AU Boyez, E Malherbe, P AF Boyez, E Malherbe, P TI Curarization for contributing symptomatic treatment of myoclonic jerks induced by chloralose poisoning SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE poisoning; chloralose; myoclonus syndrome ID INTOXICATION; EEG AB Chloralose poisoning especially leads to consciousness failure and hyperexcitability with typical myoclonic jerks. In an observation of chloralose poisoning by ingestion of synthetic substance against moles, curarization by cistracurium besylate was proposed to contribute in the symptomatic treatment of myoclonus syndrome induced by chloralose poisoning and resistant to a large dose of diazepam. (C) 2004 Elsevier SAS. Tons droits reserves. C1 Ctr Hosp Cambrai, Serv Reanimat Polyvalente, F-59407 Cambrai, France. RP Boyez, E (reprint author), Ctr Hosp Cambrai, Serv Reanimat Polyvalente, 513 Ave Paris, F-59407 Cambrai, France. EM evaboyez@yahoo.fr NR 10 TC 1 Z9 1 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS PA 23 RUE LINOIS, 75724 PARIS, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD APR PY 2004 VL 23 IS 4 BP 361 EP 363 DI 10.1016/j.annfar.2003.11.020 PG 3 WC Anesthesiology SC Anesthesiology GA 827CH UT WOS:000221875600006 ER PT J AU Schmitt, HJ Wick, S Munster, T AF Schmitt, HJ Wick, S Munster, T TI Rocuronium for muscle relaxation in two children with Friedreich's ataxia SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthetic techniques, intravenous; complications, Friedreich's ataxia; neuromuscular block, rocuronium ID ANESTHESIA AB Friedreich's ataxia is a rare hereditary neurodegenerative disease caused by a defect in the gene that encodes a mitochondrial protein called frataxin. We report the use of rocuronium 0.6 mg kg(-1) in two adolescent girls with Friedreich's ataxia undergoing propofol-sufentanil-oxygen-air anaesthesia for spinal surgery. Neuromuscular transmission was monitored using acceleromyography, and onset and recovery times were recorded. The clinical duration of rocuronium was comparable to that of children without neuromuscular disease (25% recovery T-1=44 and 24 min for patients 1 and 2 respectively). C1 Univ Erlangen Nurnberg, Dept Anaesthesiol, D-91054 Erlangen, Germany. RP Schmitt, HJ (reprint author), Univ Erlangen Nurnberg, Dept Anaesthesiol, Krankenhausstr 12, D-91054 Erlangen, Germany. EM hubert.schmitt@kfa.imed.uni-erlangen.de NR 11 TC 9 Z9 9 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD APR PY 2004 VL 92 IS 4 BP 592 EP 596 DI 10.1093/bja/aeh106 PG 5 WC Anesthesiology SC Anesthesiology GA 802RK UT WOS:000220180400024 ER PT J AU Rapp, HJ Altenmueller, CA Waschke, C AF Rapp, HJ Altenmueller, CA Waschke, C TI Neuromuscular recovery following rocuronium bromide single dose in infants SO PEDIATRIC ANESTHESIA LA English DT Article DE muscle relaxant; recovery : rocuronium bromide; infants; newborn ID INTUBATING CONDITIONS; TIME-COURSE; PEDIATRIC-PATIENTS; BLOCKING-AGENTS; ONSET TIME; CHILDREN; ANESTHESIA; HALOTHANE; PHARMACOKINETICS; ISOFLURANE AB Background: Rocuronium bromide, a steroid nondepolarizing muscle relaxant, has a rapid onset and an intermediate duration of action in infants, children and adults. However, clinical evidence shows a longer duration of recovery in small infants. The aim of this study was to investigate the influence of age on rocuronium recovery during the first year of life. Methods: ASA I-II infants, scheduled for elective surgery under general anaesthesia and intubation were included after ethics committee approval and parents' written consent. According to age the patients were randomly allocated to receive either 0.45 mg(.)kg(-1) or 0.6 mg(.)kg(-1) rocuronium bromide in three age-groups: (A) 0-1 month, (B) 2-4 months and (C) 5-12 months. After induction with thiopentone (5-7 mg(.)kg(-1)), anesthesia was maintained with isoflurane without opioids. Prior to surgery, caudal block with bupivacaine (0.125%) 1.0 ml(.)kg(-1) and paracetamol 25 mg(.)kg(-1) rectally were given for analgesia.. Efficacy variables were intubation conditions 60 s after administration of muscle relaxant (TO) and recovery of neuromuscular blockade measured as T, at 10, 25, 50 and 75 % of baseline, train-of-four (TOF) of 0.7 and Recovery Index (RI). Data were characterized by summary statistics and analysis of variance. Results: A total of 61 infants with a median age range of 67 (2364) days were included. Intubation conditions were excellent or good in all dose and age groups. T-0 in group A was reached in a range of 15-30 s, in others up to 60 s. T-1 recovery (T75) after 0.45 mg(.)kg(-1) was 56.4 +/- 16 (A), 62.7 +/- 32 (B) and 45.8 +/- 18 (C) min. Recovery times for of 0.6 mg(.)kg(-1) were 100.8 +/- 35 (A), 70.6 +/- 19 (B) and 63.4 +/- 21 (C) min, respectively. The TOF ratio (0.7) was 62.3 +/- 18 (A), 64.1 +/- 27 (B) and 43.7 +/- 12 (C) min using 0.45 mg(.)kg(-1) compared with 94.8 +/- 31 (A), 63.8 +/- 14 (B) and 67.5 +/- 18 (C) min with 0.6 mg(.)kg(-1). The differences of T75 and TOF 0.7 in A and C were significant (P less than or equal to 0.05). Conclusions: Recovery of muscle relaxation using rocuronium bromide under isoflurane anesthesia in infants differs widely and shows great differences between age groups as well as dose regimen. A dose of 0.6 mg(.)kg(-1) resulted in a significantly longer duration of action in group A. The reduced dose of 0.45 mg(.)kg(-1) resulted in rapid and good relaxation in all infants without very long lasting effects. Reduced doses of rocuronium should be used in newborns and small infants. C1 Univ Heidelberg, Hosp Mannheim gGmbH, Dept Anaesthesiol & Intens Care Med, D-68167 Mannheim, Germany. Univ Heidelberg, Hosp Mannheim, Dept Paediat, D-68167 Mannheim, Germany. Organon GmbH, Oberschleissheim, Germany. RP Rapp, HJ (reprint author), Univ Heidelberg, Hosp Mannheim gGmbH, Dept Anaesthesiol & Intens Care Med, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany. EM h-j.rapp@urz.uni-heidelberg.de NR 20 TC 9 Z9 12 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PEDIATR ANESTH JI Pediatr. Anesth. PD APR PY 2004 VL 14 IS 4 BP 329 EP 335 DI 10.1046/j.1460-9592.2003.01216.x PG 7 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 837CY UT WOS:000222606900008 ER PT J AU Wright, PMC McCarthy, G Szenohradszky, J Sharma, ML Caldwell, JE AF Wright, PMC McCarthy, G Szenohradszky, J Sharma, ML Caldwell, JE TI Influence of chronic phenytoin administration on the pharmacokinetics and pharmacodynamics of vecuronium SO ANESTHESIOLOGY LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; CHRONIC ANTICONVULSANT THERAPY; ACUTELY ADMINISTERED PHENYTOIN; INDUCED RESISTANCE; ACETYLCHOLINE-RECEPTORS; ACCELERATED RECOVERY; RECEIVING PHENYTOIN; ROCURONIUM; CARBAMAZEPINE; ATRACURIUM AB Background: The duration of action of vecuronium is reduced in patients receiving phenytoin. In this study, the authors examined, simultaneously, the influence of phenytoin on both the pharmacokinetics and the pharmacodynamics of vecuronium. Methods: This study was approved by the institutional review board of the University of California, San Francisco, and patients gave written informed consent. Twenty-two patients, 11 taking phenytoin and all scheduled to undergo prolonged neurosurgical procedures with general anesthesia, participated in the study. In 12 patients (6 phenytoin, 6 control), vecuronium was infused at 7.5 mug(.)kg(-1.)min(-1) until the first response (T1) of each train-of-four decreased by 50%; in the remaining 10 patients (5 phenytoin, 5 control), 200 mug/kg vecuronium was infused over 10 min. Arterial blood samples were drawn at intervals over the next 5-7 h. Plasma concentrations of vecuronium and 3-desacetylvecuronium were measured by capillary gas chromatography. Pharmacokinetic and pharmacodynamic modeling was used to characterize the disposition of vecuronium and patient responses to it in the two groups. Results. Clearance was typically increased by 138% (95% confidence interval, 93-183%) in patients taking phenytoin. The effect of vecuronium was well described using a sigmoid Emax model. The concentration of vecuronium giving 50% twitch depression was increased 124% (45-202%) in patients taking phenytoin. Conclusions: Chronic phenytoin therapy reduces the effect of vecuronium by mechanisms that include both increased vecuronium metabolism and reduced sensitivity of the patient to circulating concentrations of vecuronium. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. RP Wright, PMC (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, 513 Parnassus Ave, San Francisco, CA 94143 USA. EM npmcw@itsa.ucsf.edu NR 36 TC 11 Z9 12 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 2004 VL 100 IS 3 BP 626 EP 633 DI 10.1097/00000542-200403000-00024 PG 8 WC Anesthesiology SC Anesthesiology GA 778QF UT WOS:000189251700023 ER PT J AU Fuchs-Buder, T Strowitzki, M Rentsch, K Schreiber, JU Philipp-Osterman, S Kleinschmidt, S AF Fuchs-Buder, T Strowitzki, M Rentsch, K Schreiber, JU Philipp-Osterman, S Kleinschmidt, S TI Concentration of rocuronium in cerebrospinal fluid of patients undergoing cerebral aneurysm clipping SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE blood-brain barrier, mass spectrometry high pressure liquid chromatography; neuromuscular blocking agents, rocuronium; surgery, cerebrovascular ID NICOTINIC ACETYLCHOLINE-RECEPTORS; LAUDANOSINE; ATRACURIUM; VECURONIUM; ACTIVATION; PLASMA AB Background. This study assessed the concentration of rocuronium in the cerebrospinal fluid (CSF) of patients undergoing cerebral aneurysm clipping, and investigated whether the mode of administration (single bolus vs continuous infusion) influenced the CSF concentration. Methods. Twenty patients with subarachnoid haemorrhage were randomly allocated to receive a bolus dose (bolus group), or a bolus followed by a continuous infusion of rocuronium (infusion group) (n=10 for each group). Arterial blood and ventricular CSF were sampled 2 h after the rocuronium bolus. Samples were analysed by liquid chromatography electrospray ionization-tandem mass spectrometry. Results. Rocuronium could be detected in all the CSF samples. The mean (range) CSF concentration was 2.2 (0.9-4.6) ng ml(-1) in the bolus group and 12.4 (2.4-34.6) ng ml(-1) in the infusion group; P<0.01. Conclusions. This study demonstrated that rocuronium, normally not considered to cross the blood-brain barrier, is regularly found in the CSF of patients undergoing cerebral clipping; continuous infusion of the drug led to higher plasma and CSF concentrations than after a single bolus dose. C1 Univ Saarland, Dept Anaesthesia & Crit Care, D-6650 Homburg, Germany. Univ Saarland, Dept Neurosurg, D-6650 Homburg, Germany. Univ Zurich Hosp, Inst Clin Chem, CH-8091 Zurich, Switzerland. RP Fuchs-Buder, T (reprint author), Ctr Hosp Univ Nancy Brabois, Dept Anesthesie & Reanimat, 4 Rue Morvan, F-54500 Vandoeuvre Les Nancy, France. EM t.fuchs-buder@chu-nancy.fr RI Schreiber, Jan-Uwe/B-1340-2012 NR 10 TC 5 Z9 6 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAR PY 2004 VL 92 IS 3 BP 419 EP U2 DI 10.1093/bja/aeh062 PG 3 WC Anesthesiology SC Anesthesiology GA 776VP UT WOS:000189140300018 ER PT J AU Moll, H Stumpf, T Merroun, M Rossberg, A Selenska-Pobell, S Bernhard, G AF Moll, H Stumpf, T Merroun, M Rossberg, A Selenska-Pobell, S Bernhard, G TI Time-resolved laser fluorescence spectroscopy study on the interaction of curium(III) with Desulfovibrio aspoensis DSM 10631 SO ENVIRONMENTAL SCIENCE & TECHNOLOGY LA English DT Article ID RADIOACTIVE-WASTE REPOSITORY; COMPACTED BENTONITE CLAY; 3 ECO-TYPES; ACIDITHIOBACILLUS-FERROOXIDANS; TRIVALENT ACTINIDES; SORPTION PROCESS; HUMIC-ACID; CM(III); COMPLEXATION; BACTERIA AB The influence of microorganisms on migration processes of actinides has to be taken into account for the risk assessment of potential high-level nuclear waste disposal sites. Therefore it is necessary to characterize the actinide-bacteria species formed and to elucidate the reaction mechanisms involved. This work is focused on the sulfate-reducing bacterial (SRB) strain Desulfovibrio aspoensis (D. aspoensis) DSM 10631(T) which frequently occurs in the deep granitic rock aquifers at the Aspo Hard Rock Laboratory (Aspo HRL), Sweden. We chose Cm(Ill) due to its high fluorescence spectroscopic sensitivity as a model system for exploring the interactions of trivalent actinides with D. aspoensis in the trace concentration range of 3 x 10(-7) mol/L. A time-resolved laser fluorescence spectroscopy (TRLFS) study has been carried out in the pH range from 3.00 to 7.55 in 0.154 mol/L NaCl. We interpret the pH dependence of the emission spectra with a biosorption forming an inner-sphere surface complex of Cm(III) onto the D. aspoensis cell envelope. This Cm(III)-D. apoensis-surface complex is characterized by its emission spectrum (peak maximum at 600.1 nm) and its fluorescence lifetime (162 +/- 5 mus). No evidence was found for incorporation of Cm(III) into the bacterial cells under the chosen experimental conditions. C1 Forschungszentrum Rossendorf eV, Inst Radiochem, D-01314 Dresden, Germany. Forschungszentrum Karlsruhe, Inst Nukl Entsorgung, D-76021 Karlsruhe, Germany. RP Moll, H (reprint author), Forschungszentrum Rossendorf eV, Inst Radiochem, POB 510119, D-01314 Dresden, Germany. EM h.moll@fz-rossendorf.de RI The Rossendorf Beamline at ESRF, Radiochemistry/A-2586-2011 NR 49 TC 19 Z9 19 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0013-936X J9 ENVIRON SCI TECHNOL JI Environ. Sci. Technol. PD MAR 1 PY 2004 VL 38 IS 5 BP 1455 EP 1459 DI 10.1021/es0301166 PG 5 WC Engineering, Environmental; Environmental Sciences SC Engineering; Environmental Sciences & Ecology GA 780FC UT WOS:000189360800035 ER PT J AU Mak, PH Irwin, MG AF Mak, PH Irwin, MG TI The effect of cisatracurium and rocuronium on cisatracurium precurarization and the priming principle SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE anesthesia; general; mechanisms; priming; neuromuscular blocking agents; cisatracurium; rocuronium ID NEUROMUSCULAR BLOCKING-DRUGS; RAPID TRACHEAL INTUBATION; SEQUENCE INDUCTION; TRAIN-OF-4 FADE; TIME-COURSE; VECURONIUM; PHARMACOKINETICS; PHARMACODYNAMICS; POTENCY; TUBOCURARINE AB Study Objective: To demonstrate the effect of administering a precurarizing dose of cisatracurium or rocuronium, on the speed of onset of cisatracurium, and to review the possible mechanisms and value of the priming principle. Design: Double-blind, randomized, controlled trial. Setting: Inpatient anesthesia in a university teaching hospital. Patients: 90 ASA physical status I and II patients undergoing elective surgery requiring endotracheal intubation. Interventions: Three groups of 30 patients each were investigated. Following induction of anesthesia with fentanyl and propofol, Group 1 received cisatracurium 0.015 mg.k(-1), Group 2 received rocuronium 0.09 mg (.) kg(-1), and Group 3 (control) received normal saline. Six minutes after priming, Groups 1 and 2 received cisatracurium 0.135 mg (.) kg(-1) whereas Group 3 received cisatracurium 0.15 mg (.) kg(-1). Measurements and Main Results: In each group, first twitch height and the train-of-four ratios were recorded every 10 seconds after the initial priming dose. Intubation was attempted after the first twitch height became less than 15% of baseline. The decrease in the train-of-four ratios at 6 minutes was 0.97 for cisatracurium and 0.85 for rocuronium. The onset of muscle relaxation was significantly faster after priming with cisatracurium and rocuronium (71.7 +/- 21.3 and 65 +/- 19.8 sec, respectively) compared with control (148.7 +/- 43.1 sec). Females receiving both muscle relaxants had a faster onset of paralysis than did males (65.9 +/- 20.6 vs. 79.2 +/- 20.6 and 55 +/- 14.5 vs. 71.7 +/- 20.4 sec). Intubation conditions were either excellent or satisfactory in all patients. Conclusions: Six minutes after precurarization, there is no significant difference between rocuronium and cisatracurium when used as priming drugs. An even faster onset time with both drugs was demonstrated in females. The use of priming doses of 25% to 30% of ED95 may cause symptomatic muscle weakness. The mechanisms of the priming principle are discussed. (C) 2004 by Elsevier Inc. C1 Univ Hong Kong, Queen Mary Hosp, Dept Anaesthesiol, Fac Med, Hong Kong, Hong Kong, Peoples R China. RP Mak, PH (reprint author), Univ Hlth Network, Toronto Western Hosp, Dept Anesthesia, 399 Bathurst St, Toronto, ON M5T 2S8, Canada. EM peter.mak@uhn.on.ca NR 26 TC 4 Z9 10 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2004 VL 16 IS 2 BP 83 EP 87 DI 10.1016/j.jclinane.2003.05.004 PG 5 WC Anesthesiology SC Anesthesiology GA 818XJ UT WOS:000221277500002 ER PT J AU Reisli, R Apilliogullari, S Reisli, I Tuncer, S Erol, A Okesli, S AF Reisli, R Apilliogullari, S Reisli, I Tuncer, S Erol, A Okesli, S TI The effect of environmental tobacco smoke on the dose requirements of rocuronium in children SO PAEDIATRIC ANAESTHESIA LA English DT Article DE rocuronium; passive smoking; anaesthesia; tobacco smoke pollution ID RECEIVING GENERAL-ANESTHESIA; ADVERSE RESPIRATORY EVENTS; NEUROMUSCULAR BLOCKADE; EXPOSURE; RISK; PHARMACODYNAMICS AB Background: Smoking affects the pharmacodynamic and pharmacokinetic behaviour of several drugs. The aim of this study was to evaluate the effects of environmental tobacco smoke on onset and recovery time after single dose rocuronium in children. Methods: Forty children between 4 and 10 years were enrolled into the study. Children who have no familial smoking history were included in the first group whereas passive smokers included in the second group. Sevoflurane in 50% O-2 and 50% N2O was used for induction of anaesthesia. Evoked adductor pollicis electromyography was used to monitor neuromuscular block. The T-95 and T-25 values were recorded. Results: The T-95 values (+/-SD) for rocuronium were 110.1 +/- 39.3 s and 79.3 +/- 35.6 s for group 1 and group 2, respectively (P < 0.05). The T-25 value of group 2 was 40.1 +/- 10.6 min and compared with group 1 values (30.85 +/- 7.02 min) it was significantly longer (P < 0.01). Conclusion: This study shows that passive smoking children consume less rocuronium than nonsmokers during similar anaesthesia. We think that a history of passive smoking must also be taken into consideration during preoperative evaluation of paediatric patients. C1 Selcuk Univ, Meram Fac Med, Dept Anaesthesiol, TR-42080 Konya, Turkey. Selcuk Univ, Meram Fac Med, Dept Pediat, TR-42080 Konya, Turkey. RP Reisli, R (reprint author), Selcuk Univ, Tip Fak Hastanesi, TR-42080 Konya, Turkey. EM ireisli@hotmail.com NR 13 TC 4 Z9 4 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD MAR PY 2004 VL 14 IS 3 BP 247 EP 250 DI 10.1046/j.1460-9592.2003.01186.x PG 4 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 779VY UT WOS:000189323400007 ER PT J AU Reisli, R Apilliogullari, S Reisli, I Tuncer, S Erol, A Okesli, S AF Reisli, R Apilliogullari, S Reisli, I Tuncer, S Erol, A Okesli, S TI The effect of environmental tobacco smoke on the dose requirements of rocuronium in children SO PEDIATRIC ANESTHESIA LA English DT Article DE rocuronium; passive smoking; anaesthesia; tobacco smoke pollution ID RECEIVING GENERAL-ANESTHESIA; ADVERSE RESPIRATORY EVENTS; NEUROMUSCULAR BLOCKADE; EXPOSURE; RISK; PHARMACODYNAMICS AB Background: Smoking affects the pharmacodynamic and pharmacokinetic behaviour of several drugs. The aim of this study was to evaluate the effects of environmental tobacco smoke on onset and recovery time after single dose rocuronium in children. Methods: Forty children between 4 and 10 years were enrolled into the study. Children who have no familial smoking history were included in the first group whereas passive smokers included in the second group. Sevoflurane in 50% O-2 and 50% N2O was used for induction of anaesthesia. Evoked adductor pollicis electromyography was used to monitor neuromuscular block. The T-95 and T-25 values were recorded. Results: The T-95 values (+/-SD) for rocuronium were 110.1 +/- 39.3 s and 79.3 +/- 35.6 s for group 1 and group 2, respectively (P < 0.05). The T-25 value of group 2 was 40.1 +/- 10.6 min and compared with group 1 values (30.85 +/- 7.02 min) it was significantly longer (P < 0.01). Conclusion: This study shows that passive smoking children consume less rocuronium than nonsmokers during similar anaesthesia. We think that a history of passive smoking must also be taken into consideration during preoperative evaluation of paediatric patients. C1 Univ Selcuk, Meram Fac Med, Dept Anaesthesiol, Konya, Turkey. Univ Selcuk, Meram Fac Med, Dept Pediat, Konya, Turkey. RP Reisli, R (reprint author), Selcuk Univ, Tip Fak Hastanesi, Anestezi Reanimasyon Anabilim Dali, TR-42080 Konya, Turkey. EM ireisli@hotmail.com NR 13 TC 4 Z9 4 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PEDIATR ANESTH JI Pediatr. Anesth. PD MAR PY 2004 VL 14 IS 3 BP 247 EP 250 DI 10.1046/j.1460-9592.2003.01186.x PG 4 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 829NI UT WOS:000222055100007 ER PT J AU McMurphy, RM Davidson, HJ Hodgson, DS AF McMurphy, RM Davidson, HJ Hodgson, DS TI Effects of atracurium on intraocular pressure, eye position, and blood pressure in eucapnic and hypocapnic isoflurane-anesthetized dogs SO AMERICAN JOURNAL OF VETERINARY RESEARCH LA English DT Article ID GENERAL-ANESTHESIA; HALOTHANE; ACETAZOLAMIDE; HORSES; PCO2 AB Objective-To determine effects of atracurium on intraocular pressure (IOP), eye position, and arterial blood pressure in eucapnic and hypocapnic dogs anesthetized with isoflurane. Animals-16 dogs. Procedure-Ventilation during anesthesia was controlled to maintain Paco(2) at 38 to 44 mm Hg in group-I dogs (n = 8) and 26 to 32 mm Hg in group-II dogs (8). Baseline measurements for IOP systolic, diastolic, and mean arterial blood pressure, central venous pressure (CVP), and heart rate (HR) were recorded. Responses to peroneal nerve stimulation were monitored by use of a force-displacement transducer. Atracurium (0.2 mg/kg) was administered IV and measurements were repeated at 1, 2, 3, and 5 minutes and at 5-minute intervals thereafter for 60 minutes. Results-Atracurium did not affect IOP HR, or CVP Group 11 had higher CVP than group 1, but IOP was not different. There was no immediate effect of atracurium on arterial blood pressure. Arterial blood pressure increased gradually over time in both groups. Thirty seconds after administration of atracurium, the eye rotated from a ventromedial position to a central position and remained centrally positioned until 100% recovery of a train-of-four twitch response. The time to 100% recovery was 53.1 +/- 5.3 minutes for group I and 46.3 +/- 9.2 minutes for group II. Conclusions and Clinical Relevance-Atracurium did not affect IOP or arterial blood pressure in isoflurane-anesthetized dogs. Hyperventilation did not affect IOP or the duration of effect of atracurium. C1 Kansas State Univ, Coll Vet Med, Dept Clin Sci, Manhattan, KS 66506 USA. RP McMurphy, RM (reprint author), Kansas State Univ, Coll Vet Med, Dept Clin Sci, Manhattan, KS 66506 USA. NR 21 TC 11 Z9 12 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 USA SN 0002-9645 J9 AM J VET RES JI Am. J. Vet. Res. PD FEB PY 2004 VL 65 IS 2 BP 179 EP 182 DI 10.2460/ajvr.2004.65.179 PG 4 WC Veterinary Sciences SC Veterinary Sciences GA 768WZ UT WOS:000188594700010 ER PT J AU Sie, MY Goh, PK Chan, L Ong, SY AF Sie, MY Goh, PK Chan, L Ong, SY TI Bispectral index during modified rapid sequence induction using thiopentone or propofol and rocuronium SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE monitoring : Bispectral Index, BIS, awareness, rapid sequence induction ID GENERAL-ANESTHESIA; AWARENESS; RECOVERY; RECALL AB This randomized controlled trial compared Bispectral Index (BIS) values in 40 patients after a modified rapid sequence induction using thiopentone 4 mg/kg or propofol 2 mg/kg with rocuronium 0.6 mg/kg as muscle relaxant. Endotracheal intubation was performed at 60 seconds from induction of anaesthesia and BIS values were recorded for three minutes after induction. At the 120, 150 and 180 second measurements there was a significantly greater proportion of subjects with BIS values less than or equal to 60 ("anaesthetized ") in the propofol group compared with the thiopentone group (P values < 0.02, < 0.01 and < 0.01 respectively). All intubations were completed within two minutes. No explicit recall of intubation was detected clinically with either induction agent. The BIS scores we have measured suggest that thiopentone 4 mg/kg is more likely to be associated with lighter planes of anaesthesia and consequent risk of awareness than propofol 2 mglkg, if intubation is delayed or prolonged. C1 Univ Malaya Med Ctr, Dept Anaesthesiol, Kuala Lumpur 50603, Malaysia. RP Sie, MY (reprint author), Univ Malaya Med Ctr, Dept Anaesthesiol, Kuala Lumpur 50603, Malaysia. RI CHAN, LUCY/B-8887-2010 NR 10 TC 8 Z9 8 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2027, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD FEB PY 2004 VL 32 IS 1 BP 28 EP 30 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 777DC UT WOS:000189158600004 ER PT J AU Fodale, V Pratico, C Girlanda, P Baradello, A Lucanto, T Rodolico, C Nicolosi, C Rovere, V Santamaria, LB Dattola, R AF Fodale, V Pratico, C Girlanda, P Baradello, A Lucanto, T Rodolico, C Nicolosi, C Rovere, V Santamaria, LB Dattola, R TI Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anti-inflammatory agent, methylprednisolone; complications, polyneuropathies; complications, weakness; neuromuscular block; neuromuscular block, cisatracurium ID CRITICAL ILLNESS POLYNEUROPATHY; INTENSIVE INSULIN THERAPY; CRITICALLY-ILL; ICU PATIENTS; NEUROPATHY; SEPSIS; METHYLPREDNISOLONE; COMPLICATIONS; VARIANT AB A 40-yr-old male was admitted to the intensive care unit following blunt chest trauma. He had multiple rib fractures, bilateral pneumothoraces, and acute respiratory failure requiring mechanical ventilation. Sedation was achieved with midazolam and morphine, and later with propofol. The patient was paralysed with a continuous infusion of cisatracurium 1.42-5.75 mug kg(-1) min(-1). Methylprednisolone 125 mg i.v. every 12 h was also started. After discontinuation of the cisatracurium infusion 7 days later, the patient manifested a flaccid quadriplegia with absence of deep-tendon reflexes. No sensory deficits were observed. Electromyography (EMG), repetitive nerve stimulation testing, and single fibre EMG (SFEMG) were performed at regular intervals after stopping cisatracurium. Clinical symptoms and electrophysiological examinations supported the diagnosis of acute motor axonal polyneuropathy related to concomitant administration of cisatracurium and corticosteroid therapy. C1 Univ Messina, Policlin Univ G Martino, Dept Neurosci Psychiat & Anesthesiol Sci, Sect Anesthesia, I-98125 Messina, Italy. Univ Messina, Policlin Univ G Martino, Dept Neurosci Psychiat & Anesthesiol Sci, Intens Care Unit, I-98125 Messina, Italy. RP Fodale, V (reprint author), Univ Messina, Policlin Univ G Martino, Dept Neurosci Psychiat & Anesthesiol Sci, Sect Anesthesia, I-98125 Messina, Italy. EM vfodale@unime.it RI Fodale, Vincenzo/G-5554-2010 OI Fodale, Vincenzo/0000-0001-9540-5665 NR 30 TC 2 Z9 2 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD FEB PY 2004 VL 92 IS 2 BP 289 EP 293 DI 10.1093/bja/aeh040 PG 5 WC Anesthesiology SC Anesthesiology GA 769KW UT WOS:000188650100028 ER PT J AU Fink, H Yasuhara, S Blobner, M Martyn, JAJ AF Fink, H Yasuhara, S Blobner, M Martyn, JAJ TI Up-regulation of acetylcholine receptors during subchronic infusion of pancuronium is caused by a posttranscriptional mechanism related to disuse SO CRITICAL CARE MEDICINE LA English DT Article ID CRITICALLY ILL PATIENTS; D-TUBOCURARINE; NEUROMUSCULAR-JUNCTIONS; ELECTRICAL-ACTIVITY; GENE-EXPRESSION; IN-VIVO; MUSCLE; RAT; NUMBER; DEGRADATION AB Objective: Contrasting with the classic theory that competitive block of the acetylcholine receptor induces up-regulation of the receptor, recent studies show that irreversible block of acetylcholine receptors with alpha-bungarotoxin decreases acetylcholine receptor number within hours. This study investigated the early effects of competitive acetylcholine receptor block with the reversible, competitive muscle relaxant, pancuronium. Design: Prospective, randomized, placebo-controlled experimental study. Subjects: Healthy adult Sprague-Dawley rats. Setting: Animal laboratory in a university hospital. Interventions: After internal review board approval, Sprague-Dawley rats were anesthetized and received pancuronium at a rate to completely suppress neuromuscular twitch. The control group received saline. Infusion times were 0, 3, 6, or 12 hrs (n = 8 per group). One sciatic nerve was stimulated to induce muscle twitch, and the other nerve remained unstimulated. Total acetylcholine receptor expression, as well as expression of messenger RNA of the five subunits, was assayed. Measurements and Main Results: There were no differences in acetylcholine receptor number between groups at time points 0, 3, and 6 hrs. At 12 hrs, acetylcholine receptor numbers in both the stimulated (35.2 +/- 4.8 fmol acetylcholine receptor/mg protein) and nonstimulated (38.3 +/- 4.8) pancuronium group, as well as the nonstimulated control saline group (37.5 +/- 4.6), were significantly increased compared with stimulated controls (27.6 +/- 4.0). Pancuronium did not potentiate the acetylcholine receptor up-regulation of the nonstimulated control group at 12 hrs. There were no changes in messenger RNA expression between groups. Conclusions: Infusion of the reversible competitive inhibitor pancuronium up to 12 hrs does not reduce acetylcholine receptor number and therefore contrasts with the irreversible acetylcholine receptor blocker alpha-bungarotoxin. This study documents that 12 hrs of disuse per se leads to an increased expression of the acetylcholine receptor number by a posttranscriptional mechanism that can be prevented by nerve-evoked muscle contraction. C1 Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Boston, MA 02114 USA. Tech Univ Munich, Klinikum Rechts Isar, Anasthesiol Klin, D-8000 Munich, Germany. RP Fink, H (reprint author), Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Boston, MA 02114 USA. NR 25 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD FEB PY 2004 VL 32 IS 2 BP 509 EP 513 DI 10.1097/01.CCM.0000109445.38396.F5 PG 5 WC Critical Care Medicine SC General & Internal Medicine GA 774ME UT WOS:000188982600028 ER PT J AU Fletcher, JE Heard, CMB AF Fletcher, JE Heard, CMB TI The clinical effect of mixing different proportions of rocuronium and mivacurium SO PAEDIATRIC ANAESTHESIA LA English DT Article DE rocuronium; mivacurium; synergy; children ID D-TUBOCURARINE; COMBINATIONS; PANCURONIUM; CHILDREN; POTENTIATION; INTUBATION; POTENCY; AGENTS; TIME AB Background: A synergistic effect has been described when rocuronium (Roc) and mivacurium (Miv) are combined in equal (i.e. 1 : 1) ED95 proportions at various total doses. We have investigated the effect of Roc or Miv alone and four different ratios (1 : 4, 2 : 3, 3 : 2 and 4 : 1) of Roc and Miv mixed to a total dose of 1.33 x ED95. The primary outcome is the ratio producing the maximum enhancement of duration of clinical effect. Methods: Sixty-eight healthy children were anaesthetized with propofol, nitrous oxide and fentanyl. They then randomly received either Roc 0.4 (mg.kg(-1)), Miv 0.133 (mg.kg(-1)) or one of four Roc + Miv combinations (mg.kg(-1)): Roc 0.32 + Miv 0.027; Roc 0.24 + Miv 0.053; Roc 0.16 + Miv 0.08; and Roc 0.08 + Miv 0.106. The mechanical response of the adductor pollicis muscle to supramaximal stimulation of the ulnar nerve at the wrist was recorded. Results: Duration of effect was greater in the combination groups than that predicted from the duration of Roc or Miv used alone. Duration was maximally increased around a 1 : 1 ratio (2 : 3 and 3 : 2) of Roc and Miv. The likelihood of achieving 100% block was greater in combination groups compared with Roc or Miv used alone. Conclusions: Combinations of Roc and Miv show a synergistic effect, which appears maximal as the mixture approaches a 1 : 1 ratio of their ED(95)s. This combination acted as if a larger effective dose of a single (new) drug had been given, but did not offer the advantage of both rapid onset and short duration of effect. C1 Univ N Carolina, Dept Anesthesiol, Chapel Hill, NC USA. SUNY Coll Buffalo, Childrens Hosp Buffalo, Dept Anesthesiol, Buffalo, NY 14222 USA. RP Fletcher, JE (reprint author), UNC Hosp, Dept Anesthesiol, CB 7010,Manning Dr, Chapel Hill, NC 27599 USA. EM jfletcher@aims.unc.edu NR 14 TC 1 Z9 2 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD FEB PY 2004 VL 14 IS 2 BP 152 EP 157 DI 10.1111/j.1460-9592.2004.01166.x PG 6 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 774PJ UT WOS:000188991500006 ER PT J AU Pohl, B Hofmockel, R Simanski, O Wende, K Lampe, BP AF Pohl, B Hofmockel, R Simanski, O Wende, K Lampe, BP TI Feedback-control of muscle relaxation with a varying on-off controller using cisatracurium SO ANAESTHESIST LA German DT Article DE closed-loop system; electromyography; neuromuscular block; cisatracurium; quality control criteria ID INDUCED NEUROMUSCULAR BLOCKADE; CLOSED-LOOP SYSTEM; ATRACURIUM; INFUSION; MODEL; SUXAMETHONIUM; PHARMACOLOGY; VECURONIUM; RELAXANTS; RECOVERY AB Background. Under clinical conditions constant neuromuscular blockade can also be maintained by a simple closed-loop system. However, delayed onset time, non-linearity of the dose-response curve and different sensitivity to muscle relaxants for each patient are limiting factors. Methods. In 20 patients who underwent elective surgical procedures under continuous propofol/alfentanil anaesthesia and relaxation with cisatracurium,the maintenance of an electromyographically controlled cisatracurium block of 90% was achieved by a varying on-off control system. Using an own computer-aided measuring device,the course of the neuromuscular blockade and deviations from the desired neuromuscular block were registered. Results. Over a period of 64.2+/-14.0 min, neuromuscular block could be controlled on average at a T-1-level of 10% (90% block). The mean error of the deviation of the obtained neuromuscular blockade from the set-point was -1.6+/-0.9% on average. To maintain this neuromuscular blockade, a dose rate of 1.4+/-0.9 mug*kg(-1)*min(-1) cisatracurium was necessary. Conclusions. It can be concluded that a simple closed-loop system allows the safe use of the intermediate term muscle relaxant cisatracurium for the performance of surgical procedures. C1 Univ Rostock, Klin & Poliklin Anasthesiol & Intensivtherapie, D-18055 Rostock, Germany. Univ Rostock, Inst Automatisierungstech, Fachbereich Elektrotech & Informat Tech, D-18055 Rostock, Germany. RP Pohl, B (reprint author), Univ Rostock, Klin & Poliklin Anasthesiol & Intensivtherapie, Schillingallee 35, D-18055 Rostock, Germany. EM birgit.pohl@med.uni-rostock.cle NR 27 TC 4 Z9 5 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD JAN PY 2004 VL 53 IS 1 BP 66 EP 72 DI 10.1007/s00101-003-0605-09 PG 7 WC Anesthesiology SC Anesthesiology GA 775PF UT WOS:000189049600009 ER PT J AU Kopman, AF Zank, LM Ng, J Neuman, GG AF Kopman, AF Zank, LM Ng, J Neuman, GG TI Antagonism of cisatracurium and rocuronium block at a tactile train-of-four count of 2: Should quantitative assessment of neuromuscular function be mandatory? SO ANESTHESIA AND ANALGESIA LA English DT Article ID POSTOPERATIVE RESIDUAL CURARIZATION; RECOVERY ROOM; VECURONIUM; ATRACURIUM; PANCURONIUM; ACCELEROMYOGRAPHY; REVERSAL; PARALYSIS; TIME AB With a train-of-four (TOF) ratio >0.70 as the standard of acceptable recovery, postoperative residual paralysis is a frequent occurrence in postanesthesia care units (PACUs). However, detailed information regarding prior anesthetic management is rarely provided. We examined the incidence of postoperative weakness after the administration of cisatracurium and rocuronium when using a rigid protocol for muscle relaxant and subsequent neostigmine administration. Under desflurane, N2O, and opioid anesthesia, tracheal intubation was accomplished after either cisatracurium 0.15 mg/kg or rocuronium 0.60 mg/kg. The response of the thumb to ulnar nerve stimulation was estimated by palpation. Additional increments of muscle relaxant were given as needed to maintain the TOF count at 1 or 2. At the conclusion of surgery, at a TOF count of 2, neostigmine 0.05 mg/kg plus glycopyrrolate 10 mug/kg was administered. The mechanical TOF response was then measured with a force transducer starting 5 min postreversal. Patients were observed until a TOF ratio of 0.90 was achieved. There were no significant differences in the recovery profiles of cisatracurium versus rocuronium. TOF ratios at 10 min postreversal were 0.72 +/- 0.10 and 0.76 +/- 0.11, respectively. At 15 min postreversal, only one subject in each group had a TOF ratio of <0.70. No patient in either group arrived in the PACU with a TOF ratio <0.70. Our results suggest that if cisatracurium or rocuronium is administered by using the TOF count as a guide, critical episodes of postoperative weakness in the PACU should be an infrequent occurrence. C1 New York Med Coll, Dept Anesthesiol, Valhalla, NY 10595 USA. RP Kopman, AF (reprint author), St Vincents Hosp Manhattan, Dept Anesthesiol, Rm 408,170 W 12th St, New York, NY 10011 USA. NR 26 TC 33 Z9 40 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2004 VL 98 IS 1 BP 102 EP 106 DI 10.1213/01.ANE.000009485.19305.E9 PG 5 WC Anesthesiology SC Anesthesiology GA 757KK UT WOS:000187561400025 ER PT J AU Breslin, DS Jiao, K Habib, AS Schultz, J Gan, TJ AF Breslin, DS Jiao, K Habib, AS Schultz, J Gan, TJ TI Pharmacodynamic interactions between cisatracurium and rocuronium SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 12-16, 2002 CL ORLANDO, FLORIDA SP Amer Soc Anesthesiologists ID NEUROMUSCULAR BLOCKADE; D-TUBOCURARINE; ANESTHESIA; ISOFLURANE; VECURONIUM; ATRACURIUM; PANCURONIUM; MIVACURIUM; COMBINATIONS; SEVOFLURANE AB The onset and duration of maintenance doses of neuromuscular blocking drugs may be influenced by the original neuromuscular blocking drug used. We assessed the effect of the interaction between steroidal and benzoisoquinolinium compounds on the clinical duration of maintenance doses of cisatracurium. Sixty adult patients undergoing anesthesia with isoflurane, nitrous oxide, and oxygen were randomized to receive the following: Group I = rocuronium 0.6 mg/kg followed by cisatracurium 0.03 mg/kg when the first twitch in the train-of-four (TOF) recovered to 25%, Group II = cisatracurium 0.15 mg/kg followed by cisatracurium 0.03 mg/kg, and Group III = rocuronium 0.6 mg/kg followed by rocuronium. 0.15 mg/kg. Neuromuscular blockade was monitored using acceleromyography (TOF-Guard(R), Boxtel, The Netherlands). The clinical duration (mean +/- SD) of the first 2 maintenance doses was 41 +/- 10, 31 +/- 7double dagger, and 25 +/- 8double dagger min, and 39 +/- 11, 30 +/- 6dagger, 29 +/- 9(star) min in Groups I-III, respectively (P-star < 0.05, daggerP < 0.01, double daggerP < 0.001; Group I versus II and III). Thus, the clinical duration of the first two maintenance doses of cisatracurium was prolonged when administered after rocuronium. C1 Duke Univ, Ctr Med, Dept Anesthesiol, Durham, NC 27710 USA. RP Gan, TJ (reprint author), Duke Univ, Ctr Med, Dept Anesthesiol, Box 3094, Durham, NC 27710 USA. NR 19 TC 3 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2004 VL 98 IS 1 BP 107 EP 110 DI 10.1213/01.ANE.0000093387.15263.48 PG 4 WC Anesthesiology SC Anesthesiology GA 757KK UT WOS:000187561400026 ER PT J AU Murphy, GS Szokol, JW Franklin, M Marymont, JH Avram, MJ Vender, JS AF Murphy, GS Szokol, JW Franklin, M Marymont, JH Avram, MJ Vender, JS TI Postanesthesia care unit recovery times and neuromuscular blocking drugs: A prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID POSTOPERATIVE RESIDUAL PARALYSIS; TACTILE EVALUATION; TRAIN-OF-4 FADE; MUSCLE-RELAXANT; BLOCKADE; ATRACURIUM; VECURONIUM; HUMANS; CURARIZATION; VOLUNTEERS AB In this study, we examined the effect of choice of neuromuscular blocking drug (NMBD) (pancuronium. versus rocuronium) on postoperative recovery times and associated adverse outcomes in patients undergoing orthopedic surgical procedures. Seventy patients were randomly allocated to a pancuronium or rocuronium group. On arrival to the postanesthesia care unit (PACU) and again 30 min later, train-of-four ratios were quantified by using acceleromyography. Immediately after acceleromyographic measurements, patients were assessed for signs and symptoms of residual paresis. During the PACU admission, episodes of hypoxemia, nausea, and vomiting were recorded. The time required for patients to meet discharge criteria and the time of actual PACU discharge were noted. Forty percent of patients in the pancuronium group had train-of-four ratios <0.7 on arrival to the PACU, compared with only 5.9% of subjects in the rocuronium group (P < 0.001). Patients in the pancuronium. group were more likely to experience symptoms of muscle weakness (blurry vision and generalized weakness; P < 0.001) and hypoxemia (10 patients in the rocuronium group versus 21 patients in the pancuronium group; P = 0.015) during the PACU admission. Significant delays in meeting PACU discharge criteria (50 min [45-61 min] versus 30 min [25-40 min]) and achieving actual discharge (70 min [60-90 min] versus 57.5 min [4561 min]) were observed when the pancuronium group was compared with the rocuronium. group (P < 0.001). In conclusion, our study indicates that PACU recovery times may be prolonged when long-acting NMBDs are used in surgical patients. C1 Northwestern Univ, Feinberg Sch Med, Evanston Northwestern Healthcare, Dept Anesthesiol, Evanston, IL 60201 USA. Northwestern Univ, Feinberg Sch Med, Dept Anesthesiol, Evanston, IL 60201 USA. RP Murphy, GS (reprint author), Northwestern Univ, Feinberg Sch Med, Evanston Northwestern Healthcare, Dept Anesthesiol, 2650 Ridge Ave, Evanston, IL 60201 USA. NR 22 TC 36 Z9 42 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2004 VL 98 IS 1 BP 193 EP 200 DI 10.1213/01.ANE.0000095040.36648.F7 PG 8 WC Anesthesiology SC Anesthesiology GA 757KK UT WOS:000187561400046 ER PT J AU Tian, GX Kimura, T Yoshida, Z Zhu, YJ Rao, LF AF Tian, GX Kimura, T Yoshida, Z Zhu, YJ Rao, LF TI Fluorescence and IR studies on the hydration state of lanthanides(III) and curium(III) in the complexes extracted with purified Cyanex301, Cyanex302 and Cyanex272 SO RADIOCHIMICA ACTA LA English DT Article DE cyanex; Ln(III); Cm(III); hydration; fluorescence; IR ID LASER-INDUCED FLUORESCENCE; TRIVALENT LANTHANIDE; SEPARATION; ACID; SPECTROSCOPY; AM(III); LUMINESCENCE; CYANEX-301; EU(III); AMERICIUM(III) AB The hydration number of lanthanides, Ln(III) (Ln = Sm, Eu, Tb, Dy), and Cm(III) in the extracted complexes with purified Cyanex301, Cyanex302 and Cyanex272 was investigated using time-resolved laser-induced fluorescence spectroscopy (TRLFS) and FT-IR spectroscopy. The results, in conjunction with the previous results on the Ln(III) and Am(III) complexes, provide insight into the composition of the extracted complexes. No difference has been observed in the hydration number or the composition between the Ln(III) and Cm(III) complexes with Cyanex302 or Cyanex272. The extracted complexes of Ln(III) and Cm(III) with Cyanex302 have the formula, ML(HL2)(2)(.)nH(2)O, where L stands for the anion of Cyanex302 and n = 3-5. No water molecules are found in the first coordination shell of Ln(III) or Cm(III) complexes with Cyanex272. In contrast to the extraction with Cyanex302 or Cyanex272, the composition of the Ln(III) complexes is different from that of the Cm(III) complex in the extraction with Cyanex301. The Ln(III) complex with Cyanex301 has one or two H2O molecules with a molecular formula of LnL(3)(.)2H(2)O or HLnL(4)(.)H(2)O, where L stands for the anion of Cyanex301. However, the Cm(III) complex with Cyanex301 does not contain H2O with the molecular formula of HCmL4, in which only the 8 sulfur atoms from Cyanex301 coordinate to Cm(III). The results for Cm(III) agree with the previous data for Am(III) from EXAFS and IR measurements. C1 Lawrence Berkeley Natl Lab, Glenn T Seaborg Ctr, Berkeley, CA 94720 USA. Japan Atom Energy Res Inst, Dept Mat Sci, Tokai, Ibaraki 3191195, Japan. Tsing Hua Univ, Inst Nucl Energy Res, Beijing 100084, Peoples R China. RP Tian, GX (reprint author), Lawrence Berkeley Natl Lab, Glenn T Seaborg Ctr, 70A-1150,1 Cyclotron Rd, Berkeley, CA 94720 USA. EM Gtian@lbl.gov NR 29 TC 5 Z9 6 PU R OLDENBOURG VERLAG PI MUNICH PA LEKTORAT MINT, POSTFACH 80 13 60, D-81613 MUNICH, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 2004 VL 92 IS 8 BP 495 EP 499 DI 10.1524/ract.92.8.495.39274 PG 5 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 854OV UT WOS:000223914100008 ER PT J AU Ozaki, T Gillow, JB Kimura, T Ohnuki, T Yoshida, Z Francis, AJ AF Ozaki, T Gillow, JB Kimura, T Ohnuki, T Yoshida, Z Francis, AJ TI Sorption behavior of europium(III) and curium(III) on the cell surfaces of microorganisms SO RADIOCHIMICA ACTA LA English DT Article; Proceedings Paper CT MIGRATION 2003 Conference CY SEP 21-26, 2003 CL Gyeongju, SOUTH KOREA DE microorganisms; europium(III); curium(III); sorption; coordination environment; time-resolved laser-induced fluorescence spectroscopy (TRLFS) ID INDUCED FLUORESCENCE SPECTROSCOPY; BACILLUS-SUBTILIS; METAL-IONS; CHLORELLA-VULGARIS; EU(III); URANIUM; BINDING; SITES; WALL; BIOTRANSFORMATION AB We investigated the association of europium(III) and curium(III) with the microorganisms Chlorella vulgaris, Bacillus subtilis. Pseudomonas fluorescens, Halomonas sp.. Halobacterium salinarum, and Halobacterium halobium. We determined the kinetics and distribution coefficients (K-d) for Eu(III) and Cm(III) sorption at pH 3-5 by batch experiments, and evaluated the number of water molecules in the inner-sphere (N-H2O) and the degree of strength of ligand field (R-E/M) for Eu(Ill) by time-resolved laser-induced fluorescence spectroscopy (TRLFS). Exudates from C. vulgaris, Halomonas sp., and H. halobium had an affinity for Eu(III) and Cm(III). The log K-d of Eu(III) and Cm(III) showed that their sorption was not fully due to the exchange with three protons on the functional groups on cell surfaces. The halophilic microorganisms (Halomonas sp., Halobacterium salinarum, H. halobium) showed almost no pH dependence in log K-d, indicating that an exchange with Na+ on the functional groups was involved in their sorption. The DeltaN(H2O) (= 9 - N-H2O) for Eu(III) on C. vulgaris was 1-3, while that for the other microorganisms was over 3. demonstrating that the coordination of Eu(III) with C. vulgaris was predominantly an outer-spherical process. The R-E/M for Eu(III) on halophilic microorganisms was 2.5-5, while that for non-halophilic ones was 1-2.5. This finding suggests that the coordination environment of Eu(III) on the halophilic microorganisms is more complicated than that on the other three non-halophilic ones. C1 Japan Atom Energy Res Inst, Adv Sci Res Ctr, Ibaraki 3191195, Japan. Brookhaven Natl Lab, Dept Environm Sci, Upton, NY 11973 USA. RP Ozaki, T (reprint author), Japan Atom Energy Res Inst, Adv Sci Res Ctr, Ibaraki 3191195, Japan. EM tozaki@popsvr.tokai.jaeri.go.jp NR 27 TC 10 Z9 10 PU R OLDENBOURG VERLAG PI MUNICH PA LEKTORAT MINT, POSTFACH 80 13 60, D-81613 MUNICH, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 2004 VL 92 IS 9-11 BP 741 EP 748 DI 10.1524/ract.92.9.741.55006 PG 8 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 880ZY UT WOS:000225831400032 ER PT J AU Ge, SJ Zhuang, XL He, RH Wang, YT Zhang, X Huang, SW AF Ge, SJ Zhuang, XL He, RH Wang, YT Zhang, X Huang, SW TI Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID HYPNOTIC LEVEL; PROPOFOL INDUCTION; BISPECTRAL INDEX; DEPTH; SEVOFLURANE AB Purpose: During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (Aline ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon. Methods: Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (FETISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg(.)kg(-1), 0.1 mg(.)kg(-1), 0.2 mg(.)kg(-1) or saline was administered in a randomized, double-blind design. The AAI and bispectral index (BIhx) were monitored throughout the study and analyzed off-line. Results: BIhx was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg(.)kg(-1) did not differ significantly from the corresponding mean recorded from 15 min to 20 min after FETISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg(.)kg(-1) or 0.2 mg(.)kg(-1), AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017). Conclusions: Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while BIhx is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation. C1 Shanghai Jiao Tong Univ, Affiliated Shaghai First Peoples Hosp, Dept Anesthesiol, Shanghai, Peoples R China. RP Ge, SJ (reprint author), Shanghai First Peoples Hosp, Dept Anesthesiol, Shanghai 200080, Peoples R China. NR 12 TC 9 Z9 13 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 2003 VL 50 IS 10 BP 1017 EP 1022 PG 6 WC Anesthesiology SC Anesthesiology GA 754BU UT WOS:000187283500009 ER PT J AU Tas, T Genccelep, M Atasoy, N Ozbek, H Ceylan, E AF Tas, T Genccelep, M Atasoy, N Ozbek, H Ceylan, E TI The comparison of effects of atracurium and mivacurium with TOF GUARD device in cats SO INDIAN VETERINARY JOURNAL LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENT; ANESTHETIZED CAT C1 Yuzuncu Yil Univ, Dept Surg, Van, Turkey. Yuzuncu Yil Univ, Fac Vet, Dept Internal Med, Van, Turkey. Yuzuncu Yil Univ, Fac Med, Dept Pharmacol, Van, Turkey. Ataturk Univ, Fac Vet, Dept Surg, Erzurum, Turkey. RP Tas, T (reprint author), Yuzuncu Yil Univ, Dept Surg, Van, Turkey. NR 10 TC 0 Z9 0 PU INDIAN VETERINARY JOURNAL PI CHENNAI PA 11 CHAMIERS RD, CHENNAI 600 035, INDIA SN 0019-6479 J9 INDIAN VET J JI Indian Vet. J. PD DEC PY 2003 VL 80 IS 12 BP 1248 EP 1250 PG 3 WC Veterinary Sciences SC Veterinary Sciences GA 778MZ UT WOS:000189246500012 ER PT J AU Assefa, Z Yaita, T Haire, RG Tachimori, S AF Assefa, Z Yaita, T Haire, RG Tachimori, S TI Photoluminescence and Raman studies of curium and americium complexes of 6-methyl 2-(2-pyridyl)-benzimidazole: Evidence for an efficient intramolecular energy transfer SO INORGANIC CHEMISTRY LA English DT Article ID LASER-INDUCED FLUORESCENCE; LUMINESCENCE; LANTHANIDE; LIGANDS; SPECTRA; IONS AB The 6-methyl-2-(2-pyridyl)-benzimidazoie (biz) ligand coordinates with the actinide species in solution, and the complexes display efficient intramolecular energy-transfer processes. The energy transfer in the Cm(III)-biz system proceeds in a nonradiative mode, whereas a radiative mode is the principal mechanism in the Am(III)-biz system. C1 Oak Ridge Natl Lab, Div Chem Sci, Oak Ridge, TN 37831 USA. Japan Atom Energy Res Inst, Dept Mat Sci, Tokai, Ibaraki 31911, Japan. RP Assefa, Z (reprint author), Oak Ridge Natl Lab, Div Chem Sci, MS 6375, Oak Ridge, TN 37831 USA. NR 23 TC 8 Z9 8 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0020-1669 J9 INORG CHEM JI Inorg. Chem. PD NOV 17 PY 2003 VL 42 IS 23 BP 7375 EP 7377 DI 10.1021/ic034759y PG 3 WC Chemistry, Inorganic & Nuclear SC Chemistry GA 743FZ UT WOS:000186562900013 ER PT J AU Ostergaard, D Viby-Mogensen, J Rasmussen, SN Gatke, MR Pedersen, NA Skovgaard, LT AF Ostergaard, D Viby-Mogensen, J Rasmussen, SN Gatke, MR Pedersen, NA Skovgaard, LT TI Pharmacokinetics and pharmacodynamics of mivacurium in patients phenotypically heterozygous for the usual and atypical plasma cholinesterase variants (UA) SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE butyrylcholinesterase; cholinesterase variants; cholinesterase; dose-response curves; enzymes; genetic factors; mivacurium; neuromuscular relaxants; pharmacodynamics; pharmacokinetics; pharmacology; pseudocholinesterase; stereoisomers ID DOSE-RESPONSE RELATIONSHIP; NEUROMUSCULAR BLOCKING-AGENTS; RESEARCH PRACTICE GCRP; ELDERLY-PATIENTS; YOUNG-ADULT; 3 ISOMERS; ANESTHESIA; INFUSION; CHLORIDE; BOLUS AB Background: Mivacurium is hydrolyzed by plasma cholinesterase (pChe). The purpose of this study was to evaluate the pharmacodynamics and the pharmacokinetics of the three isomers of mivacurium in patients phenotypically heterozygous for the usual and the atypical pChe variant (UA). Methods: Thirty-two patients were included in a dose-response study, in which the patients received one of four doses of mivacurium. An additional bolus dose of mivacurium, to a total of 0.1 mg kg(-1), was given followed by a continuous infusion adjusted to maintain 91-99% neuromuscular block. The times to different levels of recovery following the infusion were measured using mechanomyography and train-of-four (TOF) nerve stimulation. Twelve of the patients with an estimated duration of anaesthesia of more than 90 min were (randomly) selected for the pharmacokinetic part of the study. Venous samples were taken for determination of the three isomers of mivacurium. These results were compared with results from a previous study in phenotypically normal patients (UU). Results: The estimated ED50 and ED95 were 24 and 69 mug kg(-1), respectively. The median (range) infusion rate was 3.7 mug kg(-1) min(-1) (1.2-2.9) and the time to a TOF ratio of 0.7 was 29.8 min (16.1-44.8). The median clearances of the cis-cis, cis-trans and trans-trans isomers were 3.7, 29 and 28 ml kg(-1) min(-1), respectively. The elimination half-lives of the isomers were 45, 6.7 and 6.3 min, respectively. Conclusions: In patients heterozygous for the usual and the atypical variant (UA), the potency of mivacurium is higher, the infusion requirements lower and the rate of spontaneous recovery prolonged, compared with phenotypically normal patients. The clearances of the active isomers are significantly lower and the elimination half-lives longer in heterozygous patients than in phenotypically normal patients (UU). The pharmacokinetics of the inactive cis-cis isomer was not affected. C1 Copenhagen Univ Hosp, Dept Anaesthesia & Intens Care, Danish Cholinesterase Res Unit, Rigshosp, Copenhagen, Denmark. Gentoft Univ Hosp, Dept Anaesthesiol, Copenhagen, Denmark. Royal Sch Pharm, Dept Biol Sci, Copenhagen, Denmark. Inst Publ Hlth, Dept Biostat, Copenhagen, Denmark. RP Ostergaard, D (reprint author), Herlev Univ Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark. NR 21 TC 7 Z9 7 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD NOV PY 2003 VL 47 IS 10 BP 1219 EP 1225 DI 10.1046/j.1399-6576.2003.00243.x PG 7 WC Anesthesiology SC Anesthesiology GA 740DJ UT WOS:000186385900007 ER PT J AU Liou, JT Hsu, JC Liu, FC Sum, DCW Lui, PW AF Liou, JT Hsu, JC Liu, FC Sum, DCW Lui, PW TI Pretreatment with small-dose ketamine reduces withdrawal movements associated with injection of rocuronium in pediatric patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID PROPOFOL INJECTION; PAIN; ANESTHESIA; LIDOCAINE; ONDANSETRON; FENTANYL; BROMIDE AB We evaluated the pretreatment of small-dose of ketamine or normal saline in the reduction of withdrawal movements induced by rocuronium injection. One hundred pediatric patients (aged 1-6 yr) were randomly assigned into 2 groups. A 22-gauge IV cannula was inserted into the dorsum of the hand, and ketamine 0.2 mg/kg or normal saline was given, followed by a 5 mg/kg thiopental injection 10 s later. IV rocuronium (0.8 mg/kg) was injected over 5 s. The patient's response to rocuronium injection was graded by using a four-point scale in a double-blinded manner. We observed that the incidence of withdrawal movements was 83% in the saline group and 27% in patients pretreated with ketamine (P < 0.05). Some patients in both groups developed skin erythema at the site of injection. We conclude that pretreatment with small-dose ketamine significantly attenuates withdrawal movements associated with IV injection of rocuronium in pediatric patients anesthetized with thiopental. C1 Chang Gung Mem Hosp, Dept Anesthesiol, Taoyuan 333, Taiwan. Chang Gung Univ, Taoyuan, Taiwan. RP Lui, PW (reprint author), Chang Gung Mem Hosp, Dept Anesthesiol, 5 Fu Shin St, Taoyuan 333, Taiwan. RI Liu, Fu-Chao/G-4466-2010 NR 23 TC 15 Z9 17 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 2003 VL 97 IS 5 BP 1294 EP 1297 DI 10.1213/01.ANE.0000082247.39704.79 PG 4 WC Anesthesiology SC Anesthesiology GA 735YZ UT WOS:000186143600016 ER PT J AU Suzuki, T Lien, CA Belmont, MR Tjan, J Savarese, JJ AF Suzuki, T Lien, CA Belmont, MR Tjan, J Savarese, JJ TI Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 13-20, 2001 CL NEW ORLEANS, LOUISIANA SP Amer Soc Anesthesiologists ID PARTIALLY PARALYZED HUMANS; POLLICIS MUSCLE; NEOSTIGMINE; ATRACURIUM; VECURONIUM; REVERSAL; RECOVERY; DIAPHRAGM; PANCURONIUM; POTENCY AB Purpose: To examine the efficacy of antagonism of rapacuronium-, mivacurium-, rocuronium- and cisatracurium-induced neuromuscular block at the laryngeal adductors (LA). Methods: One hundred four patients were randomly assigned to one of eight study groups. They either received rapacuronium 1.5 mg(.)kg(-1), mivacurium 0.25 mg(.)kg(-1), rocuronium 0.9 mg(.)kg(-1) or cisatracurium 0.15 mg(.)kg(-1). Patients in each treatment group either received edrophonium (0.5 mg(.)kg(-1)) at 10% recovery of the first twitch (T I) of train-of-four (TOF) at the LA or were allowed to recover spontaneously from neuromuscular block. The effect of antagonism on speed of recovery of neuromuscular function at the LA was evaluated. Results: The time to recovery to a TOF ratio of 0.9 at the LA, when compared to the spontaneous recovery group, was significantly shortened by the administration of edrophonium in patients receiving rapacuronium [19.2 +/- 7.8 vs 26.2 +/- 4.9 (mean +/- SD) min], rocuronium (24.7 +/- 14.3 vs 44.4 +/- 13.0 min) and cisatracurium (24.2 +/- 5.7 vs 35.1 +/- 7.6 min). Edrophonium administration did not shorten complete recovery from mivacurium-induced block (15.7 +/- 8.0 vs 17.6 +/- 6.1 min). Conclusion: Recovery from rapacuronium-, rocuronium- or cisatracurium-induced neuromuscular block to a TOF ratio of 0.9 as measured at the LA was shortened by the administration of edrophonium, when compared to spontaneous recovery. C1 Cornell Univ, New York Presbyterian Hosp, Weill Med Coll, Dept Anesthesiol, New York, NY USA. RP Suzuki, T (reprint author), 3-24-3,Asagaya Kita,Suginami Ku, Tokyo 1660001, Japan. NR 36 TC 2 Z9 2 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD NOV PY 2003 VL 50 IS 9 BP 879 EP 885 PG 7 WC Anesthesiology SC Anesthesiology GA 748LF UT WOS:000186862800003 ER PT J AU Ozaki, T Kimura, T Ohnuki, T Yoshida, Z Francis, AJ AF Ozaki, T Kimura, T Ohnuki, T Yoshida, Z Francis, AJ TI Association mechanisms of Europium(III) and Curium(III) with Chlorella vulgaris SO ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY LA English DT Article DE Europium(III) Curium(III); Chlorella vulgaris; cellulose; exudates ID INDUCED FLUORESCENCE SPECTROSCOPY; METAL ION-EXCHANGE; DEGRADATION-PRODUCTS; HYDRATION NUMBER; BIOSORPTION; SORPTION; URANIUM; BINDING; ALGAE; CHITOSAN AB The association of Europium(III) (Eu[III]) and Curium(III) (Cm[III]) with Chlorella vulgaris and with cellulose was studied by a batch method and time-resolved laser-induced fluorescence spectroscopy (TRLFS). The kinetics study performed by the batch method showed that maximum adsorption of Eu(III) and Cm(III) on C. vulgaris was attained within 3 min of contact; afterward, the percentage adsorption decreased with time due to chelation of the ions with exudates released from C. vulgaris with a strong affinity for Eu(III) and Cm(III). The TRLFS revealed that the short-term adsorption of Eu(III) on C. vulgaris was attributable to its coordination with cellulose on the algal cell wall. However, Eu(111) coordinated with the functional groups of cellulose very weakly despite the large distribution coefficients observed. These results indicate that the reactions, both at the cell's surfaces through adsorption and in solution phases through chelation with the exudates, are important in estimating the behavior of Eu(III) and Cm(III) in aqueous environments. C1 Japan Atom Energy Res Inst, Adv Sci Res Ctr, Ibaraki 3191195, Japan. Brookhaven Natl Lab, Dept Environm Sci, Upton, NY 11973 USA. RP Ozaki, T (reprint author), Japan Atom Energy Res Inst, Adv Sci Res Ctr, Ibaraki 3191195, Japan. NR 37 TC 12 Z9 12 PU SETAC PI PENSACOLA PA 1010 NORTH 12TH AVE, PENSACOLA, FL 32501-3367 USA SN 0730-7268 J9 ENVIRON TOXICOL CHEM JI Environ. Toxicol. Chem. PD NOV PY 2003 VL 22 IS 11 BP 2800 EP 2805 DI 10.1897/02-481 PG 6 WC Environmental Sciences; Toxicology SC Environmental Sciences & Ecology; Toxicology GA 729RV UT WOS:000185788500037 ER PT J AU Milman, V Winkler, B Pickard, CJ AF Milman, V Winkler, B Pickard, CJ TI Crystal structures of curium compounds: an ab initio study SO JOURNAL OF NUCLEAR MATERIALS LA English DT Article ID GENERALIZED GRADIENT APPROXIMATION; TOTAL-ENERGY CALCULATIONS; METAL ALLOY PHASES; MAGNETIC-SUSCEPTIBILITY; ELECTRONIC-STRUCTURE; INTERMETALLIC COMPOUNDS; LANTHANUM TRIFLUORIDE; NEUTRON-DIFFRACTION; LATTICE-PARAMETERS; PLANE-WAVE AB The crystal structure and electronic properties of curium and its compounds are investigated using the density functional theory approach. The accuracy of the method is shown to be sufficient to describe structures with various types,of chemical bonding: halides, pnictides, oxides, hydrides and intermetallic compounds. Selected examples are given of the studies of properties and phase stability of curium compounds under hydrostatic compression. Further applications of the theoretical approach to crystallography and solid state chemistry of actinides are suggested. (C) 2003 Elsevier B.V. All rights reserved. C1 Accelrys Inc, Cambridge CB4 0WN, England. Univ Frankfurt, Abt Kristallog, Inst Mineral, D-60054 Frankfurt, Germany. Univ Cambridge, Cavendish Lab, Cambridge CB3 0HE, England. RP Milman, V (reprint author), Accelrys Inc, 334 Sci Pk, Cambridge CB4 0WN, England. NR 56 TC 21 Z9 21 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0022-3115 J9 J NUCL MATER JI J. Nucl. Mater. PD NOV 1 PY 2003 VL 322 IS 2-3 BP 165 EP 179 DI 10.1016/S0022-3115(03)00321-0 PG 15 WC Materials Science, Multidisciplinary; Nuclear Science & Technology; Mining & Mineral Processing SC Materials Science; Nuclear Science & Technology; Mining & Mineral Processing GA 733MW UT WOS:000186005600008 ER PT J AU Ezri, T Szmuk, P Warters, RD Gebhard, RE Pivalizza, EG Katz, J AF Ezri, T Szmuk, P Warters, RD Gebhard, RE Pivalizza, EG Katz, J TI Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol - the role of cardiac output SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ephedrine; esmolol; onset time; rocuronium ID PRESSOR-RESPONSE; ANESTHESIA; ISOFLURANE; INDUCTION; PROPOFOL; SUXAMETHONIUM; SEVOFLURANE AB Background: We investigated the hypothesis that manipulation of cardiac output ( CO) with esmolol (Es) or ephedrine ( E) affects the onset time of rocuronium. Methods: Following anesthesia induction, 33 patients received E (70 mug kg(-1)), Es (500 mug kg(-1)) or placebo (P) 30 s before rocuronium (0.6 mg kg(-1)) administration. Cardiac output was measured non-invasively after intubation every 3 min. The interval from the end of rocuronium administration to the disappearance of all twitches was considered to be the onset time. Results: Onset time was shorter after E (52.2 +/- 16.5 s) and longer after Es (114.3 +/- 11.1 s) compared with P (87.4 +/- 7.3 s) (P< 0.0001). Cardiac output increased ( P< 0.05) in group E for 15 min after rocuronium. In group Es, CO decreased ( P< 0.05) at 3 and 6 min. Cardiac output was higher in group E vs. group Es, 3-6 min post administration of rocuronium ( P = 0.015). Conclusion: Pretreatment with E or Es appears to affect the onset time of rocuronium by altering CO as measured with the NICO(TM) (Non-Invasive Cardiac Output) monitor (Novametrix Medical Systems Inc., Willingford, CO). C1 Univ Texas, Sch Med, Dept Anesthesiol, Postanesthesia Care Unit,MSB 5020, Houston, TX 77030 USA. Sackler Sch Med, Wolfson Med Ctr, Dept Anesthesia, Tel Aviv, Israel. Univ Texas, Sch Med, OUTCOMES RES Inst, Houston, TX 77030 USA. RP Szmuk, P (reprint author), Univ Texas, Sch Med, Dept Anesthesiol, Postanesthesia Care Unit,MSB 5020, 6431 Fannin, Houston, TX 77030 USA. NR 26 TC 24 Z9 30 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD OCT PY 2003 VL 47 IS 9 BP 1067 EP 1072 DI 10.1034/j.1399-6576.2003.00218.x PG 6 WC Anesthesiology SC Anesthesiology GA 720FP UT WOS:000185251000004 ER PT J AU Delogu, G Moretti, S Marcellini, S Antonucci, A Tellan, G Marandola, M Signore, M Famularo, G AF Delogu, G Moretti, S Marcellini, S Antonucci, A Tellan, G Marandola, M Signore, M Famularo, G TI Pancuronium bromide, a non-depolarizing muscle relaxant which promotes apoptosis of blood lymphocytes in vitro SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE anesthesia; apoptosis; neuromuscular blocker; pancuronium; surgical trauma ID FAS-MEDIATED APOPTOSIS; SURGICAL STRESS; ACTIVATION; SURGERY; NEUTROPHILS; ANESTHESIA; MECHANISMS; EXPOSURE; PATHWAY; CELLS AB Background: Several compounds used in anesthesia practice have demonstrated to impair immune function and to influence the process of apoptotic death in T cell population following surgical trauma. We designed this study to test in vitro the impact of neuromuscular blocker, such as pancuronium, at clinically relevant concentration on lymphocyte apoptosis, death factor expression and mitochondrial function. Methods: Following isolation, lymphocytes were incubated with pancuronium bromide at a clinically relevant concentration (0.136 mumol l(-1)) for 3 h at 37C in a 5% carbon-dioxide-humidified atmosphere and the frequency of apoptotic lymphocytes was then measured. We also investigated crucial steps in the apoptotic process, including Fas/Fas ligand ( FasL) phenotype, intracellular expression of the interleukin-1beta-converting enzyme ( ICE) p20, mitochondrial membrane potential (DeltaPsim), generation of mitochondrial reactive oxygen species, and glutathione (GSH) levels. Control experiments were performed incubating cells in the complete culture medium added with the dilution medium of the drug without addition of the drug. Results: Expression of Fas, FasL and ICEp20 was six-fold, fourfold, and five-fold increased, respectively, among pancuronium-treated lymphocytes with respect to control cultures ( P = 0.0001). The percentage of cells exhibiting either dissipation of mitochondrial membrane potential or increased production of reactive oxygen species was seven-fold increased following exposure to pancuronium compared with untreated lymphocytes ( P = 0.0001). These findings were associated with a decrease in GSH level. In addition, the frequency of apoptotic cells was 10-fold greater among lymphocytes cultured in the presence of the drug with respect to control cultures. ( P = 0.0001). Conclusion: Our data suggest an apoptogenic effect of pancuronium in vitro at clinically relevant concentration on peripheral blood lymphocytes. This could be implicated in the transient immune suppression following a surgical operation. C1 Univ Roma La Sapienza, Policlin Umberto I, Dept Anesthesia & Intens Care, I-00161 Rome, Italy. Univ Roma La Sapienza, Dept Infect Dis, I-00161 Rome, Italy. San Camillo Hosp, Dept Internal Med, Rome, Italy. RP Delogu, G (reprint author), Univ Roma La Sapienza, Policlin Umberto I, Dept Anesthesia & Intens Care, I-00161 Rome, Italy. NR 30 TC 6 Z9 6 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD OCT PY 2003 VL 47 IS 9 BP 1138 EP 1144 DI 10.1034/j.1399-6576.2003.00209.x PG 7 WC Anesthesiology SC Anesthesiology GA 720FP UT WOS:000185251000016 ER PT J AU Ledowski, T Wulf, H Ahrens, K Weindlmayr-Goettel, M Kress, HG Geldner, G Scholz, J AF Ledowski, T Wulf, H Ahrens, K Weindlmayr-Goettel, M Kress, HG Geldner, G Scholz, J TI Neuromuscular block and relative concentrations of mivacurium isomers under isoflurane versus propofol anaesthesia SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE anaesthetics, inhalation; chemistry, organic, isomerism; drug interactions; metabolism, pharmacokinetics; neuromuscular non-depolarizing agents; mivacurium ID VOLATILE ANESTHETICS; CONTINUOUS-INFUSION; SKELETAL-MUSCLE; D-TUBOCURARINE; HALOTHANE; PANCURONIUM; VECURONIUM; ENFLURANE; INVITRO AB Background and objective: The augmentation of the effect of neuromuscular blocking drugs with volatile anaesthetics is well documented, but the mechanism remains unclear. The pharmacological interaction and relative plasma concentrations of mivacurium isomers were investigated during either propofol- or isoflurane-maintained anaesthesia. Methods: Forty-four patients were randomly assigned to one of two groups: isoflurane or propofol. All patients received an initial dose of mivacurium 0.1 mg kg(-1). After recovery of the first twitch (T1) response measured by acceleromyography to 5%, a T1 depression of 90-99% was maintained by infusion. After a steady state was reached, blood samples were taken after 10 and 30 min for analysis of mivacurium isomers. Recovery times for T1 to 25/50/75/90% (TW25-90), train-of-four ratio 25/70% and recovery index (time TW25-75) were recorded after stop of infusion. Results: In the isoflurane group, lower infusion rates were needed (3.0 +/- 1.6 versus 3.6 +/- 1.6 mug kg(-1) min(-1)) and there was a slower recovery (significant for train-of-four ratio 70%: 21.9 versus 17.9 min). The plasma concentrations of mlvacurium and its trans-trans isomer (in percentage of the total) were significantly higher in the isoflurane group (10 min: 52.6 versus 25.8%; 30 min: 49.6 versus 23.2%). Conclusions: For mivacurium, the phenomenon of 'potentiation' of the effect of muscle relaxants by volatile anaesthetics could be due to an increase in the plasma concentration of the potent trans-trans isomer. C1 Univ Hosp Kiel, Dept Anaesthesiol & Intens Care Med, D-24105 Kiel, Germany. Hosp Philipps Univ, Dept Anaesthesiol & Intens Care Med, Marburg, Germany. Univ Vienna, Allgemeines Krankenhaus Wien, Dept Anaesthesiol & Gen Intens Care Med B, A-1010 Vienna, Austria. RP Ledowski, T (reprint author), Univ Hosp Kiel, Dept Anaesthesiol & Intens Care Med, Schwanenweg 21, D-24105 Kiel, Germany. NR 18 TC 1 Z9 1 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD OCT PY 2003 VL 20 IS 10 BP 821 EP 825 PG 5 WC Anesthesiology SC Anesthesiology GA 734EU UT WOS:000186042700008 ER PT J AU Geldner, G Lang, C Hoffmann, W Hossfeld, A Weinberger, J Eble, M Blobner, M AF Geldner, G Lang, C Hoffmann, W Hossfeld, A Weinberger, J Eble, M Blobner, M TI The time-course of action of rapacuronium and mivacurium after early reversal following equally lasting relaxation SO ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE LA German DT Article DE day case surgery; Rapacuronium; Mivacurium; time course of action; intubating conditions ID RAPID-SEQUENCE INDUCTION; INTUBATING CONDITIONS; ADULT PATIENTS; SUCCINYLCHOLINE; ANESTHESIA; BRONCHOSPASM; CHLORIDE; RECOVERY; NEOSTIGMINE; ORG-9487 AB This study was designed to compare the time course of action and the safety profile of Rapacuronium and Mivacurium in day case dental surgery. After Ethics Committee approval 61 healthy adult patients, scheduled for dental day case surgery, were randomised in an assessor-blinded manner to receive either 1.5 mg/kg Rapacuronium with and without 0.05 neostigmine 5 min later (19 patients each) or a total of 0.25 mg/kg Mivacurium (n = 16). Anaesthesia was induced using Propofol 2 - 5.1 mg/kg and Remifentanil 24 - 73 mcg/kg/h and maintained with Desflurane in N2O/O-2 (2/1). Endotracheal intubation was performed when maximum blockade was achieved and scored by a blinded intubator. Neuromuscular block was monitored using the train-of-four response to supramaximal stimuli at the ulnar nerve every 15 seconds using acceleromyography (TOF Watch SX(R)). Onset time, clinical duration (reappearance of the third twitch of a TOF-stimulation) and recovery to T4/T1 > 0.9 were recorded. Speed of recovery was evaluated by the time difference between reappearance of the third twitch and T4/T1 > 0.9. The intubating conditions at the time of maximum block revealed no statistically significant differences between the three groups. Changes in blood pressure, heart rate and airway pressure were not significant. Onset time in subjects who received Rapacuronium (99+/-29 s) was faster compared to the onset time in those who received Mivacurium (157+/-36 s). Also clinical duration was significantly shorter following Rapacuronium without reversal (12+/-4 min) as well as with reversal (9 1 min) compared with Mivacurium (21+/-5 min)). Patients treated with Rapacuronium and reversal recovered faster (14+/-8 min)) compared to the other two groups (Mivacurium: 20+/-6 min, Rapacuronium without reversal: 31+/-9 min). The fraction of clinical duration of the total duration was highest following Mivacurium (51%) when compared with Rapacuronium/Neostigmine (43%) and Rapacuronium (28%). C1 Klinikum Philipps Univ Marburg, Klin Anasthesiol & Intens Therapie, D-35033 Marburg, Germany. Univ Ulm, Anasthesiol Klin, Ulm, Germany. Tech Univ Munich, Anasthesiol Klin, Klinikum Rechts Isar, Munich, Germany. RP Geldner, G (reprint author), Klinikum Philipps Univ Marburg, Klin Anasthesiol & Intens Therapie, Baldingerstr 1, D-35033 Marburg, Germany. NR 25 TC 1 Z9 1 PU GEORG THIEME VERLAG KG PI STUTTGART PA RUDIGERSTR 14, D-70469 STUTTGART, GERMANY SN 0939-2661 J9 ANASTH INTENSIV NOTF JI Anasthesiol. Intensivmed. NotfMed. Schmerzther. PD SEP PY 2003 VL 38 IS 9 BP 594 EP 599 PG 6 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 723MT UT WOS:000185436700006 ER PT J AU Epemolu, O Bom, A Hope, F Mason, R AF Epemolu, O Bom, A Hope, F Mason, R TI Reversal of neuromuscular blockade and simultaneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agent Org 25969 SO ANESTHESIOLOGY LA English DT Article ID PHARMACOKINETICS AB Background: The purpose of this study was to determine the changes in the plasma concentration of rocuronium and the reversal of its neuromuscular blockade after the intravenous infusion of Org 25969, the novel neuromuscular block-reversal agent, in anesthetized guinea pigs. Methods: Rocuronium was infused for 1 h at a rate of 12-19 nmol(.)kg(-1.)min(-1) to produce a steady-state 90% neuromuscular block. After 30 min, a concomitant infusion of either the reversal agent Org 25969 at a rate of 50 nmol(.)kg(-1.)min(-1) or an infusion of an equivalent volume of saline was started. The time course of plasma concentrations of rocuronium was determined by use of liquid chromatography-mass spectrometry/mass spectrometry. Results: In both treatment groups, a steady-state plasma concentration of rocuronium was obtained after 30 min. In the saline-treated group, the plasma concentration of rocuronium and depth of block remained constant. In the Org 25969 group, neuromuscular block was reversed while the rocuronium infusion was ongoing. Simultaneously, an increase in the total plasma concentration of rocuronium (free and complexed) was observed, even though the infusion rate of rocuronium was not changed. Compared with the saline-treated group, a small increase in the postmortem bladder concentration of rocuronium was detected. Conclusions: The authors propose that the capture of rocuronium by Org 25969 causes the rapid reversal of neuromuscular block. The reversal can be explained by the rapid transfer of free rocuronium from the effect compartment (neuromuscular junction) to the central compartment, in which it is bound to Org 25969. This explains the increase in total plasma concentration of rocuronium (free and bound to Org 25969). C1 Organon Res, Dept Pharmacol, Newhouse ML1 5SH, Lanark, Scotland. RP Epemolu, O (reprint author), Organon Res, Dept Pharmacol, Newhouse Ind Estate, Newhouse ML1 5SH, Lanark, Scotland. NR 12 TC 75 Z9 79 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 2003 VL 99 IS 3 BP 632 EP 637 DI 10.1097/00000542-200309000-00018 PG 6 WC Anesthesiology SC Anesthesiology GA 715TB UT WOS:000184987400016 ER PT J AU Fawcett, WJ Stone, JP AF Fawcett, WJ Stone, JP TI Recurarization in the recovery room following the use of magnesium sulphate SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthesia; complications, morbidity; neuromuscular block, cisatracurium; pharmacology, magnesium ID NEUROMUSCULAR BLOCKADE; RESIDUAL CURARIZATION; VECURONIUM; ATRACURIUM; PANCURONIUM AB A 67-yr-old man weighing 104 kg, with a history of hypertension, underwent laparoscopic cholecystectomy. His preoperative serum potassium was 3.4 mmol litre(-1). The patient received cisatracurium 14 mg, which was antagonized with neostigmine 2.5 mg and glycoprolate 0.5 mg at the end of the procedure. A repeat dose of neostigmine 2.5 mg and glycoprolate 0.5 mg was required 5 min later, as the neuromuscular block was incompletely antagonized. He was transferred to the recovery room about 10 min after the end of surgery, having had recovery of neuromuscular function demonstrated with no fade on peripheral nerve stimulation at 50 Hz for 5 s. Five minutes later he developed rapid atrial fibrillation, which was treated over 5 min with magnesium sulphate 2 G i.v.. Within the next 3 min, the patient developed marked neuromuscular weakness of a non-depolarizing pattern leading to respiratory arrest. This necessitated re-intubation of the trachea and artificial ventilation for 20 min, until there was spontaneous recovery of neuromuscular function demonstrated by peripheral nerve stimulation. Administration of magnesium appears to have caused recurarization in this patient. The dose of magnesium alone would not be expected to cause muscle weakness. Potentiation of neuromuscular blocking drugs by magnesium is well recognized, and we recommend its use is avoided for at least 30 min after reversal of neuromuscular block. C1 Royal Surrey Cty Hosp, Dept Anaesthesia, Guildford GU2 7XX, Surrey, England. RP Fawcett, WJ (reprint author), Royal Surrey Cty Hosp, Dept Anaesthesia, Egerton Rd, Guildford GU2 7XX, Surrey, England. NR 13 TC 0 Z9 0 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD SEP PY 2003 VL 91 IS 3 DI 10.1093/bja/aeg179 PG 4 WC Anesthesiology SC Anesthesiology GA 714NR UT WOS:000184920800024 ER PT J AU Baykara, N Sahin, T Alpar, R Solak, M Toker, K AF Baykara, N Sahin, T Alpar, R Solak, M Toker, K TI Evaluation of intense neuromuscular blockade caused by rocuronium using posttetanic count in male and female patients SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE gender; monitoring : accelerometry; posttetanic count; train-of-four; neuromuscular relaxants : rocuronium ID TIME-COURSE; ADULT PATIENTS; DOSE-RESPONSE; VECURONIUM; ATRACURIUM; AGE; PHARMACOKINETICS; SUCCINYLCHOLINE; DURATION; RECOVERY AB Study Objective: To establish the relationship between train-of-four (TOF) nerve stimulation and the number of posttetanic twitches (posttetanic count [PTC]) during neuromuscular blockade caused by rocuronium in males and females. Design: Prospective, observational, clinical comparison. Setting: Operating room of a university hospital. Patients: 60 ASA physical status I and II patients (30 women and 30 men), aged 18 to 60 years, who were scheduled for elective orthopedic surgery and ear, nose, throat surgery with a planned duration of 2 hours. Interventions: During fentanyl, propofol, and nitrous oxide (N2O) anesthesia, neuromuscular blockade was evaluated with accelerometry of the thumb using TOF and posttetanic twitch stimulation (PTTS) of the ulnar nerve in patients who received rocuronium 1 mg.kg(-1). Measurements and Main Results: The first responses to PTTS were seen at mean times of 34.9 and 37.7 minutes after rocuronium injection in male and female patients, respectively (NS). The average interval between the appearance of a posttetanic response and the first response to TOF stimulation (T1) was not significantly different between male and female patients (15.4 +/- 4.8 min (SD) vs. 15.9 +/- 4.9 min, respectively). There was a significant negative correlation between PTC and the time to first response to TOF nerve stimulation (r = -0.83; p = 0.0001). Gender did not have a statistically significant effect on this relation (F = 0.9; p = 0.34). The intervals from administration of rocuronium to the first appearances of T1 and T2 were not significantly different between the two groups, but the intervals to the first appearances of T3 and T4 were significantly longer in female patients. Conclusions: Even though the times from initial administration of rocuronium 1 mg.kg(-1) to the first appearances of T3 and T4 are significantly longer in female patients, the intervals to the first detectable responses to PTTS and TOF are not significantly different between females and males. Gender has no significant effect on the relation between PTC and the time to T1. (C) 2003 by Elsevier Inc. C1 Univ Kocaeli, Sch Med, Kocaeli, Turkey. Univ Kocaeli Hosp, Dept Anesthesiol, Kocaeli, Turkey. Univ Hacettepe, Sch Med, Ankara, Turkey. RP Baykara, N (reprint author), Tubitak Loj 4A, Gebze, Turkey. NR 19 TC 1 Z9 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD SEP PY 2003 VL 15 IS 6 BP 446 EP 450 DI 10.1016/S0952-8180(03)00110-7 PG 5 WC Anesthesiology SC Anesthesiology GA 754BM UT WOS:000187282900008 ER PT J AU Komatsu, R Nagata, O Ozaki, M Sessler, DI AF Komatsu, R Nagata, O Ozaki, M Sessler, DI TI Ephedrine fails to accelerate the onset of neuromuscular block by vecuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID CARDIAC-OUTPUT; ROCURONIUM; TIME; PROPOFOL AB The onset time of neuromuscular blocking drugs is partially determined by circulatory factors, including muscle blood flow and cardiac output. We thus tested the hypothesis that a bolus of ephedrine accelerates the onset of vecuronium. neuromuscular block by increasing cardiac output. A prospective, randomized study was conducted in 53 patients scheduled for elective surgery. After the induction of anesthesia, the ulnar nerve was stimulated supramaximally every 10 s, and the evoked twitch response of the adductor pollicis was recorded with accelerometry. Patients were maintained under anesthesia with continuous infusion of propofol for 10 min and then randomly assigned to ephedrine 210 mug/kg (n = 27) or an equivalent volume of saline (n = 26). The test solution was given 1 min before the administration of 0.1 mg/kg of vecuronium. Cardiac output was monitored with impedance cardiography. Ephedrine, but not saline, increased cardiac index (17%; P = 0.003). Nonetheless, the onset of 90% neuromuscular block was virtually identical in the patients given ephedrine (183 +/- 41 s) and saline (181 +/- 47 s). There was no correlation between cardiac index and onset of the blockade. We conclude that the onset of the vecuronium-induced neuromuscular block is primarily determined by factors other than cardiac output. The combination of ephedrine and vecuronium thus cannot be substituted for rapid-acting nondepolarizing muscle relaxants. C1 Tokyo Womens Med Univ, Dept Anesthesiol, Shinjuku Ku, Tokyo 1628666, Japan. Univ Louisville, Outcomes Res Inst, Louisville, KY 40292 USA. Univ Louisville, Dept Anesthesiol, Louisville, KY 40292 USA. Univ Louisville, Dept Pharmacol & Toxicol, Louisville, KY 40292 USA. RP Komatsu, R (reprint author), Tokyo Womens Med Univ, Dept Anesthesiol, Shinjuku Ku, 8-1 Kawadacho, Tokyo 1628666, Japan. NR 20 TC 5 Z9 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2003 VL 97 IS 2 BP 480 EP 483 DI 10.1213/01.ANE.0000069212.49766.7A PG 4 WC Anesthesiology SC Anesthesiology GA 704RW UT WOS:000184354600031 ER PT J AU Bishop, MJ O'Donnell, JT Salemi, JR AF Bishop, MJ O'Donnell, JT Salemi, JR TI Mivacurium and bronchospasm SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 12-16, 2002 CL ORLANDO, FLORIDA SP Amer Soc Anesthesiologists ID LUNG-MECHANICS; RELAXANTS; HISTAMINE C1 Univ Washington, Sch Med, VA Puget Sound Hlth Care Syst, Dept Anesthesiol, Seattle, WA 98108 USA. Rush Med Coll, Dept Pharmacol, Chicago, IL 60612 USA. Pharmaconsultant Inc, Palatine, IL USA. RP Bishop, MJ (reprint author), Univ Washington, Sch Med, VA Puget Sound Hlth Care Syst, Dept Anesthesiol, 1660 S Columbian Way, Seattle, WA 98108 USA. NR 11 TC 3 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2003 VL 97 IS 2 BP 484 EP 485 DI 10.1213/01.ANE.0000067433.05538.3D PG 2 WC Anesthesiology SC Anesthesiology GA 704RW UT WOS:000184354600032 ER PT J AU Tas, A Aslan, L Atasoy, N Ceylan, E Altug, ME Ozbek, H AF Tas, A Aslan, L Atasoy, N Ceylan, E Altug, ME Ozbek, H TI The assessment of effects of atracurium and mivacurium using TOF Guard device in dogs SO INDIAN VETERINARY JOURNAL LA English DT Article ID TRACHEAL INTUBATION; CHLORIDE C1 Yuzuncu Yil Univ, Internal Med Vet Fac, Dept Surg, Van, Turkey. Yuzuncu Yil Univ, Fac Med, Dept Pharmacol, Van, Turkey. Ataturk Univ, Fac Vet, Dept Surg, Erzurum, Turkey. RP Tas, A (reprint author), Yuzuncu Yil Univ, Internal Med Vet Fac, Dept Surg, Van, Turkey. NR 9 TC 0 Z9 0 PU INDIAN VETERINARY JOURNAL PI CHENNAI PA 11 CHAMIERS RD, CHENNAI 600 035, INDIA SN 0019-6479 J9 INDIAN VET J JI Indian Vet. J. PD AUG PY 2003 VL 80 IS 8 BP 768 EP 771 PG 4 WC Veterinary Sciences SC Veterinary Sciences GA 754LR UT WOS:000187319100014 ER PT J AU Baykara, N Solak, M Toker, K AF Baykara, N Solak, M Toker, K TI Predicting recovery from deep neuromuscular block by rocuronium in the elderly SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE anesthesia : elderly; monitoring : accelerometry; posttetanic count, train-of-four; neuromuscular relaxants : rocuronium ID POST-TETANIC COUNT; POSTTETANIC COUNT; RESIDUAL BLOCK; CHILDREN; VECURONIUM; PHARMACOKINETICS; ATRACURIUM; MUSCLE; PHARMACODYNAMICS; PANCURONIUM AB Study Objective: To determine the influence of aging on the relationship between posttetanic count (PTC) and train-of four (TOF) response during intense neuromuscular blockade caused by rocuronium. Design: Prospective, observational, clinical comparison study. Setting: Operating room of a university hospital. Patients: 42 ASA physical status I and II patients, 20 of whom were elderly (ages 65 to 80 yrs) and 22 younger control patients (ages 18 to 40 yrs), who were scheduled for elective orthopedic surgery and ear, nose, and throat surgery with a planned duration of 2 hours. Interventions: Neuromuscular blockade was evaluated with accelerometry of the thumb, using posttetanic twitch (PTT) and TOF stimulation of the ulnar nerve, in patients who received rocuronium 1 mg . kg(-1). Measurements and Main Results: The first responses to posttetanic nerve stimulation were seen at mean times of 38.5 and 35.2 minutes after the injection of rocuronium in the elderly and in the young, respectively (NS). The average interval between the appearance of a posttetanic response and the first response to TOF stimulation (T1) was longer in the elderly than the young (22.3 +/- 8.1 (SP) vs. 14.8 +/- 4.2 min, p < 0. 05). There was a significant correlation between PTC and the time to first response to TOF nerve stimulation both in the elderly and in the young (r= -0. 73, p < 0.0001 and r = -0.87, p < 0.0001, respectively). Conclusions: Posttetanic twitch stimulation is a useful method of monitoring intense neuromuscular blockade caused by rocuronium in both age groups. The interval between the earliest appearance of a posttetanic response and the first response to TOF stimulation (T1) is greater in the elderly than in the young. (C) 2003 by Elsevier Science Inc. C1 Univ Kocaeli, Sch Med, Dept Anesthesiol, Kocaeli, Turkey. RP Baykara, N (reprint author), Tubitak Loj,4A, TR-41470 GebzaKocaeli, Turkey. NR 27 TC 5 Z9 5 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD AUG PY 2003 VL 15 IS 5 BP 328 EP 333 DI 10.1016/S0952-8180(03)00062-X PG 6 WC Anesthesiology SC Anesthesiology GA 726QT UT WOS:000185611100002 ER PT J AU Jha, PK Sanyal, SP AF Jha, PK Sanyal, SP TI Structural phase transition and high-pressure behaviour of curium and uranium monobismuthides SO JOURNAL OF PHYSICS AND CHEMISTRY OF SOLIDS LA English DT Article DE high pressure; phase transitions ID NEPTUNIUM AB We present the high-pressure behaviour and pressure induced structural phase transition of curium and uranium monobismuthides investigated by using a theoretical model based on the charge transfer effects arising from three body interaction. The calculated compression curves and the values of different high-pressure properties for curium monobismuthides (CmBi) and uranium monobismuthides (UBi) are compared with the experimental results. The accuracy of the present approach is quite successful in reproducing the equation of states and phase transition pressure of CmBi and UBi are in general good agreement with the experimental data. These materials exhibit first order crystallographic phase transition from their NaCl (B1) to CsCl (B2) structure at 12.0 GPa and 4.0 GPa for CmBi and UBi respectively, NaCl structure up to which is found stable. (C) 2003 Elsevier Science Ltd. All rights reserved. C1 Maharaja Sayajirao Univ Baroda, Fac Sci, Dept Phys, Vadodara 390002, India. Univ Bhopal, Mat Res Lab, Inst Phys & Elect, Bhopal 462026, India. RP Jha, PK (reprint author), Maharaja Sayajirao Univ Baroda, Fac Sci, Dept Phys, Vadodara 390002, India. RI Jha, Prafulla/D-7756-2011 NR 16 TC 6 Z9 6 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0022-3697 J9 J PHYS CHEM SOLIDS JI J. Phys. Chem. Solids PD AUG PY 2003 VL 64 IS 8 BP 1237 EP 1240 DI 10.1016/S0022-3697(03)00080-5 PG 4 WC Chemistry, Multidisciplinary; Physics, Condensed Matter SC Chemistry; Physics GA 699NM UT WOS:000184062900002 ER PT J AU Nakajima, H Hattori, H Aoki, K Katayama, T Saitoh, Y Murakawa, M AF Nakajima, H Hattori, H Aoki, K Katayama, T Saitoh, Y Murakawa, M TI Effect of milrinone on vecuronium-induced neuromuscular block SO ANAESTHESIA LA English DT Article DE neuromuscular blocking agents, vecuronium; phosphodiesterase inhibitors, milrinone ID HEART-FAILURE; ADENOSINE; ANTAGONISM AB We examined the effect of milrinone, a phosphodiesterase III inhibitor, on neuromuscular block induced by vecuronium. Thirty adult patients were randomly assigned to one of two equal groups: the milrinone group and the control group. Subjects in the milrinone group received an intravenous loading dose of milrinone 5 mug.kg(-1).min(-1) for 10 min, followed by an infusion at a rate of 0.5 mug.kg(-1).min(-1) . Subjects in the control group received normal saline at a rate of 0.1 ml.kg(-1).h(-1) . Thirty minutes after the beginning of the infusion of milrinone, anaesthesia was induced with intravenous thiopental 4 mg.kg(-1) and fentanyl 2 mug.kg(-1), and was maintained with isoflurane in oxygen and nitrous oxide. Neuromuscular blockade was monitored electromyographically at the adductor pollicis muscle. The times from the administration of vecuronium 0.1 mg.kg(-1) to the onset of neuromuscular block and the return of the first, second, third, and fourth response of the train-of-four were compared between the two groups. Times to the recovery of the ratio of the first twitch to the control twitch to 25%, 50% and 75%, and times to the recovery of train-of-four ratio to 25%, 50% and 75% were also compared between the two groups. The onset of neuromuscular block in the milrinone group was significantly slower than in the control group. The times to the returns of the four twitches of the train-of-four, times to recovery of the ratio of the first twitch to the control twitch to 25% and 50%, and the times to the recovery of the train-of-four ratio to 25% and 50% were significantly shorter in the milrinone group than in the control group. We conclude that milrinone delays the onset of neuromuscular blockade but hastens its recovery in anaesthetised patients receiving vecuronium. C1 Fukushima Med Univ, Sch Med, Dept Anaesthesiol, Fukushima 9601295, Japan. RP Nakajima, H (reprint author), Fukushima Med Univ, Sch Med, Dept Anaesthesiol, 1 Hikarigaoka, Fukushima 9601295, Japan. NR 15 TC 1 Z9 2 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUL PY 2003 VL 58 IS 7 BP 643 EP 646 DI 10.1046/j.1365-2044.2003.03197.x PG 4 WC Anesthesiology SC Anesthesiology GA 687FZ UT WOS:000183366900004 ER PT J AU Saldien, V Vermeyen, KM Wuyts, FL AF Saldien, V Vermeyen, KM Wuyts, FL TI Target-controlled infusion of rocuronium in infants, children, and adults: A comparison of the pharmacokinetic and pharmacodynamic relationship SO ANESTHESIA AND ANALGESIA LA English DT Article ID HALOTHANE ANESTHESIA; NITROUS-OXIDE; MUSCLE; VECURONIUM; ORG-9426; RAT AB Target-controlled infusion (TCI) of rocuronium can be used to maintain a stable blood concentration (Cp). At steady-state, the pharmacokinetics (PK) are compensated for by TCI, and a stable effect can be observed. The theoretical Cp may represent effect-site concentration (EC). We used the EC-effect relationship to study pharmacodynamics (PD) in infants, children, and adults. After giving their written, informed consent, 14 infants, 23 children, and 21 adults scheduled for elective surgical procedures received 3 to 6 ascending Cp targets of TO rocuronium. according to PD data. Just before each increase of TCI, venous blood samples were taken to measure Cp. Neuromuscular block was evaluated acceleromyographically. Individual effect data and measured Cp were fitted to the Hill equation. Maximum block during TCI targets-1000, 1300, and 1600 ng/mL-was smaller in children in comparison with infants and adults. The concentration in the effect compartment associated with a 50% drug effect (EC50) was significantly smaller in infants (mean [SD]) (652 [215] ng/mL) than in adults (954 [276] ng/mL) and was the largest in children (1200 [295] ng/mL). Calculated mean EC90 values were 1705, 2230, and 2035 ng/mL, respectively, in infants, children, and adults. TCI rocuronium established steady-state PK/PD at different TCI targets and allowed us to define PK/PD relationships in a standardized way. Steady-state TCI rocuronium revealed the most potency of rocuronium. in infants and the least in children. C1 Univ Antwerp Hosp, Dept Anesthesiol, B-2650 Edegem, Belgium. Univ Antwerp Hosp, Dept Otorhinolaryngol, B-2650 Edegem, Belgium. RP Saldien, V (reprint author), Univ Antwerp Hosp, Dept Anesthesiol, Wilrijkstr 10, B-2650 Edegem, Belgium. NR 23 TC 16 Z9 21 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 2003 VL 97 IS 1 BP 44 EP 49 DI 10.1213/01.ANE.0000066262.32103.60 PG 6 WC Anesthesiology SC Anesthesiology GA 695CZ UT WOS:000183814700010 ER PT J AU El-Orbany, MI Joseph, NJ Salem, MR AF El-Orbany, MI Joseph, NJ Salem, MR TI The relationship of posttetanic count and train-of-four responses during recovery from intense cistatracurium-induced neuromuscular blockade SO ANESTHESIA AND ANALGESIA LA English DT Article ID VECURONIUM; TRANSMISSION; ATRACURIUM; PTC AB Posttetanic count (PTC) has been used to quantify intense degrees of nondepolarizing neuromuscular blockade. Our objective in the present investigation was to discern whether PTC correlates with recovery from intense cisatracurium-induced neuromuscular blockade under both inhaled and IV anesthesia. In 60 patients, anesthesia was induced with propofol 2 mg/kg and fentanyl 1.5 mug/kg IV. Recovery from intense neuromuscular blockade induced by cisatracurium (0.15 mg/kg) was studied in 2 groups. Group 1 (n = 30) had anesthesia maintained with propofol 100-200 mug . kg(-1) . min(-1) and 60% N2O in O-2, whereas Group 2 (n = 30) had anesthesia maintained with isoflurane (end-tidal concentration 0.8%) and 60% N2O in O-2. Neuromuscular functions were monitored using acceleromyography. Cycles of posttetanic stimulation were repeated every 6 min with train-of-four (TOF) stimulation in between. Measurement included times to posttetanic responses and to the first response to TOF stimulation (T-1), as well as the correlation between PTC and T-1. In Group 1, the mean times to PTC1 and T-1 were 35.6 +/- 7.5 and 46.9 +/- 6.5 min, respectively. Corresponding times in Group 2 were 39.5 +/- 6.8 and 56.7 +/- 5.4 min, respectively. There was a good time correlation, r = 0.919 for propofol (Group 1) and r = 0.779 for isoflurane (Group 2), between PTC and T-1 recovery in both groups. The PTC when T-1 appeared ranged between 8 and 9 in Group 1 and 8 and 14 in Group 2. Conforming to original observations with other neuromuscular blocking drugs, there is a correlation between PTC and TOF recovery from intense cisatracurium-induced neuromuscular blockade allowing better monitoring of this intense degree of blockade during both IV (propofol) and isoflurane anesthesia. C1 Advocate Illinois Mason Med Ctr, Dept Anesthesiol, Chicago, IL 60657 USA. Univ Illinois, Chicago, IL USA. RP El-Orbany, MI (reprint author), Advocate Illinois Mason Med Ctr, Dept Anesthesiol, 836 W Wellington Ave, Chicago, IL 60657 USA. NR 14 TC 5 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 2003 VL 97 IS 1 BP 80 EP 84 DI 10.1213/01.ANE.0000063825.19503.49 PG 5 WC Anesthesiology SC Anesthesiology GA 695CZ UT WOS:000183814700016 ER PT J AU Pillon, S Somers, J Grandjean, S Lacquement, J AF Pillon, S Somers, J Grandjean, S Lacquement, J TI Aspects of fabrication of curium-based fuels and targets SO JOURNAL OF NUCLEAR MATERIALS LA English DT Article; Proceedings Paper CT 2nd Seminar on European Research on Materials for Transmutation CY SEP 26-27, 2002 CL KARLSRUHE, GERMANY ID TRANSMUTATION; ACTINIDES; AMERICIUM AB The limited fabrication possibilities will be decisive in the design of curium fuels and targets. It appears that there are significant advantages to be gained by separating the Am and Cm at the reprocessing stage, simply to concentrate the problems caused by Cm and limit its mass flow. Vibrocompaction of particles or spheres is probably the most suitable consolidation process, as it reduces the number of fabrication steps and reduces the concomitant controls and scraps occurring in pelletization routes for mixed fuel and targets. The infiltration process is the most promising method to convert aqueous Cm solutions to solid material, but sol-gel and other controlled precipitation for granulate production should not be neglected. Storage of the solidified Cm with a delayed introduction into the reactor for Plutonium transmutation is the most promising concept. (C) 2003 Elsevier Science B.V. All rights reserved. C1 CEA, Ctr Cadarache, DEN, DEC,SESC, F-13108 St Paul Les Durance, France. Commiss European Communities, Joint Res Ctr, Inst Transuranium Elements, D-76125 Karlsruhe, Germany. CEA, Ctr Valrho, DEN, DRCP,SCPS, F-30207 Bagnols Sur Ceze, France. RP Pillon, S (reprint author), CEA, Ctr Cadarache, DEN, DEC,SESC, F-13108 St Paul Les Durance, France. NR 18 TC 17 Z9 17 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0022-3115 J9 J NUCL MATER JI J. Nucl. Mater. PD JUL 1 PY 2003 VL 320 IS 1-2 BP 36 EP 43 DI 10.1016/s0022-3115(03)00168-5 PG 8 WC Materials Science, Multidisciplinary; Nuclear Science & Technology; Mining & Mineral Processing SC Materials Science; Nuclear Science & Technology; Mining & Mineral Processing GA 699CK UT WOS:000184038200007 ER PT J AU Turan, A Memis, D Karamanlioglu, B Sut, N Pamukcu, Z AF Turan, A Memis, D Karamanlioglu, B Sut, N Pamukcu, Z TI The prevention of pain from injection of rocuronium by magnesium sulphate, lignocaine, sodium bicarbonate and Alfentanil SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE neuromuscular relaxants : rocuronium pain : injection; pharmacology : magnesium sulphate; lignocaine, sodium bicarbonate, alfentanil ID LIDOCAINE; PROPOFOL; PRETREATMENT; ANALGESIA; BROMIDE; PH AB We compared the efficacy of magnesium sulphate, lignocaine, sodium bicarbonate or alfentanil in minimizing pain due to injection of rocuronium in 250 patients. After tourniquet application on the forearm, the patients were given saline, magnesium sulphate, lignocaine, sodium bicarbonate 8.4% or alfentanil, diluted into a 3 ml solution. The occlusion was released after 20 seconds, and rocuronium was injected over 10 to 15 seconds. The patients were observed and asked immediately if they had pain in the arm and the response was assessed. Reactions such as discomfort and pain, withdrawal of the hand and screaming after the administering of the rocuronium were recorded as side-effects and patients were reassessed at 24 hours postoperatively. We concluded that magnesium sulphate, lignocaine, sodium bicarbonate or alfentanil decreased the level of rocuronium injection pain. Of these drugs, magnesium sulphate, lignocaine and sodium bicarbonate were the most effective while alfentanil was the least effective. C1 Trakya Univ, Fac Med, Dept Anaesthesiol, TR-22030 Edirne, Turkey. Trakya Univ, Fac Med, Dept Biostat, TR-22030 Edirne, Turkey. RP Turan, A (reprint author), Trakya Univ, Fac Med, Dept Anaesthesiol & Reanimat, TR-22030 Edirne, Turkey. NR 29 TC 28 Z9 29 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD JUN PY 2003 VL 31 IS 3 BP 277 EP 281 PG 5 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 696EQ UT WOS:000183873900006 ER PT J AU Munir, MA Jaffar, M Arshad, M Akhter, MS Zhang, JM AF Munir, MA Jaffar, M Arshad, M Akhter, MS Zhang, JM TI Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID ACETYLCHOLINE-RECEPTORS; SKELETAL-MUSCLE; TIME-COURSE; ORG 9426; VECURONIUM; INJURY AB Purpose: To report a case of reduced duration of action of rocuronium in a patient with normocalcemic hyperparathyroidism (HPT). Clinical features: A 56-yr-old patient with primary HPT, who had had surgical resection of three and a half parathyroid glands nine months previously, was referred to our institution for further investigation of a persistent increase in parathyroid hormone. Preoperatively, the patient had a normal serum ionized and total calcium. The patient was diagnosed with a persistent parathyroid adenoma and was scheduled for an elective parathyroidectomy. General anesthesia was induced with iv propofol, fentanyl and succinylcholine. Intraoperatively, anesthesia was maintained with nitrous oxide in oxygen, and isoflurane. Neuromuscular blockade was attained using incremental doses of rocuronium. The average duration of 0.15 mg.kg(-1) incremental doses of rocuronium was 5.9 min (expected: 13-18 min), and that of 0.2 mg.kg(-1) was ten minutes (expected: 19-23 min). Conclusion: Primary HPT even in the absence of hypercalcemia may result in resistance to competitive blockade by rocuronium. It suggests that primary HPT may cause acetylcholine receptor upregulation resulting in hyposensitivity to non-depolarizing muscle relaxants. C1 Univ Arkansas Med Sci, Dept Anesthesiol, Little Rock, AR 72205 USA. RP Munir, MA (reprint author), Univ Arkansas Med Sci, Dept Anesthesiol, Slot 515, Little Rock, AR 72205 USA. NR 16 TC 0 Z9 0 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUN-JUL PY 2003 VL 50 IS 6 BP 558 EP 561 PG 4 WC Anesthesiology SC Anesthesiology GA 699PE UT WOS:000184064500006 ER PT J AU Gao, L Ramzan, I Baker, B AF Gao, L Ramzan, I Baker, B TI Rocuronium infusion requirements and plasma concentrations at constant levels of neuromuscular paralysis during three phases of liver transplantation SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE liver transplantation; rocuronium; infusion requirements; plasma concentrations ID ACID-BASE-BALANCE; DOSE REQUIREMENTS; PHARMACOKINETICS; VECURONIUM; ANESTHESIA; BLOCKADE; PIGS; ACCELEROMYOGRAPHY; PHARMACODYNAMICS; DYSFUNCTION AB Study Objective: To develop a rapid online test of graft liver function during liver transplantation. Design: Prospective, observational study. Setting: University hospital transplant unit. Patients: 17 adult patients with end-stage liver disease who underwent liver transplantation surgery. Interventions: Rocuronium infusion dose requirements and plasma concentrations to maintain constant levels of neuromuscular paralysis during three phases of liver transplantation and their relationship with early postoperative liver function tests were studied. Measurements: Infusion dose requirements of rocuronium, assay of rocuronium plasma concentrations using gas chromatography-mass spectrometry, and intensity of neuromuscular blockade were measured. Main Results: A 24% decrease in rocuronium infusion requirements was observed during the an-hepatic phase. Rocuronium requirement during the neohepatic phase was increased only modestly or remained unchanged in 14 of the 16 patients who had normal graft function in the immediate postoperative period. Rocuronium plasma concentrations for maintaining constant levels of paralysis were significantly lower during the neohepatic phase than during the paleohepatic and anhepatic phases, indicating that there is likely to be a change in pharmacodynamics during this phase. Significant reduction in rocuronium infusion requirements during the neohepatic phase was observed in the only patient who had poor graft function in the early postoperative stage, suggesting that the reduced infusion requirement to maintain a constant neuromuscular paralysis may be related to the functional state of the graft liver after reperfusion. Conclusions: A significant reduction in rocuronium infusion requirement during the neohepatic phase may be suggestive of impaired organ unction after reperfusion of the graft liver. Rocuronium may serve as a Potential online indicator of graft liver function during liver transplantation by measurement of its infusion requirements during transplantation. (C) 2003 by Elsevier Inc. C1 Univ Sydney, Dept Anaesthet D06, Sydney, NSW 2006, Australia. Univ Sydney, Fac Pharm, Sydney, NSW 2006, Australia. RP Baker, B (reprint author), Univ Sydney, Dept Anaesthet D06, Sydney, NSW 2006, Australia. NR 27 TC 3 Z9 8 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD JUN PY 2003 VL 15 IS 4 BP 257 EP 266 DI 10.1016/S0952-8180(03)00061-8 PG 10 WC Anesthesiology SC Anesthesiology GA 707QQ UT WOS:000184521700003 ER PT J AU Berg, CM Heier, T Wilhelmsen, V Florvaag, E AF Berg, CM Heier, T Wilhelmsen, V Florvaag, E TI Rocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE allergy; skin test, intradermal test; skin prick test, muscle relaxant; rocuronium, muscle relaxant; cisatracurium ID MUSCLE-RELAXANTS; ANAPHYLACTOID REACTIONS; FLARE RESPONSES; ANESTHESIA; IGE; RADIOIMMUNOASSAY; DIAGNOSIS; AGENTS; HUMANS AB Background: Muscle relaxants are believed to be responsible for 2/3 of the cases of anaphylactic reactions during anesthesia. This assumption is based mainly on positive skin tests obtained in individuals that have experienced anesthesia-related anaphylaxis. A positive skin test is supposed to be associated with mast cell degranulation of vasoactive amines. In the present study we tested the frequency of positive skin tests with two commonly used muscle relaxants, rocuronium and cisatracurium, in a selected group of volunteers with low potential for allergic reactions. Methods: Thirty healthy volunteers without known allergy or previous exposure to muscle relaxants were studied. Low potential for allergic reactions was determined prior to inclusion in the study, using various allergy tests. Each individual was tested with intradermal and skin prick tests, and molar drug concentration thresholds for positive skin reactions were determined using a dilution titration technique. The presence or absence of mast cell degranulation was tested by electron microscopic investigation of skin biopsies obtained from positive and negative skin reactions. Results: None of the volunteers had a positive skin prick test. More than 90% of the volunteers had a positive intradermal test with both rocuronium and cisatracurium. The highest molar drug concentration that was not associated with a positive intradermal test was 10(-6) M (rocuronium) and 10(-7) M (cisatracurium), equivalent to vial dilution 1 : 1000 for both drugs. In none of the volunteers was mast cell degranulation detected. Conclusion: Non-mast-cell-mediated positive intradermal skin reactions are frequently occurring with rocuronium and cisatracurium, even at vial dilution 1 : 1000. A clinically applicable test technique is needed that is able to separate positive skin tests associated with mast cell degranulation from non-mast-cell-mediated reactions. C1 Ullevaal Univ Hosp, Dept Anesthesia, N-0407 Oslo, Norway. Ullevaal Univ Hosp, Sect Lung Dis & Allergy, N-0407 Oslo, Norway. Haukeland Univ Hosp, Lab Clin Biochem, N-5021 Bergen, Norway. RP Heier, T (reprint author), Ullevaal Univ Hosp, Dept Anesthesia, N-0407 Oslo, Norway. NR 27 TC 29 Z9 29 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2003 VL 47 IS 5 BP 576 EP 582 DI 10.1034/j.1399-6576.2003.00093.x PG 7 WC Anesthesiology SC Anesthesiology GA 668QJ UT WOS:000182304400013 ER PT J AU Yorukoglu, D Asik, Y Okten, F AF Yorukoglu, D Asik, Y Okten, F TI Rocuronium combined with i.v. lidocaine for rapid tracheal intubation SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE anesthesia : general; anesthetic technique : rapid sequence induction; local anesthetic : lidocaine; neuromuscular relaxants : succinylcholine, rocuronium ID SEQUENCE INDUCTION; INTRAVENOUS LIDOCAINE; IV LIGNOCAINE; SUCCINYLCHOLINE; ANESTHESIA; PROPOFOL; SUXAMETHONIUM; ORG-9426; THIOPENTONE; ALFENTANIL AB Background: Rocuronium (ORG 9426) has been shown to have an onset of action more rapid than other nondepolarizing neuromuscular blocking agents and to provide intubating conditions similar to those of succinylcholine 60-90 s after administration. We compared the intubating conditions and hemodynamic changes after the administration of rocuronium 0.6 mg kg(-1) and lidocaine 1.5 mg kg(-1) with rocuronium alone and succinylcholine 60 and 90 s after administration. Methods: One hundred and twenty-five adult patients of ASA physical status I or II scheduled for elective surgery were randomly divided into five groups. After propofol administration in all patients, patients in group Su (succinylcholine), group R-60 (rocuronium) and group RL60 (rocuronium-lidocaine) were intubated within 60 s, while groups RL90 and R-90 were intubated 90 s after the administration of rocuronium and succinylcholine. Laryngoscopy was performed and intubating conditions were graded by an experienced anesthetist blind to the muscle relaxant allocation. Results: In this study, groups Su, RL60 , R-90 and RL90 had similar intubation scores, which were significantly better than that for group R-60 . Heart rate did not increase after intubation in groups Su, RL60 and RL90 . Conclusion: The combination of lidocaine (1.5 mg kg(-1) ) and low-dose rocuronium (0.6 mg kg(-1) ) along with propofol is clinically equivalent to succinylcholine, improves intubating conditions in 60 s and effectively blocks increases in heart rate after intubation. C1 Ankara Univ, Dept Anesthesiol & Intens Care, Fac Med, TR-06100 Ankara, Turkey. RP Asik, Y (reprint author), Kennedy Cad 98-2, TR-06700 Ankara, Turkey. NR 25 TC 11 Z9 16 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2003 VL 47 IS 5 BP 583 EP 587 DI 10.1034/j.1399-6576.2003.00086.x PG 5 WC Anesthesiology SC Anesthesiology GA 668QJ UT WOS:000182304400014 ER PT J AU Murphy, GS Szokol, JW Marymont, JH Vender, JS Avram, MJ Rosengart, TK Alwawi, EA AF Murphy, GS Szokol, JW Marymont, JH Vender, JS Avram, MJ Rosengart, TK Alwawi, EA TI Recovery of neuromuscular function after cardiac surgery: Pancuronium versus rocuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID HYPOTHERMIC CARDIOPULMONARY BYPASS; TRAIN-OF-4 FADE; BLOCKING-AGENTS; BLOCKADE; VECURONIUM AB The use of pancuronium in fast-track cardiac surgical patients may be associated with delays in clinical recovery. Our objective in this study was to evaluate the incidence and severity of residual neuromuscular blockade after cardiac surgery in patients randomized to receive either pancuronium (0.08-0.1 mg/kg) or rocuronium (0.6-0.8 mg/kg). Eighty-two patients undergoing cardiopulmonary bypass were randomized to a pancuronium (n = 41) or rocuronium (n = 41) group. Intraoperative and postoperative management was standardized. In the intensive care unit, train-of-four (TOF) ratios were measured each hour until weaning off ventilatory support was initiated. Neuromuscular blockade was not reversed. After tracheal extubation, patients were examined for signs and symptoms of residual paresis. When weaning of ventilatory support was initiated, significant neuromuscular blockade was present in the pancuronium. subjects (TOF ratio: median, 0.14; range, 0.00-1.11) compared with the rocuronium subjects (TOF ratio: median, 0.99; range, 0.87-1.21) (P < 0.05). Patients in the rocuronium group were more likely to be free of signs and symptoms of residual paresis than patients in the pancuronium group. Our findings suggest that the use of longer-acting muscle relaxants in cardiac surgical patients is associated not only with impaired neuromuscular recovery, but also with signs and symptoms of residual muscle weakness in the early postoperative period. C1 Evanston Northwestern Healthcare, Dept Surg, Evanston, IL 60201 USA. Northwestern Univ, Dept Anesthesia, Feinberg Sch Med, Chicago, IL USA. RP Murphy, GS (reprint author), Evanston Northwestern Healthcare, Dept Anesthesia, 2650 Ridge Ave, Evanston, IL 60201 USA. NR 22 TC 23 Z9 24 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 2003 VL 96 IS 5 BP 1301 EP 1307 DI 10.1213/01.ANE.0000057602.27031.C8 PG 7 WC Anesthesiology SC Anesthesiology GA 671GL UT WOS:000182456900011 ER PT J AU Motamed, C Menad, R Farinotti, R Kirov, K Combes, X Bouleau, D Feiss, P Duvaldestin, P AF Motamed, C Menad, R Farinotti, R Kirov, K Combes, X Bouleau, D Feiss, P Duvaldestin, P TI Potentiation of mivacurium blockade by low dose of pancuronium - A pharmacokinetic study SO ANESTHESIOLOGY LA English DT Article ID PLASMA CHOLINESTERASE ACTIVITY; NEUROMUSCULAR BLOCKADE; SUCCINYLCHOLINE; METOCLOPRAMIDE; METABOLITES; RELAXANT; INFUSION; ISOMERS AB Background: Mivacurium is potentiated by pancuronium to a much greater extent than other relaxants. In a previous investigation we suggested that this potentiation could be due to the ability of pancuronium to inhibit plasma cholinesterase activity, but we did not measure plasma concentrations of mivacurium. In the current study we performed a pharmacokinetic analysis by measuring the plasma concentration of mivacurium when preceded by administration of a low dose of pancuronium. Methods: After induction of general anesthesia with propofol and fentanyl and orotracheal intubation, 110 patients (pancuronium-mivacurium group) received 15 mug/kg pancuronium followed 3 min later by 0.1 mg/kg mivacurium, whereas 10 other patients (mivacurium group) received saline followed by 0.13 mg/kg mivacurium. 3 min later. Plasma cholinesterase activity was measured before and 3 and 30 min after pancuronium dosing in the pancuronium-mivacurium group and was measured before and after administration of saline in the mivacurium group. Arterial plasma concentrations of mivacurium and its metabolites, were measured at 0.5, 1, 1.5, 2, 43 10, 20, and 30 min after injection. Neuromuscular blockade was assessed by mechanomyography. Results: Plasma cholinesterase activity decreased by 26% in the pancuronium-mivacurium group 3 min after injection of pancuronium (P < 0.01) and returned to baseline values 30 min later;, however, no significant variation was observed in the mivacurium group. The clearances of the two most active isomers (Cis-Trans and Trans-Trans) were lower in the pancuronium-mivacurium group (17.6 +/- 5.1, 14.7 +/- 5.3 ml . min(-1) . kg(-1), respectively) than in the mivacurium group (32.4 +/- 20.2, 24.8 +/- 13.5 ml . min(-1) . kg(-1); P < 0.05). Conclusions: A subparalyzing dose of pancuronium decreased plasma cholinesterase activity and the clearance of the two most active isomers of mivacurium. Pancuronium potentiates mivacurium more than other neuromuscular blocking agents because, in addition to its occupancy of postsynaptic acetylcholine receptors, it slows down the hydrolysis of mivacurium. C1 Clin Hop Bichat, Serv Pharmacol, Paris, France. Hosp Univ Limoges, Serv Anesthesie, Reanimat Ctr, Limoges, France. Hop Henri Mondor, Serv Anesthesie Reanimat, APHP, F-94010 Creteil, France. RP Duvaldestin, P (reprint author), Hop Henri Mondor, Serv Anesthesie Reanimat, APHP, 51 AVe Marechal De Lattre De Tassigny, F-94010 Creteil, France. NR 19 TC 3 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAY PY 2003 VL 98 IS 5 BP 1057 EP 1062 DI 10.1097/00000542-200305000-00006 PG 6 WC Anesthesiology SC Anesthesiology GA 672LY UT WOS:000182523200005 ER PT J AU Kaufman, GE Seymour, RE Bonner, BB Court, MH Karas, AZ AF Kaufman, GE Seymour, RE Bonner, BB Court, MH Karas, AZ TI Use of rocuronium for endotracheal intubation of North American Gulf Coast box turtles SO JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION LA English DT Article ID ANESTHESIA; KETAMINE AB Objective-To determine whether rocuronium, a reversible neuromuscular blocking agent, would provide safe, short-term immobilization to facilitate endotracheal intubation in turtles. Design-Prospective study. Animals-30 healthy adult Gulf Coast box turtles. Procedure-Turtles were given rocuronium, and responses were recorded every 3 minutes. Times to onset of effects, intubation, and recovery were recorded and analyzed for associations with dose and patient characteristics to determine an optimal dose range. Neostigmine and glycopyrrolate were given to augment recovery from neuromuscular blockade. Results-Rocuronium administered at a dose of 0.25 to 0.5 mg/kg (0.11 to 0.23 mg/lb), IM, permitted intubation; lower doses were not effective. Mean +/- SD time to loss of the palpebral reflex was 6.4 +/- 4.0 minutes, and mean time to intubation was 9.2 +/- 6.4 minutes. Mean time to return of the palpebral reflex was 44 +/- 13.2 minutes, and mean time to walking was 55 +/- 16.6 minutes. Time to onset of effects was not associated with dose, but recovery times were prolonged with higher doses of rocuronium. Cardiac arrhythmias were observed in 13 (43%) turtles. Conclusions and Clinical Relevance-Administration of rocuronium at a dose of 0.25 to 0.5 mg/kg is a safe and effective adjunct to general anesthesia in Gulf Coast box turtles. Because rocuronium does not provide any analgesic or sedative effects, the duration of neuromuscular blockade without anesthesia should be minimized to avoid undue distress. C1 Tufts Univ, Sch Vet Med, Dept Environm & Populat Hlth, North Grafton, MA 01536 USA. Tufts Univ, Sch Vet Med, Dept Clin Sci, North Grafton, MA 01536 USA. Turtle Hosp New England, Upton, MA 01568 USA. Tufts Univ, Sch Med, Dept Pharmacol & Expt Therapeut, Boston, MA 02111 USA. RP Kaufman, GE (reprint author), Tufts Univ, Sch Vet Med, Dept Environm & Populat Hlth, 200 Westboro Rd, North Grafton, MA 01536 USA. NR 16 TC 6 Z9 7 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 USA SN 0003-1488 J9 J AM VET MED ASSOC JI J. Am. Vet. Med. Assoc. PD APR 15 PY 2003 VL 222 IS 8 BP 1111 EP 1115 DI 10.2460/javma.2003.222.1111 PG 5 WC Veterinary Sciences SC Veterinary Sciences GA 667VB UT WOS:000182253800027 ER PT J AU Kim, KS Cheong, MA Jeon, JW Lee, JH Shim, JC AF Kim, KS Cheong, MA Jeon, JW Lee, JH Shim, JC TI The dose effect of ephedrine on the onset time of vecuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID CARDIAC-OUTPUT; TRACHEAL INTUBATION; PRIMING PRINCIPLE; ROCURONIUM; PROPOFOL; ANESTHESIA; STIMULATION; COMBINATION; TRAIN-OF-4; RESPONSES AB A small dose of ephedrine decreases the onset time of rocuronium and cisatracurium; however, ephedrine might be associated with adverse hemodynamic effects. The appropriate dose of ephedrine has not been determined. We, therefore, studied 120 patients anesthetized with fentanyl 2 mug/kg and propofol 2-2.5 mg/kg who were randomly divided to receive either ephedrine (30,70, or 110 mug/kg) or saline. During propofol anesthesia, the neuromuscular block was monitored by mechanomyography by using submaximal current of train-of-four stimulation every 10 s. To determine cardiac output, a transcutaneous Doppler probe was placed externally at the suprasternal notch. Tracheal intubation was performed by a blinded investigator at 2 min after vecuronium. Neuromuscular block, intubating conditions, and hemodynamic effects were measured during the induction of anesthesia. Both ephedrine 70 and 110 mug/kg improved intubating conditions at 2 min after vecuronium; however, 110 mug/kg was associated with adverse hemodynamic effects. We conclude that ephedrine 70 mug/kg given before the induction of anesthesia improved intubating conditions at 2 min after vecuronium, probably by increased cardiac output without significant adverse hemodynamic effects. C1 Hanyang Univ Hosp, Dept Anesthesiol, Seoul 133792, South Korea. RP Kim, KS (reprint author), Hanyang Univ Hosp, Dept Anesthesiol, 17 Haengdang Dong, Seoul 133792, South Korea. EM kimks@hanyang.ac.kr NR 25 TC 7 Z9 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 2003 VL 96 IS 4 BP 1042 EP 1046 DI 10.1213/01.ANE.0000034551.93647.3A PG 5 WC Anesthesiology SC Anesthesiology GA 659ZB UT WOS:000181808300024 ER PT J AU Jooste, E Klafter, F Hirshman, CA Emala, CW AF Jooste, E Klafter, F Hirshman, CA Emala, CW TI A mechanism for rapacuronium-induced bronchospasm - M2 muscarinic receptor antagonism SO ANESTHESIOLOGY LA English DT Article ID GUINEA-PIG LUNG; HISTAMINE-RELEASE; GENERAL-ANESTHESIA; MUSCLE-RELAXANTS; ATRACURIUM; PHARMACOKINETICS; MIVACURIUM; CHILDREN; CISATRACURIUM; TUBOCURARINE AB Background: A safe and effective ultra-short-acting nondepolarizing neuromuscular blocking agent is required to block nicotinic receptors to facilitate intubation. Rapacuronium, which sought to fulfill these criteria, was withdrawn from clinical use due to a high incidence of bronchospasm resulting in death. Understanding the mechanism by which rapacuronium induces fatal bronchospasm is imperative so that newly synthesized neuromuscular blocking agents that share this mechanism will not be introduced clinically. Selective inhibition of M2 muscarinic receptors by muscle relaxants during periods of parasympathetic nerve stimulation (e.g., intubation) can result in the massive release of acetylcholine to act on unopposed M3 muscarinic receptors in airway smooth muscle, thereby facilitating bronchoconstriction. Methods: Competitive radioligand binding determined the binding affinities of rapacuronium, vecuronium, cisatracurium, methoctramine (selective M2 antagonist), and 4-diphenylac-etoxy-N-methylpiperidine methiodide (4-DAMP; selective M3 antagonist) for M2 and M3 muscarinic receptors. Results: Rapacuronium competitively displaced H-3-QNB from the M2 muscarinic receptors but not from the M3 muscarinic receptors within clinically relevant concentrations. Fifty percent inhibitory concentrations (mean SE) for rapacuronium were as follows: M2 muscarinic receptor, 5.10 +/- 1.5 muM (n = 6); M3 muscarinic receptor, 77.9 +/- 11 muM (n = 8). Cisatracurium and vecuronium competitively displaced H-3-QNB from both M2 and M3 muscarinic receptors but had affinities at greater than clinically achieved concentrations for these relaxants. Conclusions: Rapacuronium in clinically significant doses has a higher affinity for M2 muscarinic receptors as compared with M3 muscarinic receptors. A potential mechanism by which rapacuronium may potentiate bronchoconstriction is by blockade of M2 muscarinic receptors on prejunctional parasympathetic nerves, leading to increased release of acetylcholine and thereby resulting in M3 muscarinic receptor-mediated airway smooth muscle constriction. C1 Columbia Univ Coll Phys & Surg, Dept Anesthesiol, New York, NY 10032 USA. RP Emala, CW (reprint author), Columbia Univ Coll Phys & Surg, Dept Anesthesiol, 630 W 168th St,P&S Box 46, New York, NY 10032 USA. NR 35 TC 29 Z9 33 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 2003 VL 98 IS 4 BP 906 EP 911 DI 10.1097/00000542-200304000-00017 PG 6 WC Anesthesiology SC Anesthesiology GA 660ZG UT WOS:000181865500016 ER PT J AU Saitoh, Y Kaneda, K Hattori, H Nakajima, H Murakawa, M AF Saitoh, Y Kaneda, K Hattori, H Nakajima, H Murakawa, M TI Monitoring of neuromuscular block after administration of vecuronium in patients with diabetes mellitus SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, vecuronium; complications, diabetes ID NERVE CONDUCTION VELOCITY; POSTTETANIC TWITCH; NEUROPATHY; RESPONSES; ONSET AB Background. We studied the supramaximal current for ulnar nerve stimulation during electromyographic monitoring of onset and recovery of neuromuscular block using a neuromuscular transmission module (M-NMT Module, Datex-Ohmeda) in patients with Type 2 diabetes undergoing anaesthesia with nitrous oxide, oxygen, isoflurane and fentanyl. Methods. Thirty-six diabetic patients were randomly assigned to a post-tetanic count (PTC) group (n=17) or train-of-four (TOF) group (n= 19). In addition, 30 non-diabetic patients were divided into control PTC (n= 15) and TOF groups (n= 15). Results. In the diabetic patients (diabetes PTC and diabetes TOF groups), the mean supramaximal stimulating current was significantly higher than in the non-diabetic patients (control PTC and TOF groups) (50.5 (SD 14.1)- vs 33.4 (6.1) mA, P<0.01). Onset of neuromuscular block (time to disappearance of T1) after vecuronium 0.1 mg kg(-1) in the diabetic, patients did not differ significantly from that in the non-diabetic patients (276 (77) vs 244 (44) s, P=0.055). Time to return of PTC1 did not differ significantly between the diabetes and control PTC groups (21.0 (12.1) vs 15.7 (5.0) min, P=0.126). Times to return of T1 and T4 in the diabetes TOF group were significantly longer than in the control TOF group (T1: 37.5 (15.2) vs 25.7 (7.6) min, P=0.01; T4: 61.4 (23.7) vs 43.5 (11.4) min, P=0.01). During recovery, PTC and T4/T1 in the diabetes PTC and TOF groups were similar to those in the control PTC and TOF groups, respectively. T1/T0 in the diabetes TOF group was significantly less than in the control TOF group, 80-120 min after vecuronium (P<0.05). Conclusions. In diabetic patients, supramaximal current is higher than in non-diabetic patients. After vecuronium, onset of neuromuscular block and recovery of PTC or T4/T1 are not altered, but time to return of T1 or T4, and recovery of T1/T0 are delayed in diabetic patients. C1 Fukushima Med Univ, Sch Med, Dept Anesthesiol, Fukushima, Fukushima 9601295, Japan. Toride Kyodo Gen Hosp, Dept Anesthesiol, Ibaraki, Japan. RP Saitoh, Y (reprint author), Fukushima Med Univ, Sch Med, Dept Anesthesiol, Hikarigaoka 1, Fukushima, Fukushima 9601295, Japan. NR 22 TC 11 Z9 14 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD APR PY 2003 VL 90 IS 4 BP 480 EP 486 DI 10.1093/bja/aeg089 PG 7 WC Anesthesiology SC Anesthesiology GA 664TX UT WOS:000182078500012 ER PT J AU Nedergaard, OA AF Nedergaard, OA TI Curare: The flying death SO PHARMACOLOGY & TOXICOLOGY LA English DT Article; Proceedings Paper CT International Workshop on Vascular Neuroeffector Transmission Mechanisms CY JAN, 2002 CL ODENSE, DENMARK HO UNIV SOUTHERN DENMARK C1 Univ So Denmark, Dept Physiol & Pharmacol, DK-5000 Odense C, Denmark. RP Nedergaard, OA (reprint author), Univ So Denmark, Dept Physiol & Pharmacol, Winslowpk 21, DK-5000 Odense C, Denmark. NR 22 TC 1 Z9 1 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0901-9928 J9 PHARMACOL TOXICOL JI Pharmacol. Toxicol. PD APR PY 2003 VL 92 IS 4 BP 154 EP 155 DI 10.1034/j.1600-0773.2003.920402.x PG 2 WC Pharmacology & Pharmacy; Toxicology SC Pharmacology & Pharmacy; Toxicology GA 666YN UT WOS:000182204200002 ER PT J AU Thomas, R Smith, D Strike, P AF Thomas, R Smith, D Strike, P TI Prospective randomised double-blind comparative study of rocuronium and pancuronium in adult patients scheduled for elective 'fast-track' cardiac surgery involving hypothermic cardiopulmonary bypass SO ANAESTHESIA LA English DT Article; Proceedings Paper CT Meeting of the Association-of-Cardiothoracic-Anaesthetists CY JUN 21, 2002 CL CAMBRIDGE, ENGLAND SP Assoc Cardiothorac Anaesthetists DE neuromuscular block, pancuronium, rocuronium surgery, cardiovascular ID RESIDUAL NEUROMUSCULAR BLOCK; PARTIALLY PARALYZED HUMANS; DOUBLE BURST STIMULATION; ANESTHETIC TECHNIQUES; EARLY EXTUBATION; VECURONIUM; COMPLICATIONS; ACCELEROMYOGRAPHY; ATRACURIUM; TRAIN-OF-4 AB The majority of cardiac anaesthetists in the UK use pancuronium for fast-track cardiac surgery. We compared the duration of action of pancuronium and rocuronium in patients undergoing fast-track hypothermic cardiopulmonary bypass and cardiac surgery. We determined whether patients would have had residual neuromuscular blockade at extubation. Twenty patients were randomly allocated to receive either pancuronium 0.1 mg.kg(-1) or rocuronium 1 mg.kg(-1). Neuromuscular function was assessed by acceleromyography; spontaneous recovery was evaluated by the train-of-four. ratio measured at the adductor pollicis longus muscle. Median times to recover train-of-four ratio of 0.9 were 3 h 38 min for rocuronium and 7 h 52 min for pancuronium. The median difference in recovery times was 4 h 15 min (95% CI 2 h 30 min to 6 h 20 min; p = 0.0003 by Mann-Whitney test). None of the patients in the rocuronium group and seven of 10 patients in the pancuronium group had their extubations delayed because of residual neuromuscular blockade. Unless fast-track patients have neuromuscular function assessed before extubation, pancuronium should not be used. C1 Southampton Gen Hosp, Shackleton Dept Anaesthet, Southampton SO16 6YD, Hants, England. Salisbury Dist Hosp, Res & Dev Support Unit, Salisbury, Wilts, England. RP Thomas, R (reprint author), Southampton Gen Hosp, Shackleton Dept Anaesthet, Tremona Rd, Southampton SO16 6YD, Hants, England. NR 32 TC 6 Z9 6 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 2003 VL 58 IS 3 BP 265 EP 271 DI 10.1046/j.1365-2044.2003.30362.x PG 7 WC Anesthesiology SC Anesthesiology GA 656QZ UT WOS:000181619600010 ER PT J AU Dotan, ZA Hana, R Simon, D Geva, D Pfeffermann, RA Ezri, T AF Dotan, ZA Hana, R Simon, D Geva, D Pfeffermann, RA Ezri, T TI The effect of vecuronium is enhanced by a large rather than a modest dose of gentamicin as compared with no preoperative gentamicin SO ANESTHESIA AND ANALGESIA LA English DT Article ID THRICE-DAILY GENTAMICIN; NEUROMUSCULAR BLOCKADE; AMINOGLYCOSIDE ANTIBIOTICS; COLORECTAL SURGERY; DOUBLE-BLIND; SINGLE; INFECTIONS; COMBINATION; PROPHYLAXIS; ATRACURIUM AB We compared the effect of two doses of gentamicin versus no gentamicin (NG) given before surgery on the neuromuscular relaxant effect of vecuronium. Seventy patients (intraabdominal procedures) were randomly allocated to receive preoperative large-dose (4 mg/kg) gentamicin (LD), a modest dose (1.2 mg/kg) of gentamicin (MD), or NG. No more than one dose of gentamicin was given before the vecuronium administration. Serum gentamicin levels, the time for 25% recovery of the first twitch in the train-of-four after a bolus of vecuronium, and the time from cessation of the vecuronium infusion to extubation of the trachea were estimated. Serum gentamicin levels were higher (P < 0.001) for LD than MD. The time for 25% recovery of the first twitch after the vecuronium bolus was slightly longer with LD than MD (P = 0.06) and longer in LD than NG (P 0.001) (42.9 +/- 23.6 min versus 36.2 +/- 17 min and 27.4 +/- 9 min, respectively). The time to extubation was similar with LD and MD and longer for LD than NG (P = 0.008) (34.7 +/- 19.2 min versus 27.4 +/- 19.3 min and 19.4 +/- 10.1 min, respectively). The differences in these times were insignificant between MD and NG. Gentamicin administered as a LD rather than MD enhanced the neuromuscular blockade of vecuronium as compared with NG given before surgery. C1 Wolfson Med Ctr, Dept Anesthesia, IL-58100 Holon, Israel. Chaim Sheba Med Ctr, Dept Urol, Ramat Gan, Israel. Kaplan Med Ctr, Dept Gen Surg, Rehovot, Israel. Kaplan Med Ctr, Dept Anesthesia, Rehovot, Israel. RP Ezri, T (reprint author), Wolfson Med Ctr, Dept Anesthesia, IL-58100 Holon, Israel. NR 25 TC 3 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 2003 VL 96 IS 3 BP 750 EP 754 DI 10.1213/01.ANE.0000050280.59508.70 PG 5 WC Anesthesiology SC Anesthesiology GA 648VY UT WOS:000181172600022 ER PT J AU Chiarella, AB Jolly, DT Huston, CM Clanachan, AS AF Chiarella, AB Jolly, DT Huston, CM Clanachan, AS TI Comparison of four strategies to reduce the pain associated with intravenous administration of rocuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthetics, rocuronium; injection, pain; osmolality; pH ID INJECTION; LIDOCAINE; BROMIDE AB Background. I.V. rocuronium produces intense discomfort at the site of injection in conscious patients. Four strategies to reduce or prevent this discomfort were studied. Methods. Two hundred and fifty adult patients, ASA I-III, were randomized into five groups of 50 patients in a blinded, prospective study. The control group received rocuronium 10 mg alone. For the remaining four groups, rocuronium 10 mg was mixed with sodium bicarbonate 8.4% 2 ml, fentanyl 100 mug, lidocaine 2% or normal saline. The pH and osmolality of all mixtures were measured. Patient data were analysed using ordinal logistic regression. Osmolality and pH data were analysed using the Kruskal-Wallis test with Dunn's multiple comparison test. Results. When compared with rocuronium alone, only the addition of saline failed to significantly reduce the pain reported by patients. The addition of fentanyl reduced the complaint of pain by 1.9 times (P<0.049) and the addition of lidocaine 2% reduced it by 3.6 times (P<0.0001). Sodium bicarbonate 8.4% reduced the reporting of pain by 18.4 times (P<0.0001). Conclusions. Sodium bicarbonate 8.4%, when added to rocuronium, markedly reduces the experience of pain during the i.v. administration of a small dose of rocuronium. C1 Univ Alberta Hosp, Dept Anesthesiol & Pain Med, Walter C Mackenzie Hlth Sci Ctr 3B2 32, Edmonton, AB T6G 2B7, Canada. Univ Alberta, Fac Pharm & Pharmaceut Sci, Dent Pharm Ctr 3118, Edmonton, AB T6G 2N8, Canada. RP Chiarella, AB (reprint author), Univ Alberta Hosp, Dept Anesthesiol & Pain Med, Walter C Mackenzie Hlth Sci Ctr 3B2 32, 8440-112 St, Edmonton, AB T6G 2B7, Canada. RI Huston, Carolyn/G-4429-2012 NR 9 TC 0 Z9 0 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAR PY 2003 VL 90 IS 3 DI 10.1093/bja/aeg054 PG 3 WC Anesthesiology SC Anesthesiology GA 652ZG UT WOS:000181410300020 ER PT J AU Blunk, JA Seifert, E Schmelz, M Reeh, PW Koppert, W AF Blunk, JA Seifert, E Schmelz, M Reeh, PW Koppert, W TI Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular-blocking agents, vecuronium bromide, rocuronium bromide; peripheral nervous system, nociceptors; psychophysiology, pain ID HUMAN SKIN; RAT SKIN; CUTANEOUS NOCICEPTORS; HAND VEINS; BROMIDE; STIMULATION; SENSITIZATION; MICRODIALYSIS; BRADYKININ; LIDOCAINE AB Background and objective: Rocuronium and, to a lesser extent, vecuronium can induce burning sensations associated with withdrawal reactions during administration. Dermal microdialysis in human and electrophysiological recordings of nociceptors in mouse skin were used to elucidate the underlying mechanisms of pain induction. Methods: Microdialysis catheters were inserted intradermally into the forearm of 10 volunteers and were perfused with two different concentrations of rocuronium and vecuronium (1 and 10 mg mL(-1)) or a control. Dialysis samples were taken every 15 min and analysed for protein, histamine, tryptase and bradykinin content. Pain intensity was rated on a numerical scale of 0-10. In a parallel design, activation of cutaneous nociceptors was assessed directly in a skin-nerve in vitro preparation of the mouse hind paw. The receptive fields of identified single C-nociceptors (n = 12) were superfused with rocuronium or vecuronium solutions (10 mg mL(-1)) at physiological pH. Results: In accordance with clinical observations, microdialysis of rocuronium (10 mg mL(-1)) induced sharp burning pain (NRS 4.1 +/- 1.8), whereas vecuronium given in the usual clinical concentration (1 mg mL-1) induced only minor pain sensations (NRS 0.6 +/- 1.3). At equimolar concentrations, pain sensation and concomitant mediator release evoked by both drugs were similar. No correlations were found between pain rating and mediator release. In the in vitro preparation, C-fibres showed a consistent excitatory response with rapid onset after stimulation with vecuronium as well as rocuronium (differences not significant). Conclusions: The algogenic effect of aminosteroidal neuromuscular blocking drugs can be attributed to a direct activation of C-nociceptors. C1 Univ Erlangen Nurnberg, Dept Anaesthesiol, D-91054 Erlangen, Germany. Univ Erlangen Nurnberg, Dept Physiol & Expt Pathophysiol, D-91054 Erlangen, Germany. RP Koppert, W (reprint author), Univ Erlangen Nurnberg, Dept Anaesthesiol, Krankenhausstr 12, D-91054 Erlangen, Germany. EM kopperr@kfa.imed.uni-erlangen.de RI Reeh, Peter/J-8981-2012 OI Reeh, Peter/0000-0002-4367-094X NR 29 TC 28 Z9 32 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD MAR PY 2003 VL 20 IS 3 BP 245 EP 253 PG 9 WC Anesthesiology SC Anesthesiology GA 657UV UT WOS:000181685500011 ER PT J AU Rohling, RG Rentsch, KM Beck-Schimmer, B Fuchs-Buder, T AF Rohling, RG Rentsch, KM Beck-Schimmer, B Fuchs-Buder, T TI Risk of recurarization during retransfusion of autologous blood withdrawn after injection of muscle relaxants: A comparison of rocuronium and mivacurium SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE acute normovolemic hemodilution; anesthetic complications; mivacurium; neuromuscular blocking drugs, rocuronium ID NEUROMUSCULAR BLOCKING-AGENTS; LIQUID-CHROMATOGRAPHY; HEMODILUTION; TRANSFUSION; DECREASE; PLASMA; MASS AB Study Objectives: In the context of acute normovolemic hemodilution (ANH) recurarization, defined as significant decrease of train-of-four ratio (TOFR) during retransfusion of autologous blood withdrawn after induction of anesthesia, has been described for vecuronium and atracurium. The present study for the first time examined this risk for rocuronium and mivacurium. Design: Prospective, randomized, unblinded clinical study. Setting: University Hospital in Zurich/Switzerland. Patients: 20 ASA physical status I and II patients undergoing general anesthesia for major maxillofacial surgery. Interventions: Anesthesia was induced and maintained with propofol and remifentanil, and rocuronium, (0.9 mg kg(-1)) or mivacurium (0.25 mg kg(-1)) was given to facilitate intubation. Thereafter, ANH was started with the removal of 500 mL autologous blood and the subsequent replacement by the same amount of 6% hydroxyethyl starch. The withdrawn blood was stored at 4degreesC until retransfusion at the end of surgery. Measurements: To estimate the risk of recurarization during retransfusion, the degree of recurarization during retransfusion of the autologous blood was assessed mechanomyographically. Plasma levels of rocuronium and mivacurium in the patients' plasma and the autologous blood were determined after its removal and before retransfusion. Main Results: The TOFR before retransfusion was 0.97 (range: 0.96 to 0.98) for rocuronium(n = 10) and 0.98 (range: 0.96 to 1.0)for mivacurium (n = 8);n.s. During retransfusion, a slight, but statistically significant reduction of TOFR occurred in one patient in each group. In the mivacurium. group, this recurarization occurred 10 minutes after the start of retransfusion; in the rocuronium group, it occurred 20 minutes after retransfusion. The plasma levels of rocuronium and mivacurium in the autologous blood did not change during storage. The plasma concentration of mivacurium, in the autologous blood after its removal was 420 +/- 142 mug/L; before retransfusion, it was 384 +/- 147 mug/L. The respective concentrations for rocuronium were 2930 +/- 516 mug/L and 2660 +/- 464 mug/L. Conclusions: Recurarization during retransfusion may occur with both neuromuscular blocking drugs, mivacurium and rocuronium, when these drugs were injected before the removal of the autologous blood. (C) 2003 by Elsevier Science Inc. C1 Univ Zurich Hosp, Inst Anesthesiol, CH-8091 Zurich, Switzerland. Univ Zurich Hosp, Inst Clin Chem, CH-8091 Zurich, Switzerland. Univ Saarland, Dept Anesthesia & Crit Care, D-6650 Homburg, Germany. RP Rohling, RG (reprint author), Clin Vethanien, Inst Anesthesiol, Toblerstr 51, CH-8044 Zurich, Switzerland. NR 21 TC 1 Z9 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2003 VL 15 IS 2 BP 85 EP 90 DI 10.1016/S0952-8180(03)00519-6 PG 6 WC Anesthesiology SC Anesthesiology GA 675UQ UT WOS:000182714900001 ER PT J AU Kim, KS Jeon, JW Koh, MS Shim, JH Cho, SY Suh, JK AF Kim, KS Jeon, JW Koh, MS Shim, JH Cho, SY Suh, JK TI The duration of immobilization causes the changing pharmacodynamics of mivacurium and rocuronium in rabbits SO ANESTHESIA AND ANALGESIA LA English DT Article ID GASTROCNEMIUS DISUSE ATROPHY; TUBOCURARINE SENSITIVITY; ACETYLCHOLINE-RECEPTORS; SKELETAL-MUSCLE; RESISTANCE AB In the clinical setting, in patients with a cast, it is not known whether the monitoring of the neuromuscular paralysis induced by either mivacurium or rocuronium in the contralateral limb is the correct interpretation. We compared the dose-response relationships and the neuromuscular blocking effects of mivacurium and rocuronium in 56 anesthetized rabbits immobilized in a plaster cast for 2, 4, and 6 wk. Train-of-four stimuli were simultaneously applied every 10 s to both common peroneal nerves, and the force of contraction of both tibialis anterior muscles was measured. Immobilization was associated with a rightward shift of the mivacurium and rocuronium dose-response curves after the duration of the immobilized limb, whereas no shift occurred in the contralateral limb. The 50% effective dose values for 0, 2, 4, and 6 wk of immobilization in the immobilized limb of mivacurium were 15.1 +/- 1.4, 18.2 +/- 1.5, 21.5 +/- 1.9, and 27.8 +/- 2.5 mug/kg, respectively, and they were unchanged in the contralateral limb. The calculated 50% effective dose values for the correspondence of rocuronium were 48.1 +/- 4.1, 56.2 +/- 4.2, 64.8 +/- 4.9, and 75.1 +/- 5.5 mug/kg, respectively, and they were unchanged in the contralateral limb. The rabbits receiving mivacurium and rocuronium had a significantly accelerated recovery from neuromuscular blockade compared with the placebo group in the immobilized limb after the immobilized duration, whereas there were no differences in the contralateral limb. The results of the present study showed that immobilization disuse atrophy produced by casting led to the development of resistance to both mivacurium and rocuronium; however, no resistance was shown in the contralateral limb. The peripheral nerve stimulator could be applied on the nonimmobilized limb, which might be associated with a normal recording if either mivacurium or rocuronium was used as neuromuscular relaxants. C1 Hanyang Univ Hosp, Dept Anesthesiol, Seoul 133792, South Korea. RP Kim, KS (reprint author), Hanyang Univ Hosp, Dept Anesthesiol, 17 Haengdang Dong, Seoul 133792, South Korea. NR 14 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 2003 VL 96 IS 2 BP 438 EP 442 DI 10.1213/01.ANE.0000044671.00594.FE PG 5 WC Anesthesiology SC Anesthesiology GA 638YV UT WOS:000180601400025 ER PT J AU Vermeyen, KM Hoffmann, VL Saldien, V AF Vermeyen, KM Hoffmann, VL Saldien, V TI Target controlled infusion of rocuronium: analysis of effect data to select a pharmacokinetic model SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE pharmacokinetics, models; pharmacokinetics, rocuronium; pharmacology, rocuronium; neuromuscular block, rocuronium ID ADDUCTOR POLLICIS; BROMIDE ORG-9426; PHARMACODYNAMICS; ANESTHESIA; HALOTHANE AB Background. We aimed to evaluate whether area under the curve (AUC) analysis of pharmacodynamic data can be used to compare pharmacokinetic models taken from the literature, during a target controlled infusion (TCI) of rocuronium. Methods. Seventy-two patients scheduled for orthopaedic surgery received a TCI of rocuronium (Stanpump) based on one of four pharmacokinetic models: those described by Szenohradszky, Alvarez-Gomez, Wierda, and Cooper. The resulting theoretical plasma concentration versus time curve was calculated for all patients based on all four pharmacokinetic models. Predicted effect versus time curves Were calculated following the pharmacokinetic-pharmacodynamic link model (Sheiner and colleagues). Neuromuscular block was evaluated acceleromyographically. The difference between the area under the observed effect (AUC(OE)) and predicted effect (AUC(PE)) versus time curves was used for comparison. I Results. AUCPE differed significantly from AUCOE in the Szenohradszky and Alvarez-Gomez models, both with the reference link-pharmacodynamic data and with altered link-pharmacodynamic variables. AUCPE and AUCOE were comparable for the Wierda and Cooper models. The mean AUCOE was 25.1 (SD 11.9)% blockx h. AUC(PE)-AUC(OE) was significantly larger in the Szenohradszky model when compared with all other pharmacokinetic models. This difference remained when link or pharmacodynamic variables were modified. The smallest AUC(PE)-AUC(OE) difference was found with the Wierda model. Conclusion. It was possible to use AUC analysis for identification of the pharmacokinetic model that best predicted the pharmacodynamic characteristics of our patients. C1 Univ Antwerp Hosp, Dept Anaesthesia, B-2650 Edegem, Belgium. RP Vermeyen, KM (reprint author), Univ Antwerp Hosp, Dept Anaesthesia, Wilrijkstr 10, B-2650 Edegem, Belgium. NR 18 TC 5 Z9 12 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD FEB PY 2003 VL 90 IS 2 BP 183 EP 188 DI 10.1093/bja/aeg043 PG 6 WC Anesthesiology SC Anesthesiology GA 644AN UT WOS:000180895900013 ER PT J AU Pinard, AM Donati, F Martineau, R Denault, AY Taillefer, J Carrier, M AF Pinard, AM Donati, F Martineau, R Denault, AY Taillefer, J Carrier, M TI Magnesium potentiates neuromuscular blockade with cisatracurium during cardiac surgery SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID HYPOTHERMIC CARDIOPULMONARY BYPASS; SULFATE; VECURONIUM; ANESTHESIA; PHARMACOLOGY; ROCURONIUM; INFUSIONS; BLOCKERS; MUSCLE; TONE AB Purpose: Magnesium potentiates the effect of nondepolarizing neuromuscular blocking agents. It is used in cardiac anesthesia to prevent hypertension and arrhythmias. This study was performed to measure the interaction between magnesium and cisatracurium in cardiac surgery. Methods: Twenty patients scheduled for elective cardiac surgery were randomly assigned to receive magnesium sulfate (70 mg.kg(-1) at induction followed by 30 mg.kg(-1)-hr(-1)) or placebo. The uInar nerve was stimulated and the electromyographic response of the adductor pollicis was measured. Cisatracurium 0.1 mg.kg(-1) was given at induction, followed by 0.05 mg-kg(-1) when the first twitch in the train-of-four reached 25%. Results: Ionized magnesium was 1.32 +/- 0.24 mmol.L-1 in the treatment group vs 0.47 +/- 0.4 mmol.L-1 in the control group. Duration of action of the intubating dose was longer in the magnesium group (74 +/- 20 min) than in the placebo group (42 +/- 6 min, P = 0.0001). Duration of the first maintenance dose was 69 +/- 16 min in the magnesium group vs 35 7 min in the placebo group (P = 0.0001). Total dose of cisatracurium administered throughout surgery was 0.19 +/- 0.07 mg.kg(-1) in the magnesium group compared with 0.29 +/- 0.01 mg.kg(-1) in the placebo group (P = 0.017). Hemodynamic variables and temperature were similar in both groups. Conclusion: In patients undergoing cardiac surgery, administration of magnesium sulfate, resulting in ionized levels of 1.3 mmol.L-1, results in a 30-35 min prolongation of the neuromuscular blockade induced with intubating and maintenance doses of cisatracurium and does not alter hemodynamic stability. C1 Univ Montreal, Dept Anesthesiol, Hop Maison Neuve Rosemont, Montreal, PQ H1T 2M4, Canada. Montreal Heart Inst, Dept Anesthesiol, Montreal, PQ H1T 1C8, Canada. Montreal Heart Inst, Dept Surg, Montreal, PQ H1T 1C8, Canada. RP Pinard, AM (reprint author), Univ Montreal, Dept Anesthesiol, Hop Maison Neuve Rosemont, 5415 Assompt Blvd, Montreal, PQ H1T 2M4, Canada. NR 28 TC 11 Z9 14 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD FEB PY 2003 VL 50 IS 2 BP 172 EP 178 PG 7 WC Anesthesiology SC Anesthesiology GA 649DQ UT WOS:000181192000014 ER PT J AU Fink, H Luppa, P Mayer, B Rosenbrock, H Metzger, J Marlyn, JAJ Blobner, M AF Fink, H Luppa, P Mayer, B Rosenbrock, H Metzger, J Marlyn, JAJ Blobner, M TI Systemic inflammation leads to resistance to atracurium without increasing membrane expression of acetylcholine receptors SO ANESTHESIOLOGY LA English DT Article ID NITRIC-OXIDE SYNTHASE; SKELETAL-MUSCLE; D-TUBOCURARINE; PROTEIN-BINDING; BURN INJURY; RATS; IMMOBILIZATION; PHARMACODYNAMICS; HYPERKALEMIA; GLYCOPROTEIN AB Background: Systemic inflammation may be associated with resistance to nondepolarizing neuromuscular blocking drugs, the mechanisms of which are, however, uncharacterized. The authors therefore investigated the pharmacodynamics of atracurium and its relation to the expression of nicotinic acetylcholine receptors and alpha(1)-acid glycoprotein in a rat model of systemic inflammation. Methods: To induce a systemic inflammation, male CD rats received 56 mg/kg corynebacterium parvum intravenously. On days 2, 4, 6, 8, 10, 12, 14, or 16 after infection, neuromuscular transmission was measured. The individual effective dose of atra-curium was determined, followed by an atracurium infusion at a rate to establish a steady state neuromuscular block of 50%. Total and unbound plasma concentrations of atracurium for 50% paralysis were measured using high-performance liquid chromatography. Acetylcholine receptors were quantitated using I-125-alpha-bungarotoxin. alpha(1)-Acid glycoprotein concentrations in the serum were measured using a competitive chemiluminescence immunoassay. Results: The effective dose of atracurium was increased on days 4, 6, and 8. Total atracurium plasma concentrations at 50% neuromuscular paralysis were increased on days 4, 6, 8, and 10, with a peak at day 8 (8.0 +/- 1.3 mug/ml) compared with control rats (4.23 +/- 0.82 mug/ml). The alpha(1)-acid glycoprotein concentrations were increased between days 2 and 10, with a peak on day 4 (6-52 +/- 1.45 mg/ml), and recovered to control values (0.61 +/- 0.33 mg/ml) on day 12. Unbound plasma concentrations of atracurium to achieve 50% depression, as well as the expression of acetylcholine receptors, did not differ between groups. Conclusion: Resistance to atracurium during corynebacterium parvum-induced systemic inflammation is due to increased drug binding to alpha(1)-acid glycoprotein and is unrelated to changes in acetylcholine receptor expression. C1 Tech Univ Munich, Anasthesiol Klin, Klinikum Rechts Isar, D-81675 Munich, Germany. RP Blobner, M (reprint author), Tech Univ Munich, Anasthesiol Klin, Klinikum Rechts Isar, Ismaninger Str 22, D-81675 Munich, Germany. NR 30 TC 17 Z9 17 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2003 VL 98 IS 1 BP 82 EP 88 DI 10.1097/00000542-200301000-00016 PG 7 WC Anesthesiology SC Anesthesiology GA 632CZ UT WOS:000180207300014 ER PT J AU Kim, KS Lew, SH Cho, HY Cheong, MA AF Kim, KS Lew, SH Cho, HY Cheong, MA TI Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine SO ANESTHESIA AND ANALGESIA LA English DT Article ID DOUBLE BURST STIMULATION; RECOVERY ROOM; CURARIZATION; PANCURONIUM; TRAIN-OF-4; PHARMACOKINETICS; PHARMACODYNAMICS; NEOSTIGMINE; EDROPHONIUM; ANTAGONISTS AB We investigated postoperative residual curarization after administration of either vecuronium or rocuronium with reversal by pyridostigmine in 602 consecutive patients without perioperative neuromuscular monitoring. On arrival in the recovery room, neuromuscular function was assessed both by acceleromyography in a train-of-four (TOF) pattern and also clinically by the ability to sustain a head-lift for >5 s and the tongue-depressor test. Postoperative residual curarization was defined as a TOF ratio <0.7. One fifth of 602 patients (vecuronium., 24.7%; rocuronium, 14.7%) had a TOF <0.7 in the recovery room. There were no significant differences in the TOF ratios between 10 mg and 20 mg of pyridostigmine. The patients with residual block had several associated factors: the absence of perioperative neuromuscular monitoring, the use of pyridostigmine, which is less potent than neostigmine, a larger dose of vecuronium, shorter time from the last neuromuscular blocker to TOF monitoring, or peripheral cooling. We conclude that significant residual neuromuscular block after vecuronium. or rocuronium. was not eliminated even with reversal by a large dose of pyridostigmine. C1 Hanyang Univ Hosp, Dept Anesthesiol, Seoul 133792, South Korea. RP Kim, KS (reprint author), Hanyang Univ Hosp, Dept Anesthesiol, 17 Haengdang Dong, Seoul 133792, South Korea. NR 23 TC 35 Z9 39 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 2002 VL 95 IS 6 BP 1656 EP 1660 DI 10.1213/01.ANE.0000037150.20930.D5 PG 5 WC Anesthesiology SC Anesthesiology GA 622KK UT WOS:000179646100033 ER PT J AU Laurin, J Donati, F Varin, F AF Laurin, J Donati, F Varin, F TI Stereoselective in vitro degradation pattern of mivacurium in human plasma SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE blood, plasma; metabolism, mivacurium; metabolism, stereoselective; neuromuscular block, mivacurium ID PHARMACOKINETICS; ISOMERS; PHARMACODYNAMICS; CISATRACURIUM; PHARMACOLOGY; METABOLITES; ANESTHESIA; MONKEYS AB Background. Mivacurium is a mixture of three isomers, two of which are rapidly broken down in vivo by plasma cholinesterases. This study investigates the stereospecificity of mivacurium in vitro degradation to determine if it accounts for its in vivo behaviour. Methods. The in vitro rate of degradation of each isomer of mivacurium and the in vitro rate of formation of their primary (monoesters and alcohols) and secondary (alcohols) metabolites were examined using human plasma from six healthy volunteers. The in vitro rate of degradation of the monoester metabolites was also assessed. All these determinations were made using a stereospecific high-performance liquid chromatography assay. Results. The in vitro rate of disappearance of the two active isomers of mivacurium was very rapid, with mean values for the trans trans and cis trans isomers of 0.803 and 0.921 min(-1) respectively. These values are twofold faster than published in vivo data. The in vitro rate of disappearance was much slower for the cis cis isomer, with a mean value of 0.0106 min(-1). The cis trans isomer was converted exclusively to cis monoester and trans alcohol, while only metabolites in the trans and cis configuration were found for the trans trans and cis cis isomers respectively. Mean in vitro rates of disappearance for the trans and cis monoester were 0.00750 and 0.000633 min(-1) respectively. Conclusions. The in vitro rates of hydrolysis of the active isomers of mivacurium confirm that plasma cholinesterases play a major role in their in vivo degradation, but that in vivo elimination is slowed by extravascular distribution. Mivacurium hydrolysis is stereoselective, the ester group in the trans configuration being more accessible to enzymatic attack. This stereoselective pattern, along with the relatively slow breakdown of the cis cis isomer, sheds light on the in vivo disposition of the cis alcohol metabolite. C1 Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. Univ Montreal, Fac Med, Dept Anesthesia, Montreal, PQ H3C 3J7, Canada. RP Varin, F (reprint author), Univ Montreal, Fac Pharm, CP 6128,Succ Ctr Ville, Montreal, PQ H3C 3J7, Canada. NR 13 TC 1 Z9 1 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD DEC PY 2002 VL 89 IS 6 BP 832 EP 838 DI 10.1093/bja/aef270 PG 7 WC Anesthesiology SC Anesthesiology GA 622VF UT WOS:000179667200006 ER PT J AU Moerer, O Baller, C Hinz, J Buscher, H Crozier, TA AF Moerer, O Baller, C Hinz, J Buscher, H Crozier, TA TI Neuromuscular effects of rapacuronium on the diaphragm and skeletal muscles in anaesthetized patients using cervical magnetic stimulation for stimulating the phrenic nerves SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular non-depolarizing agents, rapacuronium; respiratory muscles, diaphragm ID LARYNGEAL ADDUCTOR MUSCLES; ORBICULARIS OCULI; POLLICIS MUSCLES; BLOCKING-AGENTS; INTENSIVE-CARE; ROCURONIUM; HUMANS; VECURONIUM; ATRACURIUM; SUCCINYLCHOLINE AB Background and objective: Non-depolarizing neuromuscular blocking agents have a shorter duration of action on the diaphragm than on skeletal muscles. It was to be tested if this also held true for rapacuronium, a short-acting, amidosteroid non-depolarizing neuromuscular blocker, lately withdrawn from the market, using a novel technique for stimulating the diaphragm and assessing its function. Methods: Anaesthesia was induced with propofol 2 mg kg(-1) and remifentanil 1 mug kg(-1) and the trachea was intubated after topical anaesthesia. Rapacuronium was given at a dose of 1.5 mg kg(-1). The diaphragm. was stimulated by cervical magnetic stimulation of the phrenic nerves (2 Tesla, single coil) and airway pressure responses were measured at the endotracheal tube connector. The neuromuscular effects at the adductor pollicis and orbicularis oculi muscles were measured by acceleromyography. Results: Fifteen males and five females (ASA I and II; 27 +/- 8 yr; 73 +/- 13 kg; mean +/- SD) were recruited. Median maximal relaxation was less (P < 0.01) for the diaphragm (89%) than for the adductor pollicis or orbicularis oculi muscles (each 100%). The time to 25% recovery was shorter for the diaphragm than for adductor pollicis or orbicularis oculi (7.5 +/- 3.1 versus 14.1 +/- 3.7 and 15.1 +/- 3.5 min, respectively, P < 0.01). Recovery from 25 to 75% was identical for the diaphragm and adductor pollicis (9.4 +/- 2.9 versus 9.1 +/- 3.5 min), but longer for orbicularis oculi (13.4 +/- 4.2 min, P < 0.01). The median recovery time to TOF0.8 was shorter for the diaphragm (23.9 min) than for the adductor pollicis or orbicularis ocull muscles (31.5 and 28.4 min, respectively; P < 0.05). Conclusions: As with other non-depolarizing muscle relaxants, the duration of the clinical effect of rapacuronium was shorter for the diaphragm than for skeletal muscle. The recovery index was identical for the diaphragm and adductor pollicis. C1 Univ Gottingen, Zentrum Anaesthesiol Rettungs & Intens Med, D-37075 Gottingen, Germany. RP Crozier, TA (reprint author), Univ Gottingen, Zentrum Anaesthesiol Rettungs & Intens Med, Robert Koch Str 40, D-37075 Gottingen, Germany. NR 24 TC 2 Z9 2 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD DEC PY 2002 VL 19 IS 12 BP 883 EP 887 PG 5 WC Anesthesiology SC Anesthesiology GA 630GB UT WOS:000180098200005 ER PT J AU Lagneau, F D'honneur, G Plaud, B Mantz, J Gillart, T Duvaldestin, P Marty, J Clyti, N Pourriat, JL AF Lagneau, F D'honneur, G Plaud, B Mantz, J Gillart, T Duvaldestin, P Marty, J Clyti, N Pourriat, JL TI A comparison of two depths of prolonged neuromuscular blockade induced by cisatracurium in mechanically ventilated critically ill patients SO INTENSIVE CARE MEDICINE LA English DT Article DE intensive care unit (ICU); mechanical ventilation; neuromuscular blockade; cisatracuriurn; train-offour (TOF); depth of blockade ID INTENSIVE-CARE UNIT; INFUSION REQUIREMENTS; ADDUCTOR POLLICIS; BLOCKING-AGENTS; SEDATION; ICU; VECURONIUM; TRAIN-OF-4; MUSCLES; SCALE AB Objectives: To compare two levels of continuous cisatracurium-induced curarization in hypoxemic, ventilated patients. Design and setting: An open-labeled, multicenter, prospective, randomized study. Patients: Hundred two patients with a ratio between arterial oxygen tension and inspired oxygen tension (PaO2/FIO2) less than 200 despite optimization of sedation and ventilation were randomized into group 1 (n=52) with an end point of no response at orbicularis oculi to train-of-four (TOF) stimulation or group 2 (n=50) with an end point of two responses. Measurements and results: The PaO2/FIO2 and end-inspiratory plateau airway pressure (Pplat) were evaluated at baseline (before curarization) and at regular intervals once TOF end points had been attained for up to 2 h afterwards (T2 h). A decrease of 1 cmH(2)O or more of Pplat at T2 h compared to baseline was observed in 37% and 50% of the patients in groups 1 and 2, respectively (p=0.17). Time courses of PaO2/FIO2 (mmHg) and Pplat (cmH(2)O) [mean (SD)] were equivalent in both groups, with a mild increase in PaO2/FIO2 [p=0.0014; from 126 (33) to 141 (55) and from 134 (40) to 152 (52), respectively, in groups 1 and 2] and decrease in Pplat [p=0.016; from 29.1 (8.9) to 28.5 (8.8) and from 27.7 (7.5) to 26.6 (7.6)]. Median total durations of curarization were 28.9 h (3.1-219.7) in group 1 and 31.4 h (1.6-650.6) in group 2. Median cisatracurium infusion rates were 5.2 mug kg(-1) min(-1) (2.1-13.7) in group 1 and 3.6 mug kg(-l) min(-1) (1.0-13.5) in group 2. The median delay to recovery from paralysis was shorter in group 2 (0.75 h vs 1.25 h; p=0.0008). Conclusion: When a prolonged curarization is decided upon in an ICU patient, a blockade at 2/4 at TOF at orbicularis oculi has similar effects on respiratory parameters as a blockade at 0/4, allowing a decrease in total administered doses and a shortening of the recovery of muscle strength after cessation of infusion. C1 Univ Paris 07, Beaujon Hosp, Dept Anesthesia, F-92118 Clichy, France. Hop Henri Mondor, Dept Anesthesia, F-94000 Creteil, France. Hop Henri Mondor, Intens Care Unit, F-94000 Creteil, France. Rothschild Fdn, Dept Anesthesia, F-75012 Paris, France. Rothschild Fdn, Intens Care Unit, F-75012 Paris, France. Hop Xavier Bichat, Dept Anesthesia, F-75018 Paris, France. Hop Xavier Bichat, Intens Care Unit, F-75018 Paris, France. Montpied Hosp, Dept Anesthesia, F-63000 Clermont Ferrand, France. Montpied Hosp, Intens Care Unit, F-63000 Clermont Ferrand, France. Univ Paris 07, Beaujon Hosp, Intens Care Unit, F-92118 Clichy, France. RP Lagneau, F (reprint author), Univ Paris 07, Beaujon Hosp, Dept Anesthesia, 100 Blvd Gen Leclerc, F-92118 Clichy, France. NR 21 TC 11 Z9 13 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0342-4642 J9 INTENS CARE MED JI Intensive Care Med. PD DEC PY 2002 VL 28 IS 12 BP 1735 EP 1741 DI 10.1007/s00134-002-1508-y PG 7 WC Critical Care Medicine SC General & Internal Medicine GA 641PH UT WOS:000180753600009 ER PT J AU Gozal, Y Mints, B Drenger, B AF Gozal, Y Mints, B Drenger, B TI Time course of neuromuscular blockade with rocuronium in children with intracardiac shunts SO JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA LA English DT Article; Proceedings Paper CT 23rd Annual Meeting of the Society-of-Cardiovascular-Anesthesiologists CY MAY 05-09, 2001 CL VANCOUVER, CANADA SP Soc Cardiovasc Anesthesiol DE anesthesia; pediatric; congenital heart disease; monitoring; neuromuscular blockade; neuromuscular relaxants; rocuronium ID PHARMACOKINETICS; ANESTHESIA; LIDOCAINE; ORG-9426 AB Objective: To evaluate the time course of neuromuscular blockade after rocuronium in children with intracardiac shunts. Design: Prospective study. Setting: University hospital. Participants: Consecutive children (n = 52) with intracardiac shunts scheduled for elective cardiac surgery. Participants were allocated to 2 groups according to the direction of the shunt. Interventions: Rocuronium, 0.6 mg/kg, was administered for muscle relaxation. The ulnar nerve was stimulated at 20-second intervals with a supramaximal 2-Hz train-of-4 stimulation (TOF-Guard nerve stimulator; Biomet International, Odense, Denmark). The onset time to maximal twitch depression and the time to clinical recovery were compared between the 2 groups. Measurements and Main Results: The time to maximal block was significantly faster in children with a right-to-left shunt: 56.8 +/- 5.3 seconds versus 77.1 +/- 6.6 seconds (p = 0.01). There was a tendency to shorter recovery in children with a right-to-left shunt: 42.3 +/- 6.1 minutes versus 55.4 +/- 4.9 minutes (p = NS). Conclusion: This study shows a more rapid onset of rocuronium in children with cyanotic congenital heart disease. In these patients, rocuronium is indicated, particularly for rapid airway control. Copyright 2002, Elsevier Science (USA). All rights reserved. C1 Hadassah Univ Hosp, Dept Anesthesiol & Crit Care Med, IL-91120 Jerusalem, Israel. RP Gozal, Y (reprint author), Hadassah Univ Hosp, Dept Anesthesiol & Crit Care Med, IL-91120 Jerusalem, Israel. NR 7 TC 3 Z9 3 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1053-0770 J9 J CARDIOTHOR VASC AN JI J. Cardiothorac. Vasc. Anesth. PD DEC PY 2002 VL 16 IS 6 BP 737 EP 738 DI 10.1053/jcan.2002.128409 PG 2 WC Anesthesiology; Cardiac & Cardiovascular Systems; Respiratory System; Peripheral Vascular Disease SC Anesthesiology; Cardiovascular System & Cardiology; Respiratory System GA 626CY UT WOS:000179855800013 ER PT J AU Sagen, AL Gertsch, J Becker, R Heilmann, J Sticher, O AF Sagen, AL Gertsch, J Becker, R Heilmann, J Sticher, O TI Quinolizidine alkaloids from the curare adjuvant Clathrotropis glaucophylla SO PHYTOCHEMISTRY LA English DT Article DE Clathrotropis glaucophylla; Fabaceae; (-)-13 alpha-hydroxy-15 alpha-(1-hydroxyethyl)-anagyrine; quinolizidine alkaloids; curare ID LEGUMINOSAE AB The bark of Clathrotropis glaucophylla (Fabaceae) is used as admixture of curare arrow poison by the Yanomami Amerindians in Venezuela. A new quinolizidine alkaloid (QA), (-)-13alpha-hydroxy-15alpha-(1-hydroxyethyl)-anagyrine [(-)-clathrotropine], was isolated from the alkaloid extract of C. glaucophylla bark, together with eleven known QAs: (-)-anagyrine, (-)-thermopsine, (-)-baptifoline, (-)-epibaptifoline, (-)-rhombi foline, (-)-tinctorine, (-)-cytisine, (-)-N-methylcytisine, (-)-lupanine, (-)-6alpha-hydroxylupanine and (+)-5,6-dehydrolupanine. The isolation and structure elucidation were performed with the aid of chromatographic (TLC, HPLC and CC) and spectroscopic (UV and 1D/2D NMR) methods, and mass spectrometry. To our knowledge, this is the first time quinolizidine alkaloids have been isolated from an arrow poison ingredient. It is also the first report on Clathrotropis species being used for preparation of arrow poison. (C) 2002 Elsevier Science Ltd. All rights reserved. C1 Swiss Fed Inst Technol, Inst Pharmaceut Sci, Dept Appl Biosci, CH-8057 Zurich, Switzerland. RP Sticher, O (reprint author), Swiss Fed Inst Technol, Inst Pharmaceut Sci, Dept Appl Biosci, Winterthurerstr 190, CH-8057 Zurich, Switzerland. EM otto.sticher@pharma.anbi.ethz.ch NR 15 TC 16 Z9 16 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0031-9422 J9 PHYTOCHEMISTRY JI Phytochemistry PD DEC PY 2002 VL 61 IS 8 BP 975 EP 978 DI 10.1016/S0031-9422(02)00394-1 PG 4 WC Biochemistry & Molecular Biology; Plant Sciences SC Biochemistry & Molecular Biology; Plant Sciences GA 626TZ UT WOS:000179890500020 ER PT J AU Tassonyi, E Fathi, M Hughes, GJ Chiodini, F Bertrand, D Muller, D Fuchs-Buder, T AF Tassonyi, E Fathi, M Hughes, GJ Chiodini, F Bertrand, D Muller, D Fuchs-Buder, T TI Cerebrospinal fluid concentrations of atracurium, laudanosine and vecuronium following clinical subarachnoid hemorrhage SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE atracurium; blood brain barrier; central nervous system; electrospray mass spectrometry, high pressure liquid chromatography; laudanosine, metabolites, neuromuscular; blocking agents; vecuronium ID NEUROMUSCULAR BLOCKING-AGENTS; ACETYLCHOLINE-RECEPTORS; D-TUBOCURARINE; PANCURONIUM; PLASMA; BRAIN; DOGS; RATS; ISOFLURANE; ACTIVATION AB Background: Neuromuscular blocking agents may exert central nervous system effects when they reach the brain. This study assessed the concentrations and the time course of passage of vecuronium, atracurium, and its metabolite laudanosine in the cerebrospinal fluid (CSF) of patients undergoing intracranial aneurysm clipping. Methods: Twenty-five patients with subarachnoid hemorrhage were randomly allocated to receive an intravenous infusion of vecuronium (n = 13) or atracurium (n = 12). Arterial blood and lumbar CSF were sampled before and 1, 2, 3, 4 and 8 h after the start of the relaxant infusion. The samples were analyzed by liquid chromatography-electrospray ionization mass spectrometry (vecuronium) and high-pressure liquid chromatography (atracurium and laudanosine). Results: The data of 20 patients (10 in both groups) were analyzed. In 11 CSF samples from five patients atracurium was detected in concentrations from 10 to 50 ng/ml. Laudanosine was retrieved in all CSF samples at 1, 2, 3, 4 and 8 h; the highest CSF concentration of laudanosine occurred at 3 h [38 (18-63) ng/ml: median (range)]. Vecuronium was not found in any CSF sample. Conclusion: Significant concentrations of atracurium and laudanosine but not of vecuronium were detected in the CSF of patients during and immediately after intracranial aneurysm surgery. C1 Univ Hosp, Dept Anesthesia Pharmacol & Surg Intens Care, Geneva, Switzerland. Univ Hosp, Cent Lab, Geneva, Switzerland. Univ Hosp, Dept Med Biochem, Geneva, Switzerland. Univ Hosp, Dept Physiol, Geneva, Switzerland. CMU, Univ Med Ctr, Geneva, Switzerland. RP Fuchs-Buder, T (reprint author), Univ Saarland, Dept Anesthesia & Intens Care, D-6650 Homburg, Germany. NR 28 TC 18 Z9 20 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD NOV PY 2002 VL 46 IS 10 BP 1236 EP 1241 DI 10.1034/j.1399-6576.2002.461011.x PG 6 WC Anesthesiology SC Anesthesiology GA 612AK UT WOS:000179050800011 ER PT J AU McCaul, C Tobin, E Boylan, JF McShane, AJ AF McCaul, C Tobin, E Boylan, JF McShane, AJ TI Atracurium is associated with postoperative residual curarization SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthesia; complications, morbidity; complications, postoperative; neuromuscular block, atracurium ID VECURONIUM; BLOCK AB Background. Residual paralysis following the use of neuromuscular blocking drugs remains a clinical problem. As part of departmental quality assurance, we examined the degree of postoperative residual curarization (PORC) following atracurium. Methods. Forty patients undergoing general anaesthesia involving atracurium were studied. Quantitative neuromuscular monitoring (mechanomyography, Myograph 2000, Biometer, Denmark) was performed by assessing the response to supramaximal train-of-four (TOF) stimulation of the ulnar nerve. Anaesthesia was provided by non-participating clinicians who were blinded to the study data. A TOF ratio less than or equal to0.7 at extubation was classified as PORC. Results. At antagonism of neuromuscular block, 70% (28/40) of patients had a TOF ratio less than or equal to0.7, and 65% (26/40) of patients had a TOF ratio less than or equal to0.7 at extubation. Peripheral nerve stimulator use was associated with a longer interval from antagonism of block to extubation (P=0.01), but was not associated with differences in atracurium dosage or a reduction in PORC at extubation. Patients with TOF ratio less than or equal to0.7 at extubation had surgery of shorter duration (59 (SEM 6) vs 103 (9) min, P<0.001], greater doses of atracurium relative to the duration of surgery [6 (1) vs 11 (1) μg kg(-1) min(-1), P<0.005], and shorter intervals from administration of last dose of atracurium to antagonism of neuromuscular block [29 (2) vs 53 (9) min, P<0.005] and from antagonism to extubation [6 (1) vs 15 (4) min, P<0.01]. Duration of surgical procedure was the sole multivariate predictor of PORC [odds ratio 0.94 (95% confidence intervals 0.91-0.98), P<0.01]. Conclusions. PORC remains a clinical problem despite use of intermediate-duration neuromuscular blocking drugs and peripheral nerve stimulators. Patients undergoing procedures of short duration may be at risk of inappropriately early tracheal extubation, possibly due to work pressures. The association between suboptimal antagonism of neuromuscular blockade and short procedures needs reinforcement during postgraduate training and departmental quality assurance. C1 St Vincents Univ Hosp, Dept Anaesthesia Intens Care & Pain Med, Dublin 4, Ireland. RP McShane, AJ (reprint author), St Vincents Univ Hosp, Dept Anaesthesia Intens Care & Pain Med, Elm Pk, Dublin 4, Ireland. NR 9 TC 34 Z9 40 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD NOV PY 2002 VL 89 IS 5 BP 766 EP 769 DI 10.1093/bja/aef254 PG 4 WC Anesthesiology SC Anesthesiology GA 610JU UT WOS:000178957600017 ER PT J AU Motamed, C Donati, FO AF Motamed, C Donati, FO TI Sevoflurane and isofluranel, but not propofol, decrease mivacurium requirements over time SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID CONTINUOUS-INFUSION; INTRAVENOUS ANESTHESIA; D-TUBOCURARINE; VECURONIUM; ROCURONIUM; HALOTHANE; FORANE; CISATRACURIUM; PANCURONIUM; DESFLURANE AB Purpose: Volatile anesthetic agents potentiate neuromuscular blockade, but the magnitude of potentiation appears to be time dependent. The time course of this interaction was studied by measuring mivacurium infusion rates during sevoflurane, isoflurane and propofol anesthesia. Methods: After informed consent, anesthesia was induced in 48 ASA physical status I-II adults with propofol, fentanyl and mivacurium 0.25 mg.kg(-1) and maintained with N2O (60%) and one of the three agents chosen at random: sevoflurane 1.9%; isoflurane 1.2%; or propofol 100-150 mug.kg(-1).min(-1). Train-of-four stimulation was applied every 15 sec to the ulnar nerve. Neuromuscular blockade was monitored with accelerometry. At 5% recovery of the first twitch (TI), a mivacurium infusion was started and adjusted every five minutes to maintain 90-95% TI depression. Results: The time to 5% TI recovery after the initial dose was similar in all groups (13-15 min). Fifteen minutes after the start of the infusion mivacurium requirements were greater (P < 0.05) in the propofol group (7.5 +/- 1.7 mug.kg(-1).min(-1); mean +/- SD) than in either isoflurane (4.7 +/- 1.6 mug.kg-1. min(-1)) or sevoflurane (4.5 +/- 1.5 mug.kg(-1).min(-1)) group. Then, the rate remained stable for propofol (6.2 +/- 1.4 mug.kg(-1).min(-1) after 90 min of infusion) while it decreased with isoflurane to 2.9 +/- 1.6 mug.kg(-1).min(-1) at 90 min (P < 0.05 vs propofol) and to 1.4 +/- 1.0 mug.kg(-1). min(-1) in the sevoflurane group (P < 0.05 vs propofol and isoflurane). Conclusion: Sevoflurane and isoflurane do not prolong the effect of a bolus dose of mivacurium, but potentiation increases with time from 30-105 min of exposure. This interaction is greater with sevoflurane than isoflurane. C1 Univ Montreal, CHU Montreal, Hotel Dieu, Dept Anesthesiol, Montreal, PQ H2W 1T8, Canada. RP Donati, FO (reprint author), Univ Montreal, CHU Montreal, Hotel Dieu, Dept Anesthesiol, Pavillon Bullion,3840 Rue St Urbain, Montreal, PQ H2W 1T8, Canada. NR 23 TC 15 Z9 17 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD NOV PY 2002 VL 49 IS 9 BP 907 EP 912 PG 6 WC Anesthesiology SC Anesthesiology GA 618TB UT WOS:000179432400003 ER PT J AU Sator-Katzenschlager, SM Oehmke, MJ Kontaratos, M Wedrich, A Heinze, G Weinstabl, C AF Sator-Katzenschlager, SM Oehmke, MJ Kontaratos, M Wedrich, A Heinze, G Weinstabl, C TI Effect of different doses of cisatracurium on intraocular pressure in sedated patients SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular non-depolarizing agents, atracurium, cisatracurium; ocular physiology, intraocular pressure ID OPIOID BARBITURATE ANESTHESIA; ATRACURIUM; 51W89; VECURONIUM; PHARMACOKINETICS; SUCCINYLCHOLINE; PHARMACOLOGY; INFUSION AB Background and objective: The aim was to examine the course of intraocular pressure after relaxation with different doses of cisatracurium. Methods: The investigation was carried out as a prospective, randomized double-blind study in a crossover design in 30 postoperative patients with stable haemodynamic and respiratory function (ASA I and II). To exclude any disrupting factors, patients remained intubated and continuously sedated. Twenty patients received an intubation dose (2 x ED95) of cisatracurium (0.1 mg kg(-1)) compared with atracurium (0.5 mg kg(-1)). In a second series, 10 patients were given an effective dose, ED95 (0.05 mg kg-1), and a repeat dose (0.02 mg kg(-1)) of cisatracurium. The intraocular pressure was determined before (T0) as well as 1 (T1), 5 (T5), 10 (T10), 15 (T15), 20 (T20) and 45 (T45) min after bolus administration. Results: Intraocular pressure decreased after an intubation dose of either cisatracurium or atracurium, and reached a minimum after 10 min (6.7 +/- 2.2 and 7.9 +/- 2.1 mmHg, respectively). There was no significant difference between either muscle relaxant (P = 0.27). When lower doses of cisatracurium (0.05 and 0.02 mg kg(-1)) were applied, the intraocular pressure also decreased, albeit to a lesser extent and with a delayed onset (8.4 +/- 1.9 mmHg after 10 min, 9.9 +/- 3.4 mmHg after 15 min). There was no significant difference between dosages (P = 0.44). Conclusions: Cisatracurium is a useful drug in patients when a decrease of intraocular pressure is wanted and where muscle relaxation is necessary and acceptable. C1 Univ Vienna, Dept Anaesthesiol & Gen Intens Care B, A-1090 Vienna, Austria. Univ Vienna, Dept Anaesthesiol & Gen Intens Care A, A-1090 Vienna, Austria. Univ Vienna, Dept Ophthalmol & Optometr, A-1090 Vienna, Austria. Univ Vienna, Dept Med Comp Sci, A-1090 Vienna, Austria. RP Oehmke, MJ (reprint author), Univ Vienna, Dept Anaesthesiol & Gen Intens Care B, Waehringer Guertel 18-20, A-1090 Vienna, Austria. NR 22 TC 5 Z9 7 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD NOV PY 2002 VL 19 IS 11 BP 823 EP 828 DI 10.1017/S0265021502001333 PG 6 WC Anesthesiology SC Anesthesiology GA 617TQ UT WOS:000179377300009 ER PT J AU Cameron, KS Clark, JK Cooper, A Fielding, L Palin, R Rutherford, SJ Zhang, MQ AF Cameron, KS Clark, JK Cooper, A Fielding, L Palin, R Rutherford, SJ Zhang, MQ TI Modified gamma-cyclodextrins and their rocuronium complexes SO ORGANIC LETTERS LA English DT Article AB [GRAPHICS] A series of per-6-substituted cyclodextrin derivatives was synthesized as synthetic host molecules for rocuronium, a steroidal muscle relaxant. By forming host-guest complexes with rocuronium, these cyclodextrin derivatives reverse the muscle relaxation induced by rocuronium in vitro and in vivo. The isothermal microcalorimetry data are consistent with the biological data supporting the encapsulation mechanism of action. Binary and biphasic complexes are reported with NMR experiments clearly showing free and bound rocuronium. C1 Organon Res Labs Ltd, Dept Med & Analyt Chem, Newhouse ML1 5SH, Scotland. Univ Glasgow, Dept Chem, Glasgow G12 8QQ, Lanark, Scotland. RP Cameron, KS (reprint author), Organon Res Labs Ltd, Dept Med & Analyt Chem, Newhouse ML1 5SH, Scotland. RI Cooper, Alan/F-7813-2011 OI Cooper, Alan/0000-0001-6709-7343 NR 11 TC 17 Z9 17 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 1523-7060 J9 ORG LETT JI Org. Lett. PD OCT 3 PY 2002 VL 4 IS 20 BP 3403 EP 3406 DI 10.1021/ol020126w PG 4 WC Chemistry, Organic SC Chemistry GA 599HF UT WOS:000178327500017 ER PT J AU Martyn, JAJ Chang, Y Goudsouzian, NG Patel, SS AF Martyn, JAJ Chang, Y Goudsouzian, NG Patel, SS TI Pharmacodynamics of mivacurium chloride in 13-to 18-yr-old adolescents with thermal injury SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE complications, burn injury; enzymes, plasma cholinesterase; neuromuscular block, mivacurium ID BURN INJURY; NEUROMUSCULAR BLOCKADE; PEDIATRIC-PATIENTS; CHILDREN; RAT; PHARMACOKINETICS; ACETYLCHOLINE; ATRACURIUM; MUSCLES; DISTANT AB Background. Burned patients demonstrate resistance to the effects of non-depolarizing blocking drugs as a result of acetylcholine receptor changes. They also have decreased activity of plasma cholinesterase (PCHE), which metabolizes mivacurium. We hypothesized that decreased PCHE activity would decrease metabolism of mivacurium, and counteract the receptor-related resistance following burns. Methods. Thirteen burned patients and six controls, aged 13-18 yr were followed in 27 studies. The burned patients were sub-classified as having 10-30% or >30% body surface area burn, and were studied whenever possible at less than or equal to6 days, and at 1-12 weeks after the burn. Mivacurium pharmacodynamics were examined following a bolus (0.15 mg kg(-1)) dose, and during and after a continuous infusion. Results. Following a bolus, the onset time and the maximal effect were similar to controls. Recovery was prolonged in the 10-30% burn group at 1-12 weeks (P<0.008), with a similar trend in the >30% burn group at less than or equal to6 days (P<0.082) compared with controls. The infusion requirements for mivacurium were not increased in the burned groups. The PCHE activity was decreased in all burn groups and was inversely related to recovery following the bolus (r=0.73, P<0.001) and the infusion (r=0.69, P<0.001). Conclusion. In contrast to previous studies with non-depolarizers in burned patients, normal mivacurium doses can produce paralysis, at least as rapidly as in controls, but with a possibility of a prolonged recovery from block. The standard dose of mivacurium in the presence of decreased PCHE activity is in effect, a relative overdose that explains the above findings. Mivacurium is an effective drug for use in burns, irrespective of time after, or magnitude of burn injury. C1 Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Anesthesiol & Crit Care, Boston, MA 02114 USA. Shriners Hosp Children, Boston, MA 02114 USA. Glaxo Wellcome Inc, Anaesthesia Clin Res, Res Triangle Pk, NC 27709 USA. RP Martyn, JAJ (reprint author), Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Anesthesiol & Crit Care, Boston, MA 02114 USA. NR 25 TC 3 Z9 3 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD OCT PY 2002 VL 89 IS 4 BP 580 EP 585 DI 10.1093/bja/aef234 PG 6 WC Anesthesiology SC Anesthesiology GA 602JX UT WOS:000178503100010 ER PT J AU Okuno, H Kawasaki, H AF Okuno, H Kawasaki, H TI Critical and subcritical mass calculations of curium-243 to-247 based on JENDL-3.2 for revision of ANSI/ANS-8.15 SO JOURNAL OF NUCLEAR SCIENCE AND TECHNOLOGY LA English DT Article DE critical mass; subcritical mass; curium 243; curium 244; curium 245; curium 246; curium 247; bare; water; SS-304; JENDL-3.2; MCNP; ANSI/ANS-8.15; revision AB Critical and subcritical masses were calculated for a sphere of five, curium isotopes from Cm-243 to Cm-247 in metal and in metal-water mixtures considering three reflector conditions: bare, with a water reflector or a stainless steel reflector. The calculation were made mainly with a combination of a continuous energy Monte Carlo neutron transport calculation code, MCNP, and the Japanese Evaluated Nuclear Data Library, JENDL-3.2. Other evaluated nuclear data files, ENDF/B-VI and JEF-2.2, were also applied to find differences in calculation results of the neutron multiplication factor originated from different nuclear data files. A large dependence on the evaluated nuclear data files was found in the calculation results: more than 10%Deltak/k relative differences in the neutron multiplication factor for a homogeneous mixture of Cm-243 metal and water when JENDL-3.2 was replaced with ENDF/B-VI. and JEF-2.2, respectively; and a 44% reduction in the critical mass by changing from JENDL-3.2 to ENDF/B-VI for Cm-246 metal. The present study supplied basic information to the ANSI/ANS-8.15 Working Group for revision of the standard for nuclear criticality control of special actinide elements. The new or. revised values of the subcritical mass limits for curium isotopes accepted by the ANSI/ANS-8.15 Working Group were finally summarized. C1 Japan Atom Energy Res Inst, Tokai, Ibaraki 3191195, Japan. CRC Solut Corp, Hitachinaka, Ibaraki 3120052, Japan. RP Okuno, H (reprint author), Japan Atom Energy Res Inst, 2-4 Shirakata Shirane, Tokai, Ibaraki 3191195, Japan. NR 26 TC 1 Z9 1 PU ATOMIC ENERGY SOC JAPAN PI TOKYO PA 1-1-13 SHIMBASHI MINATO-KU, TOKYO, 105, JAPAN SN 0022-3131 J9 J NUCL SCI TECHNOL JI J. Nucl. Sci. Technol. PD OCT PY 2002 VL 39 IS 10 BP 1072 EP 1085 DI 10.3327/jnst.39.1072 PG 14 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 625QA UT WOS:000179826100008 ER PT J AU Mencke, T Becker, C Schreiber, J Bolte, M Fuchs-Buder, T AF Mencke, T Becker, C Schreiber, J Bolte, M Fuchs-Buder, T TI Precurarization of succinylcholine with cisatracurium: the influence of the precurarization interval SO ANAESTHESIST LA German DT Article DE succinylcholine; cisatracurium; side-effects; fasciculations; myalgia ID CLINICAL NEUROMUSCULAR PHARMACOLOGY; D-TUBOCURARINE; NONDEPOLARIZING RELAXANTS; INDUCED FASCICULATIONS; OUTPATIENT ANESTHESIA; VECURONIUM; PRETREATMENT; ATRACURIUM; ROCURONIUM; MYALGIA AB Purpose. To determine the influence of two different pretreatment intervals, i.e. 3 and 6 min, on the efficacy of 0.01 mg/kg cisatracurium in preventing succinylcholine-induced fasciculations and myalgia. Methods. A total of 60 adult patients were randomized and received either 0.01 mg/kg cisatracurium (0.2*ED95) i.v. (Cis 3 group: pretreatment interval 3 min, Cis 6 group: pretreatment interval 6 min) or normal saline i.v. (placebo group) prior to injection of succinylcholine. The incidence and severity of fasciculations and myalgia and side-effects of precurarization were assessed. Results. The incidence of muscle fasciculations was only reduced in the Cis 6 group (45%) compared with the Placebo group (85%), p<0.05. Cisatracurium was associated with a higher incidence of paralytic symptoms in both pretreatment groups (Cis 3: 75%, Cis 6: 80%) compared with the Placebo group (30%),p<0.05. Conclusion. Cisatracurium is only effective in preventing succinylcholine-induced fasciculations when a longer pretreatment interval, i.e. 6 min instead of 3 min, is chosen. Precurarization led to signs of paralysis in both pretreatment groups in the majority (75-80%) of patients without reducing the incidence or severity of postoperative myalgia. C1 Univ Saarlandes Kliniken, Klin Anasthesiol & Intens Med, D-66421 Homburg, Germany. RP Mencke, T (reprint author), Univ Saarlandes Kliniken, Klin Anasthesiol & Intens Med, D-66421 Homburg, Germany. RI Schreiber, Jan-Uwe/B-1340-2012 NR 26 TC 5 Z9 5 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD SEP PY 2002 VL 51 IS 9 BP 721 EP 725 DI 10.1007/s00101-002-0358-x PG 5 WC Anesthesiology SC Anesthesiology GA 599KJ UT WOS:000178333500004 ER PT J AU Soukup, J Bunk, S Grond, S Czeslick, E Doenicke, A Menzel, M AF Soukup, J Bunk, S Grond, S Czeslick, E Doenicke, A Menzel, M TI Pharmacodynamics and cardiovascular effects of rocuronium in patients with renal failure SO ANASTHESIOLOGIE & INTENSIVMEDIZIN LA German DT Article DE rocuronium; renal failure; pharmacodynamics; cardiovascular effects; neuromuscular blockade ID INTUBATING CONDITIONS; NEUROMUSCULAR BLOCK; BROMIDE ORG-9426; TIME-COURSE; ISOFLURANE ANESTHESIA; HALOTHANE ANESTHESIA; VECURONIUM; ONSET; PHARMACOKINETICS; ACCELEROMYOGRAPHY AB The primary objective of this study is to investigate the influence of renal failure on the pharmacodynamics and neuromuscular effects (using acceleromyography) and to examine the intubation conditions and frequency of adverse cardiovascular effects of a bolus administration of 0.6 mg/kg rocuronium in patients with and without renal failure. Apart from a significantly prolonged time of onset of neuromuscular effects, only a large variety in the parameters of neuromuscular spontaneous recovery was found in the patients with renal failure. Rocuronium is suitable for patients suffering from renal insufficiency. However, intraoperative monitoring of neuromuscular blockade is recommended in patients with impaired renal function. C1 Univ Halle Wittenberg, Klin Anasthesiol & Operat Intensivmed, D-06097 Halle Saale, Germany. Univ Munich, Munich, Germany. RP Soukup, J (reprint author), Univ Halle Wittenberg, Klin Anasthesiol & Operat Intensivmed, Magdeburger Str 16, D-06097 Halle Saale, Germany. NR 39 TC 0 Z9 0 PU D I O MED VERLAGS GMBH PI NURNBERG PA OBERE SCHMIEDGASSE 11, 90403 NURNBERG, GERMANY SN 0170-5334 J9 ANASTH INTENSIVMED JI Anasthesiol. Intensivmed. PD SEP PY 2002 VL 43 IS 9 BP 507 EP 514 PG 8 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 596PL UT WOS:000178173200002 ER PT J AU De Haes, A Proost, JH Kuks, JBM van den Tol, DC Wierda, JMKH AF De Haes, A Proost, JH Kuks, JBM van den Tol, DC Wierda, JMKH TI Pharmacokinetic/pharmacodynamic modeling of rocuronium in myasthenic patients is improved by taking into account the number of unbound acetylcholine receptors SO ANESTHESIA AND ANALGESIA LA English DT Article ID GRAVIS; VECURONIUM; ATRACURIUM; PHARMACOKINETICS; PHARMACODYNAMICS; MIVACURIUM; POTENCY; DRUGS; TIME AB Patients with myasthenia gravis are more sensitive than healthy patients to nondepolarizing neuromuscular blocking drugs. We performed a pharmacokinetic/pharmacodynamic modeling study of rocuronium in eight myasthenic patients and eight matched control patients. Patients were anesthetized with propofol and sufentanil and a mixture of nitrous oxide/oxygen. Mechanomyographical monitoring of the adductor pollicis was applied. Rocuronium was infused at a rate of 25 mug . kg(-1) . min(-1) in myasthenic patients and 116.7 mug . kg(-1) . min(-1) in control patients and was terminated at 70% neuromuscular block. Arterial blood samples were drawn during onset and offset of the block and for 4 h after the administration of rocuronium. Plasma concentrations were determined by high-performance liquid chromatography. Pharmacokinetic/pharmacodynamic modeling was performed by using the Sheiner model and the unbound receptor model (URM), which takes into account the number of unbound acetylcholine receptors. The effective concentration at 50% effect and the steepness of the concentration-effect relationship were significantly decreased in myasthenic patients. Both the URM and the Sheiner model provided an adequate fit in myasthenic patients. The acetylcholine receptor concentration was significantly decreased in myasthenic patients. The URM explains the observed differences in time course and potency, whereas the Sheiner model does not. C1 Univ Groningen Hosp, Dept Anesthesiol, Res Grp Expt Anesthesiol & Clin Pharmacol, NL-9700 RB Groningen, Netherlands. Univ Groningen Hosp, Dept Neurol, NL-9700 RB Groningen, Netherlands. Lievensberg Gen Hosp, Dept Anesthesiol, Bergen Op Zoom, Netherlands. RP De Haes, A (reprint author), Univ Groningen Hosp, Dept Anesthesiol, Res Grp Expt Anesthesiol & Clin Pharmacol, POB 30001, NL-9700 RB Groningen, Netherlands. NR 31 TC 10 Z9 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 2002 VL 95 IS 3 BP 588 EP 596 DI 10.1213/01.ANE.0000023282.00799.CD PG 9 WC Anesthesiology SC Anesthesiology GA 589DW UT WOS:000177743900018 ER PT J AU Ezzine, S Donati, F Varin, F AF Ezzine, S Donati, F Varin, F TI Mivacurium arteriovenous gradient during steady state infusion in anesthetized patients SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 13-17, 2001 CL NEW ORLEANS, LOUISIANA SP Amer Soc Anesthesiologists ID INDUCED NEUROMUSCULAR BLOCKADE; INTRAVENOUS-INFUSION; HEALTHY-VOLUNTEERS; SAMPLING SITE; RENAL-FAILURE; BLOOD-FLOW; 3 ISOMERS; PHARMACOKINETICS; PHARMACODYNAMICS; BUTYRYLCHOLINESTERASE AB Background: Mivacurium cis trans and trans trans isomers undergo rapid hydrolysis by plasma cholinesterase. As this enzyme is largely distributed, it cannot be excluded that these isomers might undergo peripheral elimination. This hypothesis was investigated in patients by measuring the difference between arterial and venous concentrations under a constant-rate continuous infusion of mivacurium. Methods: During propofol-remifentanil anesthesia, eight adult consenting patients received an intravenous bolus dose of 0.2 mg/kg mivacurium, followed by a constant infusion (3, 5, or 7 mug (.) kg(-1) (.) min(-1)) into the brachial vein. One hour after starting the infusion, arterial (radial artery) and venous (contralateral brachial vein) blood samples were drawn simultaneously at 15-min intervals for 45 min. Mivacurium isomers and metabolite plasma concentrations were determined by stereospecific high-performance liquid chromatography. Using the corresponding arterial and venous concentrations, the tissue extraction coefficient as well as total body clearance were calculated. Results: During steady state conditions, the venous concentrations of the trans trans and cis trans isomers were 34 +/- 13% and 42 +/- 11% (mean +/- SD) lower than the corresponding arterial concentrations (P < 0.05), respectively. For the cis cis isomer, the difference between venous and arterial concentrations was 3 +/- 4% (P = 0.063). Total body clearances of the trans trans and cis trans isomers were greater when based on venous sampling (P < 0.05). Conclusion: Pharmacokinetic parameters derived from a constant infusion of mivacurium depend heavily on the sampling site (arterial or venous) for the rapidly hydrolyzed isomers. These results strongly suggest a significant metabolism of mivacurium within muscle tissue that may account for the large interpatient variability in response to mivacurium. C1 Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. CHU Montreal, Dept Anesthesie, Montreal, PQ, Canada. RP Varin, F (reprint author), Univ Montreal, Fac Pharm, 2900 Blvd Edouard Monpetit,CP 6128,Succursale Ctr, Montreal, PQ H3C 3J7, Canada. NR 34 TC 6 Z9 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 2002 VL 97 IS 3 BP 622 EP 629 DI 10.1097/00000542-200209000-00016 PG 8 WC Anesthesiology SC Anesthesiology GA 589NL UT WOS:000177766100015 ER PT J AU Kucukyavuz, Z Arici, K AF Kucukyavuz, Z Arici, K TI Effects of atracurium added to local anesthetics on akinesia in peribulbar block SO REGIONAL ANESTHESIA AND PAIN MEDICINE LA English DT Article DE peribulbar anesthesia; akinesia; atracurium; nondepolarizing neuromuscular blockers ID REGIONAL OPHTHALMIC ANESTHESIA; CATARACT-SURGERY; HYALURONIDASE; BUPIVACAINE; 0.75-PERCENT; 0.5-PERCENT; ETIDOCAINE; 1-PERCENT; 2-PERCENT; LIDOCAINE AB Background and Objectives: Peribulbar anesthesia (PBA) is widely used in cataract surgery, but the onset time of akinesia is not as rapid as with retrobulbar block. The aim of this study was to evaluate whether addition of low-dose atracurium to the local anesthetic mixture has any effects on akinesia in PBA. Methods: Sixty adults undergoing cataract surgery were randomly allocated to receive either 8 mL of a lidocaine-bupivacaine mixture, plus 0.5 mL 0.9% NaCl (group I) or 8 mL of the same local anesthetic mixture plus 0.5 mL (5 mg) atracurium (group II). The level of akinesia was graded by a observer unaware of group assignment. The onset time and duration of akinesia were also recorded by an observer, again unaware of group assignment. Results: The onset time of complete akinesia in group II was significantly shorter than that in group I (P <.05). In group I, 86% of patients had an akinesia score of 0 (complete akinesia) in the first 10 minutes. The rate of complete akinesia was 93% in group II in the same period. This difference was not significant. The success rate of complete akinesia was 93% in group I and 100% in group II at the end of the measurement interval. None of the group II patients required supplementary block, while 2 patients in group I received additional injections for inadequate akinesia. Conclusion: Atracurium added at a dose of 5 mg to a lidocaine-bupivacaine mixture for peribulbar block decreases the onset time of akinesia and provides better surgical conditions without obvious side-effects. C1 Ankara Univ, Dis Hekimligi Fak, Dept Oral & Maxillofacial Surg, Fac Dent, TR-06100 Ankara, Turkey. Cumhuriyet Univ, Fac Med, Dept Opthalmol, Sivas, Turkey. RP Kucukyavuz, Z (reprint author), Ankara Univ, Dis Hekimligi Fak, Dept Oral & Maxillofacial Surg, Fac Dent, Agiz,Dis Cene Cerrahisi AD,06500, TR-06100 Ankara, Turkey. NR 17 TC 8 Z9 9 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1098-7339 J9 REGION ANESTH PAIN M JI Region. Anesth. Pain Med. PD SEP-OCT PY 2002 VL 27 IS 5 BP 487 EP 490 DI 10.1053/rapm.2002.34334 PG 4 WC Anesthesiology SC Anesthesiology GA 603YK UT WOS:000178588700008 ER PT J AU Loerzel, SM Smith, PJ Howe, A Samuelson, DA AF Loerzel, SM Smith, PJ Howe, A Samuelson, DA TI Vecuronium bromide, phenylephrine and atropine combinations as mydriatics in juvenile double-crested cormorants (Phalacrocorax auritus) SO VETERINARY OPHTHALMOLOGY LA English DT Article DE atropine; bird; cormorant; mydriatics; phenylephrine; vecuronium AB Topical vecuronium bromide (Norcuron(R)) and combinations with atropine and phenylephrine, were evaluated as mydriatics in juvenile double-crested cormorants (Phalacrocorax auritus). Nine cormorants were treated with each of four protocols: 1 % atropine; 4 mg/mL vecuronium bromide (total 0.16 mg/eye); atropine with vecuronium; and atropine, 2.5% phenylephrine, followed by vecuronium. Drugs were applied topically at 15-min intervals (0.01 mL/drop). Pupil diameter was measured manually every 15 min with a Pupil gauge calibrated to the nearest 0.5 mm. No effect was observed with atropine alone. Average +/- SD peak pupil diameter for vecuronium, atropine/ vecuronium, and atropine/phenylephrine/vecuronium were 5.4 +/- 1.1 mm, 5.7 +/- 0.8 mm and 6.2 +/- 0.4 mm, respectively; and duration of peak diameters were 38 +/- 28 min, 79 +/- 71 min and 103 +/- 58 min, respectively. The combined atropine, phenylephrine and vecuronium provided the most consistent dilation with larger average pupil size and longer average duration. No side-effects from vecuronium were observed in these birds. C1 Univ Florida, Coll Vet Med, Dept Small Anim Clin Sci, Gainesville, FL 32610 USA. RP Loerzel, SM (reprint author), POB 41, Micanopy, FL 32667 USA. NR 7 TC 11 Z9 11 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1463-5216 J9 VET OPHTHALMOL JI Vet. Ophthalmol. PD SEP PY 2002 VL 5 IS 3 BP 149 EP 154 DI 10.1046/j.1463-5224.2002.00231.x PG 6 WC Veterinary Sciences SC Veterinary Sciences GA 594JP UT WOS:000178046600004 ER PT J AU Perry, JJ Lee, J Wells, G AF Perry, JJ Lee, J Wells, G TI Are intubation conditions using rocuronium equivalent to those using succinylcholine? SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT SAEM Annual Meeting CY MAY, 2001 CL ATLANTA, GEORGIA SP SAEM DE succinylcholine; rocuronium; anesthesia; intubation ID RAPID-SEQUENCE INDUCTION; NEUROMUSCULAR BLOCKADE; INTRAOCULAR-PRESSURE; ANESTHESIA; SUXAMETHONIUM; MIVACURIUM; ONSET; THIOPENTONE; ORG-9426; COMBINATIONS AB Objective: To determine whether the intubation conditions created by rocuronium are equivalent to those of succinylcholine during rapid-sequence induction (RSI). Methods: Medline, EMBASE, and the Cochrane Controlled Trials Register were searched for randomized clinical trials (RCTs). The search strategy included all generic and trade names for succinylcholine and rocuronium, anesthesia, neuromuscular blockade, and a validated RCT filter. Intubation conditions were a required outcome. Two reviewers assessed studies for eligibility, data extraction, and quality. Intubation conditions were scored with Goldberg's scale (excellent conditions defined as clear vocal cords, easy tube insertion, and no cough). A-priori subgroup analysis was conducted for the sedative, use of opioids, true versus modified RSI, age group, and the dose of rocuronium. Data were analyzed with Metaview 4.1 for relative risk (RR) of achieving excellent intubation conditions. A sample size calculation determined that n = 468 is required for equivalence. Results: Forty articles were identified; ten articles were excluded by the inclusion criteria, two were duplicate publications, and two had insufficient data. Therefore, 26 studies were analyzed. Overall, rocuronium was inferior to succinylcholine, with a RR = 0.87 (95% Cl = 0.81 to 0.94) (N = 1,606). However, intubation conditions were similar in the propofol subgroup, with a RR = 0.96 (95% Cl = 0.87 to 1.06) (N = 640). Failed intubations (N = 28) were equivalent in the two groups. Conclusions: Overall, succinylcholine creates excellent intubation conditions more reliably than rocuronium. If a second-line agent is required, rocuronium used with propofol creates intubation conditions equivalent to those with succinylcholine. C1 Univ Ottawa, Dept Epidemiol & Community Med, Div Emergency Med, Ottawa, ON K1N 6N5, Canada. RP Perry, JJ (reprint author), Ottawa Civic Hosp, Clin Epidemiol Unit, F6,1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada. NR 36 TC 16 Z9 16 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD AUG PY 2002 VL 9 IS 8 BP 813 EP 823 DI 10.1111/j.1553-2712.2002.tb02170.x PG 11 WC Emergency Medicine SC Emergency Medicine GA 582HP UT WOS:000177345000008 ER PT J AU Lefrant, JY Farenc, C De la Coussaye, JE Muller, L Ripart, J Cuvillon, P Saissi, G Eledjam, JJ AF Lefrant, JY Farenc, C De la Coussaye, JE Muller, L Ripart, J Cuvillon, P Saissi, G Eledjam, JJ TI Pharmacodynamics and atracurium and laudanosine concentrations during a fixed continuous infusion of atracurium in mechanically ventilated patients with acute respiratory distress syndrome SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE acute respiratory distress syndrome; ARDS; atracurium; neuromuscular blockade ID INTENSIVE-CARE UNIT; CRITICALLY-ILL PATIENTS; PROLONGED WEAKNESS; MUSCLE-RELAXANTS; NATIONAL SURVEY; PHARMACOKINETICS; PARALYSIS; FAILURE; 51W89; ARDS AB The present study was designed to assess the pharmacodynamics and the plasma levels of atracurium and laudanosine found during a 72-hour fixed rate infusion of atracurium in acute respiratory distress syndrome patients without renal or liver failure. Nine sedated and mechanically ventilated acute respiratory distress syndrome patients without renal or liver failure were paralysed with a bolus of atracurium (I mg.kg(-1)) followed by a 72-hour continuous infusion (I mg.kg(-1).h(-1)). The count of train-of-four (TOF) and TOF ratio were monitored by an accelerograph until full neuromuscular recovery (T4/T1greater than or equal to0.7). Atracurium and laudanosine concentrations were measured from the onset to four days after cessation of the infusion. An electroencephalogram was recorded daily. Analysis showed that TOF count was always less than or equal to3 until cessation of the infusion. Following cessation, neuromuscular recovery occurred between 31 and 96 minutes (median value=45 min). The highest atracurium and laudanosine concentrations ranged from 3.3 to 5.8 mug.ml(-1) and from 3 to 20 mug.ml(-1) respectively. In four patients with renal impairment, the highest laudanosine concentration was >10 mug.ml(-1). No seizure was recorded. A fixed infusion rate of atracurium in acute respiratoty distress syndrome patients provided an effective muscle paralysis with a rapid neuromuscular recovery but can lead to accumulation of laudanosine in patients with renal impairment. C1 CHU Nimes, Federat Anesthesie Douleur Urgences Reanimat, F-30029 Nimes 04, France. CHU Nimes, Affiliat Lab Pharmacocinet, F-30029 Nimes, France. RP Lefrant, JY (reprint author), CHU Nimes, Federat Anesthesie Douleur Urgences Reanimat, 5 Rue Hoche, F-30029 Nimes 04, France. NR 24 TC 0 Z9 0 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD AUG PY 2002 VL 30 IS 4 BP 422 EP 427 PG 6 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 582LE UT WOS:000177351800003 ER PT J AU Plaud, B Marty, J Debaene, B Meistelman, C Pellissier, D LePage, JY Feiss, P Scherpereel, P Bouverne, MN Fosse, S AF Plaud, B Marty, J Debaene, B Meistelman, C Pellissier, D LePage, JY Feiss, P Scherpereel, P Bouverne, MN Fosse, S TI The cardiovascular effects of mivacurium in hypertensive patients SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 17-21, 1998 CL ORLANDO, FLORIDA SP Amer Soc Anesthesiol ID NEUROMUSCULAR BLOCK; ORBICULARIS OCULI; ADDUCTOR MUSCLES; ANESTHESIA; INTUBATION; INDUCTION AB Hypotension is common after mivacurium injection in healthy patients. This hemodynamic event had not been investigated in hypertensive patients characterized by more intense hemodynamic instability. In this open-label, multicenter randomized, and controlled study, we sought to determine whether mean arterial blood pressure (MAP) and heart rate variations were larger in hypertensive versus normotensive patients after a bolus dose of mivacurium injected over 10 or 30 s. After the induction of anesthesia with fentanyl and etomidate, normotensive (n = 149) and hypertensive (n = 57) patients received a single dose of mivacurium 0.2 mg/kg injected over 10 or 30 s by random allocation. Heart rate and MAP were recorded electronically. The incidence of hypotension (defined as a 20% MAP decrease from the control value before mivacurium injection) was 21% and 36% (10-s injection) or 11% and 10% (30-s injection) in the Normotensive and Hypertensive groups, respectively. In Hypertensive patients, the maximum decrease in MAP was significantly greater when mivacurium was injected over 10 s compared with 30 s: 20% vs 11%, respectively (P = 0.002). This difference was not observed in Normotensive patients. Hypotension after rapid (e.g., 10 s) mivacurium injection was more frequent and more pronounced in Hypertensive than in Normotensive patients. C1 Fdn Adolphe de Rothschild, Dept Anesthesiol & Intens Care, Paris, France. Univ Paris 07, Hop Beaujon, Dept Anesthesiol & Intens Care, Clichy, France. CHRU Poiters, Dept Anesthesiol & Intens Care, Poitiers, France. CHU Nancy, Dept Anesthesiol & Intens Care, Nancy, France. Hop La Timone, Dept Anesthesiol & Intens Care, Marseille, France. CHRU Nantes, Dept Anesthesiol & Intens Care, Nantes, France. CHRU Limoges, Dept Anesthesiol & Intens Care, Limoges, France. CHRU Lille, Dept Anesthesiol & Intens Care, Lille, France. GlaxoSmithKline Labs, Marly Le Roi, France. RP Marty, J (reprint author), Serv Anesthesie Reanimat, 100 Blvd Gen Leclerc, F-92118 Clichy, France. NR 11 TC 4 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2002 VL 95 IS 2 BP 379 EP 384 DI 10.1213/01.ANE.0000019434.58914.84 PG 6 WC Anesthesiology SC Anesthesiology GA 575TH UT WOS:000176964200025 ER PT J AU Gruber, M Lindner, R Prasser, C Wiesner, G AF Gruber, M Lindner, R Prasser, C Wiesner, G TI The effect of fluoride and hypothermia on the in vitro metabolism of mivacurium SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANESTHESIA; CHOLINESTERASE; SEVOFLURANE C1 Univ Regensburg, Dept Anesthesiol, D-93053 Regensburg, Germany. RP Gruber, M (reprint author), Univ Regensburg, Dept Anesthesiol, Franz Josef Strauss Allee 11, D-93053 Regensburg, Germany. RI Gruber, Michael/A-5342-2012 NR 10 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2002 VL 95 IS 2 BP 397 EP 399 DI 10.1213/01.ANE.0000020389.71460.C4 PG 3 WC Anesthesiology SC Anesthesiology GA 575TH UT WOS:000176964200029 ER PT J AU Eikermann, M Hunkemoller, I Peine, L Armbruster, W Stegen, B Husing, J Peters, J AF Eikermann, M Hunkemoller, I Peine, L Armbruster, W Stegen, B Husing, J Peters, J TI Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthesia, paediatric; intubation tracheal, technique; neuromuscular block, rocuronium ID TRACHEAL INTUBATION; PEDIATRIC-PATIENTS; VECURONIUM; ANESTHESIA; ONSET; TIME AB Background. We studied 120 children aged 2-7 yr in a prospective, randomized, assessor-blinded fashion to define the optimal rocuronium dose which provides a 95% probability of acceptable intubation conditions (ED95TI) during inhalation induction with sevoflurane. Methods. After inhalation induction with 8% sevoflurane in 60% nitrous oxide and 40% oxygen, and loss of the eyelash reflex, we administered rocuronium (0.1, 0.15, 0.22, 0.3, or 0.6 mg kg(-1)) or placebo. We quantified neuromuscular function by stimulation of the ulnar nerve at 0.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry. Intubation conditions were assessed 2 min after test drug injection. The optimal rocuronium dose was defined as the lowest dose, which allowed acceptable intubation conditions in 95% of children (ED95TI). Results. Two minutes after injection of placebo or rocuronium, intubation conditions were acceptable in 35, 45, 80, 90, 95, and 100% of children, respectively. Rocuronium 0.07 [CI 0.02-0.11], 0.24 [0.19-0.31], and 0.29 [0.23-0.38] mg kg(-1) provided 50, 90, and 95% probability of acceptable intubating conditions. When thumb acceleration was depressed by 50% or more, intubating conditions were considered acceptable in 97% of children. Recovery of the train-of-four ratio to 0.8 averaged 12 (7), 16 (7), 24 (7), 24 (8), and 50 (22) min after the respective dose of rocuronium. Conclusions. During inhalation induction with 8% sevoflurane in 60% nitrous oxide, rocuronium 0.29 mg kg(-1) (ED95) optimizes intubation conditions for surgery of short duration. C1 Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, D-45122 Essen, Germany. RP Eikermann, M (reprint author), Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, Hufelandstr 55, D-45122 Essen, Germany. NR 18 TC 16 Z9 21 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 2002 VL 89 IS 2 BP 277 EP 281 DI 10.1093/bja/aef177 PG 5 WC Anesthesiology SC Anesthesiology GA 580KC UT WOS:000177232900015 ER PT J AU Ostergaard, D Ibsen, M Skovgaard, L Viby-Mogensen, J AF Ostergaard, D Ibsen, M Skovgaard, L Viby-Mogensen, J TI Plasma cholinesterase activity and duration of action of mivacurium in phenotypically normal patients SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE butyrylcholinesterase; cholinesterase; mivacurium enzymes; neuromuscular blocking relaxants; pharmacodynamics; pseudocholinesterase ID INDUCED NEUROMUSCULAR BLOCKADE; CHLORIDE BW B1090U; HEPATIC CIRRHOSIS; 3 ISOMERS; PHARMACODYNAMICS; PHARMACOKINETICS; SUCCINYLCHOLINE; DRUG AB Background: The short duration of action of mivacurium is due to its rapid hydrolysis by plasma cholinesterase (pChe). In patients with normal phenotype, low pChe activity because of, for instance, disease or intake of drugs may prolong the duration of action of mivacurium. The purpose of this study was to evaluate the relationship between pChe activity and the duration of action of mivacurium 0.2 mg/kg in phenotypically normal patients. Material: Forty-three adult patients with normal pChe phenotype and low or normal pChe activity, undergoing a variety of surgical procedures were included in the study with their informed consent and Ethics Committee approval. The neuromuscular block was monitored using TOF stimulation every 12 s and mechanomyography. The time to reappearance of the first response to TOF stimulation was measured. Results: The patients pChe activities ranged from 45 to 1272 U/l (normal range 660-1620 U/l) and the time to first response to TOF from 8.1 to 62.7 min. An inverse relationship between enzyme activity and duration of action of mivacurium was found. The relationship was described by the equation: log(10) (time) = alpha-beta log(10) (pChe), where alpha (SD) is 2.547 (0.186) and beta (SD) 0.454 (0.069). Conclusion: In patients with phenotypically normal pChe, prediction of the duration of action of mivacurium is possible from the patients actual pChe activity. In patients with pChe activities below the normal range, the time to reappearance of the first response to TOF stimulation may vary from 10 to 180 min Only patients with pChe activities <220 U/l had a significantly prolonged duration of action of mivacurium. C1 Copenhagen Univ Hosp, Dept Anaesthesia & Intens Care, Danish Cholinesterase Res Unit, Copenhagen, Denmark. Gentofte Univ Hosp, Dept Anaesthesiol, Gentofte, Denmark. Univ Copenhagen, Dept Biostat, DK-1168 Copenhagen, Denmark. Rigshosp, Dept Anaesthesia, Copenhagen, Denmark. RP Ostergaard, D (reprint author), Herlev Univ Hosp, Dept Anaesthesia, Herlev Ringvej 75, DK-2730 Herlev, Denmark. NR 13 TC 9 Z9 9 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JUL PY 2002 VL 46 IS 6 BP 679 EP 683 DI 10.1034/j.1399-6576.2002.460608.x PG 5 WC Anesthesiology SC Anesthesiology GA 564DG UT WOS:000176299300008 ER PT J AU Ostergaard, D Viby-Mogensen, J Pedersen, NA Holm, H Skovgaard, LT AF Ostergaard, D Viby-Mogensen, J Pedersen, NA Holm, H Skovgaard, LT TI Pharmacokinetics and pharmacodynamics of mivacurium in young adult and elderly patients SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE age factors; butyrylcholinesterase; cholinesterase; dose-response curves; enzymes; metabolites; mivacurium; neuromuscular relaxants; pharmacodynamics; pharmacokinetics; pharmacology; pseudocholinesterase; stereoisomers ID PLASMA CHOLINESTERASE ACTIVITY; DOSE-RESPONSE RELATIONSHIP; CHLORIDE BW B1090U; 3 ISOMERS; INFUSION; ANESTHESIA; CISATRACURIUM; PHARMACOLOGY; VECURONIUM; RECOVERY AB Background: Mivacurium is hydrolyzed by plasma cholinesterase, and is therefore less dependent on liver metabolism and renal elimination than other neuromuscular blocking drugs. This might favor the use of mivacurium in elderly patients. The purpose of this study was to compare the pharmacodynamics and the pharmacokinetics of the three isomers of mivacurium and their metabolites in young adult and elderly patients. Methods: Sixty-four patients were included in a dose-response study, in which 32 young adults and 32 elderly patients received one of four doses of mivacurium. An additional bolus dose of mivacurium to a total of 0.1 mg/kg was given followed by a continuous infusion adjusted to maintain a 91-99% neuromuscular block. The times to maximum block and different levels of recovery were measured using mechanomyography and train-of-four (TOF) nerve stimulation. Thirty-two patients were randomly selected for the pharmacokinetic study. Venous samples were taken for determination of the three mivacurium isomers and the metabolites. Results: The estimated ED95 were 0.053 and 0.061 mg/kg in young adults and elderly patients, respectively (NS). The median infusion rate did not differ, but duration to a TOF ratio of 0.7 was significantly longer in elderly patients than in young adult patients (21.0 vs. 16.5 min). No statistically significant difference between the age groups in clearance and elimination half-life of the isomers was seen. The half-lives of the metabolites were significantly prolonged in the elderly patients. Conclusion: There were no significant differences in the potency or infusion requirements between the adult and elderly patients, but the rate of recovery was significantly, though only moderately prolonged, in the elderly patients. No significant difference in clearance was seen but the elimination half-lives of the metabolites was longer in the elderly patients. C1 Gentofte Univ Hosp, Dept Anaesthesia, Gentofte, Denmark. Rigshosp, Dept Anaesthesia, Copenhagen, Denmark. Univ Copenhagen, Dept Biostat, DK-1168 Copenhagen, Denmark. RP Ostergaard, D (reprint author), Herlev Univ Hosp, Dept Anesthesiol, DK-2730 Herlev, Denmark. NR 24 TC 6 Z9 7 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JUL PY 2002 VL 46 IS 6 BP 684 EP 691 DI 10.1034/j.1399-6576.2002.460609.x PG 8 WC Anesthesiology SC Anesthesiology GA 564DG UT WOS:000176299300009 ER PT J AU Sarti, A Cergol, M Scarpa, R Agosti, A Runti, G AF Sarti, A Cergol, M Scarpa, R Agosti, A Runti, G TI Resistance to vecuronium in a term neonate SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE neonate; neuromuscular blocking agents; non-depolarizing resistance; pediatric; vecuronium ID INDUCED NEUROMUSCULAR BLOCKADE; CEREBRAL-PALSY; ATRACURIUM; CHILDREN; PANCURONIUM; PATIENT AB We report a case of resistance to curarization in a term neonate undergoing surgery. The dosage of vecuronium required to obtain satisfactory muscular blockade and cessation of spontaneous breathing efforts was more than 10-fold the normal one. The operation was delayed for 90 min The mechanism of this marked resistance is unknown, but some possible hypotheses are presented, focusing on the neonate's poor intrauterine growth and an abnormality in pharmacodynamics. C1 IRCCS Burlo Garofolo, Res & Care Children Hosp, Dept Anaesthesia & Intens Care, I-34137 Trieste, Italy. RP Sarti, A (reprint author), IRCCS Burlo Garofolo, Res & Care Children Hosp, Dept Anaesthesia & Intens Care, Via Istria 65-1, I-34137 Trieste, Italy. NR 16 TC 0 Z9 0 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JUL PY 2002 VL 46 IS 6 BP 744 EP 746 DI 10.1034/j.1399-6576.2002.460619.x PG 3 WC Anesthesiology SC Anesthesiology GA 564DG UT WOS:000176299300019 ER PT J AU Fine, GF Motoyama, EK Brandom, BW Fertal, KM Mutich, R Davis, PJ AF Fine, GF Motoyama, EK Brandom, BW Fertal, KM Mutich, R Davis, PJ TI The effect on lung mechanics in anesthetized children with rapacuronium: A comparative study with mivacurium SO ANESTHESIA AND ANALGESIA LA English DT Article ID MUSCARINIC RECEPTORS; PEDIATRIC-PATIENTS; BRONCHOSPASM; ANESTHESIA; PANCURONIUM; ANTAGONISTS; INTUBATION; ATRACURIUM; INFANTS AB The administration of rapacuronium increases the risk of severe bronchospasm. There have been no studies of pulmonary function directly demonstrating airway constriction with rapacuronium in children. In this study, 10 ASA physical status I or II patients (aged 2-6 yr) were randomly divided into 2 equal groups, receiving either rapacuronium. or mivacurium. Anesthesia was induced with sevoflurane and maintained with remifentanil. (0.2-0.3 mug . kg(-1) . min(-1)) and propofol (200-250 mug . kg(-1) . min(-1)) infusions. We performed three sets of pulmonary function tests: baseline, after the administration of muscle relaxant, and after the administration of a beta(2) agonist. In both groups, there were no changes in static respiratory compliance. The increase in total respiratory system resistance after the administration of rapacuronium did not reach statistical significance (214.4% +/- 122.65% of baseline, P approximate to 0.1), whereas maximal expiratory flow at 10% of forced vital capacity (MEF)(10) and MEFfunctional residual capacity on partial flow-volume curves by the forced deflation technique decreased markedly (53.4% +/- 18.49%, P < 0.01 and 41.3% +/- 27.42%, P < 0.001, respectively). With the administration of mivacurium., no changes were observed in respiratory system resistance (109.5% +/- 30.28%). MEF10 decreased slightly (77.0% +/- 9.03%, P < 0.005) whereas MEFFRC did not (81.2% +/- 29.85%, not significant). After the administration of a beta(2) agonist, all measurements returned to baseline. Thus, the administration of rapacuronium consistently results in lower airway obstruction with minimal changes in static respiratory compliance when compared with mivacurium. C1 Childrens Hosp Pittsburgh, Dept Anesthesiol, Pittsburgh, PA 15213 USA. Childrens Hosp Pittsburgh, Div Pulmonol, Pittsburgh, PA 15213 USA. Univ Pittsburgh, Sch Med, Dept Anesthesiol, Pittsburgh, PA 15261 USA. Univ Pittsburgh, Sch Med, Dept Pediat, Pittsburgh, PA 15261 USA. RP Fine, GF (reprint author), Childrens Hosp Pittsburgh, Dept Anesthesiol, 3705 5th Ave, Pittsburgh, PA 15213 USA. NR 25 TC 10 Z9 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 2002 VL 95 IS 1 BP 56 EP 61 DI 10.1213/01.ANE.0000019061.79800.E1 PG 6 WC Anesthesiology SC Anesthesiology GA 569ZV UT WOS:000176634100010 ER PT J AU Itoh, H Shibata, K Nitta, S AF Itoh, H Shibata, K Nitta, S TI Sensitivity to vecuronium in seropositive and seronegative patients with myasthenia gravis SO ANESTHESIA AND ANALGESIA LA English DT Article ID ACETYLCHOLINE-RECEPTOR; SEVOFLURANE ANESTHESIA; BLOCKING ANTIBODIES; NEUROMUSCULAR BLOCK; BALANCED ANESTHESIA; PROPOFOL; ATRACURIUM; BINDING; PLASMA; FADE AB Patients with myasthenia gravis (MG) are hypersensitive to nondepolarizing neuromuscular blocking drugs. Although antibodies to the acetylcholine receptor (AChR) often are observed in MG patients, 10% to 30% of patients do not show an anti-AChR antibody. Little is known about differences in sensitivity to nondepolarizing neuromuscular blocking drugs between MG patients with and without anti-AChR antibody. Hypothesizing that seronegative patients are as sensitive to vecuronium as seropositive patients, we assessed sensitivity in seropositive and seronegative MG patients and in non-MG patients (n = 8 each). During anesthesia with sevoflurane (2.5%) and nitrous oxide (60%) in oxygen, neuromuscular transmission was monitored by measuring the twitch tension of the adductor pollicis muscle with supramaximal stimulation. After baseline measurements, 10 mug/kg IV dose increments of vecuronium were administered sequentially until blockade exceeded 90%. The degree of blockade and onset time after the initial 10 mug/kg of vecuronium were assessed, and doses required to exceed 90% blockade were recorded. In addition, effective doses of 50% and 95% for vecuronium were calculated from a single data point. Both types of MG patients showed increased sensitivity to vecuronium compared with non-MG patients. C1 Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, Kanazawa, Ishikawa 9208641, Japan. Kanazawa Univ, Sch Med, Dept Emergency & Crit Care Med, Kanazawa, Ishikawa 9208641, Japan. Ishikawa Prefectural Cent Hosp, Div Anesthesia, Kanazawa, Ishikawa, Japan. RP Itoh, H (reprint author), Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan. EM hironori@med.kanazawa-u.ac.jp NR 28 TC 8 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 2002 VL 95 IS 1 BP 109 EP 113 DI 10.1097/00000539-200207000-00019 PG 5 WC Anesthesiology SC Anesthesiology GA 569ZV UT WOS:000176634100019 ER PT J AU Yavascaoglu, B Cebelli, V Kelebek, N Uckunkaya, N Kutlay, O AF Yavascaoglu, B Cebelli, V Kelebek, N Uckunkaya, N Kutlay, O TI Comparison of different priming techniques on the onset time and intubating conditions of rocuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blocking agents, neuromuscular non-depolarizing agents, rocuronium ID NEUROMUSCULAR BLOCKADE; VECURONIUM; ANESTHESIA; ATRACURIUM; MIVACURIUM; INDUCTION; PRINCIPLE; ORG-9426 AB Background and objective: The aim was to compare the effects of two different priming doses and priming intervals with the standard intubating dose of rocuronium on the onset time and intubation conditions. Methods: After induction of anaesthesia, 75 patients were randomly assigned to one of five groups. Patients in Group I received a priming dose of rocuronium 0.06 mg kg(-1) followed 2 min later by rocuronium 0.54 mg kg(-1), Group 2 received a priming dose of 0.10 mg kg(-1) followed 2 min later by a rocuronium injection of 0.50 mg kg(-1). Group 3 was given a priming dose of 0.06 mg kg(-1) followed 3 min later by administration 0.54 mg kg(-1) where Group 4 received a priming dose of 0.10 mg kg(-1) followed 3 min later by injection of 0.50 mg kg(-1). Group 5 received a placebo injection followed 3 min later by rocuronium 0.60 mg kg(-1). Results: Priming with a 3 min priming interval shortened the onset time of rocuronium irrespective of the dosage of (P < 0.001). Clinical duration of action was significantly longer after priming in Group 4 than in Group 5. Clinically acceptable intubation conditions were obtained in all patients. Conclusions: Priming with a 3 min priming interval was effective when rapid tracheal intubation with rocuronium was necessary. However, priming with rocuronium should be used carefully with special attention given to the possibility of hypoxia and aspiration of gastric contents in awake patients. C1 Uludag Univ, Tip Fak, Anesteziyoloji & Reanimat Anabilim Dali, Bursa, Turkey. RP Yavascaoglu, B (reprint author), Uludag Univ, Tip Fak, Anesteziyoloji & Reanimat Anabilim Dali, Bursa, Turkey. NR 17 TC 13 Z9 17 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 2002 VL 19 IS 7 BP 517 EP 521 DI 10.1017/S0265021502000844 PG 5 WC Anesthesiology SC Anesthesiology GA 572CE UT WOS:000176755200009 ER PT J AU Kurt, N Kurt, I Aygunes, B Oral, H Tulunay, M AF Kurt, N Kurt, I Aygunes, B Oral, H Tulunay, M TI Effects of adding alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE anaesthesia, intravenous; anaesthetics, intravenous, alfentanil; neuromuscular non-de polarizing agents, atracurium; anaesthetics, local, lidocaine ID ANESTHESIA; FENTANYL; PRILOCAINE; KETOROLAC AB Background and objective: The addition of alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia of the arm may have advantages with respect to improved muscle relaxation and better analgesia. The study investigates these possibilities. Methods: We investigated 33 patients. Plain lidocaine solution was administered to Group 1 (n = 11). Alfentanil (0.5 mg) and atracurium (3 mg) were added to the lidocaine solution in Groups 2 (n = 11) and 3 (n = 11), respectively. The onset of sensory and motor block, intra- and postoperative pain scores, and the duration of postoperative analgesia were evaluated. Results: There was a significant difference in the speed of the onset of sensory block in the hand, but not at the tourniquet site. The onset of the motor block, intra- and postoperative pain scores, and the duration of postoperative analgesia were similar in all groups. Conclusions: No clinical benefits of adding alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia of the arm could be shown. C1 Adnan Menderes Univ, Sch Med Anaesthesiol & Reanimat, Fac Med, Dept Anaesthesiol & Reanimat, TR-09100 Aydin, Turkey. RP Kurt, N (reprint author), Adnan Menderes Univ, Sch Med Anaesthesiol & Reanimat, Fac Med, Dept Anaesthesiol & Reanimat, TR-09100 Aydin, Turkey. NR 20 TC 3 Z9 4 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 2002 VL 19 IS 7 BP 522 EP 525 DI 10.1017/S0265021502000856 PG 4 WC Anesthesiology SC Anesthesiology GA 572CE UT WOS:000176755200010 ER PT J AU Driessen, JJ Robertson, EN Van Egmond, J Booij, LHDJ AF Driessen, JJ Robertson, EN Van Egmond, J Booij, LHDJ TI Time-course of action of rocuronium 0.3 mg.kg(-1) in children with and without endstage renal failure SO PAEDIATRIC ANAESTHESIA LA English DT Article; Proceedings Paper CT Annual Meeting American-Society-of-Anesthesiologists CY OCT 14-18, 2000 CL SAN FRANCISCO, CALIFORNIA SP Amer Soc Anesthesiologists DE rocuronium; neuromuscular relaxants; renal failure ID BROMIDE ORG-9426; PHARMACOKINETICS; ANESTHESIA; PHARMACODYNAMICS; VECURONIUM; HALOTHANE AB Background : The time-course of the neuromuscular effects of rocuronium 0.3 mg.kg(-1) during nitrous oxide-halothane anaesthesia in children with and without renal failure is unknown. This study compared the neuromuscular blocking effects in these groups. Methods : The study was approved by the Hospital Ethical Committee. In the control group, 14 healthy children without renal disease were scheduled for various elective surgical procedures. Sixteen children with endstage renal failure, 14 of whom were already on renal dialysis, were scheduled for (re)placement of dialysis catheters (n =14) or for renal transplantation (n =2). Anaesthesia was induced and maintained with halothane and nitrous oxide in oxygen. Acceleromyographic thumb adduction after supramaximal ulnar nerve stimulation was recorded using train-of-four stimulation every 15 s. The onset time, the time to recovery of the first twitch to 25% or 75% and to recovery of a train-of-four ratio of 0.7 after rocuronium 0.3 mg.kg(-1) were measured. Statistical analysis was performed with Student's t -test. P < 0.05 was considered statistically significant. Results : The onset time was longer in children with renal failure (139 s, SD=71) than in control children (87 s, SD=43) (P =0.02). There were no significant differences in the duration of action of rocuronium between children without renal failure and in 15 out of 16 children with renal failure. Conclusions : In children with renal failure, aged over 1 year, a single bolus dose of rocuronium 0.3 mg.kg(-1) does not cause a prolonged block, but has a slower onset than in healthy children. C1 Univ Med Ctr, Inst Anesthesiol, NL-6500 HB Nijmegen, Netherlands. RP Driessen, JJ (reprint author), Univ Med Ctr, Inst Anesthesiol, POB 9101, NL-6500 HB Nijmegen, Netherlands. NR 8 TC 7 Z9 7 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD JUL PY 2002 VL 12 IS 6 BP 507 EP 510 DI 10.1046/j.1460-9592.2002.00891.x PG 4 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 577XL UT WOS:000177088200006 ER PT J AU Woloszczuk-Gebicka, B AF Woloszczuk-Gebicka, B TI Mivacurium infusion requirement and spontaneous recovery of neuromuscular transmission in children anaesthetized with nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane SO PAEDIATRIC ANAESTHESIA LA English DT Article DE relaxants : mivacurium; continuous infusion; recovery; anaesthetics, halothane, isoflurane, sevoflurane; fentanyl ID PEDIATRIC SURGICAL PATIENTS; CHLORIDE BW B1090U; TIME-COURSE; ANESTHESIA; BLOCK; SUXAMETHONIUM; PHARMACOLOGY; EDROPHONIUM; ADULTS; PHARMACODYNAMICS AB Background : Forty children, aged 3-11 years, ASA I or II, were allocated at random to receive N-2 O/O-2 -fentanyl or 1 MAC halothane, isoflurane or sevoflurane-N-2 O/O-2 anaesthesia. Mivacurium was used for muscle relaxation. Methods : Electromyographic response of the adductor pollicis to train-of-four (TOF) stimulation, 2 Hz for 2 s, applied to the ulnar nerve at 10-s intervals was recorded using the Relaxograph (Datex, Helsinki, Finland). An intubating dose of mivacurium, 0.2 mg.kg(-1) was given, and when T-1 returned to 5%, muscle relaxation was maintained by continuous infusion of mivacurium, adjusted manually to maintain a stable 90-99% block. Results : Halothane, isoflurane and sevoflurane groups had lower infusion requirements for mivacurium than the N-2 O-fentanyl group (P =0.000083). Mivacurium requirement was 18.8 +/- 6.8, 10.8 +/- 4.2, 6.9 +/- 3.9 and 9.6 +/- 5.6 mug.kg(-1) .min(-1) for children receiving N-2 O/O-2 -fentanyl, halothane, isoflurane and sevoflurane anaesthesia, respectively. Conclusions : Spontaneous recovery from T-1 =10% to TOF ratio=0.7 was insignificantly prolonged from 6.3 to 12.5 min in the fentanyl group to 7-16.5 min in children anaesthetized with inhalational anaesthetics. C1 Mem Childrens Hlth Inst, Dept Anaesthesiol & Intens Therapy, PL-04736 Warsaw, Poland. RP Woloszczuk-Gebicka, B (reprint author), Mem Childrens Hlth Inst, Dept Anaesthesiol & Intens Therapy, Al Dzieci Polskich 20, PL-04736 Warsaw, Poland. NR 46 TC 4 Z9 4 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD JUL PY 2002 VL 12 IS 6 BP 511 EP 518 DI 10.1046/j.1460-9592.2002.00901.x PG 8 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 577XL UT WOS:000177088200007 ER PT J AU Kanji, S Barletta, JF Janisse, JJ Kruse, JA Devlin, JW AF Kanji, S Barletta, JF Janisse, JJ Kruse, JA Devlin, JW TI Tachyphylaxis associated with continuous cisatracurium versus pancuronium therapy SO PHARMACOTHERAPY LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; CRITICALLY ILL PATIENT; INTENSIVE-CARE UNIT; SKELETAL-MUSCLE; ECONOMIC-IMPACT; RESISTANCE; ATRACURIUM; VECURONIUM; PHARMACOKINETICS; PHARMACODYNAMICS AB Study Objectives. To compare dosing requirements over time among patients receiving continuous cisatracurium versus pancuronium therapy, and to identify factors that may account for changes in pancuronium versus cisatracurium infusion requirements over time. Design. Retrospective, comparative cohort analysis. Setting. A tertiary level I trauma center. Patients. Forty-five consecutive adult patients who were admitted to intensive care units at our institution from January 1998-August 2000 and received continuous cisatracurium or pancuronium therapy for at least 48 hours. Measurements and Main Results. Dosing requirements of patients treated with pancuronium or cisatracurium were recorded over time throughout the treatment period. Factors that could affect dosing requirements of a neuromuscular blocking agent (NMBA) were stratified as time invariant (admitting service, acute physiology and chronic health evaluation 11 score, duration of mechanical ventilation, pressure control ventilation, baseline hepatic or renal insufficiency, thermal injury, train-of-four assessment, and concurrent drug administration or disorders affecting neuromuscular transmission) or time variant (concurrent sedation and narcotic analgesia therapy serum magnesium, potassium, and creatinine concentrations arterial pH levels temperature peak airway pressured and partial pressure of oxygen:fraction of inspired oxygen ratio). Hierarchical linear modeling was used to compare the dosing requirements and to identify confounders affecting the relationship. The infusion rate escalation for the cisatracurium group was greater (0.39 mug/kg/min, 95% confidence interval [CI] 0.22-0.56; 23 patients) than for the pancuronium group (-0.06 mug/kg/min; 95% CI -0.24-0.12; 22 patients; p<0.001) and was associated with an average daily cost/patient significantly higher (p<0.001) with cisatracurium ($258 +/- $114) than pancuronium ($11 +/- $5). Confounder analysis revealed that only the admitting service and the number of times the NMBA infusion was suspended because no twitch was detected differed between groups. Neither of these confounders significantly affected the temporal relationship between cisatracurium and pancuronium infusion rates. Conclusion. Dosing requirements increase over time at a significantly greater rate for cisatracurium than pancuronium infusions. Tachyphylaxis with cisatracurium is associated with substantial drug-related costs and is not accounted for by various disease-, patient-, and therapy-related factors. Further investigation is required to elucidate the mechanisms and risk factors underlying this phenomenon. C1 Detroit Receiving Hosp & Univ Hlth Ctr, Dept Pharm Serv, Detroit, MI 48201 USA. Detroit Receiving Hosp & Univ Hlth Ctr, Dept Med, Detroit, MI 48201 USA. Wayne State Univ, Coll Pharm, Detroit, MI 48202 USA. Wayne State Univ, Ctr Hlth Effectiveness Res, Detroit, MI 48202 USA. RP Devlin, JW (reprint author), Detroit Receiving Hosp & Univ Hlth Ctr, Dept Pharm Serv, 4201 St Antoine, Detroit, MI 48201 USA. RI Barletta, Jeffrey/B-2644-2013 NR 42 TC 2 Z9 2 PU PHARMACOTHERAPY PUBLICATIONS INC PI BOSTON PA NEW ENGLAND MEDICAL CENTER, 806, 750 WASHINGTON ST, BOSTON, MA 02111 USA SN 0277-0008 J9 PHARMACOTHERAPY JI Pharmacotherapy PD JUL PY 2002 VL 22 IS 7 BP 823 EP 830 DI 10.1592/phco.22.11.823.33625 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 569RV UT WOS:000176616700003 ER PT J AU Chung, DY Hardman, J AF Chung, DY Hardman, J TI Prolonged paralysis following mivacurium administration SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; PLASMA CHOLINESTERASE; REVERSAL AB Mivacurium is a benzylisoquinolone, choline-like, non-depolarizing muscle relaxant. Its onset of action is similar to that of atracurium but its duration of action is shorter (approximately 10-15 minutes). Mivacurium is metabolized by plasma cholinesterases at approximately 70% of the rate of metabolism of suxamethonium(1). Deficiency or abnormality of plasma cholinesterase may cause the duration of action of both suxamethonium(2.3) and mivacurium(2,4,5,6) to be greatly prolonged. We describe a case of prolonged mivacurium paralysis after day surgery. Laboratory investigations showed a genetic tendency toward abnormal cholinesterase levels, but markedly depressed cholinesterase activity was suggestive of additional acquired causes. This patient had a history of liver disease, malnutrition and anticholinesterase use, which we believe were the most significant factors involved. C1 Royal Brisbane Hosp, Dept Perioperat Med & Intens Care, Brisbane, Qld 4029, Australia. RP Chung, DY (reprint author), Univ Queensland, Royal Brisbane Hosp, Dept Perioperat Med & Intens Care, Herston, Qld 4006, Australia. NR 14 TC 1 Z9 1 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD JUN PY 2002 VL 30 IS 3 BP 360 EP 363 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 560EU UT WOS:000176070400016 ER PT J AU Muller-Gorges, MR Knuttgen, D Loick, HM AF Muller-Gorges, MR Knuttgen, D Loick, HM TI Treatment of generalized dystonia with pancuronium - A case report SO ANASTHESIOLOGIE & INTENSIVMEDIZIN LA German DT Article DE pancuronium bromide; dystonia; patient-controlled analgesia AB We report on the case of a female in-patient with therapy-resistant generalized dystonia who responded repeatedly to minimum doses of nondepolarizing muscle relaxants by a selective normalization of the tone of the affected spastic musculature. In consequence of that, a new therapeutic strategy consisting in a subcutaneous administration of pancuronium bromide via a commercial patient-controlled analgesia (PCA) pump was developed and successfully applied. To our knowledge, this type of treatment has not yet been described for dystonia before, which is why we would like to present it as a possible therapeutic option. C1 St Antonius Krankenhaus, Anasthesieabt, D-53937 Schleiden, Germany. RP Muller-Gorges, MR (reprint author), St Antonius Krankenhaus, Anasthesieabt, Hahnchen 36, D-53937 Schleiden, Germany. NR 13 TC 0 Z9 0 PU D I O MED VERLAGS GMBH PI NURNBERG PA OBERE SCHMIEDGASSE 11, 90403 NURNBERG, GERMANY SN 0170-5334 J9 ANASTH INTENSIVMED JI Anasthesiol. Intensivmed. PD JUN PY 2002 VL 43 IS 6 BP 350 EP + PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 568VQ UT WOS:000176565900005 ER PT J AU Memis, D Turan, A Karamanlioglu, B Sut, N Pamukcu, Z AF Memis, D Turan, A Karamanlioglu, B Sut, N Pamukcu, Z TI The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl SO ANESTHESIA AND ANALGESIA LA English DT Article ID SPONTANEOUS MOVEMENTS; PROPOFOL INJECTION; PRETREATMENT; PHARMACOLOGY; BROMIDE AB We compared the efficacy of ondansetron, lidocame, tramadol, and fentanyl in minimizing pain caused by the injection of rocuronium in 250 patients. After tourniquet application on the forearm, the patients were given saline (3 mL) (Group 1, n = 50), ondansetron (4 mg) (Group 2, n = 50), lidocaine (30 mg) (Group 3, n = 50), tramadol (50 mg) (Group 4, n = 50), or fentanyl (100 mug) (Group 5, n = 50) diluted into a 3-mL solution. The occlusion was released after 20 s and rocuronium was injected over 10-15 s. The patients were observed and asked immediately if they had pain in the arm, and the response was assessed. Reactions such as discomfort and pain, withdrawal of the hand, and so on after the administration of rocuronium were recorded as side effects for 24 h. Ten patients in Group 1, 28 patients in Group 2, 37 patients in Group 3, 30 patients in Group 4, and 15 patients in Group 5 reported no pain. Light pain was seen in 11 patients in Group 1, 14 patients in Group 2, 11 patients in Group 3,12 patients in Group 4, and 20 patients in Group 5. Moderate pain was seen in 15 patients in Group 1, 6 patients in Group 2, 2 patients in Group 3, 8 patients in Group 4, and 10 patients in Group 5. Severe pain was seen in 14 patients in Group 1, 2 patients in Group 2, 0 patients in Group 3, 0 patients in Group 4, and 5 patients in Group 5. Correlation determined with log-linear analysis found in Group I pain score 0 (P < 0.001), Group 1 pain score 1 (P < 0.001), and Group 3 pain score 0 (P < 0.001). We conclude that ondansetron, lidocaine, tramadol, and fentanyl decrease the level of rocuronium injection pain. Among these drugs, lidocame is the most effective, whereas fentanyl is the least effective. C1 Trakya Univ, Dept Anaesthesiol, Edirne, Turkey. Trakya Univ, Dept Biostat, Edirne, Turkey. RP Memis, D (reprint author), Trakya Univ, Fac Med, Dept Anesthesiol & Reanimat, TR-22030 Edirne, Turkey. NR 24 TC 33 Z9 38 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUN PY 2002 VL 94 IS 6 BP 1517 EP 1520 DI 10.1097/00000539-200206000-00026 PG 4 WC Anesthesiology SC Anesthesiology GA 557CZ UT WOS:000175890900027 ER PT J AU Tarver, GJ Grove, SJA Buchanan, K Bom, A Cooke, A Rutherford, SJ Zhang, MQ AF Tarver, GJ Grove, SJA Buchanan, K Bom, A Cooke, A Rutherford, SJ Zhang, MQ TI 2-O-substituted cyclodextrins as reversal agents for the neuromuscular blocker rocuronium bromide SO BIOORGANIC & MEDICINAL CHEMISTRY LA English DT Article AB A series of secondary face modified cyclodextrins (CDs) were synthesised with the aim of constructing host molecules capable of forming host-guest complexes with neuromuscular blockers, especially with rocuronium bromide. Perfacial 2-O-substitution of gamma-CD with 4-carboxybenzyl resulted in a CD host molecule I that forms a 1:1 binary complex with rocuronium bromide (K-a 6.2 x 10(5) M-1). The biological activities of this compound and other derivatives as reversal agents of rocuronium bromide were examined in vitro (mouse hemi-diaphragm) and in vivo (anaesthetized guinea pigs). The host molecule I was found to exert potent reversal activity (ED50 0.21 mumol/kg, iv) against rocuronium-induced neuromuscular block, and thus proved the viability of using host molecules as antidotes of a biologically active compound. (C) 2002 Elsevier Science Ltd. All rights reserved. C1 Organon Res Labs Ltd, Dept Med Chem, Newhouse ML1 5SH, Lanark, Scotland. Organon Res Labs Ltd, Dept Pharmacol, Newhouse ML1 5SH, Lanark, Scotland. Organon Res Labs Ltd, Dept Analyt Chem, Newhouse ML1 5SH, Lanark, Scotland. RP Zhang, MQ (reprint author), Shire BioChem Inc, 275 Armand Frappier Blvd, Laval, PQ H7V 4A7, Canada. NR 13 TC 26 Z9 27 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0968-0896 J9 BIOORGAN MED CHEM JI Bioorg. Med. Chem. PD JUN PY 2002 VL 10 IS 6 BP 1819 EP 1827 DI 10.1016/S0968-0896(02)00026-3 PG 9 WC Biochemistry & Molecular Biology; Chemistry, Medicinal; Chemistry, Organic SC Biochemistry & Molecular Biology; Pharmacology & Pharmacy; Chemistry GA 540YY UT WOS:000174959500018 ER PT J AU Gao, L Ramzan, I Baker, B AF Gao, L Ramzan, I Baker, B TI Rocuronium plasma concentrations during three phases of liver transplantation: relationship with early postoperative graft liver function SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rocuronium; liver, transplantation; liver, function; pharmacokinetics, rocuronium ID INDUCED NEUROMUSCULAR BLOCK; BROMIDE ORG-9426; TIME-COURSE; PHARMACOKINETICS; VECURONIUM; PHARMACODYNAMICS; PREDICTOR; EXCRETION; DURATION; BILIARY AB Background. Previous studies have suggested that neuromuscular blocking agents might be used to assess liver function during liver transplantation. This study examines changes in rocuronium plasma concentration during liver transplantation, to assess graft function. Methods. A constant-rate infusion of rocuronium was administered to 17 adult patients undergoing liver transplantation. Blood samples were taken at 30-min intervals throughout the procedure, which was divided into three phases: paleo-, an-, and neohepatic. Assay of plasma concentrations of rocuronium was by a gas chromatographic-mass spectrometry technique. Postoperative liver function was followed for up to five days by measuring plasma aminotransferases. Results. In 14 of the 15 patients who survived the transplantation procedure, there was a 7-50% decrease in rocuronium concentration during the neohepatic phase compared with the anhepatic phase. In contrast, rocuronium concentrations increased in the two patients who died after surgery, one as a result of primary non-function and one from massive bleeding. In one patient who survived there was no change in rocuronium concentration. The increase in plasma rocuronium concentration during the neohepatic phase in the two patients who died was consistent with high levels of plasma aminotransferases. Conclusions. Comparison of changes in plasma rocuronium concentration during the neohepatic phase with early postoperative liver function tests suggests the potential use of rocuronium as a pharmacokinetic probe for predicting liver function during liver transplantation. Further study of rocuronium's potential as an intraoperative pharmacodynamic probe of liver function by measuring neuromuscular paralysis is suggested. C1 Univ Sydney, Dept Anaesthesia D06, Sydney, NSW 2006, Australia. Univ Sydney, Fac Pharm, Sydney, NSW 2006, Australia. RP Baker, B (reprint author), Univ Sydney, Dept Anaesthesia D06, Sydney, NSW 2006, Australia. NR 16 TC 3 Z9 7 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JUN PY 2002 VL 88 IS 6 BP 764 EP 770 DI 10.1093/bja/88.6.764 PG 7 WC Anesthesiology SC Anesthesiology GA 557MW UT WOS:000175913200004 ER PT J AU Wedig, M Novatchev, N Worch, T Laug, S Holzgrabe, U AF Wedig, M Novatchev, N Worch, T Laug, S Holzgrabe, U TI Evaluation of the impurity profile of alcuronium by means of capillary electrophoresis SO JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS LA English DT Article DE impurity profile of alcuronium; capillary electrophoresis ID CARACURINE-V AB Alcuronium, a neuromuscular blocking drug, was recently introduced to the European Pharmacopoeia. A HPLC method is described to limit the impurities of alcuronium, namely the diallylcaracurine (DAC) and the allyl-Wieland-Gumlich-aidehyde (WCA), to less than 0.5%. Since alcuronium and all impurities are quaternary salts, capillary electrophoresis (CE) is highly suitable to evaluate the impurity profile. Using 12 mM heptakis-(2,6-di-O-methyl)-beta-cyclodextrin in a 50 mM phosphate buffer at pH 5.5 or 50 mM diethanolamine buffer (pH 9.2)-acetonitrile 19:1 containing heptakis-(2,3-O-diacetyl-6-sulfo)-beta-cyclodextrin the impurities could be baseline separated and quantified. The limit of detection for DAC and WCA was found to be in the same range as found with HPLC; thus, less than 0.1% of both DAC and WCA could be detected in the solution for injection in presence of alcuronium. In injection solutions of alcuronium which were stored at higher temperatures three additional, unidentified impurities were detected. In addition, the conversion of alcuronium to DAC, occurring under acidic condition, was monitored by means of the CE method developed. (C) 2002 Elsevier Science B.V. All rights reserved. C1 Univ Wurzburg, Inst Pharm & Food Chem, D-97074 Wurzburg, Germany. RP Holzgrabe, U (reprint author), Univ Wurzburg, Inst Pharm & Food Chem, D-97074 Wurzburg, Germany. NR 13 TC 5 Z9 5 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0731-7085 J9 J PHARMACEUT BIOMED JI J. Pharm. Biomed. Anal. PD JUN 1 PY 2002 VL 28 IS 5 BP 983 EP 990 DI 10.1016/S0731-7085(02)00052-3 PG 8 WC Chemistry, Analytical; Pharmacology & Pharmacy SC Chemistry; Pharmacology & Pharmacy GA 562PJ UT WOS:000176207800021 ER PT J AU Takagi, S Adachi, YU Saubermann, AJ Vizi, ES AF Takagi, S Adachi, YU Saubermann, AJ Vizi, ES TI Presynaptic inhibitory effects of rocuronium and SZ1677 on [H-3] acetylcholine release from the mouse hemidiaphragm preparation SO NEUROCHEMISTRY INTERNATIONAL LA English DT Article DE rocuroniuni; SZ1677; presynaptic effect; neuromuscular junction; ACh release ID NEUROMUSCULAR BLOCKING-DRUGS; RAT PHRENIC-NERVE; NONDEPOLARIZING MUSCLE-RELAXANTS; MUSCARINIC RECEPTORS; ALPHA-BUNGAROTOXIN; TRANSMITTER RELEASE; JUNCTION; FEEDBACK; AGENTS AB It has been shown that nondepolarizing muscle relaxants may have effects on nicotinic acetylcholine receptors (nAChRs) other than those located on the skeletal muscle: some of them possess inhibitory effects on neuronal nAChRs [Anesth. Analg. 59 (1980) 935; Trends Pharmacol, Sci. 9 (1988) 16; Pharmacol. Ther. 73 (1997) 75]. It was shown that, e.g. (+)-tubocurarine and pancuronium are able to inhibit ACh release from the axon terminals of hemidiaphragm preparations and produce tetanic fade indicating their presynaptic effect. In this study rocuronium, a nondepolarizing steroidal muscle relaxant with shorter onset of action, and SZ1677 [1-(3alpha-hydroxy-17beta-acetyloxy)-2beta-(1,4-dioxa-8-azaspiro-[4,5]-dec-8-yl)-(5alpha-androstane-16beta-yl)-1-(2-propenyl) pyrrolidinium bromide], a short-acting muscle relaxant [Anti. New York Acad. Sci. 757 (1995b) 84] inhibited the release of ACh in response to axonal stimulation, while alpha-bungarotoxin failed to reduce the stimulation evoked release of ACh and did not produce tetanic fade. These results indicate that in addition to their postsynaptic effect, rocuronium and SZ1677 have presynaptic inhibitory effects on neuronal nAChRs at the neuromuscular junction. The finding that alpha-bungarotoxin does not inhibit the release and does not produce tetanic fade indicates that it possesses affinity only for the postsynaptic muscle nAChRs. (C) 2002 Elsevier Science Ltd. All rights reserved. C1 Hungarian Acad Sci, Inst Expt Med, H-1450 Budapest, Hungary. Montefiore Med Ctr, Albert Einstein Coll Med, Dept Anesthesiol, Bronx, NY 10461 USA. RP Vizi, ES (reprint author), Hungarian Acad Sci, Inst Expt Med, POB 67, H-1450 Budapest, Hungary. NR 35 TC 5 Z9 8 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0197-0186 J9 NEUROCHEM INT JI Neurochem. Int. PD JUN PY 2002 VL 40 IS 7 BP 655 EP 659 DI 10.1016/S0197-0186(01)00111-5 PG 5 WC Biochemistry & Molecular Biology; Neurosciences SC Biochemistry & Molecular Biology; Neurosciences & Neurology GA 552FW UT WOS:000175609600009 ER PT J AU Jonsson, M Kim, C Yamamoto, Y Runold, M Lindahl, SGE Eriksson, LI AF Jonsson, M Kim, C Yamamoto, Y Runold, M Lindahl, SGE Eriksson, LI TI Atracurium and vecuronium block nicotine-induced carotid body chemoreceptor responses SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE atracurium; carotid body; neuromuscular blocking agents; nicotine; rabbit; vecuronium ID PARTIAL NEUROMUSCULAR BLOCK; ACETYLCHOLINE-RECEPTORS; VENTILATORY RESPONSE; CAT; HYPOXIA; PANCURONIUM; RABBIT AB Background: Vecuronium depresses carotid body chemosensitivity during hypoxia. We hypothesized that this is caused by inhibition of cholinergic transmission of the carotid body. Methods: The carotid body with its sinus nerve was removed en bloc from thiopentone-anaesthetized adult male New Zealand rabbits and perfused in vitro with modified Tyrodes buffer solution at constant perfusion pressure, temperature, a buffer pH of 7.4 and normocapnia. Chemoreceptor discharge and spike frequencies (fx) were recorded from the whole sinus nerve after administration of 500mug nicotine, given as duplicated controls and thereafter following 30 min perfusion of equipotent concentrations of atracurium (28.1 muM) or vecuronium(10 muM), after 30 min of neostigmine perfusion. (9.2 muM) and finally after 30min wash-out with buffer solution only. A short-lasting hypoxic test 0 was performed before and at the end of the experimental period to confirm the responsiveness and validity of the preparation. Results: Atracurium (n = 7) and vecuronium (n = 6) reduced chemoreceptor responses to nicotine by 70+/-30% and 66+/-19% (SEM) (P<0.05). Chemoreceptor discharges showed full recovery after neostigmine in the atracurium group and partial recovery in the vecuronium group (P<0.05). Finally, after wash-out the chemoreceptor responses to nicotine had fully recovered in both groups. Conclusion: Atracurium and vecuronium in equipotent concentrations block nicotine-induced chemoreceptor responses of the carotid body. C1 Karolinska Hosp & Inst, Dept Anesthesiol & Intens Care Med, Stockholm, Sweden. Karolinska Hosp & Inst, Dept Pulm Med, Stockholm, Sweden. Nippon Med Coll, Dept Anesthesiol, Tokyo 113, Japan. RP Jonsson, M (reprint author), Karolinska Hosp, Dept Anaesthesiol & Intens Care, SE-17176 Stockholm, Sweden. EM Malin.Jonsson@ks.se NR 22 TC 16 Z9 16 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2002 VL 46 IS 5 BP 488 EP 494 DI 10.1034/j.1399-6576.2002.460503.x PG 7 WC Anesthesiology SC Anesthesiology GA 556FN UT WOS:000175838900003 ER PT J AU Ostergaard, D Gatke, MR Berg, H Rasmussen, SN Viby-Mogensen, J AF Ostergaard, D Gatke, MR Berg, H Rasmussen, SN Viby-Mogensen, J TI The pharmacodynamics and pharmacokinetics of mivacurium in children SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE butyrylcholinesterase; children; cholinesterase; mivacurium; neuromuscular relaxants; pharmacodynamics; pharmacokinetics; pseudocholinesterase ID NEUROMUSCULAR BLOCKING-AGENTS; CHLORIDE BW B1090U; HUMAN PLASMA; ANESTHESIA; PHARMACOLOGY; SEVOFLURANE; HALOTHANE; ISOMERS; DRUG AB Background: In children, onset time and duration of action of mivacurium are shorter than in adults. Some suggest that this is due to differences in plasma cholinesterase (pChe), whereas others indicate that there is no difference. The purpose of this study was to evaluate the pharmacodynamics and pharmacokinetics of mivacurium in phenotypically normal children aged 3-6 and 10-14years old, respectively. Methods: Ten children aged 3-6 years and 10 children aged 10-14years were studied during halothane anaesthesia. Before induction of anaesthesia, a bloodsample was drawn to measure the pChe activity and phenotype. The neuromuscular block was monitored. at the thumb using train-of-four (TOF) nerve stimulation every 12s and mechanomyography. The times to different levels of neuromuscular recovery following n-Livacurium 0.2 mg/kg were recorded. The concentrations in venous blood of the three isomers and the metabolites of n-mivacurium were measured. Results: No statistically significant difference was found in pChe activity or in the pharmacodynamics of mivacurium. The onset time was 1.4min (0.8-1.9) median (range) and 1.3 min (1.1-1.9) and the time to first response to TOF nerve stimulation was 9.6n-Lin (6.5-12.6) and 10.5min (7.0-14.0) in young and older children, respectively. The pharmacokinetic data were too sparse to allow analysis of the two age groups separately (8 and 8 patients), hence the data were pooled. The median clearances of the cis-cis, the cis-trans, and the trans-trans isomer were 5.5, 51.0 and 30.5n-d/kg/min, respectively. Conclusion: Our data indicate that there are no major differences in pharmacodynamics or pharmacokinetics of mivacurium between young (3-6years) and older (10-14years) children. C1 Univ Copenhagen, Herlev Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark. Copenhagen Univ Hosp, Danish Cholinesterase Res Unit, Dept Anaesthesia & Intens Care, Rigshosp, Copenhagen, Denmark. Royal Danish Sch Pharm, Dept Pharmacol, Copenhagen, Denmark. RP Ostergaard, D (reprint author), Univ Copenhagen, Herlev Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark. NR 24 TC 2 Z9 3 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2002 VL 46 IS 5 BP 512 EP 518 DI 10.1034/j.1399-6576.2002.460507.x PG 7 WC Anesthesiology SC Anesthesiology GA 556FN UT WOS:000175838900007 ER PT J AU Soltesz, S Silomon, M Mencke, T Schlaich, N Fuchs-Buder, T AF Soltesz, S Silomon, M Mencke, T Schlaich, N Fuchs-Buder, T TI Neuromuscular blockade with cisatracurium in infants and children SO ANAESTHESIST LA German DT Article DE neuromuscular blocking agents; cisatracurium; pediatric anesthesia; infants; electromyography ID DOSE-RESPONSE RELATIONSHIP; CONTROLLED CLINICAL-TRIAL; PEDIATRIC-PATIENTS; BLOCKING-AGENTS; ANESTHESIA; ROCURONIUM; ATRACURIUM; DESFLURANE; ISOFLURANE; PHARMACOKINETICS AB Objective. To compare the onset, duration and maximum effect of 0.1 mg/kg cisatracurium during balanced anesthesia with sevoflurane and remifentanil between infants and children. Methods. We measured the time course of the neuromuscular blockade in 15 infants and 15 children by electromyography. Anesthesia was induced with propofol/ remifentanil and maintained with sevoflurane (constant 2% endtidal) and remifentanil according to the patients individual requirements. After injection of 0.1 mg/kg cisatracurium we measured the following parameters: onset time: time between the beginning of injection of cisatracurium and maximum T, depression, clinical duration: time between injection of the drug and recovery of T, to 25%, recovery index: time between recovery of T, from 25% to 75%. TOFR 0.9: time between injection of cisatracurium and recovery of the train-of-four ratio to 90%. In addition, we determined the maximum neuromuscular blockade Tmax after 0.1 mg/kg cistracurium. Results. Both groups differed significantly with regard to onset time and clinical duration. In the infants,the onset time was shorter (74 s vs. 198 s) and the clinical duration longer (55 min vs. 41 min) compared to the older children. The TOFR 0.9 was 73 min (range 56-86 min) in the group of the infants and 59 min (range 43-72 min) in the group of the older children (p<0.001). Tmax was 100% (range 97-100%) in the infants and 98% (range 92-100%) in the children (p<0.01). However, the recovery index was comparable in both groups (21 vs. 16 min). Conclusions. Infants are substantially more sensitive to cisatracurium than children,which can be demonstrated in a significantly shorter onset time, a prolonged clinical duration and a delayed neuromuscular recovery. As there exist large interindividual differences,we recommend the use of neuromuscular monitoring in the routine practice of pediatric anesthesia. C1 Klinikum Leverkusen GMBH, Klin Anasthesie & Operat Intens Med, D-51375 Leverkusen, Germany. Univ Saarland, Klin Anaesthesiol & Intens Med, Homburg, Germany. RP Soltesz, S (reprint author), Klinikum Leverkusen GMBH, Klin Anasthesie & Operat Intens Med, Dhunnberg 60, D-51375 Leverkusen, Germany. NR 19 TC 4 Z9 4 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD MAY PY 2002 VL 51 IS 5 BP 374 EP 377 DI 10.1007/s00101-002-0304-y PG 4 WC Anesthesiology SC Anesthesiology GA 560FF UT WOS:000176071500005 ER PT J AU Delboy, NJ Tomichek, RC Shields, JA AF Delboy, NJ Tomichek, RC Shields, JA TI The hemodynamic effects of rapacuronium in patients with coronary artery disease: Succinylcholine and vecuronium compared SO ANESTHESIA AND ANALGESIA LA English DT Article ID RAPID-SEQUENCE INDUCTION; ADULT PATIENTS; NEUROMUSCULAR BLOCKING; ORG-9487; ANESTHESIA; FENTANYL; HUMANS AB Rapacuronium is a nondepolarizing muscle relaxant similar in structure to pancuronium, rocuronium, and vecuronium. Rapacuronium has a mild to moderate effect on heart rate and arterial blood pressure in ASA physical status I and 11 patients. However, rapacuronium was often administered after, e.g., thiopental, an inhaled anesthetic, and fentanyl, thus modifying or masking the hemodynamic effects of rapacuronium. In this study, we investigated the hemodynamic effects of rapacuronium and compared its effects with those of vecuronium and succinylcholine. Sixty patients scheduled to undergo routine coronary artery bypass grafting were selected to receive rapacuronium 1.5 mg/kg, vecuronium 0.1 mg/kg, or succinylcholine 1 mg/kg. Heart rate, blood pressure, pulmonary artery pressures, and cardiac index were measured at 30- and 60-s internals during the 2 min after the induction of anesthesia with diazepam and for a 3-min period after study drug administration. The Rapacuronium group exhibited significantly larger decreases inblood pressure and systemic vascular resistance than the Vecuronium or Succinylcholine groups. One patient in the Rapacuronium group experienced cutaneous flushing associated with a 33% decrease in blood pressure. C1 St Thomas Hosp, Div Cardiothorac Anesthesia, Nashville, TN USA. RP Shields, JA (reprint author), 9554 Normandy Way, Brentwood, TN 37027 USA. NR 19 TC 0 Z9 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 2002 VL 94 IS 5 BP 1100 EP 1106 DI 10.1097/00000539-200205000-00008 PG 7 WC Anesthesiology SC Anesthesiology GA 546QH UT WOS:000175284500008 ER PT J AU Baykara, N Woelfel, S Fine, GF Solak, M Toker, K Brandom, BW AF Baykara, N Woelfel, S Fine, GF Solak, M Toker, K Brandom, BW TI Predicting recovery from deep neuromuscular block by rocuronium in children and adults SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE monitoring; accelerometry posttetanic count, train-of-four; neuromuscular relaxants : rocuronium; pediatrics : children ID POST-TETANIC COUNT; TRANSMISSION; VECURONIUM; ATRACURIUM; MIVACURIUM; INFANT; PTC AB Study Objective: To compare the response to motor nerve stimulation at a rate of 1 HZ after 50 Hz tetanus [posttetanic count (PTC)] and 2 Hz for 2 seconds [train-of-four (TOF)] in children and adults during spontaneous recovery from blockade caused by rocuronium. Design: Prospective, clinical, observational, multicenter study. Setting: Operating rooms of two university hospitals. Patients: 22 children (ASA physical status I and 17) aged 2 to 5 years, scheduled to undergo dental treatment and 20 adults aged 18 to 60 years, scheduled to undergo elective general or orthopedic surgery during general anesthesia with tracheal intubation. Measurements: Neuromuscular blockade was evaluated with accelerometry of the thumb, using PTC and TOF stimulation of the ulnar nerve, in patients who received rocuronium 1 mg . kg(-1). Main Results: The first response to posttetanic and TOT, nerve stimulation appeared earlier in children than in adults. The time from injection of rocuronium to appearance of the fourth response to TOF ranged from 27 to 62 minutes in children and from 37 to 94 minutes in adults. The average interval between the appearance of a posttetanic response and the first detectable response to TOF stimulation (T1) was also shorter in children, 7 minutes, than in adults, 16 minutes. The relationship between PTC and the time interval between a given PTC and the first detectable TOT response in both children and adults was exponential (R = -0.64 and R = -0.81, respectively). Conclusions: Children recover faster than adults from neuromuscular blockade after administration of 1 mg . kg(-1) rocuronium. The relationship between PTC and time to first response to TOF is exponential both in children and adults during recovery from neuromuscular blockade caused by rocuronium. (C) 2002 by Elsevier Science Inc. C1 Univ Kocaeli, Sch Med, Dept Anesthesiol, Kocaeli, Turkey. RP Baykara, N (reprint author), Tubitak Lojmanlari 4A, Gebze, Turkey. NR 20 TC 6 Z9 6 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAY PY 2002 VL 14 IS 3 BP 214 EP 217 DI 10.1016/S0952-8180(02)00346-X PG 4 WC Anesthesiology SC Anesthesiology GA 555XJ UT WOS:000175818300012 ER PT J AU Hepaguslar, H Oztekin, S Mavioglu, O Tuncali, B Elar, Z AF Hepaguslar, H Oztekin, S Mavioglu, O Tuncali, B Elar, Z TI The effect of midazolam pre-medication on rocuronium-induced neuromuscular blockade SO JOURNAL OF INTERNATIONAL MEDICAL RESEARCH LA English DT Article DE midazolam; rocuronium; drug interactions; neuromuscular responses ID BLOCKING-DRUGS; BENZODIAZEPINES; CAT AB We investigated the effect of midazolam pre-medication on rocuronium-induced neuromuscular blockade during sevoflurane anaesthesia. Twenty-two patients scheduled for elective surgery were randomly divided to receive either no pre-medication (control group) or pre-medication with 0.1 mg/kg midazolam intramuscularly (midazolam group). Anaesthesia was induced with fentanyl and propofol, and maintained with sevoflurane and nitrous oxide in oxygen. Neuromuscular responses were monitored using acceleromyography. The onset and clinical duration of action, time to recovery of first twitch of train-of-four (TOF) response to 75% of control, recovery index and time for TOF recovery to 25% and 50% were recorded. Patient-related data were similar in both groups. The parameters recorded were not significantly different between the groups. Midazolam pre-medication does not influence the time-course of action of rocuronium during sevoflurane anaesthesia. C1 Dokuz Eylul Univ Hosp, Dept Anaesthesiol, Izmir, Turkey. RP Hepaguslar, H (reprint author), 1463 Sok,No 22-2, TR-35220 Alsancak, Turkey. NR 8 TC 0 Z9 0 PU CAMBRIDGE MED PUBL PI WORTHING PA WICKER HOUSE, HIGH ST, WORTHING BN11 1DJ, W SUSSEX, ENGLAND SN 0300-0605 J9 J INT MED RES JI J. Int. Med. Res. PD MAY-JUN PY 2002 VL 30 IS 3 BP 318 EP 321 PG 4 WC Medicine, Research & Experimental; Pharmacology & Pharmacy SC Research & Experimental Medicine; Pharmacology & Pharmacy GA 573CN UT WOS:000176811900014 ER PT J AU Zahn, K Eckstein, N Trankle, C Sadee, W Mohr, K AF Zahn, K Eckstein, N Trankle, C Sadee, W Mohr, K TI Allosteric modulation of muscarinic receptor signaling: Alcuronium-induced conversion of pilocarpine from an agonist into an antagonist SO JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS LA English DT Article ID ACETYLCHOLINE-RECEPTORS; POSITIVE COOPERATIVITY; N-METHYLSCOPOLAMINE; BINDING-SITES; M-2 RECEPTORS; CHO CELLS; INHIBITION; GALLAMINE; BRUCINE; ACTIVATION AB Previous studies on allosteric interactions at muscarinic receptors have often focused on ligand-receptor binding interactions, because ligand binding seemed to reflect functional consequences. The prototypal allosteric agent alcuronium is known to bind with similar affinity to the M-2 subtype of muscarinic acetylcholine receptors whether or not the receptors are occupied by the agonist pilocarpine. To determine allosteric modulation of receptor signaling by alcuronium, the effects of pilocarpine were measured in contracting guinea pig left atria and on G-protein coupling in M-2-transfected Chinese hamster ovary (CHO) cell membranes. Alcuronium dose-dependently suppressed pilocarpine-induced reduction of isometric contraction force in atria (pIC(50), (Alc) = 5.63) without any effect on the EC50 of pilocarpine, consistent with an allosteric mechanism. In contrast, alcuronium shifted the concentration-effect curve of the agonist oxotremorine M to the right without affecting the maximal effect, in a formally competitive manner (pK(A, Alc) = 5.54). If pilocarpine remained receptor bound in the presence of alcuronium, this indicates that pilocarpine can no longer act as an agonist. In support of this hypothesis, pilocarpine acted as a competitive antagonist against oxotremorine M in the presence of 10 muM alcuronium. Measuring guanosine 5'-O-(3-[S-35] thio) triphosphate ([S-35]GTPgammaS) binding in CHO-M-2 membranes yielded similar results. Alcuronium suppressed pilocarpine-induced stimulation of [S-35]GTPgammaS binding (pIC(50, Alc) = 5.47) without shift in EC50, whereas it competitively shifted the response to oxotremorine M (pK(A, Alc) = 5.97). [H-3]Oxotremorine M binding data corresponded with the functional findings. In conclusion, alcuronium converted the agonist pilocarpine into an antagonist-a novel type of functional allosteric interaction. C1 Univ Bonn, Inst Pharm, Dept Pharmacol & Toxicol, D-53121 Bonn, Germany. Univ Calif San Francisco, Dept Biopharmaceut Sci & Pharmaceut Chem, San Francisco, CA 94143 USA. RP Mohr, K (reprint author), Univ Bonn, Inst Pharm, Dept Pharmacol & Toxicol, Immenburg 4, D-53121 Bonn, Germany. NR 40 TC 34 Z9 37 PU AMER SOC PHARMACOLOGY EXPERIMENTAL THERAPEUTICS PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0022-3565 J9 J PHARMACOL EXP THER JI J. Pharmacol. Exp. Ther. PD MAY PY 2002 VL 301 IS 2 BP 720 EP 728 DI 10.1124/jpet.301.2.720 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 543ZB UT WOS:000175132800042 ER PT J AU Holm, E Roos, P Aarkrog, A Mitchell, P Vintro, LL AF Holm, E Roos, P Aarkrog, A Mitchell, P Vintro, LL TI Curium isotopes in Chernobyl fallout SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY LA English DT Article; Proceedings Paper CT 8th International Conference on Low-Level Measurements of Actinides in Biological and Environmental Samples CY OCT 16-20, 2000 CL OARAI, JAPAN AB In nuclear reactors plutonium and transplutonium isotopes are produced by multiple neutron capture of uranium and plutonium and are important for the energy production and their composition reflects the core burnout. Under normal operation these elements are not released to the environment in significant amounts. There are accordingly very few areas or source terms where exotic transplutonium elements, such as curium isotopes, can be studied in the environment. The Chernobyl accident provided a complex spectrum of fission and activation products in fallout while the relative amounts, compared to the core inventory, of refractory elements such as transuranium and transplutonium elements were small. The major alpha-activity consisted of (242)Cm (T(1/2)=163 d) that would have decayed after a few years. In this study we have demonstrated the presence of so called "supported (242)Cm" from the long-lived (242)Am(m) (T(1/2)=141 a) in environmental samples, following fallout from the Chernobyl accident. It has also been possible to assess the core burn up by using the data obtained for the Cm isotopes. The curium isotopes (243)Cm (T(1/2)=29.1 a) and (244)Cm (T(1/2)=18.1 a) cannot be resolved by conventional alpha-spectrometry. The assessment of these isotopes in environmental samples contaminated from the Chernobyl accident has been made by studying the effective half-life of the mixture of the isotopes. The data are compared with those previously obtained by high-resolution alpha-spectrometry and spectral deconvolution. C1 Risoe Natl Lab, Roskilde, Denmark. Lund Univ, Dept Radiat Phys, S-22101 Lund, Sweden. Univ Coll Dublin, Dept Expt Phys, Radiat Phys Res Lab, Dublin 2, Ireland. RP Holm, E (reprint author), Risoe Natl Lab, Roskilde, Denmark. NR 12 TC 3 Z9 3 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0236-5731 J9 J RADIOANAL NUCL CH JI J. Radioanal. Nucl. Chem. PD MAY PY 2002 VL 252 IS 2 BP 211 EP 214 DI 10.1023/A:1015786431984 PG 4 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 553QV UT WOS:000175687700002 ER PT J AU Adam, JM Bennett, DJ Bom, A Clark, JK Feilden, H Hutchinson, EJ Palin, R Prosser, A Rees, DC Rosair, GM Stevenson, D Tarver, GJ Zhang, MQ AF Adam, JM Bennett, DJ Bom, A Clark, JK Feilden, H Hutchinson, EJ Palin, R Prosser, A Rees, DC Rosair, GM Stevenson, D Tarver, GJ Zhang, MQ TI Cyclodextrin-derived host molecules as reversal agents for the neuromuscular blocker rocuronium bromide: Synthesis and structure-activity relationships SO JOURNAL OF MEDICINAL CHEMISTRY LA English DT Article ID BETA-CYCLODEXTRINS; DERIVATIVES; DRUGS AB A series of mono- and per-6-substituted cyclodextrin derivatives were synthesized as synthetic receptors (or host molecules) of rocuronium bromide, the most widely used neuromuscular blocker in anaesthesia. By forming host-guest complexes with rocuronium, these cyclodextrin derivatives reverse the muscle relaxation induced by rocuronium in vitro and in vivo and therefore can be used as reversal agents of the neuromuscular blocker to assist rapid recovery of patients after surgery. Because this supramolecular mechanism of action does not involve direct interaction with the cholinergic system, the reversal by these compounds, e.g., compound 14 (Org 25969), is not accompanied by cardiovascular side effects usually attendant with acetylcholinesterase inhibitors such as neostigmine. The structure-activity relationships are consistent with this supramolecular mechanism of action and are discussed herein. These include the effects of binding cavity size and hydrophobic and electrostatic interaction on the reversal activities of these compounds. C1 Organon Res Labs Ltd, Dept Med Chem, Newhouse ML1 5SH, Scotland. Organon Res Labs Ltd, Dept Pharmacol, Newhouse ML1 5SH, Scotland. Heriot Watt Univ, Dept Chem, Edinburgh EH14 4AS, Midlothian, Scotland. RP Zhang, MQ (reprint author), Shire BioChem Inc, 275 Armand Frappier Blvd, Laval, PQ H7V 4A7, Canada. NR 26 TC 86 Z9 90 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0022-2623 J9 J MED CHEM JI J. Med. Chem. PD APR 25 PY 2002 VL 45 IS 9 BP 1806 EP 1816 DI 10.1021/jm011107f PG 11 WC Chemistry, Medicinal SC Pharmacology & Pharmacy GA 544PG UT WOS:000175168700009 ER PT J AU Puhringer, EK Heier, T Dodgson, M Erkola, O Goonetilleke, P Hofmockel, R Gaetke, MR Mortensen, CR Upadhyaya, B Eriksson, LI AF Puhringer, EK Heier, T Dodgson, M Erkola, O Goonetilleke, P Hofmockel, R Gaetke, MR Mortensen, CR Upadhyaya, B Eriksson, LI TI Double-blind comparison of the variability in spontaneous recovery of cisatracurium- and vecuronium-induced neuromuscular block in adult and elderly patients SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE cisatracurium; vecuronium; age; recovery; variability; predictability ID OPIOID BARBITURATE ANESTHESIA; SURGICAL PATIENTS; ELIMINATION; 51W89; PHARMACODYNAMICS; PHARMACOKINETICS AB Background: This study was designed to compare variability in the offset of two neuromuscular blocking agents with different elimination pathways. Methods: The spontaneous recovery profiles of cisatracurium. and vecuronium were compared in adult (18-64years) and elderly ( greater than or equal to65years) patients receiving N2O/O-2/fentanyl/propofol anaesthesia. Patients were randomised to receive an initial bolus dose and maintenance doses of 3xED(95), respectively, 0.6xED(95) for cisatracurium (0.15 and 0.03mg.kg(-1)) or 2xED(95), respectively, and 0.4xED(95) for vecuronium (0.1 and 0.02 mg.kg(-1)), as recommended in their prescribing information. Administration of the study drugs was double-blinded, and neuromuscular transmission was monitored using mechanomyography of the evoked response of the adductor pollicis, following ulnar nerve stimulation. Results: The clinically effective duration (minutes) of the initial bolus dose, defined as the mean time to 25% T-1 recovery (+/-SD), for the adult and elderly patients was 53.5+/-9.8 and 57.3+/-11.5 for cisatracurium, respectively, and 34.1+/-9.0 and 47.5+/-14.4 for vecuronium, respectively. The duration of spontaneous sufficient recovery (SSR), defined as the mean (+/-SD) time interval in minutes from 25% T-1 recovery to a T-4:T-1 ratio greater than or equal to0.8 after the last bolus dose, for the adult, respectively, elderly patients was 28.3+/-8.0 and 31.7+/-10.0 for cisatracurium and 38.5+/-13.2 and 60.3+/-26.1 for vecurordum. Conclusion: Whereas both the clinically effective duration and the duration of SSR are comparable between the adult and the elderly patients receiving cisatracurium, they differ substantially between these two age groups for vecuronium. Furthermore, the variability in offset is significantly lower in patients receiving cisatracurium, especially in the elderly, which may be of particular clinical interest. C1 Kreisklinikum Reutlingen, Klin Anaesthesiol & Operat Intensivmed, D-72764 Reutlingen, Germany. Univ Klin Innsbruck, Innsbruck, Austria. Ulleval Hosp, Oslo, Norway. Natl Hosp Norway, Oslo, Norway. Marias Hosp, Helsinki, Finland. Royal Melbourne Hosp, Melbourne, Vic, Australia. Univ Rostock, D-2500 Rostock 1, Germany. Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark. Univ Copenhagen, Herlev Hosp, DK-1168 Copenhagen, Denmark. Karolinska Hosp, S-10401 Stockholm, Sweden. RP Puhringer, EK (reprint author), Kreisklinikum Reutlingen, Klin Anaesthesiol & Operat Intensivmed, Steinenbergstr 31, D-72764 Reutlingen, Germany. NR 13 TC 7 Z9 8 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD APR PY 2002 VL 46 IS 4 BP 364 EP 371 PG 8 WC Anesthesiology SC Anesthesiology GA 548AV UT WOS:000175366500006 ER PT J AU Vanacker, BF Geerts, E Coppens, S van Iersel, M AF Vanacker, BF Geerts, E Coppens, S van Iersel, M TI A comparison of neuromuscular effects, tracheal intubating conditions, and reversibility of rapacuronium versus mivacurium in female patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID MUSCLE-RELAXANT; BLOCKING-AGENTS; ORG-9487; SUCCINYLCHOLINE; ROCURONIUM C1 Katholieke Univ Leuven, Univ Hosp, Dept Anesthesiol, B-3000 Louvain, Belgium. RP Vanacker, BF (reprint author), Katholieke Univ Leuven, Univ Hosp, Dept Anesthesiol, Herestr 49, B-3000 Louvain, Belgium. NR 11 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 2002 VL 94 IS 4 BP 876 EP 878 DI 10.1097/00000539-200204000-00019 PG 3 WC Anesthesiology SC Anesthesiology GA 533KK UT WOS:000174528600019 ER PT J AU Weindlmayr-Goettel, M Gilly, H Kress, HG AF Weindlmayr-Goettel, M Gilly, H Kress, HG TI Does ester hydrolysis change the in vitro degradation rate of cisatracurium and atracurium? SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, cisatracurium; neuromuscular block, atracurium; metabolism, Hofmann elimination; metabolism, ester hydrolysis ID CLINICAL PHARMACOKINETICS; INVITRO DEGRADATION; HUMAN-PLASMA; ELIMINATION; PH AB Background. We assessed the role of ester hydrolysis as an additional degradation mechanism to Hofmann elimination in the breakdown of cisatracurium and atracurium. Methods. Cisatracurium and atracurium were incubated in phosphate buffer (pH 7.4, 37degreesC) with and without the addition of carboxylesterase. Control measurements with an added esterase inhibitor were performed separately. Cisatracurium/atracurium and their degradation products, laudanosine and monoquaternary acid, were analysed using high-pressure liquid chromatography. Results. Degradation of cisatracurium and atracurium proceeded exponentially, and after addition of carboxylesterase, no significant differences in the degradation rates were found. Neither an increase in carboxylesterase activity nor the addition of esterase inhibitor showed any effect. However, areas under the peaks of the chromatogram representing monoquaternary acid increased during incubation with esterase. Conclusion. The rate-limiting step in the degradation of cisatracurium/atracurium is Hofmann elimination. Ester hydrolysis is involved in the second degradation step that forms monoquaternary acid, but its contribution to the total elimination rate is negligible. C1 Univ Vienna, Dept Anaesthesiol & Gen Intens Care B, A-1090 Vienna, Austria. L Boltzmann Inst Expt Anaesthesiol & Res Intens C, Vienna, Austria. RP Weindlmayr-Goettel, M (reprint author), Univ Vienna, Dept Anaesthesiol & Gen Intens Care B, Waehringer Guertel 18-20, A-1090 Vienna, Austria. NR 13 TC 5 Z9 5 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD APR PY 2002 VL 88 IS 4 BP 555 EP 562 DI 10.1093/bja/88.4.555 PG 8 WC Anesthesiology SC Anesthesiology GA 539CG UT WOS:000174851700016 ER PT J AU Baillard, C Korinek, AM Galanton, V Le Manach, Y Larmignat, P Cupa, M Samama, CM AF Baillard, C Korinek, AM Galanton, V Le Manach, Y Larmignat, P Cupa, M Samama, CM TI Anaphylaxis to rocuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rocuronium; complications, anaphylaxis ID ANESTHESIA; BROMIDE; DRUGS AB Reports about anaphylactic and anaphylactoid reactions to rocuronium have increased recently. We report two new cases of documented grade III anaphylaxis, leading to death in one patient. The first case occurred in an 81-year-old ASA II woman scheduled for emergency abdominal surgery. Severe hypotension and tachycardia were observed after rocuronium, without bronchospasm. Neosynephrine allowed rapid resuscitation, and the patient recovered fully. The second patient was a 64-year-old ASA II man scheduled for abdominal surgery. Severe haemodynamic instability and bronchospasm occurred after rocuronium. Despite immediate life support, the postoperative period was complicated by persistent low systolic pressure, acute respiratory distress syndrome, acute renal failure, disseminated intravascular coagulation and pancreatitis, leading to the death of the patient. C1 Hop Avicenne, Dept Anesthesia, F-93009 Bobigny, France. Hop La Pitie Salpetriere, Dept Anesthesie, Paris, France. RP Baillard, C (reprint author), Hop Avicenne, Dept Anesthesia, 125 Route Stalingrad, F-93009 Bobigny, France. NR 18 TC 12 Z9 13 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD APR PY 2002 VL 88 IS 4 BP 600 EP 602 DI 10.1093/bja/88.4.600 PG 3 WC Anesthesiology SC Anesthesiology GA 539CG UT WOS:000174851700027 ER PT J AU Dragne, A Varin, F Plaud, B Donati, F AF Dragne, A Varin, F Plaud, B Donati, F TI Rocuronium pharmacokinetic-pharmacodynamic relationship under stable propofol or isoflurane anesthesia SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID DOSE-RESPONSE; INTRAVENOUS ANESTHESIA; TIME-COURSE; BROMIDE; VECURONIUM; ORG-9426; DOXACURIUM; HALOTHANE; INFUSION; HUMANS AB Purpose: To compare the pharmacokinetics, pharmacodynamics and the concentration-effect relationship of rocuronium in patients under stable propofol or isoflurane anesthesia. Methods: Ten patients were randomized to receive fentanyl, propofol and nitrous oxide (60%) or fentanyl, thiopental, isoflurane (1.2% end-tidal concentration) and nitrous oxide (60%). To obtain good intubation conditions and maintain adequate muscle relaxation during surgery, patients received two bolus doses of rocuronium: 0.5 mg.kg(-1) (1.7 x ED95) at induction followed one hour later by 0.3 mg.kg(-1) (1 x ED95), Arterial blood samples were obtained over six hours after the second bolus dose. Plasma concentrations of rocuronium were measured using high pressure liquid chromatography. Muscle twitch tension was monitored by mechanomyography for the two doses, Pharmacokinetic and pharmacodynamic parameters were determined. Results: No differences in rocuronium pharmacokinetic parameters were observed between both groups. After the second bolus, clinical duration was 20 +/- 6 min in the propofol group vs 39 +/- 8 min in the isoflurane group (P < 0.05). The effect compartment concentration corresponding to 50% block, EC50. was higher under propofol anesthesia: 1008 vs 595 mug.L-1 (P < 0.05). Conclusion: Rocuronium body disposition is similar under stable propofol or isoflurane anesthesia. In contrast to isoflurane, propofol does not prolong the neuromuscular block. Therefore, the potentiating effect of isoflurane is of pharmacodynamic origin only, as explained by an increased sensitivity at the neuromuscular junction. In contrast with isoflurane anesthesia where the dose of rocuronium has to be decreased under stable conditions, no dose adjustment is required under propofol anesthesia. C1 Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. Univ Montreal, Dept Anesthesiol, Montreal, PQ, Canada. Ctr Hosp Univ Montreal, Hotel Dieu, Montreal, PQ, Canada. RP Varin, F (reprint author), Univ Montreal, Fac Pharm, CP 6128,Succursale Ctr Ville, Montreal, PQ H3C 3J7, Canada. NR 21 TC 16 Z9 18 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 2002 VL 49 IS 4 BP 353 EP 360 PG 8 WC Anesthesiology SC Anesthesiology GA 542ND UT WOS:000175049300005 ER PT J AU Cameron, KS Fletcher, D Fielding, L AF Cameron, KS Fletcher, D Fielding, L TI An NMR study of cyclodextrin complexes of the steroidal neuromuscular blocker drug Rocuronium Bromide SO MAGNETIC RESONANCE IN CHEMISTRY LA English DT Article DE NMR; H-1 NMR; C-13 NMR; host-guest chemistry; steroids; cyclodextrins; anaesthetics ID BETA-CYCLODEXTRIN; CONFORMATIONAL EQUILIBRIA; MOLECULAR RECOGNITION; URSODEOXYCHOLIC ACID; INCLUSION COMPLEXES; AMINO STEROIDS; 2-HYDROXYPROPYL-BETA-CYCLODEXTRIN; SPECTROSCOPY; DERIVATIVES; SENSORS AB The interaction of Rocuronium Bromide, and a model steroid Org 7402, with three cyclodextrins (beta-cyclodextrin, gamma-cyclodextrin and Org 25969) was studied by solution state NMR experiments. Stoichiometries and binding constants were determined from H-1 chemical shift titrations. All of the systems formed 1: 1 complexes. Most of the complexes were in fast exchange with unbound species on the NMR time scale, but the most tightly bound complex (Rocuronium Bromide-Org 25969) was in the slow exchange regime. The geometry of the complexes was inferred from H-1 and C-13 NMR shift changes upon complexation and from intramolecular NOE correlations. Rocuronium Bromide forms a weak complex with beta-cyclodextrin (K-a = 3.3 +/- 0.5 X 10(3) M-1) and no clear picture of the structure of the complex emerges. The complexes with gamma-cyclodextrin (K-a = 1.8 +/- 0.2 X 10(4) M-1) and Org 25969 (K-a > 10(5) M-1) are true inclusion complexes with the steroid located inside the central void of the cyclodextrin. Copyright (C) 2002 John Wiley Sons, Ltd. C1 Organon Res Labs Ltd, Akzo Nobel Pharma Div, Newhouse ML1 5SH, Lanark, Scotland. RP Fielding, L (reprint author), Organon Res Labs Ltd, Akzo Nobel Pharma Div, Newhouse ML1 5SH, Lanark, Scotland. NR 33 TC 21 Z9 23 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND SN 0749-1581 J9 MAGN RESON CHEM JI Magn. Reson. Chem. PD APR PY 2002 VL 40 IS 4 BP 251 EP 260 DI 10.1002/mrc.1008 PG 10 WC Chemistry, Multidisciplinary; Chemistry, Physical; Spectroscopy SC Chemistry; Spectroscopy GA 532TA UT WOS:000174490100002 ER PT J AU Zecevic, M Zivanovic, L Stojkovic, A AF Zecevic, M Zivanovic, L Stojkovic, A TI Validation of a high-performance liquid chromatography method for the determination of pancuronium in Pavulon injections SO JOURNAL OF CHROMATOGRAPHY A LA English DT Article; Proceedings Paper CT 25th International Symposium on High Performance Liquid Phase Separations and Related Techniques CY JUN 17-22, 2001 CL MAASTRICHT, NETHERLANDS DE pharmaceutical analysis; validation; pancuronium ID MASS-SPECTROMETRY AB A new high-performance liquid chromatography (HPLC) method was developed for the quality control of pancuronium bromide and its degradation products. The HPLC method used a 5-mum Supelcogel ODP-50 (150X4 cm) column with acetonitrile-CH3OH-water-F3CCOOH (20.5:74.9:0.1, v/v) as the mobile phase (pH value 2.0 adjusted with trifluoroacetic acid) at a flow-rate 0.8 ml/min and UV detection at 210 nm. The Beer's law plots were found to be linear over the concentration range 0.4-1.2 mg/ml of pancuronium bromide and 0.04-0.08 mg/ml of desacetyl degradation products (R-2=0.9995). The RSD of the peak areas was 1.09% and the recovery was 102.43%. The RSD value shows good precision, acceptable accuracy and reproducibility of the new method for the determination of pancuronium bromide in presence of its desacetyl degradation products. The method is rapid and sensitive enough to be used for Pavulon injection analysis. 2002 Elsevier Science B.V. All rights reserved. C1 Univ Belgrade, Fac Pharm, Inst Pharmaceut Chem & Drug Anal, YU-11000 Belgrade, Yugoslavia. Inst Pharm, YU-11000 Belgrade, Yugoslavia. RP Zecevic, M (reprint author), Univ Belgrade, Fac Pharm, Inst Pharmaceut Chem & Drug Anal, Vojvode Stepe 450 PF 146, YU-11000 Belgrade, Yugoslavia. NR 18 TC 17 Z9 17 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0021-9673 J9 J CHROMATOGR A JI J. Chromatogr. A PD MAR 8 PY 2002 VL 949 IS 1-2 BP 61 EP 64 DI 10.1016/S0021-9673(01)01552-7 PG 4 WC Biochemical Research Methods; Chemistry, Analytical SC Biochemistry & Molecular Biology; Chemistry GA 535EY UT WOS:000174633300007 ER PT J AU Saitoh, Y Kaneda, K Murakawa, M AF Saitoh, Y Kaneda, K Murakawa, M TI The effect of ulinastatin pre-treatment on vecuronium-induced neuromuscular block in patients with hepatic cirrhosis SO ANAESTHESIA LA English DT Article DE monitoring : neuromuscular function; neuromuscular relaxants : vecuronium liver disease : cirrhosis ID ORG NC 45; RENAL-FAILURE; PHARMACOKINETICS; PANCURONIUM; INHIBITOR AB The aim of this study was to investigate the effect of ulinastatin, a protease inhibitor, on the neuromuscular block produced by vecuronium in patients with hepatic cirrhosis. Thirty adult patients with hepatic cirrhosis were randomly allocated to receive ulinastatin (cirrhosis/ulinastatin group, n = 15) or saline (cirrhosis/saline group, it = 15). Fifteen healthy adult patients without hepatic cirrhosis comprised a control group. Patients were given a standardised anaesthetic that included nitrous oxide and isoflurane in oxygen, and fentanyl. A bolus dose of ulinastatin 5000 unit.kg(-1) was given to members of the cirrhosis/ulinastatin group. The same volume of normal saline was given to the other two groups. Two minutes later, vecuronium 0.1 mg.kg(-1) was given. The onset of neuromuscular block was significantly slower in the cirrhosis/ulinastatin group than in the cirrhosis/saline and control groups (p < 0.05). Spontaneous recovery of neuromuscular function was significantly quicker in the cirrhosis/ulinastatin and control groups than in the cirrhosis/saline group (1) < 0.05). The time course of recovery in the cirrhosis/ulinastatin and control groups was similar. We conclude that in cirrhotic patients, ulinastatin delays the onset of neuromuscular block produced by vecuronium. After pretreatment with ulinastatin, the speed of recovery from neuromuscular block in patients with cirrhosis becomes similar to that seen in healthy patients. C1 Fukushima Med Univ, Sch Med, Dept Anaesthesiol, Fukushima 9601295, Japan. RP Saitoh, Y (reprint author), Fukushima Med Univ, Sch Med, Dept Anaesthesiol, 1 Hikarigaoka, Fukushima 9601295, Japan. NR 20 TC 3 Z9 5 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 2002 VL 57 IS 3 BP 218 EP 222 DI 10.1046/j.0003-2409.2001.02468.x PG 5 WC Anesthesiology SC Anesthesiology GA 530QB UT WOS:000174369500003 ER PT J AU Tan, CH Onisong, MK Chiu, WKY AF Tan, CH Onisong, MK Chiu, WKY TI The influence of induction technique on intubating conditions 1 min after rocuronium administration: a comparison of a propofol-ephedrine combination and propofol SO ANAESTHESIA LA English DT Article DE anaesthetics : intravenous, propofol; sympathetic nervous system : pharmacology, ephedrine; intubation : tracheal; neuromuscular relaxants : recuronium ID RAPID-SEQUENCE INDUCTION; SUXAMETHONIUM; THIOPENTONE; SUCCINYLCHOLINE; ANESTHESIA AB We conducted a double blind, prospective, controlled trial comparing intubating conditions after induction with a propofol-ephedrine combination or propofol alone, followed by rocuronium. One hundred adult patients were randomly assigned to receive either propofol 2.5 mg.kg(-1) and ephedrine 15 mg in combination or propofol 2.5 mg.kg(-1) given over 30 s, followed by rocuronium 0.6 mg.kg(-1) given over 5 s. Tracheal intubation was performed 1 min later. jaw relaxation, vocal cord position and diaphragmatic response were used to assess intubation conditions. Tracheal intubation was successful and acceptable in all patients. There was a significantly higher proportion of intubating conditions graded as 'excellent' in the propofol-ephedrine group (84%) than in the propofol group (32%) (p < 0.0001). Vocal cord position and response to intubation were significantly better in the propofol-ephedrine group, although jaw relaxation was similar. Mean arterial pressure was maintained at pre-induction levels in the propofol-ephedrine group. In conclusion, induction with propofol and ephedrine in combination provided significantly better intubating conditions than propofol alone, when followed by rocuronium. C1 Pamela Youde Nethersole Eastern Hosp, Dept Anaesthesia, Chai Wan, Hong Kong, Peoples R China. RP Tan, CH (reprint author), Pamela Youde Nethersole Eastern Hosp, Dept Anaesthesia, 3 Lok Man Rd, Chai Wan, Hong Kong, Peoples R China. NR 10 TC 17 Z9 21 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 2002 VL 57 IS 3 BP 223 EP 226 DI 10.1046/j.0003-2409.2001.02449.x PG 4 WC Anesthesiology SC Anesthesiology GA 530QB UT WOS:000174369500004 ER PT J AU Rajchert, DM Pasquariello, CA Watcha, MF Schreiner, MS AF Rajchert, DM Pasquariello, CA Watcha, MF Schreiner, MS TI Rapacuronium and the risk of bronchospasm in pediatric patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID GENERAL-ANESTHESIA; ADULT PATIENTS AB We conducted this study to determine the risk factors for the development of bronchospasm after the administration of rapacuronium and to determine if children with bronchospasm on induction of anesthesia were more likely to have received rapacuronium compared with other muscle relaxants. In a retrospective cohort study, all anesthetic records in which rapacuronium was administered were reviewed to determine which patients developed bronchospasm during induction of anesthesia. Twohundred-eighty-seven patients were identified, of whom 12 (4.2%; 95% confidence interval [CI], 2.2 %-7.2 %) developed bronchospasm during induction of anesthesia. Significant risk factors for the development of bronchospasm with administration of rapacuronium included rapid sequence induction (relative risk [RR], 17.9; 95% Cl, 2.9-infinity) and prior history of reactive airways disease (RR, 4.6; 95% CI, 1.5-14.3). In a case-control study, all cases of bronchospasm during induction of anesthesia in the 5-mo time period that rapacuronium was available for clinical use were identified. Aside from the 12 cases of bronchospasm with rapacuronium, 11 additional cases of bronchospasm were associated with the use of other muscle relaxants. Four controls were randomly selected for each of the 23 cases of bronchospasm. Children with bronchospasm during induction of anesthesia were several times more likely (odds ratio, 10.1; 95% CI, 3.5-28.8) for having received rapacuronium compared with other muscle relaxants. C1 Univ Penn, Dept Anesthesiol & Crit Care Med, Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA. RP Rajchert, DM (reprint author), Univ Penn, Dept Anesthesiol & Crit Care Med, Childrens Hosp Philadelphia, 9th Floor Main Bldg,34th St & Civic Ctr Blvd, Philadelphia, PA 19104 USA. NR 22 TC 13 Z9 16 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 2002 VL 94 IS 3 BP 488 EP 493 DI 10.1097/00000539-200203000-00003 PG 6 WC Anesthesiology SC Anesthesiology GA 524UT UT WOS:000174031800003 ER PT J AU Gin, T Chan, MTV Chan, KL Yuen, PM AF Gin, T Chan, MTV Chan, KL Yuen, PM TI Prolonged neuromuscular block after rocuronium in postpartum patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANTHROPOMETRIC VARIABLES; VECURONIUM; PHARMACOKINETICS; DURATION; PREDICTORS AB Postpartum patients have not completely lost the weight gained during pregnancy. Drug dosing according to total body weight (TBW) can cause exaggerated effects and dosing by lean body mass (LBM) may provide a more consistent response despite the increased weight. We compared the duration of a rocuronium neuromuscular block in 22 women undergoing postpartum tubal ligation 31-79 h after delivery, with that in 22 women undergoing gynecological surgery. Anesthesia was induced and maintained with propofol and alfentanil. Half of the patients in each of the Postpartum and Control groups received a bolus dose of rocuronium 0.6 mg/kg TBW and the remaining half received rocuronium 0.6 mg/kg LBM. Neuromuscular block was monitored by electromyography and the ulnar nerve was stimulated transcutaneously using a train-of-four pattern. When rocuronium was given by TBW, median (range) duration of neuromuscular block until 25% recovery of the first twitch response was longer in the Postpartum group, 35.3 (29.7-48.7) min, compared with the Control group, 24.8 (21.5-28.6) min (P < 0.001). After dosing by LBM, the duration of block was similar between groups. The prolonged block with rocuronium in the Postpartum patients can be explained by relative drug overdose when dose calculation is based on their temporarily increased body weight. C1 Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Prince Wales Hosp, Shatin, Hong Kong, Peoples R China. Chinese Univ Hong Kong, Dept Obstet & Gynaecol, Prince Wales Hosp, Shatin, Hong Kong, Peoples R China. RP Gin, T (reprint author), Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Prince Wales Hosp, Shatin, Hong Kong, Peoples R China. RI GIN, Tony/J-2521-2013; Chan, Matthew /J-2884-2013 OI GIN, Tony/0000-0001-7283-6761; NR 12 TC 3 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 2002 VL 94 IS 3 BP 686 EP 689 DI 10.1097/00000539-200203000-00038 PG 4 WC Anesthesiology SC Anesthesiology GA 524UT UT WOS:000174031800038 ER PT J AU Joseph, P Benoit, Y Gressier, M Blanc, P Lehot, JJ AF Joseph, P Benoit, Y Gressier, M Blanc, P Lehot, JJ TI Anaphylactic reaction to rocuronium: advantage of blood tests for early diagnosis SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE anaphylaxis; relaxants; adverse effects; diagnosis laboratory; hypersensitivity ID ALLERGY AB A 56-year-old patient was scheduled for coronary artery bypass surgery, because of a severe coronary artery disease. Soon after induction of anaesthesia, he rapidly developped a cardiovascular collapse with bronchospasm and rash. Specific immunoglobulin E and tryptase measurements supported the diagnosis of grade III anaphylactic shock due to rocuronium bromide. A few days later, a general anaesthesia was administered without muscle relaxant and was uneventful. (C) 2002 Editions scientifiques et medicales Elsevier SAS. C1 Hop Cardiovasc & Pneumol Louis Pradel, Serv Anesthesie Reanimat, F-69394 Lyon 03, France. RP Joseph, P (reprint author), Hop Cardiovasc & Pneumol Louis Pradel, Serv Anesthesie Reanimat, BP Lyon Monchat, F-69394 Lyon 03, France. NR 10 TC 1 Z9 1 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD MAR PY 2002 VL 21 IS 3 BP 221 EP 223 DI 10.1016/S0750-7658(02)00573-7 PG 3 WC Anesthesiology SC Anesthesiology GA 538KR UT WOS:000174815600008 ER PT J AU Yamauchi, M Takahashi, H Iwasaki, H Namiki, A AF Yamauchi, M Takahashi, H Iwasaki, H Namiki, A TI Respiratory acidosis prolongs, while alkalosis shortens, the duration and recovery time of vecuronium in humans SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE neuromuscular blockades; respiratory acidosis; respiratory alkalosis; vecuronium ID NEUROMUSCULAR BLOCK; MUSCLE-RELAXANTS; BASE CHANGES; ONSET AB Stud., Objective: To determine the effects of respiratory acidosis and alkalosis by mechanical ventilation on the onset. duration. and recovery times of vecuronium. Design: Randomized, prospective study. Setting: Operating rooms in the Sapporo Medical University Hospital and Kitami Red Cross Hospital. Patients: 90 ASA physical status I and II patients undergoing lower abdominal surgery. Interventions: Patients were randomly allocated to one of three groups by arterial carbon dioxide tension level (PaCO2; mmHg) after induction: hyperventilation group (PaCO2 = 25-35), normoventilation group (PaCO2 = 35-45), and hypoventilation group (PaCO2 = 45-55). Anesthesia was maintained by spinal block with inhalation of 50% to 66% nitrous oxide in oxygen and intermittent intravenous administration Of fentanyl and midazolam with tracheal intubation. Measurements and Main Results: After vecuronium 0.08 mg/kg was given, onset, duration, and recovery time were measured by mechanomyography (Biometer Myograph 2,000, Odense, Denmark). There were significant differences in the duration and recovery time of vecuronium among the normoventilation group (12.7 +/- 3.3 min and 11.8 +/- 2.8 min, respectively), the hyperventilation group (10.6 +/- 3.5 min and 9.2 +/- 2.7 min, respectively; p < 0.01), and the hypoventilation group (14.4 +/- 3.1 min and 15.0 +/- 3.7 min, respectively; p < 0.01) (mean SD). The closest significant correlation in this study was observed between recovery time rind arterial blood pH (r = 0.57; p < 0.05). Conclusion: In humans, duration and recovery times of vecuronium are prolonged in respiratory acidosis and shortened in respiratory alkalosis. (C) 2002 by Elsevier Science Inc. C1 Kitami Red Cross Hosp, Dept Anesthesiol, Kitami, Hokkaido, Japan. RP Yamauchi, M (reprint author), Oji Gen Hosp, Dept Anesthesia, Wakakusa Cho 3-4-8, Tomokomai, Hokkaido 0538506, Japan. NR 13 TC 1 Z9 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2002 VL 14 IS 2 BP 98 EP 101 DI 10.1016/S0952-8180(01)00361-0 PG 4 WC Anesthesiology SC Anesthesiology GA 543ME UT WOS:000175105100005 ER PT J AU El-Orbany, MI Wafai, Y Joseph, NJ Salem, MR AF El-Orbany, MI Wafai, Y Joseph, NJ Salem, MR TI Tracheal intubation conditions and cardiovascular effects after modified rapid-sequence induction with sevoflurane-rapacuronium versus propofol-rapacuronium SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE rapid-sequence induction and intubation; sevoflurane; propofol; anesthetics, inhalation; anesthetics, IV; intubation, intratracheal ID INHALATION INDUCTION; NITROUS-OXIDE; MUSCLE-RELAXANT; ADULT PATIENTS; ANESTHESIA; SUCCINYLCHOLINE; ROCURONIUM; SUXAMETHONIUM; ORG-9487; BREATH AB Study Objectives: To compare intubation conditions and hemodynamic effects resulting from rapid-sequence induction of anesthesia with sevoflurane-rapacuronium and propofol-rapacuronium. Design: Randomized, blinded study. Setting: Operating suites of a large university-affiliated medical center. Patients: 40 ASA physical status I and II adult patients without airway abnormalities who were scheduled for elective surgery requiring endotracheal intubation. Interventions: Patients were randomly allocated to receive either sevoflurane inhalational induction (Group 1) or Propofol (2 mg/kg) intravenous induction (Group 2). Group 1 patients were coached on how to perform vital capacity breathing and the anesthesia machine was primed with sevoflurane 8%, N2O:O-2 3.5:1.5 L/min. In both groups, when loss of consciousness was established, rapacuronium 1.5 mg/kg was administered. After 50 seconds, an anesthesiologist blinded to the study entered the room and attempted laryngoscopy and intubation. Measurements: Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice (GCRP) criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded. Main Results: All patients were successfully intubated within 60 seconds. Clinically acceptable intubating conditions (excellent or good scores) were obtained in 19 of 20 Group 1 patients and in 19 of 20 Group 2 patients. Moderate tachycardia was encountered in both groups and mild systolic hypotension in the Group 2 patients. There were no complications. Conclusions: Modified rapid-sequence inhalational induction using sevoflurane and rapacuronium produced clinically acceptable intubation conditions within 60 seconds of muscle relaxant administration. The intubation conditions were similar to those produced after intravenous propofol and rapacuronium. (C) 2002 by Elsevier Science Inc. C1 Advocate Illinois Masonic Med Ctr, Dept Anesthesiol, Chicago, IL 60657 USA. RP El-Orbany, MI (reprint author), Advocate Illinois Masonic Med Ctr, Dept Anesthesiol, 836 W Wellington Ave, Chicago, IL 60657 USA. NR 28 TC 3 Z9 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2002 VL 14 IS 2 BP 115 EP 120 DI 10.1016/S0952-8180(01)00365-8 PG 6 WC Anesthesiology SC Anesthesiology GA 543ME UT WOS:000175105100009 ER PT J AU Cammu, G Bossuyt, G De Baerdemaeker, L Den Blauwen, N Struys, M Mortier, E AF Cammu, G Bossuyt, G De Baerdemaeker, L Den Blauwen, N Struys, M Mortier, E TI Dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE liver; disease; liver; transplantation; neuromuscular block; cisatracurium; pharmacodynamics; cisatracurium; pharmacokinetics; cisatracurium ID ATRACURIUM; PHARMACOKINETICS; PHARMACODYNAMICS; LAUDANOSINE; DISEASE AB Study Objective: To examine the dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation. Design: Open-label, descriptive study. Setting: University hospital. Patients: 6 ASA physical status III and IV patients with end-stage liver disease, undergoing liver transplantation. Interventions: Neuromuscular transmission was monitored electromyographically. After recovery of T-1/T-0 to 10%, cisatracurium was infused at an initial rate of 1.5 mug/kg/min. The infusion rate was adjusted to maintain T-1/T-0 at 10%. At the end of surgery, spontaneous recovery from the neuromuscular block was awaited. Measurements and Main Results: The infusion rate of cisatracurium was 1.6 +/- 0.4 mug/kg/min. Before the anhepatic phase, this rate was 1.5 0.4 mug/kg/min; during the anhepatic phase it was 1.7 +/- 0.5 mug/kg/min; and after reperfusion it was 1.9 L 0.4 mug/kg/min. There was a significant difference between the cisatracarium infusion rates before and after the anhepatic phase (p < 0.05). Following termination of the infusion, the time to 25% recovery of T-1/T-0 was 19.2 +/- 6.1 minutes, the recovery index (25% to 75%) was 28.8 +/- 7.0 minutes, and the time for the train-of-four (TOF) ratio to reach 0. 7 was 50.2 +/- 7.1 minutes. The time for the TOF ratio to reach 0.9 was 61.4 +/- 6.6 minutes. There was no difference in body temperature or pH during the consecutive stages of transplantation. Conclusions: The infusion dose requirement for cisatracurium during liver transplantation leaded to be higher than previously reported in healthy patients; recovery appeared prolonged. In continuous infusion of cisatracurium during liver transplantation, the tendency toward higher dose requirements, the Protracted duration of infusion, the non-Hofmann elimination and/or other pharmacokinetic changes during transplantation might influence recovery from the neuromuscular block. Potential temperature or pH change during surgery seemed irrelevant in explaining the delayed recovery. (C) 2002 by Elsevier Science Inc. C1 State Univ Ghent Hosp, Dept Anesthesia, B-9000 Ghent, Belgium. RP Cammu, G (reprint author), Onze Lieve Vrouw Clin, Dept Anesthet & Crit Care Med, Moorselbaan 164, B-9300 Aalst, Belgium. NR 14 TC 1 Z9 9 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2002 VL 14 IS 2 BP 135 EP 139 DI 10.1016/S0952-8180(01)00370-1 PG 5 WC Anesthesiology SC Anesthesiology GA 543ME UT WOS:000175105100013 ER PT J AU Heilbron, JL AF Heilbron, JL TI Coming to terms - Caloric, cathode, curium and quark - coinage from the mint of science. SO NATURE LA English DT Article C1 Univ Oxford Worcester Coll, Oxford OX1 2HB, England. RP Heilbron, JL (reprint author), Univ Oxford Worcester Coll, Oxford OX1 2HB, England. NR 0 TC 2 Z9 2 PU NATURE PUBLISHING GROUP PI LONDON PA MACMILLAN BUILDING, 4 CRINAN ST, LONDON N1 9XW, ENGLAND SN 0028-0836 J9 NATURE JI Nature PD FEB 7 PY 2002 VL 415 IS 6872 BP 585 EP 585 DI 10.1038/415585a PG 1 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA 519DC UT WOS:000173709100021 ER PT J AU Gatke, MR Viby-Mogensen, J Rosenstock, C Jensen, FS Skovgaard, LT AF Gatke, MR Viby-Mogensen, J Rosenstock, C Jensen, FS Skovgaard, LT TI Postoperative muscle paralysis after rocuronium: less residual block when acceleromyography is used SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE monitoring, neuromuscular block, rocuronium; neuromuscular function, mechanomyography; acceleromyography; neuromuscular function; objective neuromuscular transmission monitoring device; residual curarization ID PARTIAL NEUROMUSCULAR BLOCK; PULMONARY COMPLICATIONS; VENTILATORY RESPONSE; TACTILE EVALUATION; CARDIAC-SURGERY; RECOVERY ROOM; VECURONIUM; CURARIZATION; PANCURONIUM; ATRACURIUM AB Background: Residual muscle paralysis after anesthesia is common after pancuronium, but less common following the intermediate-acting drugs vecuronium and atracurium. Therefore, many anesthetists do not monitor neuromuscular function when using an intermediate-acting agent. The purpose of this prospective, randomised and double-blind study was to establish the incidence and degree of postoperative residual block following the use of rocuronium in patients not monitored with a nerve stimulator, and to compare it with results obtained in patients monitored using acceleromyography (AMG). Methods: During propofol/opioid anesthesia, 120 adult patients were randomised to two groups, one monitored with AMG, the other using only clinical criteria without a nerve stimulator. Postoperatively, TOF-ratio was measured with mechanomyography; a TOF-ratio <0.80 indicated residual muscle paralysis. Results: Residual muscle paralysis was found in 10 patients in the group without neuromuscular monitoring (16.7%) (95% confidence interval, 12-21%) and in two patients in the AMG-monitored group (3%) (93% CI, 0-8%); (P = 0.029, Fisher's exact test). Time from end of surgery to tracheal extubation was significantly longer in the AMG-monitored group (12.5min) than in the group not monitored with AMG (10min). Conclusion: Clinical evaluation of recovery of neuromuscular function does not exclude significant residual paralysis following the intermediate-acting muscle relaxant rocuronium, but the problem of residual block can be minimized by use of AMG. C1 Rigshosp, Copenhagen Univ Hosp, Ctr Head & Orthopaed, Dept Anaesthesia 4132, DK-2100 Copenhagen, Denmark. Copenhagen Univ Hosp, Dept Anaesthesia & Intens Care, DK-2100 Copenhagen, Denmark. Univ Copenhagen, Panum Inst, Dept Biostat, DK-1168 Copenhagen, Denmark. RP Gatke, MR (reprint author), Rigshosp, Copenhagen Univ Hosp, Ctr Head & Orthopaed, Dept Anaesthesia 4132, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. NR 26 TC 43 Z9 45 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD FEB PY 2002 VL 46 IS 2 BP 207 EP 213 DI 10.1034/j.1399-6576.2002.460216.x PG 7 WC Anesthesiology SC Anesthesiology GA 533VA UT WOS:000174549900016 ER PT J AU Motamed, C Kirov, K Combes, X Dhonneur, G Duvaldestin, P AF Motamed, C Kirov, K Combes, X Dhonneur, G Duvaldestin, P TI Effect of metoclopramide on mivacurium-induced neuromuscular block SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE mivacurium; metoclopramide; plasma cholinesterases ID PLASMA CHOLINESTERASE ACTIVITY AB In order to investigate the effect of metoclopramide on the duration of action of mivacurium, 45 patients were randomized into three groups. Group M10 (n = 15) and M20 (n = 15) received 10 and 20 mg of metoclopramide ix., respectively, and group S (n = 15) received saline 2 min before induction of anesthesia with fentanyl, thiopental and mivacurium. Plasma cholinesterase activity (pCHE) was measured before induction of anesthesia and 2 min after injection of metoclopramide and saline. Neuromuscular block was monitored by a force transducer using train of four nerve stimulation. Amesthesia was maintained with isoflurane and N2O. Time to recovery of a twitch height of 90% was significantly prolonged in group M10 and M20 (44 +/- 15 and 57 +/- 10min) as compared to group S, 32 +/- 9min, P<0.05). A slight but significant decrease in pCHE was observed in group M20. Because of the risk of prolonged duration of action of mivacurium, neuromuscular blockade should always be monitored whenever metoclopramide is given before injection of mivacurium. C1 Hop Henri Mondor, Serv Anesthesie Reanimat, F-94010 Creteil, France. RP Duvaldestin, P (reprint author), Univ Paris 12, 51 Ave Marechal De Lattre Tassigny, F-94010 Creteil, France. NR 9 TC 4 Z9 5 PU BLACKWELL MUNKSGAARD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD FEB PY 2002 VL 46 IS 2 BP 214 EP 216 DI 10.1034/j.1399-6576.2002.460217.x PG 3 WC Anesthesiology SC Anesthesiology GA 533VA UT WOS:000174549900017 ER PT J AU Lang, C Lukasewitz, P Wulf, H Geldner, G AF Lang, C Lukasewitz, P Wulf, H Geldner, G TI Plasma cholinesterase: succinylcholine and mivacurium SO ANAESTHESIST LA German DT Article DE plasma cholinesterase; prolonged apnea; mivacurium; succinylcholine ID PROLONGED NEUROMUSCULAR BLOCKADE; RAPID-SEQUENCE INDUCTION; MUSCLE-RELAXANTS; REVERSAL; NEOSTIGMINE; ANTAGONISM; EDROPHONIUM; ANESTHESIA; RECOVERY AB Succinylcholine and mivacurium are degraded more slowly in patients with a qualitatively or quantitatively reduced plasma cholinesterase and are therefore known for inducing a prolonged postoperative apnea. Perioperative laboratory screening even including plasma cholinesterase activity testing will not prevent this due to a possible aberration only in the qualitative cholinesterase activity. This is illustrated by introducing two cases reports of prolonged apnea after administration of mivacurium or succinylcholine. The pathophysiology of plasma cholinesterase is reviewed including genetically determined variants and the degradation pathways of mivacurium and succinylcholine. Only extensive laboratory chemical tests are sufficient to prevent this possible complication. Due to the rare incidence there is no evidence for recommending these laboratory investigations in all patients. Once prolonged apnea occurs following the administration of mivacurium or succinylcholine the best choice is ongoing ventilation combined with a sufficient sedation. C1 Univ Marburg, Klinikum Philipps, Klin Anasthesie & Intensivtherapie, D-35033 Marburg, Germany. RP Lang, C (reprint author), Univ Marburg, Klinikum Philipps, Klin Anasthesie & Intensivtherapie, Baldingerstr, D-35033 Marburg, Germany. NR 27 TC 4 Z9 5 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD FEB PY 2002 VL 51 IS 2 BP 134 EP 141 DI 10.1007/s00101-001-0276-3 PG 8 WC Anesthesiology SC Anesthesiology GA 530JK UT WOS:000174354400008 ER PT J AU Cerf, C Mesguish, M Gabriel, I Amselem, S Duvaldestin, P AF Cerf, C Mesguish, M Gabriel, I Amselem, S Duvaldestin, P TI Screening patients with prolonged neuromuscular blockade after succinylcholine and mivacurium SO ANESTHESIA AND ANALGESIA LA English DT Article ID ATYPICAL PLASMA CHOLINESTERASE; RESEARCH-UNIT; IDENTIFICATION; VARIANTS; SUXAMETHONIUM; DEFICIENCY; MUTATION AB Patients with pseudocholinesterase (BChE) variants may exhibit markedly prolonged paralysis after the administration of succinylcholine or mivacurium. We sought to evaluate to what extent molecular biology may contribute to the biological assessment of such patients. We conducted a prospective cohort study in patients referred to our center between 1995 and 1999 for prolonged neuromuscular blockade after mivacurium or succinylcholine. For each patient, phenotyping was performed with a conventional biochemical technique and molecular biology for the detection of the atypical mutation (A variant). Among the 36 patients referred, 31 had low BChE activity, 26 had received mivacurium (BChE activity 2.1 U/mL; 0.3-4.3 U/mL), and 5 had received succinylcholine (BChE activity, 1.9 U/mL; 1.1-3.2 U/mL) (mean; extreme values). The mean clinical duration of paralysis was 90 min (40-140 min) after succinylcholine and 301 min (120-720 min) after mivacurium. Thirty-two patients had a BChE deficiency of genetic origin: 20 were homozygous (AA), 10 were heterozygous (UA) for the A variant, and 2 did not have the A mutation (UU). One heterozygous UA patient had normal BChE activity. Nine among the heterozygous UA and the two homozygous UU patients probably carried a not-screened variant. In most cases, biochemical diagnosis was sufficient to confirm the existence of constitutional deficiency; molecular biology improved the accuracy of diagnosis in 11 patients (30%) but had few or no clinical implications for the patient him- or herself. C1 Hop Henri Mondor, Dept Anaesthesia, F-94010 Creteil, France. Hop Henri Mondor, Intens Care Unit, F-94010 Creteil, France. Hop Henri Mondor, Dept Biochem & Genet, AH HP, F-94010 Creteil, France. RP Duvaldestin, P (reprint author), Hop Henri Mondor, Dept Anaesthesia, 51 Ave Marechal Delattre de Tassigny, F-94010 Creteil, France. NR 37 TC 14 Z9 18 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 2002 VL 94 IS 2 BP 461 EP 466 DI 10.1097/00000539-200202000-00044 PG 6 WC Anesthesiology SC Anesthesiology GA 515PT UT WOS:000173505100045 ER PT J AU Cammu, G de Baerdemaeker, L den Blauwen, N de Mey, JC Struys, M Mortier, E AF Cammu, G de Baerdemaeker, L den Blauwen, N de Mey, JC Struys, M Mortier, E TI Postoperative residual curarization with cisatracurium and rocuronium infusions SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blocking agents, neuromuscular non-depolarizing agents; neuromuscular block, cisatracurium, rocuronium ID ANESTHESIA; VECURONIUM; VOLUNTEERS; REVERSAL; HUMANS AB Background and objective: Monitoring of neuromuscular blockade still often relies on clinical judgement. Moreover, there are substantial national differences in the use of agents to 'reverse' their effects. We investigated the recovery characteristics and incidence of postoperative residual curarization after cisatracurium and rocuronium infusions for long duration interventions without systematic antagonism. Methods: In 30 patients undergoing major surgery, we measured infusion dose requirements for rocuronium and cisatracurium during propofol anaesthesia. Infusions were discontinued at the beginning of surgical closure; spontaneous recovery of neuromuscular function was awaited in both groups. Neostigmine (50 mug kg(-1)) was administered only when a patient started to wake without a train-of-four ratio (TOF) of 0.9. Results: In the cisatracurium and rocuronium groups, four (27%) and one (7%) patients, respectively, had a TOF ratio greater than or equal to0.9 at the end of surgery. The TOF ratio in each group at that time was 51 +/- 32% for cisatracurium and 47 +/- 31% for rocuronium (P = 0.78). Six patients (40%) in the cisatracurium group and seven (47%) in the rocuronium group required neostigmine. The TOF ratio at the time of reversal was 63 +/- 7% for cisatracurium and 40 +/- 1996 for rocuronium (P = 0.01). The time interval between the end of surgery and a TOF ratio of 0.9 was 10 +/- 9 min for cisatracurium and 18 +/- 13 min for rocuronium (P = n.s.). Conclusions: Patients receiving a cisatracurium or rocuronium infusion have a high incidence of postoperative residual curarization when the block is not antagonized. When 'reversal' is not attempted, cisatracurium seems to be safer than rocuronium. C1 State Univ Ghent Hosp, Dept Anaesthesia, B-9000 Ghent, Belgium. St Lucas Hosp, Dept Anaesthesia, Ghent, Belgium. RP Cammu, G (reprint author), OLV Clin, Moorselbaan 164, B-9300 Aalst, Belgium. NR 15 TC 17 Z9 26 PU GREENWICH MEDICAL MEDIA LTD PI LONDON PA 137 EUSTON RD, 4TH FLOOR, LONDON NW1 2AA, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD FEB PY 2002 VL 19 IS 2 BP 129 EP 134 DI 10.1017/S0265021502000236 PG 6 WC Anesthesiology SC Anesthesiology GA 526WV UT WOS:000174153600010 ER PT J AU Eikermann, M Bredendiek, M Schaper, J Hovel, M Peters, J AF Eikermann, M Bredendiek, M Schaper, J Hovel, M Peters, J TI Resistance to rocuronium in a child with Schwartz-Jampel syndrome Type 1 B SO NEUROPEDIATRICS LA English DT Article DE dose-response relationship; muscle relaxants; perlecan; acetylcholinesterase ID VECURONIUM; ANESTHESIA; PERLECAN AB In Schwartz-Jampel syndrome micrognathia and jaw muscle rigidity may result in difficult or impossible tracheal intubation. Since the dose-response relationship to muscle relaxants is unknown in this rare disease we assessed by mechanomyography the neuromuscular response to the rocuronium in a two-year-old child with Schwartz-Jampel syndrome (SJS) Type 1 B. Rocuronium's dose-response curve was markedly shifted (3.5-fold dose) to the right when compared to healthy children and intubation conditions were improved. This resistance to NDMR may result from a lower acetylcholine degradation rate suggested as being the consequence of mutation of the gene encoding perlecan (HSPG2) in SJS. Thus, considerably higher doses of NDMR than usual may be required for facilitation of tracheal intubation in patients with SJS. Since evidence for genetic heterogeneity of SJS exists we also recommend incremental doses of a rapidly acting NDMR with continuous monitoring of neuromuscular function so as to assess the optimum relaxant dose. C1 Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, D-45122 Essen, Germany. Univ Essen Gesamthsch, Zent Inst Rontgendiagnost, D-45122 Essen, Germany. Univ Essen Gesamthsch, Klin & Poliklin Orthopadie, D-45122 Essen, Germany. RP Eikermann, M (reprint author), Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, D-45122 Essen, Germany. NR 15 TC 4 Z9 4 PU GEORG THIEME VERLAG KG PI STUTTGART PA RUDIGERSTR 14, D-70469 STUTTGART, GERMANY SN 0174-304X J9 NEUROPEDIATRICS JI Neuropediatrics PD FEB PY 2002 VL 33 IS 1 BP 43 EP 46 DI 10.1055/s-2002-23596 PG 4 WC Clinical Neurology; Pediatrics SC Neurosciences & Neurology; Pediatrics GA 541KY UT WOS:000174984800010 ER PT J AU Cheng, CAY Aun, CST Gin, T AF Cheng, CAY Aun, CST Gin, T TI Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children SO PAEDIATRIC ANAESTHESIA LA English DT Article DE anaesthesia : rapid-sequence induction; neuromuscular relaxant : rocuronium, suxamethonium; intubation ID SEQUENCE INDUCTION; SUCCINYLCHOLINE; ANESTHESIA; PROPOFOL; THIOPENTONE; ALFENTANIL; ADOLESCENTS; VECURONIUM; ONSET; TIME AB Background: The purpose of our study was to determine whether a smaller dose of rocuronium than previously reported could provide similar intubating conditions to suxamethonium during rapid-sequence induction of anaesthesia in children. Methods: One hundred and twenty ASA I, unpremedicated children, aged 1-10 years, who were undergoing elective surgery, were randomized into three groups to receive rocuronium 0.6 mg.kg(-1), rocuronium 0.9 mg.kg(-1) or suxamethonium 1.3 mg.kg(-1). The study was double-blinded, anaesthesia. and timing of injection was standardized to alfentanil 10 mug.kg(-1), thiopentone 5 mg.kg(-1) and the study drug. Intubation was attempted at 30 s after injection of neuromuscular relaxant and intubating conditions graded as excellent, good, poor or impossible. Results: All 120 children were successfully intubated within 60 s without need for a second attempt after administration of neuromuscular relaxant. Differences between suxamethonium and rocuronium 0.6 mg.kg(-1) and between the two doses of rocuronium were statistically significant (P = 0.016 and 0.007, respectively). Conclusions: Rocuronium 0.9 mg.kg(-1) provides similar intubating conditions to suxamethonium 1.5 mg.kg(-1) during modified rapid-sequence induction using alfentanil and thiopentone in children (P = 0.671). Rocuronium 0.6 mg.kg(-1) was inadequate. C1 Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Prince Wales Hosp, Shatin, Hong Kong, Peoples R China. RP Aun, CST (reprint author), Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Prince Wales Hosp, Shatin, Hong Kong, Peoples R China. RI GIN, Tony/J-2521-2013 OI GIN, Tony/0000-0001-7283-6761 NR 30 TC 15 Z9 20 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD FEB PY 2002 VL 12 IS 2 BP 140 EP 145 DI 10.1046/j.1460-9592.2002.00771.x PG 6 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 524KM UT WOS:000174012400006 ER PT J AU Ozlu, O Eris, S Mert, A AF Ozlu, O Eris, S Mert, A TI Effects of rocuronium pretreatment on muscle enzyme levels following suxamethonium SO PAEDIATRIC ANAESTHESIA LA English DT Article DE sevoflurane; rocuronium; creatinine-phosphokinase ID SKELETAL-MUSCLE; SUCCINYLCHOLINE; MYALGIA; SERUM; FASCICULATIONS; MYOGLOBINEMIA; VECURONIUM; ANESTHESIA; MIDAZOLAM; KINASE AB Background: The effects of different time intervals between rocuronium pretreatment and suxamethonium administration on muscle-derived enzymes and myoglobin were evaluated. Methods: Fifty-two patients, aged 3-6 years, were allocated randomly to receive pretreatment of either rocuronium 1 min or 4 min, or a placebo, before suxamethonium. Serum creatine-phosphokinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase (AST) and myoglobin concentrations were measured before treatment and at 30 min, 6 h and 24 h after suxamethonium administration. Results: Mean serum CK and myoglobin concentrations in the rocuronium groups were significantly less than in the saline group 24 h and 30 min after suxamethonium administration, respectively (P < 0.05). There were no significant differences between the rocuronium groups. Mean LDH and AST concentrations were higher at 6 h and 24 h after suxamethonium administration compared with pre-administration levels, respectively (P < 0.05). Conclusions: We concluded that intervals of 1 min or 4 min between the rocuronium and suxamethonium administrations have the same effect on enzyme levels. C1 Social Secur Ankara Children Hosp, Dept Anaesthesiol, Ankara, Turkey. Social Secur Ankara Children Hosp, Dept Biochem, Ankara, Turkey. Social Secur Ankara Children Hosp, Dept Microbiol, Ankara, Turkey. RP Ozlu, O (reprint author), Akabad Cad,56-3, Bahcelievler Ankara, Turkey. NR 20 TC 2 Z9 2 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD FEB PY 2002 VL 12 IS 2 BP 151 EP 155 DI 10.1046/j.1460-9592.2002.00817.x PG 5 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 524KM UT WOS:000174012400008 ER PT J AU Igarashi, A Amagasa, S Horikawa, H Shirahata, M AF Igarashi, A Amagasa, S Horikawa, H Shirahata, M TI Vecuronium directly inhibits hypoxic neurotransmission of the rat carotid body SO ANESTHESIA AND ANALGESIA LA English DT Article ID NICOTINIC ACETYLCHOLINE-RECEPTORS; PARTIAL NEUROMUSCULAR BLOCK; MUSCLE-RELAXANTS; VENTILATORY RESPONSE; PANCURONIUM; PHARMACOKINETICS; ATRACURIUM AB Previous studies have suggested that partial neuromuscular blockade by vecuronium may inhibit the chemoreceptor neural response to hypoxia. Because acetylcholine and its receptors are critically involved in the hypoxic neurotransmission of the carotid body, we examined whether vecuronium interferes with nicotinic processes in the carotid body and inhibits the chemoreceptor neural response to hypoxia. The carotid body was harvested from anesthetized adult Wister rats. Carotid sinus nerve activity (CSNA) was recorded in vitro, whereas the carotid body was perfused with Krebs solutions equilibrated with 5% CO2/air or 5% CO2/N-2. Vecuronium (0.1, 0.5, and 5 muM) was administered via perfusion. Hypoxic perfusion increased CSNA and the response remained stable for two hours. With vecuronium 0.5 and 5 muM, the increase in CSNA (DeltaCSNA) in response to hypoxia was significantly attenuated. The inhibitory effect of vecuronium was dose-related. Acetylcholine and nicotine increased CSNA, and the values of DeltaCSNA were significantly attenuated by vecuronium. These results indicate that vecuronium directly inhibits the carotid body neural response to hypoxia, possibly because of the inhibition of neuronal nicotinic receptors in the carotid body. C1 Shinjo Prefectural Hosp, Dept Anesthesiol, Yamagata 9960025, Japan. Yamagata Univ, Sch Med, Dept Anesthesiol & Resuscitat, Yamagata 99023, Japan. Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Environm Hlth Sci, Baltimore, MD 21205 USA. Johns Hopkins Univ, Dept Anesthesiol Crit Care Med, Baltimore, MD 21205 USA. RP Shirahata, M (reprint author), Shinjo Prefectural Hosp, Dept Anesthesiol, 12-25 Wakaba Chou, Yamagata 9960025, Japan. NR 25 TC 19 Z9 20 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2002 VL 94 IS 1 BP 117 EP 122 DI 10.1097/00000539-200201000-00022 PG 6 WC Anesthesiology SC Anesthesiology GA 508HN UT WOS:000173082800022 ER PT J AU Sloan, PA Rasul, M AF Sloan, PA Rasul, M TI Prolongation of rapacuronium neuromuscular blockade by clindamycin and magnesium SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANTIBIOTICS C1 Univ Kentucky, Coll Med, Lexington, KY USA. RP Sloan, PA (reprint author), Univ Kentucky Hosp, Dept Anesthesiol, 800 Rose St, Lexington, KY 40536 USA. NR 10 TC 6 Z9 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2002 VL 94 IS 1 BP 123 EP 124 DI 10.1097/00000539-200201000-00023 PG 2 WC Anesthesiology SC Anesthesiology GA 508HN UT WOS:000173082800023 ER PT J AU Kirkegaard, H Heier, T Caldwell, JE AF Kirkegaard, H Heier, T Caldwell, JE TI Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 07-22, 1999 CL DALLAS, TEXAS SP Amer Soc Anesthesiol ID SPONTANEOUS-RECOVERY; ATRACURIUM; MIVACURIUM; HUMANS; VOLUNTEERS; ANTAGONISM; PARALYSIS; RATIO; COUNT; TIME AB Background: Because tactile evaluation is the most common form of clinical neuromuscular monitoring, this study examines die relative efficacy of antagonizing residual block at different levels of recovery of the tactile train-of-four (TOF) response. Methods: Anesthesia was induced in 64 adults with 2-5 mug/kg fentanyl and 1-3 mg/kg propofol and maintained with fentanyl, propofol, and nitrous oxide. The tactile response of the adductor pollicis to TOF stimulation was evaluated at one arm, and the mechanomyographic response was recorded at the other. Patients received 0.15 mg/kg cisatracurium and were randomized to receive 0.07 mg/kg neostigmine on reappearance of the first (group I), second (group II), third (group III), or fourth (group IV) tactile TOF response (16 patients per group). Times from administration of neostigmine until the TOF ratio recovered to 0.7 (R-0.7), 0.8 (R-0.8), and 0.9 (R-0.9) were measured. Results: Data are presented as median with range In parentheses. R-0.7 was 10.3 (5.9-23.4), 7.6 (3.2-14.1), 5.0 (2.0-18.4), and 4.1 (2.4-11.0) min in groups I, II, III, and IV, respectively (P < 0.05, group I > II, III, and IV, group II > IV). R-0.8 was 16.6 (8.9-30.7), 9.8 (5.3-25.0), 8.3 (3.8-27.1), and 7.5 (3.0-74.5) min in groups I, II, III, and IV, respectively (P < 0.05, group I > II, III, and IV, group II > IV). R-0.9 was 22.2 (13.9-44.0), 20.2 (6.5-70.5), 17.1 (8.3-46.2), and 16.5 (6.5-143.3) min in groups I, II, III, and IV, respectively (no intergroup differences). Ten minutes after neostigmine, a TOF ratio of 0.7 or greater was achieved In 50, 75, 88, and 93% of patients in groups I, II, III, and IV, respectively (P < 0.05 group I > II, III, and IV). At 30 min, a TOF ratio of 0.9 or less was observed in 21, 13, 13, and 7% of patients In groups I, II, III, and IV respectively (no intergroup differences). Conclusions: To achieve rapid (within 10 min) reversal to a TOF ratio of 0.7 in more than 87% of patients, three or four tactile responses should be present at the time of neostigmine administration. It was not possible within 30 min to achieve a TOF ratio of 0.9 in all patients, regardless of the number of tactile responses present at neostigmine administration. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA USA. RP Kirkegaard, H (reprint author), Aarhus Univ Hosp, Skejby Sygehus, Dept Anaesthesia & Intens Care, DK-8200 Aarhus N, Denmark. NR 18 TC 36 Z9 39 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2002 VL 96 IS 1 BP 45 EP 50 DI 10.1097/00000542-200201000-00013 PG 6 WC Anesthesiology SC Anesthesiology GA 508JY UT WOS:000173086000009 ER PT J AU Bom, A Bradley, M Cameron, K Clark, JK van Egmond, J Feilden, H MacLean, EJ Muir, AW Palin, R Rees, DC Zhang, MQ AF Bom, A Bradley, M Cameron, K Clark, JK van Egmond, J Feilden, H MacLean, EJ Muir, AW Palin, R Rees, DC Zhang, MQ TI A novel concept of reversing neuromuscular block: Chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host SO ANGEWANDTE CHEMIE-INTERNATIONAL EDITION LA English DT Article DE cyclodextrins; drug design; host-guest systems; medicinal chemistry; neuromuscular blockers ID DESIGN C1 Organon Res Labs Ltd, Dept Med Chem, Newhouse ML1 5SH, Scotland. Organon Res Labs Ltd, Dept Pharmacol, Newhouse ML1 5SH, Scotland. Organon Res Labs Ltd, Dept Analyt Chem, Newhouse ML1 5SH, Scotland. Univ Southampton, Dept Chem, Southampton SO17 1BJ, Hants, England. Univ Nijmegen, Ctr Med, NL-6500 HB Nijmegen, Netherlands. CLRC, Daresbury Lab, Warrington WA4 4AD, Cheshire, England. RP Zhang, MQ (reprint author), Organon Res Labs Ltd, Dept Med Chem, Newhouse ML1 5SH, Scotland. EM m.zhang@organon.nhe.akzonobel.nl NR 18 TC 93 Z9 101 PU WILEY-V C H VERLAG GMBH PI WEINHEIM PA BOSCHSTRASSE 12, D-69469 WEINHEIM, GERMANY SN 1433-7851 J9 ANGEW CHEM INT EDIT JI Angew. Chem.-Int. Edit. PY 2002 VL 41 IS 2 BP 266 EP + PG 6 WC Chemistry, Multidisciplinary SC Chemistry GA 515YC UT WOS:000173523400005 ER PT J AU Dzhakhangirov, FN Bessonova, IA AF Dzhakhangirov, FN Bessonova, IA TI Alkaloids of Aconitum coreanum. X. Curare-like activity-structure relationship SO CHEMISTRY OF NATURAL COMPOUNDS LA English DT Article DE Aconitum coreanum; Ranunculaceae; diterpenoid alkaloids; toxicity; curare-like activity ID DITERPENOID ALKALOIDS; N-OXIDE AB The biological activity of 11 alkaloids isolated from Aconitum coreanum was studied. The compounds exhibit myorelaxant activity. Isoatisine and coryphine, which contain oxazolidine rings, are the most active. N-Oxides of 2-isobutyryl-14-hydroxyhetisine and 2-isobutyryl-13-acetyl-14-hydroxyhetisine are least active. C1 Acad Sci Republ Uzbekistan, Inst Chem Plant Subst, Tashkent, Uzbekistan. RP Dzhakhangirov, FN (reprint author), Acad Sci Republ Uzbekistan, Inst Chem Plant Subst, Tashkent, Uzbekistan. NR 21 TC 4 Z9 4 PU CONSULTANTS BUREAU PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0009-3130 J9 CHEM NAT COMPD+ JI Chem. Nat. Compd. PD JAN-FEB PY 2002 VL 38 IS 1 BP 74 EP 77 DI 10.1023/A:1015742001422 PG 4 WC Chemistry, Medicinal; Chemistry, Organic SC Pharmacology & Pharmacy; Chemistry GA 593HT UT WOS:000177985500014 ER PT J AU Velazquez-Armenta, EY Nava-Ocampo, AA AF Velazquez-Armenta, EY Nava-Ocampo, AA TI Population pharmacodynamic modeling without plasma concentrations of rocuronium in children SO JOURNAL OF CLINICAL PHARMACOLOGY LA English DT Article ID PHARMACOKINETIC ANALYSIS; ANESTHESIA AB Using the pharmacodynamic model without plasma concentrations described by Bragg et al, an individual approach resulted in highly variable parameters for rocuronium. Using a population approach Of the model, the time course of the effect of an TV bolus dose of 400, 600, and 800 mug/kg of rocuronium was studied, Response was measured by accelerometry (TOF-Guard) in 45 low-risk surgical children, ages 2 to 14 years, who were receiving general anesthesia with isoflurane. Using a Bayesian approach and the software P-PHARM, response (the first twitch of the TOF) was modeled. The apparent rate constant of elimination, the rate constant for equilibrium between plasma and the effect compartment, the sigmoidicity factor of the relationship between drug concentration in the effect compartment and the effect, and the in-fusion rate that produces 50% of the effect at steady state were obtained. Population and individual post hoc parameters were similar among groups and variability was reduced. (C) 2002 the American College of Clinical Pharmacology. C1 IMSS, Siglo XXI, CMN, UMR Pharmacol,Hosp Especialidades, Mexico City 03020, DF, Mexico. Hosp Infantil Mexico Dr Federico Gomez, Dept Clin Pharmacol & Anesthesia, Mexico City, DF, Mexico. Hosp Infantil Mexico Dr Federico Gomez, Dept Resp Therapy, Mexico City, DF, Mexico. RP Nava-Ocampo, AA (reprint author), IMSS, Siglo XXI, CMN, UMR Pharmacol,Hosp Especialidades, AP 73032, Mexico City 03020, DF, Mexico. RI Nava-Ocampo, Alejandro/K-3850-2012 NR 25 TC 4 Z9 4 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0091-2700 J9 J CLIN PHARMACOL JI J. Clin. Pharmacol. PD JAN PY 2002 VL 42 IS 1 BP 37 EP 42 DI 10.1177/0091270002042001004 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 506VF UT WOS:000172991900004 ER PT J AU Hemadri, M Purva, M Traykova, V Traykova, K AF Hemadri, M Purva, M Traykova, V Traykova, K TI Unexpected prolonged neuromuscular block after mivacurium: A case report SO MEDICAL PRINCIPLES AND PRACTICE LA English DT Article; Proceedings Paper CT Conference on Minimal Intervention Approach for Dental Treatment CY DEC 06-08, 1999 CL KIWAIT CITY, KUWAIT HO KIWAIT UNIV, FAC DENT HLTH SCI CTR DE muscle relaxant; prolonged apnoea; pseudocholinesterase deficiency; mivacurium ID PLASMA CHOLINESTERASE; ANTAGONISM; APNEA AB Objective: To present a case of unexpected prolonged apnoea following the administration of mivacurium, a short-acting muscle relaxant and to identify the factors for early diagnosis and management. Clinical Presentation and Intervention: A 19-year-old physically fit lady without personal or family history suggestive of anaesthetic problems had an excision of fibro-adenoma from the breast. She did not recover as quickly as was expected from the anaesthetic, which included the administration of mivacurium. She had prolonged neuromuscular blockade. She was kept ventilated and sedated. Five hours after the last dose of mivacurium, she showed signs of spontaneous respiration and at 6 h she was extubated and fully recovered. It was shown later that the patient had a pseudocholinesterase deficiency. Conclusion: Pseudocholinesterase deficiency is an uncommon occurrence but should be highly suspected in cases of prolonged paralysis following the administration of a short-acting muscle relaxant. The use of a nerve stimulator is recommended whenever muscle relaxants are used. Muscle relaxants should be used only when facilities for prolonged ventilation are available. Copyright (C) 2002 S. Karger AG, Basel. C1 Mubarak Al Kabeer Hosp, Dept Surg, Jabriya, Kuwait. RP Hemadri, M (reprint author), 56 Cullingworth St, Dewsbury WF13 4AN, England. NR 10 TC 0 Z9 0 PU KARGER PI BASEL PA ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND SN 1011-7571 J9 MED PRIN PRACT JI Med. Princ. Pract. PD JAN-MAR PY 2002 VL 11 IS 1 BP 50 EP 52 DI 10.1159/000048662 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 533TD UT WOS:000174545600010 ER PT J AU Epemolu, O Mayer, I Hope, F Scullion, P Desmond, P AF Epemolu, O Mayer, I Hope, F Scullion, P Desmond, P TI Liquid chromatography/mass spectrometric bioanalysis of a modified gamma-cyclodextrin (Org 25969) and Rocuronium bromide (Org 9426) in guinea pig plasma and urine: its application to determine the plasma pharmacokinetics of Org 25969 SO RAPID COMMUNICATIONS IN MASS SPECTROMETRY LA English DT Article ID BETA-CYCLODEXTRIN; ATRACURIUM; VECURONIUM AB A sensitive and specific liquid chromatography/mass spectrometry (LC/MS) method has been developed and validated for the quantification of the modified y-cyclodextrin Org 25969 and Rocuronium bromide (Roc or Org 9426) in the plasma and urine of guinea pigs. The assay was linear and reproducible over the range 25-10000 ng/mL for both compounds. The lowest limit of quantification (LLOQ) for both compounds in urine was 25 ng/mL. In plasma, the LLOQ was 25 ng/mL for Org 9426 and 50 ng/mL for Org 25969. The inter- and intra-day variation was lower than 20%. The physicochemical properties of both compounds imposed different modes of extraction from plasma. The modified y-cyclodextrin was extracted by trifluoroacetic acid (TFA) precipitation while Rocuronium was extracted by acetonitrile precipitation. Both compounds were quantified in urine by direct injection onto the column. The LC/MS analyses of Org 25969 and Org 9426 were performed using two different assay conditions. It was not possible to quantify the complex of cyclodextrin and Roc as it dissociated on the LC column. The use of LC/MS conferred great advantage to the quantification of both Org 25969 and Org 9426, as they were not chromogenic enough to afford the sensitivity and specificity required for the assay. Copyright (C) 2002 John Wiley Sons, Ltd. NR 16 TC 26 Z9 27 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND SN 0951-4198 J9 RAPID COMMUN MASS SP JI Rapid Commun. Mass Spectrom. PY 2002 VL 16 IS 20 BP 1946 EP 1952 DI 10.1002/rcm.812 PG 7 WC Chemistry, Analytical; Spectroscopy SC Chemistry; Spectroscopy GA 604AD UT WOS:000178592700008 ER PT J AU Dugdale, AHA Adams, WA Jones, RS AF Dugdale, AHA Adams, WA Jones, RS TI The clinical use of the neuromuscular blocking agent rocuronium in dogs SO VETERINARY ANAESTHESIA AND ANALGESIA LA English DT Article DE dogs; neuromuscular blockade; rocuronium ID ONSET; VECURONIUM; ISOFLURANE; ANESTHESIA; HALOTHANE; ENFLURANE; POTENCY; DRUG AB Objective The aim of this study was to characterize the onset and duration of action of the aminosteroid muscle relaxant rocuronium in dogs under clinical conditions. Study design Prospective single dose trial. Animals Twenty-three dogs aged between 6 months and 12 years, weighing between 5.5 and 61.5 kg admitted to the University of Liverpool Small Animal Hospital between January and March 2000, and undergoing elective surgical procedures under general anaesthesia. Materials and methods Following induction of general anaesthesia, neuromuscular function was evaluated using train-of-four (TOF) stimulation. An initial dose of 0.4 mg kg(-1) rocuronium was administered intravenously (IV) and neuromuscular blockade was monitored by visually assessing the number of responses (twitches) to TOF stimulation (train-of-four count: TOM. incremental doses of 0.16 mg kg(-1) rocuronium. were administered as indicated, when at least two twitches of the TOFC had returned. Results Rocuronium (0.4 mg kg-1) abolished all responses to TOF stimulation in all dogs. The mean time to onset of neuromuscular blockade (complete abolition of all twitches) was 98 52 seconds. Neuromuscular blockade (absence of all twitches to return of all four) lasted 323 +/- 8.2 minutes. Incremental doses of 0.16 mg kg(-1) had a mean duration of action of 20.8 +/- 4.9 minutes and up to seven increments were shown to be noncumulative. The effects of rocuronium were readily antagonized with neostigmine and atropine. Small transient increases in arterial blood pressure. which occurred in three dogs after the administration of rocuronium, were the only cardiovascular side-effects observed. Conclusions Rocuronium is an effective nondepolarizing neuromuscular blocking agent in the dog, with a rapid onset of neuromuscular block after intravenous administration and an intermediate duration of action, Clinical relevance Rocuronium produced a neuromuscular block with similar characteristics to those obtained with vecuronium, thus apparently offering little advantage over vecuronium. However, its availability in aqueous solution and a longer shelf-life increases convenience. C1 Univ Liverpool, Dept Anaesthesia, Liverpool L69 3GA, Merseyside, England. RP Adams, WA (reprint author), Univ Liverpool, Dept Anaesthesia, Duncan Bldg,Daulby St, Liverpool L69 3GA, Merseyside, England. NR 13 TC 5 Z9 5 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 1467-2987 J9 VET ANAESTH ANALG JI Vet. Anaesth. Analg. PD JAN PY 2002 VL 29 IS 1 BP 49 EP 53 DI 10.1046/j.1467-2987.2001.00057.x PG 5 WC Veterinary Sciences SC Veterinary Sciences GA 616TH UT WOS:000179318700007 ER PT J AU Eikermann, M Renzing-Kohler, K Peters, J AF Eikermann, M Renzing-Kohler, K Peters, J TI Sevoflurane augments the degree and speeds the onset of rocuronium evoked neuromuscular blockade in children. SO ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE LA German DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 07-22, 1999 CL DALLAS, TEXAS SP Amer Soc Anesthesiol DE onset time; volatile anaesthetics; muscle relaxants; dose-response relationship ID ISOFLURANE ANESTHESIA; HALOTHANE ANESTHESIA; BLOCKING-AGENTS; SUCCINYLCHOLINE; ENFLURANE AB In adults, sevoflurane augments the intensity of rocuronium evoked neuromuscular blockade. However, in children effective doses and onset of action of rocuronium have not been reported during sevoflurane anaesthesia. To test in children the hypothesis that sevoflurane speeds the onset and potentiates the degree of rocuronium induced neuromuscular blockade we studied 50 children aged 2-7 years following approval by the local ethics committee. Methods: After induction and maintenance of anaesthesia with either 2% end-tidal sevoflurane in 60% N2O/O-2 (n=30) or with propofol (3mg.kg(-1) and 10mg.kg(-1)h(-1), n=20) and 60% N2O/O-2 for 17+/-1 min, we injected either 0.15, 0.22, or 0.3 mg.kg(-1) rocuronium and quantified by mechanomyography the evoked (0.1 Hz ulnar nerve stimulation) response of the adductor pollicis muscle. Dose-response relationships of rocuronium under both anaesthetic regimes were assessed using a generalised linear model based on the maximum-likelihood-technique. Data were compared by analysis of covariance, F-test, and Mann-Whitney-U-test as indicated, p<0.05, mean&PLUSMN;SD, (95% confidence interval). Results: The degree of neuromuscular blockade was greater (p<0.05) during sevoflurane (estimated ED 50: 0.15 (0.076-0.177) mg-kg(-1)) than propofol (ED 50: 0.25 (0.15-0.35) mg.kg(-1)) anaesthesia. Furthermore, onset time was significantly faster under sevoflurane/N2O compared to propofol/N2O anaesthesia (110+/-31 versus 230+/-52 s, p<0.01, after rocuronium 0.3mg.kg(-1)). Conclusion: In young children during steady state anaesthesia onset of action of rocuronium is halved and the degree of neuromuscular blockade is markedly augmented during sevoflurane/N2O anaesthesia compared to propofol. C1 Univ Klin Essen, Abt Anasthesiol & Intens Med, Essen, Germany. Univ Klin Essen, Abt Biometrie Epidemiol & Stat, Essen, Germany. RP Eikermann, M (reprint author), Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, Hufelandstr 55, D-45122 Essen, Germany. NR 19 TC 1 Z9 1 PU GEORG THIEME VERLAG KG PI STUTTGART PA RUDIGERSTR 14, D-70469 STUTTGART, GERMANY SN 0939-2661 J9 ANASTH INTENSIV NOTF JI Anasthesiol. Intensivmed. NotfMed. Schmerzther. PD DEC PY 2001 VL 36 IS 12 BP 754 EP 758 DI 10.1055/s-2001-18983 PG 5 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 509UF UT WOS:000173167500006 ER PT J AU Kirov, K Motamed, C Dhonneur, G AF Kirov, K Motamed, C Dhonneur, G TI Differential sensitivity of abdominal muscles and the diaphragm to mivacurium - An electromyographic study SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the French-Society-of-Anesthesiology CY SEP 22-23, 2000 CL PARIS, FRANCE SP French Soc Anesthesiol ID ADDUCTOR POLLICIS MUSCLE; CHEST-WALL FUNCTION; NEUROMUSCULAR BLOCK; HALOTHANE ANESTHESIA; HUMANS; ATRACURIUM; AWAKE; VECURONIUM; SUCCINYLCHOLINE; PANCURONIUM AB Background: Respiratory muscles are considered to be more resistant to muscle relaxants as compared with peripheral muscles. However, the relative sensitivity of respiratory muscles participating to the pump function has not been compared. We used electromyography to compare pharmacodynamic parameters of the diaphragm and abdominal muscles after mivacurium. Methods: Forty adults undergoing elective surgery were randomly allocated in five dosing groups of mivacurium (50, 100, 150, 200, and 250 mug/kg). Patients anesthetized with propofol and fentanyl underwent intubation without relaxants. Anesthesia was maintained with nitrous oxide and propofol. The right phrenic nerve, the left 10th Intercostal nerve, and the ulnar nerve were stimulated. Electromyography of the diaphragm and abdominal muscles was recorded from surface electrodes. Mechanomyography was used to measure adductor pollicis evoked contraction. After a 5-min stable recording period, patients received a single intravenous bolus (20 s) dose of mivacurium. By using log dose-probit effect regression analysis, dose-response curves were constructed. Effective doses and 95% confidence intervals were derived for the diaphragm and abdominal muscles and were compared. Results: The dose-response regression line of abdominal muscles differed from that of the diaphragm. Calculated ED., and ED90 were higher for the diaphragm than for the abdominal muscles (104 (82-127] and 196 [177-2131 mug/kg, and 67 [51-82] and 161 [143-181] mug/kg, respectively). The onset of block was faster and recovery of control responses were shorter at the diaphragm than at the abdominal muscles. Conclusion: Diaphragm and abdominal muscles have differential sensitivity to mivacurium. The diaphragm is more resistant to mivacurium than abdominal muscles are. C1 Henri Mondor Univ Hosp, Dept Anesthesiol, Trauma Intens Care Unit, F-94010 Creteil, France. Henri Mondor Univ Hosp, Surg Intens Care Unit, Creteil, France. Univ Paris 12, Sch Med, Creteil, France. RP Dhonneur, G (reprint author), Henri Mondor Univ Hosp, Dept Anesthesiol, Trauma Intens Care Unit, F-94010 Creteil, France. NR 24 TC 8 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 2001 VL 95 IS 6 BP 1323 EP 1328 DI 10.1097/00000542-200112000-00008 PG 6 WC Anesthesiology SC Anesthesiology GA 499NP UT WOS:000172577500004 ER PT J AU Itoh, H Shibata, K Nitta, S AF Itoh, H Shibata, K Nitta, S TI Difference in sensitivity to vecuronium between patients with ocular and generalized myasthenia gravis SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE equipment, force transducer; complications, myasthenia gravis; neuromuscular block, Osserman classification ID ACETYLCHOLINE-RECEPTOR; NEUROMUSCULAR BLOCK; BALANCED ANESTHESIA; SEVOFLURANE; ATRACURIUM AB Patients with myasthenia gravis show sensitivity to non-depolarizing neuromuscular blocking drugs, but little is known about differences in this sensitivity between types of myasthenia. In 10 patients with ocular myasthenia gravis and 10 with generalized myasthenia gravis, twitch tension was monitored in the adductor pollicis muscle by supramaximal train-of-four stimulation of the ulnar nerve during anaesthesia with sevoflurane 2.5% and nitrous oxide 60%. After baseline measurement, an initial dose of vecuronium 10 mug kg(-1) was given. When the twitch height stabilized (maximum block after the first 10 mug kg(-1)), the next incremental dose of 10 mu -tg kg(-1) was given and repeated until block, defined as [1-(first twitch/baseline first twitch)]x 100 reached 90%. Maximum block after the first dose of vecuronium in ocular patients was significantly less than that in generalized patients (median 51 vs 91%; P<0.05). Onset of block after the first dose of vecuronium was significantly slower in ocular than in generalized myasthenic patients (mean 300 vs 200 s; P<0.05). Doses required to attain a block of 90% or more were significantly higher in ocular than in generalized patients (median 20 vs 10 mug kg(-1); P<0.05). Clinicians should consider the type of disease according to the Osserman classification when using non-depolarizing neuromuscular blocking drugs in patients with myasthenia gravis. C1 Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, Kanazawa, Ishikawa 9208641, Japan. Kanazawa Univ, Sch Med, Dept Emergency & Crit Care Med, Kanazawa, Ishikawa 920, Japan. Ishikawa Prefectural Cent Hosp, Div Anesthesia, Kanazawa, Ishikawa, Japan. RP Itoh, H (reprint author), Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan. NR 17 TC 6 Z9 7 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD DEC PY 2001 VL 87 IS 6 BP 885 EP 889 DI 10.1093/bja/87.6.885 PG 5 WC Anesthesiology SC Anesthesiology GA 500KV UT WOS:000172627100014 ER PT J AU Dahaba, AA Schweitzer, E Fitzgerald, RD Schwarz, S AF Dahaba, AA Schweitzer, E Fitzgerald, RD Schwarz, S TI Equi-lasting doses of rocuronium, compared to mivacurium, result in improved neuromuscular blockade in patients undergoing gynecological laparoscopy SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID INTUBATING CONDITIONS; RESPONSE RELATIONSHIP; FENTANYL ANESTHESIA; CLINICAL RESEARCH; CHLORIDE; ORG-9426; SUXAMETHONIUM; SURGERY; TIME AB Purpose: To compare equi-lasting doses of a short-acting (mivacurium) to an intermediate-acting (rocuronium) neuromuscular relaxant, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic alterations, adverse events and cost, in patients undergoing laparoscopic gynecological surgery. Methods: Sixty patients were randomly allocated to receive either 0.2 mg.kg(-1) (3 x ED(95)) mi mivacurium or 0.5 mg.kg(-1) (1.7 x ED(95)) rocuronium, under propofol/fentanyl anesthesia, T1, first twitch of the train-of-four (TOF) and TOF ratio (T4:T1) were used to evaluate neuromuscular block using the Relaxometer (R) mechanomyograph. The trachea was intubated when T1 was maximally suppressed, Neuromuscular block was maintained at 25% TI with equi-lasting doses of 0.075 mg.kg(-1) mivacurium or 0.15 mg.kg(-1) rocuronium, Results: Mean (min) +/- SD mivacurium onset time (1.9 +/- 0.4) was longer than that of rocuronium (1.3 +/- 0.3), This did not yield a statistical difference in intubating conditions between the two groups. Interval 25-75% T1 recovery and time to 0.8 TOF recovery were prolonged following rocuronium (11.9 +/- 3.9, 52.6 +/- 15.5 respectively) compared to mivacurium (6.7 +/- 2.3, 39.2 +/- 8.1 respectively). More patients, 22/30, required mivacurium maintenance doses compared to 14/30 patients in the rocuronium group. Arterial blood pressure declined and 13/30 patients manifested erythema following mivacurium administration. The acquisition costs of rocuronium (6.93 Euro/patient) were 23% lower compared to mivacurium (8.96 Euro/patient), Conclusion: Equi-lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with erythema, compared to mivacurium. C1 Lainz Hosp, Dept Anaesthesia & Intens Care, Vienna, Austria. Ludwig Boltzmann Inst Econ Med Anaesthesia & Int, Vienna, Austria. RP Dahaba, AA (reprint author), Karl Franzens Univ Graz, Dept Anaesthesiol & Intens Care Med, Auenbruggerpl 29, A-8036 Graz, Austria. EM Ashraf.Dahaba@kfunigraz.ac.at NR 20 TC 2 Z9 2 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 2001 VL 48 IS 11 BP 1084 EP 1090 PG 7 WC Anesthesiology SC Anesthesiology GA 505YK UT WOS:000172943000007 ER PT J AU Kopman, AF Khan, NA Neuman, GG AF Kopman, AF Khan, NA Neuman, GG TI Precurarization and priming: A theoretical analysis of safety and timing SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKING-DRUGS; DOSE-RESPONSE CURVE; TRACHEAL INTUBATION; TRAIN-OF-4 FADE; D-TUBOCURARINE; VECURONIUM; PHARMACOKINETICS; CISATRACURIUM; PHARMACODYNAMICS; PHARMACOLOGY AB The priming principle suggests that the onset of neuro-muscular block may be accelerated if an intubating dose is preceded by a priming dose administered a few minutes earlier. We thought it would be instructive to use a pharmacodynamic/pharmacokinetic model to estimate the risk associated with different priming doses and intervals. In any normal population, there is wide variability in the response to neuromuscular blocking drugs. For most relaxants, the coefficient of variation for the 50% effective dose (ED50) approximates 20%-25%. Thus, 1 patient in 50 (-2.05 SD) may have an ED50 only half of the commonly cited value. By using published pharmacodynamic/pharmacokinetic data, we calculated the effect of administering 10%, 20%, or 30% of the ED,, on the response of the adductor pollicis muscle in a population normally distributed with respect to drug sensitivity. A dose equivalent to 10% of the ED95 will rarely produce a measurable neuromuscular effect. As this dose is increased, the potential for clinical weakness rapidly escalates. In 1 in 50 individuals, the usual recommendation of 10% of the intubation dose will produce measurable neuromuscular depression. For vecuronium, the optimal priming interval is 5 min. The safety and dependability of the priming principle is very much subject to the laws of probability. C1 St Vincents Hosp & Med Ctr, Dept Anesthesiol, New York, NY 10011 USA. RP Kopman, AF (reprint author), St Vincents Hosp & Med Ctr, Dept Anesthesiol, Room NR 408,170 W 12th St, New York, NY 10011 USA. NR 22 TC 20 Z9 26 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 2001 VL 93 IS 5 BP 1253 EP 1256 DI 10.1097/00000539-200111000-00042 PG 4 WC Anesthesiology SC Anesthesiology GA 486MA UT WOS:000171820500037 ER PT J AU Krombach, J Hunzelmann, N Koster, F Bischoff, A Hoffmann-Menzel, H Buzello, W AF Krombach, J Hunzelmann, N Koster, F Bischoff, A Hoffmann-Menzel, H Buzello, W TI Anaphylactoid reactions after cisatracurium administration in six patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID VECURONIUM; IGE C1 Malteser Hosp, Dept Anesthesiol, Bonn, Germany. Weyertal Hosp, Dept Anesthesiol, Cologne, Germany. Municipal Hosp, Dept Anesthesiol, Leverkusen, Germany. Univ Cologne, Dept Dermatol, D-5000 Cologne, Germany. Univ Cologne, Dept Anesthesiol, D-5000 Cologne, Germany. RP Krombach, J (reprint author), Univ Cologne, Dept Anesthesiol & Crit Care Med, D-50924 Cologne, Germany. NR 12 TC 10 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 2001 VL 93 IS 5 BP 1257 EP 1259 DI 10.1097/00000539-200111000-00043 PG 3 WC Anesthesiology SC Anesthesiology GA 486MA UT WOS:000171820500038 ER PT J AU Schulz-Stubner, S Wettmann, G Reyle-Hahn, SM Rossaint, R AF Schulz-Stubner, S Wettmann, G Reyle-Hahn, SM Rossaint, R TI Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT 12th World Congress of Anesthesiologists CY JUN 04-09, 2000 CL MONTREAL, CANADA DE anaesthesia, intravenous; magnesium; ophthalmological surgical procedures, vitrectomy; reflex, oculocardiac ID SULFATE; PREECLAMPSIA; EFFICACY; PAIN AB Background and objective To test the hypothesis that magnesium sulphate reduces the amount of remifentanil needed for general anaesthesia in combination with propofol and mivacurium, we studied 50 patients undergoing elective pars plana vitrectomy in a double-blind, randomized prospective fashion. Methods Magnesium sulphate (50 mg kg(-1) body weight) or placebo (equal volume of NaCl) was given slowly intravenously after induction of anaesthesia with propofol 1-2 mg kg(-1). Anaesthesia was maintained with propofol (using electroencephalographic control), mivacurium (according to train-of-four monitoring of neuromuscular blockade) and remifentanil (according to heart rate and arterial pressure). Results We observed a significant reduction in remifentanil consumption from 0.14 to 0.09 mug kg(-1) min(-1) (P< 0.01). Mivacurium consumption was also markedly reduced from 0.01 to 0.008 mg kg(-1) min(-1) (P< 0.01), whereas propofol consumption remained unchanged. There was a trend towards lower postoperative pain scores, less pain medication requirements in 24 h after surgery and less postoperative nausea and vomiting in the magnesium group but not statistically significant. No side-effects were observed. Conclusion We can recommend the use of magnesium sulphate as a safe and cost-effective supplement to a general anaesthetic regimen with propofol, remifentanil and mivacurium, although we cannot clearly distinguish between a mechanism as a (co)analgesic agent at the NMDA-receptor site or its properties as a sympatholytic. The effect of a single bolus dose of 50 mg kg(-1) on induction lasts for about 2 h. For longer cases, either a continuous infusion or repeated bolus doses might be necessary. C1 Rhein Westfal TH Aachen Klinikum, Anasthesiol Klin, D-52074 Aachen, Germany. RP Schulz-Stubner, S (reprint author), Rotackerstr 25, D-79104 Freiburg, Germany. NR 23 TC 35 Z9 41 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD NOV PY 2001 VL 18 IS 11 BP 723 EP 729 DI 10.1046/j.1365-2346.2001.00921.x PG 7 WC Anesthesiology SC Anesthesiology GA 486ZJ UT WOS:000171849000004 ER PT J AU Stucke, AG Stuth, EAE AF Stucke, AG Stuth, EAE TI Use of rapacuronium in a child with spinal muscular atrophy SO PAEDIATRIC ANAESTHESIA LA English DT Article DE lower motor neurone disease; rapacuronium; nondepolarizing muscle relaxant; succinylcholine ID MUSCLE-RELAXANTS; ANESTHESIA AB We report the case of an 18-month-old girl with spinal muscular atrophy (SMA) that received 1 mg.kg(-1) rapacuronium for laryngospasm during induction of anaesthesia. Within 15 min, we observed some diaphragmatic recovery and, after emergence from anaesthesia, the child demonstrated adequate respiratory efforts. However, the child showed diminished strength of the upper extremity muscles. Since the preoperative workup had revealed bulbar symptoms and laryngeal function could not be easily assessed, the patient was kept intubated until upper extremity strength had returned to preoperative levels. Small doses of midazolam had been given to reduce the patient's anxiety but the patient was extubated within 5 h without any complications. Train of four (TOF) monitoring of the right adductor pollicis muscle, performed during anaesthetic recovery, was equivocal. In SMA, muscle groups are differentially affected so that TOF responses may be inconclusive and not reflect the state of the upper airway muscles. To our knowledge, this is the first report of use of a nondepolarizing neuromuscular blocking agent in a child with SMA. C1 Vet Adm Med Ctr, Anesthesia Res Serv 151, Milwaukee, WI 53295 USA. Childrens Hosp Wisconsin, Sect Pediat Anesthesia, Milwaukee, WI 53201 USA. RP Stucke, AG (reprint author), Vet Adm Med Ctr, Anesthesia Res Serv 151, 5000 W Natl Ave, Milwaukee, WI 53295 USA. NR 15 TC 6 Z9 6 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD NOV PY 2001 VL 11 IS 6 BP 725 EP 728 DI 10.1046/j.1460-9592.2001.00732.x PG 4 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 482ZV UT WOS:000171610000015 ER PT J AU Tobias, JD Johnson, JO Sprague, K Johnson, G AF Tobias, JD Johnson, JO Sprague, K Johnson, G TI Effects of rapacuronium on respiratory function during general anesthesia - A comparison with cis-atracurium SO ANESTHESIOLOGY LA English DT Article ID SUCCINYLCHOLINE; MUSCLE; INDUCTION; HALOTHANE; AIRWAYS AB Background: With its introduction for widespread clinical use, there has been an increase in reports of bronchospasm related to the administration of rapacuronium. As it Is commonly used for rapid sequence intubation, it has been suggested that these effects may be related to an inadequate depth of anesthesia. The current study examines the airway effects of rapacuronium in tracheally intubated, anesthetized adults. Methods: Endotracheal intubation was accomplished without the use of neuromuscular blocking agents. Dynamic compliance, tidal volume, peak inspiratory flow rate, peak expiratory flow rate, and peak inflating pressure were measured after administration of either rapacuronium (1-5 mg/kg) or cis-atracurium (0.2 mg/kg) to 20 adult patients (10 received rapacuronium and 10 received cis-atracurium) anesthetized with propofol-remifentanil. Results: Statistically significant increases in peak inflating pressure (22 +/- 6 to 28 +/- 9 cm H2O, P = 0.0012) and decreases in dynamic compliance (108 +/- 43 to 77 +/- 41 ml/cm H2O, P = 0.0001), peak inspiratory flow rate (0.43 +/- 0.11 to 0.39 +/- 0.09 1/s, P = 0.0062), peak expiratory flow rate (0.67 +/- 0.10 to 0.59 +/- 0.09 1/s, P = 0.0015), and tidal volume (744 +/- 152 to 647 +/- 135 ml, P = 0.0293) occurred after administration of rapacuronium. No changes were seen after administration of cis-atracurium. Conclusion: These data demonstrate that rapacuronium, but not cis-atracurium, has significant airway effects In intubated, mechanically ventilated adults. C1 Univ Missouri, Dept Anesthesiol 3W40H, Columbia, MO 65212 USA. RP Tobias, JD (reprint author), Univ Missouri, Dept Anesthesiol 3W40H, 1 Hosp Dr, Columbia, MO 65212 USA. NR 14 TC 12 Z9 12 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 2001 VL 95 IS 4 BP 908 EP 912 DI 10.1097/00000542-200110000-00019 PG 5 WC Anesthesiology SC Anesthesiology GA 479JU UT WOS:000171401900015 ER PT J AU Kainuma, M Miyake, T Kanno, T AF Kainuma, M Miyake, T Kanno, T TI Extremely prolonged vecuronium clearance in a brain death case SO ANESTHESIOLOGY LA English DT Article ID 3-DESACETYLVECURONIUM ORG-7268; PHARMACOKINETICS; PARALYSIS; PHARMACODYNAMICS; CORTICOSTEROIDS C1 Fujita Hlth Univ, Dept Anesthesiol, Toyoake, Aichi 4701192, Japan. Fujita Hlth Univ, Dept Crit Care Med, Toyoake, Aichi 4701192, Japan. RP Kainuma, M (reprint author), Fujita Hlth Univ, Dept Anesthesiol, 1-98 Dengakugakubo,Kutsukake Cho, Toyoake, Aichi 4701192, Japan. NR 11 TC 9 Z9 9 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 2001 VL 95 IS 4 BP 1023 EP 1024 DI 10.1097/00000542-200110000-00035 PG 2 WC Anesthesiology SC Anesthesiology GA 479JU UT WOS:000171401900031 ER PT J AU Konings, RJM AF Konings, RJM TI Thermochemical and thermophysical properties of curium and its oxides SO JOURNAL OF NUCLEAR MATERIALS LA English DT Article ID MAGNETIC-SUSCEPTIBILITY; THERMAL-CONDUCTIVITY; ACTINIDE IONS; LANTHANIDE; THERMODYNAMICS; POTENTIALS; PLUTONIUM AB A consistent set of thermophysical and thermochemical properties of Cm(cr), CM(g), Cm3+ (aq), Cm4+ (aq), Cm2+ (aq), Cm2O3 (cr), CmO2 (cr) and CmO(g) is presented, The data have been obtained from critical assessment of experimental determinations published in literature which are supplemented by estimates that are principally based on the extrapolation of trends in the lanthanide series to the actinide series. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Commiss European Communities, Joint Res Ctr, Inst Transuranium Elements, D-76125 Karlsruhe, Germany. RP Konings, RJM (reprint author), Commiss European Communities, Joint Res Ctr, Inst Transuranium Elements, Postfach 2340, D-76125 Karlsruhe, Germany. NR 85 TC 16 Z9 16 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0022-3115 J9 J NUCL MATER JI J. Nucl. Mater. PD OCT PY 2001 VL 298 IS 3 BP 255 EP 268 DI 10.1016/S0022-3115(01)00652-3 PG 14 WC Materials Science, Multidisciplinary; Nuclear Science & Technology; Mining & Mineral Processing SC Materials Science; Nuclear Science & Technology; Mining & Mineral Processing GA 479AK UT WOS:000171381600006 ER PT J AU Osaka, M Koyama, S Morozumi, K Namekawa, T Mitsugashira, T AF Osaka, M Koyama, S Morozumi, K Namekawa, T Mitsugashira, T TI Analysis of curium isotopes in mixed oxide fuel irradiated in fast reactor SO JOURNAL OF NUCLEAR SCIENCE AND TECHNOLOGY LA English DT Article DE minor actinide; curium isotopes; mixed oxide fuels; fast reactors; isotopic analysis; chemical separation; ion exchange; irradiation C1 Japan Nucl Cycle Dev Inst, Alpha Gamma Sect, Oarai Engn Ctr, Ibaraki 3111393, Japan. Tohoku Univ, Mat Res Inst, Oarai Branch, Oarai, Ibaraki 3111313, Japan. RP Osaka, M (reprint author), Japan Nucl Cycle Dev Inst, Alpha Gamma Sect, Oarai Engn Ctr, Ibaraki 3111393, Japan. EM osaka@oec.jnc.go.jp NR 6 TC 3 Z9 3 PU ATOMIC ENERGY SOC JAPAN PI TOKYO PA 3-7 SHIMBASHI 2-CHOME, MINATO-KU, TOKYO, 105-0004, JAPAN SN 0022-3131 J9 J NUCL SCI TECHNOL JI J. Nucl. Sci. Technol. PD OCT PY 2001 VL 38 IS 10 BP 912 EP 914 PG 3 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 498RC UT WOS:000172523400017 ER PT J AU Krejci, A Tucek, S AF Krejci, A Tucek, S TI Changes of cooperativity between N-methylscopolamine and allosteric modulators alcuronium and gallamine induced by mutations of external loops of muscarinic M-3 receptors SO MOLECULAR PHARMACOLOGY LA English DT Article ID SITE-DIRECTED MUTAGENESIS; ACETYLCHOLINE-RECEPTORS; SUBTYPE SELECTIVITY; LIGAND-BINDING; COMMON SITE; IDENTIFICATION; LOCATION; GENES AB To clarify the involvement of specific domains of muscarinic receptors in the action of allosteric modulators, muscarinic M-3 receptors (on which allosteric interactions are weak) were genetically modified to become more similar to M-2 receptors (on which allosteric interactions are strong) and were expressed in COS-7 cells. Affinity for allosteric modulator gallamine was enhanced 25- to 50-fold by modifications of the third external loop (o3) and the negative effect of gallamine on the affinity for classical antagonist N-[H-3]methylscopolamine ([H-3]NMS) was augmented. Affinity for alcuronium became 3-fold higher after the o3 loop of M-3 receptors was made identical with the o3 loop of M-2 receptors, and alcuronium acquired positive influence on the affinity for [H-3]NMS. This is the first instance of inducing positive cooperativity on muscarinic receptors by genetic manipulation. Transferring whole o2 loop from M-2 to M-3 receptors substantially enhanced affinities for gallamine and alcuronium without augmenting their negative action on [H-3]NMS binding. In contrast, effects of simply adding two negative charges into the o2 loop of M-3 receptors were small. Removal of Arg from o1 loop abolished the negative effect of gallamine but not of alcuronium on [H-3]NMS binding at equilibrium. Data point to an important role of o3 loop in the mechanism of the positive and negative cooperativity between [H-3]NMS and alcuronium and gallamine, respectively, and in the binding of both modulators to M-2 receptors and reveal independence between mutation-induced changes in the affinity for a modulator and in the magnitude and direction of the allosteric effect of the modulator. C1 Acad Sci Czech Republ, Inst Physiol, CR-14220 Prague, Czech Republic. RP Tucek, S (reprint author), Acad Sci Czech Republ, Inst Physiol, Videnska 1083, CR-14220 Prague, Czech Republic. NR 26 TC 29 Z9 31 PU AMER SOC PHARMACOLOGY EXPERIMENTAL THERAPEUTICS PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0026-895X J9 MOL PHARMACOL JI Mol. Pharmacol. PD OCT PY 2001 VL 60 IS 4 BP 761 EP 767 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 477LJ UT WOS:000171284800017 ER PT J AU Wenningmann, I Dilger, JP AF Wenningmann, I Dilger, JP TI The kinetics of inhibition of nicotinic acetylcholine receptors by (+)-tubocurarine and pancuronium SO MOLECULAR PHARMACOLOGY LA English DT Article ID MEMBRANE PATCHES; D-TUBOCURARINE; BINDING-SITE; OPENING RATE; CHANNEL; MUSCLE; ANTAGONIST; RESOLUTION; AGONIST; LOCALIZATION AB Equilibrium conditions of neurotransmitter concentration and receptor binding are never achieved during synaptic transmission at the neuromuscular junction. Thus, it is important to determine the binding kinetics of drugs that act this synapse. Previous determinations of the dissociation rate of (+)-tubocurarine have produced inconsistent results ranging from 0.1 to 4000/s. Here, we used a direct approach to measure association (l(on)) and dissociation (l(on)) rates for two competitive antagonists (clinically used as nondepolarizing muscle relaxants), pancuronium and (+)-tubocurarine, at nicotinic acetylcholine receptors (nAChR). We made macroscopic current recordings from outside-out patches of BC3H-1 cells expressing embryonic mouse muscle nAChR. We used a three-tube rapid perfusion system to make timed applications of antagonists and acetylcholine to the patch. We made independent measurements of the equilibrium inhibition (IC50) and the kinetics of onset and recovery of antagonist inhibition at 20 to 23 degreesC. Rate constants were calculated from the predictions of a single (high-affinity) site model of competitive inhibition. For pancuronium: IC50 = 5.5 +/-0.5 nM (mean +/-S.D.), l(on) = 2.7 +/-0.9 x 10(8) M-1 s(-1), l(off) = 2.1 +/-0.7 x 10(8)/s. For (+)-tubocurarine: IC50 = 41 +/-2 nM, l(on) = 1.2 +/-0.2 x 10(8) M-1 s(-1), l(off) = 5.9 +/-1.3/s. The kinetic results are consistent with the equilibrium results in that l(off)/l(on) is in good agreement with the IC50 values. All differences between the antagonists are significant at the p<0.001 level. The higher affinity of pancuronium is caused by a faster association rate (2.2-fold) coupled with a slower dissociation rate (2.8-fold). The association rates of both antagonists are comparable with or greater than the association rate for acetylcholine binding to nAChR. C1 SUNY Stony Brook, Dept Anesthesiol, Stony Brook, NY 11794 USA. SUNY Stony Brook, Dept Physiol & Biophys, Stony Brook, NY 11794 USA. Univ Bonn, Anasthesiol Klin, D-5300 Bonn, Germany. RP Dilger, JP (reprint author), SUNY Stony Brook, Dept Anesthesiol, Stony Brook, NY 11794 USA. RI Dilger, James/A-9283-2009 OI Dilger, James/0000-0002-8928-3283 NR 34 TC 38 Z9 38 PU AMER SOC PHARMACOLOGY EXPERIMENTAL THERAPEUTICS PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0026-895X J9 MOL PHARMACOL JI Mol. Pharmacol. PD OCT PY 2001 VL 60 IS 4 BP 790 EP 796 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 477LJ UT WOS:000171284800021 ER PT J AU Demazumder, D Dilger, JP AF Demazumder, D Dilger, JP TI The kinetics of competitive antagonism by cisatracurium of embryonic and adult nicotinic acetylcholine receptors SO MOLECULAR PHARMACOLOGY LA English DT Article ID D-TUBOCURARINE; NEUROMUSCULAR-JUNCTION; MUSCARINIC RECEPTORS; OPEN-CHANNEL; AGONIST; ACTIVATION; BINDING; SPEED; (+)-TUBOCURARINE; PHARMACOKINETICS AB Competitive antagonists to nicotinic acetylcholine receptors are clinically used as muscle relaxants. Previously, we reported the kinetics of inhibition (in the absence of acetylcholine) by (+)-tubocurarine and pancuronium on embryonic receptors. Here, we examine cisatracurium, a commonly used muscle relaxant. Outside-out patches were equilibrated with cisatracurium before application of 300 muM acetylcholine. cisatracurium inhibited the initial peak current, but the decay of these currents displayed a pronounced biphasic behavior. The IC50 value was 54 +/-2 nM and 115 +/-4 nM for adult and embryonic receptors, respectively. We designed a rapid perfusion system to apply or remove cisatracurium for various times before application of acetylcholine. We determined the association (embryonic, 3.4 +/-0.4 x 10(8) M-1 s(-1); adult, 1.8 +/-0.3 x 10(8) M-1 s(-1)) and dissociation (embryonic, 34 +/-6/s; adult: 13 +/-5/s) rates for cisatracurium. Association was 2.9- and 1.3-fold greater than that of (+)-tubocurarine and pancuronium, respectively. Dissociation was 6- and 16-fold higher than (+)-tubocurarine and pancuronium, respectively. These measurements correspond to dissociation of cisatracurium from receptors in the absence of acetylcholine. Physiologically, acetylcholine interacts with receptors equilibrated with antagonist. We developed a mathematical technique that removes the effect of desensitization and determined dissociation (embryonic, 52 +/-9/s; adult, 33 +/-5/s) in the presence of acetylcholine. These data suggest that presence of acetylcholine on one binding site of the receptor increases the dissociation rate of antagonist from the other binding site. We incorporated all of these rates into a computer simulation of a comprehensive 11-state Markov model. There was excellent agreement (without curve fitting) between simulated and experimental currents. C1 SUNY Stony Brook, Dept Anesthesiol, Hlth Sci Ctr L4, Stony Brook, NY 11794 USA. SUNY Stony Brook, Dept Physiol & Biophys, Stony Brook, NY 11794 USA. RP Dilger, JP (reprint author), SUNY Stony Brook, Dept Anesthesiol, Hlth Sci Ctr L4, Stony Brook, NY 11794 USA. RI Dilger, James/A-9283-2009 OI Dilger, James/0000-0002-8928-3283 NR 40 TC 17 Z9 21 PU AMER SOC PHARMACOLOGY EXPERIMENTAL THERAPEUTICS PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0026-895X J9 MOL PHARMACOL JI Mol. Pharmacol. PD OCT PY 2001 VL 60 IS 4 BP 797 EP 807 PG 11 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 477LJ UT WOS:000171284800022 ER PT J AU Mencke, T Beerhalter, U Fuchs-Buder, T AF Mencke, T Beerhalter, U Fuchs-Buder, T TI Spontaneous movements, local reactions and pain on injection of rocuronium - A comparison between female and male patients SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE neuromuscular block, rocuronium; pain, injection; gender, pharmacodynamics ID PROPOFOL; BROMIDE; ANESTHESIA; LIDOCAINE; CHILDREN AB Background: We investigated the incidence of withdrawal, local reactions and pain on injection of rocuronium in 120 adult ASA I-H patients undergoing general anaesthesia (group A: 60 male patients, group B: 60 female patients). Methods: After induction of anaesthesia with propofol and remifentanil, rocuronium 0.6 mg kg(-1) was injected in a separate intravenous cannula on the opposite arm. The patient's response to the injection of rocuronium was graded using a four-point scale. The appearance of local signs (i.e. erythema, venous sequelae) on the arm where rocuronium had been injected was recorded at the end of the injection as well as I h and 24 h after recovery from anaesthesia. Moreover, patients were asked 24 h after recovery from anaesthesia whether they had recall of pain or movements in this arm during induction of anaesthesia. Results: In 26 of the 120 patients (22%) included, withdrawal reactions after injection of rocuronium were observed. Of these 26 patients, 16 (13%) had severe movements. The overall incidence of withdrawal reactions after rocuronium as well as the incidence of severe reactions was significantly higher in female patients compared to male patients (overall incidence: 18 females (30%) vs. 8 males (13%), P <0.05; severe reaction: 13 females (22%) vs. 3 males (5%), P <0.05). No local reactions were observed and no patient remembered any pain or movements during induction of anaesthesia. Conclusion: The incidence and the degree of withdrawal reactions in response to the injection of rocuronium were significantly higher in women than in men. This was not associated with adverse clinical consequences for the patient's outcome. C1 Univ Saarland, Dept Anaesthesia & Crit Care, D-66421 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Saarland, Dept Anaesthesia & Crit Care, D-66421 Homburg, Germany. NR 18 TC 18 Z9 20 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD SEP PY 2001 VL 45 IS 8 BP 1002 EP 1005 DI 10.1034/j.1399-6576.2001.450813.x PG 4 WC Anesthesiology SC Anesthesiology GA 478ZX UT WOS:000171380400013 ER PT J AU Eikermann, M Renzing-Kohler, K Peters, J AF Eikermann, M Renzing-Kohler, K Peters, J TI Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE rocuronium; intubating conditions; pediatric ID TRACHEAL INTUBATION; NEUROMUSCULAR BLOCKADE; PEDIATRIC-PATIENTS; ADDUCTOR POLLICIS; ANESTHESIA; MIVACURIUM; VECURONIUM; INDUCTION; HALOTHANE; DURATION AB Background: To define the rocuronium doses which would provide 50%, 90%, and 95% probability of 'acceptable' intubation conditions during light sevoflurane anaesthesia, we studied 60 children aged 2-7 years in a prospective, randomised, assessor blinded study. Methods: After mask ventilation with 1 MAC sevoflurane/N2O for 17 +/-1 ((x) over bar +/- SD) min we administered rocuronium (either 0.15, 0.22, 0.3, 0.3, or 1.0 mg . kg(-1)) or placebo, and quantified the evoked force of the adductor pollicis muscle. Intubation conditions were assessed before and 2 min after injection of the test drug. Results: Intubation conditions were improved significantly with rocuronium. and scored 'acceptable' in 70%, 90%, and 100% of the children after injection of rocuronium 0.15, 0.22, and 0.3 mg kg-1, respectively. In parallel, twitch tension decreased to 53% (6-100), 26% (11-100), and 11% (0-19) of baseline (median (range)). Recovery of train-of-four ratio to 0.8 was achieved 13 (7-19), 16 (8-28), and 27 (23-44) min after injection of the respective rocuronium doses. Higher rocuronium doses did not further improve intubation conditions but only prolonged time of neuromuscular recovery. Logistic regression analysis revealed that rocuronium 0.11 (CI 0.05-0.16), 0.21 (0.14-0.28), and 0.25 (0.13-0.34) mg . kg(-1) provides a 50%, 90%, and 95% probability of 'acceptable' intubation conditions in children during 1 MAC sevoflurane/N2O anaesthesia, respectively. Furthermore, we calculated that force depression of adductor pollicis muscle to 81% (Cl 72-90), 58% (42-74), and 50% (29-71) of baseline is associated with 50%, 90%, and 95% probability of 'acceptable' intubation conditions. Conclusions: Submaximal depression of muscle force with low dose rocuronium improves intubation conditions in children during light sevoflurane anaesthesia while allowing rapid recovery of neuromuscular function. However, when using low dose rocuronium neuromuscular monitoring may be helpful to detect children with inadequate response to the relaxant so as to avoid an unsuccessful intubation attempt. C1 Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, Dept Anaesthesiol & Intens Care, D-45122 Essen, Germany. Univ Essen Gesamthsch, Dept Biometr, D-45122 Essen, Germany. Univ Essen Gesamthsch, Dept Epidemiol & Stat, D-45122 Essen, Germany. RP Eikermann, M (reprint author), Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, Dept Anaesthesiol & Intens Care, Hufelandstr 55, D-45122 Essen, Germany. NR 17 TC 15 Z9 15 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD SEP PY 2001 VL 45 IS 8 BP 1036 EP 1041 DI 10.1034/j.1399-6576.2001.450819.x PG 6 WC Anesthesiology SC Anesthesiology GA 478ZX UT WOS:000171380400019 ER PT J AU Reddy, MS Chen, FG Ng, HP AF Reddy, MS Chen, FG Ng, HP TI Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, double-blind controlled comparison with lidocaine SO ANAESTHESIA LA English DT Article DE neuromuscular non-depolarising agents : rocuronium; anaesthetics, intravenous : propofol; anti-emetics : ondansetron complications : pain ID TIMING PRINCIPLE; PREVENTION AB In a randomised, controlled, double-blinded trial to study the effect of ondansetron pretreatment on the pain produced after intravenous injection of rocuronium and propofol in comparison with lidocaine, 60 patients were randomly assigned to one of three groups. Group 1 received 5 ml of intravenous 0.9% sodium chloride solution pretreatment, group 2 received ondansetron 4 mg (2 mg.ml(-1) solution) diluted into a 5-ml solution, and group 3 received 50 mg lidocaine (5 ml 1% solution); this was followed 1 min later by rocuronium. and propofol. Pain was reduced significantly in the ondansetron and lidocaine groups (p < 0.0001) compared with placebo, and significantly better with lidocaine than with ondansetron (p = 0.02). We conclude that ondansetron is effective in relieving the pain of rocuronium but is not as effective as lidocaine. C1 Natl Univ Singapore Hosp, Dept Anaesthesia, Singapore 119074, Singapore. RP Reddy, MS (reprint author), Natl Univ Singapore Hosp, Dept Anaesthesia, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore. NR 18 TC 17 Z9 22 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD SEP PY 2001 VL 56 IS 9 BP 902 EP 905 DI 10.1046/j.1365-2044.2001.02059-6.x PG 4 WC Anesthesiology SC Anesthesiology GA 469CD UT WOS:000170794600018 ER PT J AU Amann, A Rieder, J Fleischer, M Niedermuller, P Hoffmann, G Amberger, A Marth, C Nigrovic, V Puhringer, F AF Amann, A Rieder, J Fleischer, M Niedermuller, P Hoffmann, G Amberger, A Marth, C Nigrovic, V Puhringer, F TI The influence of atracurium, cisatracurium, and mivacurium on the proliferation of two human cell lines in vitro SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT 8th Annual Meeting of the European-Society-of-Anaesthesiologists CY APR 01-04, 2000 CL VIENNA, AUSTRIA SP European Soc Anaesthesiologists ID ISOLATED RAT HEPATOCYTES; MOUSE LYMPHOMA-CELLS; MULTIFUNCTIONAL ACRYLATES; LIPID-PEROXIDATION; ENDOTHELIAL-CELLS; GLUTATHIONE; TOXICITY; PLASMA; METHACRYLATE; GENOTOXICITY AB We tested the influence of atracurium and cisatracurium (final concentrations: 0, 0.96, 3.2, 9.6, 32, and 96 muM) on proliferation of human cells (hepatoma HepG2 cells and human umbilical vein endothelial cells) in vitro. In additional experiments, glutathione, N-acetylcysteine, or carboxyl esterase was added before the addition of either relaxant. The number of cells, counted after 72 h of incubation was expressed as a percentage of the mean cell number in wells incubated without additives. Atracurium and cisatracurium progressively decreased cell proliferation in a concentration-dependent pattern. With human umbilical vein endothelial cells, atracurium or cisatracurium (3.2 muM) decreased the cell count to 67.7 % (SD, 14.8%) and 50% (SD, 8.6%), respectively. Cell proliferation was not inhibited by mivacurium. The results were similar to those with HepG2 cells. Glutathione, N-acetylcysteine, and carboxyl esterase partially reversed the effects of atracurium and cisatracurium. When incubated in a buffer with glutathione, atracurium decreased the number of glutathione-sulfhydryl groups. The findings that atracurium and cisatracurium inhibit proliferation of human cell lines in vitro, but that mivacurium does not, and that this effect is alleviated by glutathione and N-acetylcysteine, as well as by the carboxyl esterase, indicate that the inhibition may be caused by the reactive acrylate metabolites. C1 Univ Innsbruck, Dept Anesthesiol & Crit Care Med, A-6020 Innsbruck, Austria. Univ Innsbruck, Dept Obstet & Gynecol, A-6020 Innsbruck, Austria. Univ Innsbruck, D Swarovski Res Lab, Dept Transplant Surg, A-6020 Innsbruck, Austria. Univ Bonn, Dept Physiol 1, D-5300 Bonn, Germany. Med Coll Ohio, Dept Anesthesiol, Toledo, OH 43699 USA. Med Coll Ohio, Dept Pharmacol, Toledo, OH 43699 USA. Klinikum Steinenberg, Dept Anaesthesia & Intens Care Med, Reutlingen, Germany. RP Amann, A (reprint author), Univ Innsbruck, Dept Anesthesiol & Crit Care Med, Anichstr 35, A-6020 Innsbruck, Austria. EM anton.amann@uibk.ac.at RI Hoffmann, Georg/B-9201-2013 NR 20 TC 7 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 EI 1526-7598 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 2001 VL 93 IS 3 BP 690 EP 696 DI 10.1097/00000539-200109000-00031 PG 7 WC Anesthesiology SC Anesthesiology GA 466XU UT WOS:000170672100031 ER PT J AU Gatke, MR Ostergaard, D Bundgaard, JR Varin, F Viby-Mogensen, J AF Gatke, MR Ostergaard, D Bundgaard, JR Varin, F Viby-Mogensen, J TI Response to mivacurium in a patient compound heterozygous for a novel and a known silent mutation in the butyrylcholinesterase gene - Genotyping by sequencing SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 25th Congress of the Scandinavian-Society-of-Anaesthesiologists CY 1999 CL AARHUS, DENMARK SP Scandinavian Soc Anaesthesiologists ID PLASMA CHOLINESTERASE ACTIVITY; PROLONGED NEUROMUSCULAR BLOCK; SERUM-CHOLINESTERASE; BCHE GENE; 3 ISOMERS; VARIANTS; PHARMACOKINETICS; PHARMACODYNAMICS; ALLELES; IDENTIFICATION AB Background: Patients who are homozygous for the atypical mutation, compound heterozygous for atypical and silent mutations, or homozygous for silent mutations (SS) respond to mivacurium with extensively prolonged neuromuscular block. Although important, exact phenotyping of these patients is difficult. This article presents the pharmacodynamics and pharmacokinetics of a normal dose of mivacurium in a patient with phenotype SS, including a pedigree analysis and delineation of the molecular genetic method used to identify the genotype. Methods: The neuromuscular block following administration of mivacurium, at a dose of 0.14 mg/kg, was monitored in a 30-yr-old healthy man with use of a mechanosensor and mechanomyography, and times to different levels of recovery were measured. Venous samples for determination of the mivacurium isomers were collected during the interval 134-494 min after administration of mivacurium, and the terminal half-lives were calculated. Butyrylcholinesterase activity, phenotype, and genotype were determined for both the patient and the family. Complete nucleotide sequencing was used to identify the genotype. Results: A train-of-four ratio of 0.75 was reached 469 min after the injection of mivacurium. The terminal elimination half-lives of the mivacurium isomers, cis-trans and trans-trans, were 90 min. Complete nucleotide sequencing revealed two point mutations, the known silent variant S7 and a previously undescribed mutation of amino acid residue 170 introducing a stop codon. Conclusions: The patient was compound heterozygous for silent mutations in the butyrylcholinesterase gene. The response to mivacurium was an extensively prolonged duration of action. Identification of the rare silent mutations presupposes access to modern molecular genetic methods such as complete nucleotide sequencing. C1 Univ Copenhagen Hosp, Rigshosp 4132, Dept Anaesthesia & Intens Care, Danish Cholinesterase Res Unit, DK-2100 Copenhagen, Denmark. RP Gatke, MR (reprint author), Univ Copenhagen Hosp, Rigshosp 4132, Dept Anaesthesia & Intens Care, Danish Cholinesterase Res Unit, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. NR 33 TC 16 Z9 16 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 2001 VL 95 IS 3 BP 600 EP 606 PG 7 WC Anesthesiology SC Anesthesiology GA 470LF UT WOS:000170872900006 ER PT J AU Itoh, H Shibata, K AF Itoh, H Shibata, K TI Comparison between sevoflurane and propofol neuromuscular effects in a patient with myasthenia gravis: Effective doses of vecuronium SO ANESTHESIOLOGY LA English DT Article ID ORBICULARIS OCULI; ADDUCTOR POLLICIS; BLOCK; MUSCLE; MIVACURIUM; ATRACURIUM; ANESTHESIA; CORTEX C1 Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, Kanazawa, Ishikawa 9208641, Japan. Kanazawa Univ, Sch Med, Dept Emergency & Crit Care Med, Kanazawa, Ishikawa 9208641, Japan. RP Itoh, H (reprint author), Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan. NR 17 TC 4 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 2001 VL 95 IS 3 BP 803 EP 805 DI 10.1097/00000542-200109000-00041 PG 3 WC Anesthesiology SC Anesthesiology GA 470LF UT WOS:000170872900038 ER PT J AU Wiesner, G Gruber, M Keyl, C Schneider, A Drescher, J Hobbhahn, J AF Wiesner, G Gruber, M Keyl, C Schneider, A Drescher, J Hobbhahn, J TI In vitro effects of fluoride on pseudocholinesterase activity and the metabolism of the cis-trans and trans-trans isomers of mivacurium SO ANESTHESIOLOGY LA English DT Article ID HUMAN PLASMA; CHOLINESTERASE; ANESTHESIA; SEVOFLURANE; ASSAY C1 Univ Regensburg, Dept Anesthesiol, D-93053 Regensburg, Germany. RP Wiesner, G (reprint author), Univ Regensburg, Dept Anesthesiol, Franz Josef Strauss Allee 11, D-93053 Regensburg, Germany. RI Gruber, Michael/A-5342-2012 NR 11 TC 4 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 2001 VL 95 IS 3 BP 806 EP 807 DI 10.1097/00000542-200109000-00042 PG 2 WC Anesthesiology SC Anesthesiology GA 470LF UT WOS:000170872900039 ER PT J AU Mayer, B Fink, H Bogdanski, R Stadler, J Blobner, M AF Mayer, B Fink, H Bogdanski, R Stadler, J Blobner, M TI Inflammatory liver disease shortens atracurium-induced neuromuscular blockade in rats SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE anesthesia and analgesia, neuromuscular blockade; digestive system, liver; free radical scavengers, nitric oxide; neuromuscular non-depolarizing agents, atracurium; neurotransmitters, nitric oxide; pathological processes, inflammation; rats ID INTENSIVE THERAPY UNIT; MONOMETHYL-L-ARGININE; INFUSION REQUIREMENTS; D-TUBOCURARINE; VECURONIUM; PHARMACODYNAMICS; MUSCLE; PHARMACOKINETICS; 51W89 AB Background and objective Inflammatory liver dysfunction in rats leads to a prolonged vecuronium-induced neuromuscular blockade due to insufficient metabolism. A coexisting resistance against the drug partly counteracts this prolongation. The present study investigates the pharmacodynamics of atracurium whose metabolism does not depend on liver function. Methods Male Sprague-Dawley rats (n = 14; 290 +/- 30 g) were randomly allocated to either a group in which liver inflammation was induced by intravenous injection of 60 mg kg(-1) heat-killed Corynebacterium parvum or to a control group. On day 5 after injection, liver function was assessed using the aminopyrine breath test. Under propofol anaesthesia, duration of action of atracurium (4.8 mg kg-1) was measured by evoked mechanomyography (stimulation of the sciatic nerve; contraction of the gastrocnemius muscle). Nitric oxide concentrations, as variables for the severity of the inflammation, were assessed by measurement of nitrite/nitrate plasma concentrations. Results In C. parvum-injected rats, nitrite/nitrate plasma concentrations were increased (972 +/- 597 vs. 25 +/- 7 mu mol L-1), the aminopyrine turnover was depressed (1.7 +/- 0.4% vs. 3.5 +/- 0.5%), and the atracurium-induced neuromuscular blockade was shortened (372 +/- 128 s vs. 1081 +/- 234 s). Conclusions A systemic inflammatory response syndrome with liver dysfunction results in decreased sensitivity to atracurium. Further investigations are needed regarding a possible up-regulation of acetylcholine receptors or an increased protein binding of atracurium during sepsis to clarify reasons behind this phenomenon. C1 Tech Univ Munich, Klinikum Rechts Isar, Anasthesiol Klin, D-8000 Munich, Germany. Tech Univ Munich, Klinikum Rechts Isar, Inst Expt Onkol & Therapieforsch, D-8000 Munich, Germany. Kreiskrankenhaus Prien, Prien Am Chiemsee, Germany. RP Blobner, M (reprint author), Tech Univ Munich, Klinikum Rechts Isar, Anasthesiol Klin, D-8000 Munich, Germany. NR 18 TC 5 Z9 5 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD SEP PY 2001 VL 18 IS 9 BP 599 EP 604 DI 10.1046/j.1365-2346.2001.00897.x PG 6 WC Anesthesiology SC Anesthesiology GA 471AU UT WOS:000170905300007 ER PT J AU Geller, TJ Kaiboriboon, K Fenton, GA Hayat, GR AF Geller, TJ Kaiboriboon, K Fenton, GA Hayat, GR TI Vecuronium-associated axonal motor neuropathy: a variant of critical illness polyneuropathy? SO NEUROMUSCULAR DISORDERS LA English DT Article DE non-depolarizing neuromuscular blocking agent; vecuronium; neuromuscular blockade; polyneuropathy; critical illness polyneuropathy ID LONG-TERM INFUSION; PROLONGED PARALYSIS; NEUROMUSCULAR BLOCKADE; BLOCKING-AGENTS; ILL PATIENTS; BROMIDE AB Neuromuscular blocking agents are routinely used as an adjunct therapy for critically ill patients. Unlike many neuromuscular blocking agents, vecuronium does not cause significant histamine release, which may lead to bronchoconstriction. Due to a short duration of action and limited accumulation, vecuronium has been widely used. Prolonged ventilatory dependence due to persistent neuromuscular blockade has been reported in patients treated with vecuronium. We report a case of an 8-year-old girl who had a primarily motor axonopathy presenting with weakness after extended vecuronium administration with prolonged course of recovery. This primarily motor neuropathy with axonal features may be a variant of critical illness polyneuropathy, a rarely reported condition in pediatric patients. (C) 2001 Elsevier Science B.V. All rights reserved. C1 St Louis Univ, Dept Neurol, St Louis, MO 63110 USA. RP Geller, TJ (reprint author), St Louis Univ, Dept Neurol, 3635 Vista Ave & Grand Blvd,POB 15250, St Louis, MO 63110 USA. NR 10 TC 20 Z9 20 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0960-8966 J9 NEUROMUSCULAR DISORD JI Neuromusc. Disord. PD SEP PY 2001 VL 11 IS 6-7 BP 579 EP 582 DI 10.1016/S0960-8966(01)00200-0 PG 4 WC Clinical Neurology; Neurosciences SC Neurosciences & Neurology GA 469NQ UT WOS:000170822100010 ER PT J AU Abdulatif, M El-Sanabary, M AF Abdulatif, M El-Sanabary, M TI Edrophonium antagonism of cisatracurium-induced neuromuscular block: Dose requirements in children and adults SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE anaesthesia : paediatric; neuromuscular block : cisatracurium; antagonists : neuromuscular block; edrophonium ID RESPONSE RELATIONSHIPS; NEOSTIGMINE; ANESTHESIA; PHARMACOLOGY; ATRACURIUM; VECURONIUM; RECOVERY; REVERSAL; INFANTS; PANCURONIUM AB This randomized, controlled study compared edrophonium dose requirements to antagonize cisatracurium-induced neuromuscular block in children and adults. Sixty children, aged two to 10 years, and 60 adults aged 20 to 60 years, all subjects ASA physical status 1 or 2, having propofol, fentanyl and isoflurane-N2O anaesthesia, were studied. Cisatracurium 0.1 mg.kg(-1) was given for muscle relaxation. Neuromuscular block was monitored with accelerometry. Edrophonium 0.1, 0.2, 0.4 or 1 mg.kg(-1) or no anticholinesterase (controls) was given by random allocation to antagonize 90% neuromuscular block in each of the study groups (n = 12). Atropine 5 to 10 mug.kg(-1) was given according to edrophonium dose. Onset time of cisatracurium-induced block in children was mean (SD) 2.4 (0.8) versus 4.1 (2.3) minutes in adults, P < 0.01. The times to 10% spontaneous recovery of the first twitch (TI) were respectively, 28.4 (5.2) and 41.8 (6.1) minutes in children and adults, P < 0.01. Spontaneous and antagonist assisted neuromuscular recovery was more rapid in children. Adequate neuromuscular recovery (train of four (TOF) ratio 80%) was achieved in children at 3 and 10 minutes after edrophonium 1.0 mg.kg(-1) and 0.4 mg.kg(-1), respectively. A TOF ratio of 80% was not achieved, within 10 minutes, with any of the four dose levels of edrophonium in adults. The dose of edrophonium to achieve a TOF ratio of 80% (EDTOF-80) after 5 and 10 minutes in children were, respectively, mean (SD) 0.85 (0.38) and 0.38 (0.19) mg.kg(-1). The equivalent EDTOF-80 in adults was outside the edrophonium dose range studied. C1 Cairo Univ, Fac Med, Dept Anaesthesiol, Cairo, Egypt. RP Abdulatif, M (reprint author), POB 147,Panorama October 11811, Cairo, Egypt. NR 28 TC 1 Z9 1 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD AUG PY 2001 VL 29 IS 4 BP 364 EP 370 PG 7 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 462TJ UT WOS:000170435600006 ER PT J AU Fine, GF Brandom, BW Yellon, RF AF Fine, GF Brandom, BW Yellon, RF TI Unmasked residual neuromuscular block after administration of vecuronium for days SO ANESTHESIA AND ANALGESIA LA English DT Article ID CRITICALLY ILL PATIENTS; PEDIATRIC-PATIENTS; CHILDREN; INFUSION; INFANTS; PHARMACOKINETICS; VOLUNTEERS; ATRACURIUM; PARALYSIS; RECOVERY C1 Univ Pittsburgh, Sch Med, Childrens Hosp Pittsburgh, Dept Anesthesiol, Pittsburgh, PA 15213 USA. Univ Pittsburgh, Sch Med, Childrens Hosp Pittsburgh, Dept Otolaryngol, Pittsburgh, PA 15213 USA. RP Fine, GF (reprint author), Univ Pittsburgh, Sch Med, Childrens Hosp Pittsburgh, Dept Anesthesiol, 1 Childrens Pl, Pittsburgh, PA 15213 USA. NR 21 TC 0 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2001 VL 93 IS 2 BP 345 EP 347 DI 10.1097/00000539-200108000-00021 PG 3 WC Anesthesiology SC Anesthesiology GA 456YU UT WOS:000170111000021 ER PT J AU Larijani, GE Donati, F Bikhazi, G Bartkowski, R Kenaan, CA Plaud, B Goldberg, ME AF Larijani, GE Donati, F Bikhazi, G Bartkowski, R Kenaan, CA Plaud, B Goldberg, ME TI A multicenter evaluation of the time-course of action of two doses of rapacuronium after early and late reversal with neostigmine SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT Annual Meeting American-Society-of-Anesthesiology CY OCT 14-18, 2000 CL SAN FRANCISCO, CALIFORNIA SP Amer Soc Anesthesiol ID NEUROMUSCULAR BLOCKING-AGENTS; CLINICAL-PHARMACOLOGY; VECURONIUM; ORG-9487; BROMIDE AB Early reversal of rapacuronium may accelerate return of neuromuscular function. This study was designed to compare early (2 min after rapacuronium) or late (at 25% recovery of the first twitch [T1] of train-of-four) reversal of rapacuronium with neostigmine. We studied 119 subjects between the ages of 18 and 75 yr. Anesthesia was induced with fentanyl and thiopental and maintained with nitrous oxide, propofol, and fentanyl. Mechanomyographic neuromuscular monitoring was performed by using train-of-four stimulation of the ulnar nerve. Two groups received 1.5 mg/kg rapacuronium followed by neostigmine (50 mug/kg) and glycopyrrolate (10 mug/kg) either at 2 min after rapacuronium bolus or at 25% TI recovery. The other two groups received 2.0 mg/kg rapacuronium, after which neostigmine was similarly given. For each rapacuronium dose, the time from the administration of rapacuronium to the start of Tl recovery or 25% T1 recovery was significantly shorter in subjects who received the reversal 2 min after rapacuronium. However, late recovery, defined by times from administration of rapacuronium to 70%, or 80% T4/T1 recovery, was not influenced by early reversal administration. We conclude that initial recovery is accelerated by early administration of neostigmine. Time to full recovery after rapacuronium administration is, however, dose-dependent and not significantly altered by early administration of neostigmine. C1 Univ Med & Dent New Jersey, Dept Anesthesiol, Camden, NJ 08103 USA. Univ Montreal, Dept Anesthesiol, Montreal, PQ, Canada. Univ Miami, Dept Anesthesiol, Miami, FL 33152 USA. Thomas Jefferson Univ, Jefferson Med Coll, Dept Anesthesiol, Philadelphia, PA 19107 USA. RP Larijani, GE (reprint author), Univ Med & Dent New Jersey, Dept Anesthesiol, 1 Cooper Plaza, Camden, NJ 08103 USA. NR 12 TC 3 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2001 VL 93 IS 2 BP 370 EP 374 PG 5 WC Anesthesiology SC Anesthesiology GA 456YU UT WOS:000170111000027 ER PT J AU Dhonneur, G Cerf, C Lagneau, F Mantz, J Gillotin, C Duvaldestin, P AF Dhonneur, G Cerf, C Lagneau, F Mantz, J Gillotin, C Duvaldestin, P TI The pharmacokinetics of cisatracurium in patients with acute respiratory distress syndrome SO ANESTHESIA AND ANALGESIA LA English DT Article ID CRITICALLY ILL PATIENTS; INTENSIVE-CARE UNIT; NEUROMUSCULAR-BLOCKING-AGENTS; MECHANICAL VENTILATION; INFUSION REQUIREMENTS; DOUBLE-BLIND; PHARMACODYNAMICS; VECURONIUM; ATRACURIUM; BLOCKADE AB Continuous neuromuscular blockade is often necessary in patients being treated for acute respiratory distress syndrome (ARDS) to optimize oxygenation. In this study, neuromuscular blockade (no response to two responses at the train-of-four stimulation at the orbicularis oculi muscle) was achieved in six patients with ARDS by a continuous infusion of cisatracurium. The plasma concentration of cisatracurium during the infusion averaged 1.00 (0.25-1.45) mug/mL, expressed as median (range). The clearance and half-life were 6.5 (3.3-7.6) mL . min(-1) . kg(-1) and 25 (16-48) min, respectively. The laudanosine plasma concentrations were 0.70 (0.12-1.20) mug/mL. The pharmacokinetic variables of cisatracurium are similar to those of patients without organ failure undergoing elective surgery. Plasma laudanosine levels always remained well less that those associated with seizure activity in animal models. Long-term infusion of cisatracurium was not associated with any side effects. Cisatracurium is a suitable muscle relaxant when deep and continuous levels of muscle relaxation are required in patients treated for ARDS. C1 Hop Henri Mondor, Dept Anaesthesia, F-94010 Creteil, France. Hop Henri Mondor, Intens Care Unit, F-94010 Creteil, France. Beaujon Hosp, Dept Anaesthesia, Clichy, France. Beaujon Hosp, Intens Care Unit, Clichy, France. Bichat Hosp, Dept Anaesthesia, Paris, France. Bichat Hosp, Intens Care Unit, Paris, France. Glaxo Wellcome Labs, Marly de Roi, France. RP Duvaldestin, P (reprint author), Hop Henri Mondor, Dept Anaesthesia, 51 Ave Marechal de Lattre de Tassigny, F-94010 Creteil, France. NR 28 TC 3 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2001 VL 93 IS 2 BP 400 EP 404 DI 10.1097/00000539-200108000-00033 PG 5 WC Anesthesiology SC Anesthesiology GA 456YU UT WOS:000170111000033 ER PT J AU Bergeron, L Bevan, DR Berrill, A Kahwaji, R Varin, F AF Bergeron, L Bevan, DR Berrill, A Kahwaji, R Varin, F TI Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient SO ANESTHESIOLOGY LA English DT Article ID OPIOID BARBITURATE ANESTHESIA; ATRACURIUM BESYLATE; TWITCH DEPRESSION; ADDUCTOR POLLICIS; SURGICAL PATIENTS; MUSCLE-RELAXANTS; PHARMACOKINETICS; PHARMACODYNAMICS; ELIMINATION; PLASMA AB Background The linearity of cisatracurium elimination and its concentration-effect relation were determined as part of a traditional rich data study with three dose levels in patients receiving balanced anesthesia. Methods. Forty-eight adults with American Society of Anesthesiologists status T-H were randomized to receive an intravenous bolus dose of 0.075, 0.15, or 0.30 mg/kg cisatracurium. Anesthesia was induced and maintained with nitrous oxide-oxygen, propofol, and fentanyl. The mechanical response of the adductor pollicis muscle was recorded. Arterial blood samples were collected over 8 h. Cisatracurium, laudanosine, and the monoquaternary alcohol concentrations were measured by high-performance liquid chromatography. To assess the relative contribution of the input function, a parametric (assuming elimination from both the central and peripheral compartments) and a nonparametric pharmacokinetic-pharmacodynamic model were both applied to data. Results. Dose proportionality of the body disposition of cisatracurium. and its two major metabolites at doses up to 0.30 mg/kg was confirmed. With the parametric approach, the effect compartment concentration at 50% block (EC50) Significantly increased with the dose (136 vs. 157 vs. 209 ng/ml), whereas the effect compartment equilibration rate constant decreased (0.0675 vs. 0.0568 vs. 0.0478 min(-1)). A similar dose-dependent effect of the pharmacokinetic-pharmacodynamic relation was observed with the nonparametric approach, but the trend was 50% less pronounced. Conclusion: A dose-related change in pharmacokinetic-pharmacodynamic parameters was identified with both modeling approaches. A pharmacokinetic origin was ruled out, although no definite explanation of the underlying mechanism could be provided. These findings suggest that doses relevant to the anesthetic practice be used for estimation of EC50. C1 Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. Univ British Columbia, Vancouver Gen Hosp, Dept Anesthesia, Vancouver, BC V5Z 1M9, Canada. RP Varin, F (reprint author), Univ Montreal, Fac Pharm, CP 6128,Succursale Ctr Ville, Montreal, PQ H3C 3J7, Canada. NR 32 TC 16 Z9 20 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD AUG PY 2001 VL 95 IS 2 BP 314 EP 323 DI 10.1097/00000542-200108000-00010 PG 10 WC Anesthesiology SC Anesthesiology GA 459EJ UT WOS:000170237800006 ER PT J AU Ledowski, T Wulf, H AF Ledowski, T Wulf, H TI The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidate and rocuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blocking drugs, rocuronium; succinylcholine; anaesthetics general, anaesthetics intravenous; etomidate, fentanyl; anaesthetics dissociative, s-ketamine ID RAPID-SEQUENCE INDUCTION; CONDITIONS ONE MINUTE; TRACHEAL INTUBATION; NEUROMUSCULAR BLOCK; TIMING PRINCIPLE; ONSET TIME; ANESTHESIA; SUCCINYLCHOLINE; PROPOFOL; THIOPENTONE AB Background and objective In the present study, we investigated the combination of etomidate and s-ketamine with regard to its suitability for modified rapid-sequence induction using rocuronium for muscle relaxation. Methods In a prospective, randomized and double-blinded study, 90 patients were assigned to one of three groups for induction of anaesthesia in combination with etomidate (0.3 mg kg(-1)) and muscle relaxation with rocuronium (0.6 mg kg(-1)). The groups were as follows: (a) control, i.e. placebo; (b) fentanyl, fentanyl (1.5 tg kg(-1)); (c) ketamine, s-ketamine (0.5 mg kg(-1)). Tracheal-intubating conditions after 1 min were classified as excellent, good or poor. During the induction of anaesthesia, arterial pressure and heart rate were measured every 60 s. Results Intubating conditions were best using etomidate and s-ketamine (23 excellent, 7 good, 0 poor) compared with the control (8, 16, 6 respectively) and fentanyl groups (7, 21, 2 respectively) (P < 0.01). While heart rate and arterial pressure remained stable in the control and fentanyl groups during induction, both significantly increased in the ketamine group (P < 0.01). Conclusions The combination of etomidate and s-ketamine for anaesthesia induction produces mostly excellent intubating conditions after 60 s using only 0.6 mg kg(-1) of rocuronium. This combination of drugs may be a useful alternative, if succinylcholine needs to be avoided, for modified rapid-sequence induction. C1 Univ Kiel Hosp, Dept Anaesthesiol & Intens Care Med, D-24105 Kiel, Germany. Univ Marburg Hosp, Dept Anaesthesiol & Intens Care Med, D-35033 Marburg, Germany. RP Ledowski, T (reprint author), Univ Kiel Hosp, Dept Anaesthesiol & Intens Care Med, Schwanenweg 21, D-24105 Kiel, Germany. NR 24 TC 10 Z9 10 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD AUG PY 2001 VL 18 IS 8 BP 519 EP 523 DI 10.1046/j.1365-2346.2001.00886.x PG 5 WC Anesthesiology SC Anesthesiology GA 462NA UT WOS:000170425100006 ER PT J AU Miguel, RV Soto, R Dyches, P AF Miguel, RV Soto, R Dyches, P TI A double-blind, randomized comparison of low-dose rocuronium and atracurium in a desflurane anesthetic SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE monitoring : neuromuscular block; neuromuscular relaxants : atracurium, hemodynamic effects, rocuronium ID TIME-COURSE; VECURONIUM; ISOFLURANE; HUMANS; SUCCINYLCHOLINE; PANCURONIUM; ENFLURANE AB Study Objectives: To compare the neuromuscular and hemodynamic effects of rocuronium and atracurium when administered during a desflurane-based anesthetic. Design: Randomized, double-blind clinical trial. Patients: 51 adult ASA physical status I and II Patients scheduled for general surgical operations. Setting: University-based NCI-designated cancer center. Interventions: Patients received either 0.45 mg/kg rocuronium (n = 28) or atracurium 0.5 mg/kg (n = 23). Induction of anesthesia was accomplished by, 2 mug/kg fentanyl intravenously (TV) and 1.5 mg/kg propofol IV and maintained by a nitrous oxide/oxygen desflurane anesthetic. Measurements and Main Results: A neuromuscular monitor was used at the adductor pollicis to monitor and record twitch response to train-of-four electrical stimulation. Baseline heart rate (HR) and blood pressure (BP) were measured and again at 2, 5, 10, and 15 minutes after muscle relaxant administration. Patients in the rocuronium group were found to have shorter times to 80 % T-1 depression (109 +/- 53 vs. 135 +/- 47 sec), although those differences did not reach statistical significance (p = 0. 07). Percent of the first twitch (T-1) was significantly lower in the patients receiving rocuronium at 60 seconds (53 +/- 24 vs. 73 +/- 27 sec, p = 0.006) and 90 seconds (25 +/- 22 vs. 47 +/- 29 sec; p = 0.003) than in the patients receiving atracurium. Duration was shorter in rocuronium-treated patients (25 % T-1 recovery = 32 +/- 12 vs. 54 +/- 14 min; p < 0.001) than the patients receiving atracurium. Intubation scores were better at 60 seconds after muscle relaxant administration in the rocuronium group. No significant differences in HR or BP were seen between the patients in the two groups. Conclusions: Rocuronium at a dose of 0.45 mg/kg possesses a fairly rapid onset of neuromuscular blockade and has short:intermediate duration of action when used with a desflurane anesthetic. This quality makes it a desirable drug for operations of relatively short duration. Rocuronium at a dose of 0.45 mg/kg has a faster onset and shorter duration than atracurium, at 0.5 mg/kg, when used with a desflurane anesthetic. (C) 2001 by Elsevier Science Inc. C1 Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Anesthesiol, Tampa, FL 33612 USA. RP Miguel, RV (reprint author), Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Anesthesiol, 12902 Magnolia Dr,Suite 2149, Tampa, FL 33612 USA. NR 18 TC 1 Z9 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD AUG PY 2001 VL 13 IS 5 BP 325 EP 329 DI 10.1016/S0952-8180(01)00282-3 PG 5 WC Anesthesiology SC Anesthesiology GA 463YE UT WOS:000170504200002 ER PT J AU Mendez, DR Goto, CS Abramo, TJ Wiebe, RA AF Mendez, DR Goto, CS Abramo, TJ Wiebe, RA TI Safety and efficacy of rocuronium for controlled intubation with paralytics in the pediatric emergency department SO PEDIATRIC EMERGENCY CARE LA English DT Article DE rocuronium; vecuronium; tracheal intubation; aspiration; hypoxia; hypotension; bradycardia ID HALOTHANE ANESTHESIA; TIME-COURSE; VECURONIUM; ORG-9426; SEQUENCE; CHILDREN; BROMIDE; SUCCINYLCHOLINE; ATRACURIUM; INDUCTION AB Background: Controlled intubation in the pediatric emergency department (ED) requires a paralytic agent that is safe, efficacious, and of rapid onset. The safety of succinylcholine has been challenged, leading some clinicians to use vecuronium as an alternative. Rocuronium's onset is similar to that of succinylcholine. Objective: To evaluate the safety and efficacy of rocuronium for controlled intubation with paralysis (CIP) in the pediatric ED. Methods: A retrospective, observational study reviewed the records of patients less than 15 years of age, who received controlled intubation with paralytics at two Dallas EDs. The patients received either vecuronium or rocuronium. Results: The study included 84 patients (vecuronium 19, rocuronium 65). Complications were similar between the two groups. Rocuronium had a shorter time from administration to intubation when compared to vecuronium (P < 0.05). Conclusion: Rocuronium is as safe and efficacious as vecuronium for CIP in the pediatric ED. C1 Univ Texas, SW Med Ctr, Dept Pediat, Dallas, TX USA. RP Mendez, DR (reprint author), 3623 Kennedy Dr, Pearland, TX 77584 USA. NR 25 TC 3 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0749-5161 J9 PEDIATR EMERG CARE JI Pediatr. Emerg. Care PD AUG PY 2001 VL 17 IS 4 BP 233 EP 236 DI 10.1097/00006565-200108000-00001 PG 4 WC Emergency Medicine; Pediatrics SC Emergency Medicine; Pediatrics GA 464YR UT WOS:000170561400001 ER PT J AU Plaud, B Debaene, B Donati, F AF Plaud, B Debaene, B Donati, F TI The corrugator supercilii, not the orbicularis oculi, reflects rocuronium neuromuscular blockade at the laryngeal adductor muscles SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 07-13, 1999 CL DALLAS, TEXAS SP Amer Soc Anesthesiol ID POLLICIS MUSCLES; ONSET TIME; ANESTHESIA; ATRACURIUM; HUMANS; VECURONIUM; SUCCINYLCHOLINE; DURATION; SUXAMETHONIUM; STIMULATION AB Background: Some studies suggest that the orbicularis oculi is resistant to neuromuscular blocking drugs and behaves like laryngeal muscles. Others report little or no difference between the orbicularis oculi and the adductor pollicis, These discrepancies could be related to the exact site of recording. The purpose of this study was to compare two monitoring sites around the eye with the adductor pollicis and the laryngeal adductor muscles, Methods: After institutional approval and informed consent, the evoked response to train-of-four stimulation was measured In 12 patients by acceleromyography at the thumb (adductor pollicis), the eyelid (orbicularis oculi), and the superciliary arch (corrugator supercilii) after 0.5 mg/kg rocuronium during propofol-fentanyl-nitrous oxide anesthesia. In 12 other patients, laryngeal adductor neuromuscular blockade was assessed via the cuff of the tracheal tube and compared with the adductor pollicis and the corrugator supercilii after 0.6 mg/kg rocuronium, Results: After 0.5 mg/kg, maximum blockade (%T1, mean +/- SD) was less at the corrugator supercilii (80 +/- 20%) than at the adductor pollicis (100 +/- 1%) and the orbicularis oculi (93 +/- 8%) (P < 0.01). Clinical duration (25%T1) was shorter at the corrugator supercilii (12 +/- 7 min) than at the adductor pollicis (25 +/- 4 min) and orbicularis oculi (24 +/- 10 min) (P < 0.01). After 0.6 mg/kg, maximum blockade was similar at the corrugator supercilii (88 +/- 8%) and the laryngeal adductor muscles (89 +/- 11%). Clinical duration at the corrugator supercilii and the laryngeal adductors was 17 +/- 7 and 17 +/- 10 min, respectively. Conclusions: Muscles around the eye vary in their response to rocuronium, The response of the superciliary arch (corrugator supercilii) reflects blockade of laryngeal adductor muscles. However, the eyelid (orbicularis oculi) and thumb (adductor pollicis) have similar sensitivities. C1 Ctr Hosp Univ Montreal, Dept Anesthesiol, Hotel Dieu, Montreal, PQ H2W 1T8, Canada. Univ Montreal, Dept Anaesthesiol, Montreal, PQ, Canada. RP Donati, F (reprint author), Ctr Hosp Univ Montreal, Dept Anesthesiol, Hotel Dieu, Campus Hotel Dieu,3840 St Urbain St, Montreal, PQ H2W 1T8, Canada. NR 23 TC 54 Z9 56 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 2001 VL 95 IS 1 BP 96 EP 101 DI 10.1097/00000542-200107000-00019 PG 6 WC Anesthesiology SC Anesthesiology GA 448YN UT WOS:000169657700015 ER PT J AU Tobias, JD Johnson, JO AF Tobias, JD Johnson, JO TI Rapacuronium administration to patients receiving phenytoin or carbamazepine SO JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY LA English DT Article DE neuromuscular blocking agents; rapacuronium; phenytoin; carbamazepine ID PHARMACOKINETIC DRUG-INTERACTIONS; MUSCLE-RELAXANT; DURATION; ATRACURIUM; ROCURONIUM; ORG-9487; THERAPY; ONSET AB Patients receiving anticonvulsants such as phenytoin or carbamazepine may be resistant to neuromuscular blocking agents. The authors report the response to rapacuronium bromide (1.5 mg/kg) in two adult patients; one receiving phenytoin and the other receiving carbamazepine. In both patients, there was a delay in achieving maximum blockade; 100% depression of the first twitch was never achieved in the patient receiving phenytoin. Recovery of neuromuscular function was rapid. In the patient receiving phenytoin and carbamazepine respectively, the clinical duration (time to return of T-1% to 25% of baseline) was 5 and 9 minutes, the recovery index (T-1 25%-75%) was 4 minutes and 3 minutes, and the time to return of T-4/T-1 to greater than 0.7 was 15 minutes and 18 minutes 40 seconds. As has been reported with other neuromuscular blocking agents of the aminosteroid class, the clinical duration and the recovery index of rapacuronium are shortened in patients receiving either phenytoin or carbamazepine. C1 Univ Missouri, Dept Anesthesiol, Columbia, MO 65212 USA. Univ Missouri, Dept Pediat, Columbia, MO 65212 USA. Univ Missouri, Dept Neurosurg, Columbia, MO 65212 USA. Univ Missouri, Div Pediat Crit Care Pediat Anesthesiol, Columbia, MO 65212 USA. RP Tobias, JD (reprint author), Univ Missouri, Hlth Sci Ctr, Dept Child Hlth M658, 1 Hosp Dr, Columbia, MO 65212 USA. NR 12 TC 0 Z9 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0898-4921 J9 J NEUROSURG ANESTH JI J. Neurosurg. Anesthesiol. PD JUL PY 2001 VL 13 IS 3 BP 240 EP 242 DI 10.1097/00008506-200107000-00011 PG 3 WC Anesthesiology; Clinical Neurology; Surgery SC Anesthesiology; Neurosciences & Neurology; Surgery GA 445TV UT WOS:000169475400011 ER PT J AU Gao, L Ramzan, I Baker, B AF Gao, L Ramzan, I Baker, B TI Gas chromatographic-mass spectrometric assay for rocuronium with potential for quantifying its metabolite, 17-desacetylrocuronium, in human plasma SO JOURNAL OF CHROMATOGRAPHY B LA English DT Article DE rocuronium; 17-desacetylrocuronium ID FLUIDS AB A rapid, sensitive and selective method has been developed for the quantification of plasma concentrations of neuromuscular blocking drug, rocuronium, using gas chromatography with mass spectrometric detection. 3-Desacetylvecuronium served as the internal standard. The method involved iodide ion pair formation and a single-step liquid-liquid extraction with dicholoromethane. This method also permits simultaneous determination of its putative metabolite, 17-desacetylrocuronium, although the high detection limit for the metabolite limits the practical application of this method in pharmacokinetic study of the metabolite. The extraction efficiency was similar to 75% for rocuronium and similar to 50% for 17-desacetylrocuronium. The limit of quantification was 26 ng/ml for rocuronium and 870 ng/ml for its metabolite. The assay was used successfully in a patient undergoing liver transplantation and receiving rocuronium as a constant rate infusion and in a patient undergoing general elective surgery receiving the drug as an intravenous bolus. This assay is a time-saving alternative to published gas or liquid chromatographic methods for assaying rocuronium. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Univ Sydney, Fac Pharm, Sydney, NSW 2006, Australia. Univ Sydney, Dept Anaesthesia, Sydney, NSW 2006, Australia. RP Ramzan, I (reprint author), Univ Sydney, Fac Pharm, Bldg A15, Sydney, NSW 2006, Australia. NR 5 TC 12 Z9 13 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0378-4347 J9 J CHROMATOGR B JI J. Chromatogr. B PD JUN 15 PY 2001 VL 757 IS 2 BP 207 EP 214 DI 10.1016/S0378-4347(01)00147-5 PG 8 WC Biochemical Research Methods; Chemistry, Analytical SC Biochemistry & Molecular Biology; Chemistry GA 436QK UT WOS:000168946400002 ER PT J AU Saitoh, Y Kaneda, K Tokunaga, Y Murakawa, M AF Saitoh, Y Kaneda, K Tokunaga, Y Murakawa, M TI Infusion of amino acid enriched solution hastens recovery from neuromuscular block caused by vecuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE monitoring, neuromuscular function; neuromuscular block; temperature, body; neuromuscular block, vecuronium; pharmacology, vecuronium ID GENERAL-ANESTHESIA; HYPOTHERMIA; SUPPLEMENTATION AB We investigated the effect of an amino acid infusion on neuromuscular block produced by vecuronium, and on rectal temperature and surface temperature over the adductor pollicis muscle. Sixty adult patients undergoing general anaesthesia were randomly divided into four groups of 15 patients each: amino acid (AA)-post-tetanic count (PTC); AA-train-of-four (TOF); control (C)-PTC; or C-TOF group. In the AA-PTC and AA-TOF groups, after a bolus of vecuronium 0.1 mg kg(-1), a continuous infusion of an 18 amino acid enriched solution (AMIPAREN((R))) was started at a rate of 166 kJ h(-1). In the C-PTC and C-TOF groups, normal saline was administered. Time from vecuronium to the return of the PTC in the AA-PTC group was significantly shorter than in the C-PTC group (mean (SD), 13.3 (4.5) versus 18.0 (5.6) min, P <0.05). Times to return of T1, T2, T3, and T4 (first, second, third, and fourth twitch of TOF) in the AA-TOF group were significantly shorter than in the C-TOF group (21.1 (4.5) versus 28.0 (8.2) min for T1, P <0.05). PTC in the AA-PTC group was significantly greater than in the C-PTC group; 25-35 min after administration of vecuronium (P <0.05). T1/T0 and T4/T1 in the AA-TOF group were significantly higher than in the C-TOF group, 40-120 and 50-120 min after vecuronium respectively (P <0.05). Rectal temperature and surface temperature over the adductor pollicis muscle in the AA-PTC and AA-TOF groups were significantly higher than in the control groups 50-120 and 100-120 min after vecuronium respectively (P <0.05). Infusion of amino acid enriched solution hastens recovery from neuromuscular block. C1 Fukushima Med Univ, Sch Med, Dept Anesthesiol, Fukushima 9601295, Japan. Toride Kyodo Gen Hosp, Dept Anesthesiol, Ibaraki, Osaka, Japan. RP Saitoh, Y (reprint author), Fukushima Med Univ, Sch Med, Dept Anesthesiol, Hikarigaoka 1, Fukushima 9601295, Japan. NR 15 TC 3 Z9 3 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JUN PY 2001 VL 86 IS 6 BP 814 EP 821 DI 10.1093/bja/86.6.814 PG 8 WC Anesthesiology SC Anesthesiology GA 439WV UT WOS:000169141300013 ER PT J AU Hemmerling, TM Schuettler, J Schwilden, H AF Hemmerling, TM Schuettler, J Schwilden, H TI Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID LOOP FEEDBACK-CONTROL; NEUROMUSCULAR BLOCK; ATRACURIUM; ANESTHESIA; VECURONIUM; REQUIREMENTS; ENFLURANE; ORG-9426; RECOVERY; HUMANS AB Purpose: The present study investigated the interaction between the cumulative dose requirements of cisatracurium and anesthesia with isoflurane, sevoflurane, desflurane or propofol using closed-loop feedback control. Methods: Fifty-six patients (18-85 yr, vitrectomies of more than one hour) were studied. In the volatile anesthetics groups, anesthesia was maintained by 1.3 MAC of isoflurane, sevoflurane or desflurane; in the propofol group, anesthesia was maintained by a continuous infusion of 6-8 mg(.)kg(-1) hr(-1) propofol. After bolus application of 0.1 mg(.)kg(-1) cisatracurium, a T1%-level of 10% of control level (train-of-four stimulation every 20 sec) was maintained using closed-loop feedback controlled infusion of cisatracurium. The effective therapeutic infusion rate (ETI) was estimated from the asymptotic steady-state infusion rate I-ss. The I-SS was derived from fitting an asymptotic line to the measured cumulative dose requirement curve. The ETI of the different groups was compared using Kruskal-Wallis- test, followed by rank sum test, corrected for the number of comparisons, P <0.05 was regarded as showing significant difference. Results: ETI in the isoflurane group was 35.6 +/- 8.6 mug(.)m(-2) min(-1), in the sevoflurane group 36.4-+/- 11.9 mug m(-2) min(-1), in the desflurane group 23.8 +/- 6.3 mug(.)m(-2) min(-1). The ETI of the volatile anesthetic groups were all significantly lower than the ETI in the propofol group at 61.7 +/- 25.3 mug(.)m(-2)min(-1) (P <0.002). The ETI in the desflurane group was significantly lower than in all other groups (P <0.02). Conclusion: In comparison to propofol, isoflurane, sevoflurane and desflurane reduce the cumulative dose requirements of cisatracurium to maintain a 90% neuromuscular blockade by 42%, 41% and 60%, respectively. C1 Univ Erlangen Nurnberg, Dept Anesthesiol, Erlangen, Germany. RP Hemmerling, TM (reprint author), Univ Montreal, Dept Anesthesiol, CHUM, Hotel Dieu, 3840 Rue St Urbain, Montreal, PQ H2W 1T8, Canada. NR 24 TC 9 Z9 16 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUN PY 2001 VL 48 IS 6 BP 532 EP 537 PG 6 WC Anesthesiology SC Anesthesiology GA 445QT UT WOS:000169430700006 ER PT J AU Theroux, MC Rose, JB Iyengar, S Katz, MS AF Theroux, MC Rose, JB Iyengar, S Katz, MS TI Succinylcholine pretreatment using gallamine or mivacurium during rapid sequence induction in children: A randomized, controlled study SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article; Proceedings Paper CT Annual Meeting of the International-Anesthesia-Research-Society CY MAR 07-20, 1998 CL ORLANDO, FLORIDA SP Int Anesthesia Res Soc DE creatinine phosphokinase; fasciculation; hyperkalemia; myoglobinemia; pediatrics; pretreatment ID NONDEPOLARIZING RELAXANTS; RAPACURONIUM ORG-9487; ROCURONIUM BROMIDE; SERUM POTASSIUM; SUXAMETHONIUM; HYPERKALEMIA; VECURONIUM; ANESTHESIA; PROPOFOL; SURGERY AB Study Objective: To determine if pretreatment with either gallamine or mivacurium before succinylcholine in children is associated with reduction in fasciculations; postoperative myalgias; or serum levels of potassium, creatinine phosphokinase (CPK), and myoglobin. Design: Prospective, randomized double-blinded study. Setting: Operating room at a children's hospital. Patients: 45 ASA physical status IE children, aged 3 to 15 years, scheduled for emergency surgery. Interventions: The children received either normal saline 0.5 mt, mivacurium chloride 0.03 mg kg(-1), or gallamine triethiodide 0.04 mg.kg(-1) 2 minutes prior to rapid sequence induction (RSI) using thiopental sodium 5 mg kg(-1), fentanyl 2 mug.kg(-1), and succinylcholine 2 mg kg(-1). Measurements: Serum potassium concentration (0, 3, 7.5, and 15 min), myoglobin concentration (5 and 15 min), and CPK concentration (0 min and 24 hr. Fasciculation and myalgia were rated on a 0 to 3 score. Main Results: There was no difference between groups for fasciculation (p = 0.87) or myalgia score (p = 0.52). The mivacurium group had significantly less increase in potassium at 5 minutes (0.45vs. 0.0, p = 0. 01), myoglobin at 5 minutes (56vs. 2 p < 0.001), myoglobin at 15 minutes (128 vs. 2.5, p < 0.001), and CPK at 24 hours (399 vs. 138, p < 0.001) following succinylcholine when compared with normal saline. Additionally, we found a significant level of association (p < 0.001) between fasciculation and myoglobin levels and fasciculation and CPK levels (p < 0.001). Gallamine was not effective in reducing the increase of potassium, myoglobin, or CPK. However, the dose of gallamine used for pretreatment was 13 times less than the dose of mivacurium. Conclusions: Administration of mivacurium 0.03 mg.kg(-1) intravenously 2 minutes before administration of succinylcholine 2 mg.kg(-1) in children is effective in reducing the increase in serum potassium at 5 minutes, the increase in myoglobin at 5 minutes and 15 minutes, and the increase in CPK at 24 hours. (C) 2001 by Elsevier Science Inc. C1 Alfred I duPont Hosp Children, Dept Anesthesiol & Crit Care Med, Wilmington, DE 19899 USA. RP Theroux, MC (reprint author), Alfred I duPont Hosp Children, Dept Anesthesiol & Crit Care Med, POB 269, Wilmington, DE 19899 USA. NR 35 TC 6 Z9 7 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD JUN PY 2001 VL 13 IS 4 BP 287 EP 292 DI 10.1016/S0952-8180(01)00267-7 PG 6 WC Anesthesiology SC Anesthesiology GA 449XW UT WOS:000169713300010 ER PT J AU Kaldor, I Feldman, PL Mook, RA Ray, JA Samano, V Sefler, AM Thompson, JB Travis, BR Boros, EE AF Kaldor, I Feldman, PL Mook, RA Ray, JA Samano, V Sefler, AM Thompson, JB Travis, BR Boros, EE TI Stereocontrolled synthesis of cis-dibenzoquinolizine chlorofumarates: Curare-like agents of ultrashort duration SO JOURNAL OF ORGANIC CHEMISTRY LA English DT Article ID TETRAHYDROISOQUINOLINIUM; HYDROGENATION AB The quaternizations of dibenzoquinolizines 9 and 14 with 3-halo-1-propanols are highly cis-selective (94-100% cis), results consistent with the N-methylation of O-methylcapaurine (7b), but in contrast to the proposed trans-stereochemistry of dibenzo [a,h]quinolizine methiodide 10 and the analogous quaternizations of 1-benzyl- and 1-phenylisoquinoline congeners 5b and 5c. In this report, we describe stereoselective preparation of the unique cis-dibenzoquinolizinium propanols 15 and 16 and their transformation into bis- and mixed-onium chlorofumarates 19; 20ab, and 26. Dibenzo[a,g]quinolizinium propanol 15 was prepared enantioselectively in three steps from dihydroisoquinoline 11; Asymmetric transfer hydrogenation of 11 in the presence of triethylamine/formic acid and Noyori's chiral ruthenium catalyst 12 produced R-(-)-5 ' ,8-dimethoxynorlaudanosine (13) in 98% yield and 87% ee. Pictet-Spengler cyclization of 13 in formalin/formic acid afforded the dibenzo [a,g]quinolizine 14 in 65% yield. Quaternization of 14 with 3-chloro-1-propanol under Finkelstein conditions generated cis-dibenzoquinolizinium propanol 15 in 85% yield with > 94% cis-selectivity. The cis-dibenzo [a,h] quinolizinium propanol 16 was obtained as a single stereoisomer by reaction of the known tetramethoxyquinolizine 9 with neat 3-iodo-1-propanol. Bis-onium chlorofumarates 18 and 19 and the mixed-onium derivative 20ab were prepared by a pool synthesis procedure from (1R)-trans-6a, 16, and chlorofumaryl chloride (17). Mixed-onium alpha -chlorofumarate 26 was synthesized from; (1S)-trans-6d, 15 and (+/-)-trans-2,3-dichlorosuccinic anhydride (22), employing a recently disclosed chlorofumarate mixed-diester synthesis. The title compounds (19, 20ab, and 26) displayed curare-like effects of ultrashort duration in rhesus monkeys. C1 GlaxoSmithKline Res & Dev, Div Med Chem, Res Triangle Pk, NC 27709 USA. RP Boros, EE (reprint author), GlaxoSmithKline Res & Dev, Div Med Chem, 5 Moore Dr, Res Triangle Pk, NC 27709 USA. NR 23 TC 19 Z9 19 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0022-3263 J9 J ORG CHEM JI J. Org. Chem. PD MAY 18 PY 2001 VL 66 IS 10 BP 3495 EP 3501 DI 10.1021/jo010032k PG 7 WC Chemistry, Organic SC Chemistry GA 435XP UT WOS:000168907700032 ER PT J AU Schultz, P Ibsen, M Ostergaard, D Skovgaard, LT AF Schultz, P Ibsen, M Ostergaard, D Skovgaard, LT TI Onset and duration of action of rocuronium - from tracheal intubation, through intense block to complete recovery SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE pharmacodynamic; neuromuscular relaxant; rocuronium; neuromuscular transmission; nerve stimulator; post tetanic count ID RAPID-SEQUENCE INDUCTION; ORG 9426; SUCCINYLCHOLINE; SUXAMETHONIUM; ANESTHESIA; ORG-9426; COUNT AB Background: The primary objective of this study was to establish the relation between the post tetanic count (PTC) and the time to reappearance of the first response (T-1) in train-of-four (TOF) nerve stimulation following rocuronium 0.6 mg/kg, 0.9 mg/kg, and 1.2 mg/kg. The secondary objective was to evaluate the intubation conditions after 1 min. Methods: One hundred and eight patients were randomised to one of three doses of rocuronium: 0.6, 0.9 or 1.2 mg/kg. Tracheal intubation was performed at 60 s by a blinded investigator During propofol, fentanyl, midazolam anaesthesia the neuromuscular block was monitored by mechanography using TOF stimulation every 12 s. At 6 min intervals, a tetanic stimulation (50 Hz) was applied for 5 s preceded and followed by a 30 s period of 1 Hz stimulation until the reappearance of T-1. Results: There was a significant difference in recovery following the high dose and the two lower doses. The relation between time (min) to reappearance of T-1 (t) and PTC can be expressed as follows: t((0.6 and 0.9 mg/kg)(min)) = 18.8-6.46 root PTC and t((1.2 mg/kg)(min)) = 26.1-9.12 root PCT. T-1 was seen at a mean PTC level of 8 or 9 in all three soups. The intubation conditions were graded as excellent or good in all patients except in two patients following the 0.6 mg/kg dose of rocuronium. Conclusion: The PTC method can be used to predict the time to first response to TOF nerve stimulation during intense rocuronium induced neuromuscular blockade. The relation between PTC and the time to T-1 was prolonged after 1.2 mg/kg compared with 0.6 mg/kg and 0.9 mg/kg. No further improvement in intubation conditions at 60 s was evident by increasing the rocuronium dose from 0.9 mg/kg to 1.2 mg/kg. C1 Gentofte Hosp, Dept Anesthesiol, Copenhagen, Denmark. Univ Copenhagen, Dept Biostat, Copenhagen, Denmark. RP Ostergaard, D (reprint author), Herlev Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark. NR 17 TC 17 Z9 18 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2001 VL 45 IS 5 BP 612 EP 617 DI 10.1034/j.1399-6576.2001.045005612.x PG 6 WC Anesthesiology SC Anesthesiology GA 428QB UT WOS:000168471400017 ER PT J AU Kirkegaard-Nielsen, H Caldwell, JE Abengochea, A Berry, PD Heier, T AF Kirkegaard-Nielsen, H Caldwell, JE Abengochea, A Berry, PD Heier, T TI Does discontinuation of desflurane at the time of neostigmine administration speed recovery from cisatracurium block compared to that with a propofol-based technique? SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE anesthetic solubility; anticholinesterase; intravenous anesthesia ID INDUCED NEUROMUSCULAR BLOCKADE; OPIOID BARBITURATE ANESTHESIA; ENFLURANE ANESTHESIA; ISOFLURANE; VECURONIUM; SEVOFLURANE; HALOTHANE; REVERSAL; HUMANS; ANTAGONISM AB Background: Volatile anaesthetics are known to influence the effect of neostigmine as an antagonist of neuromuscular block. The aim of the present study was to investigate whether discontinuation of desflurane at the time of neostigmine administration shortens reversal time from cisatracurium block, compared to that with a propofol-based anaesthesia. Methods: Ten volunteers were studied twice. For one study, anaesthesia was induced with alfentanil and propofol and maintained with nitrous oxide 70% and propofol 150 mug . kg(-1) . min(-1). For the other study, experimental conditions were replicated except that desflurane 6% was administered and the dose of propofol was only 50 mug . kg(-1) . min(-1). The evoked mechanical response of the adductor pollicis to train-of-four (TOF) stimulation was recorded. Neuromuscular block was induced with cisatracurium 0.2 mg . kg(-1). When the magnitude of the first TOF response (T1) had recovered to 10%, the block was antagonized with neostigmine 70 mug . kg(-1). At this time, propofol was decreased to 50 mug . kg(-1) . min(-1), or the desflurane was discontinued. Results: There were no significant differences between the two techniques of anaesthesia in the rate of neostigmine-induced recovery of the TOF ratio. The times (mean +/- SD) to achieve TOF ratios of 0.7, 0.8, and 0.9 were (propofol first, desflurane second) 6.1 +/-2.2 and 6.5 +/-1.6 min; 10.4 +/-4.2 and 9.6 +/-2.7 min; 17.1 +/-6.9 and 21.0 +/- 13.0 min, respectively. Conclusion: Discontinuing desflurane does not speed neostigmine-induced recovery from cisatracurium neuromuscular block, when compared to that during propofol-based anaesthesia. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. RP Kirkegaard-Nielsen, H (reprint author), Aarhus Univ Hosp, Skejby Sygehus, Dept Anaesthesia & Intens Care, Brendstrupgaardsvej, DK-8200 Aarhus N, Denmark. NR 19 TC 1 Z9 1 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2001 VL 45 IS 5 BP 618 EP 623 DI 10.1034/j.1399-6576.2001.045005618.x PG 6 WC Anesthesiology SC Anesthesiology GA 428QB UT WOS:000168471400018 ER PT J AU Kadar, AG Kramer, BA Barth, MC White, PF AF Kadar, AG Kramer, BA Barth, MC White, PF TI Rapacuronium: An alternative to succinylcholine for electroconvulsive therapy SO ANESTHESIA AND ANALGESIA LA English DT Article ID MIVACURIUM; ECT C1 Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX 75390 USA. Cedars Sinai Med Ctr, Dept Anesthesiol, Los Angeles, CA 90048 USA. Cedars Sinai Med Ctr, Dept Psychiat, Los Angeles, CA 90048 USA. RP White, PF (reprint author), Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, 5323 Harry Hines Blvd, Dallas, TX 75390 USA. NR 11 TC 8 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 2001 VL 92 IS 5 BP 1171 EP 1172 PG 2 WC Anesthesiology SC Anesthesiology GA 426EB UT WOS:000168335900017 ER PT J AU Gan, TJ Madan, R Alexander, R Jhaveri, R El-Moalem, H Weatherwax, K Glass, PSA AF Gan, TJ Madan, R Alexander, R Jhaveri, R El-Moalem, H Weatherwax, K Glass, PSA TI Duration of action of vecuronium after an intubating dose of rapacuronium, vecuronium, or succinylcholine SO ANESTHESIA AND ANALGESIA LA English DT Article ID MUSCLE-RELAXANT; PANCURONIUM; MIVACURIUM; ANESTHESIA; ROCURONIUM; ORG-9487; PHARMACOKINETICS; BROMIDE AB Rapacuronium (RAP) is a new, rapid-onset, short-duration, nondepolarizing neuromuscular blocker. Lf RAP is used to facilitate endotracheal intubation, what will the duration of a subsequent maintenance dose of vecuronium (VEC) be? We investigated the duration of action of a maintenance dose of VEC after intubation with RAP, VEC, or succinylcholine (SUC). Adult surgical patients under general anesthesia were randomly allocated to receive a tracheal intubating dose of RAP 1.5 mg/kg, VEC 0.1 mg/kg, or SUC 1 mg/kg. The anesthetic was induced with propofol and maintained with propofol, nitrous oxide, and oxygen. Neuromuscular function was monitored with electromyography. Recovery of the intubating dose of neuromuscular blocker was allowed to occur spontaneously until the first twitch of the train-of-four (T1) reached 50% of baseline, and then VEC 0.025 mg/kg (0.5 x 95% effective dose [ED95]) was administered. The onset, duration, and recovery to T1 = 25% and 50% were recorded. The durations of action (recovery of T1 25%) after intubating doses of RAP, VEC, and SUC were 13.7 +/- 5.3, 43.2 +/- 13.2, and 9.2 +/- 3.7 min (mean +/- so), respectively (P < 0.0001). The times to maximum depression of T1 after a maintenance dose of VEC (0.5 x ED95) were 5.4 2.9, 5.1 +/- 2.5, and 5.3 +/- 2.8 min (mean +/- so) for the RAP,VEC, and SUC groups, respectively. Recoveries to T1 25% after VEC for the RAP, VEC, and SUC groups were 18.9 +/- 11.5, 21.5 +/- 8.03, and 12.8 +/- 8.4 min,and at TI 50% they were 21.5 +/- 9.1, 30.8 +/- 9.5, and 15.5 +/- 9.7 min (mean +/- so), respectively (P < 0.001, RAP and VEC versus SUC). The duration of action of a maintenance dose of VEC was similar after an intubating dose of RAP or VEC but was shortened when preceded by an intubating dose of SUC. C1 Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA. SUNY Stony Brook, Med Ctr, Dept Anesthesiol, Hlth Sci Ctr, Stony Brook, NY 11794 USA. RP Gan, TJ (reprint author), Duke Univ, Med Ctr, Dept Anesthesiol, Box 3094, Durham, NC 27710 USA. NR 15 TC 4 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 2001 VL 92 IS 5 BP 1199 EP 1202 PG 4 WC Anesthesiology SC Anesthesiology GA 426EB UT WOS:000168335900021 ER PT J AU de Ruiter, J Crawford, MW AF de Ruiter, J Crawford, MW TI Dose-response relationship and infusion requirement of cisatracurium besylate in infants and children during nitrous oxide-narcotic anesthesia SO ANESTHESIOLOGY LA English DT Article ID PEDIATRIC-PATIENTS; ANESTHETIZED INFANTS; HALOTHANE ANESTHESIA; D-TUBOCURARINE; ATRACURIUM; PHARMACOKINETICS; AGE; VECURONIUM; PHARMACODYNAMICS; DOSAGE AB Background: To determine the effect of age on the dose-response relation and infusion requirement of cisatracurium besylate in pediatric patients, 32 infants (mean age, 0.7 yr; range, 0.3-1.0 yr) and 32 children (mean age, 4.9 yr; range, 3.1-9.6 yr) were studied during thiopentone-nitrous oxide-oxygen-narcotic anesthesia. Methods: Potency was determined using a single-dose (20, 26, 33, or 40 mug/kg) technique. Neuromuscular block was assessed by monitoring the electromyographic response of the adductor pollicis to supramaximal train-of-four stimulation of the ulnar nerve at 2 Hz. Results: Least-squares linear regression analysis of the log-probit transformation of dose and maximal response yielded median effective dose (ED50) and 95% effective dose (ED95) values for infants (29 +/- 3 mug/kg and 43 +/- 9 mug/kg, respectively) that were similar to those for children (29 +/- 2 mug/kg and 47 +/- 7 mug/kg, respectively). The mean infusion rate necessary to maintain 90-99% neuromuscular block during the first hour in infants (1.9 +/- 0.4 mug . kg(-1) . min(-1); range: 1.3-2.5 mug . kg(-1) . min(-1)) was similar to that in children (2.0 +/- 0.5 mug . kg(-1) . min(-1); range: 1.3-2.9 mug . kg(-1) . min(-1)). Conclusion: The authors conclude that cisatracurium is equipotent in infants and children when dose is referenced to body weight during balanced anesthesia. C1 Univ Toronto, Hosp Sick Children, Dept Anesthesia, Toronto, ON M5G 1X8, Canada. RP Crawford, MW (reprint author), Univ Toronto, Hosp Sick Children, Dept Anesthesia, 555 Univ Ave, Toronto, ON M5G 1X8, Canada. NR 19 TC 5 Z9 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAY PY 2001 VL 94 IS 5 BP 790 EP 792 DI 10.1097/00000542-200105000-00016 PG 3 WC Anesthesiology SC Anesthesiology GA 428YA UT WOS:000168488200012 ER PT J AU Sztark, F Cantini, O Bourdalle-Badie, C Gardien, PL Erny, P AF Sztark, F Cantini, O Bourdalle-Badie, C Gardien, PL Erny, P TI Recovery of neuromuscular block after continuous infusion of cisatracurium in patients with renal dysfunction. SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE cisatracurium; neuromuscular relaxant; pharmacodynamics; renal failure ID OPIOID BARBITURATE ANESTHESIA; 51W89; ATRACURIUM; FAILURE; PHARMACODYNAMICS; PHARMACOKINETICS; ELIMINATION; ISOFLURANE; HEALTH; HUMANS AB Objective: Study of the recovery of neuromuscular block after continuous infusion of cisatracurium in patients with renal dysfunction. Study design: Prospective case-control study. Patients: Forty adult patients scheduled for urological surgery were assigned to two groups according to the creatinine clearance (CC) as a measure of the renal function: group IR (CC < 60 mL(.)min(-1)) or group NR (CC greater than or equal to 60 ml(.)min(-1)). Methods:After premedication with hydroxyzine, anaesthesia was induced with propofol, sufentanil and cisatracurium (0.15 mg(.)kg(-1)), and maintained using isoflurane, sufentanil and a continuous infusion of cisatracurium (0.12 mg(.)kg(-1.)h(-1)) adjusted for maintained a post-tetanic count less than or equal to 5. Neuromuscular transmission was monitored at the adductor pollicis using accelerography (TOF Gard((R))). Onset and recovery times in both groups were compared using Student's t test. Results: infusion time and total dose of cisatracurium were comparable in both groups. Onset times were 3.9 +/- 0.8 min and 3.5 +/- 0.6 min in groups IR and NR respectively. After the infusion, the time to train-of-four ratio of 0.8 were not different in both groups : 77 +/- 18 min (group IR) and 73 +/- 13 min (group NR). However, the spontaneous recovery intervals 25 % - 75 % were delayed in group IR (20 +/- 9 min vs 14 +/- 5 min p < 0.05). Conclusion: There are minor differences in the pharmacodynamics of cisatracurium between patients with normal or impaired renal function. Nevertheless, a marked interindividual variability in the recovery parameters was observed in patients with renal dysfunction. (C) 2001 Editions scientifiques et medicales Elsevier SAS. C1 CHU Pellegrin, Dept Anesthesie Reanimat 1, F-33076 Bordeaux, France. RP Sztark, F (reprint author), CHU Pellegrin, Dept Anesthesie Reanimat 1, F-33076 Bordeaux, France. NR 14 TC 0 Z9 1 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD MAY PY 2001 VL 20 IS 5 BP 446 EP 451 PG 6 WC Anesthesiology SC Anesthesiology GA 441PH UT WOS:000169238400003 ER PT J AU Rose, M Fisher, M AF Rose, M Fisher, M TI Rocuronium: high risk for anaphylaxis SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article ID MAST-CELL TRYPTASE; FRENCH MULTICENTER; ANESTHETIC DRUGS; IGE ANTIBODIES; IMMUNOASSAYS; DIAGNOSIS; HISTAMINE; AGENTS; SHOCK AB Patients suspected of anaphylaxis during anaesthesia have been referred to the senior author's clinic since 1974 for investigation. Since release of rocuronium on to the worldwide market, concern has been expressed about its propensity to cause anaphylaxis. We identified 24 patients who met clinical and laboratory (intradermal, mast cell tryptase and morphine radioimmunoassay) criteria for anaphylaxis to rocuronium. The incidence of rocuronium allergy in New South Wales, Australia has risen in pal allel with sales, while there has been an associated fail in reactions to other neuromuscular blocking drugs. Data from intradermal testing suggested that rocuronium is intermediate in its propensity to cause allergy in known relaxant reactors compared with low-risk agents (e.g, pancuronium, vecuronium) and higher-risk agents (e.g. alcuronium, succinylcholine). C1 Royal N Shore Hosp, Intens Therapy Unit, St Leonards, NSW 2065, Australia. Univ Sydney, Dept Anaesthesia, Sydney, NSW, Australia. RP Fisher, M (reprint author), Royal N Shore Hosp, Intens Therapy Unit, Pacific Highway, St Leonards, NSW 2065, Australia. NR 18 TC 59 Z9 63 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAY PY 2001 VL 86 IS 5 BP 678 EP 682 DI 10.1093/bja/86.5.678 PG 5 WC Anesthesiology SC Anesthesiology GA 430CH UT WOS:000168555600014 ER PT J AU Sakamoto, H Takita, K Kemmotsu, O Morimoto, Y Mayumi, T AF Sakamoto, H Takita, K Kemmotsu, O Morimoto, Y Mayumi, T TI Increased sensitivity to vecuronium and prolonged duration of its action in patients with endstage renal failure SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE biotransformation; kidney failure, chronic; hemodialysis; kidney transplantation; vecuronium bromide : pharmacokinetics ID NEUROMUSCULAR BLOCKADE; ATRACURIUM; PHARMACODYNAMICS; PHARMACOKINETICS AB Study Objectives: To determine whether the duration of action of vecuronium is influenced by chronic renal failure. Design: Prospective clinical comparison. Setting: Operating room, Hokkaido University Hospital. Patients: 7 adult ASA Physical status II and III patients with impaired renal function undergoing living-related renal transplantation (Croup A), 5 adult ASA physical status II and III patients with impaired renal function undergoing elective surgery other than renal transplantation (Group B), and 13 adult ASA Physical status I and II patients with normal hepatorenal function undergoing elective surgery (Group C). Interventions: Anesthesia was induced with thiamylal 5 mg . kg(-1) and fentanyl 100 mug IV and maintained with 60% nitrous oxide and 1% isoflurane. An initial dose of vecuronium was administered and patients' tracheas were intubated. Measurements: Neuromuscular function was monitored by acceleration of thumb adduction with train-of-four stimulation. Vecuronium 60 mug.kg(-1) was administered as the initial dose via a central catheter, and if the first twitch was more than 3% of the control, another dose of vecuronium 20 mug.kg(-1) was given as necessary. Both onset time and duration of action until 25% recovery were measured. Plasma vecuronium and its metabolite, 3-desacetyl-vecuronium, levels were measured at onset and at 25% recovery in Groups A and C. Main Results: The total dose of vecuronium and initial concentration of vecuronium showed no significant difference between Group A and Group C. Duration of action was significantly prolonged in Group A and Group B compared with Group C. Conclusions: Duration of action of vecuronium is prolonged in patients with end-stage renal failure mainly due to higher sensitivity to vecuronium. (C) 2001 by Elsevier Science Inc. C1 Hokkaido Univ, Grad Sch Med, Dept Anesthesiol & Crit Care Med, Sapporo, Hokkaido 0608638, Japan. RP Sakamoto, H (reprint author), Hokkaido Univ, Grad Sch Med, Dept Anesthesiol & Crit Care Med, N 15,W 7, Sapporo, Hokkaido 0608638, Japan. RI Morimoto, Yuji/B-5650-2013 NR 16 TC 4 Z9 5 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAY PY 2001 VL 13 IS 3 BP 193 EP 197 DI 10.1016/S0952-8180(01)00253-7 PG 5 WC Anesthesiology SC Anesthesiology GA 438HD UT WOS:000169046800006 ER PT J AU Payne, RF LaMont, SP Filby, RH Glover, SE AF Payne, RF LaMont, SP Filby, RH Glover, SE TI Optimization and characterization of a sulfate based electrodeposition method for alpha-spectrometry of neptunium and curium SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY LA English DT Article; Proceedings Paper CT 5th International Conference on Methods and Applications of Radioanalytical Chemistry (MARC-V) CY APR 09-14, 2000 CL KAILUA-KONA, HAWAII SP Amer Nucl Soc Top ID OXALATE-CHLORIDE ELECTROLYTE; ACTINIDES AB The parameters for a sulfate based electrodeposition method were optimized for the preparation of Cm and Np alpha-spectrometry sources. Alphaspectrometry requires the preparation of essentially massless sources to eliminate self-absorption of alpha-particles, which can cause degraded alpha-spectra A variety of methods for the electrodeposition of actinides have been reported in the literature, many of which require long deposition times and lack reproducibility. A previously reported sulfate based method has been evaluated for the preparation of Np and Cm sources. High yields were achieved and source preparation took 90 minutes or less. The effects of electrodeposition time and pH of the depositing solution were evaluated for each element. Typical resolution (FWHM) for sources prepared by this method is 50 keV or less with recoveries approaching 100%. C1 Washington State Univ, Dept Chem, Pullman, WA 99164 USA. Univ Pittsburgh, Dept Environm & Occupat Hlth, Pittsburgh, PA 15238 USA. RP Payne, RF (reprint author), Washington State Univ, Dept Chem, Pullman, WA 99164 USA. NR 9 TC 3 Z9 3 PU KLUWER ACADEMIC PUBL PI DORDRECHT PA SPUIBOULEVARD 50, PO BOX 17, 3300 AA DORDRECHT, NETHERLANDS SN 0236-5731 J9 J RADIOANAL NUCL CH JI J. Radioanal. Nucl. Chem. PD MAY PY 2001 VL 248 IS 2 BP 449 EP 452 DI 10.1023/A:1010608931914 PG 4 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 446MA UT WOS:000169516000032 ER PT J AU Chiodini, F Charpantier, E Muller, D Tassonyi, E Fuchs-Buder, T Bertrand, D AF Chiodini, F Charpantier, E Muller, D Tassonyi, E Fuchs-Buder, T Bertrand, D TI Blockade and activation of the human neuronal nicotinic acetylcholine receptors by atracurium and laudanosine SO ANESTHESIOLOGY LA English DT Article ID NEUROMUSCULAR BLOCKING-DRUGS; CONCENTRATION-RESPONSE RELATIONSHIPS; VERTEBRATE SKELETAL-MUSCLE; CEREBROSPINAL-FLUID; XENOPUS OOCYTES; CHANNEL DOMAIN; CIS-ATRACURIUM; ALPHA-7; EXPRESSION; PHARMACOLOGY AB Background: Curaremimetic nondepolarizing muscle relaxants are widely used in clinical practice to prevent muscle contraction either during surgery or during intensive care. Although primarily acting at the neuromuscular junction, these compounds can cause adverse effects, including modification of cardiac rhythm, arterial blood pressure, and in the worst cases, triggering of seizures. In this study, we assessed the interaction of atracurium and its metabolite, laudanosine, with neuronal nicotinic receptors. Methods: The human neuronal nicotinic receptors alpha4 beta2, alpha3 beta4, alpha3 alpha5 beta4, and alpha7 are heterologously expressed in Xenopus laevis oocytes, and the effect of atracurium and its degradation product, laudanosine, were studied on these receptors. Results: Atracurium and laudanosine inhibited in the micromolar range the major brain alpha4 beta2 receptor and the ganglionic alpha3 beta4 or alpha3 beta4 alpha5 and the homomeric alpha7 receptors. For all four receptors, inhibition was rapid and readily reversible within less than 1 min. Atracurium blockade was competitive at alpha4 beta2 and alpha7 receptors but displayed a noncompetitive blockade at the alpha3 beta4 receptors. Inhibition at this receptor subtype was not modified by alpha5. Laudanosine was found to have a dual mode of action; first, it competes with acetylcholine and, second, it blocks the ionic pore by steric hindrance. At low concentrations, these two drugs are able to activate both the alpha4 beta2 and the alpha3 beta4 receptors. Conclusion: Adverse effects observed during atracurium administration may be attributed, at least partly, to an interaction with neuronal nicotinic receptors. C1 Ctr Med Univ Geneva, Dept Physiol, CH-1211 Geneva 4, Switzerland. Univ Hosp Geneva, Div Neuropharmacol, Geneva, Switzerland. Univ Hosp Geneva, Div Anaesthesiol, Geneva, Switzerland. Univ Hosp Geneva, Dept Physiol, Geneva, Switzerland. RP Bertrand, D (reprint author), Ctr Med Univ Geneva, Dept Physiol, 1 Rue Michel Servet, CH-1211 Geneva 4, Switzerland. NR 40 TC 29 Z9 29 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 2001 VL 94 IS 4 BP 643 EP 651 DI 10.1097/00000542-200104000-00019 PG 9 WC Anesthesiology SC Anesthesiology GA 416ZT UT WOS:000167811100016 ER PT J AU Reid, JE Breslin, DS Mirakhur, RK Hayes, AH AF Reid, JE Breslin, DS Mirakhur, RK Hayes, AH TI Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane, isoflurane or propofol SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID INTRAVENOUS ANESTHESIA; ENFLURANE ANESTHESIA; NEUROMUSCULAR BLOCK; TIME-COURSE; VECURONIUM; REVERSAL; HALOTHANE; PANCURONIUM; ATRACURIUM; PARALYSIS AB Purpose: To examine the influence of continuing administration of sevoflurane or isoflurane during reversal of rocuronium induced neuromuscular block with neostigmine, Methods: One hundred and twenty patients, divided into three equal groups, were randomly allocated to maintenance of anesthesia with sevoflurane, isoflurane or propofol. Neuromuscular block was induced with rocuronium and monitored using train-of-four (TOF) stimulation of the ulnar nerve and recording the force of contraction of the adductor poilicis muscle. Neostigmine was administered when the first response in TOF had recovered to 25%. At this time the volatile agent administration was stopped or propofol dosage reduced in half the patients in each group (n = 20 in each group). The times to attain TOF ratio of 0.8, and the number of patients attaining this end point within 15 min were recorded. Results: The times (mean +/- SD) to recovery of the TOF ratio to 0.8 were 12.0 +/- 5.5 and 6.8 +/- 2.3 min in the sevoflurane continued and sevoflurane stopped groups, 9.0 +/- 8.3 and 5.5 +/- 3.0 min in the isoflurane continued and isoflurane stopped groups, and 5.2 +/- 2.8 and 4.7 +/- 1.5 min in the propofol continued and propofol stopped groups (P < 0.5-0.1), Only 9 and 15 patients in the sevoflurane and isoflurane continued groups respectively had attained a TOF ratio of 0.8 within 15 min (P < 0.001) for sevoflurane). Conclusions: The continued administration of sevoflurane, and to a smaller extent isoflurane, results in delay in attaining adequate antagonism of rocuronium induced neuromuscular block. C1 Queens Univ Belfast, Dept Anaesthet & Intens Care Med, Belfast BT9 7BL, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet & Intens Care Med, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 20 TC 23 Z9 26 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 2001 VL 48 IS 4 BP 351 EP 355 PG 5 WC Anesthesiology SC Anesthesiology GA 422QU UT WOS:000168131400006 ER PT J AU Hernandez-Palazon, J Tortosa, JA Martinez-Lage, JF Perez-Ayala, M AF Hernandez-Palazon, J Tortosa, JA Martinez-Lage, JF Perez-Ayala, M TI Rocuronium-induced neuromuscular blockade is affected by chronic phenytoin therapy SO JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY LA English DT Article DE muscle relaxants : rocuronium anticonvulsant : phenytoin ID ACUTELY ADMINISTERED PHENYTOIN; CHRONIC ANTICONVULSANT THERAPY; CADAVER RENAL-TRANSPLANTATION; INDUCED RESISTANCE; CARBAMAZEPINE; VECURONIUM; PHARMACOKINETICS; METOCURINE; ATRACURIUM; RECOVERY AB Patients receiving chronic anticonvulsant therapy have been reported to show resistance to certain nondepolarizing neuromuscular blockers. In this study, the effects of chronic phenytoin therapy on the onset, duration, and recovery of rocuronium action was assessed. Thirty-six patients scheduled for various neurosurgical procedures were studied: 18 receiving chronic phenytoin therapy (Group I) and 18 controls (Group II). Rocuronium 0.6 mg/kg (2 x DE95) was administered after induction of general anesthesia with 4-6 mg/kg thiopental sodium and 3-5 mug/kg intravenous (IV) fentanyl. Maintenance anesthesia consisted of N2O in O-2, 0.5% end-tidal isoflurane, and a fentanyl infusion. Neuromuscular block was monitored with acceleromyography of the adductor pollicis-brevis muscle by using a TOF-GUARD Biometer monitor (Biometer International A/S. Odense, Denmark). According to the amplitude of the first response of train-of-four, neither the lag time nor the onset time differed between the two groups. However, the recovery index was significantly shorter in patients chronically treated with phenytoin (mean recovery index: control group. 8.3 +/- 1.7 minutes: phenytoin group. 6.7 +/- 2.3 minutes: P <.05). In addition, the times of recovery to 10%, 25%. 75%, and 90% of the baseline response were also significantly shorter in the phenytoin group than in the control group. We conclude that the duration of action of rocuronium and the recovery index were affected by chronic phenytoin therapy. C1 Hosp Univ Virgen Arrixaca, Dept Anesthesia, Murcia, Spain. Hosp Univ Virgen Arrixaca, Dept Neurosurg, Murcia, Spain. Hosp Univ Virgen Arrixaca, Dept Clin Chem, Murcia, Spain. RP Tortosa, JA (reprint author), Ricardo Gil 26,2B, Murcia 30002, Spain. NR 31 TC 6 Z9 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0898-4921 J9 J NEUROSURG ANESTH JI J. Neurosurg. Anesthesiol. PD APR PY 2001 VL 13 IS 2 BP 79 EP 82 DI 10.1097/00008506-200104000-00003 PG 4 WC Anesthesiology; Clinical Neurology; Surgery SC Anesthesiology; Neurosciences & Neurology; Surgery GA 416DK UT WOS:000167764800002 ER PT J AU Torres, RF Mochon, MC Sanchez, JCJ Lopez, MAB Perez, AG AF Torres, RF Mochon, MC Sanchez, JCJ Lopez, MAB Perez, AG TI Electrochemical oxidation of cisatracurium on carbon paste electrode and its analytical applications SO TALANTA LA English DT Article DE cisatracurium; differential pulse voltammetry; carbon paste electrode; urine; serum ID IDENTIFICATION; METABOLITES; URINE AB The electrochemical oxidation of cisatracurium was investigated by cyclic voltammetry and differential pulse voltammetry at a carbon paste electrode and the experimental parameters have been optimized in order to obtain the optimum analytical signal. A differential pulse voltammetric method with carbon paste electrode is described for the determination of cisatracurium with detection limit of 0.38 mug/ml and quantitation limit of 1.26 mug/ml. The proposed method was applied to determine the content of cisatracurium in human urine and human serum, obtaining accurate and precise results. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Univ Seville, Fac Chem, Dept Analyt Chem, E-41012 Seville, Spain. RP Mochon, MC (reprint author), Univ Seville, Fac Chem, Dept Analyt Chem, E-41012 Seville, Spain. NR 11 TC 8 Z9 8 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0039-9140 J9 TALANTA JI Talanta PD MAR 16 PY 2001 VL 53 IS 6 BP 1179 EP 1185 DI 10.1016/S0039-9140(00)00604-4 PG 7 WC Chemistry, Analytical SC Chemistry GA 414FX UT WOS:000167656500010 ER PT J AU Takeishi, H Kitatsuji, Y Kimura, T Meguro, Y Yoshida, Z Kihara, S AF Takeishi, H Kitatsuji, Y Kimura, T Meguro, Y Yoshida, Z Kihara, S TI Solvent extraction of uranium, neptunium, plutonium, americium, curium and californium ions by bis(1-phenyl-3-methyl-4-acylpyrazol-5-one) derivatives SO ANALYTICA CHIMICA ACTA LA English DT Article DE solvent extraction; bis(1-phenyl-3-methyl-4-acylpyrazol-5-one) uranium; transuranium elements ID LIQUID-LIQUID-EXTRACTION; POLYMETHYLENE CHAIN-LENGTH; N-OCTYLPHOSPHINE OXIDE; BIS(4-ACYLPYRAZOL-5-ONE) DERIVATIVES; SYNERGISTIC EXTRACTION; U(VI); SEPARATION; CHEMISTRY; ELEMENTS; AGENTS AB Comprehensive study has been performed on the extraction of actinide ions of various oxidation states, An(n+) (An = U, Np, Pu, Am, Cm and Cf), with bis(1-phenyl-3-methyl-4-acylpyrazol-5-one) derivatives, H(2)BPn (n; number of polymethylene chain = 3, 4, 5, 6, 7, 8, 10 and 22). All H(2)BP(n) derivatives showed higher extraction efficiencies for An(n+) than 1-phenyl-3-methyl-4-benzoylpyrazol-5-one (HPMBP) did, which is attributable to the strong multidentate interaction with An(n+) or high hydrophobicity of H(2)BPn in comparison with HPMBP. The highest efficiency for all An(n+) examined was obtained with H(2)BP8 or H(2)BP7. The extracted species were confirmed as An(BPn)(HBPn) for Am(3+), Cm(3+) and Cf(3+), and An(BPn)(2) for U(4+), Np(4+) and Pu(4+). The extracted species of UO(2)(2+) depended on the length of the polymethylene chain. The species UO(2)(HBPn)(2) was extracted with H(2)BP3 or H(2)BP4 and UO(2)(BPn) with H(2)BPn of n greater than or equal to 5. NpO(2)(+) was hardly extracted from the solution of pH less than 9. On the basis of the correlation between the distribution ratio and pH the procedure for the successive separation of the actinides in nitric acid medium was developed. The recommended procedure using H(2)BP8 was applied to the mutual separation of UO(2)(2+), NpO(2)(+), Pu(4+) and trivalent transplutonium ions. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Japan Atom Energy Res Inst, Adv Sci Res Ctr, Tokai, Ibaraki 3191195, Japan. Kyoto Inst Technol, Dept Chem, Sakyo Ku, Kyoto 6068585, Japan. RP Yoshida, Z (reprint author), Japan Atom Energy Res Inst, Adv Sci Res Ctr, Tokai, Ibaraki 3191195, Japan. EM zyoshida@popsvr.tokai.jaeri.go.jp NR 33 TC 18 Z9 21 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0003-2670 J9 ANAL CHIM ACTA JI Anal. Chim. Acta PD MAR 8 PY 2001 VL 431 IS 1 BP 69 EP 80 DI 10.1016/S0003-2670(00)01324-6 PG 12 WC Chemistry, Analytical SC Chemistry GA 412UA UT WOS:000167571700007 ER PT J AU Legros, CB Orliaguet, A Mayer, MN Labbez, F Carli, PA AF Legros, CB Orliaguet, A Mayer, MN Labbez, F Carli, PA TI Severe anaphylactic reaction to cisatracurium in a child SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANESTHESIA C1 Grp Hosp Necker Enfants Malad, Dept Anesthesiol & Crit Care, F-75743 Paris 15, France. RP Orliaguet, A (reprint author), Grp Hosp Necker Enfants Malad, Dept Anesthesiol & Crit Care, 149 Rue Sevres, F-75743 Paris 15, France. NR 7 TC 8 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 2001 VL 92 IS 3 BP 648 EP 649 PG 2 WC Anesthesiology SC Anesthesiology GA 405JW UT WOS:000167157100017 ER PT J AU Pan, PH Moore, C AF Pan, PH Moore, C TI Comparison of cisatracurium-induced neuromuscular blockade between immediate postpartum and nonpregnant patients SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article; Proceedings Paper CT Annual Meeting American-Society-of-Anesthesiology CY OCT 16-18, 2000 CL SAN FRANCISCO, CALIFORNIA SP Amer Soc Anesthesiol DE cisatracurium; muscle relaxants; pregnancy; postpartum, intubation ID OPIOID BARBITURATE ANESTHESIA; TRACHEAL INTUBATION; CESAREAN-SECTION; ROCURONIUM; VECURONIUM; DURATION; ONSET; 51W89 AB Study Objective: To evaluate and compare cisatracurium-induced neuromuscular blockade and intubating conditions between immediate postpartum (PP) and nonpregnant (NP) patients. Design: Prospective control study Settings: University Hospital Center Patients: 44 ASA physical status I and II patients: 22 immediate postpartum (PP) patients (< 48 hours after delivery) scheduled for elective postpartum tubal ligation and 22 nonpregnant (NP) patients (> 40 weeks from prior pregnancy) scheduled for elective gynecological procedures. Interventions: General anesthesia was induced intravenously (IV) with thiopental sodium 5 mg/kg, fentanyl 2.0 to 3.0 ug/kg, midazolam 0.015 to 0.025 mg/kg, and cisatracurium 0.2 mg/kg. Evoked electromyographic responses of the adductor pollicis muscle were obtained by supra-maximal train-of-four stimulation of the ulnar nerve every ten seconds via surface electrodes at the wrist. Intubation was attempted at 90 s after completion of cisatracurium administration and again at 120 seconds if the first attempt was unsuccessful. The intubating anesthesiologist assessed the intubating conditions with four variables: jaw relaxation, vocal cord immobility and exposure, patient/diaphragmatic movement, and overall intubating impression. Intraoperative anesthetic was maintained with 30 % oxygen, 70 % nitrous oxide, and 1 % end-tidal isoflurane, as tolerated. Patient temperature was maintained at 35.5 degrees to 37.5 degrees Celsius (C), and end-tidal carbon dioxide at 30 to 36 mmHg. Measurements and Main Results: The mean onset times to 50%, 90%, and maximal T-1 depression and mean time to 25% T-1 recovery in the PP group (68 +/- 19 sec, 110 +/- 26 sec, 147 +/- 32 sec, 60 +/- 6 min) were significantly less than those in the NP group (80 +/- 17 sec, 131 +/- 28 sec, 181 +/- 44 sec, 69 +/- 12 min), respectively (p < 0.05). All patients were successfully intubated on the first attempt at 90 seconds. 91% of the NP group and 81% of the PP group had excellent overall intubating conditions. Conclusions: This is the first published control study to compare the effects of cisatracurium between NP and PP patients. The results suggest that the mean onset time and clinical duration of cisatracurium are significantly shorter in immediate postpartum patients than those in nonpregnant female patients. (C) 2001 by Elsevier Science Inc. C1 Virginia Commonwealth Univ, Med Coll Virginia, Dept Anesthesiol, Div Obstet Anesthesia, Richmond, VA 23298 USA. RP Pan, PH (reprint author), Virginia Commonwealth Univ, Med Coll Virginia, Dept Anesthesiol, Div Obstet Anesthesia, POB 980695, Richmond, VA 23298 USA. NR 25 TC 2 Z9 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2001 VL 13 IS 2 BP 112 EP 117 DI 10.1016/S0952-8180(01)00226-4 PG 6 WC Anesthesiology SC Anesthesiology GA 431CF UT WOS:000168613800007 ER PT J AU Farenc, C Enjalbal, C Sanchez, P Bressolle, F Audran, M Martinez, J Aubagnac, JL AF Farenc, C Enjalbal, C Sanchez, P Bressolle, F Audran, M Martinez, J Aubagnac, JL TI Quantitative determination of rocuronium in human plasma by liquid chromatography-electrospray ionization mass spectrometry SO JOURNAL OF CHROMATOGRAPHY A LA English DT Article DE rocuronium ID NEUROMUSCULAR BLOCKING-AGENTS; PHARMACOKINETICS; VALIDATION AB Liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS) was used for the quantification of the neuromuscular blocking agent rocuronium in human plasma. Verapamil was used as internal standard. The samples were subjected to a dichloromethane liquid-liquid extraction after ion pairing of the positively charged ammonium compound with iodide prior to LC-MS. Optimized conditions involved separation on a Symmetry Shield RP-18 column (50X2.1 mm, 3.5 mum) using a 15-min gradient from 10 to 90% acetonitrile in water containing 0.1% trifluoroacetic acid at 250 mul/min. Linear detector responses for standards were observed from 25 to 2000 ng/ml. The extraction recovery averaged 59% for rocuronium and 83% for the internal standard. The limit of quantification (LOQ), using 500 mul of plasma, was 25 ng/ml. Precision ranged from 1.3 to 19% (LOQ), and accuracy was between 92 and 112%. In plasma samples, at 20 and 4 degreesC, rocuronium was stable at physiological pH for 4 h; frozen at - 30 degreesC it was stable for at least 75 days. The method was found suitable for the analysis of samples collected during pharmacokinetic investigations in humans. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Fac Pharm Montpellier, Lab Pharmacocinet Clin, F-34060 Montpellier 2, France. Univ Montpellier 1, Lab Aminoacides Peptide & Prot, UMR 5810, F-34095 Montpellier, France. Univ Montpellier 2, F-34095 Montpellier 5, France. Fac Pharm Montpellier, Biophys Lab, F-34060 Montpellier 2, France. RP Bressolle, F (reprint author), Fac Pharm Montpellier, Lab Pharmacocinet Clin, 15 Ave Ch Flahault, F-34060 Montpellier 2, France. NR 16 TC 12 Z9 15 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0021-9673 J9 J CHROMATOGR A JI J. Chromatogr. A PD FEB 23 PY 2001 VL 910 IS 1 BP 61 EP 67 DI 10.1016/S0021-9673(00)01164-X PG 7 WC Biochemical Research Methods; Chemistry, Analytical SC Biochemistry & Molecular Biology; Chemistry GA 399WY UT WOS:000166838300006 ER PT J AU Lowenick, CV Krampfl, K Schneck, H Kochs, E Bufler, J AF Lowenick, CV Krampfl, K Schneck, H Kochs, E Bufler, J TI Open channel and competitive block of nicotinic receptors by pancuronium and atracurium SO EUROPEAN JOURNAL OF PHARMACOLOGY LA English DT Article DE nicotinic receptor channel, embryonic-type; atracurium; pancuronium; open channel block; competitive block ID FROG NEUROMUSCULAR-JUNCTION; ACETYLCHOLINE-RECEPTOR; MOUSE MYOTUBES; MUSCLE; DESENSITIZATION; TUBOCURARINE; PROCAINE; NEURONS; CURARE AB Mouse myotubes were used to investigate effects of the nondepolarizing neuromuscular blocking drugs pancuronium and atracurium on embryonic-type nicotinic acetylcholine receptor channels. Experiments were performed using patch-clamp techniques in combination with devices for ultra-fast solution exchange at outside-out patches. Application of 0.1 mM acetylcholine resulted in a fast current transient. When the peak amplitude was achieved, the current decayed monoexponentially due to desensitization. After application of drugs (pancuronium or atracurium), two different mechanisms of block were observed: (1) open channel block of embryonic-type nicotinic acetylcholine receptor channels after coapplication of blocker and acetylcholine, characterized by decrease of the time constant of current decay; (2) competitive block of embryonic-type nicotinic acetylcholine receptor channels by pancuronium or atracurium after preincubation of outside-out patches with the respective blocker. Different affinities of pancuronium (K-B approximate to 0.01 muM) and atracurium (K-B approximate to muM) to embryonic-type nicotinic acetylcholine receptor channels were observed. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Hannover Med Sch, Dept Neurol, D-30623 Hannover, Germany. Tech Univ Munich, Dept Anesthesiol, D-81675 Munich, Germany. RP Bufler, J (reprint author), Hannover Med Sch, Dept Neurol, D-30623 Hannover, Germany. NR 23 TC 12 Z9 14 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0014-2999 J9 EUR J PHARMACOL JI Eur. J. Pharmacol. PD FEB 9 PY 2001 VL 413 IS 1 BP 31 EP 35 DI 10.1016/S0014-2999(00)00836-0 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 403EW UT WOS:000167030500003 ER PT J AU Zhou, TJ Chiu, JW White, PF Forestner, JE Murphy, MT AF Zhou, TJ Chiu, JW White, PF Forestner, JE Murphy, MT TI Reversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesia SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE anesthetics, intravenous, propofol; anesthetics, volatile, sevoflurane; neuromuscular relaxants, rocuronium; antagonists, neuromuscular relaxants; edrophonium ID INDUCED NEUROMUSCULAR BLOCK; TIME-COURSE; NEOSTIGMINE ANTAGONISM; ENFLURANE ANESTHESIA; ISOFLURANE; POTENTIATION; PANCURONIUM; DESFLURANE; ATRACURIUM; RECOVERY AB Background: The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non-depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium-atropine during propofol- versus sevoflurane-based anesthesia. Methods: Following induction of anesthesia with propofol (2-2.5 mg kg(-1), iv) and fentanyl (1-2 mug kg(-1) iv), rocuronium 0.6 mg kg(-1) iv was administered to facilitate tracheal intubation. Patients were then randomized to receive either a propofol infusion (100 mug kg(-1) min(-1)) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular blockade was monitored using electromyography at the wrist, and reversed with edrophonium 1.0 mg kg(-1) and atropine 0.015 mg kg(-1) when the first twitch hight (T-1) of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. Anesthetic maintenance with propofol or sevoflurane was continued following reversal until a TOF ratio of 0.7 was attained. Results: The clinical duration of action (i.e., time to 25% T-1 recovery) was similar during both propofol- (39.3+/-14.6 min) and sevoflurane-based (48.1+/-19.7 min) anesthesia. However, the reversal time from 25% T-1 to TOF ratio of 0.7 was significantly longer with sevoflurane [Median 2.8 (range 0.5-18.8) min] compared with propofol [1.5 (0.75-3) min] (P<0.05). Conclusions: We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg(-1) iv, was similar during both propofol- and sevoflurane-based anesthesia. However, the reversal of rocuronium-induced residual blockade was slower and more variable in the presence of sevoflurane. C1 Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX 75239 USA. RP White, PF (reprint author), Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, 5323 Harry Hines Blvd,F2-208, Dallas, TX 75239 USA. NR 16 TC 3 Z9 3 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD FEB PY 2001 VL 45 IS 2 BP 246 EP 249 DI 10.1034/j.1399-6576.2001.450217.x PG 4 WC Anesthesiology SC Anesthesiology GA 398VX UT WOS:000166778100017 ER PT J AU Rauch, H Jung, I Fleischer, F Bauer, H Martin, E Motsch, J AF Rauch, H Jung, I Fleischer, F Bauer, H Martin, E Motsch, J TI Haemodynamic and neuromuscular blocking effects of cisatracurium and pancuronium in patients undergoing coronary artery bypass operations SO ANAESTHESIST LA German DT Article DE cisatracurium; pancuronium; haemodynamic effects; onset time ID DOSE FENTANYL ANESTHESIA; VECURONIUM; PHARMACODYNAMICS; DISEASE; PHARMACOKINETICS; BLOCKADE; 2-CENTER; SURGERY AB Objective. The aim of the study was to compare haemodynamic and neuromuscular effects of cisatracurium and pancuronium in patients undergoing coronary artery bypass grafting (ASA Ill, good or moderately impaired LV function) who were chronically medicated with beta -adrenergic blocking agents. Methods. 60 Patients were randomly assigned in a double-blind fashion to receive sufentanil/midazolam/etomidate and either pancuronium (ZxED(95), group P) or cisatracurium (2xED(95),group C-2 and 4xED(95), group C-4) Haemodynamic variables were measured using arterial and pulmonary arterial catheters, neu ro muscular transmission was measured using electromyography. Results. The heart rate was significantly lower in group C-2 (50,2+/-6,8 bpm) and in group C-4 (54,3+/-11 bpm) than in the pancuronium group (62,4+/-13,2 bpm) 3 min after induction of anaesthesia and until 60 min after induction. None of the other haemodynamic parameters showed any difference between groups. Onset time was 5.22+/-3.43 min in group P,6.42+/-2.1 min in group Ct and 2.92+/-1.2 min in group C-4 Conclusion. Under high-dose opioid induction bradycardia must be considered if cis atracurium is administered to cardiac surgery patients. C1 Univ Heidelberg, Anasthesiol Klin, D-6900 Heidelberg, Germany. RP Rauch, H (reprint author), Univ Heidelberg Klinikum, Anasthesiol Klin, Neuenheimer Feld 110, D-69120 Heidelberg, Germany. NR 21 TC 2 Z9 2 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD FEB PY 2001 VL 50 IS 2 BP 87 EP + DI 10.1007/s001010050969 PG 7 WC Anesthesiology SC Anesthesiology GA 407JW UT WOS:000167269300003 ER PT J AU Beaufort, TM Proost, JH Maring, JG Scheffer, ER Wierda, JMKH Meijer, DKF AF Beaufort, TM Proost, JH Maring, JG Scheffer, ER Wierda, JMKH Meijer, DKF TI Effect of hypothermia on the hepatic uptake and biliary excretion of vecuronium in the isolated perfused rat liver SO ANESTHESIOLOGY LA English DT Article ID STEROIDAL MUSCLE-RELAXANTS; ORGANIC CATIONS; D-TUBOCURARINE; CARDIOPULMONARY BYPASS; NEUROMUSCULAR BLOCKADE; PUTATIVE METABOLITES; PHARMACOKINETICS; DRUGS; PANCURONIUM; BROMIDE AB Background: Hypothermia prolongs the time course of action of nondepolarizing muscle relaxants. It is not known whether this prolongation is caused by a reduced rate of extrahepatic distribution or elimination, liver uptake, metabolic clearance, or biliary excretion. Therefore, the authors studied the effects of hypothermia on the net hepatic uptake, metabolism, and biliary excretion of vecuronium in Isolated perfused rat liver. Methods: Livers of Wistar rats were perfused with Krebs Ringer solution (1% albumin, 3.3% carbon dioxide in oxygen, pH 7.36-7.42, 38 degreesC), Each perfusion experiment (recirculatory perfusion system) was divided into three phases. In phase 1, a bolus dose of vecuronium (950 mug) was followed by a continuous infusion of vecuronium (63 mug/min) throughout the perfusion experiment. In phase 2, the temperature was reduced to 28 degreesC, In phase 3, temperature was restored. In controls, the temperature was kept constant throughout the perfusion. Concentrations of vecuronium and its metabolites were measured in perfusion medium, bile, and liver homogenate. Parameters of a multicompartmental Liver model were fitted to the concentration patterns in perfusion medium and in bile. Results: Hypothermia increased vecuronium concentrations in the perfusion medium from 4.0 mug/ml (range, 2.5-6.6) to 15.6 mug/ml (11.5-18.4 mug/ml; P = 0.018). Hypothermia reduced the biliary excretion rate of 3-desacetyl vecuronium from 18% (range, 6-37%) to 16% (range, 4-19%) of that of vecuronium (P = 0.018), Pharmacokinetic analysis confirmed that hypothermia reduced the rate constants of hepatic uptake and metabolism from 0.219 to 0.053 and from 0.059 to 0.030, respectively. Conclusions: Hypothermia significantly and reversibly reduced the net hepatic uptake of vecuronium. Hypothermia reduced the metabolism of vecuronium and the biliary excretion rate of 3-desacetyl vecuronium. C1 Univ Groningen, Res Grp Expt Anesthesiol & Clin Pharmacol, Groningen, Netherlands. RP Beaufort, TM (reprint author), Univ Groningen Hosp, Dept Anesthesiol, POB 30-001, NL-9700 RB Groningen, Netherlands. NR 39 TC 5 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD FEB PY 2001 VL 94 IS 2 BP 270 EP 279 DI 10.1097/00000542-200102000-00017 PG 10 WC Anesthesiology SC Anesthesiology GA 397KM UT WOS:000166694900013 ER PT J AU Soriano, SG Sullivan, LJ Venkatakrishnan, K Greenblatt, DJ Martyn, JAJ AF Soriano, SG Sullivan, LJ Venkatakrishnan, K Greenblatt, DJ Martyn, JAJ TI Pharmacokinetics and pharmacodynamics of vecuronium in children receiving phenytoin or carbamazepine for chronic anticonvulsant therapy SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE complications, epilepsy; neuromuscular block, vecuronium; children ID INDUCED NEUROMUSCULAR BLOCKADE; ACETYLCHOLINE-RECEPTORS; INDUCED RESISTANCE; DRUG-INTERACTIONS; PROTEIN-BINDING; D-TUBOCURARINE; UP-REGULATION; PLASMA; SUCCINYLCHOLINE; GLYCOPROTEIN AB The pharmacokinetics and time course of action of vecuronium in normal children and children receiving anticonvulsant drugs for prolonged periods were characterized. A bolus dose of vecuronium 0.15 mg kg(-1) was administered i.v. to 10 non-epileptic children and to 10 children on phenytoin and 10 children on carbamazepine, who were matched for age and weight. Plasma concentrations of vecuronium, 3-OH desacetylvecuronium (the primary metabolite of vecuronium) and at-acid glycoprotein (AAG) were determined. Pharmacokinetic variables were derived from plasma samples collected before and after administration of vecuronium. Neuromuscular transmission was monitored by evoked compound electromyography. Recovery of the first twitch of the train-of-four (T-1/T-0) and the recovery index (RI), the time for 25-75% recovery of T-1/T-0, were determined. The elimination half-life of vecuronium was significantly reduced in both anticonvulsant groups compared with control [control 48.2 (SD 40.3), phenytoin 23.5 (13.1), carbamazepine 18.4 (16.6) min, P<0.05]. Vecuronium clearance was increased in both anticonvulsant groups [control 9.0 (3.6), phenytoin 15.1 (8.9), carbamazepine 18.8 (13.1) ml kg(-1) min(-1), 0.05g.kg(-1).min(-1) for children receiving fentanyl-nitrous oxide, halothane, isoflurane and sevo-flurane anaesthesia, respectively. Conclusions: The rocuronium infusion rate required to maintain stable 90-99% T-1 depression was reduced by approximately 20% with halothane and isoflurane anaesthesia, and by 50% with sevoflurane anaesthesia when compared to fentanyl-nitrous oxide anaesthesia. Significant patient-to-patient variability of infusion rate makes monitoring of neuromuscular transmission necessary. C1 Mem Childrens Hlth Inst, Dept Anaesthesiol & Intens Therapy, PL-04736 Warsaw, Poland. Warsaw Univ Technol, Dept Elect & Informat Syst, Warsaw, Poland. RP Woloszczuk-Gebicka, B (reprint author), Mem Childrens Hlth Inst, Dept Anaesthesiol & Intens Therapy, Al Dzieci Polskich 20, PL-04736 Warsaw, Poland. NR 24 TC 16 Z9 18 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JAN PY 2001 VL 45 IS 1 BP 73 EP 77 DI 10.1034/j.1399-6576.2001.450112.x PG 5 WC Anesthesiology SC Anesthesiology GA 386ZR UT WOS:000166096100012 ER PT J AU Denman, WT Kaplan, RF Goudsouzian, NG Uejima, T Barcelona, SL Cote, CJ Ginsberg, B Hannallah, RS AF Denman, WT Kaplan, RF Goudsouzian, NG Uejima, T Barcelona, SL Cote, CJ Ginsberg, B Hannallah, RS TI Intramuscular rapacuronium in infants and children - A comparative multicenter study to confirm the efficacy and safety of the age-related tracheal intubating doses of intramuscular rapacuronium (ORG 9487) in two groups of pediatric subjects SO ANESTHESIOLOGY LA English DT Article ID NEUROMUSCULAR BLOCKADE; ADDUCTOR POLLICIS; SUCCINYLCHOLINE; ANESTHESIA; ROCURONIUM; SEVOFLURANE; HALOTHANE; INDUCTION; ORG-9487; MUSCLES AB Background: This multicenter, assessor, blinded, randomized study was conducted to confirm and extend a pilot study in which intramuscular rapacuronium was given to infants and children to confirm efficacy and to evaluate tracheal intubating conditions. Methods: Ninety-six pediatric patients were studied in two groups: infants aged 1 to 12 months (n = 46) and children aged 1 to 3 yr (n = 50). Infants received 2.8 mg/kg and children 4.8 mg/kg of intramuscular rapacuronium during 1 minimum alveolar concentration halothane anesthesia. These two groups were studied in three subgroups, depending on the time (1.5, 3, or 4 min) at which tracheal intubation was attempted after the administration of intramuscular rapacuronium into the deltoid muscle. Neuromuscular data collected included onset time, duration of action, and recovery data during train-of-four stimulation at 0.1 Hz. Data were analyzed by the Cochran-Mantel-Haenszel procedure. Results: The tracheal intubating conditions were deemed acceptable in 17, 36, and 64% of infants and 20, 47, and 71% of children at 1.5, 3, or 4 min, respectively. The mean values for % of control twitch height (T1) 2 min after rapacuronium in both groups were similar. The mean (SD) time required to achieve more than or equal to 95% twitch depression in infants was 6.0 (3.7) versus 5.5 (3.8) min in children. Conclusions: Only 27% of patients achieved clinically acceptable tracheal intubating conditions at 1.5 or 3 min after administration of 2.8 mg/kg and 4.8 mg/kg rapacuronium during 1 minimum alveolar concentration halothane anesthesia. Tracheal intubation conditions at 4 min were acceptable in 69% of subjects. The duration of action of 4.8 mg/kg of rapacuronium in children was longer than 2.8 mg/kg of rapacuronium in infants. C1 Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Boston, MA 02114 USA. Childrens Natl Med Ctr, Dept Anesthesiol, Washington, DC 20010 USA. Childrens Mem Hosp, Dept Anesthesiol, Chicago, IL 60614 USA. Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA. Childrens Natl Med Ctr, Dept Pediat, Washington, DC 20010 USA. Childrens Mem Hosp, Dept Pediat, Chicago, IL 60614 USA. RP Denman, WT (reprint author), New England Med Ctr, Dept Anesthesia, 750 Washington St,Box 298, Boston, MA 02111 USA. NR 19 TC 7 Z9 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2001 VL 94 IS 1 BP 3 EP 7 DI 10.1097/00000542-200101000-00006 PG 5 WC Anesthesiology SC Anesthesiology GA 389WU UT WOS:000166262300002 ER PT J AU Kuipers, JA Boer, F Olofsen, E Bovill, JG Burm, AGL AF Kuipers, JA Boer, F Olofsen, E Bovill, JG Burm, AGL TI Recirculatory pharmacokinetics and pharmacodynamics of rocuronium in patients - The influence of cardiac output SO ANESTHESIOLOGY LA English DT Article ID ADDUCTOR POLLICIS; PULMONARY UPTAKE; BLOOD; MODEL; PROPOFOL; DOGS; ELIMINATION; ARTERIAL; KINETICS; MARKERS AB Background: Recirculatory models are capable of accurately describing first-pass pharmacokinetics and the influence of cardiac output (CO), which is important for drugs with a fast onset of effect. The influence of CO on pharmacokinetic and pharmacodynamic parameters of rocuronium in patients was evaluated using a recirculatory pharmacokinetic model. Methods: Fifteen patients were included to study rocuronium pharmacokinetics and pharmacodynamics. Bolus doses of rocuronium (0.35 mg/kg) and indocyanine green (25 mg) were injected simultaneously via a peripheral intravenous catheter. Blood samples were taken for 240 min from the radial artery. The force of contraction of the adductor pollicis after a train-of-four at 2 Hz every 12 s was measured. Arterial concentration-time curves of rocuronium and indocyanine green were analyzed using a recirculatory model. Pharmacodynamics were described using a sigmoid maximum effect (E-max) model. Results: The CO of the patients varied from 2.43 to 5.59 1/min. Total distribution volume of rocuronium was 17.3 +/- 4.8 1 (mean +/- SD). The CO showed a correlation with the fast tissue clearance (ClT-f; r(2) = 0.51), with the slow tissue clearance (ClT-s; r(2) = 0.31) and with the mean transit times of rocuronium except for the mean transit time of the slow tissue compartment. The blood-effect site equilibration constant (k(e0)) was strongly correlated with CO (r(2) = 0.70). Conclusions: Cardiac output influences the pharmacokinetics, including k(e0), for rocuronium in patients. For drugs with a fast onset of effect, a recirculatory model, which includes CO, can give a good description of the relation between concentration and effect, in contrast to a conventional compartmental pharmacokinetic model. C1 Leiden Univ, Med Ctr, Dept Anesthesiol P5, NL-2300 RC Leiden, Netherlands. RP Burm, AGL (reprint author), Leiden Univ, Med Ctr, Dept Anesthesiol P5, POB 9600, NL-2300 RC Leiden, Netherlands. NR 31 TC 27 Z9 31 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2001 VL 94 IS 1 BP 47 EP 55 DI 10.1097/00000542-200101000-00012 PG 9 WC Anesthesiology SC Anesthesiology GA 389WU UT WOS:000166262300008 ER PT J AU Ouattara, A Richard, L Charriere, JM Lanquetot, H Corbi, P Debaene, B AF Ouattara, A Richard, L Charriere, JM Lanquetot, H Corbi, P Debaene, B TI Use of cisatracurium during fast-track cardiac surgery SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, cisatracurium; surgery, cardiovascular ID ARTERY BYPASS GRAFT; NEUROMUSCULAR BLOCK; EXTUBATION AB We prospectively studied spontaneous recovery from cisatracurium-induced neuromuscular block in 18 patients scheduled for cardiac surgery, and its suitability for fast-track cardiac surgery. Neuromuscular block was induced by an i.v. bolus (range 0.15-0.3 mg kg(-1)) and maintained by a continuous infusion (range 1.1-3.2 mug kg(-1) min(-1)) of cisatracurium until sternal closure. In the intensive care unit (ICU), spontaneous recovery was evaluated by the train-of-four (TOF) ratio measured at the adductor pollicis muscle. The ICU medical staff were unaware of the TOF ratios until sedation was stopped. At that time, if the TOF ratio was less than 0.9, sedation was recommenced. On arrival in ICU, all patients had-residual paralysis. The mean time to reaching a TOF ratio of at least 0.9 was 102 min (range 74-144 min) after discontinuation of the cisatracurium infusion. Fifteen patients (83%) were successfully extubated during the first 8 h after stopping the cisatracurium infusion. Only one patient showed residual paralysis when sedation was discontinued. These results support the use of cisatracurium as a suitable neuromuscular blocking agent for fast-track cardiac surgery. C1 CHU La Miletrie, Dept Anesthesie Reanimat Chirurg, F-86021 Poitiers, France. CHU La Miletrie, Dept Anesthesie Reanimat, Poitiers, France. CHU La Miletrie, Serv Chirurg Cardiothorac, Poitiers, France. RP Debaene, B (reprint author), CHU La Miletrie, Dept Anesthesie Reanimat Chirurg, 350 Ave Jacques Coeur, F-86021 Poitiers, France. NR 7 TC 2 Z9 4 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JAN PY 2001 VL 86 IS 1 BP 130 EP 132 DI 10.1093/bja/86.1.130 PG 3 WC Anesthesiology SC Anesthesiology GA 387ZT UT WOS:000166153500024 ER PT J AU Saitoh, Y Kaneda, K Fujii, Y Oshima, T AF Saitoh, Y Kaneda, K Fujii, Y Oshima, T TI Nicorandil accelerates recovery of neuromuscular block caused by vecuronium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID SKELETAL-MUSCLE; STIMULATION; CHANNELS AB Purpose: To examine the effect of nicorandil, a K-ATP, channel agonist, on neuromuscular block caused by vecuronium in patients anesthetized with nitrous oxide, oxygen. isoflurane, and fentanyl. Methods: Sixty adult patients were allocated to four groups of 15: nicorandil-post-tetanic count (N-PTC), nicorandil-train-of-four (N-TOF), control-post-tetanic count (C-PTC) or control-train-of-four (C-TOF) group. In the N-PTC and N-TOF groups. 0.1 mg.kg(-1) nicorandil was given as a bolus followed by an infusion at mug.kg(-1) min(-1) Two minutes after the bolus, 0.1 mg.kg(-1) vecuronium was administered, In the C-PTC or C-TOF group normal saline was given instead of nicorandil. PTC and TOF responses were measured mechanically using a force displacement transducer. Results: Time from the administration of vecuronium to the onset of neuromuscular block in the N-PTC or N-TOF group did not differ from that in the C-PTC or C-TOF group (241 +/- 33 vs 225 +/- 32 sec, mean +/- SD), Times from vecuronium injection to the return of PTC in the N-PTC and C-PTC groups, and those of T1, T2, T3, and T4 (first, second, third, and fourth stimulation of TOF) in the N-TOF and C-TOF groups did not differ. Recoveries of PTC in the N-PTC and C-PTC groups followed similar time course. T1/control twitch height and TOF ratio (T4/T1) in the N-TOF group were higher than those in the C-TOF group 80-120 min and 100-120 min after administration of vecuronium, respectively. Conclusion: Nicorandil accelerates recovery of neuromuscular block caused by vecuronium. C1 Fukushima Med Univ, Sch Med, Dept Anesthesiol, Fukushima, Fukushima 9601295, Japan. Toride Kyodo Gen Hosp, Ibaraki, Osaka, Japan. Univ Tsukuba, Dept Anesthesiol, Inst Clin Med, Ibaraki, Osaka, Japan. Gifu Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Gifu 500, Japan. RP Saitoh, Y (reprint author), Fukushima Med Univ, Sch Med, Dept Anesthesiol, 1 Hikarigaoka, Fukushima, Fukushima 9601295, Japan. NR 18 TC 0 Z9 0 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 2001 VL 48 IS 1 BP 28 EP 33 PG 6 WC Anesthesiology SC Anesthesiology GA 395MW UT WOS:000166585000004 ER PT J AU Yamaguchi, S Egawa, H Okuda, K Mishio, M Okuda, Y Kitajima, Y AF Yamaguchi, S Egawa, H Okuda, K Mishio, M Okuda, Y Kitajima, Y TI High concentration sevoflurane induction of anesthesia accelerates onset of vecuronium neuromuscular blockade SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID VITAL CAPACITY INDUCTION; INHALATION INDUCTION; INTRAVENOUS ANESTHESIA; CARDIAC-OUTPUT; NITROUS-OXIDE; ISOFLURANE; HALOTHANE; TIME; CHILDREN; INFANTS AB Purpose: To investigate neuromuscular block using accelography after administration of vecuronium under sevoflurane 8% induction and maintenance with sevoflurane 2% in adults. Methods: Patients were allocated to three groups: (I) group I anesthesia was induced and maintained with propofol and fentanyl (n=15), (2) group II: anesthesia was induced with propofol and maintained with N2O(66%)-O-2-sevofiurane 2% (n=15), (3) group III: anesthesia was induced with sevoflurane 8% using a vital capacity inhalation induction and maintained with N2O(66%)-O-2-sevoflurane 2% (n=15), 0.1 mg.kg(-1) vecuronium was used for paralysis three minutes after anesthetic induction and reversed using intravenous 0.04 mg.kg(-1) neostigmine with 0.02 mg.kg(-1) atropine when the train-of-four (TOF) ratio returned to 25%. Results: The onset time from initial administration of vecuronium to maximal block in the group III was shorter than that in the groups I and II (139 +/- 35, 193 +/- 35 and 188 +/- 47s, respectively: P < 0.05). The clinical duration from maximal block to 25% recovery of TOF ratio in group II and III was longer than that in the group I (47 +/- 15, 48 +/- 14 and 36 +/- 10 min, respectively: P < 0.05). The reversal times from administration of neostigmine to 75% of TOF ratio in groups II and III were longer than that in the group I ( 196 +/- 53, 208 +/- 64 and 1 36 +/- 28s, respectively: P < 0.05). Conclusions: Vital capacity inhalation induction of anesthesia with sevoflurane accelerates onset and prolongs duration of vecuronium neuromuscular block compared with propofol-fentanyl anesthesia. C1 Dokkyo Univ, Sch Med, Dept Anesthesiol, Mibu, Tochigi 3210293, Japan. RP Yamaguchi, S (reprint author), Dokkyo Univ, Sch Med, Dept Anesthesiol, Mibu, Tochigi 3210293, Japan. NR 16 TC 4 Z9 4 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 2001 VL 48 IS 1 BP 34 EP 37 PG 4 WC Anesthesiology SC Anesthesiology GA 395MW UT WOS:000166585000005 ER PT J AU Soltesz, S Mencke, T Schlaich, N Fuchs-Buder, T AF Soltesz, S Mencke, T Schlaich, N Fuchs-Buder, T TI Co-induction of anaesthesia with desflurane improves intubating conditions after low-dose rocuronium - A double-blind, randomised, placebo-controlled clinical trial SO CLINICAL DRUG INVESTIGATION LA English DT Article ID TRACHEAL INTUBATION; ADDUCTOR POLLICIS; MUSCLE-RELAXANTS; SEVOFLURANE; ANESTHESIA; REMIFENTANIL; PROPOFOL; ADULTS; ISOFLURANE AB Objective: To assess the impact of co-induction of anaesthesia with desflurane on the intubating conditions after low-dose rocuronium 0.3 mg/kg (equivalent to 1 x ED95, the dose of neuromuscular blocking agent that produces an average of 95% neuromuscular block; a typical intubating dose is 2 x ED95). Design: A prospective, double-blind, randomised, placebo-controlled clinical trial carried out in surgical patients. Patients: 120 adult patients (American Society of Anaesthesiologists grades I or II) undergoing general anaesthesia for ambulatory surgery. Methods: Patients were randomised to four groups (n = 30 each) as follows: group A (control group) - desflurane 1 minimum alveolar concentration (MAC), i.e. 6% inspired concentration by volume, no myorelaxant; group B - desflurane 1 MAC and rocuronium 1 x ED95: group C - no desflurane and rocuronium 1 x ED95; group D (reference group)- no desflurane and rocuronium 2 x ED95 In all patients anaesthesia was induced with thiopental 5 mg/kg and fentanyl 2 mug/kg. After loss of consciousness, saline (group A) or the respective dose of rocuronium (groups B to D) was injected over 5 seconds and the patients were ventilated for 3 minutes via face mask with 1 MAC desflurane in O-2 (groups A and B) or with O-2 alone (groups C and D). Thereafter, all patients were intubated by the same experienced anaesthetist and the intubating conditions were assessed according to the criteria proposed by the Copenhagen Consensus Conference. Results: Without the concomitant administration of desflurane, the intubating conditions after rocuronium 0.3 mg/kg were good or excellent in only seven patients and not acceptable in 23. Adding desflurane at an inspired concentration of 1 MAC to this induction regimen significantly improved the intubating conditions: good or excellent conditions were now observed in 26 patients and unacceptable intubating conditions in only four patients (group C vs group B: p < 0.01). The rate of clinically acceptable intubating conditions in group B did not differ from those obtained after the usual intubating dose of rocuronium 0.6 mg/kg in group D (26 patients vs 30 patients, respectively). Conclusions: After co-induction of anaesthesia with desflurane, reduced doses of rocuronium (1 x ED95) are sufficient to obtain good to excellent intubating conditions in elective situations. This may be of clinical interest for short surgical procedures or ambulatory surgery. C1 Univ Saarland, Dept Anaesthesia & Intens Care, D-6650 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Kliniken Saarlandes, Klin Anaesthesiol & Intens Med, D-66421 Homburg, Germany. NR 16 TC 4 Z9 4 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 1173-2563 J9 CLIN DRUG INVEST JI Clin. Drug Invest. PY 2001 VL 21 IS 6 BP 409 EP 414 DI 10.2165/00044011-200121060-00003 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 443NF UT WOS:000169346700003 ER PT J AU Mirakhur, RK McCourt, KC AF Mirakhur, RK McCourt, KC TI Rapacuronium: clinical pharmacology SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT 7th International Neuromuscular Meeting CY JUN, 2001 CL BELFAST, NORTH IRELAND DE intubation, neuromuscular blocking agents, rapacuronium, antagonism; pharmacodynamics, onset, recovery ID NEUROMUSCULAR BLOCKING-AGENTS; MUSCLE-RELAXANT; INTUBATING CONDITIONS; SPONTANEOUS-RECOVERY; TIME-COURSE; ORG-9487; PHARMACOKINETICS; SUCCINYLCHOLINE; ANESTHESIA; SEVOFLURANE AB The need for a rapid-acting non-depolarizing neuromuscular blocking agent with a short duration of action resulted in the synthesis of rapacuronium. The onset of maximum block with rapacuronium occurs in 60-90s with doses of 1.5-2.5 mg kg(-1) with a duration of clinical relaxation of 15-30 min. Rapacuronium provides clinically acceptable intubating conditions in 60s in a majority of patients with these doses, although the conditions are somewhat inferior to those obtained with succinylcholine in lightly anaesthetized patients, such as those undergoing a rapid-sequence induction. The main drawbacks of rapacuronium are the occurrence of dose-related pulmonary side-effects (increased airway pressure and/or overt bronchospasm) and hypotension and tachycardia. The cause of pulmonary side-effects is not certain but these have been serious enough to make its worldwide introduction doubtful. C1 Queens Univ Belfast, Dept Anaesthet & Intens Care Med, Belfast BT9 7BL, Antrim, North Ireland. Royal Grp Hosp, Dept Clin Anaesthesia, Belfast, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet & Intens Care Med, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 33 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PY 2001 VL 18 SU 23 BP 77 EP 82 DI 10.1046/j.1365-2346.2001.00014.x PG 6 WC Anesthesiology SC Anesthesiology GA 501PH UT WOS:000172693700015 ER PT J AU Proost, JH Wright, PMC AF Proost, JH Wright, PMC TI A pharmacokinetic-dynamic explanation of the rapid onset-offset of rapacuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT 7th International Neuromuscular Meeting CY JUN, 2001 CL BELFAST, NORTH IRELAND DE neuromuscular blocking agents, rapacuronium; pharmacodynamics, onset, offset; pharmacokinetics, clearance, rate constants ID NEUROMUSCULAR BLOCK; ADDUCTOR POLLICIS; D-TUBOCURARINE; TIME-COURSE; VECURONIUM; ORG-9487; POTENCY; PHARMACODYNAMICS; PANCURONIUM; GALLAMINE AB The rapid onset and offset of rapacuronium can be explained from its pharmacokinetic and pharmacodynamic characteristics. A unique property of rapacuronium is its high value for k(e0), indicating a rapid access to the receptor site. The reason for this high k(e0) may be related to the low intrinsic potency of rapacuronium, but this is not yet fully clarified. C1 Univ Groningen, Dept Anaesthesiol, Res Grp Expt Anaesthesiol & Clin Pharmacol, NL-9700 RB Groningen, Netherlands. Univ Newcastle Upon Tyne, Acad Dept Anaesthesia, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England. RP Proost, JH (reprint author), Univ Groningen, Dept Anaesthesiol, Res Grp Expt Anaesthesiol & Clin Pharmacol, POB 30 001, NL-9700 RB Groningen, Netherlands. NR 23 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PY 2001 VL 18 SU 23 BP 83 EP 89 DI 10.1046/j.0265-0215.2001.15.x PG 7 WC Anesthesiology SC Anesthesiology GA 501PH UT WOS:000172693700016 ER PT J AU Bartkowski, RR Witkowski, TA AF Bartkowski, RR Witkowski, TA TI Rapacuronium: first experience in clinical practice SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT 7th International Neuromuscular Meeting CY JUN, 2001 CL BELFAST, NORTH IRELAND DE intubation, intratracheal, neuromuscular blocking agents, rapacuronium; pharmacodynamics, onset, recovery ID RAPID-SEQUENCE INDUCTION; INTUBATING CONDITIONS; SUCCINYLCHOLINE; ORG-9487; ROCURONIUM; RECOVERY; REVERSAL; ONSET AB Rapacuronium is a new non-depolarizing relaxant with a fast onset and rapid recovery. It was approved for the market in the United States in August 1999. The reasons for its acceptance in practice and the niche it fills are the subject of this review. Rapacuronium has been accepted wherever rapid onset and short duration of action are advantageous. It has received the greatest acceptance in brief outpatient procedures that require tracheal intubation. The average time of recovery to a train-of-four ratio of 80% is about 25 min after a usual intubating dose of 1.5 mg kg(-1), when block is reversed. Its rapid onset has led some to use it in rapid-sequence induction, but the exact place in this scenario is still being defined. Its spontaneous recovery is rapid enough that many practitioners do not reverse the block if the procedure is long enough. Data suggest that this is reasonable after 60 min and may even be earlier, even 30 min, if verified by monitoring. The main adverse effects of rapacuronium are bronchospasm, hypotension and tachycardia. Of these, only bronchospasm has had significant clinical impact. These effects are dose related and the recommended dose of 1.5 mg kg(-1) may keep problems to a minimum. Because rapacuronium is a new drug with unique properties its use gradually increased in its first year. Because of the problems associated with succinylcholine, rapacuronium may have advantages for brief outpatient procedures and in cases where rapid termination of block is desired, provided its adverse effects can be minimized. C1 Thomas Jefferson Univ, Jefferson Med Coll, Dept Anesthesiol, Philadelphia, PA 19107 USA. RP Bartkowski, RR (reprint author), Thomas Jefferson Univ, Jefferson Med Coll, Dept Anesthesiol, Philadelphia, PA 19107 USA. NR 20 TC 1 Z9 1 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PY 2001 VL 18 SU 23 BP 90 EP 93 PG 4 WC Anesthesiology SC Anesthesiology GA 501PH UT WOS:000172693700017 ER PT J AU Farenc, C Lefrant, JY Audran, M Bressolle, F AF Farenc, C Lefrant, JY Audran, M Bressolle, F TI Pharmacokinetic-pharmacodynamic modeling of atracurium in intensive care patients SO JOURNAL OF CLINICAL PHARMACOLOGY LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENTS; CRITICALLY-ILL PATIENTS; UNIT PATIENTS; PARALYSIS; INFUSION; PLASMA; LAUDANOSINE; VECURONIUM; DRUGS AB The authors have studied 10 critically ill patients with acute respiratory distress syndrome who required a neuromuscular blocking drug to assist mechanical ventilation. patients received a bolus dose of 1 mg/kg of atracurium followed by a constant infusion rate of 1 mg/kg/h of this drug for 72 hears. Neuromuscular block was monitored using an accelerograph. Blood samples were obtained over a 96-hour period. A preliminary independent analysis was done to estimate the individual pharmacokinetic parameters; data were consistent with a one-compartment model. The pharmacodynamic data analysis was then performed using the changes in train-of-four (TOF) count as an index of the therapeutic effect of atracurium. Pharmacokinetic-dynamic variables were calculated using the Sheiner model and the Hill equation. The elimination half-life of atracurium averaged 22 minutes. Mean volume of distribution and plasma clearance were 217 ml/kg and 550 ml/min, respectively. There was a significant hysteresis loop when the TOF count was plotted against predicted plasma atracurium concentrations. The mean sigmoidicity factor, gamma, was 4.04. The concentration producing 50% of the E-max was 1.36 mug/mL, and the mean k(e0) was 0.059 min(-1). Recovery time ranged from 30 to 80 minutes, and none of the patients of this study had residual paralysis. Journal of Clinical Pharmacology, 2001.;41:44-50 (C) 2001 the American College of Clinical Pharmacology. C1 Fac Pharm Montpellier, Lab Pharmacocinet Clin, F-34060 Montpellier 2, France. Fac Pharm Montpellier, Biophys Lab, F-34060 Montpellier, France. CHU Nimes, Federat Anesthesiol Intens Care & Emergency, Nimes, France. RP Bressolle, F (reprint author), Fac Pharm Montpellier, Lab Pharmacocinet Clin, F-34060 Montpellier 2, France. NR 28 TC 4 Z9 4 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0091-2700 J9 J CLIN PHARMACOL JI J. Clin. Pharmacol. PD JAN PY 2001 VL 41 IS 1 BP 44 EP 50 DI 10.1177/00912700122009827 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 384FP UT WOS:000165932400005 ER PT J AU Raison, PE Haire, RG AF Raison, PE Haire, RG TI Zirconia-based materials for transmutation of americium and curium: cubic stabilized zirconia and zirconium oxide pyrochlores SO PROGRESS IN NUCLEAR ENERGY LA English DT Article; Proceedings Paper CT 6th Workshop on Inert Matrix Fuel, E-MRS Symposium B CY MAY 30-JUN 02, 2000 CL STRASBOURG, FRANCE DE americium; curium; zirconia; pyrochlore; transmutation; inert matrix AB We present here experimental results involving the incorporation of americium and curium elements in zirconia-based compounds, applicable for reactor transmutation schemes. Two materials are considered: Cubic-Stabilized Zirconia (CSZ) and the pyrochlore oxides having the formula An(2)Zr(2)O(7), where An = Am, Cm. (C) 2001 Published by Elsevier Science Ltd. All rights reserved. C1 CEA Cadarache, DRN, DEC, SPUA,LACA, F-13108 St Paul Durance, France. Oak Ridge Natl Lab, Oak Ridge, TN 37831 USA. RP Raison, PE (reprint author), CEA Cadarache, DRN, DEC, SPUA,LACA, F-13108 St Paul Durance, France. NR 13 TC 40 Z9 40 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0149-1970 J9 PROG NUCL ENERG JI Prog. Nucl. Energy PY 2001 VL 38 IS 3-4 SI SI BP 251 EP 254 DI 10.1016/S0149-1970(00)00110-4 PG 4 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 402UJ UT WOS:000167006300008 ER PT J AU Kimura, T Nagaishi, R Kato, Y Yoshida, Z AF Kimura, T Nagaishi, R Kato, Y Yoshida, Z TI Luminescence study on solvation of americium(III), curium(III) and several lanthanide(III) ions in nonaqueous and binary mixed solvents SO RADIOCHIMICA ACTA LA English DT Article DE actinide(III) ion; lanthanide(III) ion; nonaqueous solvent; solvation; hydration; luminescence lifetime ID RADIATIONLESS TRANSITIONS; SYSTEMATIC ANALYSIS; ORGANIC-SOLVENTS; HYDRATION NUMBER; RARE-EARTH; SPECTRA; CM(III); NEODYMIUM(III); EU(III); WATER AB The luminescence lifetimes of An(III) and Ln(III) ions [An=Am and Cm; Ln=Nd, Sm, Eu, To and Dy] were measured in dimethyl sulfoxide(DMSO), N,N-dimethylformamide(DMF), methanol(MeOH), water and their perdeuterated solvents. Nonradiative decay rates of the ions were in the order of H2O > MeOH > DMF > DMSO, indicating that O-H vibration is more effective quencher than C-H, C=O, and S=O vibrations in the solvent molecules. Maximal lifetime ratios tau (D)/tau (H) were observed for Eu(III) in H2O for Sm(III) in MeOH and DMF, and for Sm(III) and Dy(III) in DMSO. The solvent composition in the first coordination sphere of Cm(III) and Ln(III) in binary mixed solvents was also studied by measuring the luminescence lifetime. Cm(III) and Ln(III) were preferentially solvated by DMSO in DMSO-H2O, by DMF in DMF-H2O, and by H2O in MeOH-H2O over the whole range of the solvent composition. The order of the preferential solvation, i.e., DMSO > DMF > H2O > MeOH, correlates with the relative basicity of these solvents. The Gibbs free energy of transfer of ions from water to nonaqueous solvents was further estimated from the degree of the preferential solvation. C1 Japan Atom Energy Res Inst, Adv Sci Res Ctr, Tokai, Ibaraki 3191195, Japan. RP Kimura, T (reprint author), Japan Atom Energy Res Inst, Adv Sci Res Ctr, Tokai, Ibaraki 3191195, Japan. NR 25 TC 34 Z9 34 PU R OLDENBOURG VERLAG PI MUNICH PA LEKTORAT M/N, K BERBER-NERLINGER, POSTFACH 80 13 60, D-81613 MUNICH, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 2001 VL 89 IS 3 BP 125 EP 130 DI 10.1524/ract.2001.89.3.125 PG 6 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 435BF UT WOS:000168853000001 ER PT J AU Huntley, MW AF Huntley, MW TI Sequential separation of americium, curium, plutonium, neptunium and uranium in various matrices from the electrometallurgic treatment of spent-nuclear fuel SO RADIOCHIMICA ACTA LA English DT Article DE ion exchange; spent fuel; transplutonium actinides; alpha spectroscopy; electrorefining AB The separation of americium-241, curium-242/244, plutonium-238/239, neptunium-237, and uranium-234/235/238, in the same sample aliquot of clear acidic solution resulting from the electrometallurgical treatment of spent nuclear fuel has been investigated. Using ion exchange techniques in 10 M HCl media, it was determined that good separation can be achieved to resolve each isotope via alpha spectroscopy. The resin used was AG 1-x8 chloride form supplied by BioRad (R) Laboratories. The retention and eluting conditions for each isotope were determined using tracer techniques and will be presented. Based on this work, an analytical procedure for the sequential separation of Am, Cm, Pu, Np, and U, in various sample matrices recovered from the demonstration project is presented. C1 Argonne Natl Lab, Nucl Technol Div, Idaho Falls, ID 83403 USA. RP Huntley, MW (reprint author), Argonne Natl Lab, Nucl Technol Div, POB 2528, Idaho Falls, ID 83403 USA. NR 10 TC 10 Z9 10 PU R OLDENBOURG VERLAG PI MUNICH PA LEKTORAT M/N, K BERBER-NERLINGER, POSTFACH 80 13 60, D-81613 MUNICH, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 2001 VL 89 IS 10 BP 605 EP 612 DI 10.1524/ract.2001.89.10.605 PG 8 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA 485HQ UT WOS:000171747800001 ER PT J AU Circeo, LE Reeves, ST AF Circeo, LE Reeves, ST TI Multicenter trial of prolonged infusions of rocuronium bromide in critically ill patients: Effects of multiple organ failure SO SOUTHERN MEDICAL JOURNAL LA English DT Article ID INTENSIVE-CARE UNIT; PHARMACOKINETICS; PHARMACODYNAMICS; VECURONIUM; PANCURONIUM; CIRRHOSIS; ORG-9426 AB Background. This study was done to determine the safety, efficacy, dosing requirements, and spontaneous recovery profiles of prolonged infusions of rocuronium bromide in the critically ill. Methods. This multicenter, prospective, nonrandomized, open label trial enrolled 32 patients at two university-based medical centers. Patients who were determined to require neuromuscular blockade for at least 24 hours received a bolus of 0.6 mg/kg of rocuronium. After subsequent recovery of two responses (T2) to the TOF stimulation, an infusion of rocuronium was begun at 10 mug/kg/min and continued for 24 to 120 hours as required by the patients' clinical status. Results. Patients were divided into multiple organ failure (MOF) and non-multiple organ failure (non-MOF) groups on enrollment. The mean infusion rates for the MOF and non-MOF groups were 0.2 and 0.5 mg/kg/hour, respectively. Conclusion. The mean infusion rate or rocuronium that provides approximately 90% blockade is less for critically ill patients with MOF. Spontaneous recovery was prolonged in patients with MOF. C1 Tufts Univ, Sch Med, Baystate Med Ctr, Dept Anesthesia, Springfield, MA 01199 USA. Med Univ S Carolina, Dept Anesthesia & Perioperat Med, Charleston, SC USA. RP Circeo, LE (reprint author), Tufts Univ, Sch Med, Baystate Med Ctr, Dept Anesthesia, 759 Chestnut St, Springfield, MA 01199 USA. NR 16 TC 1 Z9 1 PU SOUTHERN MEDICAL ASSN PI BIRMINGHAM PA 35 LAKESHORE DR PO BOX 190088, BIRMINGHAM, AL 35219 USA SN 0038-4348 J9 SOUTHERN MED J JI South.Med.J. PD JAN PY 2001 VL 94 IS 1 BP 36 EP 42 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 400CJ UT WOS:000166850800007 ER PT J AU Laurin, EG Sakles, JC Panacek, EA Rantapaa, AA Redd, J AF Laurin, EG Sakles, JC Panacek, EA Rantapaa, AA Redd, J TI A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients SO ACADEMIC EMERGENCY MEDICINE LA English DT Article DE rapid-sequence intubation; tracheal intubation; neuromuscular-blocking agents; succinylcholine; rocuronium ID DUCHENNE MUSCULAR-DYSTROPHY; INDUCED CARDIAC-ARREST; ADDUCTOR POLLICIS; AIRWAY MANAGEMENT; SUXAMETHONIUM; INDUCTION; VECURONIUM; MUSCLES; ONSET; THIOPENTONE AB Objective: To compare rocuronium and succinylcholine for rapid-sequence intubation (RSI) in the emergency department (ED). Methods: A one-year prospective cohort comparison study was performed using a data collection form completed at the time of intubation. Data collected included the reason for the neuromuscular-blocking agent (NMBA) chosen, the time to onset of paralysis, and any complications encountered. Three ten-paint numerical descriptor scales recorded the degree of body movement, vocal cord movement, and the physician's overall satisfaction with the extent of paralysis. Results: Succinylcholine was used in 382 patients and rocuronium was used in 138 (26% of all RSI) patients. The mean (+/- SD) times of onset of succinylcholine and rocuronium were 39 +/- 13 sec and 44 +/- 20 sec, respectively (p = 0.04). No patient desaturated and required assisted ventilations while waiting for paralysis to occur. Types of body movements were similar with the two agents, but less frequent with succinylcholine (median = 10, mean = 9.5 +/- 1.1) than rocuronium (median = 10, mean = 9.1 +/- 1.5) (p = 0.01). Vocal cord movements were similar for succinylcholine (median = 10, mean = 9.2 +/- 1.6) and rocuronium (median = 9, mean = 9.0 +/- 1.6) (p = 0.15). The physician's overall satisfaction with the extent of paralysis was also higher for succinylcholine (median = 10, mean = 9.4 +/- 1.3) than rocuronium (median = 10, mean = 8.8 +/- 2.0) (p < 0.01). Only one complication, widening of the QRS complex secondary to succinylcholine use in a patient with unsuspected hyperkalemia, could be attributed to the choice of NMBA. Conclusions: Both succinylcholine and rocuronium produced fast and reliable paralysis for RSI. Although succinylcholine had a faster onset and provided more relaxation, the difference had no clinical significance. Approximately a fourth of ED RSI patients qualified for use of rocuronium using these high-risk criteria. C1 Univ Calif Davis, Med Ctr, Div Emergency Med, PSSB, Sacramento, CA 95817 USA. Univ Cincinnati, Med Ctr, Coll Med, Dept Emergency Med, Cincinnati, OH 45267 USA. RP Laurin, EG (reprint author), Univ Calif Davis, Med Ctr, Div Emergency Med, PSSB, Suite 2100,2315 Stockton Blvd, Sacramento, CA 95817 USA. NR 50 TC 14 Z9 14 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD DEC PY 2000 VL 7 IS 12 BP 1362 EP 1369 DI 10.1111/j.1553-2712.2000.tb00493.x PG 8 WC Emergency Medicine SC Emergency Medicine GA 384XH UT WOS:000165972200005 ER PT J AU Cara, DM Armory, P Mahajan, RP AF Cara, DM Armory, P Mahajan, RP TI Prolonged duration of neuromuscular block with rapacuronium in the presence of sevoflurane SO ANESTHESIA AND ANALGESIA LA English DT Article ID ACCELEROMYOGRAPHY; ANESTHESIA; ROCURONIUM; ISOFLURANE; CHILDREN; AGENTS C1 Univ Nottingham Hosp, Queens Med Ctr, Dept Anaesthesia, Nottingham NG7 2UH, England. RP Mahajan, RP (reprint author), Univ Nottingham Hosp, Queens Med Ctr, Dept Anaesthesia, Nottingham NG7 2UH, England. RI Mahajan, Ravi/G-9960-2011 NR 11 TC 3 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 2000 VL 91 IS 6 BP 1392 EP 1393 DI 10.1097/00000539-200012000-00016 PG 2 WC Anesthesiology SC Anesthesiology GA 376HL UT WOS:000165452100014 ER PT J AU Collins, LM Bevan, JC Bevan, DR Villar, GCP Kahwaji, R Smith, MF Donati, F AF Collins, LM Bevan, JC Bevan, DR Villar, GCP Kahwaji, R Smith, MF Donati, F TI The prolonged duration of rocuronium in Chinese patients SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENTS; FEMALE-PATIENTS; DOSE-RESPONSE; TIME-COURSE; PLASMA-BINDING; VECURONIUM; ANESTHESIA; CHILDREN; ADULTS; PHARMACOKINETICS AB We compared the potency and duration of action of rocuronium in Chinese and Caucasian patients during general anesthesia. Thirty-six women (18 Caucasian and 18 Chinese) and 36 children (18 Caucasian and 18 Chinese) were evaluated during the administration of propofol/fentanyl anesthesia. Patients in each age group were randomized into three subgroups to receive single doses of 0.06, 0.12, or 0.18 mg/kg rocuronium (adults) or 0.12, 0.18, or 0.24 mg/kg rocuronium (children). Neuromuscular blockade was assessed by electromyography of the adductor pollicis after train-of-four (TOF) stimulation of the ulnar nerve. Dose response curves were constructed when maximum neuromuscular depression of the first twitch of the train (T-1) was obtained. A second bolus dose of rocuronium was then administered to a total dose of 0.6 mg/kg. The times of spontaneous recovery to T-1 10%, 25%, and 90% of control and to TOF 0.25, 0.50, and 0.70 were recorded. For both adults and children, recovery occurred later in Chinese than in Caucasian patients (P < 0.05 for T-1 of 10%, 25%. 75%, and 90% and TOF to 0.7). The 50% effective dose was smaller in Chinese adults (125 +/- 63 vs 159 +/- 66 g/kg) and Chinese children (171 +/- 43 vs 191 +/- 46 mug/kg) than in Caucasian adults and children, but the difference was not statistically significant. In adults, time to 25% T-1 recovery was 43 +/- 13 min in Chinese patients and 33 +/- 10 min in Caucasian patients (P < 0.05). The corresponding values were more rapid for children: 30 +/- 10 and 24 +/- 6 min (P < 0.05). We conclude that the recovery from rocuronium neuromuscular blockade was longer in Chinese compared with Caucasian patients and in adults compared with children. C1 Vancouver Gen Hosp, Dept Anesthesia, Vancouver, BC V5Z 4E3, Canada. Univ British Columbia, British Columbia Childrens Hosp, Vancouver, BC V5Z 1M9, Canada. Univ Montreal, Montreal, PQ, Canada. RP Collins, LM (reprint author), Vancouver Gen Hosp, Dept Anesthesia, Room 3200,910 W 10th Ave, Vancouver, BC V5Z 4E3, Canada. NR 27 TC 7 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 2000 VL 91 IS 6 BP 1526 EP 1530 DI 10.1097/00000539-200012000-00042 PG 5 WC Anesthesiology SC Anesthesiology GA 376HL UT WOS:000165452100040 ER PT J AU Kostopanagiotou, G Mylona, M Massoura, L Siafaka, I AF Kostopanagiotou, G Mylona, M Massoura, L Siafaka, I TI Accidental epidural injection of vecuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEOSTIGMINE; ANESTHESIA; BLOCK; PHARMACOKINETICS; SEVOFLURANE; ANTAGONISM; ISOFLURANE C1 Univ Athens, Sch Med, Aretaieion Hosp, Dept Anesthesiol, GR-11527 Athens, Greece. RP Kostopanagiotou, G (reprint author), 2 Florinis Str, GR-15235 Athens, Greece. NR 13 TC 7 Z9 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 2000 VL 91 IS 6 BP 1550 EP 1551 DI 10.1097/00000539-200012000-00046 PG 2 WC Anesthesiology SC Anesthesiology GA 376HL UT WOS:000165452100044 ER PT J AU Fisher, DM Dempsey, GA Atherton, DPL Brown, R Abengochea, A Hunter, JM AF Fisher, DM Dempsey, GA Atherton, DPL Brown, R Abengochea, A Hunter, JM TI Effect of renal failure and cirrhosis on the pharmacokinetics and neuromuscular effects of rapacuronium administered by bolus followed by infusion SO ANESTHESIOLOGY LA English DT Article DE muscle relaxants ID BROMIDE AB Background: Recent trials indicate that rapacuronium's pharmacokinetic characteristics are influenced by both renal failure and cirrhosis but the time course of a single bolus dose of 1.5 mg/kg is affected minimally. The authors reassessed these pharmacokinetic findings and examined the time course of the same bolus dose followed by a 30-min infusion. Methods: During nitrous oxide-isoflurane anesthesia, patients with normal renal and hepatic function (n = 25), those with renal failure (n = 28), and those with cirrhosis (n = 6) received a bolus dose of rapacuronium (1.5 mg/kg) followed by a 30-min infusion adjusted to maintain 90-95% twitch depression. At 25% recovery, neostigmine was administered. Blood was sampled until 8 h after the infusion to determine concentrations of rapacuronium and its active metabolite ORG9488. Rapacuronium's pharmacokinetic parameters were determined using mixed-effects modeling. Results Onset and facilitated recovery of twitch depression were similar in the three groups. Patients with renal failure required 22% less rapacuronium to maintain target twitch depression during the infusion. Rapacuronium's plasma clearance was 24% smaller in renal failure and decreased 0.5%/yr of age; rapid distribution clearance was 51% smaller in men than in women. After the infusion, ORG9488 concentrations decreased markedly more slowly in patients with renal failure. Cirrhosis did not alter the pharmacokinetics of rapacuronium, Conclusion: Rapacuronium's plasma clearance and infusion requirement were decreased by renal failure. By dosing to maintain target twitch depression, recovery was not prolonged. Cirrhosis does not affect the pharmacokinetics or neuromuscular effects of rapacuronium. Persistence of ORG9488 in patients with renal failure might prolong recovery after rapacuronium if target twitch depression is not maintained or with administration of rapacuronium for more than 30 min. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. Univ Liverpool, Liverpool L69 3BX, Merseyside, England. Durect Corp, Cupertino, CA USA. Hosp La Fe, E-46009 Valencia, Spain. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. NR 10 TC 6 Z9 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 2000 VL 93 IS 6 BP 1384 EP 1391 DI 10.1097/00000542-200012000-00007 PG 8 WC Anesthesiology SC Anesthesiology GA 380JN UT WOS:000165698200003 ER PT J AU Kirov, K Motamed, C Combes, X Duvaldestin, P Dhonneur, G AF Kirov, K Motamed, C Combes, X Duvaldestin, P Dhonneur, G TI Sensibility to atracurium of the lateral abdominal muscles. SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE abdominal muscles; adductor pollicis; atracurium; electromyography; monitoring; neuromuscular relaxants ID INDUCED NEUROMUSCULAR BLOCK; ADDUCTOR POLLICIS MUSCLE; ORBICULARIS OCULI; ANESTHETIZED DOGS; HUMANS; DIAPHRAGM; RESPONSES; SUCCINYLCHOLINE; PANCURONIUM; VECURONIUM AB Objective: To study the effect of atracurium on the electromyographic activity of the lateral abdominal muscles and adductor pollicis in anaesthetized subjects. Study design: Prospective, comparative, open study. Patients and methods: Sixteen patients, ASA physical status 1 or 2, undergoing elective orthopaedic surgery under general anaesthesia were studied. Anaesthesia was induced with propofol/fentanyl and orotracheal intubation performed after glottic local anaesthesia without using muscle relaxant. Anaesthesia was maintained with isoflurane/nitrous oxide/oxygen and fentanyl reinjections. Supramaximal percutaneous stimulations in a simple twitch mode (0.1 Hz) were applied at the 9th-10th intercostal nerve on the posterior axillary line and at the ulnar nerve at the wrist. The electromyographic responses were enregistered using shin surface electrodes, placed on the D9-D10 dermatome in regard of the lateral abdominal muscles and of the thenar muscles. After a single bolus dose of atracurium 0.5 mg . kg(-1), the following parameters were studied : the maximum effect (Emax), the time for obtaining Emax (Delay) and the recovery time of 5,10, 25, 50,75 and 100% of the control neuromuscular response (T5, T10, T25, T50, T75, T100). Results: The dose of 0.5 mg . kg(-1) of atracurium induced 100% block in both lateral abdominal muscles and adductor pollicis. Lateral abdominal muscles blockade had faster onset (136 +/- 4 s versus 205 +/- 29 s) and shorter recovery, 15, T10, T25, T50, T75 and T100 were significantly (p < 0.05) shorter than at the adductor pollicis. Conclusion: Lateral abdominal muscles blockade have faster onset and recovery than adductor pollicis. (C) 2000 Editions scientifiques et medicales Elsevier SAS. C1 CHU Henri Mondor, Serv Anesthesie Reanimat, F-94010 Creteil, France. RP Dhonneur, G (reprint author), CHU Henri Mondor, Serv Anesthesie Reanimat, 51 Ave Marechal du Lattre de Tassigny, F-94010 Creteil, France. NR 22 TC 6 Z9 6 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD DEC PY 2000 VL 19 IS 10 BP 734 EP 738 PG 5 WC Anesthesiology SC Anesthesiology GA 395TY UT WOS:000166598400006 ER PT J AU Levy, JH Gottge, M Szlam, F Zaffer, R McCall, C AF Levy, JH Gottge, M Szlam, F Zaffer, R McCall, C TI Weal and flare responses to intradermal rocuronium and cisatracurium in humans SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rocuronium; neuromuscular block, cisatracurium; allergy ID ANAPHYLACTOID REACTIONS; MUSCLE-RELAXANTS; ANESTHESIA; AGENTS; WHEAL AB Thirty volunteers underwent intradermal skin testing with increasing concentrations of rocuronium and cisatracurium to evaluate weal and flare responses, and whether either agent would cause mast cell degranulation and sensitization upon re-exposure. We found that intradermal injection of rocuronium and cisatracurium at concentrations > 10(4) M resulted in positive weal (> 8 mm) responses, and positive flare responses at >10(-4) and >10(-5) M respectively. Only cisatracurium caused mild to moderate mast cell degranulation, and neither drug caused significant in vitro histamine release from whole blood collected from study subjects 4 weeks after skin testing. Skin testing with rocuronium and cisatracurium should be performed at concentrations < 10(-4) and < 10(-5) M respectively to avoid false-positive responses. The ability of these agents to produce positive weal and flare responses at relatively low concentrations may explain the high incidence of potential reactions reported. C1 Emory Univ Hosp, Dept Anesthesiol, Atlanta, GA 30322 USA. Emory Univ Hosp, Dept Dermatol, Atlanta, GA 30322 USA. RP Levy, JH (reprint author), Emory Univ Hosp, Dept Anesthesiol, 1364 Clifton Rd NE, Atlanta, GA 30322 USA. NR 19 TC 62 Z9 64 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD DEC PY 2000 VL 85 IS 6 BP 844 EP 849 DI 10.1093/bja/85.6.844 PG 6 WC Anesthesiology SC Anesthesiology GA 380TQ UT WOS:000165719900008 ER PT J AU Chow, B Bowden, MI Ho, E Weatherley, BC Bion, JF AF Chow, B Bowden, MI Ho, E Weatherley, BC Bion, JF TI Pharmacokinetics and dynamics of atracurium infusions after paediatric orthotopic liver transplantation SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE intensive care; neuromuscular block, atracurium; monitoring; children; liver, transplantation; monitoring, electromyography ID LAUDANOSINE; CHILDREN; FAILURE; REQUIREMENTS; INFANTS; PLASMA AB We examined the pharmacokinetics and pharmacodynamics of atracurium besylate and its metabolites in children after orthotopic liver transplantation (OLT), as a suitable model for critically ill children. Ten children were studied after OLT on return to the intensive care unit (ICU). The mean (range) age was 36 (7-78) months, and weight 6-24.2 kg. Atracurium was started at induction of anaesthesia and adjusted in the ICU according to clinical need. Neuromuscular block was measured using accelerometry (TOFguard) and the train-of-four (TOF) ratio or count. Arterial plasma samples for atracurium and metabolites taken before, 12-hourly during, and at frequent intervals after the infusion were analysed by HPLC. The mean (range) maximum infusion rate during steady-state conditions was 1.44 (0.48-3.13) mg kg(-1) h(-1) and the duration of infusion 36.9 (22.5-98.4) h. Tachyphylaxis was not observed. The mean terminal half-life (t(1/2)) for atracurium was 18.8 (12-32.3) min. The steady-state plasma clearance (CLss) was 13.9 (7.9-20.3) mi min(-1) kg(-1) and the terminal volume of distribution (V-Z) 390 (124-551) ml kg(-1); both were higher than in adults after successful OLT. The maximum concentration (C-max) of laudanosine was 1190 (400-1890) ng ml(-1) and t(1/2) was 3.9 (1.1-6.7) h. The renal clearance of laudanosine was 0.9 (0.1-2.5) ml min(-1) kg(-1) and increased with urine flow, but there was no significant relationship with serum creatinine. EEG spikes were confirmed in one child only; the corresponding laudanosine C-max was 720 ng ml(-1) Monoquaternary alcohol C-max was 986 (330-1770) ng ml(-1) and t(1/2) 42.9 (30-57.7) min. Mean recovery time on stopping the atracurium infusion to a TOF ratio >0.75 was 23.6 (12-27) min. Atracurium is an effective and safe neuromuscular blocking agent in this population. Laudanosine concentrations are not excessive if graft function is satisfactory. C1 Univ Birmingham, Queen Elizabeth Hosp N5, Dept Anaesthesia & Intens Care, Birmingham B15 2TH, W Midlands, England. Class & Bayesian Solut, Orpington BR6 0EP, Kent, England. RP Bion, JF (reprint author), Univ Birmingham, Queen Elizabeth Hosp N5, Dept Anaesthesia & Intens Care, Birmingham B15 2TH, W Midlands, England. NR 17 TC 3 Z9 3 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD DEC PY 2000 VL 85 IS 6 BP 850 EP 855 DI 10.1093/bja/85.6.850 PG 6 WC Anesthesiology SC Anesthesiology GA 380TQ UT WOS:000165719900009 ER PT J AU Pogson, D Telfer, J Wimbush, S AF Pogson, D Telfer, J Wimbush, S TI Prolonged vecuronium neuromuscular blockade associated with Charcot Marie Tooth neuropathy SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, vecuronium; complications, Charcot Marie Tooth disease ID DISEASE; PATIENT; ANESTHESIA; DISORDERS AB Charcot Marie Tooth (CMT) disease comprises a group of disorders characterized by progressive distal muscle weakness and wasting. Review of the anaesthetic literature produced conflicting reports concerning the responses to neuromuscular blocking drugs in these patients. We describe a case in which vecuronium 0.11 mg kg(-1) produced prolonged neuromuscular blockade lasting 115 min in a patient with the condition. Conduction velocity in the facial nerve is usually less affected than the ulnar or peroneal nerve in CMT patients. This nerve may be more useful in monitoring neuromuscular blockade, both in titrating the dose of neuromuscular blocking drug and ensuring adequate reversal at the end of a procedure. Recent advances in molecular biology have enabled identification of the underlying genetic abnormalities and pathophysiology of CMT. These advances are reviewed and implications of CMT for the anaesthetist discussed. C1 Derriford Hosp, Dept Anaesthesia, Plymouth PL6 8DH, Devon, England. Royal Cornwall Hosp, Dept Anaesthesia, Truro TR1 3LJ, England. RP Pogson, D (reprint author), Derriford Hosp, Dept Anaesthesia, Plymouth PL6 8DH, Devon, England. NR 15 TC 10 Z9 10 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD DEC PY 2000 VL 85 IS 6 BP 914 EP 917 DI 10.1093/bja/85.6.914 PG 4 WC Anesthesiology SC Anesthesiology GA 380TQ UT WOS:000165719900023 ER PT J AU Withington, D Menard, G Harris, J Kulkarni, P Donati, F Varin, F AF Withington, D Menard, G Harris, J Kulkarni, P Donati, F Varin, F TI Vecuronium pharmaco-kinetics and pharmacodynamics during hypothermic cardiopulmonary bypass in infants and children SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID NEUROMUSCULAR BLOCKADE; PEDIATRIC-PATIENTS; CARDIAC-SURGERY; D-TUBOCURARINE; ATRACURIUM INFUSIONS; BALANCED ANESTHESIA; PANCURONIUM; ROCURONIUM; CISATRACURIUM; ELIMINATION AB Purpose: To determine the effect of moderate and deep hypothermic cardiopulmonary bypass (CPB) on the pharmacokinetic and pharmacodynamic behaviour of vecuronium in infants and children. Methods: We studied 12 patients undergoing surgery for congenital heart disease under narcotic-nitrous oxide anesthesia. Neuromuscular blockade was maintained constant (TI 4-10% by Datex electromyograph) by adjusting a vecuronium infusion. Plasma vecuronium concentrations (Cpss) were analysed by HPLC to describe a pseudosteady-state during each of the pre-CPB, CPB and post-CPB phases. Paired arterial blood samples were taken 20 min apart after at least 20 min of constant infusion. Results: Nine cases were analysed, mean age 20 mo, mean weight 9 kg, Three patients had deep and six moderate hypothermia. In the pre-CPB phase Cpss fell into two groups (mean +/- SD: 330 +/- 42 ng.ml(-1); 127 +/- 27 ng.ml(-1) P < 0.001); similarly the clearances showed a bimodal distribution (mean +/- SD: 5.08 +/- 0.94; 11.51 +/- 0.2 ml.min(-1).kg(-1) P < 0.001), although in different patients. During CPB this bimodal distribution disappeared. Vecuronium infusion rate (VIR) decreased by 84% and 92% from pre-CPB to CPB phase in deep and moderate hypothermia groups respectively (P < 0.05), paralleled by decreases in Cpss of 36% (P > 0.05) and 52% (P < 0.05). Conclusion: Changes in vecuronium requirements and plasma concentrations during CPB demonstrate vecuronium pharmacokinetics and pharmacodynamics are both affected by hypothermic CPB in infants. The finding of bimodal distributions for plasma vecuronium and vecuronium clearance highlights the need for individual monitoring of neuromuscular blockade in this age group. C1 McGill Univ, Montreal Childrens Hosp, Dept Anaesthesia, Montreal, PQ H3H 1P3, Canada. Univ Montreal, Fac Pharm, Montreal, PQ H3C 3J7, Canada. Univ Montreal, Dept Anesthesie, Montreal, PQ H3C 3J7, Canada. RP Withington, D (reprint author), McGill Univ, Montreal Childrens Hosp, Dept Anaesthesia, 2300 Tupper St,Rm C-1117, Montreal, PQ H3H 1P3, Canada. NR 45 TC 8 Z9 10 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 2000 VL 47 IS 12 BP 1188 EP 1195 PG 8 WC Anesthesiology SC Anesthesiology GA 380VF UT WOS:000165723600006 ER PT J AU Kintz, P Tracqui, A Ludes, B AF Kintz, P Tracqui, A Ludes, B TI The distribution of laudanosine in tissues after death from atracurium injection SO INTERNATIONAL JOURNAL OF LEGAL MEDICINE LA English DT Article DE atracurium; laudanosine; fatality; postmortem redistribution ID PHARMACOKINETICS; METABOLITES AB A case is presented involving an acute fatality resulting from self-administration of atracurium, a muscle relaxant by a 45-year-old nurse. In the body, atracurium undergoes a spontaneous non-enzymatic degradation to laudanosine and an acrylate moiety. Laudanosine was quantified using gas chromatography coupled to mass spectrometry after extraction with chloroform-isopropanol-n-heptane (50:17:33 v/v) at pH 9.5 and separation on a HPS-MS capillary column. Laudanosine was subject to postmortem redistribution due to release from drug-rich tissues such as the lung and heart. The heart blood (917 ng/ml) to peripheral blood (390 ng/ml) ratio was 2.4, No other drugs, including ethanol were detected. C1 Inst Med Legale, Fac Med, F-67085 Strasbourg, France. RP Kintz, P (reprint author), Inst Med Legale, Fac Med, 11 Rue Humann, F-67085 Strasbourg, France. NR 4 TC 12 Z9 12 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0937-9827 J9 INT J LEGAL MED JI Int. J. Legal Med. PD DEC PY 2000 VL 114 IS 1-2 BP 93 EP 95 DI 10.1007/s004140000133 PG 3 WC Medicine, Legal SC Legal Medicine GA 386HQ UT WOS:000166055400018 ER PT J AU Ellis, J Seidenberg, M AF Ellis, J Seidenberg, M TI Interactions of alcuronium, TMB-8, and other allosteric ligands with muscarinic acetylcholine receptors: Studies with chimeric receptors SO MOLECULAR PHARMACOLOGY LA English DT Article ID SITE-DIRECTED MUTAGENESIS; SUBTYPE SELECTIVITY; AMILORIDE ANALOGS; BINDING-SITE; ANTAGONISTS; MODULATION; GALLAMINE; EPITOPES; CLASSIFICATION; ENHANCEMENT AB A series of ligands that allosterically modulate the binding of classical ligands to muscarinic receptors was evaluated at wildtype and chimeric receptors. All of the ligands studied had highest affinity toward the M-2 subtype and lowest affinity toward the M-5 subtype. The chimeric receptors were mostly M-5 sequence; the amount of M-2 sequence ranged from about 6 to just under 30%. Alcuronium and TMB-8 had much higher affinity for the chimeric receptor that included the M-2 second outer loop of the receptor plus flanking regions of TM4 and TM5 than for any of the other chimeric receptors (the affinities of which remained similar to that of the M-5 subtype). However, this chimera retained the negative cooperativity between alcuronium and the classical antagonist N-methylscopolamine that is characteristic of M-5 (these ligands are positively cooperative at M-2). Verapamil, tetrahydroaminoacridine, and d-tubocurarine were also sensitive to that chimeric substitution, although verapamil and tetrahydroaminoacridine had even higher affinity for a chimera with M-2 sequence in TM7. None of these ligands shared gallamine's sensitivity to a region of the third outer loop, but studies in which obidoxime reversed the allosteric effects of gallamine and other ligands suggested that they nevertheless compete for a common site. In summary, although the present data are consistent with previous studies that have suggested that allosteric ligands bind to the outermost regions of muscarinic receptors, it appears that different allosteric ligands may derive subtype selectivity from different regions of the receptor. C1 Penn State Univ, Coll Med, Dept Psychiat, Hershey, PA USA. Penn State Univ, Coll Med, Dept Pharmacol, Hershey, PA USA. RP Ellis, J (reprint author), Milton S Hershey Med Ctr, Dept Psychiat H073, 500 Univ Dr, Hershey, PA 17033 USA. NR 36 TC 41 Z9 43 PU AMER SOC PHARMACOLOGY EXPERIMENTAL THERAPEUTICS PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0026-895X J9 MOL PHARMACOL JI Mol. Pharmacol. PD DEC PY 2000 VL 58 IS 6 BP 1451 EP 1460 PG 10 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 377EA UT WOS:000165497900035 ER PT J AU Taivainen, T Meakin, GH Meretoja, OA Wirtavuori, K Perkins, RJ Murphy, AK Fisher, GR Waiter, MRD AF Taivainen, T Meakin, GH Meretoja, OA Wirtavuori, K Perkins, RJ Murphy, AK Fisher, GR Waiter, MRD TI The safety and efficacy of cisatracurium 0.15 mg.kg(-1) during nitrous oxide-opioid anaesthesia in infants and children SO ANAESTHESIA LA English DT Article DE anaesthesia, paediatric; neuromuscular relaxants, cisatracurium; pharmacodynamics ID BARBITURATE ANESTHESIA; BALANCED ANESTHESIA; SURGICAL PATIENTS; 51W89; HALOTHANE; INTUBATION; ATRACURIUM; VECURONIUM AB We studied the neuromuscular and cardiovascular effects of a single, rapidly administered intravenous dose of cisatracurium 0.15 mg.kg(-1) in 27 infants (aged 1-23 months) and 24 children (aged 2-12.5 years). After midazolam premedication, anaesthesia was induced and maintained with thiopental and alfentanil in addition to nitrous oxide in oxygen. Neuromuscular function was monitored by evoked adductor pollicis electromyography. At least 15 min after intubation, each patient received cisatracurium 0.15 mg.kg(-1) over 5 s. Complete neuromuscular blockade was produced by this dose in all but one infant. The mean (SD) onset time of maximal blockade was more rapid in infants [2.0 (0.8) min] than in children [3.0 (1.2) min], p = 0.0011. The clinical duration of action of cisatracurium (recovery of evoked response to 25% of control) was significantly longer in infants [43.3 (6.2) min] than in children [36.0 (5.4) min], p < 0.0001. Once neuromuscular function started to recover, the rate of recovery was similar in both age groups. Changes in blood pressure and heart rate after the administration of cisatracurium were negligible in both age groups. Cisatracurium, at a dose of 0.15 mg.kg(-1), was effective and well tolerated in infants and children. C1 Helsinki Univ Hosp, Dept Anaesthesia & Intens Care Med, FIN-00029 Helsinki, Finland. Royal Manchester Childrens Hosp, Dept Anaesthesia, Manchester M27 1HA, Lancs, England. Glaxo Wellcome Res & Dev Ltd, Greenford, Middx, England. RP Taivainen, T (reprint author), Helsinki Univ Hosp, Dept Anaesthesia & Intens Care Med, PL281, FIN-00029 Helsinki, Finland. NR 18 TC 9 Z9 20 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD NOV PY 2000 VL 55 IS 11 BP 1047 EP 1051 DI 10.1046/j.1365-2044.2000.01623.x PG 5 WC Anesthesiology SC Anesthesiology GA 373EM UT WOS:000165275500002 ER PT J AU Jellish, WS Brody, M Sawicki, K Slogoff, S AF Jellish, WS Brody, M Sawicki, K Slogoff, S TI Recovery from neuromuscular blockade after either bolus and prolonged infusions of cisatracurium or rocuronium using either isoflurane or propofol-based anesthetics SO ANESTHESIA AND ANALGESIA LA English DT Article ID PHARMACOKINETICS; ATRACURIUM; PHARMACODYNAMICS; PHARMACOLOGY; VECURONIUM AB We examined the recovery characteristics of cisatracurium or rocuronium after bolus or prolonged infusion under either isoflurane or propofol anesthesia. Sixty patients undergoing neurosurgical procedures of at least 5 h were randomized to receive either isoflurane with fentanyl (Groups land 2) or propofol and fentanyl (Groups 3 and 4) as their anesthetic. Groups 1 and 3 received cisatracurium 0.2 mg/kg IV bolus, spontaneously recovered, after which time an infusion was begun. Groups 2 and 4 received rocuronium 0.6 mg/kg IV, spontaneously recovered, and an infusion was begun Before the end of surgery, the infusion was stopped and recovery of first twitch (T-1), recovery index, clinical duration, and train-of-four (TOF) recovery was recorded and compared among groups by using appropriate statistical methods. Clinical duration was shorter for rocuronium compared with cisatracurium using either anesthetic. Cisatracurium T-1 75% recovery after the infusion was shorter with propofol compared with isoflurane. Cisatracurium TOF 75% recovery was similar after either bolus or infusion, but rocuronium TOF 75% recovery after the infusion was delayed. Infusion rates decreased for cisatracurium but remained relatively constant for rocuronium regardless of the anesthetic used. Isoflurane enhances the effect of both muscle relaxants but prolonged cisatracurium recovery more than rocuronium. Of the two muscle relaxants studied, rocuronium's recovery was most affected by length of the infusion. Cisatracurium may be a more desired muscle relaxant for prolonged procedures because recovery was least affected by prolonged infusion. C1 Loyola Univ, Med Ctr, Dept Anesthesiol, Maywood, IL 60153 USA. RP Jellish, WS (reprint author), Loyola Univ, Med Ctr, Dept Anesthesiol, 2160 S 1st Ave, Maywood, IL 60153 USA. NR 20 TC 10 Z9 12 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 2000 VL 91 IS 5 BP 1250 EP 1255 PG 6 WC Anesthesiology SC Anesthesiology GA 369ET UT WOS:000165053600037 ER PT J AU Motamed, C Kirov, K Abadie, Y Duvaldestin, P AF Motamed, C Kirov, K Abadie, Y Duvaldestin, P TI Decreased potency of a bolus of mivacurium due to concomitant non-invasive blood pressure measurement in the ipsi-lateral arm. SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE adductor pollicis; intubating conditions; mivacurium; orbicularis oculi ID PLASMA CHOLINESTERASE ACTIVITY; ONSET; PHARMACOKINETICS; RECOVERY; CHLORIDE AB Objective: We assessed the neuromuscular characteristics of 0.2 mg . kg(-1) of mivacurium while its injection was concomitant to a non invasive blood pressure measurement in the ipsilateral arm. Patients: Thirty-one patients ASA I-II were randomized into two groups. Group cuff (n = 15) and Group control (n = 16). Methods: General anaesthesia was induced with fentanyl, thiopentone and mivacurium in all patients, however in the cuff group, measurement of non invasive blood pressure was performed immediately after the injection of mivacurium. Comparison was made on neuromuscular blockade of the adductor pollicis (AP) by mechanomyography, and intubating conditions which were guided by the visual estimation of the orbicularis oculi's (OO) response. Results: In the cuff group, six out of 15 patients did not have complete blockade at the OO against one out of 16 in the control group, (Fisher exact test p < 0.05). Intubation time was significantly delayed in the cuff group, 201 +/- 66 s versus 123 +/- 32 s in the control group, (t test p < 0.001). The maximum neuromuscular blocking effect at the AP was significantly greater in the control group 99 +/- 2% against 89 +/- 7% in the cuff group, (t test p < 0.01). The onset of maximum blockade at the AP was longer in the cuff group 294 +/- 40 s versus 179 +/- 92 s, (t test p < 0.001] in the control group. Time to 25% recovery was shorter in the cuff group 16+/-3 min versus 20+/-5 min, in the control group (t test p < 0.05). Conclusion: This study suggests that non invasive blood pressure measurement of the ipsilateral arm, concomitant to the injection of mivacurium decreases the potency of mivacurium. This finding is mostly explained by the early hydrolysis of mivacurium in the plasma of the excluded arm. (C) 2000 Editions scientifiques et medicates Elsevier SAS. C1 Hop Henri Mondor, AP HP, Serv Anesthesie Reanimat, F-94010 Creteil, France. RP Motamed, C (reprint author), Hop Henri Mondor, AP HP, Serv Anesthesie Reanimat, 51 Ave Marechal de Lattre de Tassigny, F-94010 Creteil, France. NR 9 TC 0 Z9 0 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD NOV PY 2000 VL 19 IS 9 BP 649 EP 653 PG 5 WC Anesthesiology SC Anesthesiology GA 383EN UT WOS:000165870300004 ER PT J AU Proost, JH Eriksson, LI Mirakhur, RK Roest, G Wierda, JMKH AF Proost, JH Eriksson, LI Mirakhur, RK Roest, G Wierda, JMKH TI Urinary, biliary and faecal excretion of rocuronium in humans SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rocuronium; pharmacokinetics, rocuronium; metabolism, rocuronium ID NORMAL RENAL-FUNCTION; VECURONIUM BROMIDE; HUMAN HEPATOCYTES; ORGANIC CATIONS; TIME-COURSE; PHARMACOKINETICS; PHARMACODYNAMICS; ORG-9426; ISOFLURANE; ANESTHESIA AB The excretion of rocuronium and its potential metabolites was studied in 38 anaesthetized patients, ASA I-III and 21-69 yr old. Rocuronium bromide was administered as an i.v. bolus dose of 0.3 or 0.9 mg kg(-1). in Part A of the study, the excretion into urine and bile, and the liver content were studied. Plasma kinetics (n=19) were similar to those reported previously. Urinary recovery within 48 h after administration was 26 (8)% (mean (SD)) (n=8) of the dose. In bile obtained from T-drains, the recovery within 48 h was 7 (6)% (n=11). The rocuronium concentration in bile declined bi-exponentially, with half-lives of 2.3 (0.7) and 16 (11) h respectively (n=6). In three patients from whom stoma fluid was collected, the amount of rocuronium recovered ranged from 0.04 to 12.0% of the dose. In liver tissue obtained from four patients undergoing hemihepatectomy, the estimated amount of rocuronium at 2-5 h after administration ranged between 6.3 and 13.2% (n=4). In the second part of the study (Part B), urine and faeces were collected over 4-8 days and the recovery was 27 (13)% and 31 (23)% of the dose respectively (n=10). In most samples, irrespective of the type of biological material, only small amounts of the metabolite 17-desacetyl-rocuronium was found. The results demonstrate that rocuronium is taken up by the liver and excreted into bile in high concentrations. The faecal and urinary excretion of unchanged rocuronium are the major routes of rocuronium elimination. C1 Univ Hosp, Dept Anaesthesiol, Res Grp Expt Anaesthesiol & Clin Pharmacol, NL-9713 GZ Groningen, Netherlands. Karolinska Hosp & Inst, Dept Anaesthesiol & Intens Care, Stockholm, Sweden. Queens Univ Belfast, Dept Anaesthet & Intens Care, Belfast, Antrim, North Ireland. Organon Teknika, Boxtel, Netherlands. RP Proost, JH (reprint author), Univ Hosp, Dept Anaesthesiol, Res Grp Expt Anaesthesiol & Clin Pharmacol, Hanzepl 1, NL-9713 GZ Groningen, Netherlands. NR 32 TC 31 Z9 35 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD NOV PY 2000 VL 85 IS 5 BP 717 EP 723 DI 10.1093/bja/85.5.717 PG 7 WC Anesthesiology SC Anesthesiology GA 370AW UT WOS:000165100800010 ER PT J AU Blobner, M Mirakhur, RK Wierda, JMKH Wright, PMC Olkkola, KT Debaene, B Pendeville, P Engbaek, J Rietbergen, H Sparr, HJ AF Blobner, M Mirakhur, RK Wierda, JMKH Wright, PMC Olkkola, KT Debaene, B Pendeville, P Engbaek, J Rietbergen, H Sparr, HJ TI Rapacuronium 2.0 or 2.5 mg kg(-1) for rapid-sequence induction: comparison with succinylcholine 1.0 mg kg(-1) SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthesia, rapid sequence induction; anaesthesia, intubation; neuromuscular block, rapacuronium; neuromuscular block, succinylcholine ID INTUBATING CONDITIONS; ADDUCTOR POLLICIS; ADULT PATIENTS; NEUROMUSCULAR BLOCKADE; MUSCLE-RELAXANT; ROCURONIUM; ANESTHESIA; SUXAMETHONIUM; ORG-9487; HUMANS AB The purpose of this nine-centre study in 602 patients was to show that the frequency of acceptable intubating conditions after rapacuronium 2.0 or 2.5 mg kg(-1) is not more than 10% lower than the frequency after succinylcholine 1.0 mg kg(-1) during rapid-sequence induction of anaesthesia with fentanyl 1-2 mug kg(-1) and thiopental 2-7 mg kg(-1). Laryngoscopy and intubation were carried out 60 s after administration of muscle relaxant by an anaesthetist blinded to its identity. Intubating conditions were clinically acceptable (excellent or good) in 91.8% of patients given succinylcholine and in 84.1 and 87.6% of patients given rapacuronium 2.0 and 2.5 mg kg(-1) respectively. With respect to the percentage of clinically acceptable intubating conditions, the estimated difference (and the upper limit of the one-sided 97.5% confidence interval) between succinylcholine and rapacuronium 2.0 mg kg(-1) was 7.8 (14.4)% and between succinylcholine and rapacuronium 2.5 mg kg(-1) it was 4.0 (10.2)%. For both comparisons, the upper limit of the one-sided confidence interval exceeded the predefined 10% difference. Hence, it could not be demonstrated that the intubating conditions with either of the two doses of rapacuronium were not inferior to those with succinylcholine 1.0 mg kg(-1). The increase in heart rate was significantly greater during the first 5 min in the rapacuronium groups, but the arterial pressure increased significantly only in the succinylcholine group (P<0.001). Respiratory side-effects were observed in 4.0, 13.5 and 18.5% of patients after succinylcholine and rapacuronium 2.0 and 2.5 mg kg(-1) respectively (P<0.05). As the non-inferiority of intubating conditions after rapacuronium 2.0 and 2.5 mg kg(-1) could not be proven, succinylcholine should be considered the neuromuscular blocking agent that provides better intubating conditions for rapid-sequence induction. C1 Tech Univ Munich, Klinikum Rechts Isar, Anasthesiol Klin, Dept Anaesthesia, D-81675 Munich, Germany. Queens Univ Belfast, Belfast, Antrim, North Ireland. Univ Groningen Hosp, Groningen, Netherlands. Univ Newcastle Upon Tyne, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England. Univ Helsinki, Cent Hosp, Helsinki, Finland. Inst Gustave Roussy, Paris, France. Catholic Univ Louvain, Clin Univ St Luc, Brussels, Belgium. Herlev Univ Hosp Kobenhavn, Copenhagen, Denmark. Organon Tekn BV, Boxtel, Netherlands. Leopold Franzens Univ, Innsbruck, Austria. RP Blobner, M (reprint author), Tech Univ Munich, Klinikum Rechts Isar, Anasthesiol Klin, Dept Anaesthesia, Ismaninger Str 22, D-81675 Munich, Germany. NR 27 TC 23 Z9 23 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD NOV PY 2000 VL 85 IS 5 BP 724 EP 731 DI 10.1093/bja/85.5.724 PG 8 WC Anesthesiology SC Anesthesiology GA 370AW UT WOS:000165100800011 ER PT J AU Suzuki, T Iwasaki, K Fukano, N Hariya, S Saeki, S Ogawa, S AF Suzuki, T Iwasaki, K Fukano, N Hariya, S Saeki, S Ogawa, S TI Duration of exposure to sevoflurane affects dose-response relationship of vecuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE pharmacology, dose-response relationship; neuromuscular block, vecuronium; anaesthetics volatile, sevoflurane ID TIME-COURSE; NEUROMUSCULAR BLOCKADE; BALANCED ANESTHESIA; ISOFLURANE; HALOTHANE; POTENTIATION; MIVACURIUM; CHILDREN; AUGMENTATION; DESFLURANE AB The purpose of this study was to quantify the relationship between the dose-response curve of vecuronium and duration of exposure to an end-tidal concentration of 1.7% sevoflurane in 67% nitrous oxide and oxygen. Forty adult patients, in groups of 10, were allocated randomly to receive vecuronium by a cumulative dose method at intervals of 15 min (group 15), 30 min (group 30), 60 min (group 60) or 90 min (group 90) after starting inhalation of sevoflurane. Neuromuscular function was monitored by acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation. Dose-response curves were constructed by least-squares regression analysis and the effective doses of vecuronium (ED50, ED90 and ED95) were estimated and compared between groups. Mean (SEM) ED50, ED90 and ED95 were 16.8 (0.5), 32.6 (1.7) and 40.9 (2.4) mug kg(-1), respectively, in group 15; 10.6 (1.0), 20.8 (1.7) and 26.2 (2.2) mug kg(-1), respectively, in group 30; 11.2 (1.1), 21.7 (1.6) and 27.3 (1.8) mug kg(-1), respectively, in group 60; and 11.0(1.1), 21.7 (1.6) and 27.5 (1.9) mug kg(-1), respectively, in group 90. The values obtained in group 15 were significantly higher than those in the other three groups (P<0.05). The results indicate that the duration of sevoflurane anaesthesia influences the dose-response of vecuronium and 30 min inhalation of 1.7% end-tidal concentration is sufficient to achieve a stable potentiating effect. C1 Surugadai Nihon Univ Hosp, Dept Anaesthesiol, Chiyoda Ku, Tokyo, Japan. Nihon Univ, Sch Med, Dept Hyg, Tokyo, Japan. Nihon Univ, Sch Med, Dept Anaesthesiol, Tokyo, Japan. RP Suzuki, T (reprint author), Surugadai Nihon Univ Hosp, Dept Anaesthesiol, Chiyoda Ku, 1-8-13 Kanda Surugadai, Tokyo, Japan. NR 18 TC 2 Z9 4 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD NOV PY 2000 VL 85 IS 5 BP 732 EP 734 DI 10.1093/bja/85.5.732 PG 3 WC Anesthesiology SC Anesthesiology GA 370AW UT WOS:000165100800012 ER PT J AU Naguib, M Riad, W AF Naguib, M Riad, W TI Dose-response relationships for edrophonium and neostigmine antagonism of atracurium and cisatracurium-induced neuromuscular block SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID OPIOID BARBITURATE ANESTHESIA; CLINICAL-PHARMACOLOGY; HEALTHY PATIENTS; PHARMACOKINETICS; BESYLATE; PHARMACODYNAMICS; PYRIDOSTIGMINE; DEGRADATION; ROCURONIUM; PLASMA AB Purpose: To study the dose-response relationships for neostigmine and edrophonium during antagonism of neuromuscular block induced by atracurium and cisatracurium. Methods: One hundred and twenty eight, ASA group 1 or 2 adults were given either 0.5 mg.kg(-1) atracurium or 0.1 mg.kg(-1) cisatracurium during fentanyl-thiopental-nitrous oxide-isoflurane anesthesia. The neuromuscular block was measured by an acceleration-responsive transducer. Responses were defined in terms of percent depression in the first twitch (T1) and train-of-four (TOF) response. When spontaneous recovery of first twitch height reached 10% of its initial control value, edrophonium (0, 1, 0.2, 0,4, or 1 mg.kg(-1)) or neostigmine (0.005, 0.01, 0.02, or 0.05 mg.kg(-1)) was administered by random allocation, Neuromuscular function in another sixteen subjects was allowed to recover spontaneously Results: At five minutes, unlike edrophonium, neostigmine was equally effective against atracurium and cisatracurium with respect to TI recovery. The neostigmine TI-ED50 was 10.3 +/- 1.06 (SEM) mug.kg(-1) after atracurium and 11.2 +/- 1.06) mug.kg(-1) after cisatracurium. The edrophonium ED50 was 157 +/- 1.07 mug.kg(-1) with atracurium and 47.4 +/- 1.07 mug.kg(-1) with cisatracurium, giving a neostigmine:edrophonium potency ratios of 15.2 +/- 1.7 and 4.2 +/- 0.41 (P < 0.001)for atracurium and cisatracurium, respectively At 10 min neostigmine was 13 +/- 1.4 times as potent as edrophonium for achieving 50% TOF recovery after atracurium paralysis. After cisatracurium the potency ratio was 11.8 +/- 1.3 (NS). Conclusions: Although there were differences at five minutes, neostigmine:edrophonium potency ratios at 10 min, were similar in both relaxants studied. C1 Univ Iowa, Coll Med, Dept Anesthesia, Iowa City, IA 52242 USA. King Saud Univ, Dept Anesthesia, Riyadh 11451, Saudi Arabia. RP Naguib, M (reprint author), Univ Iowa, Coll Med, Dept Anesthesia, 200 Hawkins Dr,6JCP, Iowa City, IA 52242 USA. NR 24 TC 3 Z9 4 PU CANADIAN ANESTHESIOLOGISTS SOC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD NOV PY 2000 VL 47 IS 11 BP 1074 EP 1081 PG 8 WC Anesthesiology SC Anesthesiology GA 372JA UT WOS:000165229500005 ER PT J AU Xue, FS Zhang, YM Liao, X Liu, JH An, G AF Xue, FS Zhang, YM Liao, X Liu, JH An, G TI A comparative study of the dose-response and time course of recovery of atracurium and rocuronium SO CHINESE MEDICAL JOURNAL LA English DT Article DE atracurium; rocuronium; dose-response; time course of recovery ID VECURONIUM; PANCURONIUM; POTENCY; INFUSION AB Objective To compare the characteristics of the dose-response relationship and the time course of action between atracurium and rocuronium in adult patients anesthetized with N2O-O-2-fentanyl-thiopene. Methods Sixty patients, ASA grade I,aged 18-50 years, scheduled for elective plastic surgery were studied. All patients were randomly divided into either the atracurium or rocuronium group. General anesthesia was maintained with 60% nitrous oxide and 40% oxygen, thiopentone, and fentanyl. Neuromuscular function was assessed using an accelograph with train-of-four (TOF) stimulation at the wrist every 12 seconds. The percentage depression of the first twitch (T-1) was used as the study parameter. The dose-response relationship of atracurium and rocuronium was determined by the cumulative dose-response technique. Results According to the dose-response curves established by a least squares linear regression, the potency ratio of atracurium to rocuronium was 1:1.2. There were significant differences in the ED50, ED90, and ED95 between the two drugs. After the intravenous administration of equipotent doses of both drugs (1.5 x ED95), the duration of peak effect, clinical duration, and total duration were significantly different between the two drugs, but their recovery indexes were similar. Conclusions Atracurium and rocuronium are low-potency nondepolarizing relaxants with intermediate duration. As compared to atracurium, the neuromuscular blocking effect of rocuronium was about 20% less potent and its duration of action was shorter. C1 Chinese Acad Med Sci, Plast Surg Hosp, Dept Anesthesia, Beijing 100041, Peoples R China. Peking Union Med Coll, Beijing 100041, Peoples R China. RP Xue, FS (reprint author), Chinese Acad Med Sci, Plast Surg Hosp, Dept Anesthesia, Beijing 100041, Peoples R China. NR 8 TC 2 Z9 3 PU CHINESE MEDICAL ASSOCIATION PI BEIJING PA 42 DONGSI XIDAJIE, BEIJING 100710, PEOPLES R CHINA SN 0366-6999 J9 CHINESE MED J-PEKING JI Chin. Med. J. PD NOV PY 2000 VL 113 IS 11 BP 1019 EP 1021 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 381FX UT WOS:000165752600013 ER PT J AU Grundmann, U Mencke, T Soltesz, S Fuchs-Buder, T AF Grundmann, U Mencke, T Soltesz, S Fuchs-Buder, T TI Onset properties of rocuronium during co-induction of anaesthesia with desflurane and isoflurane or total intravenous anaesthesia - A randomised, controlled clinical trial SO CLINICAL DRUG INVESTIGATION LA English DT Article ID ANESTHESIA; SEVOFLURANE; ATRACURIUM AB Objective: To compare the onset properties of 0.3 mg/kg rocuronium during co-induction of anaesthesia with desflurane, isoflurane or total intravenous anaesthesia (TIVA) with propofol/remifentanil. Design: A prospective, randomised controlled trial carried out in surgical patients. Patients: 60 adult ASA I-II patients undergoing general anaesthesia for elective surgery were randomised to three groups (n = 20 each) according to the anaesthetic technique: co-induction with desflurane, isoflurane or TIVA. Methods: Neuromuscular transmission was assessed by electromyography (EMG) with Train-of-Four stimulation. In all patients anaesthesia was induced and maintained during the whole study with propofol 2.0 to 2.5 mg/kg intravenously followed by a continuous infusion (4 to 6 mg/kg/h) and 0.25 mug/kg/min remifentanil. After stabilisation of the EMG-response patients received 0.3 mg/kg rocuronium concomitantly with desflurane or isoflurane, both at an inspired concentration of 1 MAC (minimum alveolar concentration), or no volatile anaesthetic (TIVA control-group). Maximum neuromuscular block and onset time of rocuronium-induced neuromuscular blockade were measured. Results: The maximum neuromuscular block after rocuronium 0.3 mg/kg was significantly deeper in the desflurane group compared with isoflurane or TIVA [96% (range 79-100) vs 87% (range 69-97) and 86% (range 65 - 100), respectively; p < 0.01]. Onset time did not differ between the three groups [242s (range 160-380), 252s (range 160-400), and 244s (120-400), respectively; not significant]. Conclusions: Co-induction with desflurane led to a deeper rocuronium-induced neuromuscular block compared with isoflurane or TIVA. Faster uptake and distribution of desflurane may be the main reasons for this early interaction between desflurane and rocuronium. C1 Univ Saarland, Dept Anaesthesia & Intens Care Med, D-66421 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Saarland, Dept Anaesthesia & Intens Care Med, D-66421 Homburg, Germany. NR 16 TC 3 Z9 3 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 1173-2563 J9 CLIN DRUG INVEST JI Clin. Drug Invest. PD NOV PY 2000 VL 20 IS 5 BP 351 EP 355 DI 10.2165/00044011-200020050-00006 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 375CA UT WOS:000165380900006 ER PT J AU Sutcliffe, DG Murphy, CM Maslow, A Uppington, J Shorten, GD AF Sutcliffe, DG Murphy, CM Maslow, A Uppington, J Shorten, GD TI A comparison of antagonism of rocuronium-induced neuromuscular blockade during sevoflurane and isoflurane anaesthesia SO ANAESTHESIA LA English DT Article DE anaesthetic agents, isoflurane, sevoflurane neuromuscular blocking agent, rocuronium ID INTRAVENOUS ANESTHESIA; SPONTANEOUS-RECOVERY; TRAIN-OF-4 FADE; VECURONIUM; REVERSAL; NEOSTIGMINE; ATRACURIUM; PANCURONIUM; EDROPHONIUM; DESFLURANE AB Volatile anaesthetic agents potentiate neuromuscular blocking agents and retard their rate of reversal. We hypothesised that there was a difference in the rate of reversal of rocuronium-induced neuromuscular blockade based on the selection of inhalation agent. Thirty-eight patients undergoing elective surgical procedures received either sevoflurane or isoflurane, by random allocation. Neuromuscular blockade was induced using rocuronium 0.6 mg.kg(-1) followed by continuous intravenous infusion to maintain 90% suppression of the single twitch response. Upon completion of surgery, the rocuronium infusion was discontinued, neostigmine 50 mug.kg(-1) and glycopyrrolate 10 mug.kg(-1) were administered. Times from reversal to T-1 = 25, 50 and 60% and train-of-four ratio = 0.6 were recorded. The mean (SD) times to train-of-four ratio = 0.6 in the isoflurane and sevoflurane groups were 327 (132) and 351 (127) s, respectively. The mean (SD) times to single twitch response T-1 = 25, 50 and 60% in the isoflurane group were 81 (33), 161 (59) and 245 (84) s, respectively and in the sevoflurane group were 95 (35), 203 (88) and 252 (127) s, respectively. It is concluded that reversal of rocuronium-induced neuromuscular blockade is similar during isoflurane and sevoflurane anaesthesia. C1 Cork Univ Hosp, Cork, Ireland. Natl Univ Ireland Univ Coll Cork, Cork, Ireland. Beth Israel Deaconess Med Ctr, Dept Anaesthesia & Crit Care, Boston, MA 02215 USA. Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Boston, MA 02114 USA. RP Shorten, GD (reprint author), Cork Univ Hosp, Cork, Ireland. NR 22 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD OCT PY 2000 VL 55 IS 10 BP 960 EP 964 DI 10.1046/j.1365-2044.2000.01526.x PG 5 WC Anesthesiology SC Anesthesiology GA 368TB UT WOS:000090132700005 ER PT J AU Kopman, AF Klewicka, MM Ghori, K Flores, F Neuman, GG AF Kopman, AF Klewicka, MM Ghori, K Flores, F Neuman, GG TI Dose-response and onset/offset characteristics of rapacuronium SO ANESTHESIOLOGY LA English DT Article DE potency; recovery ID INTUBATING CONDITIONS; NEUROMUSCULAR BLOCK; SINGLE BOLUS; TIME-COURSE; ORG-9487; SUCCINYLCHOLINE; MUSCLE; PHARMACOKINETICS; TEMPERATURE; NEOSTIGMINE AB Background: A rigorous study of the dose-response relation of rapacuronium has, to our knowledge, yet to be performed. In addition, there is little information available regarding the onset or offset profile of rapacuronium when administered in subparalyzing doses. These issues necessitate further study. Methods: Forty-seven adult patients, American Society Anesthesiologists physical status I or II, were studied. Tracheal intubation was accomplished without muscle relaxants. Anesthesia was maintained with use of nitrous oxide, propofol, and alfentanil The electromyogram of the first dorsal interosseous muscle was measured using a monitor. Single stimuli at 0.10 Hz were administered. A single dose of rapacuronium was administered. After log-dose or logit transformation of the data, the best-fit line of regression was determined using the method of least squares. For each subject, the authors estimated the 50% effective dose (ED50) and 95% effective dose (ED95) from the Hill equation using the slope obtained from regression analysis. The onset times to 50 and 90% of peak effect were estimated in a subset of 10 individuals in which peak twitch depression decreased to the range of 90-99%. Results: The calculated ED50 and ED95 values for rapacuronium were 0.39 +/- 0.08 (SD) and 0.75 +/- 0.16 mg/kg, respectively. After a single ED95 dose, 90% of the drug's peak effect was evident in 77 +/- 17 s. After this dose, rapacuronium has a clinical duration of 6.1 +/- 1.1 min. Conclusions: The authors found the ED95 of rapacuronium to be substantially less than suggested by previous estimates. Rapacuronium has an onset profile that is not different from that previously reported for succinylcholine. The rate of spontaneous recovery was faster after rapacuronium than the authors previously observed after mivacurium administration but was slower than after succinylcholine, using an identical protocol. C1 St Vincents Hosp & Med Ctr, Dept Anesthesiol, New York, NY 10011 USA. RP Kopman, AF (reprint author), St Vincents Hosp & Med Ctr, Dept Anesthesiol, Room NR 408,170 W 12th St, New York, NY 10011 USA. NR 17 TC 13 Z9 14 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 2000 VL 93 IS 4 BP 1017 EP 1021 DI 10.1097/00000542-200010000-00025 PG 5 WC Anesthesiology SC Anesthesiology GA 360MN UT WOS:000089671900020 ER PT J AU Radchenko, V Andreichikov, B Wanke, H Gavrilov, V Korchuganov, B Rieder, R Ryabinin, M Economou, T AF Radchenko, V Andreichikov, B Wanke, H Gavrilov, V Korchuganov, B Rieder, R Ryabinin, M Economou, T TI Curium-244 alpha-sources for space research SO APPLIED RADIATION AND ISOTOPES LA English DT Article; Proceedings Paper CT 4th Topical Meeting on the Industrial Radiation and Radioisotope Measurement Applications (IRRMA 99) CY OCT 03-07, 1999 CL RALEIGH, NC SP Amer Nuclear Soc, Isotopes & Radiat Div, Amer Nuclear Soc, Eastern Carolinas Sect, N Carolina State Univ, Ctr Engn Applicat Radioisotopes, Quantum Res Serv Inc DE alpha-proton-X-ray spectrometric complex; mars pathfinder; curium-244 AB Special alpha-proton-X-ray spectrometric complexes (APXS) have been developed in order to perform chemical analyses of the Mars atmosphere and rock surface compounds by alpha back-scattering, alpha-proton measurements, and X-ray fluorescence. The sources were prepared by high temperature condensation of metal curium vapour onto silicon substrates. They are silicon disks with curium-244 fixed on their surfaces as a silicide. The sources have overall dimensions as follows: disk diameter 8 mm; thickness 0.3 mm; and 6 mm diameter active spot. The source activities are 5 +/- 1 mCi and the alpha-line half-widths are equal to (1.7-2.5) and (2.9-4.5)% of full width at 10% of Maximum (Maximum is equal to 5.8 MeV). Thermovacuum (from 196 to 1000 degrees C), mechanical, and resource tests were performed and demonstrated that the sources maintained their characteristics. The applicability of the sources for the above-mentioned analytical purposes was confirmed during NASA Mars Pathfinder mission. (C) 2000 Published by Elsevier Science Ltd. C1 Russia Res Inst Atom Reactors, State Sci Ctr, Dimitrovgrad 433510, Russia. Russian Acad Sci, Space Res Inst, Moscow 117810, Russia. Max Planck Inst Chem, D-55128 Mainz, Germany. Univ Chicago, Chicago, IL 60637 USA. RP Radchenko, V (reprint author), Russia Res Inst Atom Reactors, State Sci Ctr, Dimitrovgrad 433510, Russia. EM kar@orip.niiar.simbirsk.su NR 0 TC 4 Z9 5 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0969-8043 J9 APPL RADIAT ISOTOPES JI Appl. Radiat. Isot. PD OCT-NOV PY 2000 VL 53 IS 4-5 BP 821 EP 824 DI 10.1016/S0969-8043(00)00260-8 PG 4 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging SC Chemistry; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging GA 345TE UT WOS:000088830600045 ER PT J AU Radchenko, VM Ryabinin, MA Andreytchuk, NN Gavrilov, VD Karelin, YA AF Radchenko, VM Ryabinin, MA Andreytchuk, NN Gavrilov, VD Karelin, YA TI Curium-248 standard neutron source SO APPLIED RADIATION AND ISOTOPES LA English DT Article; Proceedings Paper CT 4th Topical Meeting on the Industrial Radiation and Radioisotope Measurement Applications (IRRMA 99) CY OCT 03-07, 1999 CL RALEIGH, NORTH CAROLINA SP Amer Nuclear Soc, Isotopes & Radiat Div, Amer Nuclear Soc, Eastern Carolinas Sect, N Carolina State Univ, Ctr Engn Applicat Radioisotopes, Quantum Res Serv Inc DE curium-248; neutron source; alloy of platinum with curium AB A new standard neutron source based on curium-248 has been developed, prepared, and certified. The curium-248 isotope is more long-lived than californium-252. The active core of this source is a pellet made of an alloy of platinum with curium. The measured full neutron yield for this source is 2.30 x 10(4) s(-1) with 4% error at 0.95 confidence. (C) 2000 Published by Elsevier Science Ltd. C1 State Sci Ctr Russian Federat, Res Inst Atom Reactors, Dimitrovgrad 433510, Russia. RP Radchenko, VM (reprint author), State Sci Ctr Russian Federat, Res Inst Atom Reactors, Dimitrovgrad 433510, Russia. NR 5 TC 1 Z9 1 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0969-8043 J9 APPL RADIAT ISOTOPES JI Appl. Radiat. Isot. PD OCT-NOV PY 2000 VL 53 IS 4-5 BP 833 EP 835 DI 10.1016/S0969-8043(00)00256-6 PG 3 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging SC Chemistry; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging GA 345TE UT WOS:000088830600048 ER PT J AU Miller, DR Wherrett, C Hull, K Watson, J Legault, S AF Miller, DR Wherrett, C Hull, K Watson, J Legault, S TI Cumulation characteristics of cisatracurium and rocuronium during continuous infusion SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article; Proceedings Paper CT 56th Annual Meeting of the Canadian-Anesthesiologists-Society CY JUN 17-22, 1999 CL CALGARY, CANADA SP Canadian Anesthesiologists Soc ID OPIOID BARBITURATE ANESTHESIA; INTRAVENOUS-INFUSION; SURGICAL PATIENTS; PHARMACOKINETICS; PHARMACODYNAMICS; ORG-9426; VECURONIUM; 51W89 AB Purpose: The dissimilar pharmacokinetic properties of cisatracurium (CIS) and rocuronium (ROC) predict different potential for drug cumulation when these drugs are administered by continuous infusion. A study was therefore undertaken to compare cumulation potential of CIS and ROC during surgical procedures of relatively long duration (2-4 hr). Methods: Sufentanil/propofol-N2O anesthesia was administered to 40 ASA I and II adults. In a double-blind protocol, patients were randomly allocated to receive a continuous iv infusion of either CIS or ROC, titrated in progressive increments or decrements as required to achieve and maintain 95 +/- 5% depression of the T I response of the adductor pollicis muscle, using a Datex NMT- 100 Relaxograph EMG monitor applied at the wrist. At the end of surgery, 60 mu g.kg(-1) neostigmine plus 15 mu g kg atropine were administered for reversal. Results: The duration of infusion was 104 +/- 33 min in group CIS and 1 1 0 +/- 23 min in group ROC (P=NS). In both groups, a progressive decrease in potency-adjusted infusion rates was observed after 30 min, then stabilized beyond 60 min. When allowing for an initial period of stabilization, mean potency-adjusted infusion requirements were: CIS 0.81 +/- 0.02 mu g.kg(-1) min(-1) and ROC 5.58 +/- 1.94 mu g.kg(-1) min(-1). There were no differences between groups at any time with regard to potency-adjusted infusion requirements necessary to maintain 90-99% block(P=NS), However, drug costs/hr for maintenance of neuromuscular block were less with CIS ($3.57 +/- 0.09) than with ROC ($6.03 +/- 0.27), P < 0.00 1. Conclusion: When adjusted to equipotency, infusion requirements of CIS and ROC vary at similar rates during general anesthesia. Despite pharmacokinetic differences, neither drug demonstrates cumulation for infusion lasting up to 3.5 hr. C1 Ottawa Hosp, Dept Anesthesia, Ottawa, ON, Canada. Univ Ottawa, Ottawa, ON, Canada. RP Miller, DR (reprint author), Ottawa Gen Hosp, Dept Anesthesiol, Gen Campus,501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. NR 17 TC 5 Z9 11 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD OCT PY 2000 VL 47 IS 10 BP 943 EP 949 PG 7 WC Anesthesiology SC Anesthesiology GA 362QR UT WOS:000089790200003 ER PT J AU Itoh, H Shibata, K Nitta, S Kobayashi, T AF Itoh, H Shibata, K Nitta, S Kobayashi, T TI Train-of-four fade and neuromuscular block in rats: a comparison between pancuronium, vecuronium, and rocuronium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID SPONTANEOUS OFFSET; TWITCH DEPRESSION; TETANIC FADE; TRANSMISSION; DRUGS; PHARMACOKINETICS; TUBOCURARINE; DIAPHRAGM; PROFILES AB Purpose: To clarify the relationship between neuromuscular block and train-of-four fade and to investigate the causes of these drug-dependent differences, we compared the neuromuscular block and TOF fade after pancuronium, vecuronium and rocuronium. Methods: In 24 anesthetized rats, the sciatic nerve was stimulated, and the twitch of left tibialis anterior muscle was recorded. After T-1 (first twitch response) was kept constant at 95% block by administration of pancuronium, vecuronium, or rocuronium (n=8, in each), the TOF fade was measured when T-1 block was decreased to 40% and 20%. In addition, using 24 phrenic nerve-diaphragm preparations, the fade was measured when the T-1 block increased to 20% and 40% by titrating of either one of the three drugs (n=8, in each). Results: In in vivo experiments, the fade produced by pancuronium was greater than that by vecuronium or rocuronium when T-1 block was at 40% (81 +/- 9 vs 63 +/- 15 and 63 +/- 6%, respectively) and at 20% (66 +/- 13 vs 34 +/- 17 and 40 +/- 6%, respectively). In contrast, in in vitro experiments, the differences did not reach significant levels among the three drugs either at 20% (32 +/- 19 vs 33 +/- 10 and 32 +/- 17%) or 40% of block(62 +/- 29 vs 65 +/- 14 and 55 +/- 14%). Conclusions: For vecuronium and rocuronium, the results were similar in vivo and in vitro. For pancuronium, fade was greater in vivo. These results suggest that different neuromuscular blocking agent have different relationships between the fade and the block. In vitro results might not be the same as in vivo, possibly due to pharmacokinetic differences. C1 Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, Kanazawa, Ishikawa 9208641, Japan. Ishikawa Prefectural Cent Hosp, Dept Anesthesia, Kanazawa, Ishikawa, Japan. RP Itoh, H (reprint author), Kanazawa Univ, Sch Med, Dept Anesthesiol & Intens Care Med, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan. NR 25 TC 6 Z9 6 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD OCT PY 2000 VL 47 IS 10 BP 950 EP 955 PG 6 WC Anesthesiology SC Anesthesiology GA 362QR UT WOS:000089790200004 ER PT J AU [Anonymous] AF [Anonymous] TI Rapacuronium bromide - Raplon (R) - Neuromuscular blocker SO DRUGS OF THE FUTURE LA English DT Article NR 8 TC 0 Z9 0 PU PROUS SCIENCE, SA PI BARCELONA PA PO BOX 540, PROVENZA 388, 08025 BARCELONA, SPAIN SN 0377-8282 J9 DRUG FUTURE JI Drug Future PD OCT PY 2000 VL 25 IS 10 BP 1099 EP 1100 PG 2 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 382GE UT WOS:000165814000037 ER PT J AU Koenig, HM Edwards, TL AF Koenig, HM Edwards, TL TI Cisatracurium-induced neuromuscular blockade in anticonvulsant treated neurosurgical patients SO JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY LA English DT Article DE cisatracurium; benzylisoquinolinium; neuromuscular relaxant; antiepileptics ID ACUTELY ADMINISTERED PHENYTOIN; INDUCED RESISTANCE; CARBAMAZEPINE; THERAPY; VECURONIUM; ATRACURIUM; PIPECURONIUM; RECOVERY AB Patients treated with the anticonvulsants phenytoin or carbamazepine are resistant to steroidal neuromuscular blocking agents. We studied the effect of cisatracurium on onset, duration, and speed of recovery from neuromuscular blockade (NMB) in acutely anticonvulsant treated patients ([< 2 weeks] [AA]), chronically anticonvulsant treated patients ([> 2 weeks] [CA]) and patients not on anticonvulsants ([controls] ICI). After internal Review Board approval, 10 AA, 14 CA, and 14 C neurosurgical patients were studied. Anesthetic induction was midazolam, fentanyl, and thiopental, and maintenance was fentanyl and 0.5 MAC isoflurane in O-2. The evoked compound electromyogram of the hypothenar eminence was monitored (TOF supramaximal stimulus at 2 Hz every 20 seconds). Baseline TOF was established, then cisatracurium (0.2 mg/kg) was administered IV. Onset (time to maximal paralysis), duration [time to recovery of first twitch (T1) to 25% of baseline] and speed of recovery (time of recovery from 10%-25% of baseline) were recorded. Data were analyzed using ANOVA. Onset(C = 4 +/- 2, AA = 3 +/- 1, CA = 3 +/- 1.5 minutes) and duration (C = 69 +/- 13, AA = 64 +/- 19, CA = 59 +/- 19 minutes) were not different among the groups (P > .7). Speed of recovery was significantly faster in both AA (6 +/- 2 minutes) and CA (6 +/- 3 minutes) than in C (12 +/- 9 minutes) patients (P < .05). (Data = mean +/- SD). Onset and duration of cisarracurium-induced neuromuscular relaxation was not affected by acute or chronic anticonvulsant treatment, but speed of recovery was significantly faster. Frequent NMB monitoring is necessary to detect the greater speed of recovery in anticonvulsant-treated patients during cisatracurium muscle relaxation. C1 Univ Illinois, Dept Anesthesiol, Chicago, IL 60612 USA. Univ Pittsburgh, Dept Anesthesiol, Pittsburgh, PA 15260 USA. RP Koenig, HM (reprint author), Univ Illinois, Dept Anesthesiol, M-C 515,1740 W Taylor,Suite 3200 W, Chicago, IL 60612 USA. NR 24 TC 5 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0898-4921 J9 J NEUROSURG ANESTH JI J. Neurosurg. Anesthesiol. PD OCT PY 2000 VL 12 IS 4 BP 314 EP 318 DI 10.1097/00008506-200010000-00003 PG 5 WC Anesthesiology; Clinical Neurology; Surgery SC Anesthesiology; Neurosciences & Neurology; Surgery GA 360PL UT WOS:000089676400003 ER PT J AU Hayes, A Breslin, D Reid, J Mirakhur, RK AF Hayes, A Breslin, D Reid, J Mirakhur, RK TI Comparison of recovery following rapacuronium, with and without neostigmine, and succinylcholine SO ANAESTHESIA LA English DT Article DE neuromuscular relaxants, rapacuronium; succinylcholine; antagonists, neostigmine; neuromuscular relaxants; pharmacodynamics ID NEUROMUSCULAR BLOCKING-AGENTS; RAPID-SEQUENCE INDUCTION; INTUBATING CONDITIONS; MUSCLE-RELAXANT; ADULT PATIENTS; TIME-COURSE; ORG-9487; ANESTHESIA; PHARMACODYNAMICS; SUXAMETHONIUM AB The neuromuscular blocking effects of a single dose of rapacuronium 1.5 mg.kg(-1) with or without reversal with neostigmine have been examined in the present study and compared with a dose of succinylcholine 1.0 mg.kg(-1). Neuromuscular block was measured mechanomyographically using train-of-four stimulation. Complete block occurred within 1 min with both agents. Twenty-five per cent recovery of the first response of the train-of-four occurred in a median [range] time of 7.6 [5.7-11.3] min in the succinylcholine group and in 14.2 [8.8-23.6] and 15.1 [9.6-23.4] min in the rapacuronium groups with and without neostigmine reversal, respectively. Spontaneous recovery to a train-of-four ratio of 0.8 took 33.4 [20.0-79.0] min with rapacuronium but this was reduced to about 21.2 [13.9-33.7] min when neostigmine was administered at 25% recovery of first twitch of the train-of-four. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 17 TC 10 Z9 10 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD SEP PY 2000 VL 55 IS 9 BP 859 EP 863 DI 10.1046/j.1365-2044.2000.01541.x PG 5 WC Anesthesiology SC Anesthesiology GA 351KW UT WOS:000089157200005 ER PT J AU Zhou, TJ Coloma, M White, PF Tang, J Webb, T Forestner, JE Greilich, NB Duffy, LL AF Zhou, TJ Coloma, M White, PF Tang, J Webb, T Forestner, JE Greilich, NB Duffy, LL TI Spontaneous recovery profile of rapacuronium during desflurane, sevoflurane, or propofol anesthesia for outpatient laparoscopy SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; TIME-COURSE; ISOFLURANE ANESTHESIA; ADDUCTOR POLLICIS; VECURONIUM; MIVACURIUM; ORG-9487; MUSCLE; PANCURONIUM; NEOSTIGMINE AB We evaluated the spontaneous recovery characteristics of rapacuronium during desflurane-, sevoflurane, or propofol-based anesthesia in 51 consenting women undergoing laparoscopic tubal ligation procedures. After the induction of the anesthesia with standardized doses of propofol and fentanyl, 1.5 mg/kg IV rapacuronium was administered to facilitate tracheal intubation. Patients were randomized to receive either 1 minimum alveolar anesthetic concentration of desflurane, 1 minimum alveolar concentration of sevoflurane, or 100 mu g . kg(-1) . min(-1) propofol infusion in combination with 66% nitrous oxide in oxygen for maintenance of anesthesia. Neuromuscular blockade was monitored at the wrist by using electromyography. The degree of maximum blockade and the times for first twitch recovery (T-1) to 5%, 25%, 50%, 75%, and 90%, as well as the recovery index, were similar in all three anesthetic groups. However, recovery times for the train-of-four ratio to achieve 0.7 and 0.8 were significantly longer with desflurane (44.4 +/- 18.9 and 53.5 +/- 22.4 min) and sevoflurane (44.8 +/- 15.1 and 53.2 +/- 15.8 min) compared with propofol (31.8 +/- 5.3 and 36.5 +/- 6.5 min). Eight patients (16%) required a maintenance dose of 0.5 mg/kg rapacuronium and reversal of rapacuronium residual block occurred in three (6%) patients. We conclude that spontaneous recovery after an intubating dose of 1.5 mg/kg rapacuronium was significantly prolonged by both desflurane and sevoflurane compared with propofol-based anesthesia. Routine monitoring of neuromuscular activity is recommended even when a single bolus dose of rapacuronium is administered during ambulatory anesthesia. C1 Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX 75235 USA. Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. RP White, PF (reprint author), Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, 5323 Harry Hines Blvd,F2-208, Dallas, TX 75235 USA. NR 28 TC 10 Z9 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 2000 VL 91 IS 3 BP 596 EP 600 PG 5 WC Anesthesiology SC Anesthesiology GA 348EZ UT WOS:000088973700018 ER PT J AU Motamed, C Kirov, K Lieutaud, T Duvaldestin, P AF Motamed, C Kirov, K Lieutaud, T Duvaldestin, P TI The mechanism of pancuronium potentiation of mivacurium block: Use of the isolated-arm technique SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKADE; PLASMA CHOLINESTERASE; COMBINATIONS; ROCURONIUM; VECURONIUM; DURATION; RECOVERY; POTENCY; ADULTS; ONSET AB The neuromuscular blocking effects of mivacurium are greatly enhanced when mivacurium is preceded by a subparalyzing dose of pancuronium. The mechanism of this potentiation has not been elucidated. This study investigated the effects of the anticholinesterase activity of a small dose of pancuronium on the neuromuscular blocking effects of mivacurium. Forty patients were enrolled in the study. The neuromuscular effects of 7.5 and 15 mu g/kg pancuronium, followed by 50 and 100 mu g/kg mivacurium, were assessed in Groups PM1 and PM2 (n = 20), respectively. The neuromuscular effects of 65 and 130 mu g/kg mivacurium were assessed in Groups M1 and M2 (n = 20), respectively. One arm was excluded from circulation with a tourniquet, which was inflated before the injection of pancuronium and deflated 3 min after the injection of mivacurium. The plasma cholinesterase activity was measured before induction for all patients and 3 min after the injection of pancuronium for Groups PM1 and PM2. The plasma cholinesterase activity was decreased by 16% and 33% after pancuronium administration in Groups PM1 and PM2, respectively. In the nonexcluded arm, pancuronium significantly potentiated the effects of mivacurium. In the excluded arm, no significant block was detected for Groups M1 and M2, whereas the maximal degree of neuromuscular block was 79% and 100% for Groups PM1 and PM2, respectively. Using the isolated-arm technique, we suggest that pancuronium potentiation of the neuromuscular blocking effects of mivacurium is more likely attributable to an increase in the effective plasma concentration of mivacurium than to occupancy of postsynaptic acetylcholine receptors. C1 Univ Paris 12, Hop Henri Mondor, Dept Anesthesia, F-94010 Creteil, France. RP Duvaldestin, P (reprint author), Univ Paris 12, Hop Henri Mondor, Dept Anesthesia, 51 Ave Marechal Lattre Tassigny, F-94010 Creteil, France. NR 21 TC 3 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 2000 VL 91 IS 3 BP 732 EP 735 PG 4 WC Anesthesiology SC Anesthesiology GA 348EZ UT WOS:000088973700044 ER PT J AU Klemola, UM Hiller, A AF Klemola, UM Hiller, A TI Tracheal intubation after induction of anesthesia in children with propofol - remifentanil or propofol-rocuronium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID MUSCLE-RELAXANTS; NEUROMUSCULAR BLOCKADE; ADDUCTOR POLLICIS; DOSE-RESPONSE; ALFENTANIL; PHARMACOKINETICS; PHARMACODYNAMICS; SUCCINYLCHOLINE; ORG-9426; BROMIDE AB Purpose: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil. Methods: in a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 mu g.kg(-1) remifentanil (Re2 or Re4); 2 mu g.kg(-1) remifentanil and 0.2 mg.kg(-1) rocuronium (Re2-Ro0.2); 0.4 mg.kg(-1) rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mg.kg(-1) propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation. Results: in all children intubation was successful, Overall intubating conditions were better(P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. Conclusion: The best intubating conditions were produced by the combination of 4 mu g.kg(-1) remifentanil and 3.5 mg.kg(-1) propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression. C1 Univ Helsinki, Cent Hosp, Dept Anaesthesia, Clin Otolaryngol, SF-00290 Helsinki, Finland. RP Klemola, UM (reprint author), Univ Helsinki, Cent Hosp, Dept Anaesthesia, Clin Otolaryngol, Haartmaninkatu 4 E, SF-00290 Helsinki, Finland. NR 28 TC 25 Z9 28 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 2000 VL 47 IS 9 BP 854 EP 859 PG 6 WC Anesthesiology SC Anesthesiology GA 362KJ UT WOS:000089776900005 ER PT J AU Matthey, P Wang, P Finegan, BA Donnelly, M AF Matthey, P Wang, P Finegan, BA Donnelly, M TI Rocuronium anaphylaxis acid multiple neuromuscular blocking drug sensitivities SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID AGENTS AB Purpose: To report a case of anaphylaxis to rocuronium and the sensitivities to multiple neuromuscular blocking drugs in a patient with no previous exposure to this group of drugs. We describe the current recommendations for both intraoperative and postoperative testing of these patients. Clinical Features: A 36-yr-old man was admitted for repair of a ruptured Achilles tendon, Following induction of general anesthesia with fentanyl and propofol, 60 mg of rocuronium were given to facilitate tracheal intubation, He immediately became profoundly hypotensive with impalpable pulses, and blood pressure could not be recorded. Airway pressure increased markedly, and hand Ventilation of the lungs became very difficult. His airway was secured and he was successfully resuscitated with 3 mg epinephrine and three litres crystalloid and colloid intravenous fluid therapy. His recovery in the intensive care unit was uneventful and the operation was performed four days later under spinal anesthesia. Subsequent skin prick testing, performed six weeks later, demonstrated strong positive weal and flare reactions to rocuronium, vecuronium and pancuronium, and some cross-reactivity with the benzylisoquinolinium group of muscle relaxants, Conclusion: Muscle relaxants are responsible for 61.6% of cases of anaphylaxis during general anesthesia. Cross-reactivity is common, as this group of drugs share a quaternary ammonium group. It is mandatory that patients be tested for both the agent responsible and cross-reactivity following an anaphylactic response. We suggest a protocol for investigation of suspected anaphylaxis. C1 Univ Alberta, Walter C Mackenzie Hlth Sci Ctr, Edmonton, AB T6G 2B7, Canada. Adelaide & Meath Hosp, Natl Childrens Hosp, Dept Anesthesia & Intens Care, Dublin, Ireland. RP Matthey, P (reprint author), Univ Alberta, Walter C Mackenzie Hlth Sci Ctr, 3B2-32, Edmonton, AB T6G 2B7, Canada. NR 13 TC 15 Z9 16 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 2000 VL 47 IS 9 BP 890 EP 893 PG 4 WC Anesthesiology SC Anesthesiology GA 362KJ UT WOS:000089776900011 ER PT J AU Gutteck-Amsler, U Rentsch, KM AF Gutteck-Amsler, U Rentsch, KM TI Quantification of the aminosteroidal non-depolarizing neuromuscular blocking agents rocuronium and vecuronium in plasma with liquid chromatography-tandem mass spectroscopy SO CLINICAL CHEMISTRY LA English DT Article ID METABOLITES; FLUIDS C1 Univ Zurich Hosp, Inst Clin Chem, CH-8091 Zurich, Switzerland. RP Rentsch, KM (reprint author), Univ Zurich Hosp, Inst Clin Chem, Ramistr 100, CH-8091 Zurich, Switzerland. NR 6 TC 13 Z9 16 PU AMER ASSOC CLINICAL CHEMISTRY PI WASHINGTON PA 2101 L STREET NW, SUITE 202, WASHINGTON, DC 20037-1526 USA SN 0009-9147 J9 CLIN CHEM JI Clin. Chem. PD SEP PY 2000 VL 46 IS 9 BP 1413 EP 1414 PG 2 WC Medical Laboratory Technology SC Medical Laboratory Technology GA 351WQ UT WOS:000089182500021 ER PT J AU de Rossi, L Fritz, H Klein, U AF de Rossi, L Fritz, H Klein, U TI Comparison of cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscle SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular blockade; neuro-muscular blocking agents; neuromuscular non-depolarizing agents, cisatracurium; monitoring, intraoperative; muscle skeletal, masseter, adductor pollicis ID ROCURONIUM; ATRACURIUM; HUMANS AB Adequate relaxation of the masseter muscle is important during endotracheal intubation and for the patency of a patient's airway during recovery from anaesthesia. We evaluated onset and recovery from cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscles. Thirty patients were randomly allocated to receive either 0.1 or 0.15 mg kg(-1) cisatracurium. The evoked response was measured at both muscles using acceleromyography. Onset time was significantly shorter at the masseter muscle than at the adductor pollicis (0.1 mg kg(-1) cisatracurium: 155 +/- 52 vs. 229 +/- 44 s; 0.15 mg kg(-1) cisatracurium: 105 +/- 24 vs. 174 +/- 35 s). Following 0.1 mg kg(-1) cisatracurium, recovery to a TOP-ratio of 0.7 was faster at the masseter compared to the adductor pollicis (P < 0.05). In the 0.15 mg kg(-1) cisatracurium group recovery of T-1 to 75% of control and to a TOF-ratio of 0.7 occurred sooner at the masseter (P < 0.05). We conclude that onset and recovery from cisatracurium neuromuscular block occurs more rapidly at the masseter than at the adductor pollicis. It appears unlikely that residual paralysis is present at the masseter once neuromuscular function at the adductor pollicis has completely recovered. C1 Univ Jena, Clin Anaesthesiol & Intens Care Therapy, D-07740 Jena, Germany. RP de Rossi, L (reprint author), Rhein Westfal TH Aachen, Clin Anaesthesiol, Paulwelsstr 30, D-52057 Aachen, Germany. NR 10 TC 2 Z9 2 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD SEP PY 2000 VL 17 IS 9 BP 583 EP 586 PG 4 WC Anesthesiology SC Anesthesiology GA 359BW UT WOS:000089592500007 ER PT J AU Lam, AM Pavlin, EG Visco, E Taraday, J AF Lam, AM Pavlin, EG Visco, E Taraday, J TI Rocuronium versus succinylcholine-atracurium for tracheal intubation and maintenance relaxation during propofol anesthesia SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE anesthetic drugs, intravenous : propofol; muscle relaxants : succinylcholine, rocuronium; intubation, intratracheal; neuromuscular block ID RAPID-SEQUENCE INDUCTION; SUXAMETHONIUM; THIOPENTONE; ORG-9426; HUMANS; ONSET AB Study Objectives: To compare the onset and offset time (clinical duration), and intubating conditions obtained with rocuronium bromide 0.6 mg/kg and succinylcholine 1.0 mg/kg after induction with propofol and fentanyl; and to compare rocuronium with atracurium for maintenance during propofol anesthesia. Design: Prospective, open-label, parallel group comparative, randomized study. Setting: Operating rooms of a university hospital. Patients: 30 ASA physical status I and II adult patients scheduled for elective surgeries with general anesthesia. Interventions: Patients premedicated with midazolam 2 mg were anesthetized with fentanyl 2 mug/kg followed by propofol 2.5 mg/kg and muscle relaxants. Group 1 (n = 15) received succinylchloline 1.5 mg/kg and Group 2 (n = 16) received rocuronium bromide 0.6 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxant. Patients in Group 1 received atracurium and patients in Group 2 received rocuronium for maintenance if required. Measurements: The ease of intubation was scored using a scale of 1 to 4. Onset and offset time monitored with evoked twitch response of the adductor pollicis were recorded. Main Results: Intubation was successful in all patients and there was no difference in scores between the two groups. Although onset time was shorter with succinylcholine than with rocuronium, neuromuscular blockade was successfully antagonized in both groups, and the recovery profile was not different between the two groups. Conclusions: Rocuronium bromide at a nose of 0.6 mg/kg, when used with propofol and fentanyl for induction provides intubating conditions similar to succinylcholine 1.0 mg/kg at 1 minute The actual onset time and offset time, however, are significantly longer with rocuronium. There was no difference between atracurium and rocuronium as a maintenance drug Rocuronium is suitable for surgical procedures greater than 30 minutes, eliminating the need for an additional relaxant to succinylcholine. (C) 2000 by Elsevier Science Inc. C1 Univ Washington, Harborview Med Ctr, Dept Anesthesiol, Seattle, WA 98104 USA. RP Lam, AM (reprint author), Univ Washington, Harborview Med Ctr, Dept Anesthesiol, 325 9Th Ave,Box 359724, Seattle, WA 98104 USA. NR 16 TC 7 Z9 7 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD SEP PY 2000 VL 12 IS 6 BP 449 EP 453 DI 10.1016/S0952-8180(00)00191-4 PG 5 WC Anesthesiology SC Anesthesiology GA 376AH UT WOS:000165435300005 ER PT J AU Driessen, JJ Robertson, EN Van Egmond, J Booij, LH AF Driessen, JJ Robertson, EN Van Egmond, J Booij, LH TI The time-course of action and recovery of rocuronium 0.3 mg center dot kg(-1) in infants and children during halothane anaesthesia measured with acceleromyography SO PAEDIATRIC ANAESTHESIA LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 17-21, 1998 CL ORLANDO, FLORIDA SP Amer Soc Anesthesiol DE muscle relaxants; anaesthesia; monitoring AB This study compares the time-course of action of neuromuscular paralysis after 0.3 mg.kg(-1) of rocuronium during nitrous oxide-halothane anaesthesia in children of three different age groups. With appropriate approval and informed consent from the parents, 51 children, ASA I-II, scheduled for elective surgery requiring muscle relaxation, were studied. The children were assigned to three groups according to age: group 1, 0-6 months; group 2, 6-24 months; and group 3, > 24 months of age. Induction of anaesthesia and tracheal intubation were performed under halothane anaesthesia. Acceleromyography of the thumb was recorded after supramaximal transcutaneous ulnar nerve stimulation using train-of-four (TOF) stimulation. Rocuronium 0.3 mg.kg(-2) was given as a rapid i.v. bolus prior to surgical incision. The onset time (time to max effect) and the maximal depth of the block, the time to recovery of the first twitch (T1) to 25% and 75% of its baseline, the recovery index (RI), and the time to recovery of the TOF ratio to 70% after the end of injection of rocuronium were all measured. The mean (SD) age of the children in groups 1, 2, and 3 was 3.1 (1.6), 12.6 (3.7), and 63 (46) months, respectively. The onset time of rocuronium was 47 (12), 83 (42) and 94 (12) s, respectively, in groups 1, 2, and 3 (P < 0.05 group 1 vs. 2 and 3). One hundred percent block was achieved in 18/19 patients in group 1, 12/14 in group 2 and 6/18 in group 3. The times to 25% and 75% recovery of T1 and the time for recovery of the TOF ratio to 70% were all significantly longer in groups 1 and 2 compared to group 3. Group 1 and 2 showed no significant differences in recovery times. The RI was significantly prolonged in group 1 versus 3. The authors conclude that rocuronium 0.3 mg.kg(-1) during halothane anaesthesia causes more neuromuscular depression and has a longer duration of action in infants than in children older than 2 years. C1 Univ Nijmegen Hosp, Dept Anesthesiol, NL-6500 HB Nijmegen, Netherlands. RP Driessen, JJ (reprint author), Univ Nijmegen Hosp, Dept Anesthesiol, Geert Grootepl 10, NL-6500 HB Nijmegen, Netherlands. NR 12 TC 6 Z9 6 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD SEP PY 2000 VL 10 IS 5 BP 493 EP 497 DI 10.1046/j.1460-9592.2000.00543.x PG 5 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 356BV UT WOS:000089424900005 ER PT J AU Heier, T Guttormsen, AB AF Heier, T Guttormsen, AB TI Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: A report including 3 cases SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE adverse effects, anaphylaxis; drugs, muscle relaxants, rocuronium; allergy testing, skin prick test, serum tryptase ID MAST-CELL TRYPTASE; HISTAMINE-RELEASE; NEUROMUSCULAR BLOCKERS; SYSTEMIC-ANAPHYLAXIS; ANESTHESIA; PANCURONIUM; VECURONIUM; ATRACURIUM; RELAXANTS; ALLERGY AB Anaphylaxis during induction of anaesthesia is a dreaded complication with a mortality rate of 3-6%, most frequently associated with the use of muscle relaxants. Current knowledge on this matter is reviewed in relation to the presentation of 3 cases of anaphylaxis and bronchospasm associated with the use of the recently released nondepolarizing muscle relaxant rocuronium. Bronchospasm may be the sole sign of a serious drug reaction, triggered by precipitation of insoluble thiopental crystals when mixed with a muscle relaxant in the intravenous (iv) line. It is recommended that these drugs are administered via different injection ports. The hypotension requires immediate treatment with oxygen, epinephrine and large amounts of iv fluids. Epinephrine infusion may be needed for hours. It is recommended that serum tryptase is measured approximately 2 h after debut of the serious drug reaction. Allergy testing should be performed for all the drugs the patient was exposed to, 4-8 weeks after the incident, and due to cross-reactivity, including all available muscle relaxants. Doctors are urged to inform their patients, and systematically register adverse drug reactions. C1 Ullevaal Univ Hosp, Dept Anaesthesia, N-0407 Oslo, Norway. RP Heier, T (reprint author), Ullevaal Univ Hosp, Dept Anaesthesia, N-0407 Oslo, Norway. NR 64 TC 26 Z9 27 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD AUG PY 2000 VL 44 IS 7 BP 775 EP 781 DI 10.1034/j.1399-6576.2000.440702.x PG 7 WC Anesthesiology SC Anesthesiology GA 338YR UT WOS:000088451300002 ER PT J AU Suzuki, T Nakamura, T Saeki, S Ogawa, S AF Suzuki, T Nakamura, T Saeki, S Ogawa, S TI Vecuronium - Induced neuromuscular blockade in a patient with cerebral palsy and hemiplegia SO ANESTHESIA AND ANALGESIA LA English DT Article ID RESISTANCE; SENSITIVITY; ATRACURIUM; PHENYTOIN; THERAPY; RAT C1 Surugadai Nihon Univ Hosp, Dept Anesthesiol, Chiyoda Ku, Tokyo, Japan. RP Suzuki, T (reprint author), Surugadai Nihon Univ Hosp, Dept Anesthesiol, Chiyoda Ku, 1-8-13 Kanda Surugadai, Tokyo, Japan. NR 14 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 2000 VL 91 IS 2 BP 492 EP 493 PG 2 WC Anesthesiology SC Anesthesiology GA 338YD UT WOS:000088450100049 ER PT J AU Mann, R Blobner, M Jelen-Esselborn, S Busley, R Werner, C AF Mann, R Blobner, M Jelen-Esselborn, S Busley, R Werner, C TI Preanesthetic train-of-four fade predicts the atracurium requirement of myasthenia gravis patients SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the Society-of-Neurosurgical-Anesthesia-and-Critical-Care CY OCT 16-17, 1998 CL SAN DIEGO, CALIFORNIA SP Soc Neurosurg Anesthesia & Crit Care DE neuromuscular monitoring; pyridostigmine ID ACETYLCHOLINE-RECEPTORS; VECURONIUM; BLOCK AB Background: The most sensitive diagnostic criterion of myasthenia gravis is a decrement in the muscular response to repetitive stimulation. The authors hypothesized that myasthenia gravis patients who show a train-of-four ratio (T4/T1) < 0.9 in the preanesthetic period will have increased sensitivity to nondepolarizing neuromuscular blocking agents compared with myasthenia gravis patients with preanesthetic T4/T1 greater than or equal to 0.9. Methods: After institutional review board approval was obtained, 20 electrophysiologically documented myasthenia gravis patients were studied, Current pyridostigmine therapy was continued until the morning of surgery. Before induction of anesthesia, neuromuscular transmission was recorded from the hypothenar muscles using electromyography with train-of-four stimulation of the ulnar nerve. According to the T4/T1 ratio, patients were assigned to the "normal'' group (T4/T1 greater than or equal to 0.9) or the "decrement" group (T4/T1 < 0.9). After induction of intravenous anesthesia, the effective dose to achieve a 95% neuromuscular blockade (ED95) for atracurium was assessed with a cumulative bolus technique. Postoperatively, pyridostigmine was titrated to obtain a T4/T1 > 0.75 and to treat residual myasthenic symptoms. Results: In 14 patients, preanesthetic T4/T1 was greater than or equal to 0.9 (normal), whereas 6 patients presented with T4/T1 < 0.9 (decrement). Decrement patients had a lower ED95 of 0.07 +/- 0.03 mg/kg atracurium(mean +/- SD) compared with normal patients with an ED95 of 0.24 +/- 0.11 mg/kg atracurium (P = 0.002). All patients were extubated within 30 min after surgery. Postoperative pyridostigmine infusion did not differ significantly between groups. Conclusions: The requirement for atracurium is significantly reduced in myasthenia gravis patients with a T4/T1 ratio < 0.9 before anesthesia. This study indicates that routine neuromuscular monitoring in myasthenia gravis patients should be extended into the preinduction period to identify patients who require less atracurium. C1 Tech Univ Munich, Klinikum Rechts Isar, Klin Anaesthesiol, D-81675 Munich, Germany. RP Blobner, M (reprint author), Tech Univ Munich, Klinikum Rechts Isar, Klin Anaesthesiol, Troger Str 16, D-81675 Munich, Germany. NR 20 TC 22 Z9 26 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD AUG PY 2000 VL 93 IS 2 BP 346 EP 350 DI 10.1097/00000542-200008000-00011 PG 5 WC Anesthesiology SC Anesthesiology GA 340ZB UT WOS:000088565600006 ER PT J AU McGehee, DS Krasowski, MD Fung, DL Wilson, B Gronert, GA Moss, J AF McGehee, DS Krasowski, MD Fung, DL Wilson, B Gronert, GA Moss, J TI Cholinesterase inhibition by potato glycoalkaloids slows mivacurium metabolism SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 07-13, 1999 CL DALLAS, TEXAS SP Amer Soc Anesthesiol DE neuromuscular blocking drugs; rabbit; reversal agents; solanidine ID CHLORIDE BW B1090U; HUMAN BUTYRYLCHOLINESTERASE; ADDUCTOR POLLICIS; PHARMACOKINETICS; ATRACURIUM; DRUG; PHARMACODYNAMICS; PANCURONIUM; ROCURONIUM; TOXICITY AB Background: The duration of action for many pharmaceutical agents is dependent on their breakdown by endogenous hydrolytic enzymes. Dietary factors that interact with these enzyme systems may alter drug efficacy and time course. Cholinesterases such as acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) hydrolyze and inactivate several anesthetic drugs, including cocaine, heroin, esmolol, local ester anesthetics, and neuromuscular blocking drugs. Natural glycoalkaloid toxins produced by plants of the family Solanaceae, which includes potatoes and tomatoes, Inhibit both AChE and BuChE. Here the authors assess the extent to which two solanaceous glycoalkaloids (SGAs), alpha-solanine and alpha-chaconine, can alter the effects of neuromuscular blocking drugs and cholinesterase inhibitors in vivo and in vitro. Methods: Inhibition of purified human AChE and BuChE by SGAs, neuromuscular blocking drugs, and cholinesterase inhibitors was assessed by an in vivo colorimetric cholinesterase assay. In vivo experiments were carried out using anesthetized rabbits to test whether SGAs affect recovery from mivacurium-induced paralysis. Results: SGAs inhibited human BuChE at concentrations similar to those found in serum of individuals who have eaten a standard serving of potatoes. Coapplication of SGAs (30-100 nM) with neuromuscular blocking drugs and cholinesterase inhibitors produced additive cholinesterase inhibition. SGA administration to anesthetized rabbits inhibited serum cholinesterase activity and mivacurium hydrolysis. In addition, SGA prolonged the time needed for recovery from mivacurium-induced paralysis (149 +/- 12% of control; n = 12). Conclusions: These findings support the hypothesis that inhibition of endogenous enzyme systems by dietary factors can influence anesthetic drug metabolism and duration of action. Diet may contribute to the wide variation in recovery time from neuromuscular blockade seen in normal, healthy individuals. C1 Univ Chicago, Dept Anesthesia & Crit Care, Chicago, IL 60637 USA. Univ Chicago, Comm Neurobiol, Chicago, IL 60637 USA. Univ Calif Davis, Dept Anesthesiol, Davis, CA 95616 USA. Univ Calif Davis, Dept Anim Sci, Davis, CA 95616 USA. Univ Calif Davis, Dept Environm Toxicol, Davis, CA 95616 USA. RP Moss, J (reprint author), Univ Chicago, Dept Anesthesia & Crit Care, 5841 S Maryland Ave,MC 4028, Chicago, IL 60637 USA. NR 37 TC 36 Z9 37 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD AUG PY 2000 VL 93 IS 2 BP 510 EP 519 DI 10.1097/00000542-200008000-00031 PG 10 WC Anesthesiology SC Anesthesiology GA 340ZB UT WOS:000088565600026 ER PT J AU Gerasimov, AS Zaritskaya, TS Kiselev, GV Myrtsymova, LA AF Gerasimov, AS Zaritskaya, TS Kiselev, GV Myrtsymova, LA TI Conditions of transmutation of plutonium, americium, and curium in nuclear facilities SO ATOMIC ENERGY LA English DT Article AB The transmutation of plutonium, americium, and curium isotopes in reactors with thermal and fast neutron spectra is analyzed. The radiotoxicity of a nuclide mixture is calculated. For transmutation of plutonium the radiotoxicity is maximum at the initial stage of irradiation as a result of the production of Pu-241 and, after further irradiation, the production of Cm-244. For transmutation of americium and curium the maximum radiotoxicity is 2-2.5 times greater than the initial value; it is due to the formation of Pu-238. It is established that the neutron flux density affects the rate of decrease of radiotoxicity. NR 5 TC 1 Z9 1 PU CONSULTANTS BUREAU PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1063-4258 J9 ATOM ENERGY+ JI Atom. Energy PD AUG PY 2000 VL 89 IS 2 BP 663 EP 667 DI 10.1023/A:1011355626592 PG 5 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 403CG UT WOS:000167024500009 ER PT J AU Zhou, TJ White, PF Chiu, JW Joshi, GP Dullye, KK Duffy, LL Tongier, WK AF Zhou, TJ White, PF Chiu, JW Joshi, GP Dullye, KK Duffy, LL Tongier, WK TI Onset/offset characteristics and intubating conditions of rapacuronium: a comparison with rocuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rapacuronium; neuromuscular block, rocuronium; anaesthetics i.v., propofol; anaesthetics volatile, sevoflurane; intubation, tracheal ID NEUROMUSCULAR BLOCKING-AGENTS; ADDUCTOR POLLICIS; TIME-COURSE; MUSCLE-RELAXANT; DOSE-RESPONSE; VOCAL CORDS; ORG-9487; PHARMACOKINETICS; DURATION; HUMANS AB We compared onset and offset of action and tracheal intubating conditions after rapacuronium and rocuronium in 60 patients in a randomized, assessor-blinded study. Following induction of anaesthesia with propofol 2.5 mg kg(-1), either rapacuronium 1.5 mg kg(-1) (n=30) or rocuronium 0.6 mg kg(-1) (n=30) was administered to facilitate tracheal intubation. Anaesthesia was maintained with either a propofol infusion (100 mu g kg(-1) min(-1)) or sevoflurane (1% end-tidal) with 66% nitrous oxide (N2O), n=15 in each subgroup. Neuromuscular monitoring was performed using an electromyographic (EMG) device (Datex Relaxograph). The lag times (mean 42 (SD 11) s and 44 (16) s), maximum block (99 (2)% and 98 (3)%) and intubating conditions at 60 s (good-to-excellent in 86% and 84% of patients) were similar for rapacuronium and rocuronium, respectively. The onset time of rapacuronium was shorter than rocuronium (87 (20) vs 141 (65) s, P<0.001), and the degree of block at 60 s was greater (69 (26) vs 50 (27)%, P<0.05). Twenty-five per cent recovery was shorter with rapacuronium than rocuronium during propofol (15.0 (3.2) vs 39.1 (14.2) min, P<0.001) and sevoflurane (15.1 (4.2) vs 47.8 (19.0) min, P<0.001) anaesthesia. We conclude that rapacuronium 1.5 mg kg(-1) had a more rapid onset, similar intubating conditions, and shorter recovery times than rocuronium 0.6 mg kg(-1). C1 Univ Texas, SW Med Ctr, Dept Anaesthesiol & Pain Management, Dallas, TX 75235 USA. RP White, PF (reprint author), Univ Texas, SW Med Ctr, Dept Anaesthesiol & Pain Management, 5323 Harry Hines Blvd, Dallas, TX 75235 USA. NR 23 TC 10 Z9 10 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 2000 VL 85 IS 2 BP 246 EP 250 DI 10.1093/bja/85.2.246 PG 5 WC Anesthesiology SC Anesthesiology GA 341MR UT WOS:000088594600014 ER PT J AU Hemmerling, TM Schmidt, J Wolf, T Klein, P Jacobi, K AF Hemmerling, TM Schmidt, J Wolf, T Klein, P Jacobi, K TI Comparison of succinylcholine with two doses of rocuronium using a new method of monitoring neuromuscular block at the laryngeal muscles by surface laryngeal electromyography SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, succinylcholine; neuromuscular block, rocuronium; larynx ID RAPID-SEQUENCE INDUCTION; ADDUCTOR MUSCLES; HUMANS; SUXAMETHONIUM; ANESTHESIA; POLLICIS AB We compared the onset of neuromuscular block with succinylcholine (1 mg kg(-1)) and two doses of rocuronium (0.6 and 0.9 mg kg(-1)) at the adductor pollicis muscle using electromyography (EMG) and acceleromyography (AMG), and at the adductor laryngeal muscles with a new electromyographic method using a disposable surface electrode attached to the cuff of a tracheal tube. At the larynx, the mean (+/-SD) time to 90% block and the onset time of succinylcholine (38+/-15 and 47+/-19 s, respectively) were significantly shorter (P<0.01) than for rocuronium 0.6 mg kg(-1) (92+/-42 and 106+/-38 s) and rocuronium 0.9 mg kg(-1) (52+/-31 and 64+/-30 s). We found that, with comparable degrees of neuromuscular block, the onset time of succinylcholine at the adductor pollicis was significantly shorter (P<0.01) than for rocuronium 0.6 mg kg(-1) and 0.9 mg kg(-1) (EMG, 80+/-39 vs 145+/-48 s and 99+/-31 a; AMG, 90+/-39 vs 124+/-53 s and 106+/-38 s). Clinical duration at the adductor pollicis (AMG) was significantly longer (P<0.01) for both rocuronium groups than for succinylcholine (T-4:T-1=0.7, 54+/-18 and 77+/-21 vs 8+/-6 min). The surface laryngeal electrode proved non-invasive, easy to use and reliable in measuring onset of the neuromuscular block at the larynx. C1 Univ Erlangen Nurnberg, Dept Anaesthesiol, Nurnberg, Germany. Univ Erlangen Nurnberg, Dept Surg, Nurnberg, Germany. RP Hemmerling, TM (reprint author), Postfach 1367, D-66363 St Ingbert, Germany. NR 12 TC 21 Z9 21 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 2000 VL 85 IS 2 BP 251 EP 255 DI 10.1093/bja/85.2.251 PG 5 WC Anesthesiology SC Anesthesiology GA 341MR UT WOS:000088594600015 ER PT J AU Fu, W Klein, KW White, PF Chiu, JW Lemmens, HJM Whalley, DG Drover, DR Greenberg, CP AF Fu, W Klein, KW White, PF Chiu, JW Lemmens, HJM Whalley, DG Drover, DR Greenberg, CP TI Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol-based anaesthesia SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rapacuronium; anaesthetics, volatile, desflurane; anaesthetics, volatile, sevoflurane; anaesthetics, volatile, isoflurane; anaesthetics i.v., propofol; monitoring, acceleromyography ID SEVOFLURANE ANESTHESIA; ROCURONIUM ORG-9426; TIME-COURSE; ISOFLURANE; PHARMACOKINETICS; PHARMACODYNAMICS; DESFLURANE; VECURONIUM AB We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of rapacuronium. Eighty ASA I-III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5-2.5 mg kg(-1) and fentanyl 1-2 mu g kg(-1), followed by a bolus of rapacuronium 1.5 mg kg(-1). The patients were randomized to receive either desflurane (2-4% end-tidal, ET), sevoflurane (0.75-1.5% ET), isoflurane (0.4-0.8% ET), or a propofol infusion (75-150 mu g kg(-1) min(-1)) for maintenance of anaesthesia in combination with nitrous oxide (60-70%) in oxygen. When the first twitch CTI) of a train-of-four stimulus (using the TOF Guard(R) accelerometer) returned to 5%, an infusion of rapacuronium was started at 3 mg kg(-1) h(-1) and adjusted to maintain T-1/T-0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg(-1) h(-1). There were no significant differences among the groups in the times for T-1/T-0 to return to 25%, 75% or 90%, or for T-4/T-1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique. C1 Univ Texas, SW Med Ctr, Dept Anesthesiol, Dallas, TX 75235 USA. Stanford Univ, Stanford, CA 94305 USA. Cleveland Clin Fdn, Cleveland, OH 44195 USA. Columbia Univ, New York, NY USA. RP White, PF (reprint author), Univ Texas, SW Med Ctr, Dept Anesthesiol, Dallas, TX 75235 USA. NR 10 TC 5 Z9 5 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 2000 VL 85 IS 2 BP 302 EP 305 DI 10.1093/bja/85.2.302 PG 4 WC Anesthesiology SC Anesthesiology GA 341MR UT WOS:000088594600023 ER PT J AU Nagele, P Hammerle, AF AF Nagele, P Hammerle, AF TI Sevoflurane and mivacurium in a patient with Huntington's chorea SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE genetic factors; anaesthesia; complications AB There is little experience of anaesthesia for patients with Huntington's chorea. These patients have an increased risk of intraoperative complications such as pulmonary aspiration. We present the successful anaesthetic management of a 17-yr-old patient suffering from Huntington's chorea requiring urgent appendectomy. After rapid-sequence induction with thiopental 400 mg and succinylcholine 100 mg, anaesthesia was maintained with sevoflurane. For maintenance of neuromuscular blockade mivacurium 10 mg was administered and repeated IS min later. Except for a short episode of postoperative shivering, the perioperative course was uneventful. Sevoflurane and mivacurium were used safely and effectively in this patient. C1 Univ Vienna, Gen Hosp, Dept Anaesthesiol & Gen Intens Care, A-1090 Vienna, Austria. RP Nagele, P (reprint author), Univ Vienna, Gen Hosp, Dept Anaesthesiol & Gen Intens Care, Wahringer Gurtel 18-20, A-1090 Vienna, Austria. RI Nagele, Peter/A-2922-2008 OI Nagele, Peter/0000-0001-8369-3858 NR 9 TC 12 Z9 13 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 2000 VL 85 IS 2 BP 320 EP 321 DI 10.1093/bja/85.2.320 PG 2 WC Anesthesiology SC Anesthesiology GA 341MR UT WOS:000088594600029 ER PT J AU Wong, TKM Chen, C Liou, SC Lee, YH Huang, CS AF Wong, TKM Chen, C Liou, SC Lee, YH Huang, CS TI Prolonged neuromuscular block with mivacurium in a patient with cholinesterase deficiency SO JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION LA English DT Article DE mivacurium; cholinesterase deficiency; prolonged neuromuscular block ID ABNORMAL PLASMA CHOLINESTERASE; SERUM-CHOLINESTERASE; VARIANTS AB Mivacurium is a short-acting, nondepolarizing neuromuscular blocking agent hydrolyzed by plasma cholinesterase. Because it allows fast recovery, it is a commonly used muscle relaxant for patients undergoing short surgical procedures. We report the case of a 5-year-old boy who underwent outpatient inguinal hemiorraphy and developed unexpected prolonged neuromuscular block after. the use of mivacurium. He required mechanical ventilation support in the intensive care unit because he could not attain adequate muscle power 1 hour after termination of anesthesia; the muscular paralysis persisted for 5 hours after the bolus dose of 0.3 mg/kg mivacurium. Subsequent investigation revealed an extremely low plasma cholinesterase concentration (115 U/L), and this was later determined to be a congenital condition. This is the first reported case of cholinesterase deficiency diagnosed as a result of general anesthesia in Taiwan. C1 Chang Gung Mem Hosp, Dept Anesthesiol, Lin Kou Med Ctr, Tao Yuan, Taiwan. Chang Gung Mem Hosp, Dept Pediat Surg, Lin Kou Med Ctr, Tao Yuan, Taiwan. RP Wong, TKM (reprint author), Chang Gung Mem Hosp, Dept Anesthesiol, Lin Kou Med Ctr, 5 Fushing Rd, Tao Yuan, Taiwan. NR 20 TC 1 Z9 1 PU EXCERPTA MEDICA ASIA LTD PI CHAI WAN PA 19/F, EIGHT COMMERCIAL TOWER, 8 SUN YIP ST, CHAI WAN, HONG KONG SN 0929-6646 J9 J FORMOS MED ASSOC JI J. Formos. Med. Assoc. PD AUG PY 2000 VL 99 IS 8 BP 656 EP 658 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 342QV UT WOS:000088657400012 ER PT J AU Alvarez, AO Cascardo, A Menendez, SA Capria, JJ Cordero, RA AF Alvarez, AO Cascardo, A Menendez, SA Capria, JJ Cordero, RA TI Total intravenous anesthesia with midazolam, remifentanil, propofol and cisatracurium in morbid obesity SO OBESITY SURGERY LA English DT Article DE anesthesia; bariatric surgery; TIVA; remifentanil; midazolam; cisatracurium; rocuronium; propofol; morbid obesity; co-induction ID INORGANIC FLUORIDE LEVELS; RECEIVING NITROUS-OXIDE; SUCCINYLCHOLINE; MANAGEMENT; INDUCTION; INFUSION; FENTANYL; SURGERY; HUMANS; BYPASS AB Background: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed. Methods: 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases,Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated, Results: The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency. Conclusions: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients. C1 Arturo Onativia Hosp, Specialized Multidisciplinary Inst Obes Treatment, Buenos Aires, DF, Argentina. RP Alvarez, AO (reprint author), Los Padres 399,Barrio El Trebol, RA-1804 Ezeiza, Buenos Aires, Argentina. NR 39 TC 14 Z9 15 PU F D-COMMUNICATIONS INC PI TORONTO PA 3100 BAYVIEW AVE, UNIT 4, TORONTO, ONTARIO MZN 5L3, CANADA SN 0960-8923 J9 OBES SURG JI Obes. Surg. PD AUG PY 2000 VL 10 IS 4 BP 353 EP 360 DI 10.1381/096089200321629120 PG 8 WC Surgery SC Surgery GA 349FH UT WOS:000089032600003 ER PT J AU Schlaich, N Mertzlufft, F Soltesz, S Fuchs-Buder, T AF Schlaich, N Mertzlufft, F Soltesz, S Fuchs-Buder, T TI Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE pharmacology, propofol, remifentanil; neuromuscular block, rocuronium; intubation tracheal; pharmacodynamics; antagonists neuromuscular block, neostigmine; monitoring, electromyography ID RAPID-SEQUENCE INDUCTION; NEUROMUSCULAR BLOCK; HEMODYNAMIC-RESPONSE; TIME-COURSE; ANESTHESIA; SUCCINYLCHOLINE; SURGERY; ALFENTANIL; ORG-9426 AB Background: The use of muscle relaxants in outpatient anaesthesia is controversial; some authors recommend an induction regimen including propofol and opioids without muscle relaxants. This study evaluated the requirements for rocuronium after remifentanil/propofol. Methods: We examined in four groups of ASA I-II patients (n=30 for each) the intubating conditions three minutes after induction of anaesthesia with remifentanil 0.5 mu g kg(-1) min(-1), propofol 2 mg kg(-1) without muscle relaxants or with different doses of rocuronium (0.6 mg kg(-1), 0.45 mg kg(-1), 0.3 mg kg(-1)) applying the criteria proposed by the Copenhagen Consensus Conference. In the second part of the study the time course of neuromuscular block was determined by electromyography using train-of-four (TOF) stimulation. To this end, another 60 ASA I-patients were randomly assigned to receive remifentanil 0.5 mu g kg(-1) min(-1), propofol 2 mg kg(-1) and either rocuronium 0.6 mg kg(-1) 0.45 mg kg(-1), 0.3 mg kg(-1), or 0.3 mg kg(-1) followed by neostigmine 40 mu g kg(-1) and atropine 20 mu g kg(-1) at a TI recovery of 10% (n=15 for each). Results: Intubating conditions were good or excellent in 30 patients after rocuronium 0.6 mg kg(-1) and in 18 patients when rocuronium was omitted (P<0.01). After 0.45 mg kg(-1) and 0.3 mg kg(-1) rocuronium the numbers were 29 and 30 patients, respectively. Reducing rocuronium from 0.6 mg kg(-1) to 0.45 mg kg(-1) or 0.3 mg kg(-1) increased the onset time from 136 (35) s to 199 (34) s and 249 (52) s (mean (SD)), (P<0.01); the clinical duration decreased from 38 (10) min to 24 (8) min and 16 (5) min, respectively (P<0.01); and the duration to a TOF-ratio of 0.8 decreased from 60 (11) min to 45 (9) min and 34 (7) min (P<0.01). After rocuronium 0.3 mg kg(-1) this time interval further decreased to 22 (3) min when neostigmine was given at a T1 of 10% (P<0.01 compared with spontaneous recovery after rocuronium 0.3 mg kg(-1)). Conclusion: After remifentanil/propofol intubation conditions were poor in 40% of patients without muscle relaxants; adding reduced doses of rocuronium to this regimen improved the intubation conditions significantly. In addition, reducing the initial dose of rocuronium markedly shortened its time course of action. (C) Acta Anaesthesiologica Scandinavica 44 (2000). C1 Univ Saarlandes, Dept Anaesthesia & Crit Care, D-66421 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Saarlandes, Dept Anaesthesia & Crit Care, D-66421 Homburg, Germany. NR 20 TC 32 Z9 36 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JUL PY 2000 VL 44 IS 6 BP 720 EP 726 DI 10.1034/j.1399-6576.2000.440610.x PG 7 WC Anesthesiology SC Anesthesiology GA 331PT UT WOS:000088028000010 ER PT J AU Mencke, T Soltesz, S Grundmann, U Bauer, M Schlaich, N Larsen, R Fuchs-Buder, T AF Mencke, T Soltesz, S Grundmann, U Bauer, M Schlaich, N Larsen, R Fuchs-Buder, T TI Time course of neuromuscular blockade after rocuronium - A comparison between women and men SO ANAESTHESIST LA German DT Article DE neuromuscular blocking agent : rocuronium; neuromuscular blocking agent :; pharmacodynamic; neuromuscular blocking agent : gender; neuromuscular monitoring :; electromyography ID FEMALE-PATIENTS; DOSE-RESPONSE; VECURONIUM; PHARMACODYNAMICS; PHARMACOKINETICS; ANESTHESIA; MORPHINE; GENDER AB Background. We studied 40 patients (20 female and 20 male) undergoing elective surgery under general anaesthesia to evaluate the effect of gender on the pharmacodynamics of rocuronium. Methods. Using electromyography (EMG) we determined the maximal neuromuscular block and time course of action of 0.45 mg/kg rocuronium (1.5xED(95)). Results. Age and body mass index were comparable between females and males (38 (+/-8) vs.37 (+/-10) years and 24.2 (+/-2.9) vs. 25.2 (+/-1.7) kg/m(2). However, significant differences in weight and height were found between females and males (65.7+/-9.3 kg vs. 77.5+/-5.5 kg; p<0.01 and 178+6.8 cm vs. 164+/-6.7 cm; p<0,01). Onset time was shorter in females (168+/-65 s vs.211+/-56 s; p<0.05). Maximal neuromuscular blockade after 0.45 mg/kg rocuronium was 94 (+/-3) % in females and 89 (+/-6) % in males; p<0.01. Clinical duration was increased in females (23+/-5 min vs. 17+/-5 min; p<0.05), while the recovery index was comparable between both groups (9+/-4 min in females and 9+/-3 min in males; n.s.). Conclusion. Compared to men neuromuscular blockade after 0.45 mg/kg rocuronium was more pronounced in women. The onset time was shortened and the clinical duration increased in female patients. C1 Univ Saarlandes Kliniken, Klin Anaesthesiol & Intens Med, D-66421 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Saarlandes Kliniken, Klin Anaesthesiol & Intens Med, D-66421 Homburg, Germany. NR 22 TC 14 Z9 20 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD JUL PY 2000 VL 49 IS 7 BP 609 EP 612 DI 10.1007/s001010070077 PG 4 WC Anesthesiology SC Anesthesiology GA 342AK UT WOS:000088623000004 ER PT J AU Frankowski, GA Johnson, JO Tobias, JD AF Frankowski, GA Johnson, JO Tobias, JD TI Rapacuronium administration to two children with Duchenne's muscular dystrophy SO ANESTHESIA AND ANALGESIA LA English DT Article ID CARDIAC-ARREST; SUCCINYLCHOLINE; NEOSTIGMINE; ANESTHESIA C1 Univ Missouri, Dept Anesthesiol, Columbia, MO USA. Univ Missouri, Dept Neurosurg, Columbia, MO USA. Univ Missouri, Dept Pediat, Columbia, MO USA. Univ Missouri, Div Pediat Crit Care Pediat Anesthesiol, Columbia, MO USA. RP Tobias, JD (reprint author), Univ Missouri, Dept Child Hlth, Hlth Sci Ctr M658, 1 Hosp Dr, Columbia, MO 65212 USA. NR 12 TC 9 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 2000 VL 91 IS 1 BP 27 EP 28 DI 10.1097/00000539-200007000-00005 PG 2 WC Anesthesiology SC Anesthesiology GA 329XG UT WOS:000087933300005 ER PT J AU Briassoulis, G Hatzis, T Mammi, P Alikatora, A AF Briassoulis, G Hatzis, T Mammi, P Alikatora, A TI Persistent anaphylactic reaction after induction with thiopentone and cisatracurium SO PAEDIATRIC ANAESTHESIA LA English DT Article DE cisatracurium; histamine; tryptase; anaphylaxis; bronchospasm; thiopentone ID HISTAMINE-RELEASE; PLASMA HISTAMINE; VECURONIUM; ANESTHESIA; ATRACURIUM; TRYPTASE; DRUG AB A 6-year-old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 mu g.kg(-1).min(-1) was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed. C1 Aghia Sophia Childrens Hosp, Paediat Intens Care Unit, Athens 11527, Greece. Aghia Sophia Childrens Hosp, Dept Anaesthesia, Athens 11527, Greece. RP Briassoulis, G (reprint author), Aghia Sophia Childrens Hosp, Paediat Intens Care Unit, Levadias & Thivon St, Athens 11527, Greece. NR 21 TC 7 Z9 7 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD JUL PY 2000 VL 10 IS 4 BP 429 EP 434 DI 10.1046/j.1460-9592.2000.00527.x PG 6 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 328UE UT WOS:000087867900014 ER PT J AU McKenzie, AG AF McKenzie, AG TI Prelude to pancuronium and vecuronium SO ANAESTHESIA LA English DT Article DE history, pancuronium, vecuronium; neuromuscular relaxants, pancuronium, vecuronium ID NEUROMUSCULAR BLOCKING-AGENTS; ORG-NC-45; BROMIDE AB The discovery of the neuromuscular blocking activity of malouetine isolated from Malouetia bequaertiana Woodson by Quevauviller and Laine in 1960 stimulated interest in aminosteroids as potential neuromuscular blockers. Alauddin (a pharmacist) and Martin-Smith (a medicinal chemist) began research in this area, which was then taken up by pharmaceutical companies. Pure pancuronium was synthesised in 1964 by Savage and his co-workers, directed by Hewett. Pharmacologists headed by Buckett discovered that pancuronium was far more potent than d-tubocurarine and had minimal side-effects. Buckett quickly recognised the value of pancuronium, and his persistence resulted in successful clinical trials, followed by the commercial launch of pancuronium in 1968. Vecuronium was synthesised, tested and the studies published by Buckett, Hewett and Savage in 1973, but this was before anaesthetists called for a 'clean muscle relaxant' and, furthermore, it was unstable in aqueous solution. Hence, it was only promoted for clinical trials six years later. C1 Royal Infirm Edinburgh, Dept Anaesthet, Edinburgh EH3 9YW, Midlothian, Scotland. RP McKenzie, AG (reprint author), Royal Infirm Edinburgh, Dept Anaesthet, Lauriston Pl, Edinburgh EH3 9YW, Midlothian, Scotland. NR 39 TC 5 Z9 5 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUN PY 2000 VL 55 IS 6 BP 551 EP 556 DI 10.1046/j.1365-2044.2000.01423.x PG 6 WC Anesthesiology SC Anesthesiology GA 319VT UT WOS:000087364600007 ER PT J AU Oehmke, MJ Sator-Katzenschlager, S Haslinger-Akramian, J Weinstabl, C Hoerauf, K AF Oehmke, MJ Sator-Katzenschlager, S Haslinger-Akramian, J Weinstabl, C Hoerauf, K TI Effect of mivacurium and atracurium on intraocular pressure SO ANASTHESIOLOGIE & INTENSIVMEDIZIN LA German DT Article DE anaesthesia; intraocular pressure; curare-like agents ID VECURONIUM; SUCCINYLCHOLINE AB We investigated the effects on intraocular pressure of relaxation with mivacurium or atracurium in a prospective, randomized, double-blind examination of 30 hemodynamically and respiratorically stable patients. To exclude disruptive factors the patients were all intubated and continously sedated. As active agent the patients were given a bolus of mivacurium (0.15 mg/kg) or atracurium (0.5 mg/kg) which equals the dose of intubation (2 x ED95). The IOP was controlled before giving the bolus as well as after one, five, ten and 30 minutes. Our data showed that both mivacurium and atracurium decreased IOP, The greatest decrease was reached after five minutes. The influence of mivacurium was significantly greater than that of atracurium. We conclude that mivacurium is a useful drug in clinical situations in which decreased intraocular pressure is desired. C1 Univ Vienna, Abt Allgemeine Anaesthesie & Intens Med B, A-1090 Vienna, Austria. RP Oehmke, MJ (reprint author), Univ Vienna, Allgemeines Krankenhaus Wien, Abt Allgemeine Anaesthesie & Intens Med B, Waehringer Guertel 18-20, A-1090 Vienna, Austria. NR 14 TC 0 Z9 0 PU BLACKWELL WISSENSCHAFTS-VERLAG GMBH PI BERLIN PA KURFURSTENDAMM 57, D-10707 BERLIN, GERMANY SN 0170-5334 J9 ANASTH INTENSIVMED JI Anasthesiol. Intensivmed. PD JUN PY 2000 VL 41 IS 6 BP 503 EP 506 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 331HY UT WOS:000088014100003 ER PT J AU Ostergaard, D Rasmussen, SN Viby-Mogensen, J Pedersen, NA Boysen, R AF Ostergaard, D Rasmussen, SN Viby-Mogensen, J Pedersen, NA Boysen, R TI The influence of drug-induced low plasma cholinesterase activity on the pharmacokinetics and pharmacodynamics of mivacurium SO ANESTHESIOLOGY LA English DT Article DE butyrylcholinesterase; enzymes; metabolites; neuromuscular relaxants; pseudocholinesterase; stereoisomers ID INDUCED NEUROMUSCULAR BLOCKADE; CHLORIDE BW B1090U; HEPATIC CIRRHOSIS; 3 ISOMERS; SUCCINYLCHOLINE; SUXAMETHONIUM; BAMBUTEROL; ANESTHESIA AB Background: The short duration of action of mivacurium results from its rapid hydrolysis by plasma cholinesterase. Bambuterol, an oral bronchodilator, has an inhibiting effect on plasma cholinesterase. The purpose of this study was to evaluate the effect of bambuterol-induced low plasma cholinesterase activity on the pharmacokinetics and pharmacodynamics of mivacurium. Methods: Fourteen patients received 20 mg bambuterol and 14 patients received placebo orally 2 h before induction of anesthesia. During anesthesia the neuromuscular block was monitored at the thumb using train-of-four nerve stimulation every 12 s and mechanomyography. The times to different levels of neuromuscular recovery after 0.2 mg/kg mivacurium were measured. The concentrations in venous blood of the three isomers and the metabolites of mivacurium were measured using high-performance liquid chromatography. Results: Plasma cholinesterase activity was inhibited a median of 90% (range, 67-97%) after bambuterol. The time to first response to train-of-four nerve stimulation was 15 min (range, 9-21 min) and 59 min (range, 32-179 min) in patients receiving placebo and bambuterol, respectively. The estimated clearances of the Isomers were significantly lower and the elimination half-lives of all three isomers significantly prolonged in patients receiving bambuterol. No difference was seen in elimination half-lives of the metabolites. The elimination rate constant from the effect compartment and the potency of mivacurium was not affected by bambuterol. Conclusion: A 90% inhibition of plasma cholinesterase activity significantly reduced clearance of the isomers of mivacurium. Correspondingly, the duration of action of 0.2 mg/kg mivacurium was prolonged three- to fourfold, compared with patients not administered bambuterol. C1 Gentofte Univ Hosp, Dept Anesthesiol, Copenhagen, Denmark. RP Ostergaard, D (reprint author), Herlev Hosp, Dept Anesthesia, Herlev Ringvej, DK-2730 Herlev, Denmark. NR 20 TC 16 Z9 16 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUN PY 2000 VL 92 IS 6 BP 1581 EP 1587 PG 7 WC Anesthesiology SC Anesthesiology GA 320ER UT WOS:000087389300010 ER PT J AU Lagneau, F Marty, J AF Lagneau, F Marty, J TI Selection criteria for curare in long-term critical care SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article C1 Hop Beaujon, Serv Anesthesie Reanimat, F-92118 Clichy, France. RP Lagneau, F (reprint author), Hop Beaujon, Serv Anesthesie Reanimat, F-92118 Clichy, France. NR 3 TC 0 Z9 0 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD JUN PY 2000 VL 19 IS 6 BP FI112 EP FI114 PG 3 WC Anesthesiology SC Anesthesiology GA 349BB UT WOS:000089023000013 ER PT J AU Baraka, AS Taha, SK Kawkabani, NI AF Baraka, AS Taha, SK Kawkabani, NI TI Neuromuscular interaction of sevoflurane cisatracurium in a myasthenic patient SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID GRAVIS; VECURONIUM; ANESTHESIA; ISOFLURANE; HALOTHANE AB Purpose: To describe the influence of sevoflurane anesthesia on cisatracurium neuromuscular block in a myasthenic patient undergoing thymectomy. Clinical features: A myasthenic patient (Osserman IIB) was managed for one year before surgery with 60 mg pyridostigmine qid, 50 mg immuran tid and 30 mg prednisone therapy. Pyridostigmine was interrupted three months before surgery, and five sessions of plasmapheresis were done within 13 days before surgery, The neuromuscular response was monitored by Datex electromyographic response to train-of-four stimulation of the ulnar nerve. Sevoflurane 4% decreased the T-1/C ratio by 20%. Administration of 0.025 mg.kg(-1) cisatracurium, during sevoflurane anesthesia, was followed by complete neuromuscular block for 45 min, Discontinuation of sevoflurane resulted, after 10 min, in recovery of the T-1 which reached T-1/C ratio of 50% after 30 min. Conclusion: The marked sensitivity of this myasthenic patient to 0.5 x ED95 of cisatracurium can be attributed to potentiation of cisatracurium neuromuscular block by sevoflurane, as evidenced by the reappearance of the first twitch of the train-of-four response 10 min after sevoflurane was discontinued. C1 Amer Univ Beirut, Dept Anesthesiol, Beirut, Lebanon. RP Baraka, AS (reprint author), Amer Univ Beirut, Dept Anesthesiol, Beirut, Lebanon. NR 13 TC 2 Z9 2 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUN PY 2000 VL 47 IS 6 BP 562 EP 565 PG 4 WC Anesthesiology SC Anesthesiology GA 362KE UT WOS:000089776500013 ER PT J AU Aysel, I Hepaguslar, H Balcioglu, T Uyar, M AF Aysel, I Hepaguslar, H Balcioglu, T Uyar, M TI The effects of nimodipine on vecuronium-induced neuromuscular blockade SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE pharmacology, drug interactions; calcium channel blockers, nimodipine; neuromuscular non-depolarizing agents, vecuronium ID CALCIUM-CHANNEL BLOCKERS; MUSCLE-RELAXANTS; ATRACURIUM; ANESTHESIA; POTENTIATION; ISOFLURANE; RESISTANCE; ELECTROMYOGRAPHY; SEVOFLURANE; NIFEDIPINE AB Nimodipine, a calcium channel blocking drug, is used in the treatment of cerebral arterial spasm after subarachnoid haemorrhage due to bleeding from an intracranial aneurysm. The purpose of this study was to evaluate the effects of nimodipine on neuromuscular blockade after vecuronium had been given to facilitate tracheal intubation and maintenance of muscle paralysis in patients undergoing clipping of intracranial aneurysm. Twenty patients were divided into two groups: a control group (n = 10) who received no calcium channel blocking drug, and a nimodipine group (n = 10) consisting of patients treated with nimodipine at clinically used doses of 0.03 mg kg(-1) h(-1) pre- and perioperatively. Anaesthesia was induced with atropine 10 mu g kg(-1) dehydrobenzperidol 5 mg, fentanyl 5 mu g kg(-1), thiopental 5 mg kg(-1) and maintained with a mixture of N2O and isoflurane (0.5-1% inspired concentration) in O-2, and additional doses of fentanyl 2.5 mu g kg(-1). Neuromuscular responses were monitored by acceleromyograpy. The first twitch of the train-of-four response (T-1) was considered as twitch height. After a stabilization period, an intubating dose of vecuronium 0.1 mg kg(-1) was administered. The onset of action, the time of first appearance of T-1 and clinical duration of action were recorded. Then, maintenance doses of vecuronium 0.03 mg kg(-1) were administered twice more when T-1 had recovered to 25% of control twitch height. The study ended when the recordings of the 3rd 25% T-1 recovery had been obtained. There were no statistical differences in the onset time (120 +/- 44 s in the control group, 141 +/- 33 s in the nimodipine group), in the first appearance time of T-1 (28 +/- 6 min in the control group, 30 +/- 8 min in the nimodipine group), and in the times for 25% recovery in T-1 (41 +/- 11, 32 +/- 2, 40 +/- 13 min in the control group, respectively, and 44 +/- 16, 36 +/- 15, 38 +/- 15 min in nimodipine group, respectively) between the groups studied. The time between the injection of the intubating dose of vecuronium and the third recovery of T-1-25% of control was not significantly different between the control group (113 +/- 34 min) and the nimodipine group (117 +/- 42 min). This study indicates that nimodipine does not have any significant effect on the time course of action of vecuronium including the onset time and its clinical duration of action after the initial and the two maintenance doses in these patients. C1 Ege Univ Hosp, Dept Anaesthesiol, Izmir, Turkey. RP Hepaguslar, H (reprint author), 1463 Sok,22-2, TR-35220 Alsancak Izmir, Turkey. NR 30 TC 0 Z9 1 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUN PY 2000 VL 17 IS 6 BP 383 EP + DI 10.1046/j.1365-2346.2000.00695.x PG 8 WC Anesthesiology SC Anesthesiology GA 334CG UT WOS:000088167100014 ER PT J AU Ortega, A Sarobe, C Iribarren, MJ Giraldez, J AF Ortega, A Sarobe, C Iribarren, MJ Giraldez, J TI Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium SO PHARMACY WORLD & SCIENCE LA English DT Article DE cisatracurium; atracurium; costs; neuromuscular blocking agents; vecuronium; rocuronium; pharmacoeconomics ID OPIOID BARBITURATE ANESTHESIA; 51W89; PHARMACOLOGY AB Cisatracurium (C), Atracurium (A), Rocuronium (R) and Vecuronium (V) are four neuromuscular blockers (NMB) used in the operating room with similar efficacy, defined as adequate muscle relaxation, but different pharmacokinetics. C and A have organ-independent elimination, A is associated with histamine release and R has a shorter onset time. The objective of this study was to economically compare these four NMB from the hospital point of view in order to facilitate drug selection. A cost analysis was performed. Only direct costs were considered and data were collected through a retrospective chart review. A total of 151 patient charts were randomly selected. Differences between patients receiving one of the four NMB were evaluated by ANOVA or Kruskal-Wallis tests. Then a multiple linear regression analysis was conducted. In the chart review, no significant difference was observed between the four groups of patients in age, weight or surgery duration (p > 0.05). Multiple regression analysis revealed that atracurium was on average PTA 237 (1 Euro = PTA 166) cheaper per surgery than any other NMB after adjusting for other factors (p < 0.01) and there is no significant difference in cost between the other three NMBs (p>0.1). We recommend the use of rocuronium when a quick onset is needed and the patient does not have hepatic failure, cisatracurium when a haemodynamic instability is possible and atracurium in the remaining cases. If just one NMB can be included in the drug formulary we would select cisatracurium due to its pharmacological advantages over atracurium with a small increment in cost. C1 Univ Hosp Navarra, Dept Pharm, Pamplona 31008, Spain. Univ Hosp Navarra, Dept Anaesthesia, Pamplona, Spain. RP Ortega, A (reprint author), Univ Hosp Navarra, Dept Pharm, Pio XII 36, Pamplona 31008, Spain. NR 17 TC 4 Z9 4 PU KLUWER ACADEMIC PUBL PI DORDRECHT PA SPUIBOULEVARD 50, PO BOX 17, 3300 AA DORDRECHT, NETHERLANDS SN 0928-1231 J9 PHARM WORLD SCI JI Pharm. World Sci. PD JUN PY 2000 VL 22 IS 3 BP 82 EP 87 DI 10.1023/A:1008737332389 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 354XF UT WOS:000089356000003 ER PT J AU Michalek-Sauberer, A Gilly, H Steinbereithner, K Vizi, ES AF Michalek-Sauberer, A Gilly, H Steinbereithner, K Vizi, ES TI Effects of vecuronium and rocuronium in antagonistic laryngeal muscles and the anterior tibial muscle in the cat SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE animal model : cat; larynx : posterior cricoarytenoid muscle, lateral cricoarytenoid muscle, vocal cords; neuromuscular blocking agents : vecuronium, rocuronium ID NEUROMUSCULAR BLOCKING-AGENTS; ADDUCTOR POLLICIS MUSCLES; ANESTHETIZED CATS; VOCAL CORDS; BLOCKADE; HUMANS; RECOVERY; SUCCINYLCHOLINE; SENSITIVITY; MIVACURIUM AB Background: Adequate vocal cord paralysis and full recovery of laryngeal muscle function are important when muscle relaxants are used perioperatively. This study was designed to compare the effects of vecuronium and rocuronium at the vocal cord abductor and adductor muscles and the anterior tibial muscle in cats. Methods: Twelve adult cats were studied under pentobarbitone-N2O/O-2-anesthesia. After supramaximal electrical stimulation of the peroneal nerve and the recurrent laryngeal nerve (0.1 Hz and intermittent train-of-four) evoked electromyographic responses were obtained from the anterior tibial muscle, the posterior cricoarytenoid muscle (vocal cord abductor) and two vocal cord adductor muscles, the lateral cricoarytenoid and the vocal muscle. Six cats received bolus doses of increasing size of vecuronium (ED90 22.5 mu g.kg(-1)) and six cats rocuronium (ED90 90 mu g.kg(-1)). Results: Equipotent doses of vecuronium and rocuronium caused a similar degree of paralysis in all muscles (vecuronium ED90: 70% blockade at the posterior cricoarytenoid, 83% at the lateral cricoarytenoid, 84% at the vocal muscle and 90% at the anterior tibial muscle; rocuronium ED90: 71% at the posterior cricoarytenoid, 67% at the lateral cricoarytenoid, 78% at the vocal muscle and 90% at the anterior tibial muscle; vecuronium 2xED(90): 93% blockade at the posterior cricoarytenoid, 95% at the lateral cricoarytenoid, 97% at the vocal muscle and 99% at the anterior tibial muscle; rocuronium 2xED(90): 89% blockade at the posterior and lateral cricoarytenoid, 93% at the vocal muscle and 100% at the anterior tibial muscle). Onset time was significantly shorter at the posterior cricoarytenoid muscle (290 s) compared to the lateral cricoarytenoid muscle (400 s) after vecuronium ED90 and to the vocal muscle (150 s versus 210 s) after rocuronium ED90. Compared to the anterior tibial muscle (interval 25-75%: 6.5 min after vecuronium 2xED(90) and 3.3 min after rocuronium 2xED(90)) and to the posterior cricoarytenoid muscle (interval 25-75%: 7 min after vecuronium 2xED(90) and 4.3 min after rocuronium 2xED(90)), recovery of laryngeal adductor muscle function was markedly delayed with both neuromuscular blocking drugs (interval 25-75% at the lateral cricoarytenoid and vocal muscle: 14 min and 15.8 min after vecuronium 2xED(90) and 10.3 min and 11.6 min after rocuronium 2xED(90) respectively). Conclusion: In cats, the time course of neuromuscular blockade after vecuronium and rocuronium differs in antagonistic laryngeal muscles. The protective laryngeal function of glottis closure recovers later than vocal cord abduction after both vecuronium and rocuronium. C1 Univ Vienna, AKH Wien, Dept Anesthesiol & Gen Intens Care A, A-1090 Vienna, Austria. Ludwig Boltzmann Inst Expt Anesthesia & Res Inten, Vienna, Austria. Hungarian Acad Sci, Inst Expt Med, Budapest, Hungary. RP Michalek-Sauberer, A (reprint author), Univ Vienna, AKH Wien, Dept Anesthesiol & Gen Intens Care A, Waehringer Guertel 18-20, A-1090 Vienna, Austria. NR 35 TC 8 Z9 8 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD MAY PY 2000 VL 44 IS 5 BP 503 EP 510 DI 10.1034/j.1399-6576.2000.00502.x PG 8 WC Anesthesiology SC Anesthesiology GA 306LF UT WOS:000086597600002 ER PT J AU Lysakowski, C Fuchs-Buder, T Tassonyi, E AF Lysakowski, C Fuchs-Buder, T Tassonyi, E TI Mivacurium or vecuronium for paediatric ENT surgery - Clinical experience and cost analysis SO ANAESTHESIST LA English DT Article DE anaesthesia, paediatric; neuromuscular blocking agents, mivacurium, vecuronium; anaesthetic techniques, total intravenous anaesthesia, propofol, alfentanil; measurement techniques, electromyography; cost analysis ID NEUROMUSCULAR BLOCKADE; ANESTHESIA; CHILDREN; CHLORIDE; ROCURONIUM; SUXAMETHONIUM; ADULTS AB Background:The present study compared the quality of neuromuscular block and costs after equipotent doses of mivacurium and vecuronium in the context of paediatric ENT surgery. Methods: A total of 30 children undergoing elective tonsillectomy were included and randomised in two groups (n=15 for each) according to the neuromuscular blocking agent (NMBA) used. Anaesthesia was induced with alfentanil (15 mu g/kg), propofol (3 mg/kg) and either 0.2 mg/kg mivacurium or 0.14 mg/kg vecuronium. For maintenance of anaesthesia propofol (8-12 mg/kg/h) was given. Neuromuscular block was assessed by electromyography using train-of four stimulation and the following parameters were quantified: Twitch height (T1) 2 min after the initial bolus of the myorelaxant; duration until recovery to 18% T1, number and duration of bolus injections of the myorelaxant needed to maintain neuromuscular block to a T1<10%. In addition,the intubating conditions, number of patients needing pharmacological reversal at the end of surgery, adverse reactions and the costs for neuromuscular block and pharmacological antagonization were assessed. Results: Intubation conditions were comparable between both study groups: mivacurium - excellent: 7, good: 5, not acceptable: 1; vecuronium - excellent: 11, good: 4 (n.s.). T1 at 2 min was 16 (15)% for mivacurium and 6 (9)% for vecuronium (P<0.05). Time to 10% T1 recovery was 6.1 (1.7) min for mivacurium and 21.8 (3.7) min for vecuronium (P<0.01). In the mivacurium group 7 repetitive doses (range: 4-18) were needed to maintain T1<10% during surgery, whereas children treated with vecuronium needed only 1 maintenance dose (range: 0-2) (P<0.01). Two children in the mivacurium group and 11 in the vecuronium group required pharmacological reversal of the NMB at the end of surgery (P<0.01). The overall costs of NMB were significantly higher in the mivacurium group as compared to vecuronium 12.88 (4.5) Euro vs 9.96 (2.4) Euro; P<0.05. Conclusions: In conclusion, mivacurium-induced NMB is of very short duration in paediatric patients, and therefore repetitive doses are required to maintain a deep neuromuscular block. Nevertheless, residual paralysis is less frequent after mivacurium. The neuromuscular block after mivacurium was more expensive and residual pa ra lysis less frequent compared to vecuronium. C1 Univ Hosp Geneva, Dept Anaesthesiol Pharmacol & Surg Intens Care, Div Anaesthesiol, CH-1211 Geneva 14, Switzerland. Univ Saarland, Dept Anaesthesiol & Intens Care, D-6650 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Hosp Geneva, Dept Anaesthesiol Pharmacol & Surg Intens Care, Div Anaesthesiol, 24 Rue Micheli du Crest, CH-1211 Geneva 14, Switzerland. NR 24 TC 4 Z9 4 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD MAY PY 2000 VL 49 IS 5 BP 387 EP 391 DI 10.1007/s001010070106 PG 7 WC Anesthesiology SC Anesthesiology GA 323RW UT WOS:000087579600003 ER PT J AU Szmuk, P Ezri, T Chelly, JE Katz, J AF Szmuk, P Ezri, T Chelly, JE Katz, J TI The onset time of rocuronium is slowed by esmolol and accelerated by ephedrine SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT 60th Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 15-26, 1998 CL ORLANDO, FLORIDA SP Amer Soc Anesthesiol ID MIVACURIUM AB Administration of ephedrine prior to rocuronium decreases the onset time of neuromuscular blockade from rocuronium by 26%. This effect was attributed to a increased cardiac output. If so, beta adrenergic-blocking drugs, which decrease cardiac output, should prolong the onset time of rocuronium. In a double-blind study, 60 patients were randomly assigned to three groups (n = 20) to receive either 70 mu g.kg(-1) of ephedrine, 0.5 mg.kg(-1) esmolol or placebo, 30 s before induction of anesthesia. Onset time of rocuronium was defined as the time from the end of its injection to disappearance of all four twitches of the train-of-four. The onset time of rocuronium was significantly shorter after ephedrine (22%) and longer after esmolol (26%), as compared to placebo. No differences were observed among the three groups with regard to heart rate, systolic, diastolic or mean blood pressure. We concluded that a dose of 0.5 mg.kg(-1) of esmolol significantly prolongs the onset time of rocuronium with minimal hemodynamic changes. C1 Univ Texas, Sch Med, Dept Anesthesiol, Houston, TX 77030 USA. RP Szmuk, P (reprint author), Univ Texas, Sch Med, Dept Anesthesiol, 6431 Fannin,MSB 5020, Houston, TX 77030 USA. NR 15 TC 27 Z9 30 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 2000 VL 90 IS 5 BP 1217 EP 1219 DI 10.1097/00000539-200005000-00041 PG 3 WC Anesthesiology SC Anesthesiology GA 309JF UT WOS:000086764200040 ER PT J AU Rollino, C Visetti, E Borsa, S Pignataro, A Pozzato, M Vallero, A Quarello, F AF Rollino, C Visetti, E Borsa, S Pignataro, A Pozzato, M Vallero, A Quarello, F TI Is vecuronium toxicity abolished by hemodialysis? A case report SO ARTIFICIAL ORGANS LA English DT Article DE vecuronium; uremia AB Vecuronium is a curaric agent, largely used in anesthesia. Indications as to its employ in uremic patients appear to be debated because of partial renal elimination of the drug. A 52-year-old hemodialyzed woman required transplantectomy for rejection. At awakeness after general anesthesia (induced with fentanyl, propofol, and 6 mg of vecuronium, repeated with a single 2 mg dose 30 min later), she presented diafragmatic and muscular limb weakeness that lasted 180 min in spite of prostigmine administration. A 2 h 30 min predilutional hemofiltration was then performed, which induced rapid disappearance of neuromuscular blockade. Even if vecuronium can be used in dialysis patients, one should remember its possible side effects, especially with repeated doses, in determining prolonged neuromuscular blockade. Cautious use of this drug in renal failure is mandatory. Low dosage must be employed and repeated administration avoided. Neuromuscular blockade seems to be rapidly reversible with dialytic treatment. C1 Osped G Bosco, Div Nephrol, I-10154 Turin, Italy. Osped G Bosco, Div Anaesthesiol, I-10154 Turin, Italy. RP Rollino, C (reprint author), Osped G Bosco, Div Nephrol, Pza Donatore di Sangue 3, I-10154 Turin, Italy. NR 4 TC 0 Z9 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0160-564X J9 ARTIF ORGANS JI Artif. Organs PD MAY PY 2000 VL 24 IS 5 BP 386 EP 387 DI 10.1046/j.1525-1594.2000.06496.x PG 2 WC Engineering, Biomedical; Transplantation SC Engineering; Transplantation GA 319VG UT WOS:000087363100009 ER PT J AU Cammu, G Coddens, J Hendrickx, J Deloof, T AF Cammu, G Coddens, J Hendrickx, J Deloof, T TI Dose requirements of infusions of cisatracurium or rocuronium during hypothermic cardiopulmonary bypass SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE hypothermia; neuromuscular block, rocuronium; neuromuscular block, cisatracurium; surgery, cardiovascular ID NITROUS-OXIDE; PHARMACOKINETICS; VECURONIUM; ATRACURIUM; SURGERY; PHARMACODYNAMICS; PANCURONIUM; DISPOSITION; ANESTHESIA; PLASMA AB We investigated the influence of mild hypothermic cardiopulmonary bypass (CPB) on the dose requirements of cisatracurium or rocuronium used as a continuous infusion. We studied eight patients given cisatracurium and nine given rocuronium. They were ASA class III and IV and scheduled for elective coronary artery bypass grafting. Neuromuscular transmission was monitored electromyographically. After recovery of T1/T0 to 10%, a cisatracurium infusion or a rocuronium infusion was started at a rate of 1.5 or 10 mu g kg(-1) min(-1), respectively, and adjusted to maintain T1/T0 at 15%. Infusion rate and duration were recorded before, during and after CPB in each patient and the mean infusion rates were calculated. One-way ANOVA showed a statistically significant difference between the cisatracurium infusion rates before, during and after CPB: A T1/T0 of 15% could be achieved with a mean infusion rate of 1.1, 0.75 and 0.98 mu g kg(-1) min(-1) before, during and after CPB, respectively. There was no significant difference between the rocuronium infusion rates before, during and after CPB. The mean rocuronium infusion rate required to maintain T1/T0 at 15% throughout the procedure was 4.1 mu g kg(-1) min(-1). Cisatracurium infusion rates should be halved during CPB. Even after CPB, requirements are reduced. The same tendency occurs with rocuronium, but the changes in infusion rate were not statistically significant. C1 OLV Ziekenhuis, Dept Anaesthesiol & Crit Care Med, B-9300 Aalst, Belgium. RP Cammu, G (reprint author), State Univ Ghent Hosp, Dept Anaesthesia, Pintelaan 185, B-9000 Ghent, Belgium. NR 21 TC 8 Z9 18 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAY PY 2000 VL 84 IS 5 BP 587 EP 590 PG 4 WC Anesthesiology SC Anesthesiology GA 311NP UT WOS:000086890700009 ER PT J AU Kenaan, CA Estacio, RL Bikhazi, GB AF Kenaan, CA Estacio, RL Bikhazi, GB TI Pharmacodynamics and intubating conditions of cisatracurium in children during halothane and opioid anesthesia SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE cisatracurium; pediatrics; pharmacodynamics ID CLINICAL NEUROMUSCULAR PHARMACOLOGY; 51W89; VECURONIUM AB Study Objectives: To determine the pharmacodynamics and intubating conditions of cisatracurium 0.2 mg/kg in children aged 2 to 12 years. Design: Open-label, randomized study. Setting: Operating room of a university-affiliated hospital. Patients: 42 ASA physical status I and II patients, 24 to 155 months of age. Interventions: Patients were assigned to one of two groups: halothane anesthesia (G1) and opioid anesthesia (G2). Subsequently, each group was divided into two age subgroups: 24-59 months and 60-155 months. All patients were premedicated with midazolam intranasal 0.1 to 0.2 mg/kg. IN G1, anesthesia was induced with halothane up to 3% and N2O/O-2 (60-70/30-40%). Halothane was reduced to less than or equal to 2%, 2 minutes before cisatracurium was administered. In G2, anesthesia was induced with fentanyl 2 mu g/kg and thiopental 5 mg/kg. Anesthesia was maintained with halothane 0.8-1.5% in N2O/(2) in G1, and it was maintained with fentanyl, thiopental, and N2O/O-2 in G2. Electromyography (EMG) assessed the neuromuscular function of the adductor pollicis every 10 seconds with single-twitch supramaximal stimulus at induction and train-of-four at recovery. After obtaining EMG baseline, cisatracurium was administered. Onset time, time to 90% block, percentage of maximal block, clinical duration, and intubating conditions were recorded. For statistical analysis, Chi-square test, analysis of variance, and Tukey's test were used, with p-value less than 0.05. Measurements and Main Results: Only first twitch (T-1) recovery to 25% was significantly longer in patients ages 24 to 59 months who received halothane-based anesthesia, compared with those who received opioid-based anesthesia (p < 0.05). Onset time, maximum block, and intubating conditions conditions did not differ between groups (p > 0.05). Conclusions: Cisatracurium 0.2 mg/kg offered acceptable intubating conditions at 90 seconds in 98% of pediatric patients, regardless of the anesthesia-based technique. Longer clinical duration in the halothane group in younger children may be due to age-related potentiation or to the small number of patients enrolled in the younger subgroup. (C) 2000 by Elsevier Science Inc. C1 Univ Miami, Jackson Mem Med Ctr, Dept Anesthesiol R370, Miami, FL 33101 USA. RP Kenaan, CA (reprint author), Univ Miami, Jackson Mem Med Ctr, Dept Anesthesiol R370, POB 016370, Miami, FL 33101 USA. NR 14 TC 5 Z9 7 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAY PY 2000 VL 12 IS 3 BP 173 EP 176 DI 10.1016/S0952-8180(00)00132-X PG 4 WC Anesthesiology SC Anesthesiology GA 328XW UT WOS:000087877900001 ER PT J AU Cheam, EWS Chui, PT AF Cheam, EWS Chui, PT TI Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion SO ANAESTHESIA LA English DT Article DE larnygeal mask airway; neuromuscular blocking drugs, mivacurium; analgesic drugs, fentanyl ID PROPOFOL; COINDUCTION; THIOPENTONE; MIDAZOLAM; INDUCTION AB In a double-blind randomised study, we compared conditions during insertion of the: laryngeal mask airway in 150 patients who received either fentanyl 1 mu g.kg(-1), mivacurium 0.04 mg.kg(-1) or normal saline, before induction of anaesthesia with propofol 2 mg.kg(-1). Insertion conditions, including mouth opening, swallowing, gagging or coughing, head or Limb movement and ease of insertion, were each graded using a three-point scale. The median (interquartile range) summed insertion scores were more favourable with the use of fentanyl [8.0 (7.0-9.0)] and mivacurium [7.5 (6.8-8.3)] than with normal saline [9.0 (7.8-10.3); p<0.01]. Fentanyl and mivacurium decreased swallowing and head or limb movement, and mivacurium improved mouth opening. Insertion conditions were similar between fentanyl and mivacurium, while both prolonged apnoea. Fentanyl and mivacurium are equally effective in facilitating insertion of the laryngeal mask airway following anaesthetic induction with propofol. C1 Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Shatin, Hong Kong, Peoples R China. RP Chui, PT (reprint author), Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Shatin, Hong Kong, Peoples R China. NR 10 TC 8 Z9 10 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD APR PY 2000 VL 55 IS 4 BP 323 EP 326 DI 10.1046/j.1365-2044.2000.01214.x PG 4 WC Anesthesiology SC Anesthesiology GA 308LM UT WOS:000086713000003 ER PT J AU Deehan, S Henderson, D Stewart, K AF Deehan, S Henderson, D Stewart, K TI Intubation conditions and postoperative myalgia in outpatient dental surgery: A comparison of succinylcholine with mivacurium SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE muscle relaxants : succinylcholine; mivacurium; complications : myalgia ID SUXAMETHONIUM-INDUCED MYALGIA; LAPAROSCOPIC SURGERY; MUSCLE PAIN; PRETREATMENT; ROCURONIUM; PREVENTION; VECURONIUM; SEQUELAE; DRUGS AB Ninety-four patients undergoing elective outpatient third molar extraction were recruited into a double-blind, randomized, prospective trial comparing mivacurium (group hi) with succinylcholine (Group S) for conditions for endotracheal intubation and the occurrence of postoperative myalgia. Anaesthesia was induced with fentanyl 1 mu g.kg(-1) and propofol 2.5 mg.kg(-1) in all patients, Group S patients were given gallamine 20 mg while group M patients were given mivacurium 0.2 mg.kg(-1). Manual ventilation was commenced and anaesthesia maintained with nitrous oxide 70% and isoflurane I to 2% in oxygen. After two minutes, group S patients were given succinylcholine 1.5 mg.kg(-1) and group M patients 0.9% saline, Nasotracheal intubation was performed 30 seconds Infer: Intubating conditions iii group M were significantly better than those in group S (P<0.001), The incidence of postoperative myalgia was 9.5% in group M and 26% in group S but this was not statistically significant (P=0.09). We propose that mivacurium is a suitable neuromuscular blocker to use for endotracheal intubation in outpatient dental surgery. C1 St Johns Hosp, Dept Anaesthet, Livingston EH54 6PP, West Lothian, Scotland. RP Stewart, K (reprint author), St Johns Hosp, Dept Anaesthet, Livingston EH54 6PP, West Lothian, Scotland. NR 24 TC 0 Z9 0 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD APR PY 2000 VL 28 IS 2 BP 146 EP 150 PG 5 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 304YC UT WOS:000086511400003 ER PT J AU Klaus, K Friedrich, S Reinhardt, D Bufler, J AF Klaus, K Friedrich, S Reinhardt, D Bufler, J TI Pentobarbital has curare-like effects on adult-type nicotinic acetylcholine receptor channel currents SO ANESTHESIA AND ANALGESIA LA English DT Article ID MOUSE MYOTUBES; BLOCK; ISOFLURANE; MECHANISMS; ANESTHESIA; MEMBRANE; KINETICS; PATCHES; MUSCLE; CELLS AB Pentobarbital (PB) is widely used as a short-term sedative and anticonvulsive drug with a side-effect of relaxing muscle tone. We investigated block of nicotinic acetylcholine receptor (nAChR) channel currents by PB using the patch-clamp technique in combination with an ultrafast system for solution exchange. As a preparation, recombinant rat adult-type nAChR channels transiently expressed in HEK293 cells were used. Appli-cation of 1 mM acetylcholine to small cells or outside-outpatches showed a transient current with fast activation and desensitization kinetics. Adding PB to the acetylcholine-containing solution resulted in a decrease of the time constant of current decay and of the peak current amplitude starting at concentrations >0.01 mM PB. Preincubation of nAChR channels with PB led to a decrease of the peak current amplitude without alteration of activation and desensitization kinetics caused by competitive block of nAChR channels. In conclusion, similar to the effect of d-Tubocurarine, block of nAChR channel currents by PB can be explained by a combination of open-channel and competitive block. Implications: The interaction between adult-type nicotinic acetylcholine receptors, acetylcholine, and pentobarbital was biophysically investigated by using the patch-clamp technique in combination with tools for ultrafast solution exchange. PB elicited open-channel block and competitive block of nicotinic acetylcholine receptor channel currents, whereas the latter seems to be effective in clinically relevant concentrations. C1 Hannover Med Sch, Dept Neurol, D-30623 Hannover, Germany. RP Bufler, J (reprint author), Hannover Med Sch, Dept Neurol, D-30623 Hannover, Germany. NR 21 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 2000 VL 90 IS 4 BP 970 EP 974 PG 5 WC Anesthesiology SC Anesthesiology GA 299GZ UT WOS:000086191800036 ER PT J AU Sundman, E Witt, H Olsson, R Ekberg, O Kuylenstierna, R Eriksson, LI AF Sundman, E Witt, H Olsson, R Ekberg, O Kuylenstierna, R Eriksson, LI TI The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans - Pharyngeal videoradiography and simultaneous manometry after atracurium SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 24th Congress of the Scandinavian-Society-of-Anaesthesiologists CY JUN, 1997 CL STOCKHOLM, SWEDEN SP Scandinavian Soc Anaesthesiologists DE dysphagia; postoperative pulmonary complications; respiration ID SPHINCTER PRESSURE; SWALLOWING REFLEX; HUMAN VOLUNTEERS; VIDEOMANOMETRY; DYSPHAGIA; ANESTHESIA AB Background: Residual neuromuscular block caused by vecuronium alters pharyngeal function and impairs airway protection. The primary objectives of this investigation were to radiographically evaluate the swallowing act and to record the incidence of and the mechanism behind pharyngeal dysfunction during partial neuromuscular block The secondary objective was to evaluate the effect of atracurium on pharyngeal function. Methods: Twenty healthy volunteers were studied while awake during liquid-contrast bolus swallowing. The incidence of pharyngeal dysfunction was studied by fluoroscopy. The initiation of the swallowing process, the pharyngeal coordination, and the bolus transit time were evaluated. Simultaneous manometry was used to document pressure changes at the tongue base, the pharyngeal constrictor muscles, and the upper esophageal sphincter. After control recordings, an intravenous infusion of atracurium was administered to obtain train-of-four ratios (T-4/T-1) of 0.60, 0.70, and 0.80, followed by recovery to a train-of-four ratio of more than 0.90. Results: The incidence of pharyngeal dysfunction was 6% during the control recordings and increased (P < 0.05) to 28%, 17%, and 20% at train-of-four ratios 0.60, 0.70, and 0.80, respectively. After recovery to a train-of-four ratio of more than 0.90, the incidence was 13%. Pharyngeal dysfunction occurred in 74 of 444 swallows, the majority (80%) resulting in laryngeal penetration. The initiation of the swallowing reflex was impaired during partial paralysis (P = 0.0081). The pharyngeal coordination was impaired at train-of-four ratios of 0.60 and 0.70 (P < 0.01). A marked reduction in the upper esophageal sphinacter resting tone was found, as well as a reduced contraction force in the pharyngeal constrictor muscles. The bolus transit time did not change significantly. Conclusion: Partial neuromuscular paralysis caused by atracurium is associated with a four- to fivefold increase in the incidence of misdirected swallowing. The mechanism behind the pharyngeal dysfunction is a delayed initiation of the swallowing reflex, impaired pharyngeal muscle function, and impaired coordination. The majority of misdirected swallows resulted in penetration of bolus to the larynx. C1 Karolinska Hosp & Inst, Dept Anesthesiol, S-17176 Stockholm, Sweden. Karolinska Hosp & Inst, Dept Diagnost Radiol, S-17176 Stockholm, Sweden. Karolinska Hosp & Inst, Dept Otorhinolaryngol, S-17176 Stockholm, Sweden. Malmo Univ Hosp, Malmo, Sweden. RP Sundman, E (reprint author), Karolinska Hosp & Inst, Dept Anesthesiol & Intens Care, S-17176 Stockholm, Sweden. NR 22 TC 92 Z9 100 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 2000 VL 92 IS 4 BP 977 EP 984 DI 10.1097/00000542-200004000-00014 PG 8 WC Anesthesiology SC Anesthesiology GA 299AB UT WOS:000086172700010 ER PT J AU Meakin, GH Meretoja, OA Motsch, J Taivainen, T Wirtavuori, K Schonstedt, R Perkins, R McCluskey, A AF Meakin, GH Meretoja, OA Motsch, J Taivainen, T Wirtavuori, K Schonstedt, R Perkins, R McCluskey, A TI A dose-ranging study of rapacuronium in pediatric patients SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 19-23, 1999 CL NEW ORLEANS, LOUISIANA SP Amer Soc Anesthesiolog DE muscle relaxants; pediatric anesthesia; tracheal intubation ID NEUROMUSCULAR BLOCKING-AGENTS; HALOTHANE ANESTHESIA; TIME-COURSE; ROCURONIUM BROMIDE; RESPONSE CURVE; CHILDREN; VECURONIUM; INFANTS; ACCELEROMYOGRAPHY; PHARMACOKINETICS AB Background: The aim of this study was to determine the dose or doses of the new rapid-onset, short-acting, neuromuscular blocking drug rapacuronium that would provide satisfactory conditions for tracheal intubation at 60 s in infants and children. Methods: Sixty-five infants (< 1 yr), 51 younger children (1-6 yr), and 49 older children (7-12 yr) were studied. Anesthesia was induced with thiopental-nitrous oxide-oxygen. Tracheal intubation was attempted 60 s after administration of one of five doses of rapacuronium (0.5, 1.0, 1.5, 2.0, or 2.5 mg/kg) and intubating conditions were assessed using a four-point scale. Following tracheal intubation, anesthesia was maintained with nitrous oxide-oxygen and alfentanil (12.5-50 mu g/kg) as necessary. Neuromuscular transmission was monitored in an uncalibrated fashion using an acceleromyograph. Results: Intubating conditions were good or excellent at 60 s in all infants after doses of 1.5 mg/kg or more and in all younger and older children after doses of 2.0 mg/kg or more. The duration of action of rapacuronium was dose- and age-dependent. Mean times to reappearance of the third twitch of the train-of-four (TOF; T-3) were less than 10 min in infants at doses of 1.5 mg/kg or less and in younger and older children at doses of 2.0 mg/kg or less. Recovery of T-3 after 1.0-2.0 mg/kg rapacuronium was significantly slower in infants compared with younger (P = 0.001) and older (P = 0.02) children. Five adverse experiences were related to rapacuronium administration: Bronchospasm (two instances), tachycardia (one instance), and increased salivation (two Instances). None were serious. Conclusions: Doses of 1.5 and 2.0 mg/kg rapacuronium can produce satisfactory intubating conditions at 60 s in anesthetized infants and children, respectively, and are associated with a short duration of action. C1 Univ Manchester, Royal Manchester Childrens Hosp, Dept Anesthesia, Manchester M27 4HA, Lancs, England. Univ Helsinki, Childrens Hosp, Dept Anesthesia, FIN-00014 Helsinki, Finland. Univ Heidelberg, Dept Anesthesia, D-6900 Heidelberg, Germany. RP Meakin, GH (reprint author), Univ Manchester, Royal Manchester Childrens Hosp, Dept Anesthesia, Manchester M27 4HA, Lancs, England. NR 27 TC 15 Z9 15 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 2000 VL 92 IS 4 BP 1002 EP 1009 DI 10.1097/00000542-200004000-00017 PG 8 WC Anesthesiology SC Anesthesiology GA 299AB UT WOS:000086172700013 ER PT J AU Puhringer, FK Keller, P Lockinger, A Kleinsasser, A Scheller, A Raedler, C Keller, C AF Puhringer, FK Keller, P Lockinger, A Kleinsasser, A Scheller, A Raedler, C Keller, C TI Smoking does not alter the dose-requirements and the pharmacodynamics of rocuronium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article AB Purpose: Controversial data about the effect of smoking on the dose-requirements and-the pharamcodynamics of rocuronium have been reported recently. This study was conducted to evaluate the dose;requirements and the pharmacodynamics of rocuronium in smokers using target controlled infusion. Methods: The dose-requirements of rocuronium for 60 min relaxation, using target controlled infusion, given under intravenous anaesthesia with propofol, fentanyl and nitrous oxide was studied in 37 smokers and 37 nonsmokers. Initially 450 mu g.kg(-1) rocuronium were administered, neuromuscular effects were quantified by recording the single twitch response of the adductor pollicis muscle after ulnar nerve stimulation using a force transducer, and the neuromuscular block was kept at 80% by target controlled infusion throughout the procedure. Results: The dose-requirements for one hour relaxation were 867 +/- 116 mu g.kg(-1).hr(-1) for smokers (S) and 839 +/- 149 mu g.kg(-1).hr(-1) for non-smokers (NS), The duration to 10% and the spontaneous recovery from 25% to 75% of the control twitch response also showed no differences between S ( 17.2 +/- 3.4 min, 10.6 +/- 0.9 min) and NS (18.9 +/- 4.3 min, 10.9 +/- 3.2 min), as well as maximum block, onset time and infusion rate. Conclusion: Smoking does not alter the dose-requirements for rocuronium and no effects on the onset time, degree of block, time to maximum block, duration 10% and spontaneous recovery index were observed. C1 Univ Innsbruck, Dept Anaesthesia & Gen Intens Care Med, A-6020 Innsbruck, Austria. RP Puhringer, FK (reprint author), Univ Innsbruck, Dept Anaesthesia & Gen Intens Care Med, Anichstr 35, A-6020 Innsbruck, Austria. EM friedrich.puehringer@uibk.ac.at NR 6 TC 5 Z9 4 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 2000 VL 47 IS 4 BP 347 EP 349 PG 3 WC Anesthesiology SC Anesthesiology GA 362KC UT WOS:000089776300012 ER PT J AU Johnston, AJ Hall, JM Levy, DM AF Johnston, AJ Hall, JM Levy, DM TI Anaesthesia with remifentanil and rocuronium for caesarean section in a patient with long-QT syndrome and an automatic implantable cardioverter-defibrillator SO INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA LA English DT Article ID LANGE-NIELSEN-SYNDROME; T INTERVAL SYNDROME; CESAREAN-SECTION; ANESTHESIA; MANAGEMENT; JERVELL AB A 24-year-old woman with congenital long-QT syndrome (LQTS) required caesarean section at 32 weeks' gestation. Her risk of premature death from malignant ventricular tachyarrhythmias had necessitated implantation of an automatic cardioverter-defibrillator (AICD) with pacemaker capability. The patient expressed a preference for general anaesthesia. To minimise the risk of increased serum catecholamine concentrations and consequent ventricular arrhythmias, an analgesia-based regimen was chosen. With cardioversion, defibrillation, and antitachycardia pacing functions of the AICD selectively deactivated, anaesthesia was induced with bolus doses of thiopentone and remifentanil. Rocuronium was used for neuromuscular block. Anaesthesia was maintained with nitrous oxide and isoflurane, supplemented by a remifentanil infusion. We outline the pathophysiology and treatment of LQTS, and discuss the anaesthetic management of an obstetric patient with the congenital syndrome. This is the first reported case of caesarean section in a patient with an AICD, and the first description of the use of either remifentanil or rocuronium in LQTS. (C) 2000 Harcourt Publishers Ltd. C1 Univ Nottingham Hosp, NHS Trust, Queens Med Ctr, Nottingham NG7 2UH, England. RP Levy, DM (reprint author), Univ Nottingham Hosp, NHS Trust, Queens Med Ctr, Nottingham NG7 2UH, England. NR 19 TC 10 Z9 11 PU CHURCHILL LIVINGSTONE PI EDINBURGH PA JOURNAL PRODUCTION DEPT, ROBERT STEVENSON HOUSE, 1-3 BAXTERS PLACE, LEITH WALK, EDINBURGH EH1 3AF, MIDLOTHIAN, SCOTLAND SN 0959-289X J9 INT J OBSTET ANESTH JI Int. J. Obstet. Anesth. PD APR PY 2000 VL 9 IS 2 BP 133 EP 136 DI 10.1054/ijoa.1999.0362 PG 4 WC Anesthesiology; Obstetrics & Gynecology SC Anesthesiology; Obstetrics & Gynecology GA 333FA UT WOS:000088117900008 ER PT J AU Zhou, TJ Tang, J White, PF Joshi, GP Wender, R Murphy, MT Chiu, JW Webb, T AF Zhou, TJ Tang, J White, PF Joshi, GP Wender, R Murphy, MT Chiu, JW Webb, T TI Reversal of rapacuronium block during propofol versus sevoflurane anesthesia SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCK; TIME-COURSE; ISOFLURANE ANESTHESIA; MUSCLE-RELAXANT; VECURONIUM; ATRACURIUM; SUCCINYLCHOLINE; EDROPHONIUM; NEOSTIGMINE; RECOVERY AB We studied the antagonism of rapacuronium with edrophonium-atropine during propofol- or sevoflurane-based anesthesia in 60 healthy outpatients. After the induction of anesthesia with standardized doses of propofol and fentanyl, rapacuronium 1.5 mg/kg was administered to facilitate tracheal intubation. Patients were randomized to receive either a propofol infusion (100 mu g.kg(-1).min(-1)) or sevoflurane (1.0%, end-tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular block was monitored by using electromyography at the wrist and reversed with edrophonium 1.0 mg/kg and atropine 0.015 mg/kg when the first twitch (T-1) response of the train-of-four (TOF) stimulation recovered to 25% of the baseline value. The clinical duration of action (i.e., time to 25% T-1 recovery) was similar during both propofol (13.1 +/- 3.6 min) and sevoflurane (13.7 +/- 4.4 min) anesthesia. The time from 25% T-1 recovery to TOF ratio of 0.8 was also similar with propofol (3.4 +/- 2.1 min) and sevoflurane (5.9 +/- 8.7 min) (P > 0.05). Although none of the patients in the propofol group required more than 9 min to achieve a TOF ratio of 0.8, two patients receiving sevoflurane required 31 min and 37 min. Adequate antagonism of rapacuronium block with edrophonium can be achieved within 10 min during propofol anesthesia. However, more prolonged recovery may occur in the presence of sevoflurane. Implications: We studied the reversal of rapacuronium-induced block with edrophonium and found that the residual rapacuronium block can be readily antagonized during propofol-based anesthesia. However, reversal of rapacuronium appears to be less predictable during sevoflurane-based anesthesia. C1 Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX 75235 USA. Cedars Sinai Med Ctr, Dept Anesthesiol, Los Angeles, CA 90048 USA. RP White, PF (reprint author), Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, 5323 Harry Hines Blvd,F2 208, Dallas, TX 75235 USA. NR 21 TC 10 Z9 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 2000 VL 90 IS 3 BP 689 EP 693 DI 10.1097/00000539-200003000-00033 PG 5 WC Anesthesiology SC Anesthesiology GA 288KW UT WOS:000085562800033 ER PT J AU Szenohradszky, J Fogarty, D Kirkegaard-Nielsen, H Brown, R Sharma, ML Fisher, DM AF Szenohradszky, J Fogarty, D Kirkegaard-Nielsen, H Brown, R Sharma, ML Fisher, DM TI Effect of edrophonium and neostigmine on the pharmacokinetics and neuromuscular effects of mivacurium SO ANESTHESIOLOGY LA English DT Article DE antagonists; drug interaction; muscle relaxants ID DOSE-RESPONSE RELATIONSHIPS; SPONTANEOUS-RECOVERY; MUSCLE-RELAXANT; BLOCK; INFUSION; ANTAGONISM; ANESTHESIA; REVERSAL; REQUIREMENTS; VECURONIUM AB Background: Previous studies demonstrated that both edrophonium and neostigmine affect mivacurium's pharmacokinetics, thereby potentially affecting its recovery profile. However, those studies were not clinically relevant because mivacurium was still infused after the antagonists were given. in the present study. the authors gave antagonists (or placebo) after discontinuing a mivacurium infusion, thereby obtaining data that are more clinically relevant. Methods: in 18 patients, mivacurium was infused at 10 mu g.kg(-1).min(-1) for 40 min, the infusion was discontinued for 15 min and then restarted at the same rate for another 40 min. Patients were randomized to receive 500 mu g/kg edrophonium, 50 mu g/kg neostigmine, or saline at discontinuation of the second infusion: all subjects received 1 mg atropine. Plasma was sampled during the final 10 min of each infusion to determine steady state mivacurium concentrations and for 15 min after each infusion. Twitch tension was recorded. Mivacurium concentrations after each of the two infusions were compared. Results: After discontinuation of the second infusion, mivacurium concentrations were larger than those after the first infusion at 2 min with edrophonium and at 2, 4, and 7 min with neostigmine. With both neostigmine and edrophonium, twitch tension recovered after infusion #2 more rapidly than after infusion +1: however, the magnitude of this effect was small, Conclusion: Edrophonium transiently slows the rate at which mivacurium concentrations decrease; this is consistent with our previous findings. Neostigmine has a similar, although longer, effect, Despite altering mivacurium's elimination characteristics, both drugs facilitate neuromuscular recovery, although their benefit is small. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. NR 19 TC 2 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 2000 VL 92 IS 3 BP 708 EP 714 DI 10.1097/00000542-200003000-00015 PG 7 WC Anesthesiology SC Anesthesiology GA 289NL UT WOS:000085628800013 ER PT J AU Kindler, CH Verotta, D Gray, AT Gropper, MA Yost, CS AF Kindler, CH Verotta, D Gray, AT Gropper, MA Yost, CS TI Additive inhibition of nicotinic acetylcholine receptors by corticosteroids and the neuromuscular blocking drug vecuronium SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 72nd Clinical and Scientific Congress of the International-Anesthesia-Research-Society CY MAR 07-11, 1998 CL ORLANDO, FLORIDA SP Int Anesthesia Res Soc DE antagonists; corticosteroids; drug interaction; intensive care; paralysis; vecuronium ID CRITICALLY ILL PATIENTS; PROLONGED PARALYSIS; STATUS-ASTHMATICUS; MUSCLE-RELAXANTS; LIGAND-BINDING; ACUTE MYOPATHY; AGENTS; FETAL; POLYNEUROPATHY; HYDROCORTISONE AB Background Neuromuscular disorders associated with muscular weakness and prolonged paralysis are common in critically iu patients. Acute myopathy has been described in patients receiving a combination therapy of corticosteroids and nondepolarizing neuromuscular blocking drugs for treatment of acute bronchospasm. The cause of this myopathy is not fully established and may involve drug interactions that perturb neuromuscular transmission. To investigate the interaction of corticosteroids with neuromuscular blocking drugs, the authors determined the effects of methylprednisolone and hydrocortisone alone and in combination with vecuronium on fetal (gamma-subunit containing) and adult (epsilon-subunit containing) subtypes of the muscle-type nicotinic acetylcholine receptor. Methods: Functional channels were expressed in Xenopus laevis oocytes and activated with 1 mu M acetylcholine. The resulting currents were recorded using a whole cell two-electrode voltage clamp technique. Results: Both forms of the muscle-type acetylcholine receptor were potently inhibited by methylprednisolone and hydrocortisone, with concentrations producing 50% inhibition in the range of 400-600 mu M and 1-2 mM, respectively. The corticosteroids produced noncompetitive antagonism of the muscle-type nicotinic acetylcholine receptor at clinical concentrations. Both receptor forms were also inhibited, even more potently, by vecuronium, with a concentration producing 50% inhibition in the range of 1-2 nM. Combined application of vecuronium and methylprednisolone showed additive effects on both receptor forms, which were best described by a two-site model, with each site independent. Conclusions: The enhanced neuromuscular blockade produced when corticosteroids are combined with vecuronium may augment pharmacologic denervation and contribute to the pathophysiology of prolonged weakness observed in some critically ill patients. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. Univ Calif San Francisco, Dept Biopharmaceut Sci & Pharmaceut Sci, San Francisco, CA 94143 USA. Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA. RP Yost, CS (reprint author), Univ Calif San Francisco, Dept Anesthesia, 513 Parnassus Ave,Box 0542, San Francisco, CA 94143 USA. NR 45 TC 28 Z9 28 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 2000 VL 92 IS 3 BP 821 EP 832 DI 10.1097/00000542-200003000-00026 PG 12 WC Anesthesiology SC Anesthesiology GA 289NL UT WOS:000085628800024 ER PT J AU Baillard, C Gehan, G Reboul-Marty, J Larmignat, P Samama, CM Cupa, M AF Baillard, C Gehan, G Reboul-Marty, J Larmignat, P Samama, CM Cupa, M TI Residual curarization in the recovery room after vecuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, vecuronium; neuromuscular block, measurement of response; monitoring, neuromuscular function ID ATRACURIUM; VOLUNTEERS; BLOCK AB We have investigated residual block after anaesthesia which included the use of the neuromuscular blocking agent vecuronium but no anticholinesterase, in 568 consecutive patients on admission to the recovery room. The ulnar nerve was stimulated submaximally using TOF stimulation (30 mA). Postoperative residual curarization was defined as a TOF ratio <0.7. Of the 568 patients, 239 (42%) had a TOF <0.7 in the recovery room. These patients had received a larger cumulative dose of vecuronium than patients who had full recovery (mean 7.7 (SD 3.6) mg vs 6.2 (2.7) mg; P<0.05) and a shorter time had elapsed since the last vecuronium dose (117 (70) min vs 131 (80) min; P<0.05). Of 435 patients whose trachea was extubated, 145 (33%) exhibited inadequate recovery from neuromuscular block Six of these had one or no response to TOF stimulation and were reintubated. In the remaining 139 patients, neuromuscular block was successfully antagonized. Only 20 patients (3.5%) remembered TOF stimulation when questioned 2 h later in the recovery room, and discomfort associated with it was assessed using a visual analogue scale before discharge. We conclude that it is necessary to antagonize residual block produced by vecuronium. C1 Univ Hosp, Dept Anaesthesiol, Bobigny, France. Sch Med, Publ Hlth Unit, Bobigny, France. RP Baillard, C (reprint author), Hop Avicenne, Dept Anesthesie, 125 Route Stalingrad, F-93009 Bobigny, France. NR 6 TC 76 Z9 86 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAR PY 2000 VL 84 IS 3 BP 394 EP 395 PG 2 WC Anesthesiology SC Anesthesiology GA 289TL UT WOS:000085638000018 ER PT J AU Motamed, C Donati, F AF Motamed, C Donati, F TI Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID ADDUCTOR POLLICIS MUSCLES; VECURONIUM NEUROMUSCULAR BLOCKADE; ORBICULARIS OCULI; TRACHEAL INTUBATION; D-TUBOCURARINE; DOSE-RESPONSE; ATRACURIUM; ONSET; SUXAMETHONIUM; DURATION AB Purpose: Mivacurium-rocuronium combinations have been demonstrated to be more potent than either drug given alone. Combinations were compared with mivacurium and rocuronium, with respect to onset, intubating conditions, and duration of action in young and elderly adults. Methods: Fentanyl-propofol-N2O-isoflurane anesthesia was given to ASA I and II adults aged 18-65 yr (45 patients) and over 66 yr (45 patients), In this blinded randomized study, we compared accelerographic adductor pollicis response and visual assessment of response to facial nerve stimulation after 0.25 mg.kg(-1) mivacurium, 0.6 mg.kg(-1) rocuronium, and a combination of 0.08 mg.kg(-1) mivacurium plus 0.2 mg.kg(-1) rocuronium. Intubating conditions at 2.5 min were rated as excellent, good, fair or poor. Results: Onset times were similar for all drugs regimens and for both age groups (204-276 sec at the thumb; 142-196 sec at the eye) (P < 0.05 between muscles). Intubating conditions were similar in all groups, and rated good or excellent, except in two subjects, In young patients duration to 25% recovery was longer (P < 0.05) for rocuronium (mean +/- SD) (39 +/- 11 min) than for either mivacurium (23 +/- 6 min), or the combination (27 +/- 7 min). Duration was prolonged in the elderly for rocuronium (54 +/- 17 min), and the combination ( 35 +/- 11 min), but not for mivacurium (24 +/- 6 min), Conclusions: Mivacurium-rocuronium combinations yield onset times and intubating conditions similar to either parent agent with only two thirds as much total drug. Duration for such a mixture is similar to that of mivacurium in young adults and slightly prolonged in the elderly. C1 CHU Montreal, Hotel Dieu, Dept Anesthesie, Montreal, PQ H2W 1T8, Canada. RP Donati, F (reprint author), CHU Montreal, Hotel Dieu, Dept Anesthesie, 3840 Rue St Urbain, Montreal, PQ H2W 1T8, Canada. NR 31 TC 6 Z9 6 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 2000 VL 47 IS 3 BP 225 EP 231 PG 7 WC Anesthesiology SC Anesthesiology GA 362KB UT WOS:000089776200007 ER PT J AU St Pierre, M Landsleitner, B Schwilden, H Schuettler, J AF St Pierre, M Landsleitner, B Schwilden, H Schuettler, J TI Awareness during laryngoscopy and intubation: Quantitating incidence following induction of balanced anesthesia with etomidate and cisatracurium as detected with the isolated forearm technique SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE anesthesia, induction of; awareness; cisatracurium; etomidate ID GENERAL-ANESTHESIA; RESPONSES; ALFENTANIL; PROPOFOL; SURGERY; RECALL; EEG AB Study Objective: To measure the incidence of awareness during induction of anesthesia with etomidate and fentanyl, and to model its frequency as a function as a function of dose of etomidate. Design: Prospective cohort study. Setting: Anesthesia department of university hospital. Patients: 30 ASA physical status I, II, and III patients undergoing elective general surgery. Interventions: Patients were assigned to one of three groups of etomidate (0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg) and received fentanyl (2 mu g/kg) and 2 x ED95 of cisatracurium (0.1 mg/kg). Neuromuscular block was monitored with a peripheral nerve stimulator. Intubation was performed after maximum T-1-depression. To identify awareness, the isolated forearm technique (IFT) was used. The IFT was performed by prompting the patient every 20 seconds. Only a verified response was considered a positive IFT response. Anesthesia was maintained with isoflurane in oxygen/air and fentanyl. Measurements and Main Results: Maximum neuromuscular block occurred after 352 +/- 96 seconds and intubation was performed 424 +/- 86 seconds after loss of consciousness (LOC). Awareness was dose dependent: 80% of patients receiving 0.2 mg/kg etomidate, 70% of patients receiving 0.3 mg/kg etomidate, and 20% of patients receiving 0.4 mg/kg etomidate had a positive IFT response. Awareness occurred in one patient 3 minutes after LOC, in 65% during laryngoscopy, and in 30% within the following 120 seconds. One patient had explicit recall without finding awareness unpleasant. Hemodynamic parameters did not differ between patient with a positive or a negative IFT response. Conclusions: The incidence of awareness during bolus induction can be modelled as dose dependent. However when combining a short-acting induction drug and a delayed-onset neuromuscular blocker, the continuous infusion of the hypnotic drug may prevent awareness during induction. (C) 2000 by Elsevier Science Inc. C1 Univ Erlangen Nurnberg, Anasthesiol Klin, D-91054 Erlangen, Germany. RP St Pierre, M (reprint author), Univ Erlangen Nurnberg, Anasthesiol Klin, Krankenhausstr 12, D-91054 Erlangen, Germany. NR 23 TC 7 Z9 7 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 2000 VL 12 IS 2 BP 104 EP 108 DI 10.1016/S0952-8180(00)00127-6 PG 5 WC Anesthesiology SC Anesthesiology GA 318JA UT WOS:000087279100004 ER PT J AU Shaheen, B Wig, J Grewal, S Tewari, MK AF Shaheen, B Wig, J Grewal, S Tewari, MK TI Effect of pipecuronium and pancuronium on intracranial pressure and cavdiovascular parameters in patients with supratentorial tumours SO NEUROLOGY INDIA LA English DT Article DE neuromuscular relaxants; pancuronium; pipercuronium; intracranial pressure; cardiovascular parameters; neuro-anaesthesia ID HEART-RATE; HALOTHANE; BROMIDE AB A prospective, randomised, single blind study was conducted to evaluate and compare the intracranial pressure (ICP) and cardiovascular effects of pipecuronium (PPC) and pancuronium (PNC) in 20 patients undergoing supratentorial surgery. Patients were randomly divided into two groups. Patients in Group I (n=10) received pancuronium (0.1 mg kg(-1)) and in Group II (n=10) pipecuronium (0.07 mg kg(-1)) for intubation, Intracranial pressure (ICP), heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP, MAP), central venous pressure (CVP), nasopharyngeal temperature and arterial blood gases (ABG) were monitored at the following time periods: before induction (0 minutes); 3 minutes after thiopentone and muscle relaxant; immediately after intubation; and 4, 6, 8, 10, 20 and 30 minutes following intubation, The rise in intracranial pressure at intubation was significantly greater in group 1 (21.10+/-3.97 torr, 122.59%) when compared to group II patients (1.80+/-0.70 torr, 10.04%) (p<0.0 1), Cardiovascular parameters also showed a significantly greater degree of rise in group I when compared to group II patients. Heart rate increased by 29+/-6.32 beats min(-1) (33.52%) and systolic arterial pressure by 11.60+/-7.37 torr (9.47%) in group I. These parameters did not change significantly in group II, No significant alterations were observed in the other measured parameters in either of the two groups. C1 Postgrad Inst Med Educ & Res, Dept Anaesthesia, Chandigarh 160012, India. Postgrad Inst Med Educ & Res, Dept Neurosurg, Chandigarh 160012, India. NR 20 TC 0 Z9 1 PU NEUROL SOC INDIA PI CHANDIGARH PA C/O J S CHOPRA, PGIMER, DEPT NEUROLOGY, CHANDIGARH 160 012, INDIA SN 0028-3886 J9 NEUROL INDIA JI Neurol. India PD MAR PY 2000 VL 48 IS 1 BP 37 EP 42 PG 6 WC Neurosciences SC Neurosciences & Neurology GA 313GJ UT WOS:000086991700008 ER PT J AU Soriano, SG Kaus, SJ Sullivan, LJ Martyn, JAJ AF Soriano, SG Kaus, SJ Sullivan, LJ Martyn, JAJ TI Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy SO PAEDIATRIC ANAESTHESIA LA English DT Article DE epilepsy; nondepolarizing neuromuscular relaxants; rocuronium ID PHARMACOKINETIC DRUG-INTERACTIONS; INDUCED NEUROMUSCULAR BLOCKADE; INDUCED RESISTANCE; PHENYTOIN; CARBAMAZEPINE; VECURONIUM; MIVACURIUM; ATRACURIUM; INFANTS AB The onset and time course of action of rocuronium in normal children and children receiving anticonvulsant drugs for prolonged periods was characterized. A single bolus dose of 0.6 mg.kg(-1) rocuronium was administered i.v. to seven nonepileptic patients on no medication, and eight patients on chronic anticonvulsant therapy consisting of either phenytoin, carbamazepine, or both who were age and weight matched. Neuromuscular transmission was monitored by the evoked compound electromyography of the thenar muscles using train of four stimulation every 20 s. Recovery times of the first twitch to 10%, 25%, 50%, 75% and 100% of baseline values and recovery index were obtained. The onset times were 1.05 +/- 0.5 and 1.41 +/- 0.5 min for the control and anticonvulsant groups respectively and were not significantly different. Children receiving chronic anticonvulsant therapy had significantly shorter recovery index than the control group (control 10.4 +/- 5.1 min, anticonvulsant 4.8 +/- 1.7 min, P < 0.05). Furthermore, the duration of recovery to 10%, 50%, 75% and 100% of baseline T-1 values was less in the anticonvulsant drug group. Our data confirm resistance to rocuronium in children on chronic anticonvulsant drugs. C1 Harvard Univ, Childrens Hosp, Sch Med, Dept Anesthesia, Boston, MA 02115 USA. Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Anesthesia, Boston, MA 02115 USA. Minneapolis Childrens Hosp, Minneapolis, MN USA. RP Soriano, SG (reprint author), Harvard Univ, Childrens Hosp, Sch Med, Dept Anesthesia, 300 Longwood Ave, Boston, MA 02115 USA. NR 17 TC 15 Z9 15 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD MAR PY 2000 VL 10 IS 2 BP 133 EP 136 DI 10.1046/j.1460-9592.2000.00472.x PG 4 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 292MK UT WOS:000085798600004 ER PT J AU Xue, FS Liao, X Liu, JH Zhang, YM An, G Luo, LK AF Xue, FS Liao, X Liu, JH Zhang, YM An, G Luo, LK TI Influence of acute normovolaemic haemodilution on the dose-response and time-course of action of atracurium SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE neuromuscular relaxants, atracurium; pharmacodynamics; anesthetic technique : acute isovolemic hemodilution ID ACUTE NORMOVOLEMIC HEMODILUTION; NEUROMUSCULAR BLOCKING-AGENTS; ISOFLURANE ANESTHESIA; VECURONIUM; POTENCY; PANCURONIUM; BOLUS AB Background: Acute normovolaemic haemodilution is a common method to save and avoid homologous blood transfusion during surgery The aim of this study was to evaluate the influence of acute isovolaemic haemodilution on the dose-response and time-course of action of atracurium. Methods: We studied 25 patients undergoing acute isovolaemic haemodilution during surgery and 25 patients not receiving haemodilution as a control group. All patients were ASA grade I and aged 18-54 yr. The haemodilution patients underwent major elective plastic surgery with an anticipated surgical blood loss of more than 600 ml, and the control patients underwent elective superficial plastic surgery with an anticipated surgical blood loss of less than 200 ml. Anaesthesia was induced with thiopental 4-6 mg/kg and fentanyl 2-4 mu g/kg i.v., and maintained with 60% nitrous oxide in oxygen. After stabilization of anaesthesia, acute isovolaemic haemodilution in the haemodilution group was achieved by drainage of venous blood and an i.v. infusion of lactated Ringer's solution, and 6% dextran, during which haematocrit and haemoglobin decreased from 45.1% to 25.8% and from 147.2 g/l to 91.2 g/l, respectively. When anaesthesia was stable in the control group and haemodilution was completed in the haemodilution group, neuromuscular function was assessed by measuring with accelerography the response of the adductor pollicis muscle to supramaximal train-of-four (TOF) stimuli every 12 s to the ulnar nerve at the wrist via surface electrodes. The dose-response relationships of atracurium in the two groups were determined by the cumulative dose-response technique. Results: The results showed that during haemodilution, the dose-response curve of atracurium was shifted to the left in a parallel fashion and the potency of atracurium was increased. In patients undergoing haemodilution, ED50, ED90 and ED95 of atracurium were decreased by 25-33%, and duration of action was increased by 21-48% following administration of the same dose (mg/kg), as compared with patients not undergoing haemodilution. Conclusion: We concluded that the patients undergoing acute isovolaemic haemodilution were about 30% more sensitive to neuromuscular blockade of atracuium and had a longer duration after administration of the same dose (mu g/kg) than the control patients. Care must be taken with this problem when atracurium is used as a muscle relaxant during acute haemodilution. C1 Chinese Acad Med Sci, Plast Surg Hosp, Dept Anaesthesia, Beijing 100041, Peoples R China. Peking Union Med Coll, Beijing 100041, Peoples R China. RP Xue, FS (reprint author), Chinese Acad Med Sci, Plast Surg Hosp, Dept Anaesthesia, Ba-Da-Chu Rd,Shi-Jing-Shan Dist, Beijing 100041, Peoples R China. NR 25 TC 4 Z9 11 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD FEB PY 2000 VL 44 IS 2 BP 163 EP 169 DI 10.1034/j.1399-6576.2000.440206.x PG 7 WC Anesthesiology SC Anesthesiology GA 283MJ UT WOS:000085279100006 ER PT J AU Eikermann, M Peters, J AF Eikermann, M Peters, J TI Nerve stimulation at 0.15 Hz when compared to 0.1 Hz speeds the onset of action of cisatracurium and rocuronium SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE neuromuscular block; monitoring : neuromuscular; function; nerve stimulation frequency; onset of action; cisatracurium; rocuronium ID NEUROMUSCULAR BLOCK; STIMULUS FREQUENCY; D-TUBOCURARINE; DOSE-RESPONSE; BLOOD-FLOW; MUSCLE; SUXAMETHONIUM; ANESTHESIA; ATRACURIUM; TRAIN-OF-4 AB Background: Onset time of specific non-depolarizing muscle relaxants (NDMR), as reported in the literature, varies widely. To test the suggestion of a consensus panel (Copenhagen Consensus Conference 1996) that onset time in muscle relaxant studies depends on stimulation frequency, even in the low frequency range, we examined the onset time of cisatracurium and rocuronium by parallel ulnar nerve stimulation in both upper extremities at 0.1 Hz and 0.15 Hz. Methods: Thirty patients (ASA class I and II) were included. Onset of action following the administration of 2xED90 of cisatracurium (0.092 mg.kg(-1)) or rocuronium (0.74 mg.kg(-1)) was measured by quantifying the evoked response of the adductor pollicis muscles using mechanomyography. Single twitch stimulations were applied simultaneously to the ulnar nerves of both forearms using a 0.1 Hz and 0.15 Hz stimulation frequency, respectively. Results: Both relaxants showed a significantly (P<0.01) shorter onset time with 0.15 Hz compared to 0.1 Hz stimulation (cisatracurium: 186+/-50 s vs. 233+/-59 s, rocuronium: 73+/-14 s vs. 99+/-23 s; (x) over bar +/- SD). Conclusions: Onset time of NDMR depends on the stimulation frequency, even in the low frequency range. When comparing onset studies, the reader must also compare the stimulation rates used by the investigators. We recommend the use of 0.1 Hz single twitch nerve stimulation frequency as the standard for studies of onset profile of NDMR. C1 Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, D-45122 Essen, Germany. RP Eikermann, M (reprint author), Univ Essen Gesamthsch, Abt Anasthesiol & Intens Med, D-45122 Essen, Germany. NR 20 TC 5 Z9 5 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD FEB PY 2000 VL 44 IS 2 BP 170 EP 174 DI 10.1034/j.1399-6576.2000.440207.x PG 5 WC Anesthesiology SC Anesthesiology GA 283MJ UT WOS:000085279100007 ER PT J AU Wajima, Z Shitara, T Inoue, T Yoshikawa, T Ogawa, R AF Wajima, Z Shitara, T Inoue, T Yoshikawa, T Ogawa, R TI The effect of previous administration of nizatidine on the neuromuscular effects of vecuronium and the effect of nizatidine on gastric secretion SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE pharmacology : nizatidine, vecuronium, interactions ID ORAL NIZATIDINE; ANESTHESIA; RANITIDINE; VOLUME; PH AB Nizatidine, a new Hz-receptor antagonist, has been reported to inhibit acetylcholinesterase activity. This could lead to an interaction with neuromuscular blocking drugs. This study examined the effects of nizatidine on the actions of vercuronium. Oral nizatidine has been reported to be an effective protective agent against acid aspiration syndrome, and Mle reevaluated this effect. The control group (n = 10) received a placebo with water 50 mi and the nizatidine group (n = 10) received nizatidine 300 mg with water 50 mi two hours before arrival in the operating room. Gastric contents were aspirated and the volume and pH measured before induction of anaesthesia, Anaesthesia was induced in all patients with thiopentone 5 mg/kg and 1.5% isoflurane in 98.5% oxygen followed by vecuronium 0.1 mg/kg. Vecuronium onset time and duration time 25 (time from injection until recovery of 25% of vaseline twitch amplitude) were obtained using electromyography, There were no significant differences between the two groups in vecuronium onset time or duration time 25, Gastric fluid volume was gr eater and gastric pH was lower in the control group than in the nizatidine group. 70% Of the control group and none of the nizatidine group (P < 0.005) had a gastric content pH < 2.5 or volume > 25 mi. C1 Chiba Hokusoh Hosp, Dept Anaesthesia, Nippon Med Sch, Inba, Chiba 2701694, Japan. RP Wajima, Z (reprint author), Chiba Hokusoh Hosp, Dept Anaesthesia, Nippon Med Sch, 1715 Kamagari, Inba, Chiba 2701694, Japan. NR 11 TC 0 Z9 0 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD FEB PY 2000 VL 28 IS 1 BP 46 EP 48 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 284ZK UT WOS:000085362600008 ER PT J AU Puhringer, FK Scheller, A Kleinsasser, A Lockinger, A Keller, P Raedler, C Keller, C AF Puhringer, FK Scheller, A Kleinsasser, A Lockinger, A Keller, P Raedler, C Keller, C TI The effect of different priming doses on the pharmacodynamics of cisatracurium SO ANAESTHESIST LA German DT Article DE cisatracurium; priming principle; onset time; duration of action ID ATRACURIUM; VECURONIUM; INTUBATION; PRINCIPLE; ONSET AB Objective: The aim of the study was to evaluate the effect of two different priming regimen on the onset time of 100 mu g/kg cisatracurium, when compared to bolus administration. Methods: 51 patients were randomly assigned and received either a bolus of 100 mu g/kg cisatracurium, or a priming dose of 10 mu g/kg cisatracurium followed after 4 min by 90 mu g/kg cisatracurium, ora priming dose of 15 mu g/kg cisatracurium followed after 4 min by 85 mu g/kg cisatracurium. The neuromuscular monitoring was performed using a mechanomyograph (Groningen II Monitor). Anaesthesia was induced with propofol and fentanyl and maintained by continuous infusion of propofol. Results: The priming combination of 15 mu g/kg cisatracurium followed after 4 min by 85 mu g/kg cisatracurium produced a statistically significant reduction in the onset time (95% block) (180+/-60 s) and time to complete block (210+/-48 s), when compared to the bolus group (240+/-60 s and 288+/-66 s) (p<0.05). Conclusion: Our data indicate that the "priming principle" is an appropriate technique to shorten the onset time of cisatracurium. To achieve a maximum effect the priming combination of 15 mu g/kg cisatracurium followed after 4 min by 85 mu g/kg cisatracurium is recommended. C1 Univ Innsbruck, Univ Klin Anaesthesie & Allgemeine Intens Med, A-6020 Innsbruck, Austria. RP Puhringer, FK (reprint author), Univ Innsbruck, Univ Klin Anaesthesie & Allgemeine Intens Med, Anichstr 35, A-6020 Innsbruck, Austria. EM friedrich.puehringer@uibk.ac.at NR 13 TC 9 Z9 13 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD FEB PY 2000 VL 49 IS 2 BP 102 EP 105 DI 10.1007/s001010050015 PG 4 WC Anesthesiology SC Anesthesiology GA 295EL UT WOS:000085953700004 ER PT J AU Busley, R Blobner, M Kochs, E AF Busley, R Blobner, M Kochs, E TI Rapacuronium: A new, non-depolarising muscle relaxant for rapid sequence induction SO ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE LA German DT Article ID ORG-9487 C1 Tech Univ Munich, Klinikum Rechts Isar, Inst Anaesthesiol, D-81675 Munich, Germany. RP Busley, R (reprint author), Tech Univ Munich, Klinikum Rechts Isar, Inst Anaesthesiol, Ismaninger Str 22, D-81675 Munich, Germany. NR 8 TC 1 Z9 1 PU GEORG THIEME VERLAG PI STUTTGART PA P O BOX 30 11 20, D-70451 STUTTGART, GERMANY SN 0939-2661 J9 ANASTH INTENSIV NOTF JI Anasthesiol. Intensivmed. NotfMed. Schmerzther. PD FEB PY 2000 VL 35 IS 2 BP 112 EP 114 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 289AG UT WOS:000085596700014 ER PT J AU Reynolds, LM Infosino, A Brown, R Hsu, J Fisher, DM AF Reynolds, LM Infosino, A Brown, R Hsu, J Fisher, DM TI Pharmacokinetics of rapacuronium in infants and children with intravenous and intramuscular administration SO ANESTHESIOLOGY LA English DT Article DE intramuscular injections; mixed-effects modeling; ORG9487 ID PHARMACODYNAMICS; BIOAVAILABILITY; ATRACURIUM; VECURONIUM; ROCURONIUM AB Background: A nondepolarizing muscle relaxant with an onset and offset profile similar to succinylcholine is desirable for pediatric anesthesia. The onset and offset of rapacuronium are rapid in children. In the current study, the authors determined its pharmacokinetic characteristics in children. In addition to administering rapacuronium by the usual intravenous route, the authors also gave rapacuronium intramuscularly to determine uptake characteristics and bioavailability. Methods: Forty unpremedicated patients aged 2 months to 3 yr were anesthetized with halothane, 0.82-1.0% end-tidal concentration. When anesthetic conditions were stable, rapacuronium was injected either into a peripheral vein (2 mg/kg for infants, 3 mg/kg for children) or a deltoid muscle (2.8 mg/kg for infants, 4.8 mg/kg for children). Four venous plasma samples were obtained from each subject 2-240 min after rapacuronium administration. A mixed-effects population pharmacokinetic analysis was applied to these values to determine bioavailability, absorption rate constant, and time to peak plasma concentration with intramuscular administration. Results: Plasma clearance was 4.77 ml.kg(-1).min(-1) + 8.48 ml/min. Intramuscular bioavailability averaged 56%. Absorption from the intramuscular depot had two rate constants: 0.0491 min(-1) (72.4% of absorbed drug) and 0.0110 min(-1) (27.6% of the absorbed drug). Simulation indicated that plasma concentration peaks 4.0 and 5.0 min after intramuscular rapa curonium in infants and children, respectively, and that, at 30 min, less than 25% of the administered dose remains to be absorbed from the intramuscular depot. Conclusions: In infants and children, rapacuronium's clearance and steady state distribution volume are less than in adults. After intramuscular administration, bioavailability is 56%, and plasma rapacuronium concentrations peak within 4 or 5 min. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. NR 17 TC 9 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD FEB PY 2000 VL 92 IS 2 BP 376 EP 386 DI 10.1097/00000542-200002000-00018 PG 11 WC Anesthesiology SC Anesthesiology GA 280AC UT WOS:000085078600014 ER PT J AU Feiss, P Fompeyrine, S Banssillon, V Caramella, P Ecoffey, C Gateau, O Guy, P Haberer, JP Hemery, F Oberlin, P Schmitt, M AF Feiss, P Fompeyrine, S Banssillon, V Caramella, P Ecoffey, C Gateau, O Guy, P Haberer, JP Hemery, F Oberlin, P Schmitt, M TI Short text - Indications for curare in anesthesia SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article C1 CHU Dupuytren, Limoges, France. RP Feiss, P (reprint author), CHU Dupuytren, Limoges, France. NR 0 TC 5 Z9 5 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD FEB PY 2000 VL 19 IS 2 BP FI34 EP FI37 PG 4 WC Anesthesiology SC Anesthesiology GA 292AZ UT WOS:000085773100015 ER PT J AU Brandom, BW Margolis, JO Bikhazi, GB Ross, AK Ginsberg, B Dear, GD Kenaan, CA Eck, JB Woelfel, SK Lloyd, ME AF Brandom, BW Margolis, JO Bikhazi, GB Ross, AK Ginsberg, B Dear, GD Kenaan, CA Eck, JB Woelfel, SK Lloyd, ME TI Neuromuscular effects of rapacuronium in pediatric patients during nitrous oxide-halothane anesthesia: comparison with mivacurium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article; Proceedings Paper CT 48th Annual Meeting of American-Society-of-Anesthesiologists CY OCT 17-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiol ID ENDOTRACHEAL INTUBATING CONDITIONS; NERVE-STIMULATION; TIME-COURSE; CHILDREN; VECURONIUM; ORG-9487; INFANTS; ONSET; SUCCINYLCHOLINE; ROCURONIUM AB Purpose: To describe neuromuscular effects of rapacuronium in pediatric patients during N2O-halothane anesthesia and compare them with mivacurium in children. Methods: 103 pediatric patients. seven days - 12 yr, received rapacuronium or mivacurium during N2O-halothane anesthesia. Onset and recovery of block were measured using EMG (Datex). Block was compared between groups based on drug treatment and age. Children < two years received I or 2 mg.kg(-1) rapacuronium: 2 - 12 yr received either 2 mg.kg(-1) or 3 mg.kg(-1) rapacuronium, or 0.2 mg.kg(-1) mivacurium. Results: There were no differences in onset( 1.7 +/- 1.8 min) or maximum block (T1 2.4 +/- 8%) among neonates, infants, and toddlers after either dose of rapacuronium. There was no difference between I and 2 mg.kg(-1) of rapacuronium block at 60 sec. Train-of-four ratio (T4/T1) > 0.7 occurred later after 2 mg.kg(-1) than 1 mg.kg(-1) in these patients (P < 0.05). There was no difference in T25 among neonates, infants and toddlers for I mg.kg(-1) or 2 mg.kg(-1) doses. Rapacuronium, 3 mg.kg(-1), produced maximum block 1.5 min earlier than did mivacurium, 0.2 mg.kg(-)1 (P < 0.001). There was no difference in block at 60 sec. maximum block or time to maximum block between 2 and 3 mg.kg(-1) rapacuronium for children > two years of age. Maximum block occurred 1.0 +/- 0.5 min after 2 or 3 mg.kg(-1) when T1 was 0.2 +/- 1.1% of baseline. T25 and T4/T1 > 0.7 occurred 10 to 11 min later after this dose of rapacuronium than after mivacurium. Conclusion: Rapacuronium produces block earlier than mivacurium, Recovery from rapacuronium block is dose related and slower than that following mivacurium during halothane anesthesia. C1 Childrens Hosp Pittsburgh, Dept Anesthesiol, Pittsburgh, PA 15213 USA. Univ Miami, Jackson Mem Hosp, Dept Anesthesiol, Miami, FL 33136 USA. Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA. RP Brandom, BW (reprint author), Childrens Hosp Pittsburgh, Dept Anesthesiol, 3705 5th Ave, Pittsburgh, PA 15213 USA. NR 22 TC 13 Z9 13 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD FEB PY 2000 VL 47 IS 2 BP 143 EP 149 PG 7 WC Anesthesiology SC Anesthesiology GA 362KA UT WOS:000089776100008 ER PT J AU Farenc, C Lefrant, JY Audran, M Saissi, G de la Coussaye, JE Bressolle, F AF Farenc, C Lefrant, JY Audran, M Saissi, G de la Coussaye, JE Bressolle, F TI Pharmacokinetics of atracurium and laudanosine in intensive care patients with acute respiratory distress syndrome undergoing mechanical ventilation SO CLINICAL DRUG INVESTIGATION LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENTS; RENAL-FAILURE; HEALTHY PATIENTS; UNIT PATIENTS; THERAPY UNIT; PHARMACODYNAMICS; INFUSION; PLASMA; CISATRACURIUM; PARALYSIS AB Objective: To determine the pharmacokinetic profiles of atracurium and its main metabolite (laudanosine) in patients with acute respiratory distress syndrome undergoing mechanical ventilation. Patients and Methods: Plasma pharmacokinetic profiles of atracurium and laudanosine were studied in eight critically ill patients with acute respiratory distress syndrome who required a neuromuscular blocking drug to assist mechanical ventilation. Patients received an infusion of atracurium (1 mg/kg per hour) for 72 hours after an initial intravenous bolus dose of 1 mg/kg. Neuromuscular blockade was monitored using an accelerograph. Blood samples were obtained over a 96-hour period. Atracurium and laudanosine concentrations in plasma were determined by high performance liquid chromatography. A single-compartment pharmacokinetic model was fitted to plasma concentrations of atracurium and laudanosine. Results: For atracurium, the median elimination half-life value was 20.7 minutes (0.35h); the steady-state volume of distribution ranged from 0.148 to 0.327 L/kg and the total clearance from 0.27 to 0.67 L/h/kg (4.5 to 11 ml/min/kg). For laudanosine, the elimination half-life ranged from approximately 2 to 21 hours and the maximum plasma concentration ranged from 0.86 to 16 mg/L. For all patients, the train-of-four (TOF) count was recorded to 4 at baseline. Within 1 hour after the beginning of infusion, 7 of 8 patients had a TOF count of less than or equal to 1. The neuromuscular recovery ranged from 32 to 67 minutes. Conclusion: The pharmacokinetic properties of atracurium in intensive care unit patients with acute respiratory distress syndrome are similar to those in patients during anaesthesia. Moreover, the dosage regimen administered to the patients in this study (i) provided sufficient neuromuscular blockage for adequate ventilation, and (ii) does not require monitoring of neuromuscular function, a procedure that does not seem to eliminate prolonged weakness and myopathy. C1 Fac Pharm Montpellier, Clin Pharmacokinet Lab, F-34060 Montpellier 2, France. Ctr Hosp Univ, Federat Anaesthesiol Intens Care & Emergency, Nimes, France. Fac Pharm, Biophys Lab, Montpellier, France. RP Bressolle, F (reprint author), Fac Pharm Montpellier, Clin Pharmacokinet Lab, F-34060 Montpellier 2, France. NR 28 TC 2 Z9 2 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 1173-2563 J9 CLIN DRUG INVEST JI Clin. Drug Invest. PD FEB PY 2000 VL 19 IS 2 BP 143 EP 150 DI 10.2165/00044011-200019020-00007 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 290WL UT WOS:000085700800007 ER PT J AU Heier, T Caldwell, JE AF Heier, T Caldwell, JE TI Rapid tracheal intubation with large-dose rocuronium: A probability-based approach SO ANESTHESIA AND ANALGESIA LA English DT Article ID SEQUENCE INDUCTION; INTRACRANIAL-PRESSURE; THIOPENTONE; SUXAMETHONIUM; ALFENTANIL; ANESTHESIA; PROPOFOL; SUCCINYLCHOLINE; DESFLURANE; ISOFLURANE AB There are situations in anesthesia in which it may be desirable to achieve rapid tracheal intubation with perfect conditions, i.e., no coughing or straining. To determine the dose of rocuronium that gives a high probability of achieving perfect conditions for rapid (within 60 s) tracheal intubation, we administered a range of doses of rocuronium, some larger than used previously. Sixty adults, anesthetized with thiopental 4 mg/kg IV and alfentanil 10 mu g/kg IV, received rocuronium 0.4 to 2.0 mg/kg IV. We used logistic regression to define the relationship of rocuronium dose to probability of achieving perfect intubation conditions. We estimated the doses giving 90% and 95% probability of achieving perfect intubation and used resampling to determine confidence limits for these estimates. Rocuronium 1.85 and 2.33 mg/kg gave, respectively, 90% and 95% probability of perfect intubation conditions. The confidence limits (5th and 95th percentile) for these estimates were 1.15 to 2.31 and 1.23 to 3.22 mg/kg, respectively. In conclusion, it is possible to achieve perfect intubation conditions with large doses of rocuronium, but the long duration of action and expense may limit the usefulness of the technique. Implications: We found that it is possible to have a 90% probability of achieving perfect conditions for rapid tracheal intubation with large (up to 2.0 mg/kg) doses of rocuronium. These large doses of rocuronium may be useful in, for instance, head trauma or open globe injuries if succinylcholine is contraindicated. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. Ullevaal Univ Hosp, Oslo, Norway. RP Caldwell, JE (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. NR 25 TC 22 Z9 25 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 2000 VL 90 IS 1 BP 175 EP 179 DI 10.1097/00000539-200001000-00036 PG 5 WC Anesthesiology SC Anesthesiology GA 270WF UT WOS:000084559600036 ER PT J AU Martyn, JAJ Goudsouzian, NG Chang, YC Szyfelbein, SK Schwartz, AE Patel, SS AF Martyn, JAJ Goudsouzian, NG Chang, YC Szyfelbein, SK Schwartz, AE Patel, SS TI Neuromuscular effects of mivacurium in 2-to 12-yr-old children with burn injury SO ANESTHESIOLOGY LA English DT Article DE pediatrics; plasma cholinesterase; relaxant resistance; succinylcholine; alternative to ID PEDIATRIC-PATIENTS; THERMAL-INJURY; INFUSION; PHARMACODYNAMICS; REQUIREMENTS; ATRACURIUM; BLOCKADE AB Background: Burned patients are usually resistant to the neuromuscular effects of nondepolarizing relaxants, mostly because of receptor changes. The magnitude of the resistance is related to burn size and time after burn. Mivacurium is a muscle relaxant, degraded by plasma cholinesterase, whose enzyme activity is decreased in burns. The present study tested the hypothesis that burn-induced depressed plasma cholinesterase activity counteracts the receptor-mediated resistance, resulting in a lack of resistance to mivacurium. Methods: Burned patients (n = 23), aged 2-12 yr, subclassified into burns of 10-30% or > 30% of body surface, were studied at less than or equal to 6 days and again at 1-12 weeks after burn if possible. Thirteen additional patients served as controls. Neuromuscular variables monitored included onset and recovery following bolus dose, continuous infusion rates required to maintain 95 +/- 4% paralysis, and recovery rates following infusion. Results: The onset times of maximal twitch suppression were not different between burns and controls, but recovery to 25% of baseline twitch height was prolonged in patients with > 30% burn irrespective of time after injury. The continuous infusion rates to maintain twitch suppression at 95 +/- 4% were not different between groups. The recovery indices, including train-of-four to > 75%, 25-75%, or 5-95% in burned patients, were similar or prolonged compared with controls. The prolonged recovery in burned patients was inversely related to plasma cholinesterase activity (R-2 = 0.86, r = -0.93, P < 0.001), and the decreased plasma cholinesterase activity was related to burn size and time after burn. Conclusions: A normal mivacurium dosage (0.2 mg/kg) effects good relaxation conditions in burned patients, with an onset time similar to that in controls. This finding contrasts with the response seen with other nondepolarizing drugs, higher doses of which are required to effect paralysis. The decreased metabolism of mivacurium, resulting from depressed plasma cholinesterase activity, probably counteracts the receptor-mediated potential for resistance. Because succinylcholine is contraindicated in burned patients, larger doses of nondepolarizing agents are advocated to effect rapid onset of paralysis. This generalization does not hold for mivacurium. C1 Harvard Univ, Dept Anesthesiol & Crit Care, Massachusetts Gen Hosp, Sch Med, Boston, MA 02114 USA. Shriners Burns Inst, Boston, MA USA. RP Martyn, JAJ (reprint author), Harvard Univ, Dept Anesthesiol & Crit Care, Massachusetts Gen Hosp, Sch Med, 32 Fruit St, Boston, MA 02114 USA. NR 20 TC 10 Z9 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2000 VL 92 IS 1 BP 31 EP 37 DI 10.1097/00000542-200001000-00011 PG 7 WC Anesthesiology SC Anesthesiology GA 273XZ UT WOS:000084735800007 ER PT J AU Caldwell, JE Heier, T Wright, PMC Lin, S McCarthy, G Szenohradszky, J Sharma, ML Hing, JP Schroeder, M Sessler, DI AF Caldwell, JE Heier, T Wright, PMC Lin, S McCarthy, G Szenohradszky, J Sharma, ML Hing, JP Schroeder, M Sessler, DI TI Temperature-dependent pharmacokinetics and pharmacodynamics of vecuronium SO ANESTHESIOLOGY LA English DT Article DE gender; hypothermia; mixed-effects modeling; muscle relaxants ID MILD INTRAOPERATIVE HYPOTHERMIA; ORGANIC CATIONS; RENAL-FUNCTION; HUMANS; 3-DESACETYLVECURONIUM; DISPOSITION; HEPATOCYTES; ATRACURIUM; MECHANISMS; ROCURONIUM AB Background: The authors evaluated the influence of temperature on the pharmacokinetics and pharmacodynamics of vecuronium because mild core hypothermia doubles its duration of action. Methods: Anesthesia was induced with alfentanil and propofol and maintained with nitrous oxide and isoflurane in 12 healthy volunteers. Train-of-four stimuli were applied to the ulnar nerve, and the mechanical response of the adductor pollicis was measured. Volunteers were actively cooled or warmed until their distal esophageal temperatures were in one of four ranges: < 35.0 degrees C, 35.0-35.9 degrees C, 36.0-36.9 degrees C, and greater than or equal to 37.0 degrees C. With temperature stabilized, vecuronium was infused at 5 mu g . kg(-1) . min(-1) until the first response of each train-of-four had decreased by 70%. Arterial blood (for vecuronium analysis) was sampled at intervals until the first response recovered to at least 90% of its prevecuronium level. Vecuronium, 20 mu g . kg(-1) . min(-1), was then infused for 10 min, and arterial blood was sampled at intervals for up to 7 h. population-based nonlinear mixed-effects modeling was used to examine the effect of physical characteristics and core temperature on vecuronium pharmacokinetics and pharmacodynamics. Results: Decreasing core temperature over 38.0-34.0 degrees C decreases the plasma clearance of vecuronium (11.3% per degrees C), decreases the rate constant for drug equilibration between plasma and effect site (0.023 min(-1) per degrees C), and increases the slope of the concentration-response relationship (0.43 per degrees C). Conclusions: Our results show that reduced clearance and rate of effect site equilibration explain the increased duration of action of vecuronium with reducing core temperature. Tissue sensitivity to vecuronium is not influenced by core temperature. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. RP Caldwell, JE (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. NR 26 TC 43 Z9 45 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 2000 VL 92 IS 1 BP 84 EP 93 DI 10.1097/00000542-200001000-00018 PG 10 WC Anesthesiology SC Anesthesiology GA 273XZ UT WOS:000084735800014 ER PT J AU Bock, M Klippel, K Nitsche, B Bach, A Martin, E Motsch, J AF Bock, M Klippel, K Nitsche, B Bach, A Martin, E Motsch, J TI Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article; Proceedings Paper CT 60th Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 15-22, 1998 CL ORLANDO, FLORIDA SP Amer Soc Anesthesiologists DE neuromuscular block, rocuronium; neuromuscular block, recovery; neuromuscular block, measurement of response; anaesthetics volatile, isoflurane; anaesthetics volatile, desflurane; anaesthetics volatile, sevoflurane; anaesthetics i.v., propofol ID TIME-COURSE; INTRAVENOUS ANESTHESIA; VECURONIUM; INFUSION; HALOTHANE; ENFLURANE; POTENTIATION; MIVACURIUM; MAGNITUDE; ORG-9426 AB We have studied the potency and recovery characteristics of rocuronium during 1.25 MAC of isoflurane, desflurane, sevoflurane or propofol anaesthesia in 84 patients using electromyography. Potency was determined by a cumulative bolus technique. The mean ED50 of rocuronium was 169 (SD 41), 126 (32), 121 (28) and 136 (25) mu g kg(-1) during propofol, isoflurane, sevoflurane and desflurane anaesthesia, respectively (ns), and ED90 values were 358 (62), 288 (29), 289 (28) and 250 (28) mu g kg(-1), respectively. The reduction in ED90 was statistically significant for all three inhalation anaesthetics (P<0.05) compared with propofol. After 120 min, the cumulative infusion rate of rocuronium to obtain twitch depression of 90-95% was 9.0 (1.9), 6.3 (1.6), 6.1 (2.0) and 6.1 (1.1) mu g kg(-1) min(-1) during propofol, isoflurane, sevoflurane and desflurane anaesthesia, respectively (P<0.01). Recovery index was 22 (13), 27 (10), 28 (13) and 26 (14) min under propofol, isoflurane, sevoflurane and desflurane anaesthesia, respectively (ns). There were no significant differences between the three potent inhalation anaesthetics in relation to potency, infusion requirements or recovery characteristics of rocuronium. C1 Univ Heidelberg, Dept Anaesthesiol, D-69120 Heidelberg, Germany. RP Bock, M (reprint author), Univ Heidelberg, Dept Anaesthesiol, Neuenheimer Feld 110, D-69120 Heidelberg, Germany. NR 19 TC 22 Z9 29 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JAN PY 2000 VL 84 IS 1 BP 43 EP 47 PG 5 WC Anesthesiology SC Anesthesiology GA 272RA UT WOS:000084663700010 ER PT J AU Cheong, KF Wong, WH AF Cheong, KF Wong, WH TI Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, rocuronium; anaesthetics local, lidocaine; pain, injection AB We have assessed the incidence of pain on injection of rocuronium and evaluated if pretreatment with lidocaine i.v. reduced it, in a randomized, controlled study in 90 patients. We found that 37% of patients who received lidocaine 10 mg pretreatment had pain on injection of rocuronium compared with 77% of patients who received saline pretreatment and 7% of patients who were pretreated with lidocaine 30 mg (P<0.05 in each instance compared with control). In addition, patients pretreated with lidocaine were less likely to suffer moderate or severe pain. Both lidocaine 10 mg and 30 mg i.v. given before administration of rocuronium significantly reduced the incidence and severity of pain on injection of rocuronium, and the higher dose was more effective. C1 Natl Univ Singapore Hosp, Dept Anaesthesia, Singapore 119074, Singapore. RP Cheong, KF (reprint author), Natl Univ Singapore Hosp, Dept Anaesthesia, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore. NR 6 TC 35 Z9 37 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JAN PY 2000 VL 84 IS 1 BP 106 EP 107 PG 2 WC Anesthesiology SC Anesthesiology GA 272RA UT WOS:000084663700023 ER PT J AU Neal, SM Manthri, PR Gadiyar, V Wildsmith, JAW AF Neal, SM Manthri, PR Gadiyar, V Wildsmith, JAW TI Histaminoid reactions associated with rocuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE histamine; neuromuscular block, rocuronium; complications, anaphylaxis ID ANESTHESIA; ANAPHYLAXIS AB We describe three histaminoid reactions occurring on induction of anaesthesia. The patients were all resuscitated successfully and subsequent skin testing suggested sensitivity to rocuronium. In this hospital, the incidence of such reactions is of the order of 1 in 3000. This may be coincidental but suggests that there should be close monitoring of the incidence of reactions to rocuronium. Review of the cases suggests that current guidelines on management are not always followed. C1 Univ Dundee, Ninewells Hosp & Med Sch, Dept Anaesthesia, Dundee DD1 9SY, Scotland. RP Neal, SM (reprint author), Univ Dundee, Ninewells Hosp & Med Sch, Dept Anaesthesia, Dundee DD1 9SY, Scotland. NR 12 TC 25 Z9 26 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JAN PY 2000 VL 84 IS 1 BP 108 EP 111 PG 4 WC Anesthesiology SC Anesthesiology GA 272RA UT WOS:000084663700024 ER PT J AU De Haes, A Eleveld, DJ Wierda, JMKH AF De Haes, A Eleveld, DJ Wierda, JMKH TI The relationship between rate of administration of an intubating dose of rocuronium and time to 50% and 90% block at the adductor pollicis muscle SO JOURNAL OF CLINICAL MONITORING AND COMPUTING LA English DT Article DE neuromuscular relaxants; rocuronium; kinetics; distribution ID PHARMACOKINETICS; HUMANS AB Objective. To determine the relationship between the rate of rocuronium injection and the onset time of neuromuscular block. Methods.After intravenous induction, 60 female patients (ASA I-II) were assigned randomly into 3 groups for rocuronium administration within 1-15, 15-30 or 30-60 seconds. Acceleromyography of the thumb was performed using train-of-four (TOF) stimulation. Times to 50% and 90% twitch depression of the first twitch of the TOF stimulation (T1) were recorded. Results. Injection time significantly influences time to 50% relaxation, but not time to 90% relaxation. Body mass index is negatively correlated with time to 50% and 90% relaxation. Conclusions. We conclude that rate of injection influences only the initial phase of development of the block and that slower injection times do not significantly affect time to 90% relaxation at the adductor pollicis muscle. C1 Univ Groningen, Res Grp Expt Anesthesiol & Clin Pharmacol, Groningen, Netherlands. RP Wierda, JMKH (reprint author), Univ Groningen Hosp, Dept Anesthesiol, POB 30-001, NL-9700 RB Groningen, Netherlands. NR 5 TC 0 Z9 0 PU KLUWER ACADEMIC PUBL PI DORDRECHT PA SPUIBOULEVARD 50, PO BOX 17, 3300 AA DORDRECHT, NETHERLANDS SN 1387-1307 J9 J CLIN MONITOR COMP JI J. Clin. Monitor. Comp. PY 2000 VL 16 IS 3 BP 219 EP 222 DI 10.1023/A:1009964305762 PG 4 WC Anesthesiology SC Anesthesiology GA 375BK UT WOS:000165379500008 ER PT J AU Playfor, SD Thomas, DA Choonara, I AF Playfor, SD Thomas, DA Choonara, I TI Duration of action of atracurium when given by infusion to critically ill children SO PAEDIATRIC ANAESTHESIA LA English DT Article DE atracurium; infusion; paediatric intensive care ID PERIPHERAL-NERVE STIMULATION; INTENSIVE-CARE UNIT; NEUROMUSCULAR BLOCKADE; VECURONIUM; PATIENT; REQUIREMENTS; RESISTANCE; ISOFLURANE; RECOVERY; PROPOFOL AB The aim of the study was to investigate the offset time of atracurium when given by continuous infusion on a paediatric intensive care unit and to look for evidence of tolerance. Over a period of 8 months, 20 mechanically ventilated children had a steady-state infusion of atracurium discontinued to enable the assessment of their level of sedation. The offset time of atracurium was assessed by train-of-four (TOF) stimulation of the ulnar nerve. The initial TOF reading was documented as was the time taken to reach a TOF ratio of 0.9. Thirty-five assessments were carried out. The mean offset time of atracurium was 28.7 min (SEM 1.76 min, range 8-56 min). There was no correlation between the dose of atracurium. at discontinuation and the offset time of the infusion. The duration of infusion was negatively correlated with the offset time of atracurium, and this effect was most prominent in children who had received infusions for longer than 48 h. When given by continuous infusion, the offset time of atracurium is very variable between individual patients. Infusions administered for longer than 48 h are associated with a significant reduction in the offset time as a result of increasing tolerance. C1 Queens Med Ctr, Paediat Intens Care Unit, Nottingham NG7 2UH, England. Univ Nottingham, Derbyshire Childrens Hosp, Acad Div Child Hlth, Derby, England. RP Playfor, SD (reprint author), Queens Med Ctr, Paediat Intens Care Unit, Nottingham NG7 2UH, England. NR 22 TC 2 Z9 2 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD JAN PY 2000 VL 10 IS 1 BP 77 EP 81 DI 10.1046/j.1460-9592.2000.00436.x PG 5 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 278LN UT WOS:000084991400013 ER PT J AU Playfor, SD Thomas, DA Choonara, I AF Playfor, SD Thomas, DA Choonara, I TI The effect of induced hypothermia on the duration of action of atracurium when given by infusion to critically ill children SO PAEDIATRIC ANAESTHESIA LA English DT Article DE atracurium; induced hypothermia; paediatric intensive care ID CARDIOPULMONARY BYPASS; MILD HYPOTHERMIA; MODERATE HYPOTHERMIA; TWITCH TENSION; BRAIN INJURY; HEAD-INJURY; PHARMACOKINETICS; TEMPERATURES; CONDUCTION AB The aim of the study was to investigate the effect of induced hypothermia on the offset time of atracurium when given by continuous infusion to critically ill children. Over a period of 8 months, six mechanically ventilated children had a steady-state infusion of atracurium discontinued. The offset time of atracurium was assessed by train-of-four (TOF) stimulation of the ulnar nerve; recording the time taken to reach a TOF ratio of 0.9. Nine assessments were carried out. The mean offset time of atracurium was 82 min. This was significantly longer than in patients with temperatures within the normal physiological range. When considering all assessments, performed both in hypothermic and normothermic patients, there is a strong correlation between rectal temperature and the offset time of atracurium. Prolonged moderate hypothermia has a very significant effect on the offset time of atracurium when given by infusion to critically ill children. C1 Queens Med Ctr, Paediat Intens Care Unit, Nottingham NG7 2UH, England. Univ Nottingham, Derbyshire Childrens Hosp, Acad Div Child Hlth, Derby, England. RP Playfor, SD (reprint author), Queens Med Ctr, Paediat Intens Care Unit, Nottingham NG7 2UH, England. NR 30 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD JAN PY 2000 VL 10 IS 1 BP 83 EP 88 DI 10.1046/j.1460-9592.2000.00437.x PG 6 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 278LN UT WOS:000084991400014 ER PT J AU Bissinger, U Schimek, F Lenz, G AF Bissinger, U Schimek, F Lenz, G TI Postoperative residual paralysis and respiratory status: A comparative study of pancuronium and vecuronium SO PHYSIOLOGICAL RESEARCH LA English DT Article DE postoperative residual paralysis; pancuronium; vecuronium; neuromuscular function; pulse oximetry; arterial blood gas analysis; pulmonary function; hypoxemia; hypercapnia ID PARTIAL NEUROMUSCULAR BLOCK; PULMONARY COMPLICATIONS; VENTILATORY RESPONSE; ANESTHETIC PRACTICE; RECOVERY ROOM; RISK-FACTORS; ATRACURIUM; CURARIZATION; HYPOXEMIA; SURGERY AB The objective of this prospective double-blind study was to determine whether postoperative residual paralysis (PORP) after pancuronium or vecuronium results in hypoxemia and hypercapnia in the immediate admission period to the recovery ward. Eighty-three consecutive surgical patients received balanced or intravenous anesthesia with pancuronium for operations lasting longer than one hour or vecuronium for those lasting less than 60 min, both combined with neostigmine at the end of anesthesia. Standard clinical criteria assessed neuromuscular function intraoperatively. Postoperatively, we determined neuromuscular function (acceleromyography with supramaximal train-of-four (TOF) stimulation of the ulnar nerve, and a 5-s head lift) and pulmonary function (pulse oximetry: SpO(2), and blood gas analysis: SaO(2), PaCO2). We defined PORP as a TOF-ratio <70%, hypoxemia as a postoperative SpO(2) greater than or equal to 5% below the pre-anesthestic level together with a postoperative SaO(2) <93%, and hypercapnia as a PaCO2 greater than or equal to 46 mm Hg. Among the 49 pancuronium and 27 vecuronium patients studied, the PORP rates were 20% in the pancuronium group and 7% in the vecuronium group (p>0.05). Hypoxemia and hypercapnia occurred more often in pancuronium patients with PORP than in those without PORP namely 60% vs. 10% (p<0.05) and 30% vs. 8% (p>0.05), respectively. We conclude that PORP after pancuronium is a significant risk factor for hypoxemia. C1 Univ Tubingen, Fac Med, Dept Anesthesiol, D-72076 Tubingen, Germany. Charles Univ, Fac Med 3, Dept Physiol, Prague, Czech Republic. Inst Anesthesiol & Intens Care Med, Ingolstadt, Germany. RP Bissinger, U (reprint author), Univ Tubingen, Klin Anasthesiol & Transfus Med, Abt Anasthesiol, Hoppe Seyler Str 3, D-72076 Tubingen, Germany. NR 22 TC 22 Z9 23 PU ACAD SCIENCES CZECH REPUBLIC, INST PHYSIOLOGY PI PRAGUE 4 PA VIDENSKA 1083, PRAGUE 4 142 20, CZECH REPUBLIC SN 0862-8408 J9 PHYSIOL RES JI Physiol. Res. PY 2000 VL 49 IS 4 BP 455 EP 462 PG 8 WC Physiology SC Physiology GA 354RN UT WOS:000089343600008 ER PT J AU Harvey, A Anderson, L Broome, IJ AF Harvey, A Anderson, L Broome, IJ TI A comparison of the effect of rocuronium and vecuronium on heart rate during gynaecological laparoscopy SO ANAESTHESIA LA English DT Article DE neuromuscular blocking agents, rocuronium; vecuronium; surgery, laparoscopy; complications, cardiovascular ID INDUCED BRADYCARDIA; CARDIAC-ARREST; ANESTHESIA; FENTANYL; PANCURONIUM; SURGERY AB The effect on intra-operative heart rate of two nondepolarising muscle relaxants, rocuronium and vecuronium, was compared in 116 fit out-patients undergoing gynaecological laparoscopic procedures. Both groups received an anaesthetic technique which differed only in the choice of muscle relaxant. Intra-operatively it was noted that patients given rocuronium (20 mg) had significantly fewer episodes of bradycardia bradycardia (heart rate < 50 beat.min(-1)) than patients given vecuronium 4 mg (p < 0.05). Profound bradycardias (heart rate < 30 beat.min(-1)) did not occur in any of the patients in the rocuronium study group, whereas 5% of patients receiving vecuronium had a period of transient asystole. We conclude that, at the doses stated, rocuronium results in significantly fewer episodes of bradycardia than vecuronium when used as a muscle relaxant for laparoscopic gynaecological procedures. C1 Western Infirm, Dept Anaesthesia, Glasgow G11 6NT, Lanark, Scotland. Falkirk & Dist Royal Infirm, Falkirk FK1 5QE, Scotland. RP Broome, IJ (reprint author), Western Infirm, Dept Anaesthesia, Dumbarton Rd, Glasgow G11 6NT, Lanark, Scotland. NR 19 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD DEC PY 1999 VL 54 IS 12 BP 1212 EP 1216 DI 10.1046/j.1365-2044.1999.01076.x PG 5 WC Anesthesiology SC Anesthesiology GA 268VL UT WOS:000084437200015 ER PT J AU Saitoh, Y Fujii, Y Oshima, T AF Saitoh, Y Fujii, Y Oshima, T TI The ulinastatin-induced effect on neuromuscular block caused by vecuronium (Retracted article. See vol. 115, pg. 976, 2012) SO ANESTHESIA AND ANALGESIA LA English DT Article ID URINARY TRYPSIN-INHIBITOR; ORG NC 45; PROTEASE INHIBITOR; RENAL-FAILURE; PHARMACOKINETICS; ELIMINATION; PANCURONIUM; RATS AB We examined the effect of ulinastatin, a protease inhibitor purified from human urine, on neuromuscular block caused by vecuronium. Sixty adult patients were randomly divided into four groups of 15 patients each: ulinastatin-posttetanic count (U-PTC), ulinastatin-train-of-four (U-TOF), control-posttetanic count (C-PTC) or control-train-of-four (C-TOF) group. In the U-PTC and U-TOF groups, a bolus dose of ulinastatin 5000 U/kg was administered 2 min before the injection of vecuronium 0.1 mg/kg. In the C-PTC and C-TOF groups, normal saline was administered instead of ulinastatin. The onset of neuromuscular block in the U-PTC and U-TOF groups was significantly slower than in the C-PTC and C-TOF groups (250 +/- 49 vs 214 +/- 35 s, mean +/- SD, P < 0.05). The time from the vecuronium injection to the return of PTC in the U-PTC group was significantly shorter than in the C-PTC group (11.0 +/- 2.8 vs 17.6 +/- 6.8 min, P < 0.05). Similarly, times to the returns of T1, T2 T3, and T4 (first, second, third, and fourth stimulation of TOF) in the U-TOF group were significantly shorter than in the C-TOF group (18.5 +/- 5.0 vs 28.0 +/- 9.1 min for T1, P < 0.05). PTC in the U-PTC group was significantly higher than in the C-PTC Group 10-30 min after the administration of vecuronium (P < 0.05). T1/control twitch height and TOF ratios in the U-TOF group were significantly higher than those in the C-TOF Group 30-70 min and 40-70 min after the administration of vecuronium, respectively (P < 0.05). Ulinastatin delays the onset of neuromuscular block and hastens its recovery caused by vecuronium. Implications: Ulinastatin delays the onset of neuromuscular block and hastens its recovery caused by vecuronium. This is because ulinastatin may release acetylcholine at the neuromuscular junction and increase hepatic and/or renal clearance of vecuronium. C1 Toride Kyodo Gen Hosp, Dept Anesthesiol, Toride, Ibaraki 3020022, Japan. Univ Tsukuba, Inst Clin Med, Dept Anesthesiol, Tsukuba, Ibaraki 305, Japan. Gifu Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Gifu 500, Japan. RP Saitoh, Y (reprint author), Toride Kyodo Gen Hosp, Dept Anesthesiol, 2-1-1 Hongo, Toride, Ibaraki 3020022, Japan. EM 69481654@people.or.jp NR 14 TC 3 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1999 VL 89 IS 6 BP 1565 EP 1569 DI 10.1097/00000539-199912000-00048 PG 5 WC Anesthesiology SC Anesthesiology GA 260ZB UT WOS:000083982400048 ER PT J AU Naguib, M Gomaa, M Samarkandi, AH Bevan, DR Akkielah, AK Watson, C Billecke, S La Du, BN AF Naguib, M Gomaa, M Samarkandi, AH Bevan, DR Akkielah, AK Watson, C Billecke, S La Du, BN TI Increased plasma cholinesterase activity and mivacurium resistance: Report of a family SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; HYPERCHOLINESTERASEMIA C1 Univ Iowa, Coll Med, Dept Anesthesia, Iowa City, IA 52242 USA. Secur Forces Hosp, Dept Anesthesia, Riyadh, Saudi Arabia. King Saud Univ, Dept Anesthesia, Riyadh, Saudi Arabia. Univ British Columbia, Dept Anesthesia, Vancouver, BC V5Z 1M9, Canada. Univ Michigan, Med Ctr, Dept Anesthesia, Ann Arbor, MI USA. RP Naguib, M (reprint author), Univ Iowa, Coll Med, Dept Anesthesia, 200 Hawkins Dr,6JCP, Iowa City, IA 52242 USA. NR 18 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1999 VL 89 IS 6 BP 1579 EP 1582 DI 10.1097/00000539-199912000-00052 PG 4 WC Anesthesiology SC Anesthesiology GA 260ZB UT WOS:000083982400052 ER PT J AU Zappi, L Song, PF Nicosia, S Nicosia, F Rehder, K AF Zappi, L Song, PF Nicosia, S Nicosia, F Rehder, K TI Do pipecuronium and rocuronium affect human bronchial smooth muscle? SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 6th Annual Meeting of the European Society-of-Anaesthesiologists CY APR 24-28, 1998 CL BARCELONA, SPAIN SP European Soc Anaesthesiologists DE airway; smooth muscle; bronchoconstriction; pilocarpine ID M2 MUSCARINIC RECEPTORS; AUTORECEPTORS; PANCURONIUM; RELAXANTS; TRACHEA; AIRWAY; HEART; M(2) AB Background: Muscle relaxants affect nicotinic and muscarinic receptors, Interaction of muscle relaxants with muscarinic receptors of human airways has been studied incompletely. Methods: The effects of pipecuronium bromide (long-acting, nondepolarizing) and rocuronium bromide (intermediate-acting, nondepolarizing) on prejunctional and postjunctional muscarinic receptors were studied in 96 isolated human bronchial rings from 12 patients. Contractile isometric responses to electric field stimulation of pilocarpine-stimulated and nonstimulated M-2 muscarinic receptors were compared before and after incubation with the two muscle relaxants. The effect on postjunctional muscarinic receptors was studied by comparing acetylcholine concentration-response curves before and after incubation with the two muscle relaxants. Results: Pipecuronium bromide, but not rocuronium bromide, inhibited pilocarpipe-stimulated prejunctional M-2 muscarinic receptors, Neither pipecuronium bromide nor rocuronium bromide had significant inhibitory effects on nonstimulated M-2 muscarinic receptors and on postjunctional M-3 muscarinic receptors. Conclusions: The inhibitory effect of pipecuronium bromide on pilocarpine-stimulated prejunctional, M-2 muscarinic receptors occurred at clinical concentrations. C1 Ist Nazl Ric Canc, Serv Anestesia & Rianimaz, Dept Anesthesiol, I-16132 Genoa, Italy. RP Zappi, L (reprint author), Ist Nazl Ric Canc, Serv Anestesia & Rianimaz, Dept Anesthesiol, Viale Benedetto XV 10, I-16132 Genoa, Italy. NR 19 TC 4 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 1999 VL 91 IS 6 BP 1616 EP 1621 DI 10.1097/00000542-199912000-00011 PG 6 WC Anesthesiology SC Anesthesiology GA 262WX UT WOS:000084092200008 ER PT J AU Miguel, R Witkowski, T Nagashima, H Fragen, R Bartkowski, R Foldes, FF Shanks, C AF Miguel, R Witkowski, T Nagashima, H Fragen, R Bartkowski, R Foldes, FF Shanks, C TI Evaluation of neuromuscular and cardiovascular effects of two doses of rapacuronium (ORG 9487) versus mivacurium and succinylcholine SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the International-Anesthesia-Research-Society CY MAR 07-20, 1998 CL ORLANDO, FLORIDA SP Int Anesthesia Res Soc DE monitoring; neuromuscular blockade; neuromuscular relaxant ID ADDUCTOR POLLICIS; MUSCLE-RELAXANT; HUMANS; ORG-9487; ATRACURIUM; BLOCKADE; LARYNX; ONSET; TIME AB Background: This study compares the neuromuscular blocking and cardiovascular effects of rapacuronium (ORG 9487), a new aminosteroid nondepolarizing muscle relaxant, to recommended intubating doses of succinylcholine and mivacurium . Methods: Adult patients were randomized in an open-label fashion to receive 1-5 mu g/kg fentanyl before 1.5 mg/kg propofol induction followed by 1.5 or 2.5 mg/kg rapacuronium, 1.0 mg/kg succinylcholine, or 0.25 mg/hg mivacurium (i.e., 0.15 mg/kg followed by 0.1 mg/kg 30 s later). Results: Patient neuromuscular blockade status was monitored by measuring the train-of-four response to a supramaximal stimulus at the ulnar nerve every 12 s, Percentage of the first twitch of the train-of-four (T-1) at 60 s was similar in patients receiving 1.5 mg/kg rapacuronium, 2.5 mg/kg rapacuronium, and succinylcholine and was significantly less than in patients in the mivacurium group (26, 16, and 18%, respectively, ns. 48%; P < 0.01), Times to 80% T-1 depression were also similar among patients in the 1.5 mg/kg rapacuronium, 2.5 mg/kg rapacuronium, and succinylcholine groups and significantly longer in the mivacurium group (62, 54, and 54 s, respectively, vs. 112 s; P < 0.01). Clinical duration was longer in all groups compared with the succinylcholine group; however, clinical duration in the 1.5 mg/kg rapacuronium group was shorter compared with the mivacurium group (15 vs. 21 min, respectively; P < 0.01). Heart rate changes were mild in the 1.5 mg/kg rapacuronium, succinylcholine, and mivacurium groups. The patients iu the 2.5 mg/kg rapacuronium group had significantly higher heart rates compared with patients in the mivacurium group. No differences were found in blood pressure changes among patients in the four groups. Conclusions: Rapacuronium, 1.5 and 2.5 mg/kg, produced neuromuscular blockade as rapidly as succinylcholine and significantly faster than mivacrurium Although succinylcholine continued to shaw the shortest duration, 1.5 mg/kg rapacuronium used a rapid onset and a relatively short duration and may be considered an alternative to succinylcholine. C1 Univ S Florida, H Lee Moffitt Canc Ctr & Res Inst, Dept Anesthesiol, Tampa, FL 33612 USA. Thomas Jefferson Univ, Dept Anesthesiol, Philadelphia, PA 19107 USA. Montefiore Med Ctr, Dept Anesthesiol, New York, NY USA. Northwestern Univ, Dept Anesthesiol, Chicago, IL 60611 USA. RP Miguel, R (reprint author), Univ S Florida, H Lee Moffitt Canc Ctr & Res Inst, Dept Anesthesiol, 12902 Magnolia Dr,Suite 2149, Tampa, FL 33612 USA. NR 15 TC 20 Z9 21 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 1999 VL 91 IS 6 BP 1648 EP 1654 DI 10.1097/00000542-199912000-00016 PG 7 WC Anesthesiology SC Anesthesiology GA 262WX UT WOS:000084092200013 ER PT J AU Plaud, B Goujard, E Orliaguet, G Meistelman, C Ecoffey, C AF Plaud, B Goujard, E Orliaguet, G Meistelman, C Ecoffey, C TI Pharmacodynamics and safety of mivacurium in infants and children under halothane-nitrous oxide anaesthesia SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE paediatric anaesthesia; mivacurium ID CHLORIDE BW B1090U; NEUROMUSCULAR BLOCK; ANESTHESIA; VECURONIUM; ONSET; SUXAMETHONIUM; PHARMACOLOGY; STIMULATION; RECOVERY; TIME AB Objectives: To determine pharmacodynamic effects and safety of mivacurium in paediatric patients. Study design: Multicentric, prospective, open, nonrandomized study. Patients: Forty-eight three-month-old to eight-year-old physical class ASA I or II children. Method: Anaesthesia was induced and maintained with halothane and nitrous oxide. Tracheal intubation was performed without a neuromuscular blocking agent. Neuromuscular blockade was measured with a strain force transducer after train-of-four stimulation of the ulnar nerve at the wrist every ten seconds. A single bolus dose of mivacurium (0.2 mg . kg(-1)) was injected during 15 seconds in patients allocated into three groups. Group 1: three to 12-month-old infants (n = 15), group 2: one- to three-year-old children (n = 16) and group 3: three- to eight-year-old children (n = 17). Onset and recovery parameters were measured in each patient. Heart rate and noninvasive arterial blood pressure were recorded every minute for five minutes after mivacurium injection. Results: Following halothane administration for 29 and 32 min, and a FEThalothane = 1 vol%, mivacurium (0.2 mg . kg(-1)) determined a 100% neuromusmcular blockade in all patients. The onset time was 71 +/- 34 s (mean +/- SD) in all patients and did not differ between groups. Time to 25% and 95% recovery of the first twitch and recovery index for all the patients were 12 +/- 3 min, 19 +/- 5 min and 4 +/- 2 min respectively and did not differ between groups. No prolonged paralysis was observed. No significant changes of HR and BP occurred. Conclusions: Following 0.2 mg . kg(-1) of mivacurium in patients aged between three months to eight years, a complete blockade occurs with a rapid onset time and a short duration of action, without significant cardiovascular effect. (C) 1999 Editions scientifiques et medicales Elsevier SAS. C1 Hop Pontchaillou, Serv Anesthesie Reanimat Chirurg 2, F-35033 Rennes 09, France. RP Ecoffey, C (reprint author), Hop Pontchaillou, Serv Anesthesie Reanimat Chirurg 2, F-35033 Rennes 09, France. NR 18 TC 2 Z9 4 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD DEC PY 1999 VL 18 IS 10 BP 1047 EP 1053 DI 10.1016/S0750-7658(00)87438-9 PG 7 WC Anesthesiology SC Anesthesiology GA 275BZ UT WOS:000084800700005 ER PT J AU Abouleish, EI Abboud, TS Bikhazi, G Kenaan, CA Mroz, L Zhu, J Lee, J AF Abouleish, EI Abboud, TS Bikhazi, G Kenaan, CA Mroz, L Zhu, J Lee, J TI Rapacuronium for modified rapid sequence induction in elective Caesarean section: neuromuscular blocking effects and safety compared with succinylcholine, and placental transfer SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article; Proceedings Paper CT 1997 Annual Meeting of American-Society-of-Anesthesiologists CY OCT 17-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiologists DE neuromuscular block, rapacuronium; neuromuscular block, succinylcholine; anaesthesia, obstetrics; anaesthetic techniques, induction ID CESAREAN-SECTION; MUSCLE-RELAXANT; ORG-9487; VECURONIUM; AGENTS; TIME AB We have compared rapacuronium 2.5 mg kg(-1) (n=20) with succinylcholine 1.5 mg kg(-1) (n=22) in a multicentre, blinded, randomized study in full-term parturients undergoing elective Caesarean section under general anaesthesia. Thiopental 5 mg kg(-1) was given i.v. followed by the neuromuscular blocking agent Sixty seconds later intubation was performed. Intubating conditions, evaluated as excellent, good or poor, were good to excellent in 95% and 91% in the intent-to-treat patients after rapacuronium and succinylcholine, respectively (ns). Mean onset times at the adductor pollicis muscle for rapacuronium and succinylcholine were 80.4 (SEM 14.4) s and 63.9 (5.6) s (ns) while maximum block was 96 (1.9)% and 99 (0.4)%, respectively (ns). Rate of recovery was significantly longer after rapacuronium; times for return of TI to 25% were 16.9 (1.5) min and 9.6 (1.1) min for rapacuronium and succinylcholine, respectively (P=0.0004). Maternal side effects included more tachycardia and skin erythema with rapacuronium; no maternal mortality or morbidity, including bronchospasm, occurred in either group. There were no neonatal adverse effects in either group based on: Apgar scores at 1 and 5 min; times to sustained respiration; neuroadaptive capacity scores at 15 min, 2 h and 24 h; and umbilical venous and arterial blood-gas values and acid-base status. At delivery (17.7 (3.2) min), mean maternal plasma concentrations of rapacuronium were 9041.4 (1259.1) ng ml(-1) and 506.4 (24.9) ng ml(-1) for Org 9488 (the main metabolite). Corresponding values for umbilical venous plasma were 808.0 (92.1) ng ml(-1) and 59.1 (6.5) ng ml(-1), and for umbilical arterial plasma, 361.4 (56.4) ng ml(-1) and 29.7 (4.6) ng ml(-1), respectively, Umbilical venous to maternal venous ratios for rapacuronium and Org 9488 were 8.8% (1.3)% and 10.2 (1.7)%, respectively. C1 Univ Texas, Sch Med, Houston, TX 77030 USA. Univ So Calif, Los Angeles, CA USA. Univ Miami, Sch Med, Miami, FL USA. Robert Wood Johnson Med Sch, Newark, NJ USA. RP Abouleish, EI (reprint author), Univ Texas, Sch Med, Houston, TX 77030 USA. NR 20 TC 11 Z9 11 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD DEC PY 1999 VL 83 IS 6 BP 862 EP 867 PG 6 WC Anesthesiology SC Anesthesiology GA 264MT UT WOS:000084186600008 ER PT J AU de Rossi, L Preussler, NP Puhringer, FK Klein, U AF de Rossi, L Preussler, NP Puhringer, FK Klein, U TI Onset of neuromuscular block at the masseter and adductor pollicis muscles following rocuronium or succinylcholine SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID RAPID-SEQUENCE INDUCTION; INTUBATING CONDITIONS; VECURONIUM; HUMANS; ORG-9426; LARYNX; ADULTS AB Purpose: To compare the onset time of two different rocuronium doses (0.6 and 0.9 mg kg(B1)) and succinylcholine (1.5 mg.kg(-1), preceeded by 0.06 mg.kg(-1) rocuronium) at the masseter and the adductor pollicis muscle. Methods: In a randomized study, 60 ASA I or II adult women, 18-65 yr of age. were anesthetized with propofol and fentanyl and nitrous oxide in oxygen. Neuromuscular monitoring was performed using acceleromyography simultaneously on the masseter and adductor pollicis. Onset time was measured at both muscles using supramaximal 0.1 Hz single twitch stimulation (square-wave pulse 0.2 msec duration). Results: In all patients, complete neuromuscular block occured at the masseter and adductor pollicis muscles. Lag-time and onset time were faster at the masseter that at the adductor pollicis muscle in both rocuronium-groups (P < 0.01) and in the succinylcholine-group (P < 0.01). Furthermore, onset time was more rapid after 0.9 mg.kg(-1) rocuronium (65 +/- 7 s) than after succinylcholine (83 +/- 19 sec) at the AP (P < 0.05), but did not differ at the masseter(33 +/- 6 vs 36 +/- 7 sec). Conclusions: Following rocuronium and succinylcholine, onset time is faster at the masseter than at the adductor pollicis muscle. C1 Univ Jena, Clin Anaesthesiol & Intens Care Therapy, D-07740 Jena, Germany. Univ Innsbruck, Clin Anaesthesia & Gen Intens Care Med, A-6020 Innsbruck, Austria. RP de Rossi, L (reprint author), Univ Jena, Clin Anaesthesiol & Intens Care Therapy, Bachstr 18, D-07740 Jena, Germany. EM derossi@anae1.med.uni-jena.de NR 15 TC 8 Z9 8 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 1999 VL 46 IS 12 BP 1133 EP 1137 PG 5 WC Anesthesiology SC Anesthesiology GA 261FE UT WOS:000083998100006 ER PT J AU de Lemos, JM Carr, RR Shalansky, KF Bevan, DR Ronco, JJ AF de Lemos, JM Carr, RR Shalansky, KF Bevan, DR Ronco, JJ TI Paralysis in the critically ill: Intermittent bolus pancuronium compared with continuous infusion SO CRITICAL CARE MEDICINE LA English DT Article DE pancuronium; critically ill; paralysis; neuromuscular blacking agents; myopathy; prolonged paralysis; Train-of-Four monitoring; prospective ID INTENSIVE-CARE UNIT; NEUROMUSCULAR-BLOCKING-AGENTS; MECHANICALLY VENTILATED PATIENTS; PROLONGED PARALYSIS; MUSCLE-RELAXANTS; BLOCKADE; PHARMACOKINETICS; TRAIN-OF-4; WEAKNESS; FAILURE AB Objectives: To compare recovery times from neuromuscular blockade between two groups of critically ill patients in whom pancuronium was administered by continuous infusion or intermittent bolus injection. To compare the mean pancuronium requirements (milligrams per kilogram per hour) and to assess the incidence of prolonged recovery times (>12 hrs) and residual muscle weakness. Design: Prospective, observational cohort. Setting: Intensive care unit in a university-affiliate hospital. Patients: A total of 30 mechanically ventilated patients who required pharmacologic paralysis. Patients were excluded if they had renal failure (creatinine clearance <30 mL/min), heart rate >130 beats/min, hepatic failure, peripheral nerve disease or myopathy, stroke, spinal cord damage, or myasthenia gravis. Interventions: Patients were assigned to receive pancuronium either by continuous infusion (n = 14) or intermittent bolus (n = 16). Depth of paralysis was titrated to maintain one or two responses to Train-of-Four stimulation with an accelerograph and desired clinical goals. Recovery time was defined as time from discontinuation of muscle relaxant until the amplitude of the fourth twitch, measured every 15-30 min using an accelerograph, was 70% the amplitude of the first twitch (Train-of-Four greater than or equal to 0.7). Measurements and Main Results: These patients included the only three patients with status asthmaticus in our study. The groups were similar with respect to age, sex, weight, Acute Physiology and Chronic Health Evaluation II score, mode of ventilation, creatinine clearance, indications for paralysis, and duration of pancuronium administration. The median time for patients to recover from paralysis was 3.5 hrs (95% confidence interval, 1.82-5.18) in the infusion group vs. 6.3 hrs (95% confidence interval, 3.40-9.19) in the intermittent bolus group (p = .10). Less drug was administered in the intermittent group (mean, 0.02 +/- 0.01 mg/kg/hr) than by infusion (mean, 0.04 +/- 0.01 mg/kg/hr; p < .001). Six patients (five in the infusion group and one in the intermittent group) developed persistent severe muscle weakness. In addition, six different patients (three from each group) had prolonged recovery >12 hrs. Conclusions: Our study suggests that recovery time after paralysis with continuous infusion is faster than that after intermittent bolus injection. Although more pancuronium was administered in the continuous-infusion group, recovery time was not prolonged as a consequence. It is uncertain whether pancuronium given by infusion increases the risk of persistent muscle weakness. C1 Univ British Columbia, Vancouver Gen Hosp, Dept Pharmaceut Sci, Vancouver, BC V5Z 1M9, Canada. Univ British Columbia, Vancouver Gen Hosp, Dept Anaesthesia, Vancouver, BC V5Z 1M9, Canada. Univ British Columbia, Vancouver Gen Hosp, Dept Crit Care Med, Vancouver, BC V5Z 1M9, Canada. RP de Lemos, JM (reprint author), Univ British Columbia, Vancouver Gen Hosp, Dept Pharmaceut Sci, Vancouver, BC V5Z 1M9, Canada. NR 34 TC 9 Z9 9 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD DEC PY 1999 VL 27 IS 12 BP 2648 EP 2655 DI 10.1097/00003246-199912000-00007 PG 8 WC Critical Care Medicine SC General & Internal Medicine GA 270EZ UT WOS:000084523600007 ER PT J AU Uyer, M Askar, FZ Demirag, K AF Uyer, M Askar, FZ Demirag, K TI Elderly coronary artery bypass graft patients with left ventricular dysfunction are hemodynamically stable after two different doses of rocuronium SO JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA LA English DT Article DE rocuronium; elderly; CABG; hemodynamic ID HALOTHANE ANESTHESIA; ORG-9426; VECURONIUM; SURGERY; FENTANYL; BROMIDE; AGENT AB Objective: To clarify the detailed hemodynamic responses to bolus administration of 2x 95% effective dose (ED95) and 3x ED95 of rocuronium in elderly patients with left ventricular dysfunction undergoing elective coronary artery bypass grafting (CABG). Design: Prospective, randomized, clinical study. Setting: University hospital, Participants: Twenty patients aged older than 65 who had coronary artery disease with left ventricular ejection fractions equal to or less than 40%. Interventions:Using invasive cardiac monitoring, the detailed hemodynamic profile was obtained before and at 2, 4, 6, 8, and 10 minutes after the injection of rocuronium. Measurements and Main Results: Minor changes in all the measured or derived hemodynamic variables within the two groups did not attain statistical significance. Except for a higher baseline and the subsequent mean arterial pressures in one group, there were neither statistically nor clinically significant differences between two different doses of rocuronium in any of the variables at any time. Conclusion: The results demonstrate that bolus administration of rocuronium (2x to 3x ED95) in combination with high-dose fentanyl provides sufficient cardiovascular stability among elderly CABG patients with left ventricular dysfunction. The cardiovascular profile of the two different bolus doses was similar. Rocuronium, in both doses, appears to be a suitable agent for muscle relaxation, especially for patients who require a high degree of cardiovascular stability. Copyright (C) 1999 by WB. Saunders Company. C1 Ege Univ Hosp, Dept Anesthesiol, TR-35100 Izmir, Turkey. RP Uyer, M (reprint author), Ege Univ Hosp, Dept Anesthesiol, TR-35100 Izmir, Turkey. NR 23 TC 0 Z9 0 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1053-0770 J9 J CARDIOTHOR VASC AN JI J. Cardiothorac. Vasc. Anesth. PD DEC PY 1999 VL 13 IS 6 BP 673 EP 676 PG 4 WC Anesthesiology; Cardiac & Cardiovascular Systems; Respiratory System; Peripheral Vascular Disease SC Anesthesiology; Cardiovascular System & Cardiology; Respiratory System GA 266NU UT WOS:000084306700004 ER PT J AU Joshi, GP Hailey, A Cross, S Thompson-Bell, G Whitten, CC AF Joshi, GP Hailey, A Cross, S Thompson-Bell, G Whitten, CC TI Effects of pretreatment with cisatracurium, rocuronium, and d-tubocurarine on succinylcholine-induced fasciculations and myalgia: A comparison with placebo SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE neuromuscular nondepolarizing blocking drugs : cisatracurium, d-tubocurarine, rocuronium, succinylcholine; side effects : fasciculations, myalgia ID NEUROMUSCULAR BLOCKADE; PULMONARY ASPIRATION; VECURONIUM; PREVENTION AB Study Objective: To evaluate the efficacy of cisatracurium, rocuronium, and d-tubocurarine in preventing succinylcholine-induced fasciculations and postoperative myalgia in patients undergoing ambulatory surgery. Design: Randomized, prospective, placebo-controlled trial Setting: Teaching hospital. Subjects: 80 ASA physical status I and II patients scheduled for elective ambulatory surgery with general anesthesia. Intervention: A standardized balanced anesthetic technique was used for all patients. Measurements and Main Results: Patients were randomized to receive cisatracurium 0.01 mg/kg, rocuronium 0.06 mg/kg, d-tubocurarine 0.05 mg/kg, or saline, 3 minutes prior to intravenous (IV) succinylcholine 1.5 mg/kg. The intensity of fasciculations and intubating conditions were assessed using a four-point rating scale. In addition, the severity of myalgia runs assessed using a four-point rating scale in the postanesthesia care unit and at 24 hours postoperatively. No patient complained of any side effects after the administration of the study drug. Fasciculations were observed less frequently (p < 0.05) In the d-tubocurarine and rocuronium groups compared with the placebo and cisatracurium groups. However, there was no difference between the d-tubocurarine group and the rocuronium group (21% vs. 10%, respectively). Although fasciculations occurred less frequently in the cisatracurium group, than in the placebo group (59% vs. 85%, respectively), this difference did not reach statistical significance. There was no difference among the four groups in the intubating conditions or the incidence of postoperative. Conclusion: Pretreatment with rocuronium and d-tubocurarine was superior to cisatracurium in preventing succinylcholine-induced fasciculations. However, pretreatment did not have any effect on the incidence of myalgia after ambulatory surgery. (C) 2000 by Elsevier Science Inc. C1 Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX 75235 USA. RP Joshi, GP (reprint author), Univ Texas, SW Med Ctr, Dept Anesthesiol & Pain Management, 5323 Harry Hines Blvd, Dallas, TX 75235 USA. NR 21 TC 10 Z9 11 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD DEC PY 1999 VL 11 IS 8 BP 641 EP 645 DI 10.1016/S0952-8180(99)00109-9 PG 5 WC Anesthesiology SC Anesthesiology GA 282HE UT WOS:000085211600006 ER PT J AU Soppitt, AJ Glass, PSA El-Moalem, H Ginsberg, B Weatherwax, K Gan, TJ AF Soppitt, AJ Glass, PSA El-Moalem, H Ginsberg, B Weatherwax, K Gan, TJ TI Duration and recovery profile of cisatracurium after succinylcholine during propofol or isoflurane anesthesia SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE anesthesia : isoflurane, propofol; neuromuscular blockers : cisatracurium, succinylcholine; pharmacodynamic interactions ID CLINICAL NEUROMUSCULAR PHARMACOLOGY; BLOCKING-AGENT; TIME-COURSE; ATRACURIUM; SUXAMETHONIUM; PANCURONIUM; VECURONIUM; PHARMACOKINETICS; PHARMACODYNAMICS; SEVOFLURANE AB Study Objective: To determine the duration and recovery profile of maintenance doses of cisatracurium besylate following succinylcholine, and during propofol or isoflurane anesthesia. Design: Randomized, open-label study. Setting: Operating suite of a university-affiliated medical center. Patients: Forty ASA physical status I and II adult patients having elective surgery with general anesthesia lasting longer than 90 minutes. Interventions: Following a standardized induction sequence, a baseline electromyogram (EMG) was obtained. An intubating dose of intravenous (IV) succinylcholine 1.0 mg/kg was administered. Ventilation was maintained with a face mask until the first twitch (T-1) of the evoked train-of-four (TOF) reached 10% of control when tracheal intubation runs performed. Spontaneous recovery from neuromuscular blockade was allowed to occur until the first twitch returned to 25% of control. Patients then were randomized to receive cisatracurium as follows. Group 1: 0.025 mg/kg [0.5 X 95% effective dose (ED95)]; Group 2: 0.05 mg/kg (ED95); Group 3: 0.05 mg/kg (ED95); and Group 4: 0.1 mg/kg (2 x ED95). Anesthesia for Groups 1 and 2 were maintained with isoflurane 1% to 2%, 66% nitrous oxide (N2O) in oxygen (O-2), and in Groups 3 and 4, anesthesia was maintained with propofol 80 to 160 mu g/kg/min, 66% N2O in O-2. The TOF-evoked EMG was recorded at 10-second intervals. The time for the evoked EMG to spontaneously return to 25%, 50%, and 75% of the original baseline was recorded. Measurements and Main Results: There were 10 patients in each of the four groups. The duration of action of cisatracurium 0.05 mg/kg (ED95) after an intubating dose of succinylcholine is 24.5 +/- 10 minutes and 21.3 +/- 9 minutes during anesthesia maintained with isoflurane and propofol, respectively. Doubling the dose of cisatracurium resulted in approximately twice the duration of action (40.2 +/- 7 min) during propofol anesthesia. Following a dose of cisatracurium 0.025 mg/kg (0.5 x ED95), the T-1 of the EMG-evoked response did not decrease below 25% in 7 of 10 patients. Conclusion: Following succinylcholine, the duration of action of a single dose of cisatracurium 0.05 mg/kg is 20 to 25 minutes during anesthesia maintained with propofol or isoflurane. The duration and recovery profile of cisatracurium is dose dependent during propofol and isoflurane anesthetics. Cisatracurium 0.025 mg/kg is an inadequate maintenance dose following recovery from succinylcholine and it fails to provide adequate surgical relaxation. (C) 2000 by Elsevier Science Inc. C1 Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA. RP Gan, TJ (reprint author), Duke Univ, Med Ctr, Dept Anesthesiol, POB 3094, Durham, NC 27710 USA. NR 18 TC 3 Z9 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD DEC PY 1999 VL 11 IS 8 BP 652 EP 656 DI 10.1016/S0952-8180(99)00118-X PG 5 WC Anesthesiology SC Anesthesiology GA 282HE UT WOS:000085211600008 ER PT J AU de Oliveira, MJ Oliveira, AC AF de Oliveira, MJ Oliveira, AC TI Mechanisms underlying the vecuronium-induced tetanic fade in the isolated rat muscle SO PHARMACOLOGY & TOXICOLOGY LA English DT Article ID NEUROMUSCULAR-JUNCTION; ACETYLCHOLINE TRANSPORT; RUN-DOWN; RECEPTOR; TRANSMISSION; RELEASE; ANTAGONISTS; ENDPLATE; STORAGE AB The cellular mechanisms underlying the effects of vecuronium on the tetanic contraction were studied in vitro with a combination of myographic and electrophysiologic techniques. We used the isolated sciatic nerve extensor digitorum longus muscle preparation of the rat. Indirect twitches were evoked at 0.1 Hz pulses and tetani at 50 Hz pulses. Trains of end-plate potentials were generated at 50 Hz. The electrophysiological variables used in the analysis of the end-plate potentials were: amplitude, tetanic run-down, quantal size and quantal content. The myographic study demonstrated that vecuronium at 0.4 mu M caused tetanic fade, but left the twitch unaffected. Regarding electrophysiology, vecuronium (0.4 mu M) decreased the amplitude of end-plate potentials and increased their tetanic run-down. These changes were due to significant reductions in both the quantal content of the end-plate potentials and the quantal size. It is concluded that vecuronium has both pre- and postsynaptic effects at the neuromuscular junction, and that it induces fade of the tetanic contraction via a summation of these effects. C1 Univ Sao Paulo, Inst Biomed Sci, Dept Pharmacol, BR-05508900 Sao Paulo, Brazil. RP Oliveira, AC (reprint author), Univ Sao Paulo, Inst Biomed Sci, Dept Pharmacol, Avenida Lineu Prestes 1524, BR-05508900 Sao Paulo, Brazil. NR 35 TC 7 Z9 7 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0901-9928 J9 PHARMACOL TOXICOL JI Pharmacol. Toxicol. PD DEC PY 1999 VL 85 IS 6 BP 282 EP 287 PG 6 WC Pharmacology & Pharmacy; Toxicology SC Pharmacology & Pharmacy; Toxicology GA 265LP UT WOS:000084245900005 ER PT J AU Hunzelmann, N Kopner, R Hani, N Scharffetter-Kochanek, K AF Hunzelmann, N Kopner, R Hani, N Scharffetter-Kochanek, K TI Immediate-type reactions to cisatracurium SO ALLERGY LA English DT Article DE anaphylaxis; general anesthesia; neuromuscular blocking agent C1 Univ Cologne, Dept Dermatol, D-50924 Cologne, Germany. RP Hunzelmann, N (reprint author), Univ Cologne, Dept Dermatol, Joseph Stelzmann Str 9, D-50924 Cologne, Germany. NR 6 TC 2 Z9 2 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0105-4538 J9 ALLERGY JI Allergy PD NOV PY 1999 VL 54 IS 11 BP 1227 EP 1228 DI 10.1034/j.1398-9995.1999.00319.x PG 2 WC Allergy; Immunology SC Allergy; Immunology GA 259VP UT WOS:000083914900019 ER PT J AU Kaplan, RF Fletcher, JE Hannallah, RS Bui, DT Slaven, JS Darrow, EJ Tsai, KT AF Kaplan, RF Fletcher, JE Hannallah, RS Bui, DT Slaven, JS Darrow, EJ Tsai, KT TI The potency (ED50) and cardiovascular effects of rapacuronium (Org 9487) during narcotic-nitrous oxide-propofol anesthesia in neonates, infants, and children SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 17-25, 1996 CL NEW ORLEANS, LOUISIANA SP Amer Soc Anesthesiologists ID ENDOTRACHEAL INTUBATING CONDITIONS; NEUROMUSCULAR BLOCKING-AGENTS; PEDIATRIC-PATIENTS; DOSE-RESPONSE; TIME-COURSE; VECURONIUM; JUNCTION; ORG-9487 AB We studied the neuromuscular blocking effects of rapacuronium (Org 9487) (dose-response curve, onset, and 50% effective dose [ED50] value), and changes in heart rate and blood pressure, as well as evidence of histamine release in neonates, infants, and children in an open-label, randomized, two-center study. Fifteen neonates, 30 infants, and 30 children were studied. Anesthesia was induced and maintained with propofol, nitrous oxide:oxygen (60:40), and fentanyl. Mechanomyographic monitoring of neuromuscular function was performed at the thumb. The potency (ED50) for neonates, infants, and children were 0.32 (95% confidence interval [CT] 0.15-0.61), 0.28 (95% CI 0.11-0.61), and 0.39 (95% CI 0.17-0.85) mg/kg, respectively. Neonates who received 0.3, 0.6, or 0.9 mg/kg Org 9487 developed a maximum T-1 twitch depression of 34 +/- 28%, 98 +/- 3%, and 99 +/- 2%, respectively. Time-to-peak effect (onset time) for 0.9 mg/kg Org 9487 was 57 +/- 20 s. Maximum percent T-1 twitch depression (+/-SD) in infants who received 0.3, 0.6, or 0.9 mg/kg rapacuronium was 41 +/- 34%, 96 +/- 7%, and 100 +/- 1%, respectively. Time-to-peak effect for 0.9 mg/kg Org 9487 was 62 +/- 29 s. In children 03, 0.6, and 0.9 mg/kg rapacuronium resulted in an average percent T-1 twitch suppression of 29 +/- 23, 83 +/- 11, and 90 +/- 16, respectively. Time-to-peak effect of 0.9 mg/kg Org 9387 was 96 +/- 33 s, respectively. There was no evidence of histamine release or significant changes in heart rate or blood pressure in either group at any dose. Rapacuronium is a low-potency nondepolarizing muscle relaxant with a fast onset of relaxation and minimal cardiovascular effects. Its potency (ED50) is similar in neonates (0.32 mg/kg), infants (0.28 mg/kg), and children (0.39 mg/kg). T-1 suppression (90% +/- 16) is less and time to peak effect (96 +/- 33 s) is greater (0.9 mg/kg rapacuronium) in children, compared with the combined group of infants and neonates. Implications: This study assesses the potency of rapacuronium (Org 9487) in pediatric patients. The potency of rapacuronium is similar in neonates (0.32 mg/kg), infants (0.28 mg/kg), and children (0.39 mg/kg). C1 Childrens Natl Med Ctr, Dept Anesthesiol, Washington, DC 20010 USA. Childrens Natl Med Ctr, Dept Pediat, Washington, DC 20010 USA. Childrens Hosp Buffalo, Dept Anesthesiol, Buffalo, NY USA. Organon Inc, Dept Biometr, W Orange, NJ USA. RP Kaplan, RF (reprint author), Childrens Natl Med Ctr, Dept Anesthesiol, 111 Michigan Ave NW, Washington, DC 20010 USA. NR 13 TC 11 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 1999 VL 89 IS 5 BP 1172 EP 1176 PG 5 WC Anesthesiology SC Anesthesiology GA 252JK UT WOS:000083498200016 ER PT J AU Reynolds, LM Infosino, A Brown, R Hsu, J Fisher, DM AF Reynolds, LM Infosino, A Brown, R Hsu, J Fisher, DM TI Intramuscular rapacuronium in infants and children - Dose-ranging and tracheal intubating conditions SO ANESTHESIOLOGY LA English DT Article DE intramuscular drug administration; ORG9487; pediatrics; succinylcholine; vecuronium ID VECURONIUM NEUROMUSCULAR BLOCKADE; ADDUCTOR POLLICIS; MUSCLES; ONSET; SUCCINYLCHOLINE; ROCURONIUM; DIAPHRAGM; DURATION AB Background: Intravenous rapacuronium's rapid onset and short duration suggest that intramuscular rapacuronium might facilitate tracheal intubation without prolonged paralysis. Accordingly, the authors injected rapacuronium into the deltoid muscle to determine the optimal dose and time for intubation in pediatric patients. Methods: Unpremedicated patients (aged, 2 months to 3 yr) were studied. Part I: Spontaneous minute ventilation ((V) over dot(E)) and twitch tension were measured during N2O/halothane anesthesia. Rapacuronium (2.2-5.5 mg/kg, given intramuscularly, n = 23), succinylcholine (4 mg/kg, given intramuscularly, n = 12), ;or vecuronium (0.1 mg/kg, given intravenously, n = 15) was given. Time to 50% depression of (V) over dot(E) and 10% recovery of twitch mere measured. Dose for each patient was changed 10-20% according to the previous patient's response. Part II: In 22 patients anesthetized with 0.82-1.0% halothane, the optimal rapacuronium dose determined in part I (infants, 2.8 mg/kg; children, 4.8 mg/kg) was given intramuscularly. Laryngoscopy was scored. Time to laryngoscopy was increased or decreased 0.5 min according to the previous patient's response. Results: Part I: Rapacuronium typically depressed ventilation in less than or equal to 2 min with 10% twitch recovery in 20-60 min. With succinylcholine, median time to ventilatory depression was 1.3 and 1.1 min for infants and children, respectively; for vecuronium, 0.7 and 0.6 min. Part II: Intubating conditions were good-excellent at 3.0 and 2.5 min in infants and children, respectively; time to 10% twitch recovery (mean +/- SD) was 31 +/- 14 and 36 +/- 14 min in the two groups. Conclusions: This pilot study indicates that deltoid injection of rapacuronium, 2.8 mg/kg in infants and 4.8 mg/kg in children, permits tracheal intubation within 2.5-3.0 min, despite a light plane of anesthesia. Duration of action is intermediate. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. NR 15 TC 5 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1999 VL 91 IS 5 BP 1285 EP 1292 DI 10.1097/00000542-199911000-00019 PG 8 WC Anesthesiology SC Anesthesiology GA 249LU UT WOS:000083335200015 ER PT J AU Duvaldestin, P Slavov, V Rebufat, Y AF Duvaldestin, P Slavov, V Rebufat, Y TI Pharmacokinetics and pharmacodynamics of rapacuronium in patients with cirrhosis SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 1997 Annual Meeting of American-Society-of-Anesthesiologists CY OCT 17-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiologists DE liver disease; neuromuscular relaxants; plasma concentration ID TIME-COURSE; NEUROMUSCULAR BLOCK; MUSCLE-RELAXANT; ORG-9487; PANCURONIUM; VECURONIUM; ONSET; SUCCINYLCHOLINE; ROCURONIUM; EXCRETION AB Background: Delayed elimination kinetics of steroidal neuromuscular blocking agents have been observed in patients with cirrhosis. Like other steroidal muscle relaxants, rapacuronium may, in part, be eliminated by the liver. To determine the influence of Liver disease on its neuromuscular blocking effect, we studied the pharmacokinetics and pharmacodynamics of rapacuronium in patients with cirrhosis. Methods: Sixteen patients undergoing elective surgery or endoscopy with general anesthesia, eight with cirrhosis and eight with normal Liver function, mere studied. Anesthesia was induced with fentanyl 2 mu g/kg and thiopental 5-7 mg/kg and maintained with 60% nitrous oxide and 0.6-0.8% isoflurane in oxygen and repeated doses of fentanyl 1 mu g/kg. Rapacuronium 1.5 mg/kg was administered intravenously before tracheal intubation. Thumb adduction force evoked by supramaximal ulnar nerve stimulation mas recorded in 16 patients. Venous blood was sampled at frequent intervals for 8 h. Rapacuronium and its breakdown product Org 9488 were measured in plasma by high-pressure Liquid chromatography. Values are reported as median (Range). Results: The central volume of distribution was increased to 131 (104-141) ml/kg in patients with cirrhosis (P < 0.01), compared with 75 (47-146) ml/kg in controls. The total apparent volume of distribution was also increased (P < 0.05) to 331 (284-488) ml/kg in patients with cirrhosis, compared with 221 (124-285) ml/kg in controls. The elimination half-life was 88 (77-102) min in controls and 90 (76-117) min in patients with cirrhosis. plasma clearance was increased (P < 0.05) to 6.9 (6.1-8.9) ml.min(-1).kg(-1) in patients with cirrhosis, compared with 5.3 (4.2-8.4) ml.min(-1).kg(-1) in controls. Rapacuronium neuromuscular blocking effect was similar between the two groups. Onset time was 65 (40-110) s in controls and of 60 (52-240) s in patients with cirrhosis. Time to return to 90% of thumb adduction force control value was of 49 (28-80) min in controls and 47 (28-71) min in patients with cirrhosis. Conclusion: The neuromuscular blocking effect of a single bolus dose of rapacuronium in patients with cirrhosis is not different from that of patients with normal hepatic function. No decrease in plasma clearance of rapacuronium was observed in patients with cirrhosis. C1 Henri Mondor Hosp, Dept Anesthesia & Intens Care, Creteil, France. RP Duvaldestin, P (reprint author), Univ Paris 12, Hop Henri Mondor, Dept Anesthesia & Intens Care, 51 Ave Marechal de Lattre de Tassigny, F-94010 Creteil, France. NR 26 TC 11 Z9 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1999 VL 91 IS 5 BP 1305 EP 1310 DI 10.1097/00000542-199911000-00022 PG 6 WC Anesthesiology SC Anesthesiology GA 249LU UT WOS:000083335200018 ER PT J AU Fleming, NW Chung, F Glass, PSA Kitts, JB Kirkegaard-Nielsen, H Gronert, GA Chan, V Gan, TJ Cicutti, N Caldwell, JE AF Fleming, NW Chung, F Glass, PSA Kitts, JB Kirkegaard-Nielsen, H Gronert, GA Chan, V Gan, TJ Cicutti, N Caldwell, JE TI Comparison of the intubation conditions provided by rapacuronium (ORG 9487) or succinylcholine in humans during anesthesia with fentanyl and propofol SO ANESTHESIOLOGY LA English DT Article DE adverse events; cardiovascular; neuromuscular block ID NEUROMUSCULAR BLOCKING-AGENTS; CHANGES FOLLOWING SUXAMETHONIUM; LARYNGEAL ADDUCTOR MUSCLES; TRACHEAL INTUBATION; ELDERLY PATIENTS; ORG-9487; ROCURONIUM; VECURONIUM; ALFENTANIL; RELAXANT AB Background: Currently, the only approved muscle relaxant with a rapid onset and short duration of action is succinylcholine, a drug with some undesirable effects. Rapacuronium is an investigational nondepolarizing relaxant that also has a rapid onset and short duration and consequently should be compared with succinylcholine in its ability to facilitate rapid tracheal intubation. Methods: This prospective, randomized clinical trial involved 336 patients. Anesthesia was induced with fentanyl and propofol and either 1.5 mg/hg rapacuronium or 1.0 mg/kg succinylcholine. The goal was to accomplish tracheal intubation by 60 s after administration of the neuromuscular blocking drug. Endotracheal intubation was performed, and conditions were graded by a blinded investigator. Recovery of neuromuscular function was assessed by electromyography. Results: Intubation conditions were evaluated in 236 patients. Intubation by 60 s after drug administration occurred in 100% of patients with rapacuronium and in 98% with succinylcholine. Intubation conditions were excellent or good in 87% of patients with rapacuronium and in 95% with succinylcholine (P < 0.05). The time (median and range) to the first recovery of the train-of-four response was 8.0 (2.8-20.0) min with rapacuronium and 5.7 (1.8-17.7) min with succinylcholine (P < 0.05). The overall incidence of adverse effects was similar with both drugs. Conclusions: A 1.5-mg/kg dose of rapacuronium effectively facilitates rapid tracheal intubation. It can be considered a valid alternative to 1.0 mg/kg succinylcholine for this purpose. C1 Univ Calif Davis, Dept Anesthesiol, Davis, CA 95616 USA. Univ Toronto, Toronto Hosp, Dept Anesthesia, Toronto, ON, Canada. Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA. Univ Ottawa, Ottawa Hosp, Dept Anesthesia, Ottawa, ON, Canada. Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA USA. RP Caldwell, JE (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. NR 33 TC 19 Z9 19 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1999 VL 91 IS 5 BP 1311 EP 1317 DI 10.1097/00000542-199911000-00023 PG 7 WC Anesthesiology SC Anesthesiology GA 249LU UT WOS:000083335200019 ER PT J AU McCourt, KC Elliott, P Mirakhur, RK McMurray, TJ Phillips, AS Cochrane, D AF McCourt, KC Elliott, P Mirakhur, RK McMurray, TJ Phillips, AS Cochrane, D TI Haemodynamic effects of rapacuronium in adults with coronary artery or valvular disease SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article; Proceedings Paper CT Meeting of the Anaesthetic-Research-Society CY MAR 27, 1998 CL BELFAST, NORTH IRELAND SP Anaesthet Res Soc DE neuromuscular block, rapacuronium; neuromuscular block, vecuronium; neuromuscular block, Org 9487; cardiovascular system, effects; surgery, cardiovascular ID NEUROMUSCULAR BLOCKING-AGENTS; CARDIAC MUSCARINIC RECEPTORS; MUSCLE-RELAXANT; CLINICAL-PHARMACOLOGY; ORG-9487; SUCCINYLCHOLINE; MIVACURIUM; VECURONIUM; ANESTHESIA; DURATION AB We have assessed the haemodynamic effects of rapacuronium (Org 9487) in adults undergoing cardiac surgery and compared these with vecuronium and placebo. We studied 56 adult patients undergoing coronary artery bypass grafting or valve replacement surgery using a fentanyl-based anaesthetic technique. A pulmonary artery flotation catheter was inserted before induction of anaesthesia. After induction, tracheal intubation and stabilization of haemodynamic measurements, subjects were allocated randomly to receive rapacuronium 1.5 mg kg(-1), vecuronium 0.1 mg kg(-1) or saline placebo. Haemodynamic measurements were made before drug administration and 1, 3, 5 and 10, and if possible, 15 min after administration. Rapacuronium was associated with statistically significant increases in heart rate (17%) and cardiac index (15%) and decreases in mean arterial pressure (11%) and systemic vascular resistance (18%), whereas vecuronium and placebo were associated with significant decreases in heart rate only (14-15%) (P<0.05). No cutaneous signs of histamine release were observed. Clinically, the results were within acceptable limits. Our results suggest that administration of rapacuronium may be associated with significant changes in heart rate and arterial pressure in patients undergoing coronary artery bypass grafting. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. Royal Grp Hosp, Reg Med Cardiol Ctr, Belfast, Antrim, North Ireland. Royal Grp Hosp, Dept Clin Anaesthesia, Belfast, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 21 TC 8 Z9 8 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD NOV PY 1999 VL 83 IS 5 BP 721 EP 726 PG 6 WC Anesthesiology SC Anesthesiology GA 261PF UT WOS:000084017000007 ER PT J AU Mills, KG Wright, PMC Pollard, BJ Scott, JM Hing, JP Danjoux, G Hunter, JM AF Mills, KG Wright, PMC Pollard, BJ Scott, JM Hing, JP Danjoux, G Hunter, JM TI Antagonism of rapacuronium using edrophonium or neostigmine: pharmacodynamics and pharmacokinetics SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article; Proceedings Paper CT Meeting of the Anaesthetic-Research-Society CY JUL 11-12, 1996 CL BIRMINGHAM, ENGLAND SP Anaesthet Res Soc DE neuromuscular block, rapacuronium; neuromuscular block, Org 9487; neuromuscular block, antagonism; pharmacodynamics; pharmacokinetics, rapacuronium ID NEUROMUSCULAR BLOCKING-AGENTS; LARYNGEAL ADDUCTOR MUSCLES; HEPATIC CIRRHOSIS; TIME-COURSE; ATRACURIUM; ORG-9487; VECURONIUM; SUCCINYLCHOLINE; PANCURONIUM; MIVACURIUM AB We have studied the pharmacodynamics and pharmacokinetics of rapacuronium (Org 9487) in 70 healthy patients. Neuromuscular transmission was monitored using TOF stimulation of the ulnar nerve and mechanomyography of the adductor pollicis muscle. Half of the patients were given a single dose of rapacuronium 1.5 mg kg(-1) and the remainder rapacuronium 1.5 mg kg(-1) with three incremental doses of 0.5 mg kg(-1), each given when T1/T0 had recovered to 25%. In all patients, neuromuscular block was antagonized using neostigmine 0.05 mg kg(-1) or edrophonium 1.0 mg kg(-1) (allocated randomly), 2 min after the final dose of rapacuronium. All patients developed complete block after rapacuronium 1.5 mg kg-l. Mean onset time was 66 (SD 24) s. In patients who received an antagonist 2 min after the first dose of rapacuronium, time to recovery of T1/T0 to 25% was similar after neostigmine (9.8 (3.8) min) and edrophonium (10.3 (4.3) min); in patients who received incremental doses of rapacuronium, spontaneous recovery of T1/T0 to 25% after the first dose was 18.9 (4.7) min. In those who received an antagonist 2 min after the first dose of rapacuronium, times to recovery of T4/T1 to 0.7 were also similar after neostigmine (23.7 (7.7) min) and edrophonium (29.1 (10.7) min). After three incremental doses of rapacuronium, there was a longer time to recovery of T1/T0=25% after neostigmine compared with edrophonium (5.1 (1.0) vs 3.3 (1.3) min; P<0.05) but more rapid recovery to T1/T0=75% (10.1 (2.9) vs 16.8 (10.1) min; P<0.05) and T4/T1=0.7 (19.8 (6.3) vs 35.1 (10.4) min; P<0.05). A three-compartment pharmacokinetic model was justified. Typical values for clearance and initial volume of distribution (V-1) were 4.4 ml kg(-1) min(-1) and 94.8 ml kg(-1), respectively. In females, clearance was decreased by 38.5% compared with males and V-1 was decreased by 25% in patients aged more than 65 yr. C1 Univ Liverpool, Royal Liverpool Univ Hosp, Dept Anaesthesia, Liverpool L69 3GA, Merseyside, England. Univ Newcastle Upon Tyne, Royal Victoria Infirm, Acad Dept Anaesthesia, Newcastle Upon Tyne NE1 4LP, Tyne & Wear, England. Univ Manchester, Manchester Royal Infirm, Dept Anaesthesia, Manchester M13 9WL, Lancs, England. RP Wright, PMC (reprint author), Univ Liverpool, Royal Liverpool Univ Hosp, Dept Anaesthesia, Daulby St, Liverpool L69 3GA, Merseyside, England. NR 27 TC 7 Z9 8 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD NOV PY 1999 VL 83 IS 5 BP 727 EP 733 PG 7 WC Anesthesiology SC Anesthesiology GA 261PF UT WOS:000084017000008 ER PT J AU Deepika, K Kenaan, CA Bikhazi, GB Martineau, DB AF Deepika, K Kenaan, CA Bikhazi, GB Martineau, DB TI Influence of the priming technique on pharmacodynamics and intubating conditions of cisatracurium SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE cisatracurium; priming ID RAPID TRACHEAL INTUBATION; CLINICAL NEUROMUSCULAR PHARMACOLOGY; BLOCKING-DRUGS; VECURONIUM; PRINCIPLE; ANESTHESIA; ONSET AB Study Objectives: To determine the effects of the priming technique on the intubating conditions and pharmacodynamics of different doses of cisatracurium. Design: Open-label, randomized study. Setting: Operating room of a university-affiliated hospital. Patients: 60 ASA physical status I, II, and III female patients. Interventions: Patients were randomly assigned to one of four groups. Patients from Groups 1, 2 and 3 received 0.01 mg/kg cisatracurium as a priming dose, and patients from Group 4 received placebo. Four minutes later, patients from Groups 1, 2, 3, and 4 received the following intubating doses of cisatracurium: 0.09 mg/kg, 0.14 mg/kg, 0.19 mg/kg, and 0.2 mg/kg, respectively, Anesthesia was induced with thiopental sodium, sufentanil, droperidol, and nitrous oxide (N2O; 6 L/min) in oxygen (O-2; 4 L/min) and maintained with isoflurane up to 0.7%, N2O in O-2, and sufentanil. Mechanomyography assessed the neuromuscular function of the adductor pollicis with train-of-four supramaximal impulses. The trachea was intubated when the amplitude of the first twitch decreased to 10% to 15% of control. Measurements and Main Results: There were no significant differences among the groups regarding the demographic data the value of the first twitch at 60 seconds, the time to 90% block, and the onset time. Clinical duration of cisatracurium was significantly different between Group 3 and Groups 1 and 2, whereas Group 4 differed significantly from Group 1. Intubating conditions did not differ significantly among the groups. Conclusion: When primed, cisatracurium 0.09 mg/kg and 0.14 mg/kg produced an onset time comparable with that of 0.2 mg/kg and allowed an earlier spontaneous recovery (p < 0.05). In this study, there was no benefit in priming cisatracurium 0.19 mg/kg. (C) 1999 by Elsevier Science Inc. C1 Univ Miami, Jackson Mem Med Ctr, Dept Anesthesiol R370, Miami, FL 33101 USA. RP Deepika, K (reprint author), Univ Miami, Jackson Mem Med Ctr, Dept Anesthesiol R370, POB 016370, Miami, FL 33101 USA. NR 15 TC 3 Z9 5 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD NOV PY 1999 VL 11 IS 7 BP 572 EP 575 DI 10.1016/S0952-8180(99)00099-9 PG 4 WC Anesthesiology SC Anesthesiology GA 267XB UT WOS:000084383600010 ER PT J AU Gibson, JK Haire, RG AF Gibson, JK Haire, RG TI High-energy organometallic chemistry of curium: Laser ablation of Cm7O12 dispersed in polyimide SO ORGANOMETALLICS LA English DT Article ID HYDROCARBONS; REACTIVITY; DICARBIDE; ACTINIDE; ALKENES; ION AB Gas-phase curium organometallic ions were synthesized by metal/polymer co-ablation. Vacuum laser ablation of a dilute dispersion of curium oxide in polyimide resulted in several organocurium ions, evidently formed by nucleation of Cm+ and various neutral polymer fragment radicals in the ablation plume. The compositions and abundances of simple species such as CmC2+, CmC2H+, and CmCN+, can be rationalized on the basis of the electronic structure and energetics of the curium ion, Cm+. The results for curium are in accord with a general thermochemical model previously employed to understand the organometallic speciation of preceding actinides. The identification of the above-specified species, along with several larger organocurium ions, extends the realm of organoactinide chemistry; specifically, it represents identification of a series of unique curium complexes which presumably incorporate substantially covalent (sigma) Cm-C bonding. Also identified in the ablation plume were small clusters incorporating two or three curium atoms. Simple clusters, such as Cm3O4+, reveal a trivalent, lanthanide-like character for curium and reflect the tendency toward bulk, solid-state chemical behavior upon coalescence of only a few atoms. Finally, a notable ancillary observation was the formation of several clusters in which C-2 evidently substituted sequentially for an O atom, revealing the pseudo-oxygen character of the dicarbide moiety. C1 Oak Ridge Natl Lab, Div Chem & Analyt Sci, Oak Ridge, TN 37831 USA. RP Gibson, JK (reprint author), Oak Ridge Natl Lab, Div Chem & Analyt Sci, POB 2008, Oak Ridge, TN 37831 USA. NR 30 TC 3 Z9 3 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0276-7333 J9 ORGANOMETALLICS JI Organometallics PD OCT 25 PY 1999 VL 18 IS 22 BP 4471 EP 4477 DI 10.1021/om990397j PG 7 WC Chemistry, Inorganic & Nuclear; Chemistry, Organic SC Chemistry GA 255DR UT WOS:000083654700003 ER PT J AU Mouw, RJC Klumper, F Hermans, J Brandenburg, HCR Kanhai, HHH AF Mouw, RJC Klumper, F Hermans, J Brandenburg, HCR Kanhai, HHH TI Effect of atracurium or pancuronium on the anemic fetus during and directly after intravascular intrauterine transfusion - A double blind randomized study SO ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA LA English DT Article DE atracurium; computer analyzed fetal heart rate recording; fetal paralysis; intrauterine transfusion; pancuronium ID FETAL HEART-RATE; NEUROMUSCULAR BLOCKADE; BROMIDE; ISOIMMUNIZATION AB Background To determine the effect of atracurium or pancuronium on onset and duration of fetal paralysis, movements and heart rate parameters directly after transfusion, using computer analyzed fetal heart rate recording (c-FHR). Methods Double blind randomized study of 23 RhD alloimmunized pregnant women requiring an intravascular intrauterine fetal blood transfusion (IUT) between 24 and 36 weeks. Atracurium was injected in 11 fetuses at 17 IUT's and pancuronium in 12 fetuses at 19 IUTS. For statistical analysis the Mann-Whitney test was used. Results. No statistical differences were found in fetal heart rate and movements between both groups before transfusion. The fetal movements returned more rapidly in the atracurium group when compared to the pancuronium-group (median 24 vs. 57 min, range 6-55 vs. 4-220; (p<0.02). Fetal movements did not hamper the procedure in any case. The atracurium group showed significantly more fetal movements (p<0.01), more accelerations (p<0.05) but no significant reduction of fetal heart rate variability directly after transfusion which was in direct contrast to the pancuronium group. Conclusions. Neuromuscular blockade with atracurium produces sufficient paralysis for intrauterine transfusion with minimal disturbance of the parameters used to monitor fetal wellbeing after the procedure. Although the routine use of fetal paralysis during IUT may be questionable, we believe that when it is necessary the use of atracurium is the better choice. C1 Leiden Univ, Med Ctr, Dept Obstet, NL-2300 RC Leiden, Netherlands. Leiden Univ, Med Ctr, Dept Med Stat, NL-2300 RC Leiden, Netherlands. Leiden Univ, Med Ctr, Dept Clin Pharm, NL-2300 RC Leiden, Netherlands. RP Kanhai, HHH (reprint author), Leiden Univ, Med Ctr, Dept Obstet, Postbox 9600, NL-2300 RC Leiden, Netherlands. NR 16 TC 10 Z9 10 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-6349 J9 ACTA OBSTET GYN SCAN JI Acta Obstet. Gynecol. Scand. PD OCT PY 1999 VL 78 IS 9 BP 763 EP 767 DI 10.1034/j.1600-0412.1999.780904.x PG 5 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 247GW UT WOS:000083213900004 ER PT J AU Blobner, M Busley, R Mann, R Jelen-Esselborn, S Kochs, E AF Blobner, M Busley, R Mann, R Jelen-Esselborn, S Kochs, E TI Neuromuscular recovery following mivacurium is also predictable in patients with severe systemic diseases. SO ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE LA German DT Article DE mivacurium; neuromuscular recovery; plasma-cholinesterase; severe systemic diseases ID INFUSION; CHLORIDE; SUXAMETHONIUM; ATRACURIUM AB Fast recovery from mivacurium-induced neuromuscular blockade is impaired in patients with decreased plasma cholinesterase activity which is often associated with dysfunction of different organs. Nevertheless, predictability of neuromuscular recovery may be given. Thus, this study evaluates parameters to predict individual neuromuscular recovery in patients with uncommon diseases. Methods: 84 male or female patients (18-70 years of age) were allocated to one of two groups according to their ASA risk profile (without severe systemic diseases: ASA 1 and 2; with severe systemic diseases: ASA 3 and 4). Plasma cholinesterase activity (PChE) had been determined preoperatively. Anaesthesia was performed with propofol and fentanyl. Neuromuscular transmission was monitored by electromyography. The ulnar nerve was stimulated by train-of four stimuli and neuromuscular transmission was measured at the hypothenar. After mivacurium 0.1 mu mg/kg, an infusion of mivacurium was adjusted to maintain T-1/T-0 at approximately 5 % for at least 60 min. Duration from application of the initial bolus until recovery to T-1/T-0 = 5 % (dur 5), the mean mivacurium infusion rate (IR), infusion time, the early recovery time from cessation of infusion to T-1/T-0 = 25 % (rec 25) and the final recovery time from T-1/T-0 = 25 % to T-4/T-1 = 75 % (final rec) was measured. Statistical analysis of data was performed using t-tests. (alpha = 0.05). predictability of the recovery times (rec 25 and final rec) was tested by multiple linear least-squares regressions. Dependent variables were PChE, dur 5, IR, infusion time, and rec 25, respectively. To test for predictability of neuromuscular blockade by mivacurium with respect to severe systemic diseases, the ASA risk score was defined to be the second independent variable at each regression, the respective interaction was defined to be the third independent variable (variable 1 x group). Variables entered multiple regression analysis in a forward stepwise manner (F > 4.0). Results: PChE was significantly lower in patients with severe systemic diseases (3.7 +/- 1.2 kU/l vs. 4.5 +/- 0.9 kU/l), dur 5 significantly prolonged (17.3 +/- 7.3 min vs. 11.0 +/- 3.0 min), IR significantly lower (4.6 +/- 2.6 mu g/kg/min vs. 6.5 +/- 2.8 mu g/kg/min), and rec 25 (8.7 +/- 4.0 min vs. 6.0 +/- 1.7 min) as well as final rec (23.0 +/- 16.3 min vs. 13.0 +/- 3.7 min) significantly prolonged compared to patients without severe systemic diseases. Both recovery intervals correlated significantly with PChE, dur 5, or IR, but not with the ASA risk score. Multiple regression analysis revealed a close correlation between rec 25 and final rec very closely (R-2 = 0.875). Prolonged mivacurium infusion time and additionally high ASA risk score were correlated with a prolonged neuromuscular recovery (R-2 = 0.130). Discussion: Prolonged neuromuscular recovery could be predicted from a reduced PChE, a prolonged duration of action of the initial mivacurium bolus and a decreased mivacurium-infusion rate required to maintain a 95 % neuromuscular blockade. Measurement of plasma cholinesterase and monitoring of mivacurium induced neuromuscular blockade can avoid resting neuromuscular blockade postoperatively despite of prolonged neuromuscular recovery. C1 Tech Univ Munich, Inst Anesthesiol, D-81675 Munich, Germany. RP Blobner, M (reprint author), Tech Univ Munich, Inst Anesthesiol, Ismaninger Str 22, D-81675 Munich, Germany. NR 10 TC 3 Z9 3 PU GEORG THIEME VERLAG PI STUTTGART PA P O BOX 30 11 20, D-70451 STUTTGART, GERMANY SN 0939-2661 J9 ANASTH INTENSIV NOTF JI Anasthesiol. Intensivmed. NotfMed. Schmerzther. PD OCT PY 1999 VL 34 IS 10 BP 638 EP 641 DI 10.1055/s-1999-218 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 247RQ UT WOS:000083234100008 ER PT J AU Kopman, AF Klewicka, MM Neuman, GG AF Kopman, AF Klewicka, MM Neuman, GG TI Molar potency is not predictive of the speed of onset of atracurium SO ANESTHESIA AND ANALGESIA LA English DT Article ID PHARMACOLOGY; PANCURONIUM; VECURONIUM AB In an effort to determine the extent to which atracurium may represent an exception to the rule that molar potency predicts onset time, we studied the onset profile of atracurium after a dose selected to produce approximately 95% twitch depression. We compared these results with data obtained in a previous study after the administration of vecuronium, rocuronium, and cisatracurium. Eighteen ASA physical status I and II patients were studied. After the induction of anesthesia, tracheal intubation was accomplished without relaxants. The evoked electromyographic response to 0.10-Hz single stimuli was continuously recorded. After baseline stabilization, a single bolus of atracurium, averaging 0.21 mg/kg, was administered. If peak twitch depression did not fall within the range of 90%-98%, the patient was excluded. The time to 50% and 90% of peak effect was recorded. The time to 90% of maximal effect (192 +/- 23 s) was not different from that previously observed for vecuronium (201 +/- 20 s). The time to 50% of peak effect (110 +/- 15 s) was shorter (P < 0.05) after atracurium administration than after vecuronium (125 +/- 9 s). The onset times recorded for atracurium were slower than previously observed after rocuronium and more rapid than that which was seen after cisatracurium (P < 0.001). The observed onset profile of atracurium was considerably slower than anticipated, based on the drug's molar potency. The 95% effective dose (mu M/kg) may not be a reliable predictor of a muscle relaxant's onset time, when the drug administered is a mixture isomers of varying potency. Implications: The speed of onset of atracurium is slower than predicted, based on its molar potency. Potency of a relaxant may not be a reliable predictor of its time to peak effect, when the drug administered is a mixture of isomers with widely different neuromuscular activities. C1 St Vincents Hosp & Med Ctr, Dept Anesthesiol, New York, NY 10011 USA. New York Med Coll, Dept Anesthesiol, Valhalla, NY 10595 USA. RP Kopman, AF (reprint author), St Vincents Hosp & Med Ctr, Dept Anesthesiol, 153 W 11th St,Room NR 408, New York, NY 10011 USA. NR 9 TC 3 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 1999 VL 89 IS 4 BP 1046 EP 1049 DI 10.1097/00000539-199910000-00042 PG 4 WC Anesthesiology SC Anesthesiology GA 240LP UT WOS:000082827700043 ER PT J AU Blobner, M Kochs, E Fink, H Mayer, B Veihelmann, A Brill, T Stadler, J AF Blobner, M Kochs, E Fink, H Mayer, B Veihelmann, A Brill, T Stadler, J TI Pharmacokinetics and pharmacodynamics of vecuronium in rats with systemic inflammatory response syndrome - Treatment with N-G-monomethyl-L-arginine SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 17-25, 1996 CL NEW ORLEANS, LOUISIANA SP Amer Soc Anesthesiologists DE cytochrome P450; neuromuscular blocking agent; nitric oxide; sepsis ID NITRIC-OXIDE; LIVER; INHIBITION; METABOLISM; ENDOTOXIN; MUSCLE; DYSFUNCTION AB Background: Insufficient detoxification caused by nitric oxide-related inhibition of cytochrome P450 may be important for metabolism of numerous drugs, including vecuronium, The present study investigated the pharmacodynamics and pharmacokinetics of vecuronium in rats with inflammatory liver dysfunction. Methods: Male Sprague-Dawley rats (n = 56) were randomly allocated into two groups: In the sepsis group, liver inflammation was established by injection of 56 mg/kg heat-killed Corynebacterium parvum; control rats received the solvent. At day 4, groups were subdivided according to treatment with the nitric oxide synthase inhibitor N-G-monomethyl-L-arginine (250 mg/kg) or placebo. The aminopyrine breath test was performed to assess cytochrome P450 activity. Rats mere anesthetized with propofol and mechanically ventilated. Duration of action of vecuronium (1.2 mg/kg) was measured by evoked mechano-myography (stimulation of the sciatic nerve, contraction of the gastrocnemius muscle). In seven rats of each subgroup a 50% neuromuscular blockade was established by a continuous vecuronium infusion. Vecuronium plasma levels were measured and plasma clearance of vecuronium was calculated. Nitric oxide synthesis was assessed by measuring nitrite/nitrate serum levels. Results: In sepsis/placebo rats, vecuronium-induced neuromuscular blockade was prolonged (144% of control/placebo), vecuronium plasma levels at 50% neuromuscular blockade were increased (122% of control/placebo), and plasma clearance was decreased (68% of control/placebo). N-G-monomethyl-L-arginine therapy in rats with sepsis improved cytochrome P450 activity and plasma clearance of vecuronium, shortened duration of action of vecuronium, but did not alter the elevated vecuronium plasma levels. Conclusions: A systemic inflammatory response syndrome with liver dysfunction results in decreased sensitivity to and a decreased elimination of vecuronium, Modulation of nitric oxide synthesis may be a strategy that can be used in the future to improve xenobiotic metabolism in sepsis. C1 Tech Univ Munich, Inst Anaesthesiol, Klinikum Rechts Isar, D-81675 Munich, Germany. Tech Univ Munich, Inst Expt Onkol & Therapieforsch, Klinikum Rechts Isar, D-81675 Munich, Germany. RP Blobner, M (reprint author), Tech Univ Munich, Inst Anaesthesiol, Klinikum Rechts Isar, Ismaninger Str 22, D-81675 Munich, Germany. NR 19 TC 17 Z9 18 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 1999 VL 91 IS 4 BP 999 EP 1005 DI 10.1097/00000542-199910000-00020 PG 7 WC Anesthesiology SC Anesthesiology GA 241PR UT WOS:000082892200016 ER PT J AU Barthelet, Y Ryckwaert, Y Plasse, C Bonnet-Boyer, MC d'Athis, F AF Barthelet, Y Ryckwaert, Y Plasse, C Bonnet-Boyer, MC d'Athis, F TI Severe anaphylactic reactions to rocuronium bromide SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE rocuronium; anaphylaxie; allergy ID NEUROMUSCULAR BLOCKING-AGENTS; HISTAMINE-RELEASE; ANESTHESIA; DRUGS AB The authors report four cases of severe anaphylactic reactions (grade III or IV) to rocuronium bromide. In three of them, it was the first contact with a muscle relaxant. In three patients the reaction was mediated by IgE antibodies. A cross-reactivity with other muscle relaxants was existing in two cases (suxamethonium, vecuronium and atracurium in one patient, suxamethonium, vecuronium and pancuronium in the other). (C) 1999 Editions scientifiques et medicales Elsevier SAS. C1 Hop Lapeyronie, Dept Anesthesie Reanimat A, F-34295 Montpellier 5, France. RP Barthelet, Y (reprint author), Hop Lapeyronie, Dept Anesthesie Reanimat A, F-34295 Montpellier 5, France. NR 14 TC 12 Z9 13 PU EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER PI PARIS CEDEX 15 PA 23 RUE LINOIS, 75724 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PD OCT PY 1999 VL 18 IS 8 BP 896 EP 900 DI 10.1016/S0750-7658(00)88195-2 PG 5 WC Anesthesiology SC Anesthesiology GA 253LN UT WOS:000083558200008 ER PT J AU Melnikov, AL Malakhov, KY Helgesen, KG Lathrop, DA AF Melnikov, AL Malakhov, KY Helgesen, KG Lathrop, DA TI Cardiac effects of non-depolarizing neuromuscular blocking agents pancuronium, vecuronium, and rocuronium in isolated rat atria SO GENERAL PHARMACOLOGY LA English DT Article DE pancuronium; vecuronium; rocuronium; contractile force; refractoriness; heart rate; rat atria ID MUSCARINIC RECEPTORS; NOREPINEPHRINE; INHIBITION; BINDING; RELEASE; DRUGS; HEART AB Pancuronium, vecuronium, and rocuronium produce different cardiac effects. Using spontaneously beating right and electrically stimulated left rat atria, while measuring developed force, effective refractory period, and heart rate, we determined and compared the concentration-dependent cardiac effects of the compounds. The preparations were exposed to five progressively increasing concentrations of these compounds (10(-9), 10(-8), 10(-7), 10(-6), and 10(-5) mol/L). Pancuronium increased heart rate; vecuronium and rocuronium produced positive inotropic effects; and vecuronium shortened refractoriness. These effects may be the result of a blockade of the M-2 muscarinic receptors. However, the concentrations required to produce changes were higher than those observed in patients under neuromuscular blockade. (C) 1999 Elsevier Science Inc. All rights reserved. C1 Kirkenes Hosp, Basic Cardiac Res Lab, N-9900 Kirkens, Norway. Kirkenes Hosp, Dept Internal Med, N-9900 Kirkens, Norway. Kirkenes Hosp, Dept Anesthesiol, N-9900 Kirkens, Norway. Univ Tromso, Dept Med Physiol, N-9037 Tromso, Norway. Georgetown Univ, Med Ctr, Dept Pharmacol, Washington, DC 20007 USA. RP Melnikov, AL (reprint author), Kirkenes Hosp, Basic Cardiac Res Lab, N-9900 Kirkens, Norway. RI LATHROP, David/A-2758-2008 NR 22 TC 5 Z9 5 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0306-3623 J9 GEN PHARMACOL JI Gen. Pharmacol. PD OCT PY 1999 VL 33 IS 4 BP 313 EP 317 DI 10.1016/S0306-3623(99)00023-3 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 244JF UT WOS:000083047500004 ER PT J AU Smith, CE Botero, C Holbrook, C Pinchak, AC Hagen, JF AF Smith, CE Botero, C Holbrook, C Pinchak, AC Hagen, JF TI Rocuronium versus vecuronium during fentanyl induction in patients undergoing coronary artery surgery SO JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA LA English DT Article; Proceedings Paper CT 53rd Annual Meeting of the Canadian-Anaesthetists-Society CY JUN 14-18, 1996 CL MONTREAL, CANADA SP Canadian Anaesthetists Soc DE neuromuscular relaxants; rocuronium; vecuronium; anesthetics; intravenous; fentanyl ID ADDUCTOR POLLICIS MUSCLES; ORBICULARIS OCULI; INTUBATING CONDITIONS; NEUROMUSCULAR BLOCKADE; DIFFICULT VENTILATION; ANESTHESIA; ATRACURIUM; ORG-9426; HUMANS; ONSET AB Objective: To evaluate the neuromuscular, ventilatory, and cardiovascular effects of rocuronium and vecuronium. Design: Randomized, prospective, blinded study. Setting: Tertiary care teaching center, single institution. Participants: Patients undergoing elective coronary artery bypass graft procedure. Interventions: Patients received rocuronium, 1.0 mg/kg (n = 17), or vecuronium, 0.15 mg/kg (0 = 15), during fentanyl induction of anesthesia. Measurements and Main Results: Measures consisted of time to visual loss of orbicularis oculi twitches in response to facial nerve stimulation, ease of mask ventilation, hemodynamics, need for vasoactive drugs, and tracheal intubating conditions. Median time to twitch loss was faster (p < 0.05) after rocuronium (60 s) than after vecuronium (>84 s). Within 45 seconds, only 3 of 17 patients in the rocuronium group had moderate-to-severe difficulty with mask ventilation versus 12 of 15 patients in the vecuronium group (p < 0.05). Tracheal intubating conditions were excellent in all patients after rocuronium. In the vecuronium group, intubating conditions were excellent in 46%, good in 27%, and poor in 27% (p < 0.05 v rocuronium). Patients receiving vecuronium were more likely to require ephedrine and phenylephrine for hypotension (10/15 patients v 5/17 patients for rocuronium, p < 0.05). There were no clinically important differences in hemodynamic variables, oxygen metabolism, or myocardial ischemia between groups. Conclusion: During narcotic induction of anesthesia, rocuronium was associated with lower requirement for vasopressors, faster onset of neuromuscular blockade, and better conditions for mask ventilation and tracheal intubation compared with vecuronium. Copyright (C) 1999 by W.B. Saunders Company. C1 Case Western Reserve Univ, Metrohlth Med Ctr, Dept Anesthesiol, Cleveland, OH 44109 USA. RP Smith, CE (reprint author), Case Western Reserve Univ, Metrohlth Med Ctr, Dept Anesthesiol, 2500 Metrohlth Dr, Cleveland, OH 44109 USA. NR 27 TC 1 Z9 1 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1053-0770 J9 J CARDIOTHOR VASC AN JI J. Cardiothorac. Vasc. Anesth. PD OCT PY 1999 VL 13 IS 5 BP 567 EP 573 DI 10.1016/S1053-0770(99)90009-5 PG 7 WC Anesthesiology; Cardiac & Cardiovascular Systems; Respiratory System; Peripheral Vascular Disease SC Anesthesiology; Cardiovascular System & Cardiology; Respiratory System GA 244DH UT WOS:000083036200010 ER PT J AU Black, J AF Black, J TI Claude Bernard on the action of curare SO BRITISH MEDICAL JOURNAL LA English DT Article NR 1 TC 3 Z9 4 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-8138 J9 BRIT MED J JI Br. Med. J. PD SEP 4 PY 1999 VL 319 IS 7210 BP 622 EP 622 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 234AJ UT WOS:000082460300025 ER PT J AU Kirkegaard-Nielsen, H Severinsen, IK Pedersen, HS Lindholm, P AF Kirkegaard-Nielsen, H Severinsen, IK Pedersen, HS Lindholm, P TI Factors predicting atracurium reversal time SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE antagonism, neostigmine; nerve stimulation, train-of-four, double burst stimulation; neuromuscular monitoring, mechanomyography; neuromuscular relaxants, atracurium ID INDUCED NEUROMUSCULAR BLOCKADE; OPIOID BARBITURATE ANESTHESIA; DOSE-RESPONSE RELATIONSHIPS; EDROPHONIUM ANTAGONISM; TRAIN-OF-4 STIMULATION; DOUBLE-BURST; NEOSTIGMINE; VECURONIUM; RECOVERY; PANCURONIUM AB Background: To identify individual factors and combination of factors predictive of reversal time (defined as time from neostigmine administration to train-of-four (TOF) ratio 0.70) from atracurium-induced neuromuscular block, the present study tested the following variables as possible predictors of reversal time: 1) degree of block at the time of antagonism as quantified by first response to TOF or double-burst stimulation (DBS); 2) time from last supplemental dose of atracurium to administration of neostigmine (pre-reversal time); and 3) time from administration of initial atracurium dose to T1 (the magnitude of the first twitch in TOF) recovered to 10% (duration of action of the initial dose of atracurium). Methods: The study population comprised 83 female patients, ASA physical status 1 or 2, anaesthetized with fentanyl, thiopental, halothane and nitrous oxide. Initial and supplemental doses of atracurium were 0.5 mg . kg(-1) and 0.15 mg . kg(-1), respectively. Evoked responses to TOF or DBS were recorded mechanomyographically. Neuromuscular block was antagonized with neostigmine, 0.07 mg . kg(-1), at varying time intervals (6-50 min) after the final atracurium dose. Results: Multiple linear regression analyses testing T1, D1 (the magnitude of the first twitch in DBS), pre-reversal time and duration of action of the initial dose of atracurium, demonstrated that with superficial block, T1 >15%, T1 is the only significant Predictor for reversal time. With moderate block, 0< T1 less than or equal to 15%, both T1 and duration of action of the initial atracurium dose are significant predictors for reversal time. With profound block, T1=0, duration of action of the initial dose and pre-reversal time are significant predictors for reversal time. Conclusion: 1) T1 is a mere important predictor for reversal time from atracurium-induced neuromuscular block than D1; 2) predictors differ with the degree of block: with T1 >15%, T1 is the only significant predictor; with 0< T1 less than or equal to 15%, the duration of action of the initial dose and T1 are predictors for reversal time; with T1=0, the duration of action of the initial dose and pre-reversal time predict reversal time. C1 Odense Univ Hosp, Dept Anaesthesia & Intens Care, DK-5000 Odense, Denmark. RP Kirkegaard-Nielsen, H (reprint author), Aarhus Univ Hosp, Skejby Sygehus, DK-8200 Aarhus N, Denmark. NR 23 TC 3 Z9 3 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD SEP PY 1999 VL 43 IS 8 BP 834 EP 841 DI 10.1034/j.1399-6576.1999.430809.x PG 8 WC Anesthesiology SC Anesthesiology GA 232GR UT WOS:000082363300009 ER PT J AU Smith, LJ Moon, PF Lukasik, VM Erb, HN AF Smith, LJ Moon, PF Lukasik, VM Erb, HN TI Duration of action and hemodynamic properties of mivacurium chloride in dogs anesthetized with halothane SO AMERICAN JOURNAL OF VETERINARY RESEARCH LA English DT Article ID PROLONGED NEUROMUSCULAR BLOCK; NITROUS-OXIDE; CHOLINESTERASE ACTIVITY; PLASMA CHOLINESTERASE; HISTAMINE-RELEASE; BW B1090U; ANESTHESIA; ATRACURIUM; PHARMACOLOGY; VECURONIUM AB Objective-To describe onset and duration of neuromuscular blockade induced by mivacurium chloride and its associated hemodynamic effects at 3 dosages in healthy dogs. Animals-7 Labrador Retrievers. Procedure-Anesthesia was induced with thiopental and maintained with halothane in oxygen, and dogs were mechanically ventilated to end-tidal PCO2 between 35 and 40 mm Hg. Core temperature, endtidal PCO2, and halothane concentration were kept constant throughout the experiment. Neuromuscular function was assessed by evaluation of the train-of-four response to a supramaximal electrical stimulus of 2 Hz applied to the ulnar nerve every 10 seconds. Blood for determination of plasma cholinesterase activity was obtained prior to administration of mivacurium, a bolus of which was administered IV, using a randomized Latin-square design for dosages of 0.01, 0.02, and 0.05 mg/kg of body weight. Results-All dogs had typical plasma cholinesterase activity. After administration of mivacurium, differences were not evident between groups in heart rate, systolic, mean, or diastolic blood pressure, change at any time in heart rate, systolic, mean, or diastolic blood pressure, or pH. Interval from onset to 100% neuromuscular blockade was 3.92 +/- 1.70, 2.42 +/- 0.53, and 1.63 +/- 0.25 minutes at dosages of 0.01, 0.02, and 0.05 mg/kg, respectively. Duration of measurable neuromuscular blockade was 33.72 +/- 12.73, 65.38 +/- 12.82, and 151.0 +/- 38.50 minutes, respectively. Time of onset and duration of effect differed significantly among dosages. Conclusions and Clinical Relevance-Mivacurium provides good hemodynamic stability at the dosages tested. In dogs, this drug has a rapid onset and long duration of effect. C1 Cornell Univ, Coll Vet Med, Dept Clin Sci, Sect Anesthesiol, Ithaca, NY 14853 USA. RP Smith, LJ (reprint author), Univ Wisconsin, Sch Vet Med, Dept Surg Sci, Madison, WI 53706 USA. NR 22 TC 2 Z9 2 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 USA SN 0002-9645 J9 AM J VET RES JI Am. J. Vet. Res. PD SEP PY 1999 VL 60 IS 9 BP 1047 EP 1050 PG 4 WC Veterinary Sciences SC Veterinary Sciences GA 233KE UT WOS:000082425400007 ER PT J AU Smith, LJ Schwark, WS Cook, DR Moon, PF Looney, AL AF Smith, LJ Schwark, WS Cook, DR Moon, PF Looney, AL TI Pharmacokinetic variables of mivacurium chloride after intravenous administration in dogs SO AMERICAN JOURNAL OF VETERINARY RESEARCH LA English DT Article ID BW B1090U; PHARMACOLOGY AB Objective-To determine pharmacokinetic variables of mivacurium chloride after IV administration in dogs. Animals-5 healthy Labrador Retrievers. Procedure-Anesthesia was induced with thiopental and maintained with halothane in oxygen. Dogs were ventilated mechanically to an end-tidal Pco(2) value between 35 and 40 mm Hg. Heart rate, direct blood pressure, and arterial pH were recorded throughout the experiment. Core temperature, end-tidal Pco(2) and halothane concentration were kept constant throughout the experiment. Paired blood samples for determination of plasma cholinesterase activity were collected prior to administration of a bolus of mivacurium (0.05 mg/kg of body weight), which was administered IV during a 2-second period. Arterial blood samples were obtained for determination of plasma mivacurium concentration 0, 1, 3, 5, 10, 30, 60, 120, 150, and 180 minutes after administration of mivacurium. Blood was collected into tubes containing EDTA and 0.25% echothiophate. Mivacurium concentration was determined, using reversed-phase highperformance liquid chromatography. Results-For the trans-trans isomer, mean +/- SEM volume of distribution was 0.18 +/- 0.024 L/kg, median half-life was 34.9 minutes (range, 26.7 to 53.5 minutes), and clearance was 12 +/- 2 ml/min/kg. For the cis-trans isomer, values were 0.31 0.05 L/kg, 43.4 minutes (range, 31.5 to 69.3 minutes), and 15 +/- 2 ml/min/kg, respectively. Values for the cis-cis isomer were not calculated, because it was not detectable in plasma 60 minutes after mivacurium administration in all 5 dogs. Conclusions and Clinical Relevance-The trans trans and cis-trans isomers of mivacurium have a long half-life and slow clearance in healthy dogs anesthetized with halothane. C1 Cornell Univ, Coll Vet Med, Dept Clin Sci, Sect Anesthesiol, Ithaca, NY 14853 USA. Cornell Univ, Coll Vet Med, Dept Pharmacol, Ithaca, NY 14853 USA. Childrens Hosp Pittsburgh, Dept Anesthesiol, Pittsburgh, PA 15213 USA. RP Smith, LJ (reprint author), Univ Wisconsin, Sch Vet Med, Dept Surg Sci, Madison, WI 53706 USA. NR 8 TC 1 Z9 1 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 USA SN 0002-9645 J9 AM J VET RES JI Am. J. Vet. Res. PD SEP PY 1999 VL 60 IS 9 BP 1051 EP 1054 PG 4 WC Veterinary Sciences SC Veterinary Sciences GA 233KE UT WOS:000082425400008 ER PT J AU de Rossi, L Fritz, H Krober, L Klein, U AF de Rossi, L Fritz, H Krober, L Klein, U TI Cisatracurium in the orbicularis oculi muscle SO ANAESTHESIST LA German DT Article DE neuromuscular monitoring; adductor pollicis muscle; orbicularis oculi muscle; cisatracurium; atracurium ID ADDUCTOR POLLICIS MUSCLES; VECURONIUM NEUROMUSCULAR BLOCKADE; GOOD INTUBATING CONDITIONS; ATRACURIUM; DIAPHRAGM; ONSET; ROCURONIUM; MIVACURIUM AB Objectives: Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of cisatracurium and atracurium in the orbicularis oculi muscle (00)-which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles - and the adductor pollicis muscle (AP). Methods: Forty-five patients (ASA I-II), scheduled for elective spinal surgery were anaesthetized with propofol and fentanyl. Endotracheal intubation was performed without using a muscle relaxant. Neuromuscular transmission was monitored using acceleromyography in both muscles. Patients received 0.1 mg/kg (2x ED95) or 0.15 mg/kg (3x ED95) cisatracurium, or 0.5 mg/kg atracurium (2x ED95) at random. Onset and recovery times were measured according to the recommendation of the Copenhagen Consensus Conference. Results: Onset time was significantly shorter in the 00 than in the AP following 0.15 mg/kg cisatracurium and 0.5 mg/kg atracurium (P<0.05). No differences in onset time between the two muscles were found after 0.1 mg/kg cisatracurium. The recovery of T-1 to 10% of its control was completed sooner in the 00 than in the AP in all three groups (P<0.05). Conclusions: Cisatracurium shows a dose-dependent shorter onset time in the 00 than in the AP. This is consistent with the current view that the onset of non-depolarizing neuromuscular blockers is more rapid in the 00 than in the AP. However; at least a dose of 3x ED95 of cisatracurium was necessary to show a difference in onset time between both muscles. ln contrast, atracurium is reported to lead to a significantly shorter onset of neuromuscular block in the 00 following 2x the ED95. The more rapid recovery of T-1 to 10% of its control in all three groups in the 00 is due to the relative resistance of this muscle to muscle relaxants. C1 Univ Jena, Klin Anasthesiol & Intens Therapie, D-07740 Jena, Germany. RP de Rossi, L (reprint author), Univ Jena, Klin Anasthesiol & Intens Therapie, Bachst 18, D-07740 Jena, Germany. NR 17 TC 4 Z9 4 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD SEP PY 1999 VL 48 IS 9 BP 602 EP 606 DI 10.1007/s001010050759 PG 7 WC Anesthesiology SC Anesthesiology GA 246AZ UT WOS:000083142100003 ER PT J AU Fisher, DM Reynolds, KS Schmith, VD Hsu, A Sokoll, MD Lennon, RL Caldwell, JE AF Fisher, DM Reynolds, KS Schmith, VD Hsu, A Sokoll, MD Lennon, RL Caldwell, JE TI The influence of renal function on the pharmacokinetics and pharmacodynamics and simulated time course of doxacurium SO ANESTHESIA AND ANALGESIA LA English DT Article ID D-TUBOCURARINE; ATRACURIUM AB Doxacurium's clearance (Cl) is markedly decreased in patients with renal failure undergoing kidney transplantation. However, no studies have determined the influence of renal function las assessed by creatinine clearance [CrCl]) on its pharmacokinetics in patients without renal failure. We studied 53 patients aged 19-59 yr. During N2O/isoflurane anesthesia, doxacurium was infused over 10 min, plasma was sampled for up to 6 h, and twitch tension was measured. A three-compartment model was fit to plasma concentration data and an effect compartment model to twitch data. Mixed-effects modeling was used to determine the influence of covariates, including CrCl, on doxacurium's pharmacokinetic/pharmacodynamic parameters. Obesity decreased both doxacurium's Cl (1.1% per percent above ideal body weight [IBW]) and its neuromuscular junction sensitivity (0.4% per percent above IBW). Cl increased 0.6% per mL/min increase in CrCl. In addition, the rate constant for equilibration between plasma concentration and effect decreased 46% per 1% increase in isoflurane, central compartment volume decreased 86% per 1% increase in isoflurane concentration, and slow distributional Cl decreased 69% per mg/ 100 mL increase in serum albumin. Simulations showed that the latter two covariates influence the time course of bolus doxacurium administration minimally. Both obesity and renal dysfunction prolong doxacurium's recovery markedly. When dosing is based on IBW, effects of CrCl on neuromuscular recovery are smaller compared with dosing based on actual weight. Therefore, obese patients should be dosed based on IBW. No further dosage adjustment is necessary for patients with renal dysfunction; however, recovery will take longer in patients with moderate-to-severe renal dysfunction. Implications: We examined the factors influencing doxacurium's pharmacokinetic and pharmacodynamic characteristics. Both creatinine clearance and obesity significantly influence its time course. The effect of obesity is minimized if patients are dosed based on ideal body weight. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. Glaxo Wellcome Inc, Div Clin Pharmacol, Res Triangle Pk, NC 27709 USA. Univ Iowa, Dept Anesthesiol, Iowa City, IA USA. Mayo Clin, Dept Anesthesiol, Rochester, MN USA. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia, 513 Parnassus Ave, San Francisco, CA 94143 USA. NR 14 TC 3 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 1999 VL 89 IS 3 BP 786 EP 795 PG 10 WC Anesthesiology SC Anesthesiology GA 230KE UT WOS:000082249700049 ER PT J AU Kaplan, RF Uejima, T Lobel, G Goudsouzian, N Ginsberg, B Hannallah, R Cote, CJ Denman, W Griffith, R Clarke, C Hummer, K AF Kaplan, RF Uejima, T Lobel, G Goudsouzian, N Ginsberg, B Hannallah, R Cote, CJ Denman, W Griffith, R Clarke, C Hummer, K TI Intramuscular rocuronium in infants and children - A multicenter study to evaluate tracheal intubating conditions, onset, and duration of action SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 1997 Annual Meeting of American-Society-of-Anesthesiologists CY OCT 17-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiologists DE muscle relaxant; neuromuscular relaxants; pediatric ID SUCCINYLCHOLINE AB Background: This multicenter, assessor-blinded, randomized study was done to confirm and extend a pilot study showing that intramuscular rocuronium can provide adequate tracheal intubating conditions in infants (2.5 min) and children (3 min) during halothane anesthesia. Methods: Thirty-eight infants (age range, 3-12 months) and 38 children (age range, 1 to 5 yr) classified as American Society of Anesthesiologists physical status 1 and 2 were evaluated at four investigational sites. Anesthesia was maintained with halothane and oxygen (1% end-tidal concentration if < 2.5 yr; 0.80% end-tidal concentration if > 2.5 yr) for 5 min. One half of the patients received 0.45 mg/kg intravenous rocuronium. The others received 1 mg/kg (infants) or 1.8 mg/kg (children) of intramuscular rocuronium into the deltoid muscle. Intubating conditions and mechanomyographic responses to ulnar nerve stimulation were assessed. Results: The conditions for tracheal intubation at 2.5 and 3 min in infants and children, respectively, were inadequate in a high percentage of patients in the intramuscular group. Nine of 16 infants and 10 of 17 children had adequate or better intubating conditions at 3.5 and 4 min, respectively, after intramuscular rocuronium. Better-than-adequate intubating conditions were achieved in 14 of 15 infants and 16 of 17 children given intravenous rocuronium. Intramuscular rocuronium provided greater than or equal to 98% blockade in 7.4 +/- 3.4 min (in infants) and 8 +/- 6.3 min (in children). Twenty-five percent recovery occurred in 79 +/- 26 min (in infants) and in 86 +/- 22 min (in children). Conclusions: Intramuscular rocuronium, in the doses and conditions tested, does not consistently provide satisfactory tracheal intubating conditions in infants and children and is not an adequate alternative to intramuscular succinylcholine when rapid intubation is necessary. C1 Childrens Natl Med Ctr, Dept Anesthesiol, Washington, DC 20010 USA. Childrens Mem Hosp, Chicago, IL 60614 USA. Massachusetts Gen Hosp, Boston, MA 02114 USA. Duke Univ, Med Ctr, Durham, NC 27706 USA. RP Kaplan, RF (reprint author), Childrens Natl Med Ctr, Dept Anesthesiol, 111 Michigan Ave NW, Washington, DC 20010 USA. NR 7 TC 5 Z9 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 1999 VL 91 IS 3 BP 633 EP 638 DI 10.1097/00000542-199909000-00012 PG 6 WC Anesthesiology SC Anesthesiology GA 232KE UT WOS:000082369300007 ER PT J AU Kim, KS Chung, CW Shin, WJ AF Kim, KS Chung, CW Shin, WJ TI Cisatracurium neuromuscular block at the adductor pollicis and the laryngeal adductor muscles in humans SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, cisatracurium; muscle skeletal, responses AB We have compared the dose-response relationship (n=30) and time course of neuromuscular block (n=20) of cisatracurium at the laryngeal adductor and the adductor pollicis muscles. ED95 values for cisatracurium were 66.8 (95% confidence interval 61.3-72.3) mu g kg(-1) at the larynx and 45.2 (42.1-48.3) mu g kg(-1) at the adductor pollicis muscle (P<0.0001). After administration of cisatracurium 0.1 mg kg(-1), onset time was 2.7 (2.2-3.2) min at the larynx and 3.9 (3.0-4.8) min at the adductor pollicis (P<0.0001). Time to 95% recovery of the first twitch of the TOF was 26.9 (20.1-33.7) min and 45.6 (39.7-51.5) min, respectively (P<0.0001). We found that the laryngeal adductors were more resistant to the action of cisatracurium than the adductor pollicis muscle, but onset and recovery were faster at the larynx. C1 Hanyang Univ Hosp, Dept Anaesthesiol, Seoul 133792, South Korea. Kwandong Univ, Coll Med, Dept Anaesthesiol, Seoul, South Korea. RP Kim, KS (reprint author), Hanyang Univ Hosp, Dept Anaesthesiol, 17 Haengdang Dong, Seoul 133792, South Korea. NR 6 TC 11 Z9 13 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD SEP PY 1999 VL 83 IS 3 BP 483 EP 484 PG 2 WC Anesthesiology SC Anesthesiology GA 236UZ UT WOS:000082618700024 ER PT J AU Suzuki, T Munakata, K Watanabe, N Katsumata, N Saeki, S Ogawa, S AF Suzuki, T Munakata, K Watanabe, N Katsumata, N Saeki, S Ogawa, S TI Augmentation of vecuronium-induced neuromuscular block during sevoflurane anaesthesia: comparison with balanced anaesthesia using propofol or midazolam SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, vecuronium; anaesthetics volatile, sevoflurane; anaesthetics i.v., propofol; hypnotics benzodiazepine, midazolam; measurement techniques, acceleromyography AB We have quantified the potentiating effects of 1.7% sevoflurane (n = 12) on vecuronium-induced neuromuscular block and compared the results with those obtained during balanced anaesthesia with propofol (n=12) or midazolam (n=12) in 36 patients. Neuromuscular function was monitored using an accelerograph and the train-of-four responses of the adductor pollicis muscle to ulnar nerve stimulation. Vecuronium 0.1 mg kg(-1) was administered as an intubating dose, and maintenance doses of 0.02 mg kg(-1) were administered on three occasions when T1/T0 had recovered to 25%. Thereafter, spontaneous recovery was monitored until complete. Times to 25% recovery of T1/T0 (DUR25) after an intubating dose of vecuronium did not differ between groups (mean 44.2 (SD 18.7) min for sevoflurane, 38.3 (7.5) min for propofol and 35.5 (9.5) min for midazolam). DUR25 values after each maintenance dose were 29.8 (9.5) min, 30.3 (10.4) min and 31.6 (10.7) min during sevoflurane anaesthesia, and were significantly longer than values for propofol (21.7 (6.0) min, 21.5 (5.8) min and 21.9 (5.8) min) and midazolam (20.0 (5.9) min, 19.3 (7.7) min and 19.8 (8.0) min) (P<0.05 in each case). Recovery index(25-75%) and interval from T1/T0=25% to T4/T1=0.7 after the final dose of vecuronium were significantly prolonged by sevoflurane (28.3 (13.2) min and 42.7 (16.4) min) compared with propofol (17.6 (6.1) min and 26.6 (9.8) min) or midazolam (16.3 (9.4) min and 26.0 (10.2) min) (P<0.05 in each case). C1 Surugadai Nihon Univ Hosp, Dept Anaesthesiol, Chiyoda Ku, Tokyo 1018309, Japan. RP Suzuki, T (reprint author), Surugadai Nihon Univ Hosp, Dept Anaesthesiol, Chiyoda Ku, 1-8-13 Kanda Surugadai, Tokyo 1018309, Japan. NR 6 TC 18 Z9 19 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD SEP PY 1999 VL 83 IS 3 BP 485 EP 487 PG 3 WC Anesthesiology SC Anesthesiology GA 236UZ UT WOS:000082618700025 ER PT J AU Nitahara, K Sakuragi, T Matsuyama, M Dan, K AF Nitahara, K Sakuragi, T Matsuyama, M Dan, K TI Response to vecuronium in a patient with facioscapulohumeral muscular dystrophy SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, vecuronium; complications, muscular dystrophy ID NEUROMUSCULAR BLOCKADE; MYOPATHY AB Increased sensitivity to vecuronium has been noted in patients with Duchenne muscular dystrophy. We report the response to vecuronium in a patient with facioscapulohumeral muscular dystrophy (FSHD), an autosomal dominant disorder with an incidence of 10-20 cases per million. In this patient, sensitivity to an initial dose of vecuronium (0.02 + 0.08 mg kg(-1)) was normal, but recovery was faster and the effect of incremental doses of vecuronium (0.02 mg kg(-1)) was less than expected. Onset time and 25% recovery of T1/T0 after the intubating dose of vecuronium were 240 s and 22 min, respectively. Recovery index (spontaneous recovery of T1/T0 from 25% to 75%) was 9 min. C1 Fukuoka Univ, Sch Med, Dept Anesthesiol, Jonan Ku, Fukuoka 8140180, Japan. RP Nitahara, K (reprint author), Fukuoka Univ, Sch Med, Dept Anesthesiol, Jonan Ku, 7-45-1 Nanakuma, Fukuoka 8140180, Japan. NR 13 TC 0 Z9 0 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD SEP PY 1999 VL 83 IS 3 BP 499 EP 500 PG 2 WC Anesthesiology SC Anesthesiology GA 236UZ UT WOS:000082618700030 ER PT J AU Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA AF Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA TI Separation of curium and americium traces by displacement complexing chromatography in the presence of separating ions: 1. The use of nitrilotriacetic acid solution as eluent SO RADIOCHEMISTRY LA English DT Article AB Separation of curium and americium traces by displacement complexing chromatography in the presence of cadmium separating ions and with the use of NTA solution as eluent was studied. The curium-cadmium and americium-cadmium separation coefficients were determined. Curium is separated from americium during nonstationary transfer of boundaries of the bands of the elements being separated. The separation mechanism was determined. C1 Russian Acad Sci, Inst Phys Chem, Moscow, Russia. RP Chuveleva, EA (reprint author), Russian Acad Sci, Inst Phys Chem, Leninsky Prospekt 31, Moscow, Russia. NR 5 TC 3 Z9 3 PU MAIK NAUKA/INTERPERIODICA PI NEW YORK PA C/O PLENUM/CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 USA SN 1066-3622 J9 RADIOCHEMISTRY+ JI Radiochemistry PD SEP-OCT PY 1999 VL 41 IS 5 BP 465 EP 467 PG 3 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear SC Chemistry GA 278FC UT WOS:000084976400010 ER PT J AU Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA AF Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA TI Separation of curium and americium traces by displacement complexing chromatography in the presence of separating ions: 2. Influence of the amount of cadmium ions and modes of their introduction in the system on the efficiency of separation of curium and americium SO RADIOCHEMISTRY LA English DT Article AB The efficiency of separation of curium and americium by elution with a nitrilotriacetic acid solution was studied as influenced by the amount of cadmium separating ions and the mode of their introduction in the system. Separate sorption of curium, americium, and cadmium, as compared to their cosorption, increases the completeness of separation of curium and americium. The efficiency of the separation increases with increasing amount of cadmium introduced into the system and is independent of the elution rate. C1 Russian Acad Sci, Inst Phys Chem, Moscow, Russia. RP Chuveleva, EA (reprint author), Russian Acad Sci, Inst Phys Chem, Leninsky Prospekt 31, Moscow, Russia. NR 1 TC 1 Z9 1 PU MAIK NAUKA/INTERPERIODICA PI NEW YORK PA C/O PLENUM/CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 USA SN 1066-3622 J9 RADIOCHEMISTRY+ JI Radiochemistry PD SEP-OCT PY 1999 VL 41 IS 5 BP 468 EP 470 PG 3 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear SC Chemistry GA 278FC UT WOS:000084976400011 ER PT J AU Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA AF Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA TI Separation of curium and americium traces by displacement complexing chromatography in the presence of separating ions: 3. Influence of the nature of holding ion on separation of curium and americium during elution with nitrilotriacetic acid solution SO RADIOCHEMISTRY LA English DT Article AB The efficiency of separation of curium and americium by elution with a nitrilotriacetic acid solution was studied as influenced by the nature of holding ion (Ni, Zn). The use of the Zn form of KU-2 resin instead of the Ni form considerably deteriorates the quality of separation of curium from americium. To reach the complete separation on the Zn form, the greater number of separation bands and the smaller amount of cadmium introduced into the system are required. C1 Russian Acad Sci, Inst Phys Chem, Moscow, Russia. RP Chuveleva, EA (reprint author), Russian Acad Sci, Inst Phys Chem, Leninsky Prospekt 31, Moscow, Russia. NR 2 TC 0 Z9 0 PU MAIK NAUKA/INTERPERIODICA PI NEW YORK PA C/O PLENUM/CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 USA SN 1066-3622 J9 RADIOCHEMISTRY+ JI Radiochemistry PD SEP-OCT PY 1999 VL 41 IS 5 BP 471 EP 473 PG 3 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear SC Chemistry GA 278FC UT WOS:000084976400012 ER PT J AU Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA AF Chuveleva, EA Peshkov, AS Kharitonov, OV Firsova, LA TI Separation of curium and americium traces by displacement complexing chromatography in the presence of separating ions: 4. Separation with the use of diethylenetriaminepentaacetic acid solution as eluent SO RADIOCHEMISTRY LA English DT Article ID ELEMENTS AB Separation of curium and americium by displacement complexing chromatography in the presence of cadmium and zinc separating ions and with the use as eluent of DTPA solutions free of citric acid and containing different amounts of this acid was studied. Under these condition curium is incompletely separated from americium. C1 Russian Acad Sci, Inst Phys Chem, Moscow, Russia. RP Chuveleva, EA (reprint author), Russian Acad Sci, Inst Phys Chem, Leninsky Prospekt 31, Moscow, Russia. NR 6 TC 0 Z9 0 PU MAIK NAUKA/INTERPERIODICA PI NEW YORK PA C/O PLENUM/CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 USA SN 1066-3622 J9 RADIOCHEMISTRY+ JI Radiochemistry PD SEP-OCT PY 1999 VL 41 IS 5 BP 474 EP 476 PG 3 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear SC Chemistry GA 278FC UT WOS:000084976400013 ER PT J AU Fisher, MM AF Fisher, MM TI Cisatracurium and atracurium as antigens SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE ALLERGY; NEUROMUSCULAR RELAXANTS : cisatracurium, atracurium, skin testing ID HISTAMINE-RELEASE; VECURONIUM AB Seventy-five consecutive patients referred to an anaesthetic allergy clinic were intradermally tested with atracurium and cisatracurium. With the exception of one patient the results were identical, suggesting that allergy to either drug is associated with allergy to the stereoisomer For skin testing for allergy to neuromuscular blocking drugs it is only necessary to use either atracurium or cisatracurium and cisatracurium is the preferred drug. C1 Univ Sydney, Intens Therapy Unit, Royal N Shore Hosp, Dept Anaesthesia & Med, St Leonards, NSW 2065, Australia. RP Fisher, MM (reprint author), Univ Sydney, Intens Therapy Unit, Royal N Shore Hosp, Dept Anaesthesia & Med, St Leonards, NSW 2065, Australia. NR 5 TC 11 Z9 11 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD AUG PY 1999 VL 27 IS 4 BP 369 EP 370 PG 2 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 228XE UT WOS:000082162000006 ER PT J AU Jain, AK Hussain, S Ahuja, S AF Jain, AK Hussain, S Ahuja, S TI Undernutrition in children - Effect on vecuronium induced neuromuscular blockade SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE NEUROMUSCULAR BLOCK : nondepolarizing, vecuronium, malnutrition; paediatric ID PANCURONIUM AB Sixty children aged one to 12 years requiring anaesthesia including a muscle relaxant were assessed for their nutritional status based on simple anthropometric and biochemical parameters. They were allocated to one of four groups: normal nutrition, mild, moderate or severe malnutrition. The neuromuscular effects of vecuronium bromide 0.1 mg/kg were studied by recording evoked responses to train of four (TOF) nerve stimulation using an accelerograph. In the above nutritional groups, time to onset of 25% depression of TI was 0.8, 1.4, 1.3 and 2.1 minutes respectively. Maximal depression of TOF response was seen at 2.2, 3.2, 3.7 and 8.4 minutes. The duration of action of the initial dose was 26.5, 24.0, 17.7 and 13.3 minutes and the mean duration of action of top-up doses was 16.2, 14.9, 11.2 and 8.9 minutes respectively Reversal time with neostigmine 0.05 mg/kg was not significantly different in the four groups. These results demonstrate a statistically significant delay in onset and shortening of the duration of action of vecuronium in the undernourished groups compared with the normal nutrition group when vecuronium is administered to children on a milligram per kilogram basis. C1 Univ Coll Med Sci, Dept Anesthesiol & Crit Care, Delhi, India. Guru Teg Bahadur Hosp, Delhi, India. RP Jain, AK (reprint author), 983,Sector 15, Faridabab 121007, Haryana, India. NR 15 TC 1 Z9 4 PU AUSTRALIAN SOC ANAESTHETISTS PI EDGECLIFF PA P O BOX 600, EDGECLIFF, NSW 2021, AUSTRALIA SN 0310-057X J9 ANAESTH INTENS CARE JI Anaesth. Intensive Care PD AUG PY 1999 VL 27 IS 4 BP 381 EP 384 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA 228XE UT WOS:000082162000009 ER PT J AU Levy, JH Pitts, M Thanopoulos, A Szlam, F Bastian, R Kim, J AF Levy, JH Pitts, M Thanopoulos, A Szlam, F Bastian, R Kim, J TI The effects of rapacuronium on histamine release and hemodynamics in adult patients undergoing general anesthesia SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANAPHYLACTIC SHOCK; FRENCH MULTICENTER; ROCURONIUM; VECURONIUM; INDUCTION; RELAXANTS; FENTANYL; AGENTS; DRUGS AB Neuromuscular blocking drugs may have variable effects on heart rate (HR) and blood pressure. Rapacuronium is a rapid-acting, steroidal-derived neuromuscular blocking drug whose hemodynamic effects have not been characterized. We studied the effects of 1, 2, and 3 mg/kg rapacuronium on histamine release, HR, and blood pressure in 47 ASA physical status II or III adult patients after the induction of anesthesia with etomidate/fentanyl/N2O. Plasma histamine concentrations were measured before induction and immediately before and 1, 3, and 5 min after the rapid administration of rapacuronium. Mean arterial pressure (MAT) decreased after rapacuronium administration, but there were no significant differences among the groups for changes in HR or MAP, and there was no correlation between changes in MAP or HR and increases in histamine levels. There were no changes in HR or MAP among five patients who had significant (greater than or equal to 1 ng/mL) increases in histamine from baseline. Seven patients had bronchospasm without increases in plasma histamine levels. Rapacuronium 2-3 mg/kg increased plasma histamine levels. However, clinically significant histamine-related sequelae did not occur in this population with 1- to 3-mg/kg doses of rapacuronium, and cardiovascular changes were not directly correlated with histamine release. Rapacuronium administration can produce hypotension via mechanisms that do not seem to be related to histamine release. Implications: Rapacuronium, a new steroidal-derived muscle relaxant, may release histamine and produce slight changes in blood pressure and heart rate after administration. C1 Emory Univ, Sch Med, Dept Anesthesiol, Atlanta, GA 30322 USA. RP Levy, JH (reprint author), Emory Univ Hosp, Dept Anesthesiol, 1364 Clifton Rd NE, Atlanta, GA 30322 USA. NR 17 TC 36 Z9 37 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 1999 VL 89 IS 2 BP 290 EP 295 DI 10.1097/00000539-199908000-00005 PG 6 WC Anesthesiology SC Anesthesiology GA 222DD UT WOS:000081767400005 ER PT J AU Bevan, JC Collins, L Fowler, C Kahwaji, R Rosen, HD Smith, MF Scheepers, LD Stephenson, CA Bevan, DR AF Bevan, JC Collins, L Fowler, C Kahwaji, R Rosen, HD Smith, MF Scheepers, LD Stephenson, CA Bevan, DR TI Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCK; DOSE-RESPONSE RELATIONSHIPS; ANESTHETIZED PATIENTS; TIME-COURSE; HALOTHANE ANESTHESIA; PARALYSIS RECOVERY; RAPID ANTAGONISM; FEMALE-PATIENTS; EDROPHONIUM; PANCURONIUM AB We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T-1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T-1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T-1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Implications: These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration. C1 British Columbia Childrens Hosp, Dept Anaesthesia, Vancouver, BC V6H 3V4, Canada. Univ British Columbia, Vancouver Gen Hosp, Dept Anaesthesia, Vancouver, BC V5Z 1M9, Canada. RP Bevan, JC (reprint author), British Columbia Childrens Hosp, Dept Anaesthesia, 4480 Oak St, Vancouver, BC V6H 3V4, Canada. NR 32 TC 35 Z9 38 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 1999 VL 89 IS 2 BP 333 EP 339 DI 10.1097/00000539-199908000-00016 PG 7 WC Anesthesiology SC Anesthesiology GA 222DD UT WOS:000081767400016 ER PT J AU Uslu, M Mellinghoff, H Diefenbach, C AF Uslu, M Mellinghoff, H Diefenbach, C TI Mivacurium for muscle relaxation in a child with Duchenne's muscular dystrophy SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKADE; VECURONIUM; PANCURONIUM C1 Univ Cologne, Dept Anesthesiol, Cologne, Germany. RP Uslu, M (reprint author), Univ Cologne, Dept Anaesthesiol, D-50924 Cologne, Germany. NR 10 TC 9 Z9 9 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 1999 VL 89 IS 2 BP 340 EP 341 PG 2 WC Anesthesiology SC Anesthesiology GA 222DD UT WOS:000081767400017 ER PT J AU Ibebunjo, C Srikant, CB Donati, F AF Ibebunjo, C Srikant, CB Donati, F TI Morphological correlates of the differential responses of muscles to vecuronium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, vecuronium; muscle skeletal; muscle skeletal, responses; cat ID ADDUCTOR POLLICIS MUSCLES; NEUROMUSCULAR BLOCKING-AGENTS; ACETYLCHOLINE-RECEPTORS; LIMB MUSCLES; BLOOD-FLOW; DIAPHRAGM; BLOCKADE; MASSETER; GOAT; SUCCINYLCHOLINE AB We have noted previously that duration of vecuronium block correlated with fibre size in six muscle groups in the goat. Electrophysiological considerations suggest that the important factor should be the number of acetylcholine receptors (AChR) relative to fibre size. However, this hypothesis could not be verified in the goat because the number of AChR was relatively constant in the different muscles despite differences in fibre size. Therefore, in this study, we have investigated the relationship between sensitivity to vecuronium, as reflected by the ED50 and duration of block, of six muscles in the cat and the number of AChR per unit fibre cross-sectional area (CSA). The ED50 and duration of action (time to 50% recovery of the first twitch after a dose of 15 mu g kg(-1)) of vecuronium in the tibialis cranialis, soleus, rectus abdominis, masseter, diaphragm and thyroarytenoideus muscles were determined during train-of-four stimulation and EMG recording in seven cats anaesthetized with pentobarbital. CSA of the muscle fibres and number of junctional AChR in these muscles were measured by histological methods and I-125-alpha-bungdrotoxin binding assay, respectively, and the number of AChR per unit fibre CSA calculated. The association between muscle response (ED50 and duration of block) and fibre CSA or number of AChR per unit fibre CSA was then tested by regression analyses. Duration of block varied between the six muscles (mean 8.9 (SEM 2.6) to 20.3 (3.1) min; P = 0.0001) but ED50 did not (7.5 (1.5) to 15.6 (2.5) mu g kg(-1); P = 0.185). Fibre CSA and number of AChR per unit fibre CSA also varied between these muscles (P = 0.0001). Duration to 50% TI recovery was prolonged in muscles with a low number of AChR relative to fibre CSA (r(2) = 0.30; P = 0.0002) and the ED50 increased as the number of AChR per fibre CSA increased (r(2) = 0.240; P = 0.0016). These results in the cat suggest that the number of junctional AChR relative to fibre CSA is a morphological predictor of the differential sensitivities of muscles to neuromuscular blocking agents. C1 Royal Victoria Hosp, Dept Anaesthesia, Montreal, PQ H3A 1A1, Canada. Royal Victoria Hosp, Dept Med, Montreal, PQ H3A 1A1, Canada. McGill Univ, Montreal, PQ H3A 1A1, Canada. RP Ibebunjo, C (reprint author), Shriners Hosp Crippled Children, 51 Blossom St,2nd Floor, Boston, MA 02114 USA. NR 31 TC 18 Z9 21 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 1999 VL 83 IS 2 BP 284 EP 291 PG 8 WC Anesthesiology SC Anesthesiology GA 230PW UT WOS:000082260400018 ER PT J AU Van Oldenbeek, C Knowles, P Harper, NJN AF Van Oldenbeek, C Knowles, P Harper, NJN TI Residual neuromuscular block caused by pancuronium after cardiac surgery SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, pancuronium; neuromuscular block, measurement of; response; surgery, cardiovascular ID VECURONIUM AB We studied 20 adult patients undergoing cardiac surgery. All received pancuronium as the sole neuromuscular blocking drug and no reversal agent was used. In the postoperative intensive care unit, mechanical ventilation was continued and patients were sedated with an infusion of propofol. Neuromuscular block was measured electromyographically at appropriate intervals until the train-of-four ratio (TOF) reached 0.8. At the time when the propofol infusion would normally be discontinued, 13 patients (65%) demonstrated a TOF of less than 0.8 (group median 0.23, interquartile range 0.11-0.6). Subsequently, the median time to achieve a TOF of 0.8 was 2 h 10 min (interquartile range I h-2 h 25 min). We found that if pancuronium was used during cardiac surgery, a significant proportion of patients remained partially paralysed when they would normally be allowed to emerge from anaesthesia in the ICU. C1 Manchester Royal Infirm, Dept Anaesthesia, Manchester M13 9WL, Lancs, England. RP Harper, NJN (reprint author), Manchester Royal Infirm, Dept Anaesthesia, Oxford Rd, Manchester M13 9WL, Lancs, England. NR 6 TC 14 Z9 14 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 1999 VL 83 IS 2 BP 338 EP 339 PG 2 WC Anesthesiology SC Anesthesiology GA 230PW UT WOS:000082260400028 ER PT J AU Saitoh, Y Narumi, Y Fujii, Y AF Saitoh, Y Narumi, Y Fujii, Y TI Post-tetanic count and train-of-four responses during neuromuscular block produced by vecuronium and infusion of nicardipine SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, measurement of response; neuromuscular block, vecuronium; calcium channel block, nicardipine ID CALCIUM AB We have examined onset and recovery of neuromuscular block produced by vecuronium using either post-tetanic count (PTC), or the first twitch of the train-of-four (TOF) (T1/T0) and TOF ratio (T4/T1) during continuous infusion of nicardipine. Sixty adult patients were allocated to one of four groups of 15 patients each: nicardipine-PTC, nicardipine-TOF, control-PTC and control-TOF. In the nicardipine-PTC and nicardipine-TOF groups, nicardipine 0.03 mg kg(-1) was given before vecuronium 0.1 mg kg(-1) and a continuous infusion of nicardipine was started immediately at a rate of 2 mu g kg(-1) min(-1). Mean time from administration of vecuronium to onset of neuromuscular block in the nicardipine-PTC and nicardipine-TOF groups was significantly shorter than in the control-PTC and control-TOF groups (166 (SD 39) vs 220 (28) s; P < 0.05). There was no significant difference in recovery of PTC between the nicardipine-PTC and control-PTC groups or in recovery of TOF ratio in the nicardipine-TOF and control-TOF groups. However, during recovery, T1/T0 in the nicardipine-TOF group was significantly less than that in the control-TOF group, 60-100 min after administration of vecuronium. C1 Toride Kyodo Gen Hosp, Dept Anaesthesiol, Toride City, Ibaraki 3020022, Japan. Univ Tsukuba, Inst Clin Med, Dept Anaesthesiol, Ibaraki, Osaka, Japan. RP Saitoh, Y (reprint author), Toride Kyodo Gen Hosp, Dept Anaesthesiol, 2-1-1 Hongo, Toride City, Ibaraki 3020022, Japan. NR 6 TC 5 Z9 7 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD AUG PY 1999 VL 83 IS 2 BP 340 EP 342 PG 3 WC Anesthesiology SC Anesthesiology GA 230PW UT WOS:000082260400029 ER PT J AU Baraka, A Siddik, S Kawkabani, N AF Baraka, A Siddik, S Kawkabani, N TI Cisatracurium in a myasthenic patient undergoing thymectomy SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID GRAVIS; BLOCK; ANESTHESIA AB Purpose: The report investigates cisatracurium neuromuscular block in a myasthenic patient undergoing thymectomy. Clinical Features: A myasthenic patient (Osserman II B) was prepared preoperatively with 240 mg.day(-1) pyridostigmine. The neuromuscular block produced by 0.05 mg.kg(-1) cisatracurium was monitored by Datex electromyography. The electromyographic response was compared with that in a control group of five non-myasthenic patients. In the myasthenic patient, cisatracurium resulted in a rapid onset of complete (97-98%) neuromuscular block, while a slow onset of partial (80-90%) block was achieved in the control group. Also, administration of 0.05 mg.kg(-1) neostigmine at the end of surgery reversed the neuromuscular block of cisatracurium in the non-myasthenic patients, but did not change the rate of spontaneous recovery in the myasthenic patient. Conclusion: The myasthenic patient is sensitive to cisatracurium, as evidenced by a more rapid onset and more marked neuromuscular block compared with the control non-myasthenic patients. This may be attributed to the decreased number of functional endplate acetylcholine receptors in the myasthenic patient, with a consequent decrease of the safety margin of neuromuscular transmission. Also, in contrast with the control group, the rate of recovery from neuromuscular block in the myasthenic patient was not enhanced by neostigmine at the end of surgery. This may be attributed to the prior inhibition of acetylcholinesterase by the preoperative pyridostigmine, as well as by possible desensitization of the cholinergic receptors secondary to prolonged pyridostigmine therapy. C1 Amer Univ Beirut, Dept Anesthesiol, Beirut, Lebanon. RP Baraka, A (reprint author), Amer Univ Beirut, Dept Anesthesiol, Beirut, Lebanon. NR 18 TC 9 Z9 10 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD AUG PY 1999 VL 46 IS 8 BP 779 EP 782 PG 4 WC Anesthesiology SC Anesthesiology GA 223WT UT WOS:000081865100012 ER PT J AU Puhringer, FK Keller, C Kleinsasser, A Giesinger, S Benzer, A AF Puhringer, FK Keller, C Kleinsasser, A Giesinger, S Benzer, A TI Pharmacokinetics of rocuronium bromide in obese female patients SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular relaxants, rocuronium; pharmacokinetics, obesity; complications, obesity; potency, obesity ID ISOFLURANE ANESTHESIA; SURGICAL PATIENT; TIME-COURSE; ORG-9426; PHARMACODYNAMICS; VECURONIUM; HALOTHANE; INFUSION AB Following administration of 0.6 mg kg(-1) rocuronium, the pharmacokinetics and the pharmacodynamics were studied in six obese and six control (normal weight) patients receiving balanced anaesthesia. Twelve gynaecological patients were allocated into two groups, according to body mass index (normal weight: body mass index: 20-24, obese weight: body mass index > 28). Venous plasma concentrations were determined by high-pressure liquid chromatography before administration of rocuronium, at 1, 2, 4, 6, 8, 10, 15, 20, 25, 30, 35, 40, 48, 60, 75, 120, 180, 240, 300, 360 and 420 min after administration of rocuronium and at recovery of single twitch to 25% and 75% of control twitch height. Onset time was shorter (NS) in the obese compared with normal weight (obese weight: 65 +/- 16, normal weight: 100 +/- 39 s, mean +/- SD). Duration 25% (obese weight: 29.5 +/- 5.3, normal weight: 28.4 +/- 5.3 min) and spontaneous recovery time (obese weight: 12.6 +/- 2.7, normal weight: 12.5 +/- 2.3 min) did not show any differences between the two groups. The pharmacokinetics of rocuronium were comparable in the two groups. The volume of distribution at steady state Vss (mL kg(-1)) was 208 +/- 56 in normal weight and 169 +/- 37 in obese weight. Distribution (T1/2 alpha) and elimination half-life (T1/2 beta) as well as mean residence time were 15.6 +/- 3.7, 70.3 +/- 23.9 and 53.2 +/- 9.8 min in normal weight and 16.9 +/- 3.8, 75.5 +/- 25.5 and 51.1 +/- 18.9 min in obese weight, respectively. Also, no differences were observed in plasma clearance (3.89 +/- 0.58 in normal weight and 3.62 +/- 1.42 mL kg(-1) min(-1) obese weight). This study indicates that the pharmoacodynamics and pharmacokinetics of rocuronium are in female patients not altered by obesity. C1 Univ Innsbruck, Dept Anaesthesia & Intens Care Med, A-6020 Innsbruck, Austria. RP Puhringer, FK (reprint author), Univ Innsbruck, Dept Anaesthesia & Intens Care Med, A-6020 Innsbruck, Austria. NR 11 TC 21 Z9 22 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD AUG PY 1999 VL 16 IS 8 BP 507 EP 510 DI 10.1046/j.1365-2346.1999.00523.x PG 4 WC Anesthesiology SC Anesthesiology GA 266BK UT WOS:000084280600002 ER PT J AU Xue, FS Zhang, YM Liao, X Liu, JH An, G AF Xue, FS Zhang, YM Liao, X Liu, JH An, G TI Influences of age and gender on dose response and time course of effect of atracurium in anesthetized adult patients SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE age; atracurium; drug, dose response, time course of action; gender; neuromuscular blocking drugs; pharmacology, clinical ID VECURONIUM; PHARMACOKINETICS; INFUSION; POTENCY; PHARMACODYNAMICS; ANESTHESIA; INFANTS; HUMANS; BOLUS AB Study Objective: To determine the influences of age and gender on the dose response anti the time course of effect of atracurium. Design: Prospective, nonrandomized, clinical comparison. Setting: Operating room, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College. Patients: 72 adult ASA physical status I patients (38 mule and 34 female), aged 15 to 59 years, scheduled for elective plastic surgery. Interventions: Patients were divided into the three groups on the basis of age: Group 1, patients aged 15-29 years (n = 32); Group 2, patients aged 30-40 years (n = 21); and Group 3, patients aged 41-59 years (n = 19). Anesthesia was maintained with 60% nitrous oxide in oxygen, thiopental, and incremental doses of fentanyl,1 as required. The dose-response relationship of atracurium was determined by a cumulative dose-response technique. Measurements and Main Results: Neuromuscular function was assessed mechanomyo-graphically with train-of-four stimulation at the wrist every 12 seconds and the percentage depression of first twitch (T-1) response was used as the study variable. Age and gender significantly affected the dose-response relationship and time course of recovery of atracurium. Advancing age was associated with a reduced effective doses (ED,, ED,, and ED95) of atracurium and a longer duration of action. The effective doses of atracurium were greater, and its duration of action was shower in men than in women. There were significant differences in the 50 %, 90 %, and 95 % effective dose (ED50, ED90, and ED95) of atracurium, and clinical duration and total duration following administration, of atracurium 400 mu g/hg among the three age groups, and between men and women. Conclusions: Age and gender have significant effects on the dose response and time course of effect of atracurium. Cider patients and women ala mora sensitive to atracurium-induced neuromuscular block than are young patients and men. (C) 1999 by Elsevier Science Inc. C1 Peking Union Med Coll, Beijing 100041, Peoples R China. NR 37 TC 7 Z9 8 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD AUG PY 1999 VL 11 IS 5 BP 397 EP 405 DI 10.1016/S0952-8180(99)00075-6 PG 9 WC Anesthesiology SC Anesthesiology GA 241ZT UT WOS:000082914300009 ER PT J AU Cheung, PY Tyebkhan, JM Peliowski, A Ainsworth, W Robertson, CMT AF Cheung, PY Tyebkhan, JM Peliowski, A Ainsworth, W Robertson, CMT TI Prolonged use of pancuronium bromide and sensorineural hearing loss in childhood survivors of congenital diaphragmatic hernia SO JOURNAL OF PEDIATRICS LA English DT Article ID EXTRACORPOREAL MEMBRANE-OXYGENATION; PERSISTENT PULMONARY-HYPERTENSION; HIGH-RISK INFANTS; LOOP DIURETICS; POTENTIALS; NEWBORN AB Sensorineural hearing loss (SNHL) is a significant neurologic morbidity in survivors of neonatal congenital diaphragmatic hernia (CDH), with a reported incidence of up to 60%. In a historical cohort study of 37 neonates with CDH, we investigated the use of pancuronium bromide (PB) and common ototoxic drugs during the neonatal period and their relationship to SNHL in childhood survivors. Survivors with SNHL (n = 23) had significantly higher cumulative dose of PB administered during the neonatal illness than survivors without SNHL (n = 14). The cumulative dose and duration of PB use significantly correlated (r = 0.66-0.81) and independently predicted (adjusted r(2) = 0.42-0.64) the greatest intensity (in decibels) and the widest band (lowest frequency in hertz) loss of SNHL. No differences were identified between survivors with and without SNHL regarding demographic and neonatal characteristics (including oxygenation and ventilation variables and the cumulative dose and duration of therapy with aminoglycosides, vancomycin, and furosemide), although survivors with SNHL had received a modestly higher cumulative dose of ethacrynic acid than survivors without SNHL. Although we show that prolonged administration of PB during the neonatal period is associated with SNHL in childhood survivors of CDH, further multicenter studies are required to investigate the possible etiologies of SNHL in this high-risk population. C1 Royal Alexandra Hosp Children, Dept Newborn Med, Edmonton, AB T5H 3V9, Canada. Glenrose Rehabil Hosp, Neonatal & Infant Followup Clin, Edmonton, AB, Canada. RP Cheung, PY (reprint author), Royal Alexandra Hosp Children, Dept Newborn Med, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada. RI Cheung, Po-Yin/C-2804-2013 NR 29 TC 28 Z9 28 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0022-3476 J9 J PEDIATR JI J. Pediatr. PD AUG PY 1999 VL 135 IS 2 BP 233 EP 239 DI 10.1016/S0022-3476(99)70027-2 PN 1 PG 7 WC Pediatrics SC Pediatrics GA 224FC UT WOS:000081885900018 ER PT J AU Lee, SK Kim, JR Bai, SJ Shin, YS Nam, YT Cohen, SP AF Lee, SK Kim, JR Bai, SJ Shin, YS Nam, YT Cohen, SP TI Effects of priming with pancuronium or rocuronium on intubation with rocuronium in children SO YONSEI MEDICAL JOURNAL LA English DT Article DE neuromuscular relaxants; rocuronium; pancuronium; onset time; priming principle ID NEUROMUSCULAR BLOCKING ACTION; RAPID TRACHEAL INTUBATION; ACCELERATED ONSET; DELAYED RECOVERY; D-TUBOCURARINE; SUCCINYLCHOLINE; SUXAMETHONIUM; COMBINATIONS; MIVACURIUM; ANESTHESIA AB Rocuronium is a non-depolarizing neuromuscular blocking agent which has a rapid onset and intermediate duration of action. The goal of this study was to compare the neuromuscular blocking actions of rocuronium with and without a priming dose of pancuronium or rocuronium in children. Thirty patients were randomly allocated into 3 groups. Ten patients received a single dose of 0.6 mg/kg rocuronium (Group I). The others received either 0.015 mg/kg pancuronium (Group II) or 0.06 mg/kg rocuronium (Group III) 3 minutes before an intubating dose of 0.54 mg/kg rocuronium was given. Neuromuscular blockade was measured via accelerographic response to single stimulations (1 Hz) of the ulnar nerve until maximal twitch depression was reached followed by train-of-four (TOF) stimuli (2 Hz) at 15 second intervals for the remainder of recovery. Groups were compared with regard to onset time, duration and recovery indices. The onset time and duration of block did not differ significantly between groups. However, the time to recovery in group II (24.5+/-9.9 min) was significantly prolonged compared to that in group I (12.7+/-3.1 min) or group III (12.7+/-3.9 min). We concluded that the use of rocuronium with a preceding dose of either pancuronium or rocuronium provided no advantage for intubation in children. C1 Yonsei Univ, Coll Med, Dept Anesthesiol, Seoul 135270, South Korea. Massachusetts Gen Hosp, Dept Anesthesiol, Boston, MA 02114 USA. RP Shin, YS (reprint author), Yonsei Univ, Coll Med, Yongdong Severance Hosp, Dept Anesthesiol, POB 1217, Seoul 135270, South Korea. NR 17 TC 2 Z9 3 PU YONSEI UNIV COLLEGE MEDICINE PI SEOUL PA C/O KYUN0-IL IM, M.D., PH.D, SHINCHON DONG 134, SEODAEMOON KU, SEOUL 120-752, SOUTH KOREA SN 0513-5796 J9 YONSEI MED J JI Yonsei Med. J. PD AUG PY 1999 VL 40 IS 4 BP 327 EP 330 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 233ZP UT WOS:000082457300005 ER PT J AU Kim, JH Min, KT Ahn, EK Kim, KH Shin, YS AF Kim, JH Min, KT Ahn, EK Kim, KH Shin, YS TI The infusion rate of mivacurium or atracurium for cesarean section compared with gynecological procedures SO YONSEI MEDICAL JOURNAL LA English DT Article DE neuromuscular block; mivacurium; atracurium; cesarean section; plasma cholinesterase ID NEUROMUSCULAR BLOCKADE; PLACENTAL-TRANSFER; PHARMACOKINETICS; SUCCINYLCHOLINE; CHOLINESTERASE; PANCURONIUM; VECURONIUM; PLASMA AB Mivacurium is mainly metabolized by plasma cholinesterase, whereas atracurium is removed by Hofmann elimination. The purpose of this study was to compare the infusion rate of atracurium and mivacurium in maintaining surgical relaxation, and to compare their recovery indices between parturients and non-pregnant women. Muscle relaxation was maintained by the continuous infusion of relaxants to ret ain the first response of train-of-four (TOF) ar 5% of control. When mivacurium was used, Bolus-T-5 (duration from the end of mivacurium bolus injection to 5% single twitch recovery) was measured. After discontinuing the infusion, the recovery index was measured. The infusion rare of mivacurium, not atracurium, was significantly lower in parturients and Bolus-T-5 of parturients was significantly longer than that of non-pregnant women. There was no significant difference in the recovery indices of both relaxants. The authors concluded that the infusion rate of mivacurium in maintaining muscle relaxation in parturients should be reduced compared to the rate in non-pregnant women and measuring Bolus-T-5 may be helpful in determining the infusion rare to maintain muscle relaxation. C1 Yonsei Univ, Coll Med, Dept Anesthesiol, Seoul 120752, South Korea. RP Kim, JH (reprint author), Yonsei Univ, Coll Med, Dept Anesthesiol, CPO Box 8044, Seoul 120752, South Korea. NR 21 TC 1 Z9 1 PU YONSEI UNIV COLLEGE MEDICINE PI SEOUL PA C/O KYUN0-IL IM, M.D., PH.D, SHINCHON DONG 134, SEODAEMOON KU, SEOUL 120-752, SOUTH KOREA SN 0513-5796 J9 YONSEI MED J JI Yonsei Med. J. PD AUG PY 1999 VL 40 IS 4 BP 371 EP 376 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 233ZP UT WOS:000082457300012 ER PT J AU Mistry, N Roberts, AD Tranter, GE Francis, P Barylski, I Ismail, IM Nicholson, JK Lindon, JC AF Mistry, N Roberts, AD Tranter, GE Francis, P Barylski, I Ismail, IM Nicholson, JK Lindon, JC TI Directly coupled chiral HPLC-NMR and HPLC-CD spectroscopy as complementary methods for structural and enantiomeric isomer identification: Application to atracurium besylate SO ANALYTICAL CHEMISTRY LA English DT Article ID MAGNETIC-RESONANCE SPECTROSCOPY; LIQUID-CHROMATOGRAPHY; MASS-SPECTROMETRY; SEPARATION; IMPURITIES; MS AB Directly coupled HPLC-NMR spectroscopy has now become a standard, commercially available technique for mixture characterization. Here the extension of the technique to chiral HPLC separation is reported and it is shown that HPLC-NMR together with HPLC-CD provide complementary approaches for the identification of structural isomers and enantiomers, The general approach has been exemplified using the neuromuscular blocking agent atracurium besylate, which comprises a mixture of 10 isomers in various proportions as four racemic pairs and two meso compounds. Diagnostic reporter resonances in the H-1 NMR spectrum of atracurium besylate were assigned using a combination of one-dimensional and two-dimensional NMR experiments at 750 MHz. Stop-now 750-MHz H-1 NMR spectroscopy was used on-line after chiral column HPLC separation to identify the enantiomeric pairs, to distinguish the meso compounds, and to identify key configurational features of the isomers, The parallel HPLC-CD experiments served to assign the enantiomers based upon the known CD and absolute stereochemistry of (R)-laudanosine hydrochloride, an analogue with the same tetrahydroisoquinoline structural unit as atracurium, It is thereby demonstrated that high-field HPLC-NMR and HPLC-CD is a powerful combination of techniques which could be combined on-line for mixture characterization. C1 Univ London Imperial Coll Sci Technol & Med, Div Biomed Sci, London SW7 2AZ, England. GlaxoWellcome Med Res Ctr, Dev Chem Dept, Stevenage SG1 2NY, Herts, England. GlaxoWellcome Med Res Ctr, Dept Phys Sci, Stevenage SG1 2NY, Herts, England. GlaxoWellcome, Int Dev Biomet, Ware SG12 0DP, Herts, England. RP Lindon, JC (reprint author), Univ London Imperial Coll Sci Technol & Med, Div Biomed Sci, Sir Alexander Fleming Bldg, London SW7 2AZ, England. RI Nicholson, Jeremy/B-3395-2012 OI Nicholson, Jeremy/0000-0002-8123-8349 NR 13 TC 17 Z9 17 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 0003-2700 J9 ANAL CHEM JI Anal. Chem. PD JUL 15 PY 1999 VL 71 IS 14 BP 2838 EP 2843 DI 10.1021/ac990132e PG 6 WC Chemistry, Analytical SC Chemistry GA 216VM UT WOS:000081465200033 ER PT J AU Fernandez, R Bello, MA Callejon, M Jimenez, JC Guiraum, A AF Fernandez, R Bello, MA Callejon, M Jimenez, JC Guiraum, A TI Spectrofluorimetric determination of cisatracurium and mivacurium in spiked human serum and pharmaceuticals SO TALANTA LA English DT Article DE cisatracurium determination; fluorescence; mivacurium determination; serum ID LIQUID-CHROMATOGRAPHIC ASSAY; FLUOROMETRIC DETECTION; NEUROMUSCULAR BLOCKER; HUMAN PLASMA; METABOLITES; ISOMERS; IDENTIFICATION AB Spectrofluorimetric methods to determine cisatiacurium and mivacurium are proposed and applied to the determination of both substances in human serum and to the determination of mivacurium in pharmaceuticals. The fluorimetric methods allow the determination of 5-500 ng ml(-1) of mivacurium in aqueous solutions and 5-500 ng ml(-1) of cisatracurium in water-acetonitrile solutions, both containing acetic acid-sodium acetate buffer (pH 5.5) with lambda(exc) = 230 nm and lambda(em) = 324 nm. (C) 1999 Elsevier Science B.V. All rights reserved. C1 Fac Chem, Dept Analyt Chem, Seville 41012, Spain. RP Bello, MA (reprint author), Fac Chem, Dept Analyt Chem, Seville 41012, Spain. NR 12 TC 3 Z9 3 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0039-9140 J9 TALANTA JI Talanta PD JUL 12 PY 1999 VL 49 IS 4 BP 881 EP 887 DI 10.1016/S0039-9140(99)00084-3 PG 7 WC Chemistry, Analytical SC Chemistry GA 221ZD UT WOS:000081757000018 ER PT J AU McCourt, KC Mirakhur, RK Kerr, CM AF McCourt, KC Mirakhur, RK Kerr, CM TI Dosage of neostigmine for reversal of rocuronium block from two levels of spontaneous recovery SO ANAESTHESIA LA English DT Article DE neuromuscular relaxants, rocuronium; antagonists, neostigmine; anaesthetics, inhalational, isoflurane ID INDUCED NEUROMUSCULAR BLOCK; DOSE-RESPONSE RELATIONSHIPS; ENFLURANE ANESTHESIA; LAPAROSCOPIC SURGERY; ANTAGONISM; ISOFLURANE; MIVACURIUM; PARALYSIS; HALOTHANE; CHILDREN AB Spontaneous recovery, and recovery following neostigmine 20, 35 or 50 mu g.kg(-1) administered at 10 or 25% of recovery of the first twitch of the train-of-four, was assessed in 80 patients after rocuronium administration under continued isoflurane anaesthesia. In an additional 10 patients, isoflurane administration was discontinued and neostigmine 35 or 50 mu g.kg(-1) was given at 10 or 25% recovery. The administration of neostigmine reduced the recovery times significantly. A neostigmine dose of 20 mu g.kg(-1) resulted in slower recovery compared with the higher doses, particularly when reversal was attempted at a first twitch height of 10%. Higher doses of neostigmine given at a first twitch height of 25% resulted in rapid reversal of block [mean (SD) times of 7.0 (4.8) and 6.4 (1.9) min with the 35 and 50 mu g.kg(-1) doses, respectively, for attaining a train-of-four ratio of 0.8]. Discontinuing isoflurane did not alter recovery times. The incidence of emetic symptoms did not differ between groups, including one group that received atropine instead of glycopyrronium in combination with neostigmine. We conclude that rocuronium block can be antagonised safely using a neostigmine dose of 35 mu g.kg(-1), although recovery may be slightly slower if administered at a first twitch of 10% of control. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 24 TC 16 Z9 17 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUL PY 1999 VL 54 IS 7 BP 651 EP 655 DI 10.1046/j.1365-2044.1999.00893.x PG 5 WC Anesthesiology SC Anesthesiology GA 221BB UT WOS:000081703400006 ER PT J AU Purdy, R Bevan, DR Donati, F Lichtor, JL AF Purdy, R Bevan, DR Donati, F Lichtor, JL TI Early reversal of rapacuronium with neostigmine SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT International-Anesthesia-Research-Society Clinical and Scientific Congress CY MAR 07-11, 1998 CL ORLANDO, FLORIDA SP Int Anesthesia Res Soc DE antagonists; mechanomyography; neuromuscular relaxants; neuromuscular measurement techniques ID INDUCED NEUROMUSCULAR BLOCKADE; MUSCLE-RELAXANT; BLOCKING-AGENTS; DOSE-RESPONSE; TIME-COURSE; VECURONIUM; ATRACURIUM; ORG-9487; PANCURONIUM; RECOVERY AB Background: Rapacuronium is a rapid-onset, short-acting neuromuscular relaxant. This multiple-center study determined neuromuscular recovery when neostigmine was given 2 or 5 min after rapacuronium. Methods: One hundred seventeen patients were randomized to receive two different doses of rapacuronium and to receive neostigmine in two different doses and at two different times. During propofol anesthesia with nitrous oxide, oxygen, and fentanyl, 1.5 or 2.5 mg/kg rapacuronium was given 1 min before tracheal intubation Neuromuscular block was measured by train-of-four ulnar nerve stimulation every 12 s: The adductor pollicis force of contraction was recorded mechanomyographically. Two or five minutes after rapacuronium was administered, 0.05 or 0.07 mg/kg neostigmine was administered and recovery was compared with that of control patients who received no neostigmine. Results: Both doses of rapacuronium produced 100% block in all but one patient, who exhibited 97% block. Neostigmine accelerated recovery in all groups. After 1.5 mg/kg rapacuronium, the time to 25% T-1 twitch recovery decreased from a mean of 16 min in control patients to mean values of 8-10 min in the treatment groups: The time to train-of-four ratio of 0.7 decreased from 38 min to 17-19 min. After 2.5 mg/kg rapacuronium, the time to 25% T-1 was reduced from 23 min to 11-12 min, and the time to train-of-four ratio of 0.7 decreased from 54 min to 26-32 min. Recovery was not different among the the groups that received different doses and timing of neostigmine. Conclusions: Recovery of intense rapacuronium block was accelerated by early neostigmine administration. When given 2 min after rapacuronium, neostigmine was as effective as after 5 min, and 0.05 mg/kg neostigmine was comparable to 0.07 mg/kg neostigmine. C1 Univ British Columbia, Fac Med, Dept Anaesthesia, Vancouver, BC V5Z 4E3, Canada. Univ Montreal, Dept Anesthesia, Montreal, PQ H3C 3J7, Canada. Univ Chicago, Dept Anesthesia & Crit Care, Chicago, IL 60637 USA. RP Bevan, DR (reprint author), Univ British Columbia, Fac Med, Dept Anaesthesia, Room 3200,3rd Fl,910 W 10th Ave, Vancouver, BC V5Z 4E3, Canada. NR 27 TC 25 Z9 26 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1999 VL 91 IS 1 BP 51 EP 57 DI 10.1097/00000542-199907000-00011 PG 7 WC Anesthesiology SC Anesthesiology GA 211YA UT WOS:000081188400010 ER PT J AU Lien, CA Belmont, MR Roth, DLW Okamoto, M Abalos, A Savarese, JJ AF Lien, CA Belmont, MR Roth, DLW Okamoto, M Abalos, A Savarese, JJ TI Pharmacodynamics and the plasma concentration of mivacurium during spontaneous recovery and neostigmine-facilitated recovery SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 46th Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 21-25, 1995 CL ATLANTA, GEORGIA SP Amer Soc Anesthesiologists DE antagonism; mivacurium; neostigmine; plasma cholinesterase; stereoisomers ID INDUCED NEUROMUSCULAR BLOCKADE; ADULT PATIENTS; RENAL-FAILURE; 3 ISOMERS; INFUSION; PHARMACOKINETICS; CHOLINESTERASE; ATRACURIUM; CHLORIDE; REVERSAL AB Background: The authors examined the plasma concentrations of the isomers of mivacurium and its pharmacodynamics during spontaneous and neostigmine-facilitated recovery after a mivacurium infusion. Methods: Sixteen patients receiving nitrous oxide-opioid anesthesia received 0.25 mg/kg mivacurium. Patient response to neuromuscular stimulation was determined using a mechanomyograph. Once T1 had recovered to 25% of its baseline height, a mivacurium infusion was begun and adjusted to maintain 95-99% neuromuscular block. The infusion was discontinued after 90 min and muscle strength allowed to recover either spontaneously or after neostigmine/glycopyrrolate (0.05/0.01 mg/kg). Plasma concentrations of the isomers of mivacurium after discontinuation of the infusion were determined using an HPLC assay. Differences between the groups were determined using a one-way analysis of variance with a Bonferroni-corrected t test or Student t test as appropriate. P less than or equal to 0.05 was considered significant. Results: Differences in the times for recovery to a train-of-four ratio of 70% did not achieve statistical significance (mean +/- SD, 13.3 +/- 6.0 us. 16.3 +/- 2.5 min for the neostigmine and spontaneous groups, respectively). Plasma cholinesterase activity decreased significantly from baseline values after administration of neostigmine (5.88 +/- 0.21 us. 0.43 +/- 0.04 U/ml plasma). Plasma concentrations of the trans-trans isomer were significantly greater in the neostigmine group than in the spontaneous recovery group 5, 6, 8, and 10 min after discontinuation of the infusion. Differences in the plasma concentration of the cis-trans isomer did not achieve statistical significance. Conclusions: Although administration of neostigmine decreased plasma cholinesterase activity and caused the trans-trans isomer to remain in the plasma at higher concentration, it did not delay recovery from mivacurium-induced block. C1 Cornell Univ, New York Presbyterian Hosp, Dept Anesthesiol, New York, NY 10021 USA. RP Lien, CA (reprint author), Cornell Univ, New York Presbyterian Hosp, Dept Anesthesiol, 525 E 68th St,Room M-312A, New York, NY 10021 USA. NR 29 TC 4 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1999 VL 91 IS 1 BP 119 EP 126 DI 10.1097/00000542-199907000-00019 PG 8 WC Anesthesiology SC Anesthesiology GA 211YA UT WOS:000081188400018 ER PT J AU Kirkegaard-Nielsen, H Caldwell, JE Berry, PD AF Kirkegaard-Nielsen, H Caldwell, JE Berry, PD TI Rapid tracheal intubation with rocuronium - A probability approach to determining dose SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 1997 Annual Meeting of American-Society-of-Anesthesiologists CY OCT 17-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiologists DE anesthesia; neuromuscular blocking drug; neuromuscular function monitoring ID SEQUENCE INDUCTION; TIMING PRINCIPLE; SUCCINYLCHOLINE; SUXAMETHONIUM; ONSET; VECURONIUM; ANESTHESIA; THIOPENTONE; ALFENTANIL; ORG-9426 AB Background: Rapid tracheal intubation with rocuronium has not been studied using a probability-based approach, The authors aimed to predict doses of rocuronium giving 90% and 95% probability of intubation within 60 s and to estimate their durations of action, Methods: After premedication with midazolam, 2 mg, anesthesia was induced in 80 subjects with fentanyl, 2 mu g/kg, followed 3 min later by propofol, 2 mg/kg. Patients received randomly rocuronium, 0.0, 0.4, 0.8, or 1.2 mg/kg (n = 20/dose). Laryngoscopy began 40 s later, aiming for intubation at 60 s, and conditions were graded perfect, acceptable, or unacceptable, with the first two conditions being successful intubation, Anesthesia was maintained with isoflurane 0.5-1.0% (end-tidal) and fentanyl. Duration of action was time until reappearance of the first tactile train-of-four response. The dose versus fraction of patients with successful incubation was analyzed by logistic regression. Doses giving 90% and 95% (D-90 and D-95) probability of successful intubation were calculated. Results: Intubation was successful in 7, 11, 18, and 19 patients in the 0.0, 0.4, 0.8, and 1.2 mg/kg groups, respectively. The D-90 and D-95 doses (95% confidence limits in parentheses) were 0.83 (0.59-1.03) and 1.04 (0.76-1.36) mg/kg, respectively. Estimated time until first tactile train-of-four response after D-90 and D-95 doses was 32 and 46 min, respectively. Conclusions: After induction with fentanyl and propofol, rocuronium, 1.04 mg/kg, gives 95% probability of successful intubation at 60 s. C1 Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. RP Caldwell, JE (reprint author), Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA. NR 25 TC 24 Z9 27 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1999 VL 91 IS 1 BP 131 EP 136 DI 10.1097/00000542-199907000-00021 PG 6 WC Anesthesiology SC Anesthesiology GA 211YA UT WOS:000081188400020 ER PT J AU Villegas-Sanchez, F Charles-Torres, JD Moyao-Garcia, D Nava-Ocampo, AA Velazquez-Armenta, EY AF Villegas-Sanchez, F Charles-Torres, JD Moyao-Garcia, D Nava-Ocampo, AA Velazquez-Armenta, EY TI Rocuronium administration in children during isoflurane anesthesia: Neuromuscular effects SO ARCHIVES OF MEDICAL RESEARCH LA English DT Article DE clinical pharmacology; neuromuscular relaxants; non-depolarizing relaxants ID CLINICAL-PHARMACOLOGY; TIME-COURSE; MIVACURIUM; HALOTHANE; INFANTS AB Background. The time-course of the effect of rocuronium during isoflurane anesthesia in children has rarely been evaluated. Forty-five children, aged 2-14 years, ASA 1, undergoing elective surgery and receiving isoflurane anesthesia, were studied. Methods. Patients randomly received a dose of 400, 600, or 800 mu g/kg of rocuronium. The first response to the control height (T1:T0) was fitted to time in order to obtain times to onset of action (TOA) including time to 90 (B-90) and 99.9% (B-100) of relaxation and to spontaneous recovery of 10 (T-10), 25 (T-25), 50 (T-50), 75 (T-75), and 90% (T-90) of neuromuscular function (NMF). Each time was compared among groups. Linear regression analysis between the TOA or the times to spontaneous recovery of NMF (TSRNMF) and age or weight were also performed. Results. The TOA were similar among the three groups while TSRNF in children receiving 600 or 800 mu g/kg were longer (p <0.05) than children receiving 400 mu g/kg. The T-10 and T-25 were related to age (p = 0.05), whereas T-10, T-50, T-75, and T-90 were related to weight (p <0.01). These relationships were stronger in males than females. Conclusions. Maximal relaxation was reached in all children receiving 600 or 800 mu g/kg of rocuronium. The TSRNMF were mainly related to the weight of the children, and gender affected each relationship. Widely variable responses were observed with all three doses. (C) 1999 IMSS. Published by Elsevier Science Inc. C1 Inst Mexicano Seguro Social, Ctr Med Nacl Siglo 21, Hosp Especialidades, Unidad Invest Med Farmacol, Mexico City 03020, DF, Mexico. Hosp Nino, Saltillo, Coahuila, Mexico. Hosp Infantil Mexico Federico Gomez, Dept Anestesia Terapia Resp & Clin Dolor, Mexico City, DF, Mexico. RP Nava-Ocampo, AA (reprint author), Inst Mexicano Seguro Social, Ctr Med Nacl Siglo 21, Hosp Especialidades, Unidad Invest Med Farmacol, Apdo Postal 73-032, Mexico City 03020, DF, Mexico. RI Nava-Ocampo, Alejandro/K-3850-2012 NR 17 TC 4 Z9 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0188-0128 J9 ARCH MED RES JI Arch. Med. Res. PD JUL-AUG PY 1999 VL 30 IS 4 BP 307 EP 314 DI 10.1016/S0188-0128(99)00029-9 PG 8 WC Medicine, Research & Experimental SC Research & Experimental Medicine GA 245NF UT WOS:000083114500008 ER PT J AU Koh, KF Chen, FG Fatt, K Esuvaranathan, V AF Koh, KF Chen, FG Fatt, K Esuvaranathan, V TI Laryngeal mask insertion using thiopental and low dose atracurium: a comparison with propofol SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID TRACHEAL INTUBATION; PRIMING PRINCIPLE; AIRWAY; ANESTHESIA; INDUCTION; VECURONIUM; LIGNOCAINE; RESPONSES; COINDUCTION; LIDOCAINE AB Purpose: To compare the laryngeal mask airway (LMA) insertion conditions produced by propofol and a thiopental - low dose atracurium combination. Methods: In a randomized controlled double blind study, 120 premedicated patients were allocated into four groups. After pre-oxygenation, anesthesia was induced as follows: 1 mu g.kg(-1) fentanyl, 2.5 mg.kg(-1) propofol (group I); 1 mu g.kg(-1) fentanyl, 5 mg.kg(-1) thiopental (group II); 1 mu g.kg(-1) fentanyl, 5 mg.kg(-1) thiopental, 0.05 mg.kg(-1) or 0.1 mg.kg(-1) atracurium (groups III and IV respectively). The LMA was inserted by a blinded anesthesiologist who also assessed the following insertion conditions on a three point scale; jaw relaxation, biting, gagging, coughing, presence of laryngospasm, adequacy of airway patency, number of attempts at insertion and overall insertion conditions. Results: There was no difference in insertion conditions between groups I, III and IV: Group II produced the wont overall conditions (P < 0.05). There were no differences in hemodynamic changes and apnea times between all four groups. Conclusion: The combination of fentanyl-thiopental with low dose atracurium (0.05 or 0.1 mg.kg(-1)) provided conditions comparable with those of propofol for LMA insertion. C1 Natl Univ Singapore Hosp, Dept Anaesthesia, Singapore 119074, Singapore. RP Koh, KF (reprint author), Natl Univ Singapore Hosp, Dept Anaesthesia, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore. NR 28 TC 4 Z9 5 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUL PY 1999 VL 46 IS 7 BP 670 EP 674 PG 5 WC Anesthesiology SC Anesthesiology GA 215DP UT WOS:000081366900009 ER PT J AU Dahaba, AA von Klobucar, F Rehak, PH List, WF AF Dahaba, AA von Klobucar, F Rehak, PH List, WF TI Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID PHARMACODYNAMICS; SURGERY AB Purpose: To compare recovery parameters of total intravenous anesthesia (TIVA) with remifentanil and propofol, hemodynamic responses to perioperative events, and pharmacodynamic parameters of cisatracurium in 22 end-stage renal failure and 22 normal renal function patients. Methods: Anesthesia was induced with 2-3 mg.kg(-1) propofol and 1 mu g.kg(-1) remifentanil and maintained with 75 mu g.kg(-1).min(-1) propofol and propofol initial infusion of 0.2 mu g.kg(-1).min(-1) propofol. Arterial pressure and heart rate were maintained by remifentanil infusion rate adjustments. The first twitch (TI) was maintained at 25% by an infusion-of cisatracurium. Results: There was no difference in the time to maintenance of adequate respiration, date of birth recollection, first analgesic administration, between the renal failure (4.8 +/- 2.5, 7.8 +/- 3.2, 12.3 +/- 5.3 min respectively) and the control group (5.2 +/- 2.8, 8.1 +/- 3.1, 12.7 +/- 5.5 min): nor were there any differences in the time to 25% TI recovery, TI recovery from 25% to 75%, or cisatracurium infusion rate between the renal failure group (32.1 +/- 10.8 min, 18.2 +/- 5.5 min; 0.89 +/- 0.29 mu g.kg(-1).min(-1) respectively) and the control group (35.9 (7.9 min, 18.4 +/- 3.8 min, 0.95 +/- 0.22 mu g.kg(-1).min(-1)). Conclusion: End-stage renal failure does not prolong recovery from TIVA with remifentanil and propofol, or the recovery from cisatracurium neuromuscular block. C1 Karl Franzens Univ Graz, Dept Anesthesiol & Intens Care Med, Graz, Austria. Karl Franzens Univ Graz, Dept Surg, Biomed Engn & Comp Unit, Graz, Austria. RP Dahaba, AA (reprint author), Graz Univ, LKH, Klin Anasthesiol & Intens Med, Auenbruggerplatz 29, A-8036 Graz, Austria. RI Rehak, Peter/E-8042-2010 NR 10 TC 14 Z9 15 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUL PY 1999 VL 46 IS 7 BP 696 EP 700 PG 5 WC Anesthesiology SC Anesthesiology GA 215DP UT WOS:000081366900015 ER PT J AU Albaladejo, P Kinirons, B Brocas, E Benhamou, D Samii, K AF Albaladejo, P Kinirons, B Brocas, E Benhamou, D Samii, K TI Recurarization in the recovery room SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE neuromuscular relaxants, recurarization; recurrent paralysis, respiratory failure; general aesthesia, complications ID POSTANESTHESIA CARE UNIT; PARALYSIS AB A case of recurarization in the recovery room is reported. Accumulation of atracurium in the intravenous line led to recurarization after flushing the line in the recovery room. A respiratory arrest with severe desaturation and bradycardia occurred. Circumstances leading to this event and the mechanisms enabling a neuromuscular blockade to occur, following the administration of a small dose of relaxant, are discussed. C1 Hop Bicetre, Dept Anesthesiol, Le Kremlin Bicetre, France. RP Albaladejo, P (reprint author), Hop Bicetre, Dept Anesthesie Reanimat Chirurg, 78 Av Gen Leclerc, F-94275 Le Kremlin Bicetre, France. NR 10 TC 2 Z9 2 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1999 VL 16 IS 7 BP 493 EP 494 DI 10.1046/j.1365-2346.1999.00517.x PG 2 WC Anesthesiology SC Anesthesiology GA 265EP UT WOS:000084229000010 ER PT J AU Sakles, JC Laurin, EG Rantapaa, AA Panacek, EA AF Sakles, JC Laurin, EG Rantapaa, AA Panacek, EA TI Rocuronium for rapid sequence intubation of emergency department patients SO JOURNAL OF EMERGENCY MEDICINE LA English DT Article DE rocuronium; neuromuscular blocking agent; succinylcholine; rapid sequence intubation; emergency department intubations ID HYPERKALEMIC CARDIAC-ARREST; AIRWAY MANAGEMENT; ADDUCTOR POLLICIS; SUCCINYLCHOLINE; VECURONIUM; INDUCTION; CHILDREN; SUXAMETHONIUM; ANESTHESIA; PROPOFOL AB Rocuronium is a recently synthesized nondepolarizing neuromuscular blocking agent (NMBA) that has been demonstrated to have a faster onset of action than any other non-depolarizing NMBA, Although widely studied in the operating room, there are no reports regarding its use for emergent tracheal intubation in the emergency department (ED). The purpose of this study was to evaluate the use of rocuronium for rapid sequence intubation (RSI) in ED patients, An intubation data collection form was completed prospectively for any patient receiving rocuronium for RSI in the ED from July 1-December 31, 1997. Two hundred eighty-eight patients were intubated in the ED over this six-month period, of whom 261 (91%) underwent RSI, Fifty-eight of the patients undergoing RSI received rocuronium for paralysis (22%), The most common reason reported for use of rocuronium was a concern regarding hyperkalemia (53%). The mean dose used was 1.0 +/- 0.2 mg/kg. The mean onset to paralysis was 45 +/- 15 s, Of the complications reported, none appeared to be related to rocuronium. Use of rocuronium in the ED setting appears useful. (C) 1999 Elsevier Science Inc. C1 Univ Calif Davis, Davis Med Ctr, Div Emergency Med, PSSB, Sacramento, CA 95817 USA. Univ Calif Davis, Davis Sch Med, Davis, CA 95616 USA. RP Sakles, JC (reprint author), Univ Calif Davis, Davis Med Ctr, Div Emergency Med, PSSB, Suite 2100,2315 Stockton Blvd, Sacramento, CA 95817 USA. NR 39 TC 8 Z9 9 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0736-4679 J9 J EMERG MED JI J. Emerg. Med. PD JUL-AUG PY 1999 VL 17 IS 4 BP 611 EP 616 DI 10.1016/S0736-4679(99)00046-3 PG 6 WC Emergency Medicine SC Emergency Medicine GA 229HX UT WOS:000082189300003 ER PT J AU Hepaguslar, H Ozzeybek, D Elar, Z AF Hepaguslar, H Ozzeybek, D Elar, Z TI The effect of cerebral palsy on the action of vecuronium with or without anticonvulsants SO ANAESTHESIA LA English DT Article DE brain, cerebral palsy; pharmacology, anticonvulsants, vecuronium ID INDUCED NEUROMUSCULAR BLOCKADE; PATIENTS RECEIVING PHENYTOIN; ACETYLCHOLINE-RECEPTORS; INDUCED RESISTANCE; SKELETAL-MUSCLE; ATRACURIUM; ALCURONIUM; METOCURINE AB Patients with cerebral palsy who are treated with anticonvulsant medication are resistant to vecuronium. We examined the contributions to vecuronium resistance made by cerebral palsy and anticonvulsants in a study of children with cerebral palsy and a control group. The acceleromyographic responses of the following three groups of children were studied: children with cerebral palsy not taking anticonvulsant medication (n = 11); children with cerebral palsy taking anticonvulsant medication (n = 8); and a control group of children who did not have cerebral palsy and were not taking anticonvulsant treatment (n = 10). Using a standardised technique, general anaesthesia was induced and maintained with 0.5-1.5% isoflurane in a 60/40 nitrous oxide in oxygen mixture. After a stabilisation period which was performed with supramaximal train-of-four stimuli (2 Hz every 15 s) an intubating dose of vecuronium 0.1 mg.kg(-1) was administered. The first twitch of the train-of-four response (T-1), the onset time, the times to 25, 50, 75 and 90% recovery of T-1, recovery index, and the time to 70% recovery of train-of-four ratio were recorded. Recovery times to T-1 and train-of-four responses were reduced significantly in both groups of children with cerebral palsy compared with the control group. These results suggest that children with cerebral palsy display resistance to vecuronium whether or not they are taking anticonvulsant drugs. C1 Ege Univ Hosp, Dept Anaesthesiol, Izmir, Turkey. RP Hepaguslar, H (reprint author), Dokuz Eylul Univ Hosp, Dept Anaesthesiol, Izmir, Turkey. NR 20 TC 3 Z9 5 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUN PY 1999 VL 54 IS 6 BP 593 EP 596 DI 10.1046/j.1365-2044.1999.00799.x PG 4 WC Anesthesiology SC Anesthesiology GA 214FF UT WOS:000081317400015 ER PT J AU Spacek, A Nickl, S Neiger, FX Nigrovic, V Ullrich, OW Weindlmayr-Goettel, M Schwall, B Taeger, K Kress, HG AF Spacek, A Nickl, S Neiger, FX Nigrovic, V Ullrich, OW Weindlmayr-Goettel, M Schwall, B Taeger, K Kress, HG TI Augmentation of the rocuronium-induced neuromuscular block by the acutely administered phenytoin SO ANESTHESIOLOGY LA English DT Article DE acute administration; anticonvulsant; drug interaction; muscle relaxant ID CHRONIC ANTICONVULSANT THERAPY; ACCELERATED RECOVERY; CARBAMAZEPINE; RESISTANCE; VECURONIUM; ATRACURIUM; MECHANISM; JUNCTION; PATIENT; SODIUM AB Background: The effects of an acute administration of phenytoin on the magnitude of the rocuronium-induced neuromuscular block were evaluated. Methods: Twenty patients (classified as American Society of Anesthesiologists physical status I or II) scheduled for craniotomy mere studied: 15 received phenytoin during operation (10 mg/kg), and the others served as controls. Anesthesia was induced with thiopental and fentanyl and maintained with nitrous oxide (65%) in oxygen and end-tidal isoflurane (1%). The ulnar nerve was stimulated supramaximally and the evoked electromyography was recorded using a neuromuscular transmission monitor. Continuous Infusion of rocuronium maintained the neuromuscular block with first twitch (T-1) between 10 and 15% for 45 min before the start of an infusion of either phenytoin or NaCl, 0.9%. Twitch recordings continued for 60 min thereafter. Arterial blood samples were collected at the predefined time points (four measurements before and four after the start of the infusion) to determine the concentrations of phenytoin and rocuronium and the percentage of rocuronium bound to plasma proteins. Results: The first twitch produced by an infusion of rocuronium remained constant during the 15 min before and the 60 min after the start of the saline infusion. After the phenytoin infusion, the twitch decreased progressively, but the plasma concentrations and the protein-bound fraction of rocuronium did not change. Conclusion: Phenytoin acutely augments the neuromuscular block produced by rocuronium without altering its plasma concentration or its binding to plasma proteins. C1 Univ Vienna, Dept Anesthesia & Gen Intens Care B, A-1090 Vienna, Austria. Univ Regensburg, D-8400 Regensburg, Germany. Med Coll Ohio, Toledo, OH 43699 USA. RP Spacek, A (reprint author), Univ Vienna, Dept Anesthesia & Gen Intens Care B, Waehringer Guertel 18-20, A-1090 Vienna, Austria. NR 30 TC 11 Z9 13 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUN PY 1999 VL 90 IS 6 BP 1551 EP 1555 DI 10.1097/00000542-199906000-00009 PG 5 WC Anesthesiology SC Anesthesiology GA 200RG UT WOS:000080553400009 ER PT J AU Mason, DG Ross, JJ Edwards, ND Linkens, DA Reilly, CS AF Mason, DG Ross, JJ Edwards, ND Linkens, DA Reilly, CS TI Self-learning fuzzy control with temporal knowledge for atracurium-induced neuromuscular block during surgery SO COMPUTERS AND BIOMEDICAL RESEARCH LA English DT Article DE computer control; fuzzy control; neuromuscular block; atracurium infusion ID INDUCED MUSCLE-RELAXATION; FEEDBACK-CONTROL; LOGIC CONTROL; INFUSION; ANESTHESIA; RELAXANTS; SYSTEM; MODEL AB Self-learning fuzzy logic control has the important property of accommodating uncertain, nonlinear, and time-varying process characteristics. This intelligent control scheme starts with no fuzzy control rules and learns how to control each process presented to it in real time without the need for detailed process modeling. In this study we utilize temporal knowledge of generated rules to improve control performance. A suitable medical application to investigate this control strategy is atracurium-induced neuromuscular block of patients in the operating theater where the patient response exhibits high nonlinearity and individual patient dose requirements may vary fivefold during an operating procedure. We developed a computer control system utilizing Relaxograph (Datex) measurements to assess the clinical performance of a self-learning fuzzy controller in this application. Using a T1 setpoint of 10% of baseline in 10 patients undergoing general surgery we found a mean T1 error of 0.28% (SD = 0.39%) while accommodating a 0.25 to 0.38 mg/kg/h range in the mean atracurium infusion rate. This result compares favorably with more complex and computationally intensive model-based control strategies for atracurium infusion. (C) 1999 Academic Press. C1 Univ Sheffield, Dept Automat Control & Syst Engn, Sheffield S1 3JD, S Yorkshire, England. Univ Sheffield, No Gen Hosp, Dept Surg & Anaesthet Sci, Sheffield S5 7AU, S Yorkshire, England. RP Mason, DG (reprint author), Univ Sheffield, Dept Automat Control & Syst Engn, Sheffield S1 3JD, S Yorkshire, England. NR 21 TC 12 Z9 12 PU ACADEMIC PRESS INC PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0010-4809 J9 COMPUT BIOMED RES JI Comput. Biomed. Res. PD JUN PY 1999 VL 32 IS 3 BP 187 EP 197 DI 10.1006/cbmr.1999.1507 PG 11 WC Computer Science, Interdisciplinary Applications; Medical Informatics SC Computer Science; Medical Informatics GA 209JJ UT WOS:000081044200001 ER PT J AU Mey, JC De Baerdemaeker, L De Laat, M Rolly, G AF Mey, JC De Baerdemaeker, L De Laat, M Rolly, G TI The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE non-depolarizing neuromuscular relaxants, rocuronium; monitoring, neuromuscular function; measurement techniques, acceleromyography ID ADDUCTOR POLLICIS MUSCLES; SUCCINYLCHOLINE; CHILDREN AB After an intubating dose of rocuronium satisfactory intubating conditions are achieved before the onset time at the adductor pollicis. We examined the possibility that measurement of the relaxation of the masseter muscle is a more appropriate guide when determining the intubating time. Simultaneous accelerometry with a 0.1-Hz single twitch stimulation of the chin and thumb was performed in 20 patients after 0.6 mg kg(-1) rocuronium. We observed a significantly more brief mean lag time and onset time at the masseter muscle (22.5 and 61 vs. 32.5 and 160 s). The corresponding mean relaxation at the onset time was also significantly more pronounced at the masseter muscle (99.6 vs. 97.6%). A mean onset time at the masseter muscle of 61 s as produced by rocuronium corresponds clinically with excellent or good intubating conditions. From these results, we suggest that measurement of the onset time of muscle relaxation at the masseter muscle appears to be a better predictor of good intubating conditions than measurements made using the adductor pollicis muscle after administration of rocuronium. C1 State Univ Ghent Hosp, Dept Anaesthesia, B-9000 Ghent, Belgium. RP Mey, JC (reprint author), State Univ Ghent Hosp, Dept Anaesthesia, De Pintelaan 185, B-9000 Ghent, Belgium. NR 9 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUN PY 1999 VL 16 IS 6 BP 387 EP 389 DI 10.1046/j.1365-2346.1999.00503.x PG 3 WC Anesthesiology SC Anesthesiology GA 265EC UT WOS:000084227500007 ER PT J AU Tretyakova, SP Bonetti, R Golovchenko, AN Guglielmetti, A Hussonnois, M Ilic, R Kobzev, A Mikheev, VL Ogloblin, A Poli, C Ponomarenko, V Timofeeva, O Shigin, V Skvarc, J AF Tretyakova, SP Bonetti, R Golovchenko, AN Guglielmetti, A Hussonnois, M Ilic, R Kobzev, A Mikheev, VL Ogloblin, A Poli, C Ponomarenko, V Timofeeva, O Shigin, V Skvarc, J TI Use of phosphate glass detectors for study of curium-242 cluster radioactivity SO RADIATION MEASUREMENTS LA English DT Article; Proceedings Paper CT 19th International Conference on Nuclear Tracks in Solids (ICNTSs) CY AUG 31-SEP 05, 1998 CL BESANCON, FRANCE DE phosphate glass detectors; high alpha particle fluences; cluster radioactivity; fission fragments AB The effect of high alpha particle fluences (3 x 10(13) -2 x 10(15) cm(-2)) on properties of the two types of phosphate glass detectors with different compositions was studied. It was shown that the registration properties of glass detectors depended on the alpha particle fluence, spatial distribution of the alpha particle paths, and glass type. The critical alpha particle fluences, above which the detector properties changed, were determined. C1 Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia. Univ Milan, Inst Fis Gen Applicata, I-20133 Milan, Italy. Russian Res Ctr, Kurchatov Inst, Moscow 1123182, Russia. Inst Phys Nucl, F-91406 Orsay, France. Univ Ljubljana, Jozef Stefan Inst, Ljubljana 1000, Slovenia. Univ Maribor, Fac Civil Engn, SLO-2000 Maribor, Slovenia. RP Tretyakova, SP (reprint author), Joint Inst Nucl Res, Dubna 141980, Moscow Region, Russia. NR 6 TC 0 Z9 0 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 1350-4487 J9 RADIAT MEAS JI Radiat. Meas. PD JUN PY 1999 VL 31 IS 1-6 SI SI BP 197 EP 202 DI 10.1016/S1350-4487(99)00086-4 PG 6 WC Nuclear Science & Technology SC Nuclear Science & Technology GA 226AG UT WOS:000081997700035 ER PT J AU McCourt, KC Mirakhur, RK Lowry, DW Carroll, MT Sparr, HJ AF McCourt, KC Mirakhur, RK Lowry, DW Carroll, MT Sparr, HJ TI Spontaneous or neostigmine-induced recovery after maintenance of neuromuscular block with Org 9487 (rapacuronium) or rocuronium following an initial dose of Org 9487 SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE neuromuscular block, Org 9487; neuromuscular block, rocuronium; pharmacodynamics; antagonists neuromuscular block, neostigmine ID MUSCLE-RELAXANT; ORG-9487; PHARMACOKINETICS AB We have examined spontaneous and neostigmine-induced recovery after an initial dose of Org 9487 1.5 mg kg(-1) followed by three repeat doses of Org 9487, a 30-min infusion of Org 9487 or two incremental doses of rocuronium. Mean clinical duration after incremental doses of Org 9487 0.5 mg kg(-1) increased from 12.3 (SD 3.4) min to 14.0 (4.0) and 15.9 (5.9) min (P<0.01), and after rocuronium from 14.4 (5.2) min to 19.2 (5.9) min (P<0.01). Times for spontaneous recovery from a TI of 25% to a TOF ratio of 0.8 after the last bolus dose of Org 9487 and after a 30-min infusion were 72.4 (16.5) and 66.1 (26.9) min compared with 36.7 (15.8) min in the group receiving rocuronium. These times were significantly reduced to 9.9 (4.5), 8.6 (6.1) and 5.7 (2.5) min, respectively, after neostigmine administration at a TI of 25% (P<0.05). We conclude that administration of Org 9487 by repeat bolus doses or infusion was associated with slow spontaneous recovery but neostigmine administration resulted in adequate recovery in less than 10 min. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. Leopold Franzens Univ, Dept Anaesthesia, Innsbruck, Austria. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 7 TC 11 Z9 11 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAY PY 1999 VL 82 IS 5 BP 755 EP 756 PG 2 WC Anesthesiology SC Anesthesiology GA 198YJ UT WOS:000080451900019 ER PT J AU Chiu, CL Jaais, F Wang, CY AF Chiu, CL Jaais, F Wang, CY TI Effect of rocuronium compared with succinylcholine on intraocular pressure during rapid sequence induction of anaesthesia SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE eye, intraocular pressure; neuromuscular block, succinylcholine; neuromuscular block, rocuronium ID INTUBATING CONDITIONS; SUXAMETHONIUM; PRETREATMENT; THIOPENTONE; VECURONIUM; ONSET AB We have compared the effect of rocuronium and succinylcholine on intraocular pressure (IOP) during rapid sequence induction of anaesthesia using propofol and fentanyl, in a randomized, double-blind study. We studied 30 adult patients, allocated to one of two groups. Anaesthesia was induced with fentanyl 2 mu g kg(-1) and propofol until loss of verbal response. This was followed by succinylcholine 1.5 mg kg(-1) (group S; n=15) or rocuronium 0.9 mg kg(-1) (group R; n=15). Laryngoscopy was performed 60 s later. IOP, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, immediately before intubation and every minute after intubation for 5 min. A Keeler Pulsair air impulse tonometer was used to measure IOP and the mean of two readings obtained in the right eye at each measurement time was recorded. Intubating conditions were evaluated according to a simple scoring system. IOP in the succinylcholine group was significantly greater than that in the rocuronium group (mean 21.6 (SEM 1.4) mm Hg vs 13.3 (1.4) mm Hg; P<0.001). Intubating conditions were equally good in both groups. We conclude that with rapid sequence induction of anaesthesia using propofol and fentanyl, rocuronium did not cause as great an increase in IOP as succinylcholine and may be an alternative in open eye injury cases. C1 Univ Malaya, Dept Anaesthesia, Kuala Lumpur 59100, Malaysia. Univ Malaya, Dept Ophthalmol, Kuala Lumpur 59100, Malaysia. RP Wang, CY (reprint author), Univ Malaya, Dept Anaesthesia, Kuala Lumpur 59100, Malaysia. NR 11 TC 20 Z9 23 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD MAY PY 1999 VL 82 IS 5 BP 757 EP 760 PG 4 WC Anesthesiology SC Anesthesiology GA 198YJ UT WOS:000080451900020 ER PT J AU Ahmed, AAK Kumagai, M Otake, T Kurata, Y Amaki, Y AF Ahmed, AAK Kumagai, M Otake, T Kurata, Y Amaki, Y TI Sevoflurane exposure time and the neuromuscular blocking effect of vecuronium SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID HALOTHANE ANESTHESIA; CONTINUOUS-INFUSION; ISOFLURANE; ENFLURANE; POTENTIATION; MIVACURIUM; BLOCKADE; AGENTS AB Purpose: To determine the effect of sevoflurane exposure time on the duration of vecuronium neuromuscular blockade. Methods: In 40 adult patients anesthesia was induced with 1.5-2 mg.kg(-1) propofol and 3-5 mu g.kg(-1) fentanyl and the trachea was intubated without the aid of muscle relaxant. Patients were randomized into four groups of 10. In group 1, 0.05 mg.kg(-1) vecuronium was administered with N2O and anesthesia was maintained by propofol infusion and fentanyl. Vecuronium was administered with sevoflurane 2% in 30 patients, commencing at the same time (group 2) and at 30, and 60 min after sevoflurane (groups 3, 4). Adductor pollicis force of contraction to train-of-four ulnar nerve stimulation was recorded. Times from vecuronium injection to 95%, maximal block, and recovery times to 25% recovery were recorded. Results: There were no differences in times to 95% and maximal block in the four groups. Recovery times were longer in groups 3 and 4 than in groups 2 and 1 (P < 0.01). Times to 5% recovery were 15.0 +/- 3.7, 17.8 +/- 4.8, 28.2 +/- 9.9, and 29.5 +/- 9.5, and to 25% recovery were 22.3 +/- 5.2, 27.2 +/- 6.4, 42.3 +/- 16.3, and 50.5 +/- 16.4 in groups 1, 2, 3, and 4 respectively. No differences were found between group 1 and group 2 nor between group 3 and group 4. Conclusion: Sevoflurane produced time-dependent potentiation of vecuronium. After 30 min exposure, 25% recovery was prolonged by 89% and after 60 min by more than 100% compared with the control group. C1 Ain Shams Univ, Dept Anesthesia, Cairo, Egypt. Jikei Univ, Sch Med, Dept Anesthesia, Minato Ku, Tokyo, Japan. RP Ahmed, AAK (reprint author), Ain Shams Univ, Dept Anesthesia, Cairo, Egypt. NR 17 TC 11 Z9 13 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAY PY 1999 VL 46 IS 5 BP 429 EP 432 PN 1 PG 4 WC Anesthesiology SC Anesthesiology GA 195CB UT WOS:000080230600005 ER PT J AU Puura, A Baer, GA Rorarius, MGF AF Puura, A Baer, GA Rorarius, MGF TI Neuromuscular blocking characteristics of vecuronium after turbocurarine-induced ''fade" - An experimental double-blind clinical study SO EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY LA English DT Article DE neuromuscular relaxants; vecuronium; tubocurarine ID D-TUBOCURARINE; PRIMING PRINCIPLE; ONSET; PANCURONIUM; COMBINATION; BLOCKADE AB Objective: The fade in train-of-four (TOF) monitoring is considered to be due to blocking of the prejunctional nicotinic acetylcholine receptors (AchRs). During onset of the neuromuscular block (NMB) tubocurarine (TC) causes more fade in the TOF responses than vecuronium (VEC). Therefore we wanted to investigate whether onset or duration of action of VEC or TC would be improved with a priming dose of an agent with different prejunctional activity. Methods: The rates of NMB were measured following priming doses of 0.15 mg . kg(-1) of TC and 0.015 mg . kg(-1) of VEC with 6 min priming time. The individual time course of action of 0.6 mg . kg(-1) of TC (1.13 x ED 95) and 0.1-0.2 mg . kg(-1) of VEC (1.75-3.5 x ED95) were examined with a priming dose of the same agent or the other agent, by measurement of changes in the evoked compound EMG from the hypothenar muscle. Results: Priming doses of TC decreased mean TOF ratio to 67% [95% confidence interval (CI) = 56-78] during priming time, which was significantly lower than after priming with VEC 87% (76-97; P < 0.001). Despite the higher TOF ratio, the priming dose of VEC accelerated the onset time of intubation dose of TC more than the priming dose of TC (P = 0.0018). Priming with TC prolonged the duration of VEC-induced NMB by 35-70 min compared with priming with VEC, which means that a small priming dose of TC changes VEC from a muscle relaxant with intermediate action to a long-acting agent. Conclusion: Priming with TC caused a lower TOF ratio; however, priming with TC did not accelerate the onset time of either agent as much as priming with VEC. It appears that potentiation of NMB after combination of VEC and TC is not dependent on "fade" receptors. C1 Tampere Univ, Sch Med, Municipal Hosp Valkeakoski, FIN-33101 Tampere, Finland. Tampere Univ Hosp, Dept Anaesthesiol, Sch Med, FIN-33521 Tampere, Finland. RP Puura, A (reprint author), Katajatie 19 B, FIN-36200 Kangasala, Finland. NR 12 TC 0 Z9 1 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0031-6970 J9 EUR J CLIN PHARMACOL JI Eur. J. Clin. Pharmacol. PD MAY PY 1999 VL 55 IS 3 BP 173 EP 176 DI 10.1007/s002280050614 PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 200HT UT WOS:000080534100002 ER PT J AU Lighthall, GK Jamieson, MA Katolik, J Brock-Utne, JG AF Lighthall, GK Jamieson, MA Katolik, J Brock-Utne, JG TI A comparison of the onset and clinical duration of high doses of cisatracurium and rocuronium SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE acetylcholine receptor; anesthesia; cisatracurium; neuromuscular blockade; paralysis; rocuronium ID TRAIN-OF-4 MEASUREMENT; ADULT PATIENTS; VECURONIUM; ANESTHESIA; SUCCINYLCHOLINE; PANCURONIUM; RECOVERY; 51W89 AB Study Objective: To determine the onset and clinical duration of cisatracurium and rocuronium in equipotent doses in balanced opioid/isoflurane anesthesia Design: Randomized, controlled study. Setting: University hospital. Patients: 40 healthy patients scheduled for elective surgery. Interventions: Patients underwent anesthesia induction with thiopental or propofol with a cisatracurium intubating dose of either 0.15 or 0.2 mg/kg or a rocuronium dose of either 0.9 or 1.2 mg/kg. These doses correspond to three and four times the ED95 dose. Measurements and Main Results: The onset time and time to 25% recovery of baseline first twitch in a train-of-four were determined using an accelerometric sensor. Rocuronium had a faster onset time that cisatracurium at equipotent doses (3 X ED95: 134 vs. 220 sec respectively, and at 4 X ED95: 95 vs. 162 sec). Recovery tended to be faster, but not statistically different for cisatracurium compared to rocuronium. Conclusions: With equipotent intubating doses of rocuronium and cisatracurium, rocuronium produces a more rapid onset of muscle relaxation. The data suggest a tendency toward more rapid clinical recovery of cisatracurium compared to equipotent doses of rocuronium, although these differences were not statistically significant. (C) 1999 by Elsevier Science Inc. C1 Stanford Univ, Sch Med, Dept Anesthesia, Stanford, CA 94305 USA. RP Brock-Utne, JG (reprint author), Stanford Univ, Sch Med, Dept Anesthesia, Stanford, CA 94305 USA. NR 16 TC 7 Z9 12 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAY PY 1999 VL 11 IS 3 BP 220 EP 225 DI 10.1016/S0952-8180(99)00030-6 PG 6 WC Anesthesiology SC Anesthesiology GA 217RL UT WOS:000081512700008 ER PT J AU Shevchenko, Y Jocson, JC McRae, VA Stayer, SA Schwartz, RE Rehman, M Choudhry, DK AF Shevchenko, Y Jocson, JC McRae, VA Stayer, SA Schwartz, RE Rehman, M Choudhry, DK TI The use of lidocaine for preventing the withdrawal associated with the injection of rocuronium in children and adolescents SO ANESTHESIA AND ANALGESIA LA English DT Article ID BROMIDE; PAIN AB We designed this study to examine the incidence and degree of movement after the administration of rocuronium in children and adolescents and to measure the treatment effect of lidocaine for its prevention. One hundred patients (aged 5-18 yr) were randomly assigned to two groups. After general anesthesia was induced with 5 mg/kg thiopental sodium and manual occlusion of venous outflow was performed, one group of patients received 0.1 mL/kg 1% Lidocaine TV. A second group received 0.1 mL/kg of isotonic sodium chloride solution as a placebo control. Venous outflow occlusion was held for 15 s, released, and immediately followed by the administration of rocuronium 1 mg/kg IV. The patient's response to rocuronium injection was graded using a 4-point scale. We observed that the incidence of withdrawal was 84% in the placebo group and was significantly decreased to 46% in patients pretreated with lidocaine (P < 0.001). This study demonstrates that the TV injection of rocuronium is commonly associated with a withdrawal reaction in anesthetized pediatric patients and that this reaction can be attenuated or eliminated by pretreatment with IV lidocaine. Implications: Pain on injection of rocuronium in pediatric patients can be alleviated by pretreatment with IV lidocaine. C1 St Christophers Hosp Children, Dept Anesthesia & Crit Care, Philadelphia, PA 19134 USA. Allegheny Univ Hlth Sci, Dept Anesthesia, Philadelphia, PA 19102 USA. Allegheny Univ Hlth Sci, Dept Pediat, Philadelphia, PA 19102 USA. RP Shevchenko, Y (reprint author), St Christophers Hosp Children, Dept Anesthesia & Crit Care, Philadelphia, PA 19134 USA. NR 5 TC 31 Z9 31 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1999 VL 88 IS 4 BP 746 EP 748 DI 10.1097/00000539-199904000-00011 PG 3 WC Anesthesiology SC Anesthesiology GA 183TU UT WOS:000079570200009 ER PT J AU Dhonneur, G Kirov, K Slavov, V Duvaldestin, P AF Dhonneur, G Kirov, K Slavov, V Duvaldestin, P TI Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm - An electromyographic study in humans SO ANESTHESIOLOGY LA English DT Article DE neuromuscular relaxants; respiratory muscles; tracheal intubation ID ADDUCTOR POLLICIS MUSCLE; VECURONIUM NEUROMUSCULAR BLOCKADE; ANESTHESIA; ATRACURIUM; POTENCY; RESPONSES; TWITCH; ONSET AB Background: Paralysis of the vocal cords is one objective of using relaxants to facilitate tracheal intubation, This study compares the neuromuscular blocking effect of succinylcholine and rocuronium on the larynx, the diaphragm, and the adductor pollicis muscle. Methods: Electromyographic response was used to compare the neuromuscular blocking effect of succinylcholine and rocuronium on the laryngeal adductor muscles, the diaphragm, and the adductor pollicis muscle. Sixteen patients undergoing elective surgery were anesthetized with propofol and fentanyl, and their tracheas were intubated without neuromuscular blocking agents, The recurrent laryngeal and phrenic nerves were stimulated at the neck. The electromyographic response was recorded from electrodes placed on the endotracheal tube and intercostally before and after administration of 1 mg/kg succinylcholine or 0.6 mg/kg rocuronium, Results: The maximum effect was greater at the adductor pollicis (100 and 99%) than at the larynx (96 and 97%) and the diaphragm (94 and 96%) after administration of succinylcholine and rocuronium, respectively (P less than or equal to 0.05), Onset time was not different between the larynx (58 +/- 10 s), the diaphragm (57 +/- 8 s), and the adductor pollicis (54 +/- 13 s), after succinylcholine (all mean +/- SD). After rocuronium, onset time was 124 +/- 39 s at the larynx, 130 +/- 44 s at the diaphragm, and 115 +/- 21 s at the adductor pollicis. After succinylcholine administration, time to 90% recovery was 8.3 +/- 3.2, 7.2 +/- 3.5, and 9.1 +/- 3.0 min at the larynx, the diaphragm, and the adductor pollicis, respectively. Time to 90% recovery after rocuronium administration was 34.9 +/- 7.6, 30.4 +/- 4.2, and 49.1 +/- 11.4 min at the larynx, the diaphragm, and the adductor pollicis, respectively, Conclusion: Neuromuscular blocking effect of muscle relaxants on the larynx can be measured noninvasively by electromyography. Although the larynx appears to be resistant to muscle relaxants, we could not demonstrate that its onset time differed from that of peripheral muscles. C1 Hop Henri Mondor, Dept Anesthesia, F-94010 Creteil, France. RP Duvaldestin, P (reprint author), Hop Henri Mondor, Dept Anesthesia, 51 Ave Marechal Lattre Tassigny, F-94010 Creteil, France. NR 25 TC 46 Z9 52 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 1999 VL 90 IS 4 BP 951 EP 955 DI 10.1097/00000542-199904000-00004 PG 5 WC Anesthesiology SC Anesthesiology GA 181TC UT WOS:000079457600003 ER PT J AU Fisher, DM Kahwaji, R Bevan, D Bikhazi, G Fragen, RJ Angst, MS Ornstein, E Matteo, RS AF Fisher, DM Kahwaji, R Bevan, D Bikhazi, G Fragen, RJ Angst, MS Ornstein, E Matteo, RS TI Factors affecting the pharmacokinetic characteristics of rapacuronium SO ANESTHESIOLOGY LA English DT Article DE modeling; muscle relaxants; ORG9487; population analysis ID PHARMACODYNAMICS; VECURONIUM; CLEARANCE; ORG-9487; PANCURONIUM; YOUNGER AB Background Rapacuronium is a new nondepolarizing muscle relaxant with rapid onset and offset. As part of a study to determine its neuromuscular effects, the authors sampled plasma sparsely to determine the influence of age, gender, and other covariates on its pharmacokinetic characteristics. Methods: Of 181 patients receiving a single bolus dose of 0.5-2.5 mg/kg rapacuronium, 43 (aged 24-83 yr) had plasma sampled 3 or 4 times to determine plasma concentrations of rapacuronium and its metabolite, ORG9488. Pharmacokinetic analysis was performed using a population approach (mixed-effects modeling) to determine the influence of demographic characteristics and preoperative laboratory values on the pharmacokinetic parameters. Results: Rapacuronium's weight-normalized plasma clearance was 7.03 . (1 - 0.0507 . (HgB - 13)) ml . kg(-1) . min(-1), where HgB is the patient's preoperative value for hemoglobin (g/100 mi); however, rapacuronium's blood clearance (11.4 +/- 1.4 mi . kg(-1) . min(-1), mean +/- SD) did not vary with hemoglobin. Rapacuronium's weight-normalized pharmacokinetic parameters were not influenced by age, gender, or other covariates examined Plasma concentrations of ORG9488 were typically less than 14% those of rapacuronium during the initial 30 min after rapacuronium administration. Conclusions: In this patient population, neither age nor gender influence elimination of rapacuronium. This finding contrasts to an age-related decrease in plasma clearance observed in a study of 10 healthy volunteers and in a pooled analysis of the pharmacokinetic data from 206 adults in multiple clinical studies. Even if ORG9488 has a potency similar to that of rapacuronium, its plasma concentrations after a single bolus dose of rapacuronium are sufficiently small to contribute minimally to neuromuscular blockade. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. Univ British Columbia, Vancouver, BC V5Z 1M9, Canada. Univ Miami, Coral Gables, FL 33124 USA. Northwestern Univ, Evanston, IL 60208 USA. Stanford Univ, Stanford, CA 94305 USA. Columbia Univ, New York, NY 10027 USA. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia, Room C-450, San Francisco, CA 94143 USA. NR 12 TC 13 Z9 13 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 1999 VL 90 IS 4 BP 993 EP 1000 DI 10.1097/00000542-199904000-00011 PG 8 WC Anesthesiology SC Anesthesiology GA 181TC UT WOS:000079457600010 ER PT J AU Sparr, HJ Mellinghoff, H Blobner, M Noldge-Schomburg, G AF Sparr, HJ Mellinghoff, H Blobner, M Noldge-Schomburg, G TI Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE anaesthetic techniques, induction; neuromuscular block, rapacuronium; neuromuscular block, succinylcholine; intubation tracheal ID NEUROMUSCULAR BLOCKING-AGENTS; MUSCLE-RELAXANT; ADDUCTOR POLLICIS; ORG-9487; ROCURONIUM; HUMANS AB We have assessed intubating conditions provided by rapacuronium (Org 9487) and succinylcholine after rapid sequence induction of anaesthesia in adult patients undergoing elective surgery. We studied 335 patients, ASA I and II, in five centres. Two hundred and thirty-four subjects with normal body weight and 101 obese subjects were allocated randomly to one of four treatment groups differing in the neuromuscular blocking drug administered (rapacuronium 1.5 mg kg(-1) or succinylcholine mg kg(-1)) and in the technique used for induction of anaesthesia (fentanyl 2-3 mu g kg(-1) with thiopental 3-6 mg kg(-1) or alfentanil 20 mu g kg(-1) with propofol 1.5-2 mg kg(-1)). Intubation was started at 50 s by an anaesthetist blinded to the drugs used. Intubating conditions were clinically acceptable (excellent or good) in 89.4% of patients after rapacuronium and in 97.4% after succinylcholine (P = 0.004), the estimated difference being 8.1% (95% confidence interval (CI) 2.0-14.1%). Neither anaesthetic technique nor subject group had an influence on intubating conditions. After intubation, the maximum increase in heart rate averaged 23.1 (SD 25.4)% and 9.4 (26.1)% after rapacuronium and succinylcholine, respectively (P < 0.001). Pulmonary side effects (bronchospasm and increased airway pressure) were observed in 10.7% (95% CI 5.8-17%) and 4.1% (95% CI 1.3-8.8%) of patients given rapacuronium and succinylcholine, respectively (P = 0.021). We conclude that after rapid sequence induction of anaesthesia in adults, clinically acceptable intubating conditions were achieved less frequently after rapacuronium 1.5 mg kg(-1) than after succinylcholine. C1 Univ Innsbruck, Dept Anaesthesia & Intens Care Med, A-6020 Innsbruck, Austria. Univ Cologne, Dept Anaesthesiol & Surg Intens Care Med, Cologne, Germany. Tech Univ Munich, Dept Anaesthesiol, D-8000 Munich, Germany. Univ Freiburg, Dept Anaesthesia, Freiburg, Germany. RP Sparr, HJ (reprint author), Univ Innsbruck, Dept Anaesthesia & Intens Care Med, Anichstr 35, A-6020 Innsbruck, Austria. NR 16 TC 50 Z9 51 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD APR PY 1999 VL 82 IS 4 BP 537 EP 541 PG 5 WC Anesthesiology SC Anesthesiology GA 189FC UT WOS:000079893000010 ER PT J AU Skinner, HJ Girling, KJ Whitehurst, A Nathanson, MH AF Skinner, HJ Girling, KJ Whitehurst, A Nathanson, MH TI Influence of metoclopramide on plasma cholinesterase and duration of action of mivacurium SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article; Proceedings Paper CT Anaesthetic-Research-Society Meeting CY JUL, 1998 CL DUNDEE, SCOTLAND SP Anaesthet Res Soc DE interactions (drug); neuromuscular block, mivacurium; pharmacology, metoclopramide; enzymes, cholinesterase ID NEUROMUSCULAR BLOCK; INHIBITION; ANESTHESIA; SEVOFLURANE; HUMANS AB Mivacurium is metabolized by plasma cholinesterase (PCHE). Metoclopramide inhibits PCHE in vitro and in vivo. We have assessed the effect of metoclopramide on duration of action of mivacurium and measured PCHE at baseline and at the time of maximal block. in a randomized, double-blind study, 30 patients received metoclopramide 0.15 mg kg(-1) i.v. or saline, followed by propofol anaesthesia and mivacurium 0.15 mg kg(-1). Using a TOF-Guard accelerometer, times to recovery of TI to 25%, 75% and 90% were 13.4, 19.3 and 21.9 min in the saline group and 17.8, 25.3 and 28.8 min in the metoclopramide group (P < 0.01, P < 0.05, P < 0.05, respectively). There were no differences in onset time or recovery index between the groups. PCHE activity at the time of maximum block decreased within each group (P < 0.01) but there was no difference between groups. In a second biochemical study of eight patients, a small decrease in PCHE activity was detected after metoclopramide 0.15 mg kg(-1), but before administration of mivacurium (P < 0.025). We conclude that metoclopramide prolongs the duration of action of mivacurium. C1 Univ Nottingham, Queens Med Ctr, Dept Anaesthesia, Nottingham NG7 2UH, England. Univ Nottingham, City Hosp Nottingham, Nottingham NG7 2UH, England. City Hosp Nottingham, Dept Clin Chem, Nottingham NG5 1PB, England. RP Skinner, HJ (reprint author), Univ Nottingham, Queens Med Ctr, Dept Anaesthesia, Nottingham NG7 2UH, England. NR 16 TC 11 Z9 11 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD APR PY 1999 VL 82 IS 4 BP 542 EP 545 PG 4 WC Anesthesiology SC Anesthesiology GA 189FC UT WOS:000079893000011 ER PT J AU Koenig, HM Hoffman, WE AF Koenig, HM Hoffman, WE TI The effect of anticonvulsant therapy on two doses of rocuronium-induced neuromuscular blockade SO JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY LA English DT Article DE neuromuscular blockade; rocuronium; anticonvulsants; phenytoin; carbamazepine ID INDUCED RESISTANCE; VECURONIUM; PHENYTOIN; CARBAMAZEPINE; ATRACURIUM AB Larger and more frequent doses of steroidal neuromuscular blocking agents are required to paralyze patients taking anticonvulsants (carbamazepine and phenytoin). We compared the effects of rocuronium on onset, duration, and speed of recovery from neuromuscular blockade (NMB) in anticonvulsant-treated (Tx) and untreated (C or con trol) patients. Thirty-eight neurosurgical patients were enrolled: 11 Tx and 8 C patients received 0.6 mg/kg rocuronium; 9 Tx and 10 C patients received 1.2 mg/kg rocuronium. Anesthesia was induced with midazolam, fentanyl, and thiopental, and maintained with N2O and isoflurane in O-2 The evoked compound electromyograph (EMG) of the hypothenar eminence was recorded (train-of-four supramaximal stimulus at 2 Hz every 20 seconds). Rocuronium was administered after baseline EMG was recorded. Data = mean +/- SD. Rocuronium 1.2 mg/kg significantly shortened onset time [depression of baseline height of first twitch (T1) to 10% of baseline] of NMB versus rocuronium 0.6 mg/kg in both Tx (2.5 +/- 2 versus 3.3 +/- 2 minutes) and C (1.3 +/- 1 versus 2.8 +/- 1 minute) patients. Duration (recovery to 25% of T1) of NMB was significantly shorter in the Tx patients than in the C patients who received rocuronium 0.6 mg/kg (21 +/- 9 versus 45 +/- 20 minutes), but similar in Tx and C patients who received 1.2 mg/kg rocuronium (56 +/- 24 versus 69 +/- 21 minutes). The speed of recovery (time from 10 to 25% recovery of T1) was significantly slower in Tx patients who received 1.2 mg/kg rocuronium (9 +/- 5 minutes) than in those who received 0.6 mg/kg (5 +/- 3 minutes) and not different from controls who received 0.6 (9 +/- 4 minutes) or 1.2 mg/kg (12 +/- 7 minutes) rocuronium. We recommend the use of rocuronium 1.2 mg/kg and very frequent monitoring of NMB in anticonvulsant-treated patients to avoid premature and extremely rapid recovery after the standard 0.6 mg/kg rocuronium. C1 Univ Illinois, Dept Anesthesia, Chicago, IL 60612 USA. RP Koenig, HM (reprint author), Univ Illinois, Dept Anesthesiol, 1740 W Taylor,Suite 3200 W,MC 515, Chicago, IL 60612 USA. NR 14 TC 4 Z9 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0898-4921 J9 J NEUROSURG ANESTH JI J. Neurosurg. Anesthesiol. PD APR PY 1999 VL 11 IS 2 BP 86 EP 89 DI 10.1097/00008506-199904000-00003 PG 4 WC Anesthesiology; Clinical Neurology; Surgery SC Anesthesiology; Neurosciences & Neurology; Surgery GA 182UV UT WOS:000079517300003 ER PT J AU Farenc, C Audran, M Lefrant, JY Mazerm, I Bressolle, F AF Farenc, C Audran, M Lefrant, JY Mazerm, I Bressolle, F TI High-performance liquid chromatographic method for the determination of atracurium and laudanosine in human plasma - Application to pharmacokinetics SO JOURNAL OF CHROMATOGRAPHY B LA English DT Article DE atracurium; laudanosine ID VALIDATION; BESYLATE; DRUGS AB A high-performance liquid chromatographic method coupled with fluorimetric detection has been developed for the determination of atracurium and its major metabolite, laudanosine, in human plasma. The detection is performed at 240 nm for excitation and 320 nm for emission. Verapamil was used as the internal standard. The proposed technique, involving the direct precipitation of plasma proteins is reproducible, selective and sensitive. Linear detector responses were observed for the calibration curve standards in the range of 40 to 2000 ng/ml. Precision, expressed as C.V., was in the range 1 to 14%. The limit of quantification for both atracurium and laudanosine was 40 ng/ml. The method has been validated and stability tests under various conditions have been performed. This method has been used to determine the pharmacokinetic profile of atracurium and laudanosine in patients with acute respiratory distress syndrome. (C) 1999 Elsevier Science B.V. All rights reserved. C1 Fac Pharm Montpellier, Lab Pharmacocinet Clin, F-34060 Montpellier 2, France. Fac Pharm Montpellier, Biophys Lab, F-34060 Montpellier, France. Ctr Hosp Univ, Federat Anesthesie Reanimat & Urgence, Nimes, France. RP Bressolle, F (reprint author), Fac Pharm Montpellier, Lab Pharmacocinet Clin, F-34060 Montpellier 2, France. NR 19 TC 11 Z9 13 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0378-4347 J9 J CHROMATOGR B JI J. Chromatogr. B PD MAR 5 PY 1999 VL 724 IS 1 BP 117 EP 126 DI 10.1016/S0378-4347(98)00576-3 PG 10 WC Biochemical Research Methods; Chemistry, Analytical SC Biochemistry & Molecular Biology; Chemistry GA 175PN UT WOS:000079103700013 ER PT J AU Lowry, DW Carroll, MT Mirakhur, RK Hayes, A Hughes, D O'Hare, R AF Lowry, DW Carroll, MT Mirakhur, RK Hayes, A Hughes, D O'Hare, R TI Comparison of sevoflurane and propofol with rocuronium for modified rapid-sequence induction of anaesthesia SO ANAESTHESIA LA English DT Article DE anaesthesia, techniques, rapid-sequence induction; anaesthesia, intravenous, propofol; anaesthetics, volatile, sevoflurane; neuromuscular block, rocuronium ID TRACHEAL INTUBATION; NITROUS-OXIDE; ANESTHESIA; ALFENTANIL; SUXAMETHONIUM; THIOPENTONE; BREATH; ADULTS AB We compared the use of sevoflurane and propofol with three different doses of rocuronium for modified rapid-sequence induction of anaesthesia. One hundred and forty adult patients were randomly allocated to have a rapid-sequence intravenous induction with propofol 2-3 mg.kg(-1) (group P) or an inhalational induction with sevoflurane 8% in oxygen, using a vital capacity technique (group S). Following loss of the eyelash reflex, cricoid pressure was applied and 20 patients in each group were administered rocuronium 0.3 (groups P/0.3 and S/0.3), 0.45 (groups P/0.45 and S/0.45) or 0.6 (groups P/0.6 and S/0.6) mg.kg(-1) An additional 10 patients in each group received only saline placebo in place of the muscle relaxant (groups P/Saline and S/Saline). Laryngoscopy was started 60 s later and intubating conditions evaluated by a blinded anaesthetist according to a standard scoring system. Intubating conditions were acceptable in one patient and no patient. respectively following induction with sevoflurane and propofol without the muscle relaxant. The conditions were acceptable in 30, 55 and 90% of subjects with sevoflurane induction, and in 45, 80 and 90% of subjects with propofol induction following 0.3, 0.45 and 0.6 mg.kg(-1) of rocuronium, respectively (no significant difference for each dose of rocuronium). The: present study shows that intubating conditions during a rapid-sequence: induction using rocuronium 0.6 mg.kg(-1) following induction of anaesthesia with sevoflurane or propofol are similar. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 17 TC 12 Z9 12 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 1999 VL 54 IS 3 BP 247 EP 252 DI 10.1046/j.1365-2044.1999.00745.x PG 6 WC Anesthesiology SC Anesthesiology GA 180VG UT WOS:000079405400008 ER PT J AU Hans, P Brichant, JF Hubert, B Dewandre, PY Lamy, M AF Hans, P Brichant, JF Hubert, B Dewandre, PY Lamy, M TI Influence of induction of anaesthesia on intubating conditions one minute after rocuronium administration: comparison of ketamine and thiopentone SO ANAESTHESIA LA English DT Article DE anaesthetics, intravenous; ketamine, thiopentone; intubation, tracheal; neuromuscular relaxants, rocuronium ID LARYNGEAL ADDUCTOR MUSCLES; RAPID-SEQUENCE INDUCTION; CESAREAN-SECTION; SUXAMETHONIUM; POLLICIS; PROPOFOL; HUMANS; ONSET AB We compared the effect of thiopentone and ketamine on intubating conditions after rocuronium 0.6 mg.kg(-1) in two groups of patients (n = 16 each), aged 21-44 years, undergoing elective surgery. Premedication consisted of alprazolam 1 mg by mouth I h before surgery. All patients received midazolam 2 mg intravenously 2 min before intravenous adminstration of thiopentone 5 mg.kg(-1) or ketamine 2.5 mg.kg(-1). Muscle relaxation was provided by rocuronium 0.6 mg.kg(-1) One minute after rocuronium administration, tracheal intubation was performed within 15s by a skilled anaesthetist blinded to the treatment group assignment. Intubating conditions were graded as excellent, good, fair or poor on the basis of jaw relaxation, position of vocal cords and diaphragmatic response. Neuromuscular transmission was assessed at the adductor pollicis muscle using a TOF-GUARD monitor. Excellent and good intubating conditions were obtained in 100% of patients in the ketamine group and in 50% of patients in the thiopentone group (p = 0.002). Jaw relaxation was similar in both groups but vocal cord conditions were better and the diaphragmatic response less marked in the ketamine group compared with the thiopentone group (p = 0.002). The degree of neuromuscular block [% decrease of T1. mean (SD)] at the time of intubation nas similar: 51.8 (25)% (ketamine group) and 54.3 (23.1)% (thiopentone group). We conclude that ketamine 2.5 mg.kg(-1) provides better intubating conditions than thiopentone 5 mg.kg(-1) 1 min after administration of rocuronium 0.6 mg.kg(-t). C1 CHU Liege, CHR Citadelle, Dept Anaesthesia & Intens Care Med, B-4000 Liege, Belgium. RP Hans, P (reprint author), CHU Liege, CHR Citadelle, Dept Anaesthesia & Intens Care Med, Bldg 12eme de Ligne 1, B-4000 Liege, Belgium. NR 15 TC 23 Z9 23 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 1999 VL 54 IS 3 BP 276 EP 279 DI 10.1046/j.1365-2044.1999.00703.x PG 4 WC Anesthesiology SC Anesthesiology GA 180VG UT WOS:000079405400014 ER PT J AU Geldner, G Schwarz, U Ruoff, M Romeiser, J Lendl, M Schutz, W Georgieff, M AF Geldner, G Schwarz, U Ruoff, M Romeiser, J Lendl, M Schutz, W Georgieff, M TI Development of a new closed-loop system for controlling a mivacurium induced neuromuscular blockade SO ANAESTHESIST LA German DT Article DE closed-loop-control; neural network; muscle relaxants; mivacurium ID CONTROLLED INFUSION PUMPS; FEEDBACK-CONTROL; ATRACURIUM; PERFORMANCE; MODEL AB There are many closed-loop control systems for muscle relaxants reported, but only a few could cope with the introduction of the latest shorter acting neuromuscular blocking drugs. These new muscle relaxants such as mivacurium require a fast adapting closed-loop system for controlling an adequate infusion. Methods. After approval of the local ethics committee and having the patients' informed consent a total number of 75 patients [ASA I and II] were included in the study and assigned either to a training-, prediction-, prediclion-/feedback- or a validationphase, as needed. Anaesthesia was induced and maintained with propofol in a TCI-mode with a plasma level of 3 to 5 mu g/ml and 0.1 mg fentanyl boli as needed in all patients. In the last validation phase, having 20 patients, the prediction error and the error of the whole system was taken and analysed. Results. A closed-loop system using a neural network as a predictor could be established. In the final validation phase constisting of 20 patients the mean square prediction error was found to be 0.1%+/-0.2% [mean+/-SD]. The mean square error of the whole system was 0.55%+/-0.59% [mean+/-SD]. Conclusions. A closed-loop system for control of a mivacurium infusion could be established. The system proofed to be reliable for a closed-loop infusion of mivacurium in order to maintain a predefined degree of neuromuscular blockade of 95% during routine surgery. The performance of the described controller is comparable to all recent attempts and could therefore be useful for scientific studies. It should be further validated and esthablished for other muscle relaxants, as well. C1 Univ Ulm, Anasthesiol Klin, D-89075 Ulm, Germany. Univ Erlangen Nurnberg, Lehrstuhl Allgemeine & Theoret Elektrotech, D-8520 Erlangen, Germany. RP Geldner, G (reprint author), Univ Ulm, Anasthesiol Klin, Steinhovelstr 9, D-89075 Ulm, Germany. NR 17 TC 2 Z9 2 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD MAR PY 1999 VL 48 IS 3 BP 157 EP 162 DI 10.1007/s001010050682 PG 6 WC Anesthesiology SC Anesthesiology GA 187XC UT WOS:000079812800003 ER PT J AU Fuchs-Buder, T Schlaich, N Ziegenfuss, T AF Fuchs-Buder, T Schlaich, N Ziegenfuss, T TI Low-dose rocuronium: Time course of neuromuscular blockade and intubating conditions SO ANAESTHESIST LA German DT Article DE muscle relaxants; rocuronium; pharmacodynamic; neuromuscular blockade; electromyography; intubating conditions; randomized controlled trial (RCI) ID ADDUCTOR POLLICIS MUSCLES; ORBICULARIS OCULI; VECURONIUM; MIVACURIUM; ATRACURIUM; ANESTHESIA; ORG-9426; BROMIDE AB Background: Rocuronium is a non-depolarising neuromuscular blocking agent structurally related to vecuronium. The compound has a rapid onset and an intermediate duration of action. The rapid onset is of importance in patients at risk for pulmonary aspiration, for elective induction of anaesthesia slower onset properties generally are accepted. In this context, we asked whether the induction dose of rocuronium may be reduced to doses smaller than 2XED(95) in situations in which slower onset properties may be acceptable. Methods: The rime course of neuromuscular block and intubating conditions of two different doses rocuronium, 2XED(95) (0.6 mg/kg) and 1.3XED(95) (0.4 mg/kg), were investigated in 90 patients. We first determined the time course of neuromuscular block using electromyography (EMG), n=l5 for each group. In the second pan the intubating conditions 3 min after injection of either rocuronium 0.6 mg/kg or rocuronium 0.4 mg/kg were evaluated, n=30 for each group. Results: In the present study reduction of the dose of rocuronium led to a slower onset (148+/-32 s vs. 220+/-30 s; P<0.05) and a shorter clinical duration (21 min+/-4 vs. 36+/-7 min; P<0.05). The recovery index was modified by the dose reduction: 11+/-3 min after 0.6 mg/kg rocuronium and 9+/-2 min after 0.4 mg/kg. After both doses of rocuronium the intubating conditions were good to excellent, no difference between both rocuronium groups were found. Conclusion: In the present study dose reduction from 0.6 mg/kg rocuronium to 0.4 mg/kg rocuronium led to a slower onset and reduced clinical duration. However, the intubating conditions, evaluated 3 min after injection of the muscle relaxant were comparable. This offers new possibilities for muscle relaxation for surgical or diagnostic procedures of short duration and may reduce costs. C1 Univ Saarlandes Kliniken, Klin Anasthesie & Intensiv Med, D-66421 Homburg, Germany. RP Fuchs-Buder, T (reprint author), Univ Saarlandes Kliniken, Klin Anaesthesiol & Intensiv Med, D-66421 Homburg, Germany. NR 15 TC 1 Z9 1 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD MAR PY 1999 VL 48 IS 3 BP 164 EP 168 DI 10.1007/s001010050683 PG 5 WC Anesthesiology SC Anesthesiology GA 187XC UT WOS:000079812800004 ER PT J AU Schiere, S Proost, JH Schuringa, M Wierda, JMKH AF Schiere, S Proost, JH Schuringa, M Wierda, JMKH TI Pharmacokinetics and pharmacokinetic-dynamic relationship between rapacuronium (Org 9487) and its 3-desacetyl metabolite (Org 9488) SO ANESTHESIA AND ANALGESIA LA English DT Article; Proceedings Paper CT 1997 Annual Meeting of American-Society-of-Anesthesiologists CY OCT 18-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiologists ID NEUROMUSCULAR BLOCKING-AGENT; MUSCLE-RELAXANT; PHARMACODYNAMICS; ORG-9487; VECURONIUM AB Rapacuronium (Org 9487) is a rapid-onset and short- to intermediate-acting muscle relaxant. Its 3-desacetyl metabolite, Org 9488, also exerts neuromuscular-blocking activity that. may became apparent after prolonged maintenance of relaxation with rapacuronium. In this study, the pharmacokinetic behavior (n = 7) of this metabolite and the pharmacokinetic/pharmacodynamic (PK/PD) relationship of rapacuronium (n = 10) and Org 9488 (n = 7) were investigated in humans. Similar protocols were used for three study groups regarding the anesthetic technique, blood and urine sampling, and pharmacokinetic and PK/PD analyses. The time course of action was measured mechanomyographically using the adductor pollicis muscle. The median clearance of rapacuronium was 7.28 mL.kg(-1).min(-1) with. an excretion fraction in the urine of 6.2%. The clearance (studied in two groups) of Org = 9488 was 128 and 1.06 mL.kg(-1).min(-1) with an excretion fraction in the urine of 51.9% and 53.5%, respectively. The median rate constant of transport between plasma and the biophase of rapacuronium (0.449 min(-1)) is markedly larger than that for Org 9488 (0.105 min(-1)). The modeled concentration in the biophase at 50% effect as a measure of potency is higher for rapacuronium (4.70 mu g/mL) than for Org 9488 (1.83 mu g/mL). The lower clearance of the metabolite will gradually prolong the time course of the neuromuscular blockade during maintenance with rapacuronium. Implications: We investigated the concentration-time-effect relationship of the relaxant rapacuronium and the contribution of its metabolite. Clearance, rate constant of transport between plasma and the biophase, and modeled concentration in the biophase at 50% effect of rapacuronium are consistent with its rapid onset and short to intermediate duration. The lower clearance of the metabolite will gradually prolong the time course of the neuromuscular blockade during maintenance with rapacuronium. C1 Univ Groningen Hosp, Dept Anesthesiol, Res Grp Expt Anesthesiol & Clin Pharmacol, NL-9700 RB Groningen, Netherlands. RP Wierda, JMKH (reprint author), Univ Groningen Hosp, Dept Anesthesiol, Res Grp Expt Anesthesiol & Clin Pharmacol, POB 30-001, NL-9700 RB Groningen, Netherlands. NR 17 TC 33 Z9 33 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1999 VL 88 IS 3 BP 640 EP 647 PG 8 WC Anesthesiology SC Anesthesiology GA 171AX UT WOS:000078840900032 ER PT J AU Lien, CA Belmont, MR Abalos, A Hass, D Savarese, JJ AF Lien, CA Belmont, MR Abalos, A Hass, D Savarese, JJ TI The nature of spontaneous recovery from mivacurium-induced neuromuscular block SO ANESTHESIA AND ANALGESIA LA English DT Article ID PLASMA CHOLINESTERASE ACTIVITY; CHLORIDE BW B1090U; ADULT PATIENTS; EDROPHONIUM; NEOSTIGMINE; INFUSION; PHARMACOKINETICS; ANTAGONISM; ANESTHESIA; PARALYSIS AB The hypothesis of this study was that, in a given patient, recovery from a tracheal intubating dose of mivacurium would indicate the time course of spontaneous recovery after discontinuation of an infusion of mivacurium, Thirty-eight male patients consented to participate in the study. After induction of anesthesia and endotracheal intubation, the ulnar nerve was stimulated with train-of-four (TOF) stimuli at 12-s intervals. Patients received 0.3 mg/kg mivacurium in two evenly divided doses of 0.15 mg/kg each, separated by 30 s. Complete ablation of TOF responses occurred in most patients. Once the first twitch in the TOF (T-1) had recovered to 25% of its baseline height, a mivacurium infusion was begun to maintain 95% suppression of T-1. As surgery was nearing completion, the infusion was discontinued, and neuromuscular function was allowed to recover spontaneously. Data were analyzed for recovery intervals after the administration of the initial doses of of mivacurium and after discontinuation of the infusion. Analysis of variance was used to determine the strength of correlation between the time from administration of the initial 0.3 mg/kg dose to 5% recovery of T-1 and the times to recovery of TOF ratios of 70% and 90%. The 25%-75% recovery internal after discontinuation of the infusion ranged from 2.8 to 11.3 min. The time interval after administration of mivacurium 0.3 mg/kg to 5% recovery of T-1 correlated with both the time to recovery of a TOF ratio of 70% and 90%. Recovery to a TOF of 90% after discontinuation of the infusion required approximately the same amount of time as recovery to 5% T-1 after the administration of 0.3 mg/kg mivacurium. Each patient's recovery of neuromuscular function after discontinuation of a mivacurium infusion was related to his recovery after the administration of 0.3 mg/kg mivacurium. Therefore, the need for pharmacologic antagonism of block can be anticipated well before the end of an anesthetic. implications: Mivacurium (0.3 mg/kg) was administered to 38 patients. As they began to recover muscle strength,a mivacurium infusion was begun and later discontinued as surgery was nearing completion. Each patient's early recovery (administration to 5% recovery of T-1) after the initial dose of mivacurium correlated well with more complete recovery of muscle strength after discontinuation of an infusion. This relationship enables early prediction of recovery speed after a mivacurium infusion. C1 New York Hosp, Cornell Med Ctr, Dept Anesthesiol, New York, NY 10021 USA. RP Lien, CA (reprint author), New York Hosp, Cornell Med Ctr, Dept Anesthesiol, New York, NY 10021 USA. NR 30 TC 8 Z9 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1999 VL 88 IS 3 BP 648 EP 653 PG 6 WC Anesthesiology SC Anesthesiology GA 171AX UT WOS:000078840900033 ER PT J AU Kim, KS Shim, JC Jun, JH Lee, KH Chung, CW AF Kim, KS Shim, JC Jun, JH Lee, KH Chung, CW TI Rabbits treated with chronic isepamicin are resistant to mivacurium and rocuronium SO ANESTHESIA AND ANALGESIA LA English DT Article ID AMINOGLYCOSIDE ANTIBIOTICS; ACETYLCHOLINE-RECEPTORS; NEUROMUSCULAR BLOCKADE; PHARMACOKINETICS; DESENSITIZATION; SENSITIVITY; VECURONIUM AB We compared the dose-response relationships and the neuromuscular blocking effects of mivacurium and rocuronium after chronic isepamicin therapy for 7 days in 56 anesthetized rabbits. Train-of-four stimuli were applied every 10 s to the common peroneal nerve,and the force of contraction of the tibialis anterior muscle was measured. Chronic isepamicin therapy is associated with a rightward shift of the mivacurium and rocuronium dose-response curves. The effective dose for 50% twitch depression of mivacurium and rocuronium increased significantly, from. 16.9 +/- 4.8 and 56.5 +/- 5.3 mu g/kg, respectively with placebo to 30.6 +/- 5.3 and 75.6 +/- 47 mu g/kg, respectively during isepamicin therapy. The isepamicin rabbits receiving mivacurium 0.18 mg/kg or rocuronium 0.6 mg/kg had an accelerated recovery from neuromuscular blockade compared with those receiving placebo. The results of this study show that mivacurium and rocuronium have both a decreased effect and a shorter duration of action in rabbits when used during concurrent isepamicin therapy. Implications: We studied the dose-response relationships and the neuromuscular blocking effects of mivacurium and rocuronium during chronic isepamicin therapy in rabbits. Mivacurium and rocuronium have both a decreased effect and a shorter duration of action during chronic aminoglycoside antibiotic therapy in rabbits. C1 Hanyang Univ, Dept Anesthesiol, Seoul 133791, South Korea. Hanyang Univ, Dept Orthopaed Surg, Seoul 133791, South Korea. Kwandong Univ, Dept Anesthesiol, Seoul, South Korea. RP Kim, KS (reprint author), Hanyang Univ Hosp, Dept Anesthesiol, 17 Haengdang Dong, Seoul 133792, South Korea. NR 24 TC 1 Z9 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1999 VL 88 IS 3 BP 654 EP 658 PG 5 WC Anesthesiology SC Anesthesiology GA 171AX UT WOS:000078840900034 ER PT J AU Goldman, E Sinderby, C Lindstrom, L Grassino, A AF Goldman, E Sinderby, C Lindstrom, L Grassino, A TI Influence of atracurium on the diaphragm mean action potential conduction velocity in canines SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT 17-25, 1996 CL NEW ORLEANS, LOUISIANA SP Amer Soc Anesthesiologists DE diaphragm paralysis; neuromuscular; relaxants; sonomicrometry ID DIFFERENT FIBER TYPES; ADDUCTOR POLLICIS; NEUROMUSCULAR-JUNCTIONS; MUSCLE-FIBERS; SKELETAL-MUSCLES; POWER SPECTRUM; BLOCKADE; SIZE; ELECTROMYOGRAM; VECURONIUM AB Background It has been shown that progressive neuromuscular blockade (NMB) affects the electromyogram power spectrum and compound muscle action potential duration in skeletal muscle. These measures are Linked to the mean muscle action potential conduction velocity (APCV), but no studies have confirmed a relation between the mean APCV and NMB. The aim of this study was to determine whether diaphragm mean APCV is affected by NMB., Methods: The effects of NMB on diaphragm mean APCV were evaluated in five mongrel dogs. Progressive NMB was induced by slow intravenous infusion of atracurium. During spontaneous breathing, the diaphragm mean APCV was determined by electromyogram signals, In the time and frequency domains. The magnitude of NMB was quantified by the amplitude of the compound muscle action potential and by changes in muscle shortening during supramaximal stimulation of the phrenic nerve. Results: Progressive NMB was associated with a decrease in diaphragm mean APCV. At approximately 70% reduction in the compound muscle action potential amplitude, diaphragm mean APCV had decreased more than 20%. Recovery after NMB was characterized by a restoration of the mean APCV to control values. Conclusion: This study shows that progressive NMB paralyzes motor units within the diaphragm in an orderly manner, and the blockade first affects muscle fibers with high APCV before it affects fibers with lower APCV. C1 Univ Montreal, Guy Bernier Res Ctr, Hop Maison Neuve Rosemont, Montreal, PQ H1T 2M4, Canada. RP Sinderby, C (reprint author), Univ Montreal, Guy Bernier Res Ctr, Hop Maison Neuve Rosemont, Pavill Maisonneuve,5415 Blvd Assompt, Montreal, PQ H1T 2M4, Canada. NR 29 TC 3 Z9 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1999 VL 90 IS 3 BP 855 EP 862 DI 10.1097/00000542-199903000-00029 PG 8 WC Anesthesiology SC Anesthesiology GA 172PB UT WOS:000078932000029 ER PT J AU Ogunbiyi, OA Branch, KG AF Ogunbiyi, OA Branch, KG TI Mivacurium apnoea: A trap for the unwary SO INTERNATIONAL JOURNAL OF CLINICAL PRACTICE LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; PLASMA CHOLINESTERASE AB We present a case of unanticipated postoperative apnoea in a patient with associated medical illness to illustrate the diagnostic difficulty that can arise in the detection and subsequent management of mivacurium apnoea. A high index of suspicion is essential in the presence of concomitant medical conditions that may cause prolonged apnoea. To our knowledge, no report exists documenting the unanticipated occurrence of mivacurium apnoea in a patient with previously undiagnosed pseudocholinesterase deficiency and concomitant medical illness who has previously undergone 'balanced' general anaesthesia. C1 James Paget Hosp, Dept Anaesthet, Great Yarmouth, Norfolk, England. RP Ogunbiyi, OA (reprint author), Harrowgate Dist Hosp, Dept Anaesthet, Harrowgate HG2 7SX, Yorks, England. NR 9 TC 2 Z9 2 PU MEDICOM INTERNATIONAL PI SURREY PA CHURSTON HOUSE, PORTSMOUTH RD, ESHER, SURREY KT10 9AD, ENGLAND SN 1368-5031 J9 INT J CLIN PRACT JI Int. J. Clin. Pract. PD MAR PY 1999 VL 53 IS 2 BP 154 EP 155 PG 2 WC Medicine, General & Internal; Pharmacology & Pharmacy SC General & Internal Medicine; Pharmacology & Pharmacy GA 178FC UT WOS:000079254800019 ER PT J AU Vinik, HR AF Vinik, HR TI Intraocular pressure changes during rapid sequence induction and intubation: A comparison of rocuronium, atracurium, and succinylcholine SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE atracurium; intraocular pressure; ophthalmic surgery; rocuronium; succinylcholine ID TRACHEAL INTUBATION; SUXAMETHONIUM; ANESTHESIA; THIOPENTONE; VECURONIUM; ALFENTANIL; PROPOFOL; EYE AB Study Objective: To compare changes in intraocular pressure (IOP) during rapid sequence induction and intubation following rocuronium, succinylcholine, and atracurium. Design: Open-label, prospective, randomized study. Setting: Operating room at the Eye Foundation Hospital (University of Alabama at Birmingham) Patients: 45 ASA physical status I, II, and III patients, aged 18 to 65 years, scheduled for elective eye surgery with general anesthesia. Interventions: Anesthesia was rapidly induced in unpremedicated patients with a fixed combination of midazolam 0.025 mg/kg, alfenlanil 0.025 mg/kg, and propofol 1.5 mg/kg. Intubation was performed, as clinically indicated approximately GO seconds following administration of rocuronium 0.6 mg/kg; atracurium 0.5 mg/kg, or succinylcholine I to 1.5 mg/kg. Measurements and Main Results: Intraocular pessure was measured before induction of anesthesia (baseline), following anesthesia induction and administration of muscle relaxant (before intubation, and after intubation). The percent change in IOP from baseline was significantly decreased in the rocuronium group compared with the succinylcholine group, (p = 0.046) before intubation. This trend continued after intubation, but the difference was no longer significant (p = 0.070). Intubation scores for rocuronium and succinylcholine groups were similar, and both scores were superior to that for the atracurium group (p = 0.002). Conclusion: Intraocular, pressure can be controlled during emergency induction of aesthesia and intubation with adequate depth of anesthesia and muscle relaxation. Rocuronium, succinylcholine, and atracurium all provided sufficient muscle relaxation to achieve successful intubation and no increase in IOP. However, rocuronium 0.6 mg/kg provided significantly better intubating conditions compared with atracurium, and it resulted in a significantly greater decrease in IOP compared with baseline than succinylcholine. (C) 1999 by Elsevier Science Inc. C1 Univ Alabama, Dept Anesthesiol, Eye Fdn Hosp, Birmingham, AL 35233 USA. RP Vinik, HR (reprint author), Univ Alabama, Dept Anesthesiol, Eye Fdn Hosp, 1720 Univ Blvd, Birmingham, AL 35233 USA. NR 21 TC 17 Z9 19 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR PY 1999 VL 11 IS 2 BP 95 EP 100 DI 10.1016/S0952-8180(99)00013-6 PG 6 WC Anesthesiology SC Anesthesiology GA 205ZP UT WOS:000080851600003 ER PT J AU Uyar, M Hepaguslar, H Ugur, G Balcioglu, T AF Uyar, M Hepaguslar, H Ugur, G Balcioglu, T TI Resistance to vecuronium in burned children SO PAEDIATRIC ANAESTHESIA LA English DT Article DE burns; vecuronium; resistance ID PEDIATRIC-PATIENTS; INJURY; ATRACURIUM AB We compared the time-course of action of vecuronium in 16 burned children undergoing excision and autograft surgery with that of ten unburned children. Standardized anaesthesia was induced with thiopentone 4-6 mg kg(-1) and fentanyl 1 mu g kg(-1) and maintained with endtidal 1-1.5% isoflurane in N2O/O-2. Neuromuscular responses were monitored by acceleromyography (TOF-Guard, Organon Teknika/Biometer) with supramaximal train-of-four (TOF) stimuli delivered every 15 s. Vecuronium 0.1 mg kg(-1) was administered intravenously. Onset was recorded as the time, in seconds, between the initial bolus of vecuronium and a decline in the first twitch of TOF (T1) to 5% of control. The times for the recovery of T1-25%, 50% and 75% of control, recovery index and the recovery of TOF 25% and 50% were recorded. Onset of action was found slower in burned patients (189 +/- 70 s) than in control (98 +/- 20 s) (P< 0.01). Recovery times of T1(25), T1(50), T1(75), TOF25 and TOF50 were significantly shorter in burned patients indicative of decreased sensitivity to vecuronium (P< 0.01). C1 Ege Univ Hosp, Dept Anaesthesiol, TR-35100 Izmir, Turkey. RP Uyar, M (reprint author), Ege Univ Hosp, Dept Anaesthesiol, TR-35100 Izmir, Turkey. NR 17 TC 1 Z9 2 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PD MAR PY 1999 VL 9 IS 2 BP 115 EP 118 DI 10.1046/j.1460-9592.1999.9220328.x PG 4 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA 176ZK UT WOS:000079182200004 ER PT J AU Dobson, AP McCluskey, A Meakin, G Baker, RD AF Dobson, AP McCluskey, A Meakin, G Baker, RD TI Effective time to satisfactory intubation conditions after administration of rocuronium in adults - Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia SO ANAESTHESIA LA English DT Article DE anaesthetics, intravenous, propofol, thiopentone; anaesthetic techniques, rapid sequence intubation; intubation, tracheal; neuromuscular relaxants, rocuronium ID DOSE-RESPONSE; SUXAMETHONIUM; ORG-9426; ANESTHESIA; ALFENTANIL; CHILDREN; SURGERY; ONSET AB We determined the effective time to satisfactory intubation conditions after the administration of rocuronium 0.6 mg.kg(-1) to 120 unpremedicated adult patients anaesthetised with propofol 2.5 mg.kg(-1) or thiopentone 5 mg.kg(-1) Intubation conditions were assessed in In subgroups of 12 patients at 30, 40, 50, 60 and 70s. The effective times to satisfactory intubation conditions ill 50 and 90% of patients were obtained by the method of maximum likelihood after log time-probit response transformations. Intubation conditions after induction of anaesthesia with propofol were satisfactory ill 5/12 patients at 30 s, 7/12 at 40 s, 10/12 at 50 s, 11/13 at 60 s and 11/12 at 70 s compared with 1/12 patients at 30s, 2/12 at 30 s, 5/12 at 50 s, 7/12 at 60 s and 8/12 at 70 s after induction with thiopentone. The effective times to satisfactory intubation conditions ill 50% and 90% (95% confidence intervals) of patients after rocuronium 0.6 mg.kg(-1) were 34 (26-40) s and 61 (50-81) s in patients given propofol compared with 57 (48-69) s and 101 (79-167) s in patients given thiopentone. We conclude that rocuronium 0.6 mg.kg(-1) may be a suitable alternative to suxamethonium during rapid sequence induction of anaesthesia with propofol in situations where suxamethonium is contraindicated. C1 Stepping Hill Hosp, Dept Anaesthesia, Stockport SK2 7JE, England. Univ Manchester, Royal Manchester Childrens Hosp, Dept Anaesthesia, Manchester M27 4HA, Lancs, England. Univ Salford, Dept Math, Salford M5 4WT, Lancs, England. RP McCluskey, A (reprint author), Stepping Hill Hosp, Dept Anaesthesia, Stockport SK2 7JE, England. NR 20 TC 25 Z9 32 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD FEB PY 1999 VL 54 IS 2 BP 172 EP 176 DI 10.1046/j.1365-2044.1999.00655.x PG 5 WC Anesthesiology SC Anesthesiology GA 168EU UT WOS:000078679200011 ER PT J AU Toh, KW Deacock, SJ Fawcett, WJ AF Toh, KW Deacock, SJ Fawcett, WJ TI Severe anaphylactic reaction to cisatracurium SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANESTHESIA; DRUGS C1 Royal Surrey Cty Hosp, Dept Anaesthesia, Guildford GU2 5XX, Surrey, England. RP Fawcett, WJ (reprint author), Royal Surrey Cty Hosp, Dept Anaesthesia, Guildford GU2 5XX, Surrey, England. NR 13 TC 23 Z9 24 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 1999 VL 88 IS 2 BP 462 EP 464 DI 10.1097/00000539-199902000-00044 PG 3 WC Anesthesiology SC Anesthesiology GA 163KJ UT WOS:000078404300045 ER PT J AU Jenkins, JG AF Jenkins, JG TI Masseter muscle rigidity after vecuronium SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE non-depolarizing; muscle relaxants; vacuronium; masseter muscle rigidity ID MALIGNANT HYPERTHERMIA SUSCEPTIBILITY; ANESTHESIA; SPASM AB Masseter muscle rigidity after suxamethonium, usually occurring in children induced with halothane, is associated with malignant hyperthermia. A case is reported in which masseter muscle rigidity occurred in an adult following vecuronium. From the limited data available, this and two similar reported cases, it appears that non-depolarizing muscle relaxants can, very rarely, cause masseter muscle rigidity in adults. This masseter muscle rigidity may complicate airway management, but is unlikely to progress to generalized rigidity and malignant hyperthermia. C1 Royal Surrey Cty Hosp, Dept Anaesthesia, Surrey GU2 5XX, England. RP Jenkins, JG (reprint author), Royal Surrey Cty Hosp, Dept Anaesthesia, Surrey GU2 5XX, England. NR 10 TC 3 Z9 4 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD FEB PY 1999 VL 16 IS 2 BP 137 EP 139 DI 10.1046/j.1365-2346.1999.00448.x PG 3 WC Anesthesiology SC Anesthesiology GA 265BV UT WOS:000084219900011 ER PT J AU Searle, NR Thomson, I Dupont, C Cannon, JE Roy, M Rosenbloom, M Gagnon, L Carrier, M AF Searle, NR Thomson, I Dupont, C Cannon, JE Roy, M Rosenbloom, M Gagnon, L Carrier, M TI A two-center study evaluating the hemodynamic and pharmacodynamic effects of cisatracurium and vecuronium in patients undergoing coronary artery bypass surgery SO JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA LA English DT Article; Proceedings Paper CT Canadian-Anaesthetists-Society Annual Meeting CY JUN 07-10, 1997 CL VANCOUVER, CANADA SP Canadian Anaesthetists Soc DE neuromuscular relaxants; cisatracurium; vecuronium; cardiovascular effects; coronary artery disease ID OPIOID BARBITURATE ANESTHESIA; MYOCARDIAL ISCHEMIA; CARDIAC ANESTHESIA; PANCURONIUM; ATRACURIUM; 51W89; PHARMACOLOGY; HYPOTHERMIA; DISEASE; CATS AB Objective: To determine the hemodynamic and pharmacodynamic effects of rapid bolus administration of cisatracurium compared with vecuronium. Design: A randomized, prospective, double-blind study. Setting: Tertiary-care university hospitals. Participants: Seventy-nine adult patients with diagnosed coronary artery disease (CAD). Intervention: Elective coronary artery bypass graft surgery (CABG). Measurements and Main Results: Patients were randomly divided into four groups. Patients received a rapid bolus of two or four times the 95% peak depression of twitch (ED95) of either cisatracurium (groups 1 and 2) or vecuronium (groups 3 and 4). Three minutes after a midazolam induction, all patients received a rapid bolus administration of either study drug. Maintenance of anesthesia was with a standardized propofol-sufentanil-oxygen anesthetic. Patients were monitored with radial and pulmonary artery catheters and electromyography. End points of the study were hemodynamic stability at induction, after bolus administration of study drugs, and after intubation; the quality of intubating conditions; drug interventions to correct hemodynamic instability; the onset, duration, and recovery of neuromuscular function; and drug cost. Mean arterial pressure (MAP) and heart rate (HR) decreased in a similar proportion in all four groups after induction while, following study drug administration, MAP and HR did not change significantly. Both cisatracurium groups required more boluses to maintain neuromuscular block, but spontaneous recovery rates were faster. Both agents, but cisatracurium to a lesser degree, showed increased duration with repeated maintenance doses. Both agents afforded good to excellent intubating conditions, but the cost of cisatracurium was significantly less. Conclusion: The authors conclude there is no evidence of a hemodynamic difference between the two neuromuscular blacking drugs (NMBDs). There are some clinical and cost advantages in favor of cisatracurium. Copyright (C) 1999 by W.B. Saunders Company. C1 Montreal Heart Inst, Dept Anesthesia, Montreal, PQ H1T 1C8, Canada. Montreal Heart Inst, Dept Surg, Montreal, PQ H1T 1C8, Canada. Montreal Heart Inst, Res Ctr, Montreal, PQ H1T 1C8, Canada. Univ Manitoba, St Boniface Gen Hosp, Dept Anesthesia, Winnipeg, MB, Canada. RP Searle, NR (reprint author), Montreal Heart Inst, Dept Anesthesia, 5000 Belanger St E, Montreal, PQ H1T 1C8, Canada. NR 19 TC 7 Z9 9 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1053-0770 J9 J CARDIOTHOR VASC AN JI J. Cardiothorac. Vasc. Anesth. PD FEB PY 1999 VL 13 IS 1 BP 20 EP 25 DI 10.1016/S1053-0770(99)90167-2 PG 6 WC Anesthesiology; Cardiac & Cardiovascular Systems; Respiratory System; Peripheral Vascular Disease SC Anesthesiology; Cardiovascular System & Cardiology; Respiratory System GA 168MV UT WOS:000078697600005 ER PT J AU Knuttgen, D Jahn, M Zeidler, D Doehn, M AF Knuttgen, D Jahn, M Zeidler, D Doehn, M TI Atracurium during thoracic surgery: Impaired efficiency in septic processes SO JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA LA English DT Article DE neuromuscular relaxants; atracurium; thoracic surgery; infection; inflammation ID NEUROMUSCULAR BLOCKADE; SKELETAL-MUSCLE; RESISTANCE; VECURONIUM; BINDING AB Objective: The aim of the study was to examine whether the neuromuscular blocking potency of atracurium changes in patients with a septic intrathoracic process. Design: Prospective clinical study. Setting: Community hospital, Participants:Thirty patients who underwent thoracic surgery for resection of a pulmonary carcinoma were examined. Fifteen patients showed typical signs of a concomitant bacterial superinfection (infection group), 15 age-matched patients without infection served as the control (no-infection)group. Interventions: Relaxation was induced with atracurium, 0.6 mg/kg intravenously for intubation, followed by a continuous infusion to maintain a 90% neuromuscular blockade. Relaxometry was performed electromyographically using the Datex Relaxograph by stimulating the ulnar nerve next to the wrist. Measurements and Main Results: The onset time was significantly longer (5.3 +/- 2.9 v 3.3 +/- 1.2 minutes; p < 0.05), and the recovery phase (DUR 10%) was significantly shorter (23.5 +/- 8.6 v 36.9 +/- 7.3 minutes; p < 0.001) in the infection group compared with the controls. The infusion rate within the first hour of continuous application was 77.4% higher in the infection group than in the control group (11.0 +/- 2.9 v 6.2 +/- 1.0 mu g/kg/min; p < 0.001). Conclusion: The study showed that septic intrathoracic processes cause a clear reduction of the neuromuscular blocking potency of atracurium. To guarantee adequate muscle relaxation in such cases, precise neuromuscular monitoring is highly advisable. Copyright (C) 1999 by W.B. Saunders Company. C1 Kliniken Stadt Koln, Municipal Clin Cologne, Abt Anasthesiol, Dept Anesthesia, D-51109 Cologne, Germany. Municipal Clin Cologne, Dept Thorac Surg, Cologne, Germany. RP Knuttgen, D (reprint author), Kliniken Stadt Koln, Municipal Clin Cologne, Abt Anasthesiol, Dept Anesthesia, Ostemerheimerstr 200, D-51109 Cologne, Germany. NR 20 TC 2 Z9 2 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1053-0770 J9 J CARDIOTHOR VASC AN JI J. Cardiothorac. Vasc. Anesth. PD FEB PY 1999 VL 13 IS 1 BP 26 EP 29 DI 10.1016/S1053-0770(99)90168-4 PG 4 WC Anesthesiology; Cardiac & Cardiovascular Systems; Respiratory System; Peripheral Vascular Disease SC Anesthesiology; Cardiovascular System & Cardiology; Respiratory System GA 168MV UT WOS:000078697600006 ER PT J AU Andrews, JI Kumar, N van den Brom, RHG Olkkola, KT Roest, GJ Wright, PMC AF Andrews, JI Kumar, N van den Brom, RHG Olkkola, KT Roest, GJ Wright, PMC TI A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE neuromuscular blocking agents, rocuronium, succinylcholine; anesthesia, general ID INTUBATING CONDITIONS; SUXAMETHONIUM; THIOPENTONE; ALFENTANIL; ORG-9426; ONSET AB Background: Rocuronium has an onset of action more rapid than other non-depolarizing neuromuscular blocking agents, but it is unclear whether it and succinylcholine give equivalent intubating conditions during rapid-sequence induction of anaesthesia. We performed this study to answer the question - are there clinically relevant differences between the use of rocuronium and succinylcholine to secure acceptable intubating conditions during rapid-sequence induction of anaesthesia with propofol? Methods: Anaesthesia was induced using propofol 2.5 mg/kg in 349 ASA physical status grade I-IV patients who were undergoing either elective or emergency surgery. Propofol was followed immediately by either rocuronium 0.6 or 1 mg/kg or succinylcholine 1.0 mg/kg (randomly selected). Fifty seconds after the end of muscle relaxant injection laryngoscopy was performed and intubating conditions were graded by an experienced anaesthetist blind to the muscle relaxant allocation. This study design was selected so that a 10% difference in clinically acceptable intubating conditions between drugs would be detectable. Results: In this setting rocuronium 1.0 mg/kg provided superior intubating conditions compared with rocuronium 0.6 mg/kg. The incidence of clinically acceptable intubating conditions with rocuronium 1.0 mg/kg and succinylcholine 1.0 mg/kg was 93.2% and 97.1% respectively, the difference being -3.9% (95% C.I. -9.7% to 1.9%). Conclusion: Rocuronium 1.0 mg/kg given along with propofol in a rapid-sequence induction of anaesthesia is clinically equivalent to succinylcholine 1.0 mg/kg. C1 Royal Victoria Infirm, Dept Anaesthesia, Newcastle Upon Tyne NE1 4LP, Tyne & Wear, England. Organon Teknika NV, Turnhout, Belgium. RP Wright, PMC (reprint author), Royal Victoria Infirm, Dept Anaesthesia, Newcastle Upon Tyne NE1 4LP, Tyne & Wear, England. NR 12 TC 68 Z9 73 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JAN PY 1999 VL 43 IS 1 BP 4 EP 8 DI 10.1034/j.1399-6576.1999.430102.x PG 5 WC Anesthesiology SC Anesthesiology GA 153BH UT WOS:000077812500002 ER PT J AU Iwama, H Kaneko, T Tobishima, S Komatsu, T Watanabe, K Akutsu, H AF Iwama, H Kaneko, T Tobishima, S Komatsu, T Watanabe, K Akutsu, H TI Time dependency of the ratio of umbilical vein maternal artery concentrations of vecuronium in caesarean section SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE cesarean section; general anesthesia; perinatal anesthesia; obstetric anesthesia; priming principle; vecuronium; placental transfer; delivery time ID RAPID-SEQUENCE INTUBATION; CESAREAN-SECTION; CLINICAL PHARMACOKINETICS; PLACENTAL-TRANSFER; ROCURONIUM AB Background: The ratio of umbilical vein (UV) and maternal artery (MA) concentrations of vecuronium may more accurately determine the placental transfer ratio during caesarean section. This ratio potentially correlates with the time from induction of anaesthesia to delivery (I-D time). The aim of this study was to determine the UV/MA ratio of vecuronium and its relationship with the I-D time. Methods: Eighteen pregnant women at full term undergoing caesarean section were studied. The parturient was given intravenously 0.01 mg/kg vecuronium as a priming dose, followed 180 s later by 0.11 mg/kg vecuronium as an intubation dose and 4 mg/kg thiamylal. The time from the injection of the intubation dose to the clamping of the umbilical cord was regarded as the I-D time. At the time of clamping the umbilical cord, blood samples were collected and the UV and MA of vecuronium were measured. Results: The UV/MA ratio and the I-D time, expressed as the mean (SD), were 0.056 (0.016) and 280 (57) s, respectively. The regression equation indicated y = 0.0083 + 0.00017 x (R-2 = 0.381, r = 0.617, P = 0.0063, I-D time (s) = x, UV/MA = y). Conclusion: The present study demonstrated that the UV/MA ratio of vecuronium as an index of the placental transfer becomes smaller as the delivery time after injection of this drug becomes shorter during caesarean section. C1 Cent Aizu Gen Hosp, Dept Anaesthesiol, Aizuwakamatsu 9650011, Japan. Cent Aizu Gen Hosp, Dept Obstet & Gynaecol, Aizuwakamatsu 9650011, Japan. RP Iwama, H (reprint author), Cent Aizu Gen Hosp, Dept Anaesthesiol, 1-1 Tsuruga Machi, Aizuwakamatsu 9650011, Japan. NR 10 TC 1 Z9 3 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD JAN PY 1999 VL 43 IS 1 BP 9 EP 12 DI 10.1034/j.1399-6576.1999.430103.x PG 4 WC Anesthesiology SC Anesthesiology GA 153BH UT WOS:000077812500003 ER PT J AU Wright, PMC Brown, R Lau, M Fisher, DM AF Wright, PMC Brown, R Lau, M Fisher, DM TI A pharmacodynamic explanation for the rapid onset/offset of rapacuronium bromide SO ANESTHESIOLOGY LA English DT Article DE laryngeal muscles; modeling; muscle relaxants; ORG9487; pharmacodynamics; rapacuronium; semiparametric techniques ID LARYNGEAL ADDUCTOR MUSCLES; VECURONIUM NEUROMUSCULAR BLOCKADE; ORBICULARIS OCULI; POLLICIS MUSCLES; PHARMACOKINETICS; HUMANS; ONSET; ANESTHESIA; ROCURONIUM; ORG-9487 AB Background Nondepolarizing muscle relaxants differ in their time course at the laryngeal adductors and the adductor pollicis, a result of differences in equilibration delays between plasma and effect sites, the sensitivity of each muscle to the relaxant, and the steepness of the concentration-effect relation at each muscle (the Hill factor). To determine whether similar differences exist for rapacuronium, a muscle relaxant with rapid onset and offset, the authors determined its pharmacodynamic characteristics. Methods: The twitch tensions of the adductor pollicis and the laryngeal adductors (via a tracheal tube cuff positioned at the vocal cords) were measured in 10 volunteers who were anesthetized with propofol Rapacuronium, 1.5 mg/kg, was given and blood samples were collected. A semiparametric effect compartment pharmacodynamic model was fit to values for rapacuronium plasma concentrations and twitch tension of the adductor pollicis and laryngeal adductors. Results: Equilibration between the rapacuronium plasma concentration and both effect sites was rapid (typical values for the rate constant for equilibration between plasma and the effect site are 0.405 per min for the adductor pollicis and 0.630 per min for the laryngeal adductors) and was more rapid at the laryngeal adductors than at the adductor pollicis (ratio, 1.59 +/- 0.16; mean +/- SD). The steady state rapacuronium plasma concentration that depressed twitch tension by 50% and the Hill factor were similar for the two muscles. Conclusions: The rapid onset and offset of rapacuronium can be explained by the rapid equilibration between concentrations in plasma and at the effect site. Unlike the finding for other nondepolarizing muscle relaxants, the laryngeal muscles are not resistant to rapacuronium. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. Univ Newcastle Upon Tyne, Dept Anesthesia, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. NR 22 TC 34 Z9 34 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 1999 VL 90 IS 1 BP 16 EP 23 DI 10.1097/00000542-199901000-00005 PG 8 WC Anesthesiology SC Anesthesiology GA 153VH UT WOS:000077853300004 ER PT J AU Szenohradszky, J Caldwell, JE Wright, PMC Brown, R Lau, M Luks, AM Fisher, DM AF Szenohradszky, J Caldwell, JE Wright, PMC Brown, R Lau, M Luks, AM Fisher, DM TI Influence of renal failure on the pharmacokinetics and neuromuscular effects of a single dose of rapacuronium bromide SO ANESTHESIOLOGY LA English DT Article DE drug metabolism; mixed-effects modeling; muscle relaxants; ORG9487; rapacuronium ID MUSCLE-RELAXANT; VECURONIUM; PANCURONIUM; ATRACURIUM; TRANSPLANTATION; ORG-9487; LIVER; ONSET AB Background: Because renal function affects the elimination of muscle relaxants, each new muscle relaxant must be evaluated in patients with renal failure. Accordingly, the neuromuscular effects and pharmacokinetics of rapacuronium were identified in patients with renal failure. Methods: Rapacuronium (1.5 mg/kg) was administered to 10 healthy volunteers and 10 patients with renal failure who were undergoing non-transplant surgery, were 18-45 yr old, and were anesthetized with propofol, The adductor pollicis muscle twitch tension was monitored. Plasma samples were obtained frequently for a period of 8 h to measure the concentrations of ORG9487 and its metabolite, ORG9488, Pharmacokinetic parameters were determined using mixed-effects modeling. Results: One patient was excluded from analysis because he was taking phenytoin chronically. Twitch depression at 1 min was less in patients than in healthy volunteers (median values: 92% in patients, 99% in volunteers). The times to 90% and peak twitch depression; to 10%, 25%, and 75% twitch recovery; and to 70% and 80% train-of-four ratios mere similar in volunteers and patients. Rapacuronium's clearance was 32% less in patients with renal failure; in both groups, clearance decreased 0.909% per year of age compared with the value in a 30 yr old. The steady state distribution volume was 14% less in women than in men and 16% less in patients than in volunteers. For ORG9488, clearance was 85% less in patients than in volunteers. Conclusions: The neuromuscular effects of a single dose of rapacuronium are affected minimally by renal failure. However, the decreased clearance of rapacuronium and its potent metabolite in renal failure suggests that repeated dosing of rapacuronium may lead to prolonged effects in patients with renal failure. C1 Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. RP Fisher, DM (reprint author), Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA. NR 23 TC 23 Z9 23 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 1999 VL 90 IS 1 BP 24 EP 35 DI 10.1097/00000542-199901000-00006 PG 12 WC Anesthesiology SC Anesthesiology GA 153VH UT WOS:000077853300005 ER PT J AU Spacek, A Neiger, FX Krenn, CG Hoerauf, K Kress, HG AF Spacek, A Neiger, FX Krenn, CG Hoerauf, K Kress, HG TI Rocuronium-induced neuromuscular block is affected by chronic carbamazepine therapy SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT 1997 Annual Meeting of American-Society-of-Anesthesiologists CY OCT 18-23, 1997 CL SAN DIEGO, CALIFORNIA SP Amer Soc Anesthesiologists DE anticonvulsant; drug interaction; long-term therapy; muscle relaxant ID CHRONIC ANTICONVULSANT THERAPY; CADAVER RENAL-TRANSPLANTATION; RESISTANCE; VECURONIUM; PHENYTOIN; ATRACURIUM; PHARMACOKINETICS; METOCURINE; RECOVERY; ORG-9426 AB Background: Patients on chronic anticonvulsant drugs are relatively resistant to certain nondepolarizing neuromuscular blockers such as pancuronium, vecuronium, pipecuronium, doxacurium, or metocurine, but not resistant to mivacurium and atracurium, This study investigated the influence of chronic carbamazepine therapy on the neuromuscular block induced by the new muscle relaxant rocuronium. Methods: Twenty-two otherwise healthy individuals scheduled for neurosurgical operations were studied: 11 of them were on chronic treatment with carbamazepine; the others served as control subjects. The median duration of carbamazepine therapy was 9 weeks (range, 4-312 weeks). After premedication with Oral diazepam, anesthesia was induced with fentanyl and thiopental and maintained with nitrous oxide/oxygen and 0.5% inspired isoflurane. Rocuronium, 0.6 mg/kg (2 x ED95), was given for intubation. The ulnar nerve was stimulated, and the evoked electromyogram recorded using a Datex NMT monitor. Results: Based on the response to the first of four stimuli, neither the lag time nor the onset-time differed between the two groups, However, the intervals of recovery to 10%, 25%, 50%, and 75% of the baseline response and the recovery index (RI, 25%-75%) were significantly shorter in patients on chronic carbamazepine therapy. Conclusions: The authors conclude that the duration of the rocuronium-induced neuromuscular block is significantly shortened by preceding chronic carbamazepine therapy. C1 Univ Vienna, Dept Anesthesia, A-1090 Vienna, Austria. Univ Vienna, Dept Gen Intens Care, A-1090 Vienna, Austria. RP Spacek, A (reprint author), Univ Vienna, Dept Anesthesia & Gen Intens Care B, Wahringer Gurtel 18-20, A-1090 Vienna, Austria. NR 23 TC 17 Z9 19 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 1999 VL 90 IS 1 BP 109 EP 112 DI 10.1097/00000542-199901000-00016 PG 4 WC Anesthesiology SC Anesthesiology GA 153VH UT WOS:000077853300015 ER PT J AU Fuchs-Buder, T Ziegenfuss, T Lysakowski, K Tassonyi, E AF Fuchs-Buder, T Ziegenfuss, T Lysakowski, K Tassonyi, E TI Antagonism of vecuronium-induced neuromuscular block in patients pretreated with magnesium sulphate: dose-effect relationship of neostigmine SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article; Proceedings Paper CT ESA Annual Meeting CY APR, 1998 CL BARCELONA, SPAIN SP ESA DE antagonists neuromuscular block, neostigmine; neuromuscular block, vecuronium; pharmacology, magnesium sulphate; monitoring, electromyography ID PANCURONIUM; SULFATE; HYPERMAGNESEMIA; EDROPHONIUM; MANAGEMENT; ATRACURIUM; REVERSAL AB We have investigated the dose-effect relationship of neostigmine in antagonizing vecuronium-induced neuromuscular block with and without magnesium sulphate (MgSO4) pretreatment. Neuromuscular block was assessed by electromyography with train-of-four (TOF) stimulation. First, we determined neostigmine-induced recovery in patients pretreated with MgSO4 (group A) or saline (group B) (n = 12 each). The height of TI, 5 min after neostigmine, was 43 (7)% in group A and 65 (6)% in group B (P < 0.01). Respective values after 10 min were 59 (7)% and 83 (5)% (P < 0.01). TOF ratio, 5 min after neostigmine, was 29 (6)% in group A and 29 (5)% in group B. Respective values after 10 min were 38 (11)% and 51 (7)% (P < 0.01). To gain insight into the mechanisms leading to delayed recovery after MgSO4, we calculated assisted recovery, defined as neostigmine-induced recovery minus mean spontaneous recovery. Spontaneous recovery was assessed in another 24 patients. Patients in group C received MgSO4/vecuronium and patients in group D vecuronium only (n = 12 each). Five minutes after neostigmine, assisted recovery was 22 (7)% in the MgSO4 pretreated patients and 28 (6)% in controls (P < 0.05). Ten minutes after neostigmine, values were 24 (7)% and 22 (6)%. Maximum assisted recovery was not influenced by MgSO4 pretreatment (27 (6)% in group A and 32 (6)% in group B) and time to maximum effect was comparable between groups: 6 (4-10) min and 7 (5-8) min, respectively. We conclude that neostigmine-induced recovery was attenuated in patients treated with MgSO4. This was mainly a result of slower spontaneous recovery and not decreased response to neostigmine. C1 Univ Saarland, Dept Anaesthesia & Crit Care, D-66421 Homburg, Germany. Univ Hosp Geneva, Div Anaesthesia, CH-1211 Geneva, Switzerland. RP Fuchs-Buder, T (reprint author), Univ Saarland, Dept Anaesthesia & Crit Care, D-66421 Homburg, Germany. NR 26 TC 6 Z9 7 PU PROF SCI PUBL PI LONDON PA TAVISTOCK HOUSE EAST, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0007-0912 J9 BRIT J ANAESTH JI Br. J. Anaesth. PD JAN PY 1999 VL 82 IS 1 BP 61 EP 65 PG 5 WC Anesthesiology SC Anesthesiology GA 163BT UT WOS:000078382900014 ER PT J AU Lowry, DW Mirakhur, RK Carroll, MT McCarthy, GJ Hughes, DA O'Hare, RA AF Lowry, DW Mirakhur, RK Carroll, MT McCarthy, GJ Hughes, DA O'Hare, RA TI Potency and time course of mivacurium block during sevoflurane, isoflurane and intravenous anesthesia SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; NITROUS-OXIDE; INTUBATING CONDITIONS; HALOTHANE ANESTHESIA; DOSE TECHNIQUES; ATRACURIUM; SUXAMETHONIUM; STIMULATION; VECURONIUM; MAC AB Purpose: To determine the potency and time course of action of mivacurium neuromuscular block under routine clinical conditions during sevoflurane; isoflurane and intravenous anesthesia, Method: Patients were anesthetized with nitrous oxide 66% in oxygen and 1.5 MAC sevoflurane or isoflurane or a propofol infusion, neuromuscular block being monitored using mechanomyography. Potency was determined using administration of single doses of mivacurium of 40- 100 mu g.kg(-1) and construction of dose-response curves (n = 72). The onset and duration of action were determined following a bolus dose of 0.2 mg.kg(-1) of mivacurium (n 30), Results: The ED50 and ED95 (with 95% confidence limits) were estimated to be 42 (35-51)and 86 (74-98) mu g.kg(-1), 52 (45-60) and 89 (72-110) mu g.kg(-1), and 53:(45-62) and 95 (81-112) mu g.kg(-1) during sevoflurane, isoflurane and propofol anesthesia respectively (P < 0.05 between sevoflurane and propofol). Following administration of the 0.2 mg.kg(-1) dose, neither the times (mean +/- SD) to maximum block (1.6 +/- 0.31, 1.7 +/- 0.21 and 1.6 +/- 0.45 min, respectively) nor the times to 25 and 90% recovery of T-1 (20 +/- 4.5 and 33 +/- 8.8 min, 21 +/- 3.8 and 33 +/- 6.5 min, and 18 +/- 4.1 and 28 +/- 5.8 min respectively) were different among groups, The times to recovery of TOF ratio to 0.8 were 40 +/- 10.0, 36 +/- 8.5 and 29 +/- 5.5 min in the sevoflurane, isoflurane and propofol groups respectively (P = 0.017 between the sevoflurane and propofol groups). Conclusions: Under usual conditions of clinical anesthesia the potency of mivacurium was slightly enhanced during sevoflurane compared with intravenous anesthesia but the duration of action was only minimally prolonged during sevoflurane and isoflurane anesthesia. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. Belfast City Hosp Trust, Belfast, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 21 TC 11 Z9 13 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1999 VL 46 IS 1 BP 29 EP 33 PG 5 WC Anesthesiology SC Anesthesiology GA 170AM UT WOS:000078783000006 ER PT J AU Cheam, EWS Critchley, LAH Chui, PT Yap, JCM Ha, VWS AF Cheam, EWS Critchley, LAH Chui, PT Yap, JCM Ha, VWS TI Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article AB Purpose: To compare the efficacy of low dose (LD) mivacurium (0.08 mg.kg(-1)) with LD succinylchoiine (0.5 mg.kg(-1)) in modifying seizure activity during electroconvulsive therapy (ECT). Partial muscle relaxation is used in ECT to prevent violent muscle contractions. Current practice is to use LD succinylcholine which has several undesirable side effects. Method: Sixteen depressed, but otherwise healthy, patients, aged 27-67 yr were studied; In a randomized, double-blind, cross-over study either LD mivacurium or LD succinylcholine was given at consecutive ECTs 120 and 30 sec respectively before inducing ECT. Neuromuscular blockade following mivacurium was not reversed. Seizure modification was scored - 0 = no seizure activity, 1 = over-modified, 2 = desired level, 3 = under-modified, 4 = unmodified. Duration of seizures, time to first breath and adequate ventilation, ability to protrude tongue and sustain hand grip for five seconds were recorded. Paired t- tests and Wilcoxon matched pairs test were used to compare data. P < 0.05 was considered significant, Results: Seizure modification was better (mean (range)) after succinylchoiine 2.06(1-3) than after mivacurium 2.56(2-4) (P < 0.05). Mivacurium was unsatisfactory in eight cases compared with two cases after succinylcholine. The study was terminated early because of unsatisfactory seizure control. Clinical assessments of recovery from both relaxants were similar. Conclusion: Low dose mivacurium is unsuitable for use in ECT. C1 Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Shatin, NT, Peoples R China. RP Critchley, LAH (reprint author), Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Shatin, NT, Peoples R China. RI Critchley, Lester/J-9420-2013 NR 9 TC 12 Z9 12 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO, ONTARIO M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1999 VL 46 IS 1 BP 49 EP 51 PG 3 WC Anesthesiology SC Anesthesiology GA 170AM UT WOS:000078783000010 ER PT J AU Gibson, JK Haire, RG AF Gibson, JK Haire, RG TI Gas-phase chemistry of curium: Reactions of Cm+ and CmO+ with alkenes, acetonitrile, and hexafluoropropene SO JOURNAL OF PHYSICAL CHEMISTRY A LA English DT Article ID ORGANOMETALLIC CHEMISTRY; CYCLIC HYDROCARBONS; LANTHANIDE CATIONS; BOND ACTIVATION; OXO-LIGAND; METAL-IONS; C-H; REACTIVITY; BARE; FLUOROCARBONS AB The metal ions, Cm+, U+, and Tb+, and their oxides, MO+, were reacted in the gas phase with alkenes, acetonitrile, and hexafluoropropene. Product compositions and abundances provide a survey of essential aspects of the gas-phase chemistry of the curium cation, now the heaviest element for which such systematic studies have been carried out (U and Tb were included to provide comparisons). Of particular interest is the difference in behavior between the 4f lanthanide and 5f actinide series and variations in chemistry across the actinide series. The primary emphasis was on reactions with alkenes, particularly dehydrogenation, as indicative of the ability of a M+ to activate C-H bonds.(the extent of C-C activation was generally in parallel with that of C-H activation). With acetonitrile and all of the alkenes (except ethene), the three M+ ions induced dehydrogenation. Variations were evident for the different reactant substrates, but the overall qualitative ordering of dehydrogenation efficiency was U+ > Tb+ > Cm+. This order is consistent with the variation in electronic promotion energies (PE) required to provide two spin-unpaired, non-f valence electrons at the M+, i.e., a [Rg]f(n-2)d(1)s(1) configuration ("Rg" = Xe for the lanthanides and Rn for the actinides), Co enable its insertion into a C-H bond. The reduced reactivity of Cm+ relative to U+ and Tb+ suggests that the closed-shell 7s(2) electrons of ground Cm+ (S-8 [Rn]5f(7)s(2)) are ineffective in enabling C-H activation and that promotion to the D-10 [Rn]5f(7)6d(1)7s(1) configuration is prerequisite. The PE[Cm+] (48 kJ mol(-1)) is only slightly greater than PE[Tb+] (39 kJ mol(-1)) and the significantly greater reactivity of Tb+ vs Cm+ may reflect that the transition to the prepared "divalent" state (d(1)s(1)) is parity forbidden for Cm+. The three MO+ were substantially less reactive than the naked M+ but were comparably reactive to one another, consistent with a multicentered activation process, which is less efficient than direct cleavage of a C-H bond by M+ insertion. With hexafluoropropene, the primary reaction channel was F abstraction and the discrepant reactivities reflected the propensity for U to oxidize to higher valence states compared to Cm or Tb. The terminal MFn+ were. (CmF2+)-F-III, (TbF2+)-F-III, and (UF4+)-F-IV, and among the MO+, only UO+ induced F abstraction, producing UOFn+ with n = 1-3. C1 Oak Ridge Natl Lab, Div Chem & Analyt Sci, Oak Ridge, TN 37831 USA. RP Gibson, JK (reprint author), Oak Ridge Natl Lab, Div Chem & Analyt Sci, Oak Ridge, TN 37831 USA. EM gibsonjk@ornl.gov NR 39 TC 19 Z9 19 PU AMER CHEMICAL SOC PI WASHINGTON PA 1155 16TH ST, NW, WASHINGTON, DC 20036 USA SN 1089-5639 J9 J PHYS CHEM A JI J. Phys. Chem. A PD DEC 24 PY 1998 VL 102 IS 52 BP 10746 EP 10753 DI 10.1021/jp9836067 PG 8 WC Chemistry, Physical; Physics, Atomic, Molecular & Chemical SC Chemistry; Physics GA 153MT UT WOS:000077837400022 ER PT J AU Carroll, MT Mirakhur, RK Lowry, DW McCourt, KC Kerr, C AF Carroll, MT Mirakhur, RK Lowry, DW McCourt, KC Kerr, C TI Neuromuscular blocking effects and train-of-four fade with cisatracurium: comparison with other nondepolarising relaxants SO ANAESTHESIA LA English DT Article DE neuromuscular relaxants; cisatracurium, atracurium, mivacurium, vecuronium, rocuronium ID ANESTHESIA; 51W89; TUBOCURARINE; PANCURONIUM; ATRACURIUM; ONSET; PHARMACOLOGY; TRANSMISSION; FAILURE; DRUGS AB Neuromuscular blocking drugs exhibit different degrees of fade in response to train-of-four stimulation believed to represent their relative prejunctional effects. The present study was designed to compare the train-of-four fade after cisatracurium and compare this with other commonly used muscle relaxants. Train-of-four fade during onset and recovery of block were recorded after administration of cisatracurium 0.05 or 0.1 mg.kg(-1), atracurium 0.5 mg.kg(-1), vecuronium 0.08 mg.kg(-1), mivacurium 0.15 mg.kg(-1) or rocuronium 0.6 mg.kg(-1) to patients anaesthetised with fentanyl, nitrous oxide and a propofol infusion. Neuromuscular monitoring was by stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. The onset and recovery of block were also measured. Train-of-four fade during onset of block was greater with the lower dose of cisatracurium compared with the higher dose of cisatracurium and all other relaxants. Train-of-four fade during recovery was similar. The median times land ranges) for the onset of maximum block were 3.4 (2.1-5.6), 1.5 (1.2-2.3), 2.1 (1.2-2.6), 2.0 (1.5-2.7) and 1.0 (0.7-1.3) min for cisatracurium 0.1 mg.kg(-1) and atracurium, mivacurium, vecuronium and rocuronium, respectively The median times (and ranges) for the recovery of T-1 to 25% of control and to a Rain-of-four ratio of 0.8 were 41 (21-50) and 65 (40-78); 43 (37-54) and 69 (58-79); 15 (11-20) and 25 (19-30); 31 (23-46) and 60 (45-117); and 33 (18-57) and 50 (28-76) min following cisatracurium, 0.1 mg.kg(-1), atracurium, mivacurium, vecuronium and recuronium, respectively. C1 Queens Univ Belfast, Dept Anaesthet, Belfast BT9 7BL, Antrim, North Ireland. Royal Grp Hosp, Belfast, Antrim, North Ireland. RP Mirakhur, RK (reprint author), Queens Univ Belfast, Dept Anaesthet, Whitla Med Bldg,97 Lisburn Rd, Belfast BT9 7BL, Antrim, North Ireland. NR 17 TC 13 Z9 16 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD DEC PY 1998 VL 53 IS 12 BP 1169 EP 1173 DI 10.1046/j.1365-2044.1998.00616.x PG 5 WC Anesthesiology SC Anesthesiology GA 153TD UT WOS:000077848000007 ER PT J AU Mazurek, AJ Rae, B Hann, S Kim, JI Castro, B Cote, CJ AF Mazurek, AJ Rae, B Hann, S Kim, JI Castro, B Cote, CJ TI Rocuronium versus succinylcholine: Are they equally effective during rapid-sequence induction of anesthesia? SO ANESTHESIA AND ANALGESIA LA English DT Article ID INTUBATING CONDITIONS; TRACHEAL INTUBATION; MALIGNANT HYPERTHERMIA; NEUROMUSCULAR BLOCK; CHILDREN; SUXAMETHONIUM; ORG-9426; DESATURATION; VECURONIUM; INFANTS AB The purpose of our study was to assess the onset and quality of muscle paralysis and intubation conditions with succinylcholine (Sch) or rocuronium (Roc) during rapid-sequence induction. Patients were randomly assigned to receive thiopental (5 mg/kg) and Sch (1.5 mg/kg) or thiopental (5 mg/kg) and Roc (1.2 mg/kg). The anesthesiologists performing the endotracheal intubation were blinded by standing with their back to the patient. Thirty seconds after drug administration, laryngoscopy was performed. Intubating conditions were scored, the clinical onset of apnea was noted, and a train-of-four monitor recorded data. All patients were ASA physical status I-III and scheduled for emergency procedures; both groups were demographically similar. Thirteen patients received Roc and 13 received Sch. There was no significant difference between the two groups in the number of patients receiving excellent intubating scores (P = 0.41) or in the combined number of patients receiving good and excellent scores (P = 1.0). There was no significant difference in time of onset of apnea for Sch (22 +/- 13 s) versus Roc (16 +/- 8 s). The return of the first twitch response was significantly faster with Sch(5.05 +/- 2.5 min) compared with Roc (173 +/- 21.7 min) (P = 0.0001). Implications: Ln pediatric patients scheduled for emergency surgery, thiopental 5 mg/kg and rocuronium 1.2 mg/kg provided conditions for the completion of intubation in <60 s comparable to those provided by thiopental 5 mg/kg and succinylcholine 15 mg/kg. We conclude that rocuronium is a reasonable substitute for succinylcholine in children for rapid-sequence intubation when a rapid return to spontaneous respiration is not desired. C1 Childrens Mem Hosp, Dept Anesthesiol, Chicago, IL 60614 USA. Northwestern Univ, Sch Med, Chicago, IL 60611 USA. RP Mazurek, AJ (reprint author), Childrens Mem Hosp, Dept Anesthesiol, 2300 Childrens Plaza, Chicago, IL 60614 USA. NR 27 TC 36 Z9 37 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1998 VL 87 IS 6 BP 1259 EP 1262 DI 10.1097/00000539-199812000-00009 PG 4 WC Anesthesiology SC Anesthesiology GA 142AP UT WOS:000077178000009 ER PT J AU Wyon, N Joensen, H Yamamoto, Y Lindahl, SGE Eriksson, LI AF Wyon, N Joensen, H Yamamoto, Y Lindahl, SGE Eriksson, LI TI Carotid body chemoreceptor function is impaired by vecuronium during hypoxia SO ANESTHESIOLOGY LA English DT Article DE carotid body; hypoxemia; neuromuscular blocking agent; respiration; vecuronium ID PARTIAL NEUROMUSCULAR BLOCK; VENTILATORY RESPONSE; CAT; RABBIT; DOPAMINE AB Background Neuromuscular blocking agents reduce the human ventilatory response to hypoxia at partial neuromuscular block It was hypothesized that vecuronium impairs carotid body chemoreceptor function during hypoxia, Method The effect of systemic administration of vecuronium on single chemoreceptor activity during hypoxia, as recorded from a single nerve fiber preparation of the carotid sinus nerve, was studied in seven mechanically ventilated New Zealand White rabbits during continuous thiopental anesthesia. During normoventilation, the isocapnic hypoxic chemosensitivity of the single carotid body chemoreceptor was measured at four levels of oxygenation; these measurements were repeated at six separate occasions: control recording before injection, after intravenous administrations of 0.1 mg and 0.5 mg of vecuronium, and then at three occasions during a 90-mm recovery period. Chemoreceptor chemosensitivity during isocapnic hypoxia was expressed as a hyperbolic function: Chemoreceptor output (Hz) = a + b x Pa-O2(-1) (mmHg). Results: Chemosensitivity was reduced after both 0.1 mg and 0.5 mg vecuronium intravenous administration compared with control measurements; the hypoxic response curve was significantly depressed after both doses (P < 0.05), Notably, there was variation in the effect of vecuronium; some chemoreceptor preparations showed only minimal impairment, whereas some showed an almost abolished response to hypoxia. The chemosensitivity remained significantly depressed at 30 and 60 min but had recovered spontaneously at 90 min after 0.5 mg vecuronium, Discussion: It is concluded that vecuronium depresses carotid body chemoreceptor function to a varying extent during hypoxia and that the depression recovers spontaneously. C1 Karolinska Hosp & Inst, Dept Anesthesiol & Intens Care, S-17176 Stockholm, Sweden. Karolinska Inst, Nobel Inst Neurophysiol, S-10401 Stockholm, Sweden. RP Eriksson, LI (reprint author), Karolinska Hosp & Inst, Dept Anesthesiol & Intens Care, S-17176 Stockholm, Sweden. EM alie@kir.ks.se NR 17 TC 25 Z9 25 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 1998 VL 89 IS 6 BP 1471 EP 1479 DI 10.1097/00000542-199812000-00025 PG 9 WC Anesthesiology SC Anesthesiology GA 145MU UT WOS:000077376100024 ER PT J AU Ross, AK Dear, GD Dear, RB Margolis, JO Ginsberg, B AF Ross, AK Dear, GD Dear, RB Margolis, JO Ginsberg, B TI Onset and recovery of neuromuscular blockade after two doses of rocuronium in children SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE anesthesia; pediatric muscle relaxants; rocuronium ID HALOTHANE ANESTHESIA; TIME-COURSE; VECURONIUM; ATRACURIUM; PHARMACOKINETICS; PHARMACODYNAMICS; STIMULATION; INFANTS; BROMIDE AB Study Objective: To determine if 450 mu g/kg (1.5 times the ED95) of rocuronium would result in a comparable onset with a shorter duration of action when compared with 600 mu g/kg (2 times the ED95). Design: Randomized single-blind study. Setting: Teaching hospital. Patients: 85 ASA physical status I and II children ages 2 through 12, undergoing elective surgery with an inhalation induction using halothane. Interventions: Group received 600 mu g/kg rocuronium, and Group 2 received 450 mu g/kg rocuronium. Measurements and Main Results: The two groups were compared using a Student's t-test, with p < 0.05 significant. The time of onset, or time to 95% suppression of neuromuscular twitch with standard errors, was 140 +/- 13 seconds (range 46 to 365 sec) in Group 1 and 148 +/- 13 seconds (range 82 to 345 sec) in Group 2(NS = not significant). The times to 25% return of twitch fi om baseline (T-25) In Groups 1 and 2 were 28 +/- 1.5 minutes (range 14 to 45 min) and 25 +/- 1.6 minutes (range 10 to 55 min), respectively (NS). The differences between these two doses in onset of and recovery from, block were not found to be statistically significant. The results, however, excluded 5% of the higher dose group and 31% of the lower close group who did not achieve 95% suppression of twitch. rime to maximal suppression of neuromuscular blockade, however, was not statistically significant for the 85 patients with a ti,ne of 270 +/- 28 seconds (range 91 to 605 sec) with a mean maximal suppression of 98.7% In Group 1 and 313 +/- 25 seconds (range 91 to 899 sec) with a mean maximal suppression of 93.1% in Group 2. Conclusion: The two doses of rocuronium did not differ statistically in onset or duration. Rocuronium at 600 mu g/kg offers more reliability than 450 mu g/kg. in achieving adequate muscle relaxation, and the lower dose may result in a significantly large number of patients who may have inadequate intubating conditions. (C) 1998 by Elsevier Science Inc. C1 Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA. RP Ross, AK (reprint author), Duke Univ, Med Ctr, Dept Anesthesiol, Box 3094, Durham, NC 27710 USA. NR 17 TC 2 Z9 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD DEC PY 1998 VL 10 IS 8 BP 631 EP 635 DI 10.1016/S0952-8180(98)00098-1 PG 5 WC Anesthesiology SC Anesthesiology GA 150JR UT WOS:000077662200003 ER PT J AU Nijs, N Duvaldestin, P Slavov, V Dhonneur, G AF Nijs, N Duvaldestin, P Slavov, V Dhonneur, G TI Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity? SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE neuromuscular relaxants; monitoring; pharmacodynamics; tourniquet; mivacurium; atracurium; vecuronium ID INDUCED NEUROMUSCULAR BLOCKADE; PHARMACOKINETICS; PHARMACODYNAMICS AB Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg kg(-1) mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg kg(-1) atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg kg(-1) vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase. C1 Hop Henri Mondor, SAR, Dept Anaesthesia, F-94010 Creteil, France. RP Nijs, N (reprint author), Hop Henri Mondor, SAR, Dept Anaesthesia, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France. NR 13 TC 8 Z9 8 PU MUNKSGAARD INT PUBL LTD PI COPENHAGEN PA 35 NORRE SOGADE, PO BOX 2148, DK-1016 COPENHAGEN, DENMARK SN 0001-5172 J9 ACTA ANAESTH SCAND JI Acta Anaesthesiol. Scand. PD NOV PY 1998 VL 42 IS 10 BP 1175 EP 1179 PG 5 WC Anesthesiology SC Anesthesiology GA 140LV UT WOS:000077089500009 ER EF