FN Thomson Reuters Web of Science™ VR 1.0 PT J AU DHONNEUR, G DUVALDESTIN, P SLAVOV, V MERLE, JC AF DHONNEUR, G DUVALDESTIN, P SLAVOV, V MERLE, JC TI THE INFLUENCE OF AGING ON THE PHARMACODYNAMICS OF MIVACURIUM CHLORIDE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article; Proceedings Paper CT Symposium on Benzylisoquinolinium Muscle Relaxants - Innovations and Issues CY JAN 14-16, 1994 CL GENEVA, SWITZERLAND SP Wellcome Fdn Ltd ID PHARMACOKINETICS C1 HOP HENRI MONDOR,F-94000 CRETEIL,FRANCE. NR 4 TC 0 Z9 0 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. PY 1995 VL 39 SU 106 BP 45 EP 46 PG 2 WC Anesthesiology SC Anesthesiology GA RX691 UT WOS:A1995RX69100011 ER PT J AU JONES, RM AF JONES, RM TI MIVACURIUM IN SPECIAL PATIENT GROUPS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article; Proceedings Paper CT Symposium on Benzylisoquinolinium Muscle Relaxants - Innovations and Issues CY JAN 14-16, 1994 CL GENEVA, SWITZERLAND SP Wellcome Fdn Ltd DE COEXISTING DISEASE, RENAL FAILURE, HEPATIC FAILURE; NEUROMUSCULAR RELAXANTS, MIVACURIUM; PATIENT GROUPS, NEONATES, INFANTS, CHILDREN, ELDERLY ID INDUCED NEUROMUSCULAR BLOCKADE; OXIDE ISOFLURANE ANESTHESIA; DOSE-RESPONSE RELATIONSHIPS; CHLORIDE BW B1090U; NITROUS-OXIDE; HALOTHANE ANESTHESIA; D-TUBOCURARINE; RENAL-FUNCTION; NEOSTIGMINE ANTAGONISM; NARCOTIC ANESTHESIA AB In special patient groups, drug response may be different from that in the healthy adult patient. Mivacurium dose requirements vary with age, and children require larger doses to obtain any given degree of block, but the elderly often require smaller doses. However, the dose requirements of the neonate do not necessarily differ greatly from those of the adult. There is a relationship between the duration of action of a bolus dose - as well as infusion requirements to maintain block - and the plasma cholinesterase activity. Patients with renal disease may have a decreased cholinesterase activity and may require smaller doses of mivacurium. Patients with severe Liver disease may have a marked decrease in cholinesterase activity, and in these patients a substantially smaller dose of the drug may be needed to obtain and maintain any given degree of block. If the variation in dose requirements is kept in mind and the degree of block appropriately monitored, mivacurium may be used with safety in special patient groups, such as children, the elderly, or those with renal or hepatic impairment. RP JONES, RM (reprint author), ST MARYS HOSP,SCH MED,DEPT ANAESTHET,LONDON W2 1NY,ENGLAND. NR 57 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. PY 1995 VL 39 SU 106 BP 47 EP 54 PG 8 WC Anesthesiology SC Anesthesiology GA RX691 UT WOS:A1995RX69100012 ER PT J AU APFELBAUM, JL AF APFELBAUM, JL TI MIVACURIUM CHLORIDE ADMINISTRATION BY INFUSION SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article; Proceedings Paper CT Symposium on Benzylisoquinolinium Muscle Relaxants - Innovations and Issues CY JAN 14-16, 1994 CL GENEVA, SWITZERLAND SP Wellcome Fdn Ltd DE ATRACURIUM; INFUSION; MIVACURIUM; RECOVERY; TITRATION AB As a consequence of its rapid hydrolysis by plasma cholinesterase, mivacurium has a short duration of action, and recovery from neuromuscular blockade is rapid (5-95% twitch recovery = 13-15 min). Mivacurium is easy to titrate to individual patient requirements; the average infusion rate to maintain neuromuscular blockade at 89-99% twitch suppression during N2O/opioid anaesthesia is 6-7 mu g/kg per min in adults and approximately 14 mu g/kg per min in children. There is no evidence of a cumulative effect of mivacurium; recovery is unaffected by dose administered or duration of infusion. These characteristics make mivacurium a very suitable agent for use by infusion. RP APFELBAUM, JL (reprint author), UNIV CHICAGO HOSP,DEPT ANESTHESIA & CRIT CARE,5841 S MARYLAND AVE MC4028,CHICAGO,IL 60637, USA. NR 1 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. PY 1995 VL 39 SU 106 BP 55 EP 57 PG 3 WC Anesthesiology SC Anesthesiology GA RX691 UT WOS:A1995RX69100013 ER PT J AU TREVIEN, V LIENHART, A JUST, B CHANDON, M BARAS, E CAMATTE, S AF TREVIEN, V LIENHART, A JUST, B CHANDON, M BARAS, E CAMATTE, S TI EFFECT OF NEOSTIGMINE AT DIFFERENT LEVELS OF MIVACURIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article; Proceedings Paper CT Symposium on Benzylisoquinolinium Muscle Relaxants - Innovations and Issues CY JAN 14-16, 1994 CL GENEVA, SWITZERLAND SP Wellcome Fdn Ltd DE ANTAGONISTS; MIVACURIUM; MONITORING; NEOSTIGMINE; NEUROMUSCULAR FUNCTION ID ADDUCTOR POLLICIS MUSCLES; CHLORIDE BW B1090U; CLINICAL-PHARMACOLOGY; ORBICULARIS OCULI; ATRACURIUM; VECURONIUM; EDROPHONIUM; ANTAGONISM; SUCCINYLCHOLINE; ANESTHESIA AB The effectiveness of neostigmine 40 mu g/kg for antagonism of two different levels of neuromuscular blockade, induced by a bolus dose of mivacurium 0.15 mg/kg. was studied in 45 patients. The patients were anaesthetized with thiopentone, fentanyl, nitrous oxide in oxygen, and enflurane. Neostigmine was administered at either 10% recovery of the twitch height (TH10) at the adductor pollicis muscle (n=14) or upon reappearance of the first response at the orbicularis oculi muscle (OO1) after train-of-four (TOF) stimulation (n=16), the latter representing a deeper degree of neuromuscular blockade. Fifteen of the 45 patients did not receive neostigmine (control group). Neostigmine administration at OO1 rather than at TH10 at the adductor pollicis muscle caused reversal of neuromuscular blockade to occur 8 min earlier and shortened the time to reach 25% recovery of the twitch height (TH25) at the adductor pollicis muscle by about 5 min, compared with the control group. However, the time needed to reach a T4/T1 ratio greater than or equal to 0.8 was similar in both the early and late neostigmine administration groups, being 9 min faster than in the control group. It can be concluded that there is no advantage in administering neostigmine al profound neuromuscular blockade to achieve clinically adequate recovery (T4/T1 ratio greater than or equal to 0.8). However, the time between injection of mivacurium and TH25 may be shortened by using neostigmine at profound neuromuscular blockade, a procedure which may be useful in case of unpredictably difficult intubation, since diaphragmatic movements usually reappear at TH25. C1 LABS WELLCOME,PARIS,FRANCE. RP TREVIEN, V (reprint author), HOP ST ANTOINE,DEPT ANESTHESIE REANIMAT,184 RUE FAUBOURG ST ANTOINE,F-75012 PARIS,FRANCE. NR 21 TC 4 Z9 4 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. PY 1995 VL 39 SU 106 BP 66 EP 69 PG 4 WC Anesthesiology SC Anesthesiology GA RX691 UT WOS:A1995RX69100016 ER PT J AU MELLINGHOFF, H DIEFENBACH, C BUZELLO, W AF MELLINGHOFF, H DIEFENBACH, C BUZELLO, W TI ADMINISTRATION OF 51W89 BY INFUSION A COMPARISON WITH ATRACURIUM - PRELIMINARY COMMUNICATION SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article; Proceedings Paper CT Symposium on Benzylisoquinolinium Muscle Relaxants - Innovations and Issues CY JAN 14-16, 1994 CL GENEVA, SWITZERLAND SP Wellcome Fdn Ltd RP MELLINGHOFF, H (reprint author), UNIV COLOGNE,INST ANASTHESIOL,COLOGNE,GERMANY. NR 2 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. PY 1995 VL 39 SU 106 BP 95 EP 95 PG 1 WC Anesthesiology SC Anesthesiology GA RX691 UT WOS:A1995RX69100021 ER PT J AU ROUSSEAU, JM LEMARDELEY, P GIRAUD, D LEMARIE, J LADAGNOUS, JF BARRIOT, P PITTI, R AF ROUSSEAU, JM LEMARDELEY, P GIRAUD, D LEMARIE, J LADAGNOUS, JF BARRIOT, P PITTI, R TI ENDOTRACHEAL INTUBATION UNDER PROPOFOL, ASSOCIATED OR NOT WITH VECURONIUM SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE ENDOTRACHEAL; INTUBATION; PROPOFOL; VECURONIUM AB Objective: In order to test the hypothesis that under the association propofol-alfentanil-IV lidocaine the trachea could be intubated easily without an additional muscle relaxant, this study compared the intubation conditions when this association was combined or not with vecuronium. Study design: Randomized comparative trial. Patients: The study included 152 young adults classified as ASA physical class I and Mallampati presentation grade 1, randomly allocated either into Vecu+ group or Vecu0 group, depending on whether vecuronium was coadministered or not. Methods: All patients received midazolam 0.05 mg . kg(-1) i.v., one minute before induction. Those of group Vecu0 were given successively within two minutes: alfentanil 0.03 mg . kg(-1), lidocaine 1.5 mg . kg(-1) i.v. and propofol 2.5 mg . kg(-1). Patients of group Vecu+ received similar doses of alfentanil and propofol as well as vecuronium 0.08 mg . kg(-1). The endotracheal tube was inserted one minute after induction in the patients of Vecu0 group, and after three minutes in those of the Vecu+ group. During intubation, scores of mouth opening, glottis opening and coughing were established, in order to assess intubation conditions. Results: Similar convenient intubating conditions were obtained in both groups (in 97 % of patients in Vecu+ group vs 95 % of those in Vecu0 group). In the latter, the glottis opening was less pronounced. Conclusions: In young healthy adults, without anaesthetic risk (emergency, full stomach) and without foreseen difficult intubation, the endotracheal tube can be inserted in convenient conditions without a muscle relaxant, under the association propofol-alfentanil-lidocaine iv. RP ROUSSEAU, JM (reprint author), HIA LEGOUEST,DEPT ANESTHESIE REANIMAT,BP 10,F-57998 METZ ARMEES,FRANCE. NR 0 TC 3 Z9 3 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1995 VL 14 IS 3 BP 261 EP 264 DI 10.1016/S0750-7658(95)80004-2 PG 4 WC Anesthesiology SC Anesthesiology GA RJ594 UT WOS:A1995RJ59400004 ER PT J AU Pellissier, D Bruder, N Mokart, D Quilichini, D Camatte, S Blache, JL Francois, G AF Pellissier, D Bruder, N Mokart, D Quilichini, D Camatte, S Blache, JL Francois, G TI Mivacurium in continuous infusion for short procedures. Delays of onset and recovery from neuromuscular blockade SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE mivacurium; continuous infusion; neuromuscular blockade ID NITROUS-OXIDE FENTANYL; DOSE-RESPONSE RELATIONSHIP; SHORT SURGICAL-PROCEDURES; ENFLURANE ANESTHESIA; INTUBATING CONDITIONS; CHLORIDE BW-B1090U; ATRACURIUM; SUCCINYLCHOLINE; SUXAMETHONIUM; PHARMACOLOGY AB Objective: To assess the delays of onset and spontaneous recovery from neuromuscular block produced by univacurium administered by continuous infusion for short procedure requiring a deep relaxation. Study design :Prospective open non comparative study. Patients: Twenty-nine class ASA I and II adults undergoing a stomatological procedure of short duration were included in the study. Method :General anaesthesia was obtained with a continuous infusion of propofol, supplemented with alfentanil and N2O-O-2 mixture. Neuromuscular blockade, assessed with electromyography of the adductor pollicis muscle, was obtained with mivacurium (150 mu g . kg(-1)). After restoration of 5% of neuromuscular transmission, mivacurium was administered by continuous infusion in order to maintain a blockade between 91 and 99%. Results : The delay for decreasing twitch height by 95% was 2.9 +/- 1.0 min. The mean dose for maintenance of blockade was 10.9 +/- 1.5 mu g . kg(-1). min(-1). The delay of spontaneous recovery from blockade was 10.2 min, 16.6 min and 21.3 min for obtaining 25, 75 and 95% twitchs respectively. The delay for the twitch increase hom 25 to 75% was 6.6 min. Discussion : Mivacurium in continuous infusion provides rapidly a deep and stable neuromuscular blockade followed by a rapid spontaneous restoration of neuromuscular transmission in patients with normal pseudocholinesterases. RP Pellissier, D (reprint author), HOP TIMONE ADULTES,DEPT ANESTHESIE REANIMAT CHIRURG,BLVD JEAN MOULIN,F-13385 MARSEILLE 05,FRANCE. NR 29 TC 4 Z9 4 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1995 VL 14 IS 6 BP 467 EP 471 DI 10.1016/S0750-7658(05)80486-1 PG 5 WC Anesthesiology SC Anesthesiology GA TT220 UT WOS:A1995TT22000004 ER PT J AU Viggiano, M Soler, C Dumont, JC Pellissier, D Francois, G AF Viggiano, M Soler, C Dumont, JC Pellissier, D Francois, G TI Prolonged neuromuscular block following mivacurium SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE mivacurium; prolonged neuromuscular block; plasma cholinesterase deficiency ID PLASMA CHOLINESTERASE AB Mivacurium, a new short acting non depolarizing neurornuscular blocker, is metabolized, as suxamethonium, by plasma cholinesterase, Therefore its duration of action is increased in patients with reduced plasma cholinesterase activity. We report a case of prolonged neuromuscular block after an i.v. bolus of mivacurium (0,20 mg . k(-1)) in a 69 year-old ASA II woman with an unrecognized cholinesterase deficiency undergoing a lumbar sympathectomy for arteriopathy of the lower limbs, The duration of the block was 6 h and plasma cholinesterase concentrations were very low (54% and 610 UI . L(-1)), as well as the dibucaine number (16%), which suggests an homozygous enzymatic deficiency, Mechanical ventilation and sedation were continued until spontaneous return of full neuromuscular function. C1 CHU TIMONE,DEPT ANESTHESIE REANIMAT,F-13385 MARSEILLE 5,FRANCE. NR 12 TC 9 Z9 9 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1995 VL 14 IS 6 BP 502 EP 504 DI 10.1016/S0750-7658(05)80491-5 PG 3 WC Anesthesiology SC Anesthesiology GA TT220 UT WOS:A1995TT22000009 ER PT J AU Kaiser, E Petit, D Quinot, JF Suppini, A Sallaberry, M AF Kaiser, E Petit, D Quinot, JF Suppini, A Sallaberry, M TI Prolonged neuromuscular block after mivacurium from plasma pseudocholinesterases deficiency SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE mivacurium; prolonged neuromuscular block; plasma cholinesterase deficiency ID CHLORIDE BW B1090U; CHOLINESTERASE; PHARMACOLOGY AB Mivacurinm is a new neuromuscular blocking agent with a short acting time of about 30 min, due to a fast hydrolysis by pseudocholinesterases. This metabolism carries a risk for prolonged neuromuscular block in case of an acquired or congenital pseudocholinesterase deficiency, We report the case of a 75-year-old woman who experienced a neuromuscular block prolonged for 10 h after a single dose of 0.35 mg . kg(-1) of mivacurium, because of a major pseudocholinesterase (1800 UI . L(-1), normal value: 5400-13200 UI . L(-1)). The likely cause was a congenital deficiency by a homozygote genetic mutation, as usual causes of an acquired deficiency had been eliminated. RP Kaiser, E (reprint author), HOP INSTRUCT ARMEES ST ANNE,DEPT ANESTHESIE REANIMAT CTR BRULES,BLVD ST ANNE,F-83800 TOULON,FRANCE. NR 18 TC 8 Z9 8 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1995 VL 14 IS 6 BP 505 EP 507 DI 10.1016/S0750-7658(05)80492-7 PG 3 WC Anesthesiology SC Anesthesiology GA TT220 UT WOS:A1995TT22000010 ER PT J AU Vigouroux, D Voltaire, L AF Vigouroux, D Voltaire, L TI Prolonged neuromuscular block after mivacurium in a patient treated with cyclophosphamide SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE mivacurium; prolonged neuromuscular block; plasma cholinesterase deficiency ID CHOLINESTERASE; CHLORIDE; PLASMA AB A case is reported of prolonged neuromuscular block after mivacurium chloride for laparoscopic cholecystectomy, in a 45 years old patient, treated,vith cyclophosphamide for a Wegener's granulomatosis. The neuromuscular function monitoring by train-of-four sho wed a duration of action of 75 min after an intubation dose of 0.20 mg . kg(-1). Additional bolus of 1 mg, corresponding to 25% of usual doses, every 10 or 15 min, were sufficient for maintaining muscle relaxation. Spontaneous recovery, without any antagonization, lasted 40 min for a TOF ratio (T4/T1) greater than or equal to 70%, Recovery index from 25 to 75% were 13 min. Plasma butyrilcholinesterases activity were reduced to a level of 50%. With reference to litterature about succinylcholine, the responsability of cyclophosphamide is likely, and discussed. This observation shows the value of monitoring the neuromuscular transmission. RP Vigouroux, D (reprint author), CHR RANGUEIL,SERV ANESTHESIE URGENCES & REANIMAT,F-31054 TOULOUSE,FRANCE. NR 9 TC 9 Z9 10 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1995 VL 14 IS 6 BP 508 EP 510 DI 10.1016/S0750-7658(05)80493-9 PG 3 WC Anesthesiology SC Anesthesiology GA TT220 UT WOS:A1995TT22000011 ER PT J AU Avargues, P Cros, AM Dardel, E Darriet, M Biteau, N AF Avargues, P Cros, AM Dardel, E Darriet, M Biteau, N TI Value of muscle relaxant action monitoring in prolonged mivacurium induced neuromuscular blockade SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article DE mivacurium; prolonged neuromuscular blockade; monitoring; pseudocholinesterase ID PLASMA CHOLINESTERASE AB A case of neuromuscular blockade of about 200 min of duration, in a 9-year-old boy from mivacurium 0.15 mg . kg(-1) is reported, The diagnosis was delayed, after onset of the first signs of recovery, due to the lack of monitoring of neuromuscular transmission, The neuromuscular blockade was reversed with neostigmine 0.04 mg . kg(-1). Complete reversal required fifty minutes, The presence of an abnormal genetic variant of pseudocholinesterases was demonstrated by the measurements of pseudocholinesterase activity and dibucaine number, The importance of monitoring of neuromuscular transmission for diagnosis and treatment of mivacurium-induced neuromuscular blockade is underlined. C1 HOP PELLEGRIN ENFANTS,DEPT ANESTHESIE REANIMAT 4,F-33076 BORDEAUX,FRANCE. NR 16 TC 9 Z9 9 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1995 VL 14 IS 6 BP 511 EP 513 DI 10.1016/S0750-7658(05)80494-0 PG 3 WC Anesthesiology SC Anesthesiology GA TT220 UT WOS:A1995TT22000012 ER PT J AU MERETOJA, OA TAIVAINEN, T WIRTAVUORI, K AF MERETOJA, OA TAIVAINEN, T WIRTAVUORI, K TI PHARMACODYNAMIC EFFECTS OF 51W89, AN ISOMER OF ATRACURIUM, IN CHILDREN DURING HALOTHANE ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, ATRACURIUM; NEUROMUSCULAR BLOCK, 51W89; PHARMACODYNAMICS; PHARMACOKINETICS, STEREOISOMERS; CHILDREN ID DOSE-RESPONSE; PEDIATRIC-PATIENTS; ANESTHESIA; NEOSTIGMINE; MIVACURIUM; VECURONIUM; INFUSION; RECOVERY; PROFILE AB 51W89 is one of the 10 stereoisomers of atracurium with less propensity to release histamine than atracurium. We evaluated dose-response data and neuromuscular effects of 2 x ED(95) dose and maintenance doses of 51W89 during halothane anaesthesia in 68 children, 2-12 yr old. Neuromuscular function was monitored by evoked adductor pollicis EMG. Log-probit, single-dose, dose-response data gave ED(50) and ED(95) values of 23 and 41 mu g kg(-1), respectively, for 51W89. Twice the ED(95) dose (80 mu g kg(-1)) had an onset time (time from administration to maximum effect) of 2.5 (SD 0.8) min, a clinical duration (time to 25% EMG recovery) of 31 (7) min and a recovery index (time from 25 to 75% EMG recovery) of 11.1 (1.7) min. Seventy-nine incremental doses of 51W89 of 0.5 x ED(95) dose were given in 16 children at 85-90% neuromuscular block. The mean duration of these doses was 13.4 (3) min, with a calculated hourly maintenance requirement of 51W89 of 94 (19) mu g kg(-1). Duration of effect of incremental doses remained constant within individuals reflecting non-cumulative properties. There were insignificant changes in arterial pressure and heart rate after 51W89 and no side effects were observed. We regard 51W89 as a promising, non-cumulative, intermediate-acting neuromuscular blocking agent the effects of which can be antagonized easily by neostigmine. RP MERETOJA, OA (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIOL,STENBACKINKATU 11,SF-00290 HELSINKI,FINLAND. NR 20 TC 26 Z9 34 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 1995 VL 74 IS 1 BP 6 EP 11 DI 10.1093/bja/74.1.6 PG 6 WC Anesthesiology SC Anesthesiology GA QB730 UT WOS:A1995QB73000003 ER PT J AU BAURAIN, MJ DERNOVOI, BS DHOLLANDER, AA HENNART, DA CANTRAINE, FR AF BAURAIN, MJ DERNOVOI, BS DHOLLANDER, AA HENNART, DA CANTRAINE, FR TI LOW AND HIGH-FREQUENCY STIMULATION TESTS TO CHARACTERIZE THE EFFECTS OF EDROPHONIUM ON VECURONIUM-INDUCED NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, VECURONIUM; ANTAGONISTS NEUROMUSCULAR BLOCK, EDROPHONIUM; NEUROMUSCULAR BLOCK, MEASUREMENT OF RESPONSE; NEUROMUSCULAR BLOCK, ANTAGONISM ID DOSE-RESPONSE RELATIONSHIPS; NEOSTIGMINE; ANTAGONISM; ATRACURIUM; PANCURONIUM; RECOVERY; ISOFLURANE; REVERSAL; PYRIDOSTIGMINE; ANESTHESIA AB We recorded adductor pollicis mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation 15 min after edrophonium 250, 500 and 1000 mu g kg(-1), given to antagonize vecuronium-induced block at 10, 25 and 50% pre-reversal twitch height. We studied 54 ASA class I and II anaesthetized (methohexitone, fentanyl, nitrous oxide) young adult patients allocated randomly to nine groups of six patients each. The greater sensitivity of train-of four (TOF) ratio and residual force after 100-Hz, 5-s tetanic stimulation (RF100) to residual deficit allowed discrimination more readily between the effects of edrophonium dose and pre-reversal twitch height (P < 0.001, two-way analysis of variance). The highest reversal scores (approximately 0.9 TOF ratio and 0.6 RF100) were obtained when edrophonium 500-1000 mg kg(-1) was given at 50% twitch height (P < 0.05, Duncan's test). C1 ERASME UNIV HOSP,DEPT ANAESTHESIOL,B-1070 BRUSSELS,BELGIUM. UNIV HOSP BRUGMANN,DEPT ANAESTHESIOL,BRUSSELS,BELGIUM. FREE UNIV BRUSSELS,DEPT COMP SCI,BRUSSELS,BELGIUM. NR 30 TC 7 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 1995 VL 74 IS 1 BP 12 EP 15 DI 10.1093/bja/74.1.12 PG 4 WC Anesthesiology SC Anesthesiology GA QB730 UT WOS:A1995QB73000004 ER PT J AU ELMIKATTI, N WILSON, A POLLARD, BJ HEALY, TEJ AF ELMIKATTI, N WILSON, A POLLARD, BJ HEALY, TEJ TI PULMONARY-FUNCTION AND HEAD LIFT DURING SPONTANEOUS-RECOVERY FROM PIPECURONIUM NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, PIPECURONIUM; NEUROMUSCULAR BLOCK, MEASUREMENT OF RESPONSE; MEASUREMENT TECHNIQUES, ELECTROMYOGRAPHY; LUNG, FUNCTION ID TRANSMISSION; VECURONIUM; HUMANS AB We have studied in seven healthy conscious volunteers the correlation between the electromyographic (EMG) and clinical criteria used to identify adequate recovery from sub-paralysing doses of pipecuronium. Pipecuronium (mean dose 1.88 (range 0.92-3.16) mg) was administered to reach a T4/T1 ratio of 0.5; full recovery to 1.0 was produced in a mean time of 25.3 (14-39) min. During recovery from neuromuscular block, we measured tidal volume, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)) negative inspiratory pressure (NIP), peak expiratory flow rate (PEFR), mid-expiratory flow rate (MEFR) and 5-s head lift. The assessments were started when the train-of-four (TOF) ratio reached 0.5 +/- 0.001 and repeated at each 0.1 +/- 0.001 increase up to a ratio of 1.0. All volunteers showed ptosis and diplopia after the first dose and difficulty in swallowing with subsequent doses. They also experienced a pleasant, relaxing sedative sensation. All could sustain head lift for 5 s at a TOF ratio of 0.5 and higher, except for one subject who could not lift his head only at a ratio of 0.5. There was a statistically significant decrease in FVC, FEV(1) and PEFR with a nonsignificant decrease in other pulmonary measurements, except for NIP which only decreased significantly at a ratio of 0.5. These changes are probably of no clinical importance. All the measured respiratory variables returned to control values at a TOF ratio of 0.9. C1 MANCHESTER ROYAL INFIRM,MANCHESTER M13 9WL,LANCS,ENGLAND. NR 19 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 JAN PY 1995 VL 74 IS 1 BP 16 EP 19 DI 10.1093/bja/74.1.16 PG 4 WC Anesthesiology SC Anesthesiology GA QB730 UT WOS:A1995QB73000005 ER PT J AU ABDULATIF, M AF ABDULATIF, M TI RECOVERY CHARACTERISTICS AFTER EARLY ADMINISTRATION OF ANTICHOLINESTERASES DURING INTENSE MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANTAGONISTS NEUROMUSCULAR BLOCK, EDROPHONIUM; ANTAGONISTS NEUROMUSCULAR BLOCK, NEOSTIGMINE; NEUROMUSCULAR BLOCK, MIVACURIUM ID NEOSTIGMINE; EDROPHONIUM; ATRACURIUM; PYRIDOSTIGMINE; PHARMACOLOGY; VECURONIUM; ANTAGONISM; REVERSAL AB The time course of recovery after early administration of anticholinesterases during intense mivacurium-induced block was evaluated by recording the mechanomyographic response of the adductor pollicis to post-tetanic count (PTC) and train-of-four (TOF) ulnar nerve stimulation. Seventy-two adult patients receiving thiopentone, fentanyl, nitrous oxide, isoflurane anaesthesia and mivacurium 0.15 mg kg(-1) were allocated randomly to one of six equal groups according to the type of anticholinesterase and intensity of block at which antagonism was attempted. Groups 1, 3 and 5 received neostigmine 0.07 mg kg(-1), while groups 2, 4 and 6 received edrophonium 1 mg kg(-1). At the time of administration of antagonist there was no response to PTC in groups 1 and 2, a PTC of 1 or more was detectable in groups 3 and 4 and the first twitch of the TOF (T1) had recovered to 10% in the conventional antagonism groups (5 and 6). The longest clinical duration (CD) values (time from administration of mivacurium to T1 25%) were encountered in groups 1, 5 and 6 and were 17.4 (7.9), 19.7 (3.4) and 21.4 (4.8) min, respectively. CD was reduced significantly in groups 2, 3 and 4 and values were 13.9 (3.5), 13.7 (3.5) and 13.8 (3.3) min, respectively. Recovery indices (RI) (time interval between T1 25% and 75%) were 13.8 (7.3), 6.3 (1.4), 4.6 (1.8), 6.0 (2.1), 3.7 (2.2) and 4.8 (3.1) min in groups 1-6, respectively and was prolonged with neostigmine antagonism at PTC 0 (group 1). Reversal time (RT) (time between administration of antagonist and TOF 0.70) was 34.9 (16.6) min in group 1 who received neostigmine at PTC 0 and was prolonged markedly compared with all other groups. Antagonism with edrophonium at PTC 0 (group 2) was associated with an RT of 16.7 (5.1) min and was significantly longer compared with the conventional antagonism groups only. Reversal times were similar in groups 3-6. Total recovery times (TRT) (time between administration of mivacurium and TOF 0.70) were 41.5 (16.6), 23.2 (5.2), 23.2 (5.3), 24.1(4.5), 26.8 (4.8) and 28.5 (9.1) min in groups 1-6, respectively, and was markedly prolonged in group 1 only. In summary, administration of neostigmine during intense mivacurium block, not responsive to TOF and PTC stimulation was associated with marked delay in recovery, possibly because of inhibition of plasma cholinesterase. At this intensity of block, edrophonium was preferable. It is advisable to wait for a detectable PTC before attempting antagonism of an intense mivacurium block. After detection of PTC, neostigmine or edrophonium antagonism reduced the clinical duration but not the total recovery time compared with conventional reversal administered at T1 10%. C1 CAIRO UNIV,FAC MED,DEPT ANAESTHESIA,CAIRO,EGYPT. NR 22 TC 17 Z9 17 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 1995 VL 74 IS 1 BP 20 EP 25 DI 10.1093/bja/74.1.20 PG 6 WC Anesthesiology SC Anesthesiology GA QB730 UT WOS:A1995QB73000006 ER PT J AU NAGUIB, M ABDULATIF, M SELIM, M ALGHAMDI, A AF NAGUIB, M ABDULATIF, M SELIM, M ALGHAMDI, A TI DOSE-RESPONSE STUDIES OF THE INTERACTION BETWEEN MIVACURIUM AND SUXAMETHONIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, MIVACURIUM; NEUROMUSCULAR BLOCK, SUXAMETHONIUM; NEUROMUSCULAR BLOCK, MEASUREMENT OF RESPONSE; PHARMACOLOGY, DOSE-RESPONSE ID CHLORIDE BW B1090U; NEUROMUSCULAR BLOCKADE; INTUBATING CONDITIONS; D-TUBOCURARINE; SUCCINYLCHOLINE; PANCURONIUM; HALOTHANE; PHARMACOLOGY; PRETREATMENT; VECURONIUM AB We have determined the effect of pretreatment with mivacurium on the potency of suxamethonium and the effect of prior administration of suxamethonium on the potency of mivacurium. We studied 100 ASA I or II patients during thiopentone-fentanyl-nitrous oxide-isoflurane anaesthesia. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 12-s intervals). Single dose-response curves were determined by probit analysis. Pretreatment with mivacurium had a marked antagonistic effect on the development of subsequent depolarizing block produced by suxamethonium. The dose-response curves for suxamethonium alone and after pretreatment with mivacurium did not deviate from parallelism, but those constructed after mivacurium were shifted significantly to the right (P < 0.0001). The calculated doses producing 50% depression of T1 (ED(50)) were 86 (95% confidence intervals 83-88) and 217 (208-225) mu g kg(-1) for suxamethonium alone and after mivacurium, respectively. This study also demonstrated that prior administration of suxamethonium did not appear to influence either the slope of the regression lines or the potency of mivacurium. Combining the results of this study with a previous study (mivacurium ED(50) = 20.8 (20.3-21.3) mu g kg(-1) during isoflurane-nitrous oxide anaesthesia), we suggest that the potency of mivacurium did not differ from that observed after suxamethonium (17.4 (16.9-17.9) mu g kg(-1)). C1 KING SAUD UNIV,KING KHALID UNIV HOSP,FAC MED,DEPT ANAESSTHESIA & ICU,RIYADH 11472,SAUDI ARABIA. NR 24 TC 10 Z9 10 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 1995 VL 74 IS 1 BP 26 EP 30 DI 10.1093/bja/74.1.26 PG 5 WC Anesthesiology SC Anesthesiology GA QB730 UT WOS:A1995QB73000007 ER PT J AU KAPLAN, RF GARCIA, M HANNALLAH, RS AF KAPLAN, RF GARCIA, M HANNALLAH, RS TI MIVACURIUM-INDUCED NEUROMUSCULAR BLOCKADE DURING SEVOFLURANE AND HALOTHANE ANESTHESIA IN CHILDREN SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHESIA, PEDIATRIC; ANESTHETICS, VOLATILE, HALOTHANE, SEVOFLURANE; NEUROMUSCULAR RELAXANTS, MIVACURIUM ID PLASMA CHOLINESTERASE; ANESTHESIA; VECURONIUM; RECOVERY AB The neuromuscular blocking effects of mivacurium during sevoflurane or halothane anaesthesia was studied in 38 paediatric patients aged 1-12 yr. All received premedication with midazolam, 0.5 mg.kg(-1) po and an inhalational induction with up to 3 MAC of either agent in 70% N2O and O-2. The ulnar nerve war stimulated al the wrist by a train-of-four stimulus every ten seconds and the force of adduction of the thumb recorded with a Myotrace force transducer. Anaesthesia was maintained with a one MAC end-tidal equivalent of either volatile agent for five minutes before patients received mivacurium (0.2 mg.kg(-1)) iv. The onset of maximal blockade occurred in 2.4 +/- 1.26 (mean +/- SD) min with halothane and 1.8 +/- 0.54 min with sevoflurane (NS). Four patients failed to achieve 100% block (3 halothane, 1 sevoflurane). The times from injection to 5, 75, and 95% recovery during sevoflurane (9.8 +/- 2.6, 19.5 +/- 4.4, and 24.2 +/- 4.8 min) were greater than during halothane anaesthesia (7.2 +/- 2.2. 15.0 +/- 4.0, 19.2 +/- 4.9 min, respectively (P < 0.005). AN patients demonstrated complete spontaneous recovery of neuromuscular function (T-1 > 95%, T-4/T-1 >75%) during the surgery which lasted 24-63 min. All patients showed clinical signs of full recovery of neuromuscular blockade (i.e., headlift, gag, or cough). Pharmacological reversal war not required. It is concluded that following a single intubating dose of mivacurium, the time to maximum relaxation was nor different during halothane and sevoflurane anaesthesia; recovery times to 5.75 and 95% twitch height were longer during sevoflurane anaesthesia and neuromuscular reversal was nor necessary. C1 CHILDRENS NATL MED CTR,DEPT PEDIAT,WASHINGTON,DC 20010. GEORGE WASHINGTON UNIV,WASHINGTON,DC. RP KAPLAN, RF (reprint author), CHILDRENS NATL MED CTR,DEPT ANESTHESIOL,111 MICHIGAN AVE NW,WASHINGTON,DC 20010, USA. NR 21 TC 21 Z9 21 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1995 VL 42 IS 1 BP 16 EP 20 PG 5 WC Anesthesiology SC Anesthesiology GA QL722 UT WOS:A1995QL72200004 ER PT J AU BRULL, SJ CONNELLY, NR SILVERMAN, DG AF BRULL, SJ CONNELLY, NR SILVERMAN, DG TI RECOVERY OF TRAIN-OF-4 AFTER MIVACURIUM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MEASUREMENT TECHNIQUES, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, MIVACURIUM; RECOVERY, NONDEPOLARIZING RELAXANTS; SPONTANEOUS ID NEUROMUSCULAR BLOCKADE; STIMULATION; CHLORIDE; PHARMACOLOGY; ATRACURIUM; VECURONIUM; INFUSION; TACTILE; FADE AB The present study war designed to determine the rime-course of recovery of the train-of-four (TOF) ratio during spontaneous recovery from mivacurium-induced block. Fifteen patients, free of neuromuscular disease, undergoing general endotracheal anaesthesia with isoflurane were studied. After anaesthetic induction, patients received a bolus dose of mivacurium 0.15 mg.kg(-1). The TOF was then recorded continuously every 12 sec with a mechanogram (adductor pollicis monitor). When the TOF ratio recovered spontaneously to 0.9, an additional 0.05 mg.kg(-1) of mivacurium was given. The durations required for recovery from a TOF ratio of 0.3 to 0.7 (DUR(0.3-0.7)) and from a TOF ratio of 0.3 to 0.9 (DUR(0.3-0.9)) were determined. The DUR(0.3-0.7) averaged 7.0 +/- 2.5 min (range 3.4-12.2 min). The DUR(0.3-0.9) averaged 11.8 +/- 3.9 min (range 6.0-20.2 min). There was no evidence of prolongation of recovery times (cumulation) following repeated dosing. The present data indicate that, in patients with normal cholinesterase activity (clinical duration 7-25 min), waiting 20 min beyond the time when fade is no longer apparent by visual or tactile evaluation is sufficient to attain a TOF ratio greater than 0.7-0.9 during spontaneous recovery from mivacurium, and may enable anaesthetists to avoid antagonism of mivacurium-induced block. C1 TUFTS UNIV,SCH MED,DEPT ANESTHESIOL,SPRINGFIELD,MA 01199. BAYSTATE MED CTR,SPRINGFIELD,MA 01199. RP BRULL, SJ (reprint author), YALE NEW HAVEN MED CTR,SCH MED,DEPT ANESTHESIOL,333 CEDAR ST,NEW HAVEN,CT 06510, USA. RI Brull, Sorin/E-8578-2010 NR 13 TC 2 Z9 2 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1995 VL 42 IS 1 BP 28 EP 31 PG 4 WC Anesthesiology SC Anesthesiology GA QL722 UT WOS:A1995QL72200006 ER PT J AU HERSCHMAN, Z PAMAAR, CG AF HERSCHMAN, Z PAMAAR, CG TI PROLONGED NEUROMUSCULAR BLOCKADE WHEN MIVACURIUM AND PANCURONIUM WERE ADMINISTERED IN SERIES SO JOURNAL OF TOXICOLOGY-CLINICAL TOXICOLOGY LA English DT Article DE NEUROMUSCULAR NONDEPOLARIZING AGENTS; ISOQUINOLONES AB Long acting non-depolarizing neuromuscular blockade is useful in many clinical circumstances, especially during surgical procedures. Reinstitution of the blockade for short periods to facilitate the completion of clinical tasks can be accomplished in different ways. We present a care wherein a short-acting non-depolarizing neuromuscular blocker used after a long-acting one resulted in an unusual prolongation of the neuromuscular blockade. RP HERSCHMAN, Z (reprint author), ST BARNABAS HOSP,DEPT ANESTHESIOL,OLD SHORT HILLS RD,LIVINGSTON,NJ 07039, USA. NR 1 TC 1 Z9 1 PU MARCEL DEKKER INC PI NEW YORK PA 270 MADISON AVE, NEW YORK, NY 10016 SN 0731-3810 J9 J TOXICOL-CLIN TOXIC JI J. Toxicol.-Clin. Toxicol. PY 1995 VL 33 IS 3 BP 271 EP 272 PG 2 WC Toxicology SC Toxicology GA RA395 UT WOS:A1995RA39500015 ER PT J AU Dzhakhangirov, FN Salimov, BT Bessonova, IA Sultankhodzhaev, MN AF Dzhakhangirov, FN Salimov, BT Bessonova, IA Sultankhodzhaev, MN TI Searching and studying of curare-like preparations in diterpenoid alkaloids SO KHIMIYA PRIRODNYKH SOEDINENII LA Russian DT Article RP Dzhakhangirov, FN (reprint author), UZBEK ACAD SCI,INST BOT CHEM,TASHKENT,UZBEKISTAN. NR 24 TC 11 Z9 11 PU AKADEMIYA NAUK UZBEKSKOI SSR PI TASHKENT PA UL KUIBYSHEVA 15, TASHKENT, UZBEKISTAN SN 0023-1150 J9 KHIM PRIR SOEDIN+ JI Khimiya Prir. Soedin. PY 1995 IS 6 BP 841 EP 848 PG 8 WC Chemistry, Organic SC Chemistry GA UE031 UT WOS:A1995UE03100014 ER PT J AU WARD, JB NIFFENEGGER, AS LAVIN, CW ACQUADRO, MA AHERN, DK SMITH, PV MCKEOWN, CA AF WARD, JB NIFFENEGGER, AS LAVIN, CW ACQUADRO, MA AHERN, DK SMITH, PV MCKEOWN, CA TI THE USE OF PROPOFOL AND MIVACURIUM ANESTHETIC TECHNIQUE FOR THE IMMEDIATE POSTOPERATIVE ADJUSTMENT OF SUTURES IN STRABISMUS SURGERY SO OPHTHALMOLOGY LA English DT Article ID OCULOCARDIAC REFLEX AB Purpose: Adjustable suture techniques have become increasingly popular over the last decade and may reduce the re-operation rate after strabismus surgery. The adjustment usually is made in the hospital or office 5 to 24 hours after surgery, when the patient has fully recovered from general anesthesia. The ability to perform suture adjustment in the operating room, immediately after completion of surgery, would be an attractive alternative with respect to patient monitoring, sterility, comfort, and timing. The purpose of this study is to compare the alignment of patients in the operating room adjusted immediately after surgery with their alignment the morning after surgery. Methods: Patients with strabismus who have good vision in each eye and who were judged to be appropriate candidates for adjustable sutures were invited to enroll in a study using propofol and mivacurium total intravenous anesthetic technique. Patients underwent strabismus surgery in which one or more muscles were placed on adjustable sutures. Immediately after extubation, these patients were awakened in the operating room, assisted in sitting upright, and asked to fixate on a 20/400 Snellen E target on the operating room walt. Sutures were adjusted, when necessary, to obtain the desired postoperative alignment. Prism and alternate cover measurements, taken after the sutures were permanently tied, were compared with measurements taken the morning after surgery. Results: Twenty-nine patients qualified for inclusion. Measurements of horizontal and vertical alignment in the operating room were all within 12 prism diopters (PD) of the measurements taken 18 to 24 hours after surgery (mean variation, 4 PD horizontally and 2 PD diopters vertically). The measured deviation changed less than or equal to 6 PD horizontally in 78% of patients and less than or equal to 3 PD vertically in 70% of patients. Conclusion: For some adult patients with strabismus, a total intravenous general anesthesia technique using an infusion of propofol and mivacurium may provide the opportunity for accurate suture adjustment in the operating room, immediately after completion of surgery. C1 HARVARD UNIV,MASSACHUSETTS EYE & EAR INFIRM,SCH MED,BOSTON,MA. HARVARD UNIV,MASSACHUSETTS GEN HOSP,SCH MED,BOSTON,MA. NR 13 TC 18 Z9 18 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQUARE, PHILADELPHIA, PA 19106 SN 0161-6420 J9 OPHTHALMOLOGY JI Ophthalmology PD JAN PY 1995 VL 102 IS 1 BP 122 EP 128 PG 7 WC Ophthalmology SC Ophthalmology GA QB558 UT WOS:A1995QB55800025 ER PT J AU WEEKES, LM KENEALLY, JP GOONETILLEKE, PH RAMZAN, IM AF WEEKES, LM KENEALLY, JP GOONETILLEKE, PH RAMZAN, IM TI PHARMACOKINETICS OF ALCURONIUM IN CHILDREN WITH ACYANOTIC AND CYANOTIC CARDIAC DISEASE UNDERGOING CARDIOPULMONARY BYPASS-SURGERY SO PAEDIATRIC ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; ALCURONIUM; PHARMACOKINETICS; CARDIOPULMONARY BYPASS; CARDIAC DISEASE; ACYANOTIC; CYANOTIC ID D-TUBOCURARINE; KINETICS AB The aim of this study was to determine the pharmacokinetic parameters for alcuronium in children with cyanotic or acyanotic congenital cardiac disease undergoing cardiopulmonary bypass surgery and to compare these parameters with previously reported values in children and adults with normal cardiac function. Seven children with acyanotic disease and seven with cyanotic disease were studied. Alcuronium (base) was administered in an initial dosage of 0.25 mg . kg(-1) with additional doses as needed to maintain paralysis. Using time averaged data, cyanotic children had lower mean clearance, elimination half-life and volume of distribution at steady state than the acyanotic children; none of these differences was, however, statistically significant. In this study, children with acyanotic and cyanotic cardiac disease undergoing bypass, had a diminished clearance (P < 0.05) and a smaller volume of distribution (P < 0.05) than normal children and a shorter elimination half-life (P < 0.05) than adults. Onset of cardiopulmonary bypass caused an immediate marked decrease in alcuronium plasma concentrations which remained low in the acyanotic children at the completion of bypass. C1 UNIV SYDNEY,DEPT PHARM,SYDNEY,NSW 2006,AUSTRALIA. ROYAL ALEXANDRA HOSP CHILDREN,DEPT ANAESTHESIA,SYDNEY,NSW,AUSTRALIA. NR 15 TC 2 Z9 2 PU ARNETTE-BLACKWELL S A PI PARIS PA 1, RUE DE LILLE, 75007 PARIS, FRANCE SN 1155-5645 J9 PAEDIATR ANAESTH JI Paediatr. Anaesth. PY 1995 VL 5 IS 6 BP 369 EP 374 DI 10.1111/j.1460-9592.1995.tb00329.x PG 6 WC Anesthesiology; Pediatrics SC Anesthesiology; Pediatrics GA TE501 UT WOS:A1995TE50100006 ER PT J AU SHIN, HS LEE, BH CHOI, JG MOON, H AF SHIN, HS LEE, BH CHOI, JG MOON, H TI COMPLEXATION OF SOIL HUMIC-ACID WITH TRIVALENT CURIUM AND EUROPIUM IONS - A COMPARATIVE-STUDY SO RADIOCHIMICA ACTA LA English DT Article DE CURIUM; EUROPIUM; HUMATE COMPLEXATION; ULTRAFILTRATION; TIME-RESOLVED LASER FLUORESCENCE SPECTROSCOPY ID FULVIC-ACIDS; AMERICIUM(III); FLUORESCENCE; CONSTANTS AB The complexation between a well characterized soil humic acid (OkchunHA) and trivalent metal ions (Cm3+, Eu3+) was compared with that by the Gorleben aquatic humic acid (GohyHA) by carrying out the investigation under the same experimental conditions and with the use of the same instrumentation (time resolved laser fluorescence spectroscopy: TRLFS). The emission spectra (peak maxima: 601.2 nm) and two time components for the lifetime of fluorescence (70 mu s and 142 mu s) were found to be nearly the same, suggesting that the two Cm(III)-humates formed from two different humic acids are made of the similar chemical species. The calculated stability constants (Cm(III)-humate: log beta = 6.01+/-0.05 1 mol(-1); Eu(III)-humate: log beta = 6.05+/-0.23 1 mol(-1)) were found to be in good agreement with those obtained earlier in the GohyHA study, suggesting that the same thermodynamic description can be applied to both humic acids, provided 1:1 complex formation is assumed. C1 YONSEI UNIV,DEPT CHEM,SEOUL 120749,SOUTH KOREA. RP SHIN, HS (reprint author), KOREA ADV INST SCI & TECHNOL,DEPT CHEM,373-1 KUSONG DONG,YUSONG KU,TAEJON 305701,SOUTH KOREA. NR 16 TC 13 Z9 13 PU R OLDENBOURG VERLAG PI MUNICH 80 PA ROSENHEIMER STR 145 POSTFACH 801360, W-8000 MUNICH 80, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 1995 VL 69 IS 3 BP 185 EP 189 PG 5 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA TD580 UT WOS:A1995TD58000006 ER PT J AU FELKER, LK BENKER, DE CHATTIN, FR STACY, RG AF FELKER, LK BENKER, DE CHATTIN, FR STACY, RG TI SEPARATION OF AMERICIUM, CURIUM, AND PLUTONIUM FROM IRRADIATED TARGETS SO SEPARATION SCIENCE AND TECHNOLOGY LA English DT Article; Proceedings Paper CT 8th Symposium on Separation Science and Technology for Energy Applications CY OCT 24-28, 1993 CL GATLINBURG, TN SP US DOE, AMER CHEM SOC, AMER INST CHEM ENGINEERS, OAK RIDGE NATL LAB AB The Radiochemical Engineering Development Center (REDC) at Oak Ridge National Laboratory (ORNL) processes highly irradiated targets for the Mark 42 program to separate Am, Cm, and Pu. The target feed material for each assembly was 3.3 kg of plutonium (78% Pu-239) that was irradiated at the Savannah River Site to yield approximately 100 g each of Am-243 and Cm-244, and 100-g quantities of (242)pu for special DOE projects. The REDC has plans to process ten of these target assemblies over the next few years. The first assembly has been dissolved, and approximately 1/4 of this material has been used to test the processing flowsheet. Various aqueous processes developed at the REDC over the past years were utilized to dissolve the target segments, separate the bulk of the impurities from the transuranics, separate the plutonium from the transplutonium actinides, and separate the rare earth fission products from the Am-Cm. The separation of the Am-Cm products to the desired purity levels presented new processing challenges for REDC operations. Through a combination of precipitation and cation-exchange operations, an Am product containing part-per-million levels of Cm was obtained. Standard REDC processing techniques were used to prepare the products as oxides for shipment. Future processing will focus on the reduction of waste solutions, improvement of yields, and application of new technologies for improved processing. RP FELKER, LK (reprint author), OAK RIDGE NATL LAB,DIV CHEM TECHNOL,POB 2008,OAK RIDGE,TN 37831, USA. NR 6 TC 2 Z9 2 PU MARCEL DEKKER INC PI NEW YORK PA 270 MADISON AVE, NEW YORK, NY 10016 SN 0149-6395 J9 SEPAR SCI TECHNOL JI Sep. Sci. Technol. PY 1995 VL 30 IS 7-9 BP 1769 EP 1778 PG 10 WC Chemistry, Multidisciplinary; Engineering, Chemical SC Chemistry; Engineering GA QX561 UT WOS:A1995QX56100045 ER PT J AU KAWABATA, K SUMIKAWA, K KAMIBAYASHI, T KITA, T TAKADA, K MASHIMO, T YOSHIYA, I AF KAWABATA, K SUMIKAWA, K KAMIBAYASHI, T KITA, T TAKADA, K MASHIMO, T YOSHIYA, I TI DECREASE IN VECURONIUM INFUSION DOSE REQUIREMENTS BY NICARDIPINE IN HUMANS SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; VERAPAMIL; CHROMATOGRAPHY; POTENTIATION; PANCURONIUM; RESPONSES; REVERSAL; FAILURE; MUSCLE; CATS AB This study was designed to analyze quantitatively the interaction of nicardipine with vecuronium using a constant infusion technique. Forty-seven patients undergoing elective otolaryngeal surgery were anesthetized with isoflurane (1% end-tidal) and nitrous oxide (67%). Patients were randomly assigned to receive one of four doses of nicardipine (0, 1, 2, and 3 mu g.kg(-1).min(-1)). Vecuronium infusion dose requirement was determined as a constant infusion rate which maintained 90% depression of control twitch tension. Nicardipine significantly decreased the vecuronium requirement in a dose-dependent manner, i.e., the vecuronium doses were 0.70 +/- 0.03, 0.55 +/- 0.04, 0.42 +/- 0.04, and 0.37 +/- 0.05 mu g.kg(-1).min(-1) at nicardipine doses of 0, 1, 2, and 3 mu g.kg(-1).min(-1), respectively. Nicardipine also reduced both the plasma concentration of vecuronium to maintain the 90% depression and the total plasma clearance of vecuronium. The reversal of the vecuronium effect with neostigmine was not influenced by nicardipine. The results indicate that the vecuronium infusion dose requirements are reduced as much as 53% by a clinical dose of nicardipine. C1 NAGASAKI UNIV,SCH MED,DEPT ANESTHESIOL,NAGASAKI 852,JAPAN. OSAKA POLICE HOSP,OSAKA,JAPAN. RP KAWABATA, K (reprint author), OSAKA UNIV,SCH MED,DEPT ANESTHESIOL,2-2 YAMADAOKA,SUITA,OSAKA 565,JAPAN. NR 26 TC 7 Z9 7 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1994 VL 79 IS 6 BP 1159 EP 1164 PG 6 WC Anesthesiology SC Anesthesiology GA PU602 UT WOS:A1994PU60200023 ER PT J AU KOPMAN, AF MALLHI, MU JUSTO, MD RODRICKS, P NEUMAN, GG AF KOPMAN, AF MALLHI, MU JUSTO, MD RODRICKS, P NEUMAN, GG TI ANTAGONISM OF MIVACURIUM-INDUCED NEUROMUSCULAR BLOCKADE IN HUMANS - EDROPHONIUM DOSE REQUIREMENTS AT THRESHOLD TRAIN-OF-4 COUNT OF 4 SO ANESTHESIOLOGY LA English DT Article DE ANTAGONISTS, ANTICHOLINESTERASE, EDROPHONIUM; MONITORING, ELECTROMYOGRAPHY; NEUROMUSCULAR RELAXANTS, MIVACURIUM ID BLOCKADE; NEOSTIGMINE; RECOVERY; ATRACURIUM; VECURONIUM; TUBOCURARINE; PANCURONIUM; ANESTHESIA; DURATION; REVERSAL AB Background: Mivacurium's rapid rate of recovery has led to the suggestion that routine reversal of its residual effects may be unnecessary once signs of spontaneous recovery are evident. When antagonism is attempted at 90% twitch depression, the time saved to return to train-of-four (TOF) ratios >0.70 compared to control has been reported to average less than or equal to 8 min. This study was an attempt to determine whether similar savings in time could be achieved once spontaneous recovery was well underway. Also investigated was the ability of a TOF count of 4 to serve as a marker that might predict the dose of edrophonium necessary for satisfactory antagonism of mivacurium. Methods: Fifty-eight adult patients were studied under nitrous oxide/propofol/opioid anesthesia. Neuromuscular block was monitored electromyographically and maintained by infusion of mivacurium at a level sufficient to abolish any palpable response of the thumb. TOF stimuli were delivered to the ulnar nerve at the wrist every 20 s throughout the period of observation. When the infusion was terminated, an observer was asked to note the time when the Ist through the 4th twitches first became detectable. In group 1, recovery to a TOF ratio >0.90 was allowed to proceed spontaneously. In groups 2, 3, and 4, 0.3, 0.5, and 0.75 mg/kg edrophonium, respectively, was administered when the 4th response to TOF stimulation first became palpable. Times to TOF ratios of 0.70 and 0.90 were recorded in all groups. Results: TOF counts of 1, 2, 3, and 4 first became palpable at 8 +/- 4% (SD), 20 +/- 6%, 33 +/- 9%, and 44 +/- 10% of control twitch height. Fade on TOF stimulation could no longer be detected once the TOF ratio exceeded a value of 0.41 +/- 0.07 (range 0.25-0.51). Once the Ist evoked response was palpable, the 2nd, 3rd, and 4th responses could be detected 2.5 +/- 1.1 (SD), 4.6 +/- 1.6, and 6.1 +/- 1.6 min later. Spontaneous recovery to TOF fade ratios of 0.7 and 0.9 occurred on average 10.7 +/- 2.3 and 16.9 +/- 4.7 min, respectively, after a threshold count of 4. Administration of 0.3 mg/kg edrophonium shortened the recovery process by about 7.5 min. Increasing the dose of edrophonium beyond 0.3 mg/kg did not further accelerate recovery. Conclusions After recovery from profound mivacurium-induced neuromuscular block, TOF counts of 1, 2, 3, and 4 approximate 10%, 20%, 30%, and 40% return to control twitch height, respectively. finally, greater than or equal to 0.3 mg/kg edrophonium will accelerate recovery from mivacurium by approximately 7-8 min. RP KOPMAN, AF (reprint author), ST VINCENTS HOSP & MED CTR,DEPT ANESTHESIOL,NR ROOM 408,153 W 11TH ST,NEW YORK,NY 10011, USA. NR 20 TC 21 Z9 21 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 1994 VL 81 IS 6 BP 1394 EP 1400 DI 10.1097/00000542-199412000-00014 PG 7 WC Anesthesiology SC Anesthesiology GA PV982 UT WOS:A1994PV98200014 ER PT J AU BAURAIN, MJ DERNOVOI, BS DHOLLANDER, AA HENNART, DA AF BAURAIN, MJ DERNOVOI, BS DHOLLANDER, AA HENNART, DA TI COMPARISON OF NEOSTIGMINE-INDUCED RECOVERY WITH SPONTANEOUS-RECOVERY FROM MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, MIVACURIUM; NEUROMUSCULAR BLOCK, MEASUREMENT OF RESPONSE; NEUROMUSCULAR BLOCK, RECOVERY; ANTAGONISTS NEUROMUSCULAR BLOCK, NEOSTIGMINE ID CHLORIDE BW B1090U; PLASMA CHOLINESTERASE; ENFLURANE ANESTHESIA; VECURONIUM; PHARMACOLOGY; ATRACURIUM; ANTAGONISM; ISOFLURANE; PARALYSIS; REVERSAL AB In 24 ASA I-II adults anaesthetized with thiopentone, fentanyl and nitrous oxide in oxygen, we studied neuromuscular transmission with isometric adductor pollicis monitoring. Patients received mivacurium 0.2 mg kg-l followed by an infusion lasting at least 60 min and adjusted to maintain twitch height at 1-5%. After termination of the mivacurium infusion, when twitch height spontaneously regained 25% of its control value, the patients were allocated to two groups of 12 patients each. In group NEO patients received neostigmine 40 mu g kg(-1) and atropine 15 mu g kg(-1) and in group SPO neuromuscular transmission was allowed to recover spontaneously. Twitch height was measured every 10 s and train-of-four (TOF) (2 Hz) every 3 min. After 15 min, residual force after tetanic stimulation (50 and 100 Hz, 5-s duration (RF50(HZ), RF100(HZ)), 1 min apart) were recorded sequentially. At 15 min, mean TOF ratio was greater in group NEO (0.94 (SEM 0.01)) than in group SPO (0.87 (0.02)) (P<0.01). All patients in group NEO recovered to a TOF ratio greater than 0.7 after 6 min compared with 15 min in group SPO (P<0.005). A TOF ratio greater than 0.9 was observed in all patients in group NEO compared with only six in group SPO (P<0.025). Nevertheless, RF50(HZ) and RF100(HZ) did not differ significantly (0.92 (0.01) (group NEO), 0.91 (0.01) (group SPO) and 0.83 (0.02) (group NEO), 0.78 (0.03) (group SPO), respectively). We conclude that although there was a high degree of spontaneous recovery, administration of neostigmine-atropine accelerated the rate of recovery of neuromuscular transmission after mivacurium and greatly increased the number of patients satisfying the criteria for complete recovery of neuromuscular transmission (TOF ratio > 0.9) within 15 min. C1 FREE UNIV BRUSSELS,HOSP BRUGMANN,BRUSSELS,BELGIUM. RP BAURAIN, MJ (reprint author), ERASME UNIV HOSP,DEPT ANESTHESIOL,808 ROUTE LENNIK,B-1070 BRUSSELS,BELGIUM. NR 22 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 1994 VL 73 IS 6 BP 791 EP 794 DI 10.1093/bja/73.6.791 PG 4 WC Anesthesiology SC Anesthesiology GA PU355 UT WOS:A1994PU35500016 ER PT J AU YOUNG, ML HANSON, CW BLOOM, MJ SAVINO, JS MURAVCHICK, S AF YOUNG, ML HANSON, CW BLOOM, MJ SAVINO, JS MURAVCHICK, S TI LOCALIZED HYPOTHERMIA INFLUENCES ASSESSMENT OF RECOVERY FROM VECURONIUM NEUROMUSCULAR BLOCKADE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MEASUREMENT TECHNIQUES, NEUROMUSCULAR BLOCKADE; MONITORING, NEUROMUSCULAR FUNCTION; NEUROMUSCULAR RELAXANTS, VECURONIUM; TEMPERATURE, COOLING, HYPOTHERMIA ID D-TUBOCURARINE; CARDIOPULMONARY BYPASS; TWITCH TENSION; TEMPERATURE; MUSCLE; PHARMACOKINETICS; PANCURONIUM; HUMANS; PHARMACODYNAMICS; NEOSTIGMINE AB The purpose of this study was to determine the extent to which localized hypothermia of a monitored extremity alters the assessment of recovery from vecuronium-induced neuromuscular blockade. Bilateral integrated evoked electromy ographic (IEMG) responses were measured in the ulnar distribution of 14 anaesthetized patients who had differing upper extremity temperatures as measured at the adductor pollicis to determine whether localized hypothermia alters the clinical assessment of spontaneous recovery from vecuronium-induced neuromuscular blockade. All patients received general anaesthesia with thiopentone, N2O/O-2 and opioid 11/14 patients received isoflurane for blood pressure control. Bilateral adductor pollicis oesophageal and ambient temperatures, and IEMG evoked response (t(1)) expressed as percent unparalyzed control were recorded during the anaesthetic. The difference in evoked response between the warmer and the colder upper extremity was calculated at 25%, 50% and 75% spontaneous recovery from neuromuscular blockade in the warm extremity. Differences in temperature between extremities ranged from 0.2-11 degrees C. The difference in IEMG-evoked response between extremities war; proportional to the difference in temperature, and there was a direct correlation (r = 0.78) between IEMG response and extremity temperature; IEMG response was absent when extremity temperature was less than 25 degrees C. We concluded that localized hypothermia in the monitored extremity decreases the IEMG-evoked response to vecuronium neuromuscular blockade; the greater the temperature decrease, the less the evoked response. Thus, the administration of nondepolarizing relaxants may be inappropriately influenced by monitoring neuromuscular blockade in a cold extremity, especially if its temperature is <25 degrees C. C1 UNIV PITTSBURGH,SCH MED,DEPT ANESTHESIA,PITTSBURGH,PA. RP YOUNG, ML (reprint author), UNIV PENN,SCH MED,DEPT ANESTHESIA,3400 SPRUCE ST,PHILADELPHIA,PA 19104, USA. NR 30 TC 2 Z9 2 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 1994 VL 41 IS 12 BP 1172 EP 1177 PG 6 WC Anesthesiology SC Anesthesiology GA PW269 UT WOS:A1994PW26900008 ER PT J AU IWASAKI, H IGARASHI, M KAWANA, S NAMIKI, A AF IWASAKI, H IGARASHI, M KAWANA, S NAMIKI, A TI ACCELERATED ONSET OF VECURONIUM NEUROMUSCULAR BLOCK WITH PULMONARY ARTERIAL ADMINISTRATION SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE NEUROMUSCULAR RELAXANTS, ONSET, VECURONIUM ID DURATION; TIME AB The purpose of this study was to determine the onset times of vecuronium neuromuscular block adminir;tered into either the central circulation or a peripheral vein. One hundred and twenty adult patients with a pulmonary artery (PA) catheter were randomly divided into one of three groups with respect to the routes of vecuronium administration (n = 40 in each group). Anaesthesia was induced with midazolam 2.5 mg iv and fentanyl 10-50 mu g. kg(-1) iv and maintained with intermittent doses of fentanyl 50 mu g iv and nitrous oxide 60-70%, in oxygen. After immobilization of the forearm in a splint the ulnar nerve was stimulated supramaximally every 12 sec. The resulting force of the evoked thumb twitch was recorded (Myograph 2000, Biometer, Denmark). The times from the injection to the first depression of twitch response (latent onset) inpatients given vecuronium 0.08 mg kg(-1) into the pulmonary artery, the right atrium, and a peripheral vein on the hand were 58.0 +/- 19.5, 71.5 +/- 171, and 82.4 +/- 18.0 sec (mean +/- SD), respectively. The latent onset of neuromuscular block occurred sooner in patients given vecuronium into the central vein than when administered into a vein on the hand (P < 0.01). In comparing the patients given vecuronium into the central vein, the onset limes to 95% twitch depression (onset) were 152.3 +/- 40.7 and 168.2 +/- 35.5 sec. The onset of block was found to be faster when vecuronium was administered into the pulmonary artery than into the right atrium (P < 0.01). These findings suggest that the administration of vecuronium into the pulmonary artery is one approach to accelerate neuromuscular blockade in patients with a PA catheter. RP IWASAKI, H (reprint author), SAPPORO MED UNIV,SCH MED,DEPT ANESTHESIOL,CHUO KU,SOUTH-1,WEST-16,SAPPORO,HOKKAIDO 060,JAPAN. NR 5 TC 5 Z9 5 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 1994 VL 41 IS 12 BP 1178 EP 1180 PG 3 WC Anesthesiology SC Anesthesiology GA PW269 UT WOS:A1994PW26900009 ER PT J AU CLYDE, VL CARDEILHAC, PT JACOBSON, ER AF CLYDE, VL CARDEILHAC, PT JACOBSON, ER TI CHEMICAL RESTRAINT OF AMERICAN ALLIGATORS (ALLIGATOR-MISSISSIPPIENSIS) WITH ATRACURIUM OR TILETAMINE-ZOLAZEPAM SO JOURNAL OF ZOO AND WILDLIFE MEDICINE LA English DT Article DE ALLIGATOR; ALLIGATOR-MISSISSIPPIENSIS; ATRACURIUM; DIAZEPAM; RESTRAINT; TILETAMINE; ZOLAZEPAM ID IMMOBILIZATION AB Eight wild-caught juvenile American alligators (Alligator mississippiensis) were given diazepam (0.4 mg/kg i.m.) and atracurium (4 mg/kg i.m.) in one trial and tiletamine-zolazepam (15 mg/kg i.m.) in another trial to describe the effects and to evaluate the potential of these drugs in the chemical restraint of crocodilians. Atracurium resulted in profound immobilization, with loss of the righting reflex at 38.8 +/- 23.4 (mean +/- SD) min postinjection (PI). Recovery of the righting response occurred at 316.9 +/- 36.2 min PI. Five of the eight alligators became apneic. Apnea occurred at 28.0 +/- 16.4 min after loss of the righting reflex and persisted for 271.0 +/- 159.0 min. Resumption of spontaneous ventilation was variable, ranging from 205 min before to 195 min after recovery of the righting reflex. Temperature and heart rate were not significantly changed from baseline by atracurium. Tiletamine-zolazepam administration did not completely abolish the righting reflex, but righting was slowed in all animals by 15 min PI. Normal righting was recovered at 183.8 +/- 33.8 min PI. Peak effect, as measured by slowest righting, occurred at at 52.5 +/- 31.0 min PI. Temperature, heart rate, and respiratory rate were not significantly altered by tiletamine-zolazepam. The alligators injected with tiletamine-zolazepam were sluggish, nonaggressive, and unable to rise. Chemical restraint of alligators by tiletamine-zolazepam is sufficient for capture, translocation, and minor medical procedures. The prolonged apnea induced by atracurium is undesirable and makes this drug unsuitable for chemical restraint of American alligators. C1 UNIV FLORIDA,COLL VET MED,DEPT SMALL ANIM CLIN SCI,GAINESVILLE,FL 32610. NR 17 TC 3 Z9 3 PU AMER ASSOC Z00 VETERINARIANS PI MEDIA PA 6 NORTH PENNELL ROAD, MEDIA, PA 19063 SN 1042-7260 J9 J ZOO WILDLIFE MED JI J. Zoo Wildl. Med. PD DEC PY 1994 VL 25 IS 4 BP 525 EP 530 PG 6 WC Veterinary Sciences SC Veterinary Sciences GA QJ337 UT WOS:A1994QJ33700005 ER PT J AU ENGBAEK, J ROED, J HANGAARD, N VIBYMOGENSEN, J AF ENGBAEK, J ROED, J HANGAARD, N VIBYMOGENSEN, J TI THE AGREEMENT BETWEEN ADDUCTOR POLLICIS MECHANOMYOGRAM AND FIRST DORSAL INTEROSSEOUS ELECTROMYOGRAM - A PHARMACODYNAMIC STUDY OF ROCURONIUM AND VECURONIUM SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE MONITORING, NERVE, ELECTROMYOGRAPHY, MECHANOMYOGRAPHY; NEUROMUSCULAR TRANSMISSION; NEUROMUSCULAR RELAXANT, ROCURONIUM, VECURONIUM ID NEUROMUSCULAR BLOCKING-AGENT; INTUBATING CONDITIONS; DOSE-RESPONSE; ISOFLURANE ANESTHESIA; MECHANICAL RESPONSES; NERVE-STIMULATION; MUSCLE-RELAXANT; ORG 9426; ORG-9426; BLOCKADE AB The agreement between evoked adductor pollicis mechanomyogram and first dorsal interosseous evoked electromyogram (EMG) was evaluated during a pharmacodynamic study of rocuronium and vecuronium. In the first place the effective doses of rocuronium producing 50% and 90% block (ED(50) and ED(90), respectively) were established in 32 neurolept anaesthetized patients from the adductor pollicis mechanomyogram ram and the first dorsal interosseous EMG area and amplitude. Secondly, limits of agreement between the two methods were evaluated from the mean difference between methods +/-2 s.d. in 20 patients during onset of block following 2 x ED(90) of rocuronium and vecuronium, and during recovery from the last supplementary dose of 1/2 x ED(90). Limits of agreement show how much the EMG may be above or below the mechanomyogram. No differences were found between mechanomyographical and EMG based ED(50) (0.20 mg kg(-1)) and ED(90) (0.3-0.32 mg kg(-1)), respectively. The first EMG train-of-four (TOF) response overestimated block at 25% recovery and underestimated block at 75% and 90% recovery by only 3-7%. Limits of agreement suggested that the EMG may be 7-8% above or below the mechanomyogram during onset compared to 12-17% during recovery. The EMG TOF ratio lagged behind that of the mechanomyogram by 0.05 at TOF ratios below 0.50. No difference was found between methods at a TOF ratio of 0.75. Limits of agreement indicated that the EMG TOF ratio may be 0.12-0.15 above or below that of the mechanomyogram. Agreement between the amplitude and the area of the EMG were better than between the mechanomyogram and the EMG. Evaluation of the rime courses of action showed that rocuronium had a faster onset of action than vecuronium (1.8 min compared to 2.8 min) while duration of action and reversal were similar. In conclusion, the first dorsal interosseous EMG amplitude and area can be used to assess rocuronium and vecuronium block. C1 GLOSTRUP CTY HOSP, DEPT ANAESTHESIA, DK-2600 GLOSTRUP, DENMARK. UNIV COPENHAGEN, RIGSHOSP, DEPT ANAESTHESIA, COPENHAGEN, DENMARK. NR 37 TC 9 Z9 9 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 1994 VL 38 IS 8 BP 869 EP 878 PG 10 WC Anesthesiology SC Anesthesiology GA PX877 UT WOS:A1994PX87700027 ER PT J AU MCCOY, EP MIRAKHUR, RK MADDINENI, VR LOAN, PB CONNOLLY, F AF MCCOY, EP MIRAKHUR, RK MADDINENI, VR LOAN, PB CONNOLLY, F TI ADMINISTRATION OF ROCURONIUM (ORG-9426) BY CONTINUOUS-INFUSION AND ITS REVERSIBILITY WITH ANTICHOLINESTERASES SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACODYNAMICS, INFUSION, ANTAGONISM; ANTICHOLINESTERASES, NEOSTIGMINE, EDROPHONIUM ID INDUCED NEUROMUSCULAR BLOCKADE; HALOTHANE ANESTHESIA; BLOCKING-AGENT; EDROPHONIUM; VECURONIUM; NEOSTIGMINE; ATRACURIUM; PANCURONIUM; ANTAGONISM; REVERSAL AB The use of rocuronium (Org 9426) as a single bolus follow ed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide-oxygen and halothane. Neuromuscular block was monitored using train-of-four stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg(-1) followed by an infusion adjusted manually, to maintain the T-1, the first response in the train-of-four, at 10% of control. Following cessation of rocuronium infusion the patients were either allowed to recover spontaneously (n = 10) or were given neostigmine 50 mu g.kg(-1) or edrophonium 1 mg.kg(-1) at 10 or 25% recovery of the T-1 (n = 10 for each group). Adequate antagonism was defined as attaining a sustained train-of-four ratio of 0.7. Rocuronium requirements showed marked variation among individual patients but were relatively constant in individual patients. The mean (SD) time to attain stable infusion rates was 17.4 (10.9) min. The mean (SD) requirement of rocuronium for steady state 90% block of T-1 was 572 (190) mu g.kg(-1).h(-1) (range 242-1104 mu g.kg(-1).h(-1)). The mean (SD) time to attain a train-of-four ratio of 0.7 in the group allowed to recover spontaneously was 36.1 (7.3) min. This interval was 7.5 (1.9), 9.3 (7.0), 4.6 (1.9) and 1.9 (0.9) min respectively in the groups receiving neostigmine at T-1 of 10%, edrophonium at T-1 of 10%, neostigmine at T-1 of 25% and edrophonium at T-1 of 25%. The antagonism was significantly faster in those reversed at 25% (p < 0.05). Three patients in the group receiving edrophonium at T-1 of 10% and one in the group receiving neostigmine at T-1 of 25% failed to attain a train-of-four ratio of 0.7. It is concluded that rocuronium can be administered as a continuous infusion for stable neuromuscular block. Neostigmine may be a more reliable antagonist of deep block, whereas edrophonium is advantageous when there is a greater spontaneous recovery. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. NR 34 TC 16 Z9 18 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD NOV PY 1994 VL 49 IS 11 BP 940 EP 945 DI 10.1111/j.1365-2044.1994.tb04308.x PG 6 WC Anesthesiology SC Anesthesiology GA PQ620 UT WOS:A1994PQ62000004 ER PT J AU MADDINENI, VR MIRAKHUR, RK MCCOY, EP AF MADDINENI, VR MIRAKHUR, RK MCCOY, EP TI RECOVERY OF MIVACURIUM BLOCK WITH OR WITHOUT ANTICHOLINESTERASES FOLLOWING ADMINISTRATION BY CONTINUOUS-INFUSION SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, MIVACURIUM; ANTAGONISTS, EDROPHONIUM, NEOSTIGMINE ID NEUROMUSCULAR BLOCK; EDROPHONIUM; PHARMACOLOGY; NEOSTIGMINE; ATRACURIUM; ANTAGONISM AB Thirty patients received a bolus dose of 0.2 mg.kg(-1) of mivacurium followed by an infusion during anaesthesia with thiopentone, fentanyl and halothane. Neuromuscular block was monitored using train-of-four stimulation and mechanomyography and the block maintained to keep the first response in the train-of-four (Tl) at 10% of control. At the end of surgery the patients were for maintaining the Tl at 10% was 5.7 mu g.kg(-1).min(-1). There was a significant (r = -0.81, p < 0.001) negative correlation between time to recovery of Tl to 10% after the bolus dose and infusion rate. The times taken for Tl to reach 25, 75 and 90% of control and for the train-of-four ratio to reach 0.7 were significantly shorter (p < 0.05 to 0.001) with neostigmine and edrophonium compared to the spontaneously recovering group. The average (SD) times for attaining the train-of-four ratio of 0.7 were 7.0 (1.2), 6.8 (1.4) and 13.5 (2.3) min respectively for neostigmine, edrophonium and spontaneously recovering groups. There were no differences between endrophonium and neostigmine in any of the recovery times. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. NR 16 TC 7 Z9 7 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD NOV PY 1994 VL 49 IS 11 BP 946 EP 948 DI 10.1111/j.1365-2044.1994.tb04309.x PG 3 WC Anesthesiology SC Anesthesiology GA PQ620 UT WOS:A1994PQ62000005 ER PT J AU JALKANEN, L MERETOJA, OA TAIVAINEN, T BRANDOM, BW DAYAL, B AF JALKANEN, L MERETOJA, OA TAIVAINEN, T BRANDOM, BW DAYAL, B TI SYNERGISM BETWEEN ATRACURIUM AND MIVACURIUM COMPARED WITH THAT BETWEEN VECURONIUM AND MIVACURIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID DOSE-RESPONSE CURVE; NEUROMUSCULAR BLOCKADE; PEDIATRIC-PATIENTS; CHILDREN; PANCURONIUM; POTENTIATION; TUBOCURARINE; ANESTHESIA; HALOTHANE; INFUSION AB Synergism exists between some combinations of nondepolarizing muscle relaxants. To test the possibility of synergism between mivacurium and atracurium or vecuronium, 60 children anesthetized with propofol-alfentanil-N2O-O-2 were randomized to one of five groups. Three groups of 10 patients each received an ED(50) dose of a parent drug atracurium (A), vecuronium (V), or mivacurium (M), respectively, and two other groups of 15 patients each received a single-dose combination of atracurium with mivacurium (cAM) or vecuronium with mivacurium (cVM). Dose combinations constituted 0.5 times an ED(50) dose of each drug. Neuromuscular response was monitored by adductor pollicis electromyogram (EMG). Maximum neuromuscular block (NMB) established by a single parent drug did not differ between the groups or from 50% NMB. It averaged 5.03 +/- 0.12 probits (51.2% NMB). On the contrary, maximum NMB established by the two-dose combinations, cAM or cVM, was significantly more than NMB produced by either single parent drug of the particular combination (cAM vs A or M; P = 0.0035, and cVM vs V or M; P = 0.0004) without a statistically significant difference between groups cAM and cVM. Maximum NMB established by combinations averaged 6.15 +/- 0.21 probits (87.5% NMB). The onset of maximum NMB for mivacurium was significantly faster compared to that for atracurium or for vecuronium (2.8 +/- 0.3 vs 5.7 +/- 0.4 or 4.0 +/- 0.3 min, respectively; P = 0.0001). Our results indicate that both drug combinations are synergistic even though only vecuronium is markedly different in its molecular structure from mivacurium. C1 UNIV PITTSBURGH,CHILDRENS HOSP PITTSBURGH,PITTSBURGH,PA. RP JALKANEN, L (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANESTHESIOL,STENBACKINKATU 11,SF-00290 HELSINKI,FINLAND. NR 19 TC 17 Z9 18 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 1994 VL 79 IS 5 BP 998 EP 1002 PG 5 WC Anesthesiology SC Anesthesiology GA PN578 UT WOS:A1994PN57800031 ER PT J AU KIRKEGAARDNIELSEN, H HELBOHANSEN, HS TOFT, P SEVERINSEN, IK AF KIRKEGAARDNIELSEN, H HELBOHANSEN, HS TOFT, P SEVERINSEN, IK TI ANTHROPOMETRIC VARIABLES AS PREDICTORS FOR DURATION OF ACTION OF VECURONIUM-INDUCED NEUROMUSCULAR BLOCK SO ANESTHESIA AND ANALGESIA LA English DT Article ID OBESE SURGICAL PATIENT; PHARMACODYNAMICS; WOMEN; PHARMACOKINETICS; DISPOSITION; ATRACURIUM; BROMIDE; DRUGS; LIVER AB To identify the best anthropometric predictor for duration of action of neuromuscular block and to propose a better dosing regimen for vecuronium in obese patients, we studied 67 female patients (body weight 45-126 kg) anesthetized with thiopental, fentanyl, droperidol, and nitrous oxide. Twelve different anthropometric variables were evaluated as predictors for duration of action. Simple and multiple linear, least-squares, regression analyses were used. The predictors with the greatest correlation coefficients for duration of action of the vecuronium induction dose (100 mu g/kg) were percentage of ideal body weight (%IBW) (r(2) = 0.389, P = 0.0001) and body mass index (r(2) = 0.379, P = 0.0001). Body weight alone was also correlated to duration of action, but the r(2) value was less (r(2) = 0.312, P = 0.0001). The most significant predictors of the first supplementary dose of vecuronium (33 mu g/kg) were the sum of subscapularis and suprailiac skin folds divided by surface area (r(2) = 0.264, P = 0.0001) and %IBW (r(2) = 0.261, P = 0.0001). We conclude that %IBW, the body mass index, and the sum of subscapularis and suprailiac skin folds divided by the surface area are the best predictors of duration of action of a vecuronium neuromuscular block. RP KIRKEGAARDNIELSEN, H (reprint author), ODENSE UNIV HOSP,DEPT ANESTHESIA & INTENS CARE,DK-5000 ODENSE C,DENMARK. NR 21 TC 3 Z9 3 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 1994 VL 79 IS 5 BP 1003 EP 1006 PG 4 WC Anesthesiology SC Anesthesiology GA PN578 UT WOS:A1994PN57800032 ER PT J AU WRIGHT, PMC CALDWELL, JE MILLER, RD AF WRIGHT, PMC CALDWELL, JE MILLER, RD TI ONSET AND DURATION OF ROCURONIUM AND SUCCINYLCHOLINE AT THE ADDUCTOR POLLICIS AND LARYNGEAL ADDUCTOR MUSCLES IN ANESTHETIZED HUMANS SO ANESTHESIOLOGY LA English DT Article DE MUSCLE, SKELETAL, LARYNGEAL ADDUCTORS; NEUROMUSCULAR RELAXANTS, ROCURONIUM, SUCCINYLCHOLINE ID VECURONIUM NEUROMUSCULAR BLOCKADE; INTUBATING CONDITIONS; ORG-9426; ANESTHESIA; ALFENTANIL; PROPOFOL; SUXAMETHONIUM; INDUCTION AB Background: Rocuronium, a new nondepolarizing muscle relaxant, has a rapid onset of activity and may be suitable as a component of a rapid-sequence induction of anesthesia. We evaluated a range of doses on onset and duration of effect at the larynx and the adductor pollicis and compared these characteristics with those of succinylcholine. Methods: Forty-eight patients aged 18-70 yr, of ASA physical status 1-3, were randomly allocated to receive succinylcholine (1 mg/kg) or one of three doses of rocuronium (0.4, 0.8, or 1.2 mg/kg) during surgery. Anesthesia was induced and maintained with propofol and fentanyl. The trachea was intubated without the use of muscle relaxants, and the cuff of the endotracheal tube placed between the Focal cords. Neuromuscular transmission was monitored by mechanomyography at the laryngeal adductor and adductor pollicis muscles. Muscular activity was evoked with supramaximal stimuli in a train-of-four sequence every 12 s to the anterior branch of the recurrent laryngeal nerve and the ulnar nerve. Results: At the laryngeal adductors, peak effect exceeded 99% in all patients given succinylcholine and in none (0%), five (42%), and ten (83%) of those given rocuronium 0.4, 0.8, and 1.2 mg/kg, respectively. At the adductor pollicis, peak effect exceeded 93% in all study patients except two who received rocuronium 0.4 mg/kg (peak effects 91% and 97%). Onset of effect with succinylcholine was significantly more rapid at the laryngeal adductors (34 +/- 12 s, mean +/- SD) than at the adductor pollicis (56 +/- 15 s); this was true also for rocuronium 0.4 mg/kg (92 +/- 29 s and 155 +/- 40 s for the laryngeal adductors and adductor pollicis, respectively). Onset times were similar at the two muscle groups with rocuronium 0.8 and 1.2 mg kg(-1): 36 +/- 29 and 74 +/- 36 s with 0.8 mg/kg and 54 +/- 30 and 65 +/- 21 s with 1.2 mg/kg at the laryngeal adductors and the adductor pollicis, respectively. Conclusions: The laryngeal adductors are more resistant to the action of rocuronium than is the adductor pollicis. Consequently, the onset of effect of rocuronium, in doses greater than 0.8 mg/kg, is similar to that of succinylcholine at the adductor pollicis but is significantly delayed compared with that of succinylcholine at the laryngeal adductors. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 16 TC 97 Z9 102 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1994 VL 81 IS 5 BP 1110 EP 1115 DI 10.1097/00000542-199411000-00004 PG 6 WC Anesthesiology SC Anesthesiology GA PP715 UT WOS:A1994PP71500007 ER PT J AU MCCORMACK, DR HEISSER, AI SMITH, LJ AF MCCORMACK, DR HEISSER, AI SMITH, LJ TI INTRAOPERATIVE VECURONIUM ANAPHYLAXIS COMPOUNDED BY LATEX HYPERSENSITIVITY SO ANNALS OF ALLERGY LA English DT Article ID MUSCLE-RELAXANTS; HISTAMINE-RELEASE; IGE ANTIBODIES; GENERAL-ANESTHESIA; CROSS-REACTIVITY; SKIN-TESTS; EXPERIENCE; ATRACURIUM; ALLERGY; DRUGS AB Background: Anaphylaxis to latex or muscle relaxant drugs has been demonstrated in the perioperative period but there are no reports of a patient with anaphylaxis to both of these substances. Methods: We report a patient with meningomyelocele who was initially thought to have anaphylaxis to latex during induction of anesthesia. After recurrence of anaphylaxis following removal of latex as the suspected agent, the muscle relaxant vecuronium was found to be the actual etiology. Results: Skin testing to several muscle relaxants and other anesthetic medications confirmed a hypersensitivity to vecuronium. Skin testing and subsequent physical contact with latex also established a hypersensitivity to this substance. Conclusions: This report demonstrates the need to scrutinize closely every notation in the anesthesia record when evaluating perioperative anaphylaxis and to consider that hypersensitivity to more than one substance may be present. C1 WALTER REED ARMY MED CTR,ALLERGY IMMUNOL SERV,WASHINGTON,DC. NR 34 TC 4 Z9 4 PU AMER COLL ALLERGY ASTHMA IMMUNOLOGY PI ARLINGTON HTS PA 85 WEST ALGONQUIN RD SUITE 550, ARLINGTON HTS, IL 60005 SN 0003-4738 J9 ANN ALLERGY JI Ann. Allergy PD NOV PY 1994 VL 73 IS 5 BP 405 EP 408 PG 4 WC Allergy SC Allergy GA PT435 UT WOS:A1994PT43500006 ER PT J AU MERETOJA, OA TAIVAINEN, T JALKANEN, L WIRTAVUORI, K AF MERETOJA, OA TAIVAINEN, T JALKANEN, L WIRTAVUORI, K TI SYNERGISM BETWEEN ATRACURIUM AND VECURONIUM IN INFANTS AND CHILDREN DURING NITROUS OXIDE-OXYGEN-ALFENTANIL ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, ATRACURIUM; NEUROMUSCULAR BLOCK, VECURONIUM; PHARMACOLOGY, SYNERGISM; ANESTHESIA, PEDIATRIC ID DOSE-RESPONSE CURVE; PEDIATRIC-PATIENTS; NEUROMUSCULAR BLOCKADE; D-TUBOCURARINE; AGE; COMBINATIONS AB This study was undertaken to see if infants are more sensitive than children to a combination of atracurium and vecuronium in an equipotent dose ratio:(mu g:mu g) 5:1 in infants and 4:1 in children. We studied 15 infants (1-11 months old) and 15 children (3-10 yr old) during nitrous oxide-oxygen-alfentanil anaesthesia. Neuromuscular function was recorded by adductor pollicis EMG. An individual dose-response curve of the atracurium-vecuronium combination was determined for every patient and its potency compared with that of the parent agents alone. The combination was significantly more potent than one parent agent, both in infants (P < 0.01) and in children (P < 0.0001). However, infants were less sensitive than children to synergism produced by the atracurium-vecuronium combination: if the ED(50) dose of the parent agent is defined as one dose equivalent, then the mean ED(50) doses of the combination were 0.81 (SEM 0.05) and 0.64 (0.03) dose equivalents in infants and children, respectively (P < 0.01). We suggest that an interaction between two binding sites of competitive neuromuscular blocking agents in postsynaptic acetylcholine receptors may explain both the synergism and sensitivity of infants to non-depolarizing neuromuscular blocking agents. RP MERETOJA, OA (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIOL,STENBACKINKATU 11,SF-00290 HELSINKI,FINLAND. NR 13 TC 6 Z9 9 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 1994 VL 73 IS 5 BP 605 EP 607 DI 10.1093/bja/73.5.605 PG 3 WC Anesthesiology SC Anesthesiology GA PP065 UT WOS:A1994PP06500009 ER PT J AU MADDINENI, VR MIRAKHUR, RK MCCOY, EP SHARPE, TDE AF MADDINENI, VR MIRAKHUR, RK MCCOY, EP SHARPE, TDE TI NEUROMUSCULAR AND HEMODYNAMIC-EFFECTS OF MIVACURIUM IN ELDERLY AND YOUNG-ADULT PATIENTS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, MIVACURIUM; PHARMACODYNAMICS; AGE FACTORS ID PLASMA CHOLINESTERASE ACTIVITY; CHLORIDE BW B1090U; CLINICAL-PHARMACOLOGY; INTUBATING CONDITIONS; ENFLURANE ANESTHESIA; INFUSION; SUCCINYLCHOLINE; ATRACURIUM; BW-B1090U; SUXAMETHONIUM AB We have studied the neuromuscular effects of mivacurium and changes in heart rate and arterial pressure in 40 elderly (aged 70 yr) and 20 young adult (aged 18-40 yr) patients anaesthetized with thiopentone, fentanyl, nitrous oxide in oxygen and halothane. Neuromuscular block was monitored by train-of-four (TOF) stimulation of the ulnar nerve and recording of the force of contraction of the adductor pollicis muscle using a force displacement transducer and a neuromuscular function analyser (Myograph 2000, Biometer Ltd). Twenty elderly and 10 young adults received single doses of mivacurium 0.15 mg kg(-1) and spontaneous recovery was recorded. The other 20 elderly and 10 adults received the same dose but an infusion was started at T1 (first response in TOF) of 10% and the block maintained at this level. Haemodynamic effects were studied after administration of mivacurium over 15 or 5 s in elderly (n = 10 each) and over 5 s in adult (n = 10) patients. Onset of maximum block occurred at a mean time of 122 (SD 32) and 125 (49) s in elderly and young adults, respectively. Recovery of T1 to 25% occurred in 22.0 (5.7) and 17.2 (4.4) min, and T1 to 90% in 32.8 (6.9) and 24.4 (5.8) min in elderly and adult subjects, respectively. Recovery of the TOF ratio to 0.7 occurred in 32.8 (7.1) and 26.0 (15.0) min in the elderly and young subjects, respectively (all P(0.05 between young and elderly). Mean mivacurium requirements by continuous infusion for maintenance of 90% block were 3.67 and 5.50 mu g kg(-1) min(-1) in elderly and the young adults, respectively (P < 0.05). In the elderly, neuromuscular effects were prolonged by approximately 30% and infusion requirements reduced by 38%. Residual neuromuscular block was antagonized easily with edrophonium or neostigmine. Except for small changes in systolic arterial pressure, mivacurium exhibited good haemodynamic stability in both groups. Cutaneous flushing was observed in six elderly (15%) and six young adults (30%). C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. ROYAL VICTORIA HOSP,BELFAST BT12 6BA,ANTRIM,NORTH IRELAND. NR 24 TC 15 Z9 16 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 1994 VL 73 IS 5 BP 608 EP 612 DI 10.1093/bja/73.5.608 PG 5 WC Anesthesiology SC Anesthesiology GA PP065 UT WOS:A1994PP06500010 ER PT J AU HEADRAPSON, AG DEVLIN, JC PARKER, CJR HUNTER, JM AF HEADRAPSON, AG DEVLIN, JC PARKER, CJR HUNTER, JM TI PHARMACOKINETICS OF THE 3 ISOMERS OF MIVACURIUM AND PHARMACODYNAMICS OF THE CHIRAL MIXTURE IN HEPATIC CIRRHOSIS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, MIVACURIUM; PHARMACOKINETICS, MIVACURIUM; PHARMACOKINETICS, STEREOISOMERS; LIVER, CIRRHOSIS ID RENAL-FAILURE; CHLORIDE; PHARMACOLOGY AB We have studied the pharmokinetics of cis-trans, trans-trans and cis-cis mivacurium in 10 healthy subjects and 11 patients with mild or moderate hepatic cirrhosis, during nitrous oxide-oxygen-isoflurane anaesthesia. Mivacurium 15 mu g kg(-1) min(-1) was infused for 10 min (total dose 0.15 mg kg(-1)) and the plasma concentration of the three isomers measured at regular intervals for 190 min. The electromyographic response to the drug was also measured. Compartmental analysis of the resulting isomer profiles was undertaken: one- and two-compartment models were fitted to derive clearance, volume of distribution and half-life. Clearance of the cis-trans and trans-trans isomers was reduced significantly in the cirrhotic compared with the healthy group: cis-trans (median (range)) 44 (15-121) ml kg(-1) min(-1) vs 95 (57-213) ml kg(-1) min(-1) (P < 0.05); trans-trans 32 (12-64) ml kg(-1) min(-1) vs 70 (34-101) ml kg(-1) min(-1) (P < 0.05). The difference in the clearance of the cis-cis isomer in the cirrhotic (4.2 (2.9-12.1) ml kg(-1) min(-1) compared with the healthy group (5.2 (2.9-8.9) ml kg(-1) min(-1)) was not significant with this sample size. Clearance of each isomer correlated significantly with plasma cholinesterase activity: cis-trans r = 0.73, P < 0.001; trans-trans r = 0.69, P < 0.001; cis-cis r = 0.48, P < 0.05. Terminal half-life was prolonged significantly for the cis-trans and trans-trans isomers in the cirrhotic patients compared with the healthy subjects: cis-trans 2.5 (1.3-64.6) min vs 1.5 (0.7-2.2) min (P < 0.05); trans-trans 11.1 (2.8-36.9) min vs 2.3 (1.2-7.8) min (P < 0.001), but was not statistically significant for the cis-cis isomer: 60.8 (8.7-155) min vs 50.3 (12.6-237) min. Volume of distribution was similar for all three isomers in the healthy and cirrhotic groups. Onset and recovery from neuromuscular block were slower in the cirrhotic compared with the healthy group: time to 90% depression of T1/T0 6.8 (5.8-11.5) min vs 5.9 (5.3-10.3) min (P < 0.05); recovery index (25-75% recovery of T1/T0) 11.8 (5.6-26.3) min vs 7.4 (4.7-9.6) min (P < 0.01). There was a significant negative correlation between all recovery variables and plasma cholinesterase activity. RP HEADRAPSON, AG (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,POB 147,PRESCOT ST,LIVERPOOL L69 3BX,MERSEYSIDE,ENGLAND. NR 24 TC 32 Z9 33 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 1994 VL 73 IS 5 BP 613 EP 618 DI 10.1093/bja/73.5.613 PG 6 WC Anesthesiology SC Anesthesiology GA PP065 UT WOS:A1994PP06500011 ER PT J AU BEVAN, JC PURDAY, JP REIMER, EJ BEVAN, DR AF BEVAN, JC PURDAY, JP REIMER, EJ BEVAN, DR TI REVERSAL OF DOXACURIUM AND PANCURONIUM NEUROMUSCULAR BLOCKADE WITH NEOSTIGMINE IN CHILDREN SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE AGE; ANESTHESIA, PEDIATRIC; NEUROMUSCULAR RELAXANTS, DOXACURIUM ID DOSE-RESPONSE RELATIONSHIPS; ENFLURANE ANESTHESIA; ELDERLY PATIENTS; NITROUS-OXIDE; EDROPHONIUM; CHLORIDE; PYRIDOSTIGMINE; ANTAGONISTS; HALOTHANE; INFANTS AB Recovery after doxacurium and pancuromium neuromuscular blockade and their acceleration by neostigmine have not been compared in children. Therefore, 60 paediatric surgical patients aged 2-10 yr (ASA 1-2) were studied. They were randomized to receive doxacurium 30 mu g . kg(-1) or pancuronium 70 mu g . kg(-1) iv during propofol, fentanyl, isoflurane and nitrous oxide anaesthesia. Electromyographic (EMG) responses of the adductor pollicis to train-of-four (TOF) stimulation of the ulnar nerve were recorded every ten seconds using a Datex NMT monitor. Six patients in each relaxant group received neostigmine (0, 5, 10, 20 and 40 mu . kg(-1)) with atropine by random allocation when first twitch height (T-1) had recovered to 25% of control. Spontaneous recovery after ten minutes was similar following doxacurium (mean +/- SEM values of 45.0 +/- 3.9 vs 49.5 +/- 10.0% for T-1 and 25.2 +/- 3.8 vs 14.8 +/- 3.6% for TOF ratios ). Dose responses to neostigmine were calculated from the log dose vs logit of T-1 or TOF ratio after ten minutes. Neostigmine-assisted recovery was not different in the two groups, with ED(70) and ED(90) doses for T-1 of 14.3 +/- 1.8 and 25.7 +/- 2.7 mu g . kg(-1) for doxacurium and 12.5 +/- 1.7 and 25.3 +/- 2.3 mu g . kg(-1) for pancuronium. Time to recovery of TOF ratio to 70% after neostigmine 40 mu . kg(-1) was 2.3 +/- 1.0 and 4.2 +/- 1.7 min (P = NS) following pancuronium and doxacurium, respectively. Adjusted recovery due to neostigmine alone (spontaneous recovery subtracted from the total) required two to three times higher doses of neostigmine. Thus, in children, the spontaneous recovery and reversal of neuromuscular blockade is similar with doxacurium and pancuronium. However, compared with previous adult studies, they recover twice as quickly from doxacurium neuromuscular blockade and neostigmine antagonism is achieved at 25-50% of the adult doses. C1 UNIV BRITISH COLUMBIA,DEPT ANAESTHESIA,VANCOUVER,BC,CANADA. RP BEVAN, JC (reprint author), BRITISH COLUMBIA CHILDRENS HOSP,DEPT ANAESTHESIA,4480 OAK ST,VANCOUVER,BC V6H 3V4,CANADA. NR 29 TC 7 Z9 7 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD NOV PY 1994 VL 41 IS 11 BP 1074 EP 1080 PG 7 WC Anesthesiology SC Anesthesiology GA QT656 UT WOS:A1994QT65600011 ER PT J AU VANDENBROEK, L PROOST, JH WIERDA, JMKH NJOO, MD HENNIS, PJ AF VANDENBROEK, L PROOST, JH WIERDA, JMKH NJOO, MD HENNIS, PJ TI NEUROMUSCULAR AND CARDIOVASCULAR EFFECTS OF NEOSTIGMINE AND METHYL-ATROPINE ADMINISTERED AT DIFFERENT DEGREES OF ROCURONIUM-INDUCED NEUROMUSCULAR BLOCK SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACODYNAMICS, ANTAGONISM OF BLOCK AB The neuromuscular and cardiovascular effects of neostigmine, 40 mug kg-1, and methyl-atropine, 7 mug kg-1, administered at different degrees of rocuronium-induced (600 mug kg-1) neuromuscular block were evaluated. In one group of patients spontaneous recovery was awaited (Group A; n = 20). Neostigmine and methyl-atropine were administered 2 minutes after rocuronium (Group B; n = 20) or at 25% twitch recovery (Group C; n = 20). Neuromuscular transmission was monitored mechanomyographically. Data are presented as mean (SD) [95%-Cl]. The initial rate of recovery (time until a TOF ratio of 0.2) in group B, i.e. 14.2 (4.5) [12.1-16.3] min, was significantly faster than in group C, i.e. 28.7 (5.3) [26.3-31.1] min. However, the time until clinically sufficient recovery (time until a TOF ratio of 0.7) was similar for groups B, i.e. 29.3 (9.5) [24.9-33.7] min and group C, i.e. 31.8 (5.6) [29.2-34.4] min, both significantly different from that of group A, i.e. 53.2 (14.5) [46.5-59.9] min. The increase in heart rate following neostigmine/methyl-atropine was more pronounced in the group reversed at 2 min after rocuronium (P<0.01). C1 UNIV GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,9700 AB GRONINGEN,NETHERLANDS. NR 0 TC 5 Z9 5 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD NOV PY 1994 VL 11 IS 6 BP 481 EP 487 PG 7 WC Anesthesiology SC Anesthesiology GA PR938 UT WOS:A1994PR93800008 ER PT J AU GYERMEK, L CANTLEY, EM AF GYERMEK, L CANTLEY, EM TI COMPARISON OF THE ONSET, SPONTANEOUS-RECOVERY AND TRAIN OF 4 FADE OF THE CLINICAL NEUROMUSCULAR BLOCK PRODUCED BY PANCURONIUM AND PIPECURONIUM SO INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS LA English DT Article DE NEUROMUSCULAR BLOCK; PIPECURONIUM; PANCURONIUM; CLINICAL ONSET OF ACTION; CLINICAL DURATION OF ACTION ID SPONTANEOUS OFFSET; ATRACURIUM; VECURONIUM; BROMIDE; ANESTHESIA; TUBOCURARINE; RESPONSES; DURATION AB The following study was performed to delineate the possible differences in the onset, recovery and ''train of four'' (TOF) fade characteristics of pancuronium (Pan) and pipecuronium (Pip). Eighty adult American Society of Anesthesiologists (ASA) class I and II surgical patients were studied with institutional approval. After premedication, general anesthesia was induced with thiopental sodium i.v. followed by N-2/O-2 halothane and fentanyl. The lungs were ventilated. Normocarbia and normothermia were maintained. Two groups of 40 patients received pancuronium (0.1 mg/kg i.v.) or pipecuronium (0.07 mg/g i.v.). Neuromuscular block (NMB) was measured simultaneously by mechanomyography (MMG) and electromyographically (EMG) on the thumb adductor muscle. Supramaximal (TOF) stimuli were applied to the ulnar nerve every 20 seconds. The onset of neuromuscular blocking action, duration of action (to 25% recovery of twitch response), TOF fade during onset and up to 25% T-1 response recovery, hemodynamic changes following induction of anesthesia and after the muscle relaxant and subsequent oral intubation were determined. Mean values and the differences in the two treatments groups were statistically analyzed. The onset of action of the two agents were similar: 3.62+/-0.02 minutes (MMG) and 4.94+/-0.05 minutes (EMG, Pan) and 3.74+/-0.02 minutes (MMG) and 4.36+/-0.012 minutes (EMG, Pip). TOF fade ratios during the onset phase were similar. TOF fade at the 25% twitch responses recovery level was 100% with the MMG responses and (96% (Pan) and 94.8% (Pip) with the EMG responses at the 25% twitch response recovery level. Hemodynamic changes were similar after the single dose adminstration of the bolus administration of the two NMB agents. The only difference between the two treatment groups was in the degree of tachycardia in response to endotracheal intubation which was marginally more significant with Pan than with Pip (p=0.1>0.05). The clinical NMB onset of action and TOF fade characteristics of equipotent doses of Pan and Pip are identical. The duration of action of Pip was about 10% (p=<0.01) shorter than that of Pan, (The probable cause of this difference may be due to a differing influence of halothane anesthesia on the duration of NMB of otherwise equipotent NMB doses of these agents). Essentially no difference was observed in the hemodynamic data between the two treatment groups during the periods of induction of anesthesia. RP GYERMEK, L (reprint author), UNIV CALIF LOS ANGELES,HARBOR MED CTR,DEPT ANESTHESIOL,BOX 10,TORRANCE,CA 90509, USA. NR 23 TC 1 Z9 1 PU DUSTRI-VERLAG DR KARL FEISTLE PI MUNCHEN-DEISENHOFEN PA BAHNHOFSTRABE 9 POSTFACH 49, W-8024 MUNCHEN-DEISENHOFEN, GERMANY SN 0946-1965 J9 INT J CLIN PHARM TH JI Int. J. Clin. Pharmacol. Ther. PD NOV PY 1994 VL 32 IS 11 BP 600 EP 605 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA PT599 UT WOS:A1994PT59900007 ER PT J AU JAKUBIK, J TUCEK, S AF JAKUBIK, J TUCEK, S TI PROTECTION BY ALCURONIUM OF MUSCARINIC RECEPTORS AGAINST CHEMICAL INACTIVATION AND LOCATION OF THE ALLOSTERIC BINDING-SITE FOR ALCURONIUM SO JOURNAL OF NEUROCHEMISTRY LA English DT Article DE MUSCARINIC RECEPTORS; ALCURONIUM; ALLOSTERIC BINDING SITE; COOPERATIVITY BETWEEN RECEPTOR BINDING SITES; RECEPTORS, ALLOSTERIC CONTROL; RECEPTORS, CHEMICAL MODIFICATION ID NEUROMUSCULAR BLOCKING-DRUGS; ACETYLCHOLINE-RECEPTORS; ANTAGONIST BINDING; GALLAMINE; TYROSINE; RESIDUE AB We have found earlier that the neuromuscular blocker alcuronium binds to cardiac muscarinic receptors simultaneously with their specific antagonist [H-3]methyl-N-scopolamine ([H-3]NMS) and allosterically increases their affinity to this ligand. Nothing is known about the allosteric site with which alcuronium interacts. To gain an insight, we have now investigated how the binding of [H-3]NMS is affected by agents known to modify specific residues in proteins and how their effects are altered by alcuronium. Reagents that covalently modify the tyrosyl residues (p-nitrobenzenesulfonyl fluoride and 4-chloro-7-nitrobenzofurazan) and the carboxyl groups of aspartate and glutamate [1-ethyl-3-(3-dimethylaminopropyl)carbodiimide, N,N'-dicyclohexylcarbodiimide, and N-ethyl-5-phenylisoxazolium-3'-sulfonate] blocked the binding of [H-3]NMS to receptors in rat heart atria. Their action was probably due to the modification of tyrosyl and aspartyl residues directly in the muscarinic binding sites because it was antagonized by atropine and carbamoylcholine. Alcuronium and gallamine, another allosteric ligand, also protected the [H-3]NMS binding sites against the inactivation by tyrosine- and carboxyl-directed chemical modifiers just as well as by benzilylcholine mustard, known to attach covalently to the muscarinic binding sites. Protection by alcuronium has also been observed on cerebrocortical muscarinic receptors. The effect of alcuronium indicates that the drug interferes with the access of chemical modifiers to the muscarinic sites. In view of the unspecific nature of most of the modifiers used (with regard to muscarinic mechanisms), the protection by alcuronium appears to be best explained on the assumption that the drug binds in close vicinity of the ''classical'' muscarinic site and sterically blocks the access to this site. C1 ACAD SCI CZECH REPUBL,INST PHYSIOL,CR-14220 PRAGUE,CZECH REPUBLIC. RI Jakubik, Jan/B-7461-2012 OI Jakubik, Jan/0000-0002-1737-1487 NR 37 TC 27 Z9 27 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0022-3042 J9 J NEUROCHEM JI J. Neurochem. PD NOV PY 1994 VL 63 IS 5 BP 1932 EP 1940 PG 9 WC Biochemistry & Molecular Biology; Neurosciences SC Biochemistry & Molecular Biology; Neurosciences & Neurology GA PN458 UT WOS:A1994PN45800042 ER PT J AU FIDDES, S PRIOR, C AF FIDDES, S PRIOR, C TI IN-VITRO SMOOTH-MUSCLE RELAXANT ACTIVITY OF A SERIES OF VECURONIUM ANALOGS IN THE RAT AORTA SO JOURNAL OF PHARMACY AND PHARMACOLOGY LA English DT Article ID NEUROMUSCULAR BLOCKING ACTION; MOTOR-NERVE TERMINALS; CALCIUM-CHANNEL; SKELETAL-MUSCLE; VERAPAMIL; POTENTIATION; BLOCKADE; DOGS; CATS AB The ability of a series of 17-ester analogues of vecuronium to elicit a direct relaxant effect on vascular smooth muscle has been studied using rat isolated aortic rings contracted with 40 mM KCl. The IC50 for inhibition of KCl-induced contractions increased with increasing size of the 17-ester substituent, such that vecuronium (17 beta-acetate) was the least potent with an IC50 of around 500 mu M and Org-9827 (17 alpha-pivalate) was the most potent with an IC50 of around 5 mu M. In addition, for the weaker-acting compounds, the 17 alpha-esters were more potent than their corresponding 17 beta-esters, although this difference was lost as the size of the 17-ester substituent increased. From the results obtained here, it is concluded that the hypotensive activity of some of the newer neuromuscular blocking steroids seen in cats, pigs and dogs in-vivo is probably, at least in part, a consequence of a direct relaxant effect of the compound on vascular smooth muscle through inhibition of voltage-activated, L-type, calcium channels. This may have both advantageous and disadvantageous clinical consequences when using large doses of one of the newer vecuronium analogues with a low relative neuromuscular-blocking potency. C1 UNIV STRATHCLYDE,DEPT PHYSIOL & PHARMACOL,GLASGOW G1 1XW,LANARK,SCOTLAND. NR 23 TC 7 Z9 7 PU ROYAL PHARMACEUTICAL SOC GREAT BRITAIN PI LONDON PA 1 LAMBETH HIGH ST, LONDON, ENGLAND SE1 7JN SN 0022-3573 J9 J PHARM PHARMACOL JI J. Pharm. Pharmacol. PD NOV PY 1994 VL 46 IS 11 BP 911 EP 916 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA PU244 UT WOS:A1994PU24400013 ER PT J AU FREEBAIRN, R JOYNT, GM LIPMAN, J BOTHMA, PA AF FREEBAIRN, R JOYNT, GM LIPMAN, J BOTHMA, PA TI A DOUBLE-BLIND COMPARISON OF VECURONIUM ADMINISTERED BY THE SPRINGFUSOR(R) INFUSION DEVICE TO VECURONIUM BY INTERMITTENT BOLUS INJECTION IN CRITICALLY ILL ADULT PATIENTS SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE EQUIPMENT; SPRINGFUSOR(R); MUSCLE RELAXANT, VECURONIUM; INTRAVENOUS ADMINISTRATION; INFUSION; BOLUS ID INTENSIVE-CARE UNIT; NEUROMUSCULAR BLOCKADE; PROLONGED PARALYSIS; PANCURONIUM AB To evaluate the Springfusor(R) infusion device for clinical use in an Intensive Care Unit and to compare the technique of intermittent bolus and constant infusion of muscle relaxants, we undertook a prospective double-blind randomized placebo-controlled study. Twenty critically ill ventilated patients requiring muscle paralysis were investigated. Although we could show no clinical advantage in infusing vecuronium, the Springfusor(R) provided a more constant level of paralysis compared with hourly bolus doses. The device is robust, easy to use and reduces nursing workload. This may translate into cost-saving improvement in patient care if the Springfusor(R) is used to provide muscle relaxation, sedation and analgesia. C1 BARAGWANATH HOSP,INTENS CARE UNIT,BERSHAM 2013,SOUTH AFRICA. UNIV WITWATERSRAND,DEPT ANAESTHESIA,JOHANNESBURG 2001,SOUTH AFRICA. RI Joynt, Gavin/C-7606-2009; Freebairn, Ross/F-4255-2010 NR 18 TC 3 Z9 3 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 1994 VL 22 IS 5 BP 580 EP 585 PG 6 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA PM927 UT WOS:A1994PM92700012 ER PT J AU NAGUIB, M ABDULATIF, M ALGHAMDI, A SELIM, M SERAJ, M ELSANBARY, M MAGBOUL, MA AF NAGUIB, M ABDULATIF, M ALGHAMDI, A SELIM, M SERAJ, M ELSANBARY, M MAGBOUL, MA TI INTERACTIONS BETWEEN MIVACURIUM AND ATRACURIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, ATRACURIUM; NEUROMUSCULAR BLOCK, MIVACURIUM; POTENCY, ANESTHETIC, ED(50) ID NEUROMUSCULAR BLOCKADE; SURGICAL PATIENTS; D-TUBOCURARINE; DOSE-RESPONSE; VECURONIUM; PANCURONIUM; PHARMACOLOGY; PIPECURONIUM; POTENTIATION; COMBINATION AB We have studied the interaction between atracurium and mivacurium. The dose-response relationships of atracurium, mivacurium and their combination were studied in 96 ASA I or II patients during thiopentone-fentanyl-nitrous oxide-isoflurane (1.2% end-tidal) anaesthesia. Neuromuscular block was recorded as the evoked thenar mechano-myographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 12-s intervals). The dose-response curves were determined by probit analysis. Isobolographic and algebraic (fractional) analyses were used to assess quantitatively the combined effect of equipotent doses of atracurium and mivacurium and to define the type of interaction between these drugs. Isobolograms were constructed by plotting single drug ED(50) points on the dose co-ordinates and a combined ED(50) point in the dose field. The calculated doses producing 50% depression (ED(50)) of the first twitch height were 50.5 (95% confidence intervals 48.9-52.1) and 20.8 (20.3-21.3) mu g kg(-1) for the atracurium and mivacurium groups, respectively. Isobolographic and fractional analyses of the atracurium-mivacurium combination demonstrated zero interaction (additivism). An additional 26 patients anaesthetized with thiopentone-fentanyl-nitrous oxide-isoflurane were allocated randomly to receive either atracurium 0.5 mg kg(-1) (n = 13) or mivacurium 0.15 mg kg(-1) (n = 13). Additional maintenance doses of mivacurium 0.1 mg kg(-1) were administered to patients in both groups, whenever the first twitch recovered to 10% of control. The duration of the first maintenance dose of mivacurium to 10% recovery of the first twitch was greater (P < 0.0005) after atracurium (25 (21.8-28.5) min) than after mivacurium (14.2 (11.9-16.6) min). However, the duration of the second maintenance dose of mivacurium after atracurium (18.3 (12.6-24) min) was similar to that of mivacurium after mivacurium (14.6 (10.6-18.6) min). We conclude that the combination of atracurium and mivacurium is additive and that the use of mivacurium after atracurium-induced neuromuscular block results in increased duration of the first (but not the subsequent) maintenance dose of mivacurium. C1 KING SAUD UNIV,ICU,RIYADH 11472,SAUDI ARABIA. KING KHALID UNIV HOSP,FAC MED,RIYADH 11472,SAUDI ARABIA. RP NAGUIB, M (reprint author), KING SAUD UNIV,DEPT ANAESTHESIA,POB 7805,RIYADH 11472,SAUDI ARABIA. NR 24 TC 18 Z9 22 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 OCT PY 1994 VL 73 IS 4 BP 484 EP 489 DI 10.1093/bja/73.4.484 PG 6 WC Anesthesiology SC Anesthesiology GA PJ966 UT WOS:A1994PJ96600012 ER PT J AU MERETOJA, OA TAIVAINEN, T WIRTAVUORI, K AF MERETOJA, OA TAIVAINEN, T WIRTAVUORI, K TI PHARMACODYNAMICS OF MIVACURIUM IN INFANTS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, MIVACURIUM; PHARMACODYNAMICS; ANESTHESIA, PEDIATRIC ID OXIDE-NARCOTIC ANESTHESIA; CHLORIDE BW B1090U; NITROUS-OXIDE; CLINICAL-PHARMACOLOGY; CONTINUOUS INFUSION; CHILDREN; ATRACURIUM; HALOTHANE AB A computerized infusion system was used to determine mivacurium infusion requirements to maintain 95% and 50% neuromuscular block in 15 infants less than 1 yr of age. Neuromuscular block was measured by adductor pollicis EMG and anaesthesia maintained with 66% nitrous oxide in oxygen and alfentanil 50-100 mu g kg(-1) h(-1). Neuromuscular block was produced by repeated bolus doses of mivacurium 0.1 mg kg(-1); subsequently the target neuromuscular block was maintained by a closed loop infusion. Dose potency of mivacurium was similar to that previously published in children with a similar anaesthetic technique. Mean mivacurium requirement for 95% neuromuscular block was 820 (SD 300) mu g kg(-1) h(-1), which represented an hourly requirement of 6.6 (1.5) individual ED(50) doses. Infusion requirement for 50% neuromuscular block was 320 (150) mu g kg(-1) h(-1). These infusion rates were similar to those in children. No side effects of mivacurium were noticed. RP MERETOJA, OA (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIOL,STENBACKINKATU 11,SF-00290 HELSINKI,FINLAND. NR 17 TC 13 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 OCT PY 1994 VL 73 IS 4 BP 490 EP 493 DI 10.1093/bja/73.4.490 PG 4 WC Anesthesiology SC Anesthesiology GA PJ966 UT WOS:A1994PJ96600013 ER PT J AU PATERSON, IG HOOD, JR RUSSELL, SH WESTON, MD HIRSCH, NP AF PATERSON, IG HOOD, JR RUSSELL, SH WESTON, MD HIRSCH, NP TI MIVACURIUM IN THE MYASTHENIC PATIENT SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE MYASTHENIA GRAVIS; NEUROMUSCULAR BLOCK, MIVACURIUM ID PLASMA CHOLINESTERASE ACTIVITY; DOSE-RESPONSE RELATIONSHIP; NITROUS OXIDE-ISOFLURANE; NEUROMUSCULAR BLOCKADE; CHLORIDE BW-B1090U; SURGICAL PATIENTS; GRAVIS; ANESTHESIA; VECURONIUM; ATRACURIUM AB We have used mivacurium in four myasthenic patients presenting for thymectomy. Supramaximal single twitch stimulation was applied to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis was measured. After an initial bolus dose of 30 mu g kg(-1) (approximately one-fifth of the normal intubating dose), we observed a mean 37.5 (SEM 5.6) % reduction in evoked twitch tension, Neuromuscular block was increased with incremental doses and maintained with repeat bolus doses of 15 mu g kg(-1) at 25% recovery. The interval between maintenance bolus doses remained constant (mean 5.9 (0.7) min). Spontaneous offset was rapid with a mean recovery index (T25-T75) of 11.9 (2.1) min. Provided anticholinesterase therapy is withheld in the immediate preoperative period, mivacurium would appear to be a safe and appropriate neuromuscular blocker in this variably sensitive group of patients. The cumulative dose required to establish full neuromuscular block varied between 60 and 90 mu g kg(-1). A maintenance infusion, commencing at 3 mu g kg(-1) min(-1), is recommended, guided by neuromuscular monitoring. C1 UCL NATL HOSP NEUROL & NEUROSURG, DEPT ANAESTHESIA, LONDON WC1N 3BG, ENGLAND. NR 29 TC 17 Z9 18 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 1994 VL 73 IS 4 BP 494 EP 498 DI 10.1093/bja/73.4.494 PG 5 WC Anesthesiology SC Anesthesiology GA PJ966 UT WOS:A1994PJ96600014 ER PT J AU NAGUIB, M AF NAGUIB, M TI DIFFERENT PRIMING TECHNIQUES, INCLUDING MIVACURIUM, ACCELERATE THE ONSET OF ROCURONIUM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE INTERACTIONS, MIVACURIUM, ROCURONIUM (ORG 9426); MONITORING, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, MIVACURIUM, ROCURONIUM, SUCCINYLCHOLINE PHARMACODYNAMICS, PRIMING PRINCIPLE ID RAPID-SEQUENCE INDUCTION; NEUROMUSCULAR BLOCKADE; ADDUCTOR POLLICIS; TRACHEAL INTUBATION; VECURONIUM; ANESTHESIA; ATRACURIUM; SUCCINYLCHOLINE; MUSCLES; PANCURONIUM AB Different priming sequences of equipotent doses of rocuronium and mivacurium on the onset of maximum neuromuscular block and intubating conditions were compared with those obtained after succinylcholine, During thiopentone-fentatanyl-nitrous oxide anaesthesia, 70 patients were randomly assigned into seven groups. Group I received mivacurium 0.15 mg kg(-1) as a single bolus dose. Group II received a priming dose of mivacurium 0.015 mg kg(-1) followed three minutes later by mivacurium 0.135 mg.kg(-1). Group III received rocuronium 0.6 mg.kg(-1) as a single bolus dose, and Group IV received an initial dose of rocuronium 0.06 mg.kg(-1) followed by rocuronium 0.54 mg.kg(-1). Group V received a priming dose of mivacurium 0.015 mg.kg(-1) followed by rocuronium 0.54 mg.kg(-1) Group VI received an initial dose of rocuronium 0.06 mg.kg(-1) followed by mivacurium 0.135 mg.kg(-1) Group VII received succinylcholine 1.0 mg.kg(-1) Groups I; III, and VII received a placebo injection before the administration of the neuromuscular blocking drug. Additional thiopentone 2 mg.kg(-1) iv was given 30 sec before intubation. Onset times (mean (95% confidence interval)) after priming a rocuronium block with either rocuronium (73 (57-90) sec) or mivacurium (58 (47-69) sec) were similar to those after succinylcholine (54 (40-68) sec), and were shorter (P < 0.01) than that observed in other groups. Intubating conditions were not different between the groups. The duration of neuromuscular block was shortest with succinylcholine. It is concluded that priming a rocuronium block with either mivacurium or rocuronium resulted in a neuromuscular block comparable to that of succinylcholine in both the onset of action and intubating conditions. C1 KING SAUD UNIV,ICU,RIYADH 11472,SAUDI ARABIA. KING KHALID UNIV HOSP,FAC MED,RIYADH 11472,SAUDI ARABIA. RP NAGUIB, M (reprint author), KING SAUD UNIV,DEPT ANAESTHESIA,POB 7805,RIYADH 11472,SAUDI ARABIA. NR 26 TC 35 Z9 39 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD OCT PY 1994 VL 41 IS 10 BP 902 EP 907 PG 6 WC Anesthesiology SC Anesthesiology GA PL755 UT WOS:A1994PL75500004 ER PT J AU SALIB, Y FROSSARD, J PLAUD, B DEBAENE, B MEISTELMAN, C DONATI, F AF SALIB, Y FROSSARD, J PLAUD, B DEBAENE, B MEISTELMAN, C DONATI, F TI NEUROMUSCULAR EFFECTS OF VECURONIUM AND NEOSTIGMINE IN MONTREAL AND PARIS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, NEOSTIGMINE; MONITORING, NEUROMUSCULAR DURATION, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, VECURONIUM ID OBESE SURGICAL PATIENT; BLOCKADE; PHARMACOKINETICS; PHARMACODYNAMICS; ATRACURIUM; ISOFLURANE; RECOVERY; ONSET; PANCURONIUM; POSTPARTUM AB The potency of vecuronium was reported to be greater in Montreal than in Paris. This study was designed to determine whether there were differences in onset, duration, and reversibility with neostigmine between both centres. Twenty ASA I or II adults (ten men, ten women), aged 18-65 yr were studied in each of the two cities, during a standard thiopentone-fentanyl-nitrous oxide (60-70%) - isoflurane 0.5% end-tidal anaesthetic. Train-of-four stimulation was applied every 20 sec to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis muscle was measured. Vecuronium, 0.1 mg.kg(-1) was given as a bolus, and neostigmine, 0.04 mg.kg(-1) was administered, with atropine 0.02 mg.kg(-1), at 25% first twitch height recovery. Onset time to maximum blockade was (mean +/- SD) 3.9 +/- 1.3 min in Paris vs 4.5 +/- 1.3 min in Montreal (NS). Duration from injection to 25% first twitch recovery was shorter (28.5 +/- 6.8 min) in Paris than in Montreal (39.1 +/- 23 min) (P < 0.0001). Time from injection of neostigmine to a train-of-four ratio of 70% was not different in Paris (6.3 +/- 2.2 min) from Montreal (5.6 +/- 1.9 min). It is concluded that the duration of on ''intubating'' dose of vecuronium is longer in Montreal, but, when given at 25% first twitch recovery, neostigmine has the same efficacy in Montreal as in Paris C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,MONTREAL H3A 1A1,PQ,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,PQ,CANADA. INST GUSTAVE ROUSSY,SERV ANESTHESIE,VILLEJUIF,FRANCE. NR 21 TC 3 Z9 5 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD OCT PY 1994 VL 41 IS 10 BP 908 EP 912 PG 5 WC Anesthesiology SC Anesthesiology GA PL755 UT WOS:A1994PL75500005 ER PT J AU GASCON, JL ACENA, ML SUAREZ, JA RODRIGUEZ, M AF GASCON, JL ACENA, ML SUAREZ, JA RODRIGUEZ, M TI RADIOCHEMICAL METHODS FOR THE DETERMINATION OF PLUTONIUM, AMERICIUM AND CURIUM IN TYPICAL WASTE STREAMS SO JOURNAL OF ALLOYS AND COMPOUNDS LA English DT Article; Proceedings Paper CT International Conference on Actinides CY SEP 19-24, 1993 CL SANTE FE, NM SP LOS ALAMOS NATL LAB, GTS INST TRANSACTINIUM SCI, INT SCI FDN, INT ATOMIC ENERGY AGCY, LAWRENCE LIVERMORE NATL LAB, US DOE AB Accurate and reliable analytical methods have been developed for the measurement of Pu, Am and Cm in typical waste streams from nuclear power plants. Pu, Am and Cm were separated using anion exchange and coprecipitation techniques. The solution of Am and Cm was electrodeposited and measured by alpha-particle spectrometry. In the case of Pu the solution was divided into two aliquots, one for liquid scintillation counting and the other for electrodeposition followed by alpha-particle spectrometry. To determine the chemical recovery of alpha emitters of the Pu fraction and the Am and Cm fraction, the sample was spiked with Pu-236 and Am-243. The chemical recovery of Pu-241,as calculated using two different methods which gave reliable results. Analysis of every sample was carried out twice to examine the reproducibility of the analytical methods. The radiochemical yields of Pu and Am ranged from 80% to 100% and from 60% to 80% respectively. C1 CIEMAT,INST TECNOL NUCL,E-28040 MADRID,SPAIN. RP GASCON, JL (reprint author), CIEMAT,INST INVERST BASICA,AVDA COMPLUTENSE 22,E-28040 MADRID,SPAIN. NR 5 TC 8 Z9 9 PU ELSEVIER SCIENCE SA LAUSANNE PI LAUSANNE 1 PA PO BOX 564, 1001 LAUSANNE 1, SWITZERLAND SN 0925-8388 J9 J ALLOY COMPD JI J. Alloy. Compd. PD OCT PY 1994 VL 213 BP 557 EP 559 DI 10.1016/0925-8388(94)90987-3 PG 3 WC Chemistry, Physical; Materials Science, Multidisciplinary; Metallurgy & Metallurgical Engineering SC Chemistry; Materials Science; Metallurgy & Metallurgical Engineering GA PN811 UT WOS:A1994PN81100118 ER PT J AU GALLACCI, M OLIVEIRA, AC AF GALLACCI, M OLIVEIRA, AC TI PRESYNAPTIC AND POSTSYNAPTIC MECHANISMS INVOLVED IN TETANIC FADE INDUCED BY PANCURONIUM IN THE ISOLATED RAT MUSCLE SO PHARMACOLOGY LA English DT Article DE PANCURONIUM; NEUROMUSCULAR JUNCTION, RAT; END-PLATE POTENTIALS; TETANIC FADE MECHANISMS ID NEUROMUSCULAR-JUNCTION; NICOTINIC ANTAGONISTS; TRANSMISSION AB The mechanisms underlying the fade of the tetanic contraction induced by pancuronium were studied in vitro by means of myographical and electrophysiological techniques in the extensor digitorum longus muscle of the rat. Pancuronium (0.5 mu mol/l) induced a complete fade of the tetanic contraction while leaving the twitch unaffected. At the same concentration it decreased the amplitude and increased the tetanic rundown of trains of endplate potentials (e.p.ps) evoked in the frequency of 50 Hz. The electrophysiological changes induced by pancuronium were due to decreases in both quantal sizes and quantal contents of the e.p.ps. The former effect was the result of a postsynaptic competitive action and the latter of a presynaptic inhibitory action of that compound. The decrease in quantal. content affected the e.p.ps starting from the first in the train and became larger during the generation of the sequence of e.p.ps. This intensified their tetanic rundown. It is concluded that the fade of the tetanic contraction induced by pancuronium is due to a summation of pre- and postsynaptic actions and, therefore, not only to an increase in the tetanic rundown of e.p.ps. Possible explanations for the distinct abilities of neuromuscular blockers in affecting tetani and twitches in a differential manner are also discussed. C1 UNIV SAO PAULO,INST CIENCIAS BIOMED,DEPT FARMACOL,BR-05508900 SAO CARLOS,SP,BRAZIL. UNIV SAO PAULO,UNESP,INST BIOCIENCIAS,DEPT FARMACOL,SAO PAULO,SP,BRAZIL. RI Gallacci, Marcia /C-8479-2013 NR 18 TC 8 Z9 8 PU KARGER PI BASEL PA ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND SN 0031-7012 J9 PHARMACOLOGY JI Pharmacology PD OCT PY 1994 VL 49 IS 4 BP 265 EP 270 DI 10.1159/000139242 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA PK311 UT WOS:A1994PK31100007 ER PT J AU DUPUIS, JY NATHAN, HJ DELIMA, L WYNANDS, JE RUSSELL, GN BOURKE, M AF DUPUIS, JY NATHAN, HJ DELIMA, L WYNANDS, JE RUSSELL, GN BOURKE, M TI PANCURONIUM OR VECURONIUM FOR TREATMENT OF SHIVERING AFTER CARDIAC-SURGERY SO ANESTHESIA AND ANALGESIA LA English DT Article ID ARTERY BYPASS-SURGERY; MYOCARDIAL-ISCHEMIA; OXYGEN-CONSUMPTION; GENERAL-ANESTHESIA; SUPPRESSION; STABILITY; RECOVERY; BROMIDE; DRUGS AB This randomized double-blind study compared the hemodynamic and metabolic effects of pancuronium and vecuronium during treatment of shivering after cardiac surgery with hypothermic cardiopulmonary bypass. Thirty sedated and pain-free patients who shivered after cardiac surgery were treated with pancuronium (n = 15) or vecuronium (n = 15) 0.08 mg/kg. Baseline values of heart rate (HR), mean arterial pressure, arterial and venous blood gases, total body oxygen consumption indexed to body surface area (Vo(2)-I), and pressure work index (PWI, an estimate of myocardial oxygen consumption) were measured on arrival in the intensive care unit, at onset of shivering, and repeatedly for 2 h after treatment. Continuous ST segment analysis of leads II and V-5 were used for detection of myocardial ischemia. Treatment of shivering with pancuronium decreased Vo(2)-I by 32% (P = 0.0001). This was accompanied by a 14% increase in HR (P = 0.001) and a 10% increase in PWI (P = 0.03). Vecuronium decreased Vo(2)-I by 36% (P = 0.003) with a 4% decrease in HR (P = 0.04) and a 6% decrease in PWI (P = 0.06). Myocardial ischemia (n = 3) and ventricular arrhythmias (n = 3) occurred in five patients treated with pancuronium. Only one patient treated with vecuronium had ventricular arrhythmia (P = 0.08). Seven patients treated with pancuronium and eight treated with vecuronium were taking beta-adrenergic blockers preoperatively which was associated with lower HR (96 +/- 16 vs 109 +/- 15 bpm; P = 0.025) and lower PWI (8.8 +/- 1.2 vs 10.7 +/- 1.92 mL.min(-1).100 g(-1); P = 0.003) at onset of shivering. However, beta-adrenergic blockers did not attenuate the relative HR increase induced by pancuronium. No relationship was found between hypercapnia and tachycardia or hypertension. These results suggest that, when compared to pancuronium for treatment of postoperative shivering, vecuronium may be advantageous because it does not increase myocardial work. The disproportionate relationship between Vo(2)-I and PWI after treatment with muscle relaxants indicates that increased Vo(2)-I does not contribute significantly to the hemodynamic disturbances associated with shivering. These disturbances are more likely the results of increased adrenergic activity related to pain and recovery from anesthesia. Shivering and its associated hemodynamic disturbances appear to be concomitant but independent signs of awakening. RP DUPUIS, JY (reprint author), UNIV OTTAWA,OTTAWA CIVIC HOSP,INST HEART,DEPT ANESTHESIA,DIV CARDIAC H213,1053 CARLING AVE,OTTAWA K1Y 4E9,ON,CANADA. NR 36 TC 9 Z9 9 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 1994 VL 79 IS 3 BP 472 EP 481 PG 10 WC Anesthesiology SC Anesthesiology GA PE206 UT WOS:A1994PE20600012 ER PT J AU CANTINEAU, JP PORTE, F DHONNEUR, G DUVALDESTIN, P AF CANTINEAU, JP PORTE, F DHONNEUR, G DUVALDESTIN, P TI NEUROMUSCULAR EFFECTS OF ROCURONIUM ON THE DIAPHRAGM AND ADDUCTOR POLLICIS MUSCLES IN ANESTHETIZED PATIENTS SO ANESTHESIOLOGY LA English DT Article DE MONITORING, ADDUCTOR POLLICIS, DIAPHRAGM; NEUROMUSCULAR RELAXANTS, ROCURONIUM; RESPIRATORY EFFECTS, MUSCLE RELAXANTS ID DOSE TECHNIQUES; VECURONIUM; ORG-9426; POTENCY; ANESTHESIA; ATRACURIUM; PARALYSIS; HUMANS; PANCURONIUM; ISOFLURANE AB Background: Rocuronium has properties that may make it suitable for rapid-sequence intubation. However, its neuromuscular effects have been studied only on the adductor pollicis. This study compares the neuromuscular effect of rocuronium on the diaphragm and adductor pollicis in humans. Methods: The forces generated by the diaphragm and the adductor pollicis during supramaximal single-twitch stimulation of the phrenic and ulnar nerves, respectively, were studied during thiopental, fentanyl, and nitrous oxide-oxygen anesthesia. In 6 patients, cumulative doses of 0.15, 0.25, 0.35, 0.45, and 0.60 mg.kg(-1) rocuronium were given over a 9-min period. The doses for 50% (ED(50)) and 95% (ED(95)) depression of twitch height were calculated. In another 12 patients, the times for maximal effect and 10%, 25%, 50%, 75%, and 90% recovery of the twitch height were calculated after a bolus dose of 0.60 mg.kg(-1) rocuronium. Results: ED(50) and ED(95) were higher for the diaphragm (0.26 +/- 0.07 and 0.50 +/- 0.20 mg.kg(-1), respectively) than for the adductor pollicis (0.14 +/- 0.05 and 0.24 +/- 0.04 mg.kg(-1)). Rocuronium 0.60 mg.kg(-1) produced 100% paralysis of the adductor pollicis in all patients and of the diaphragm in 9 of 12 patients. The onset time for muscle relaxation after 0.6 mg.kg(-1) rocuronium was shorter for the adductor pollicis than for the diaphragm (80 +/- 20 vs. 120 +/- 62 s). Times for 10%, 25%, 75%, and 90% recovery of twitch height were 34 +/- 10, 40 +/- 13, 56 +/- 20, and 64 +/- 21 min, respectively, for the adductor pollicis, and significantly shorter for the diaphragm: 17 +/- 10, 23 +/- 9, 33 +/- 13, and 35 +/- 10 min, respectively. Conclusions: The diaphragm is more resistant than the adductor pollicis to rocuronium, as shown by greater ED(50) and ED(95) and faster recovery of the twitch height. The intubating dose of 0.60 mg.kg(-1) is close to the ED(95), of 0.50 mg.kg(-1) for the diaphragm. C1 UNIV PARIS 12,HOP HENRI MONDOR,DEPT ANESTHESIA,F-94010 CRETEIL,FRANCE. NR 25 TC 39 Z9 44 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 1994 VL 81 IS 3 BP 585 EP 590 DI 10.1097/00000542-199409000-00010 PG 6 WC Anesthesiology SC Anesthesiology GA PG119 UT WOS:A1994PG11900008 ER PT J AU ABOULEISH, E ABBOUD, T LECHEVALIER, T ZHU, J CHALIAN, A ALFORD, K AF ABOULEISH, E ABBOUD, T LECHEVALIER, T ZHU, J CHALIAN, A ALFORD, K TI ROCURONIUM (ORG-9426) FOR CESAREAN-SECTION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHESIA; OBSTETRIC; NEUROMUSCULAR BLOCK; ROCURONIUM ID NEUROMUSCULAR BLOCKING; INTUBATING CONDITIONS; MUSCLE-RELAXANTS; ORG-9426; SUCCINYLCHOLINE; ANESTHESIA; PHARMACOKINETICS; SUXAMETHONIUM; PANCURONIUM; VECURONIUM AB This was a prospective, non-randomized, multicentre study of rocuronium (Org 9426) in 40 elective Caesarean section patients at full term without fetal distress. Anaesthesia was induced with thiopentone 4-6 mg kg(-1) i.v. and rocuronium 0.6 mg kg(-1) and maintained with isoflurane and nitrous oxide in oxygen. Monitors included ECG, arterial pressure, pulse oximeter and train-of-four (TOF) produced by ulnar nerve stimulation. In all patients, full neuromuscular block at the hand indicating the maximum effect of rocuronium (T1 = 0) occurred at a mean time of 98.1 (SD 9.4) s. However, after 79.3 (2.9)s, excellent to good intubating conditions were achieved in 90% of patients. Injection to delivery time was 12.7 (0.9) min and the surgical procedure lasted 53.1 (3.5) min. After administration of rocuronium, T2 appeared after 32.7 (1.8) min (indicating duration of effect). At the end of the surgical procedure in 39 patients, glycopyrronium 0.2 mg and neostigmine 1 mg were given every 5 min to antagonize residual neuromuscular effect. The mean dose of neostigmine required was 1.54 (0.1) mg. Rocuronium had no clinically significant effect on maternal heart rate or arterial pressure. After administration of thiopentone and rocuronium in two patients, temporary erythema occurred, one along the site of injection and the other on the chest wall. Rocuronium had no untoward effects on the neonates, evaluated by 1- and 5-min Apgar scores, time to sustained respiration, total and muscular neuroadaptive capacity scores, acid-base status and blood-gas tensions in umbilical arterial and venous blood. At delivery in 32 patients, concentrations of rocuronium in maternal venous (MV) and umbilical venous (UV) plasma were 2412 (180) ng ml(-1) and 389.6 (27.8) ng ml(-1), respectively (UV/MV ratio 0.16). In 12 patients, the mean concentration of rocuronium in umbilical arterial (UA) plasma was 271.2 (34.7) ng ml(-1) with a UA/UV ratio of 0.62. 17-Desacetylrocuronium (Org 9943), the main metabolite of rocuronium, was below the sensitivity level (25 ng ml(-1)) in umbilical venous and arterial plasma; the maternal venous plasma concentration was 178 (31) ng ml(-1). C1 UNIV SO CALIF,DEPT ANESTHESIOL,LOS ANGELES,CA 90033. RP ABOULEISH, E (reprint author), UNIV TEXAS,SCH MED,DEPT ANESTHESIOL,HOUSTON,TX 77030, USA. NR 25 TC 52 Z9 56 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 1994 VL 73 IS 3 BP 336 EP 341 DI 10.1093/bja/73.3.336 PG 6 WC Anesthesiology SC Anesthesiology GA PD955 UT WOS:A1994PD95500012 ER PT J AU KELLY, D BRULL, SJ AF KELLY, D BRULL, SJ TI NEUROLEPTIC MALIGNANT SYNDROME AND MIVACURIUM - A SAFE ALTERNATIVE TO SUCCINYLCHOLINE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE COMPLICATIONS, MALIGNANT HYPERTHERMIA; NEUROMUSCULAR RELAXANTS, MIVACURIUM,; SUCCINYLCHOLINE ID CHLORIDE BW-B1090U; HYPERTHERMIA; SUSCEPTIBILITY; PHARMACOLOGY; CONTRACTURE; ANESTHESIA; BLOCKADE AB Neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH) may have a common pathogenic mechanism; therefore, it has been suggested that known triggering agents for MH (such as succinylcholine) should be avoided in patients with NMS. Electroconvulsive therapy (ECT) continues to play a major therapeutic role in contemporary psychiatry, and succinylcholine has been the muscle relaxant of choice in attenuating violent muscle contractions induced by ECT Mivacurium is a non-depolarizing muscle relaxant with a relatively rapid onset and a short duration of action, and to date it has been proved safe in MH-susceptible patients. In this case report, following succinylcholine use during ECT, a patient with NMS developed an increase in temperature and serum creatine kinase (CK) level, possibly due to an MH reaction. Since the patient's mental status necessitated further ECT, mivacurium was administered during subsequent treatments and resulted in effective attenuation of muscle contractions without elevation of patient temperature or CK levels. In addition, there was no marked prolongation of the anaesthetic. Mivacurium is a suitable agent for patients with NMS undergoing ECT, as it has not been associated with precipitation of an MH response. C1 YALE UNIV,SCH MED,DEPT ANESTHESIOL,NEW HAVEN,CT 06510. RI Brull, Sorin/E-8578-2010 NR 21 TC 13 Z9 13 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1994 VL 41 IS 9 BP 845 EP 849 PG 5 WC Anesthesiology SC Anesthesiology GA PE608 UT WOS:A1994PE60800012 ER PT J AU CALDWELL, JE SZENOHRADSZKY, J SEGREDO, V WRIGHT, PMC MCLOUGHLIN, C SHARMA, ML GRUENKE, LD FISHER, DM MILLER, RD AF CALDWELL, JE SZENOHRADSZKY, J SEGREDO, V WRIGHT, PMC MCLOUGHLIN, C SHARMA, ML GRUENKE, LD FISHER, DM MILLER, RD TI THE PHARMACODYNAMICS AND PHARMACOKINETICS OF THE METABOLITE 3-DESACETYLVECURONIUM (ORG-7268) AND ITS PARENT COMPOUND, VECURONIUM, IN HUMAN VOLUNTEERS SO JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS LA English DT Article ID CRITICALLY ILL PATIENTS; BLOCKING ACTIONS; RENAL-FAILURE; BROMIDE; DISPOSITION; PANCURONIUM; ORG-NC-45; DRUGS; LIVER; CAT AB The pharmacology of 3-desacetylvecuronium, the principal metabolite of vecuronium, was investigated. We studied 12 healthy volunteers, each on two occasions. First they received 3-desacetylvecuronium alone and then, on a later occasion, vecuronium. Six subjects received a large dose of each drug (pharmacokinetic study), the remaining six received a small dose (pharmacodynamic study). Drug concentrations in plasma and urine were measured using capillary gas chromatography. Neuromuscular block was assessed by measuring force of contraction of the adductor pollicis. Drug plasma concentration vs. time and neuromuscular effect data were analyzed by nonlinear mixed-effects modeling. 3-Desacetylvecuronium, compared with vecuronium (median, range in parentheses), had a smaller plasma clearance, 3.51 (2.11-6.57) vs. 5.39 (5.04-7.19) ml.kg(-1) min(-1); a larger steady-state distribution volume, 254 (215-410) vs. 152 (111-170) ml.kg(-1); a longer terminal elimination half-life 116 (44-672) vs. 34 (25-61) min and a longer mean residence time, 67 (42-145) vs. 26 (18-32) min (P < .05). Renal clearances of 3-desacetylvecuronium and vecuronium were 0.85 (0.15-1.24) and 0.58 (0.16-0.66) ml.kg(-1).min(-1), respectively (P < .05). Conversion to 3-desacetylvecuronium accounted for 12% of vecuronium's clearance. Concentrations of 3-desacetylvecuronium and vecuronium that produced 50% neuromuscular block were 123 (109-154) and 102 (71-123) ng.ml(-1), respectively (P < .05). 3-Desacetylvecuronium is a potent neuromuscular blocking drug and may be responsible for episodes of prolonged paralysis after long-term administration of vecuronium to patients in intensive care units. RP CALDWELL, JE (reprint author), UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,ROOM S-436,SAN FRANCISCO,CA 94143, USA. NR 20 TC 36 Z9 36 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0022-3565 J9 J PHARMACOL EXP THER JI J. Pharmacol. Exp. Ther. PD SEP PY 1994 VL 270 IS 3 BP 1216 EP 1222 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA PK968 UT WOS:A1994PK96800049 ER PT J AU MITAMURA, H MATSUMOTO, S STEWART, MWA TSUBOI, T HASHIMOTO, M VANCE, ER HART, KP TOGASHI, Y KANAZAWA, H BALL, CJ WHITE, TJ AF MITAMURA, H MATSUMOTO, S STEWART, MWA TSUBOI, T HASHIMOTO, M VANCE, ER HART, KP TOGASHI, Y KANAZAWA, H BALL, CJ WHITE, TJ TI ALPHA-DECAY DAMAGE EFFECTS IN CURIUM-DOPED TITANATE CERAMIC CONTAINING SODIUM-FREE HIGH-LEVEL NUCLEAR WASTE SO JOURNAL OF THE AMERICAN CERAMIC SOCIETY LA English DT Article ID SYNROC; IMMOBILIZATION; IRRADIATION; ZIRCONOLITE AB A polyphase titanate ceramic incorporating sodium-free simulated high-level nuclear waste was doped with 0.91 wt% of Cm-244 to accelerate the effects of long-term self-irradiation arising from or decays. The ceramic included three main constituent minerals: hollandite, perovskite, and zirconolite, with some minor phases. Although hollandite showed the broadening of its X-ray diffraction lines and small lattice parameter changes during damage ingrowth, the unit cell was substantially unaltered. Perovskite and zirconolite, which are the primary hosts of curium, showed 2.7% and 2.6% expansions, respectively, of their unit cell volumes after a dose of 12 x 10(17) alpha decays.g(-1). Volume swelling due to damage ingrowth caused an exponential (almost linear) decrease in density, which reached 1.7% after a dose of 12.4 X 10(17) alpha decays.g(-1). Leach tests on samples that had incurred doses of 2.0 x 10(17) and 4.5 X 10(17) alpha decays.g(-1) showed that the rates of dissolution of cesium and barium were similar to analogous leach rates from the equivalent cold ceramic, while strontium and calcium leach rates were 2-15 times higher. Although the curium, molybdenum, strontium, and calcium leach rates in the present material were similar to those in the curium-doped sodium-bearing titanate ceramic reported previously, the cesium leach rate was 3-8 times lower. C1 JAPAN ATOM ENERGY RES INST,DEPT HOT LABS,TOKAI,IBARAKI 31911,JAPAN. AUSTRALIAN NUCL SCI & TECHNOL ORG,LUCAS HTS RES LABS,ADV MAT PROGRAM,SUTHERLAND,NSW,AUSTRALIA. UNIV S AUSTRALIA,SCH CHEM TECHNOL,THE LEVELS,SA 5098,AUSTRALIA. RP MITAMURA, H (reprint author), JAPAN ATOM ENERGY RES INST,DEPT ENVIRONM SAFETY RES,TOKAI,IBARAKI 31911,JAPAN. RI White, Tim/A-8145-2008 NR 28 TC 20 Z9 20 PU AMER CERAMIC SOC PI WESTERVILLE PA 735 CERAMIC PLACE, PO BOX 6136, WESTERVILLE, OH 43081-6136 SN 0002-7820 J9 J AM CERAM SOC JI J. Am. Ceram. Soc. PD SEP PY 1994 VL 77 IS 9 BP 2255 EP 2264 DI 10.1111/j.1151-2916.1994.tb04591.x PG 10 WC Materials Science, Ceramics SC Materials Science GA PH199 UT WOS:A1994PH19900002 ER PT J AU ELHAKIM, M SADEK, RA AF ELHAKIM, M SADEK, RA TI ADDITION OF ATRACURIUM TO LIDOCAINE FOR INTRAVENOUS REGIONAL ANESTHESIA SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHESIA, LOCAL, LIDOCAINE; NEUROMUSCULAR RELAXANT; ATRACURIUM; ANESTHETIC TECHNIQUES; REGIONAL; INTRAVENOUS ID ANESTHESIA; PRILOCAINE; FENTANYL AB This study was undertaken to examine the possible clinical advantages of using muscle relaxant with intravenous regional anaesthesia, (IVRA). Ferry unpremedicated adult patients undergoing hand surgery were randomly allocated to receive either 40 mi 0.5% lidocaine or 40 mi 0.5% lidocaine with 2 mg of atracurium. The atracurium group of patients had a significantly greater degree of muscle relaxation, easier reduction of fractures, and better operative conditions (P<0.01). Less pain was also reported during surgery (P<0.025), and 5 and 15 min after release of the tourniquet (P<0.01). Clinically, there was no difference in the speed of onset of block between the two groups. It is concluded that the addition of atracurium to lidocaine improves the operating condition during IVRA with less pain during and after surgery. C1 AIN SHAMS UNIV,FAC MED,DEPT ORTHOPAED,CAIRO,EGYPT. RP ELHAKIM, M (reprint author), AIN SHAMS UNIV,FAC MED,DEPT ANAESTHESIA,CODE 11361,POB 2361,CAIRO,EGYPT. NR 15 TC 16 Z9 17 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 1994 VL 38 IS 6 BP 542 EP 544 PG 3 WC Anesthesiology SC Anesthesiology GA PE871 UT WOS:A1994PE87100004 ER PT J AU FELDMAN, SA HOOD, JR CAMPKIN, NTA REHM, S AF FELDMAN, SA HOOD, JR CAMPKIN, NTA REHM, S TI SENSITIVITY TO 2ND DOSE OF MIVACURIUM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, MIVACURIUM; PHARMACODYNAMICS C1 ST MARYS HOSP,DEPT ANAESTHET,LONDON W2,ENGLAND. ROYAL HAMPSHIRE CTY HOSP,DEPT ANAESTHET,WINCHESTER SO22 5DG,HANTS,ENGLAND. RP FELDMAN, SA (reprint author), CHELSEA & WESTMINSTER HOSP,DEPT ANAESTHET,FULHAM RD,LONDON SW10 9NH,ENGLAND. NR 11 TC 7 Z9 7 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD AUG PY 1994 VL 49 IS 8 BP 671 EP 674 DI 10.1111/j.1365-2044.1994.tb04394.x PG 4 WC Anesthesiology SC Anesthesiology GA PB296 UT WOS:A1994PB29600004 ER PT J AU HOOD, JR CAMPKIN, NTA FELDMAN, SA AF HOOD, JR CAMPKIN, NTA FELDMAN, SA TI CURARE MODIFICATION OF SUXAMETHONIUM BLOCKADE SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, SUXAMETHONIUM, TUBOCURARE RP HOOD, JR (reprint author), CHELSEA & WESTMINSTER HOSP,MAGILL DEPT ANAESTHET,FULHAM RD,LONDON SW10 9NH,ENGLAND. NR 5 TC 0 Z9 0 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD AUG PY 1994 VL 49 IS 8 BP 682 EP 685 DI 10.1111/j.1365-2044.1994.tb04397.x PG 4 WC Anesthesiology SC Anesthesiology GA PB296 UT WOS:A1994PB29600007 ER PT J AU NIELSEN, HK MAY, O AF NIELSEN, HK MAY, O TI PREDICTION OF REVERSAL TIME AND OPTIMAL TIME FOR NEOSTIGMINE ADMINISTRATION IN ATRACURIUM BLOCKADE - COURSE OF ANTAGONISM SO ANAESTHESIST LA German DT Article DE ATRACURIUM; ANTAGONISM; NEOSTIGMINE; NEUROMUSCULAR BLOCKADE; RECOVERY TIME ID INDUCED NEUROMUSCULAR BLOCKADE; EDROPHONIUM; VECURONIUM; RECOVERY AB The aims of the study were: (1) to predict reversal time from intensive atracurium blockade; and (2) to determine the optimal time of neostigmine administration during recovery from atracurium blockade, i.e., the time at which the administration of neostigmine results in the shortest total recovery time (time from administration of last supplemental dose of atracurium to train-of-four [TOF] ratio 0.70), and at the same time results in the shortest time from administration of neostigmine to TOF ratio 0.70. Method. The spontaneous and neostigmine-facilitated recovery in 52 healthy women anaesthetised with thiopentone, fentanyl, droperidol, and nitrous oxide was followed. Post-tetanic count (PTC) of TOF stimulation of the ulnar nerve and mechanomyography were used for monitoring neuromuscular transmission. The neuromuscular blockade was induced with atracurium 0.6 mg/kg and supplemental doses of 0.15 mg/kg were given when the first twitch response in the TOF (TH1) had recovered to 20%. Neostigmine 0.036 mg/kg body weight was given at different levels of neuromuscular blockade to 37 of the patients. Results. Multiple regression analyses including pre-reversal time (time from administration of the last atracurium dose to neostigmine administration), PTC, weight, and age of the patients suggest that pre-reversal time is the best predictor of reversal time: reversal time = 27.3 min - (0.89 x pre-reversal time [min]; (SEE = 6.0 min). If pre-reversal time is unknown, PTC can be used: reversal time = 24 min - (4.5 x ln PTC) at time of reversal); (SEE = 6.8 min). Total recovery time was 47 min (SEM = 2.0 min, n = 15) in the patients allowed to recover spontaneously, and 29 min (SEM = 1.2 min, n = 29) in the patients reversed by neostigmine; the difference of 18 min (SE diff 2.0 min) was significant (P < 0.0005). The level of blockade indicated by PTC (1-24) at the time of reversal had no influence on the total recovery time. The spontaneous recovery times from reappearance of TH1 and TH1 = 10% to TOF ratio 0.70 were 29.2 min (SEM = 1.7 min) and 24.4 min (SEM = 2.6 min), respectively. Discussion. The results suggest that pre-reversal time is the strongest predictor of reversal time when neostigmine is administered during intense atracurium blockade. To achieve the optimal time-saving effect, neostigmine must be given 18 min (the time saved by giving neostigmine) plus 7 to 11 min (needed for neostigmine to reach its peak effect), giving a total of 25 to 29 min before TOF ratio 0.70. As TH1 is between 1% and 10% 25 to 29 min before TOF ratio 0.70 is reached during spontaneous recovery, the optimal level of neuromuscular blockade for neostigmine administration in atracurium blockade is when TH1 is between 1% and 10% Conclusion. Reversal time can be predicted as 27.3 min - (0.89 x pre-reversal time (min), and the the optimal time of neostigmine administration in atracurium blockade appears to be when TH1 is 1%-10%. C1 KREISKRANKENHAUS ESBJERG,ANASTHESIOL ABT,ESBJERG,DENMARK. NR 13 TC 2 Z9 2 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD AUG PY 1994 VL 43 IS 8 BP 528 EP 533 DI 10.1007/s001010050088 PG 6 WC Anesthesiology SC Anesthesiology GA PD976 UT WOS:A1994PD97600007 ER PT J AU GOUDSOUZIAN, NG DENMAN, W MATTA, E AF GOUDSOUZIAN, NG DENMAN, W MATTA, E TI MIVACURIUM AFTER ATRACURIUM IN CHILDREN SO ANESTHESIA AND ANALGESIA LA English DT Article ID OXIDE-NARCOTIC ANESTHESIA; VECURONIUM; HALOTHANE; PHARMACOKINETICS; PANCURONIUM; INFUSION; INFANTS AB The effect of mivacurium after atracurium was evaluated in 36 children anesthetized with halothane-nitrous oxide-oxygen by measuring the force of contraction of the adductor pollicis during train-of-four stimulation at 0.1 Hz. The children were evaluated in two main groups. In Group 1 the effect of bolus doses of mivacurium after equipotent repeat doses of atracurium were evaluated. When the first twitch of the train-of-four response (T1) had recovered to 25% of control after a tracheally intubating dose of atracurium, a repeat dose of atracurium was given, on subsequent recovery to 25%, an equipotent dose of mivacurium was administered. In Group 2 when T1 had recovered to >10% from 0.5 mg/kg atracurium, a mivacurium infusion was started; the initial infusion rate was 4 mu g.kg(-1).min(-1) with adjustments made to maintain 90%-99% depression of T1. Patients were allowed to recover spontaneously from the effect of the relaxants. RP GOUDSOUZIAN, NG (reprint author), HARVARD UNIV,MASSACHUSETTS GEN HOSP,SCH MED,DEPT ANESTHESIA,BOSTON,MA 02114, USA. NR 15 TC 6 Z9 6 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 1994 VL 79 IS 2 BP 345 EP 349 PG 5 WC Anesthesiology SC Anesthesiology GA NZ337 UT WOS:A1994NZ33700026 ER PT J AU NAGUIB, M AF NAGUIB, M TI NEUROMUSCULAR EFFECTS OF ROCURONIUM BROMIDE AND MIVACURIUM CHLORIDE ADMINISTERED ALONE AND IN COMBINATION SO ANESTHESIOLOGY LA English DT Article DE INTERACTIONS (DRUG), ISOBOLOGRAPHIC ANALYSIS MIVACURIUM CHLORIDE ROCURONIUM BROMIDE (ORG 9426); MONITORING, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, MIVACURIUM CHLORIDE ROCURONIUM BROMIDE; POTENCY, ED(50) ID DOSE-RESPONSE; ACETYLCHOLINE-RECEPTOR; NITROUS-OXIDE; VECURONIUM; PANCURONIUM; ANESTHESIA; BLOCKADE; TUBOCURARINE; STIMULATION; ATRACURIUM AB Background: Rocuronium is a new nondepolarizing neuromuscular blocking agent with a rapid onset but with intermediate duration of action. Mivacurium, on the other hand, is a new short-acting nondepolarizing neuromuscular relaxant, but of slower onset of action. The current study was undertaken to characterize the interaction between rocuronium and mivacurium. Methods: In the first study, the dose-response relations of rocuronium, mivacurium, and their combination were studied in ASA physical status 1 or 2 patients during thiopental-fentanyl-N2O anesthesia. One hundred ten patients, randomly assigned to 1 of 11 groups of 10 patients each, received mivacurium 30, 50, or 70 mu g . kg(-1); rocuronium 100, 200, 250, or 300 mu g . kg(-1); or an equieffective combination of both drugs (1 ED(50) rocuronium + 1 ED(50) mivacurium; 1/2 ED(50) rocuronium + 1/2 ED(50) mivacurium; 1/4 ED(50) rocuronium + 1/4 ED(50) mivacurium; or 1/8 ED(50) rocuronium + 1/8 ED(50) mivacurium, where ED(50) is the dose producing 50% depression of the first twitch height). In the second study, 50 patients, ASA physical status 1 or 2, anesthetized with thiopental-fentanyl-N2O, were randomly allocated to 5 groups of 10 patients each to receive one of the following neuromuscular blocking drugs or drug combination: rocuronium 600 mu g . kg(-1) (group 1), mivacurium 150 mu g . kg(-1) (group 2) rocuronium 150 mu g . kg(-1) + mivacurium 37.5 mu g . kg(-1) (group 3), rocuronium 300 mu g . kg(-1) + mivacurium 75 mu g . kg(-1) ((group 4), or rocuronium 600 mu g . kg(-1) + mivacurium 150 mu g . kg(-1) (group 5). Results: The calculated ED(50) values and their 95% confidence intervals were 125 (122-129) and 37 (36-38) mu g . kg(-1) for the rocuronium and mivacurium groups, respectively. The interaction between rocuronium and mivacurium was found to be synergistic. The measured ED(50) of the mixture was only 62% of the predicted value assuming a purely additive interaction. In the second study, rocuronium 600 mu g . kg(-1) group and group 3 had similar onset times (99 [74-123] and 114 [100-128] s, respectively), which were significantly shorter than that observed in the mivacurium 150 mu g . kg(-1) group (178 [149-206] s). Onset times in groups 4 and 5 were significantly shorter than that in each of the other study groups (63 [63-76] and 73 [65-80] s, respectively). Clinical duration of action (recovery of T1 to 25% of baseline twitch height) was significantly greater in group 5 (55 [51-60] min) than with all other doses and agents, and briefest (P < 0.01) with mivacurium 150 mu g . kg(-1) (14.5 [12.6-16.5] min) and group 3 (14.7 [13.4-16] min). Conclusions: The interaction between rocuronium and mivacurium was found to be synergistic. C1 KING SAUD UNIV, KING KHALID UNIV HOSP, INTENS CARE UNIT, RIYADH 11472, SAUDI ARABIA. RP NAGUIB, M (reprint author), KING SAUD UNIV, KING KHALID UNIV HOSP, FAC MED, DEPT ANAESTHESIA, POB 7805, RIYADH 11472, SAUDI ARABIA. NR 26 TC 35 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 AUG PY 1994 VL 81 IS 2 BP 388 EP 395 DI 10.1097/00000542-199408000-00017 PG 8 WC Anesthesiology SC Anesthesiology GA PA479 UT WOS:A1994PA47900015 ER PT J AU OLKKOLA, KT TAMMISTO, T AF OLKKOLA, KT TAMMISTO, T TI ASSESSMENT OF THE INTERACTION BETWEEN ATRACURIUM AND SUXAMETHONIUM AT 50-PERCENT NEUROMUSCULAR BLOCK USING CLOSED-LOOP FEEDBACK-CONTROL OF INFUSION OF ATRACURIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, ATRACURIUM; NEUROMUSCULAR BLOCK, SUXAMETHONIUM; MONITORING, NEUROMUSCULAR FUNCTION ID PHARMACOKINETICS; PANCURONIUM; PHARMACODYNAMICS; SUCCINYLCHOLINE; ANESTHESIA; HALOTHANE; MODEL AB We have studied the effect of prior administration of suxamethonium on the infusion requirements of atracurium at 50% neuromuscular block in patients undergoing elective general surgery. Anaesthesia was maintained with nitrous oxide in oxygen, propofol and fentanyl. Of 20 patients given atracurium, only 10 were given prior administration of suxamethonium 1 mg kg(-1). At the beginning of the infusion, atracurium 0.3 mg kg(-1) was given by bolus administration. interaction between the two drugs was assessed by determining the steady state rate of infusion necessary to produce a constant 50% neuromuscular block. This was accomplished by applying non-linear curve fitting to data on the cumulative dose requirements during anaesthesia. The neuromuscular blocking effect was found to be similar with or without prior administration of suxamethonium. The mean steady-state rate of infusion for atracurium was 0.19 (SD 0.03) mg kg(-1) h(-1) for patients given suxamethonium and 0.18 (0.09) mg kg(-1) h(-1) for those who were not given suxamethonium. Thus prior administration of suxamethonium did not affect the infusion requirements of atracurium at 50% neuromuscular block, unlike the situation at constant 90% neuromuscular block. RP OLKKOLA, KT (reprint author), UNIV HELSINKI,DEPT ANAESTHESIA,HAARTMANINKATU 4,SF-00290 HELSINKI,FINLAND. NR 21 TC 2 Z9 3 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 1994 VL 73 IS 2 BP 199 EP 203 DI 10.1093/bja/73.2.199 PG 5 WC Anesthesiology SC Anesthesiology GA NZ746 UT WOS:A1994NZ74600016 ER PT J AU KOH, KF CHEN, FG AF KOH, KF CHEN, FG TI RAPID TRACHEAL INTUBATION WITH ATRACURIUM - THE TIMING PRINCIPLE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE INTUBATION, TRACHEAL, TECHNIQUE; NEUROMUSCULAR RELAXANTS, ATRACURIUM, SUCCINYLCHOLINE ID POST-MARKETING SURVEILLANCE; ADDUCTOR POLLICIS MUSCLES; HIGH-DOSE VECURONIUM; NEUROMUSCULAR BLOCKADE; CLINICAL-PHARMACOLOGY; HISTAMINE-RELEASE; ONSET; PANCURONIUM; DIAPHRAGM; DURATION AB The ''Timing Principle'' utilises a single bolus of nondepolarising neuromuscular blocking drug followed by thiopentone given at the onset of clinical weakness. The purpose of this study was to compare the intubating conditions after succinylcholine and after atracurium used according to the ''timing principle.'' Eighty patients were randomly assigned to four groups of 20. Three study groups were given atracurium 0.5, 0.75 or 1 mg.kg(-1) (Groups I, II and III respectively) and the control group (Group IV) received succinylcholine 1.5 mg.kg(-1). The study groups received fentanyl 1 mu g.kg(-1), atracurium three minutes later, followed by thiopentone 4-6 mg.kg(-1) at the onset of ptosis. The control group had a defasciculating dose of atracurium (0.025 mg.kg(-1)) and fentanyl (1 mu g.kg(-1)) followed by thiopentone 4-6 mg.kg(-1)) and succinylcholine three minutes later. The trachea was intubated one minute after thiopentone was given. The intubating conditions were then graded by a laryngoscopist who was unaware of the induction sequence. All patients were interviewed on the day after surgery. Intubation scores of patients in Group I were worse than in Groups II, III and IV (P < 0.005) but there were no differences between Groups II, III and IV. The technique was not associated with severe haemodynamic changes. All patients, except one were able to cough well after administration of atracurium, before induction of anaesthesia with thiopentone. Patients were generally satisfied with this method of induction. It is concluded that atracurium, when used according to the timing principle, can be an alternative to succinylcholine during rapid-sequence induction. RP KOH, KF (reprint author), NATL UNIV SINGAPORE HOSP,DEPT ANAESTHESIA,5 LOWER KENT RIDGE RD,SINGAPORE 0511,SINGAPORE. NR 33 TC 13 Z9 14 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD AUG PY 1994 VL 41 IS 8 BP 688 EP 693 PG 6 WC Anesthesiology SC Anesthesiology GA NY889 UT WOS:A1994NY88900006 ER PT J AU ROLAND, EJL WIERDA, JMKH EURIN, BG ROUPIE, E AF ROLAND, EJL WIERDA, JMKH EURIN, BG ROUPIE, E TI PHARMACODYNAMIC BEHAVIOR OF VECURONIUM IN PRIMARY HYPERPARATHYROIDISM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM; INTERACTIONS, HYPERPARATHYROIDISM, HYPERCALCEMIA; PHARMACOKINETICS, DOSE-RESPONSE RELATIONSHIPS ID NEUROMUSCULAR BLOCKADE; ANESTHETIZED PATIENTS; DOSE TECHNIQUES; POTENCY; HUMANS AB This study evaluated the potency and time course of action of vecuronium in patients with primary hyperparathyroidism (HPT) and marked hypercalcaemia during nitrous oxide-opioid anaesthesia. Twenty ASA physical status I and Il patients were studied by measuring the force of contraction of the adductor pollicis in response to stimulation of the ulnar nerve: ten control patients and ten patients with HPT and ionized calcium concentration over 2.80 mEq.L(-1). After induction of anaesthesia with thiopentone and maintenance with N2O/O-2 and fentanyl, vecuronium was administered to determine cumulative dose-response curves. When maximum block had been obtained twitch height was maintained at 10% of baseline value over 20 min by adjusting the infusion rate of a syringe-pump containing vecuronium and vecuronium plasma concentration (EC(90ss)) was determined. During spontaneous recovery, after termination of infusion, the recovery index, the time from 25 to 75% recovery, was measured. The dose to produce 90% block was greater in the HPT than in control group: 69 (24) vs 54 (18) mu g.kg(-1) (P < 0.02). The calculated ED(50) was also greater in HPT: 42 (4) vs 31 (5) mu g.kg(-1) in controls (P < 0.001). (Values are given as mean and coefficient of variation). The slope of the dose-response curve, the dose necessary to maintain 90% block, and the EC(90ss) did not differ. The RI(25-75) was slower in the HPT group although the difference did not reach statistical significance. It is concluded that hyperparathyroidism with hypercalcaemia increases vecuronium requirement; only during the onset of neuromuscular blockade. C1 UNIV GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,GRONINGEN,NETHERLANDS. RP ROLAND, EJL (reprint author), HOP UNIV ST LOUIS,DEPT ANESTHESIOL & SURG INTENS CARE,1 AV CLAUDE VELLEFAUX,F-75010 PARIS,FRANCE. NR 18 TC 5 Z9 5 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD AUG PY 1994 VL 41 IS 8 BP 694 EP 698 PG 5 WC Anesthesiology SC Anesthesiology GA NY889 UT WOS:A1994NY88900007 ER PT J AU BOHRER, H SCHMIDT, H BACH, A MARTIN, E KOHL, B BOLSEN, K GOERZ, G AF BOHRER, H SCHMIDT, H BACH, A MARTIN, E KOHL, B BOLSEN, K GOERZ, G TI PORPHYRINOGENIC EFFECTS OF ATRACURIUM, VECURONIUM, AND PANCURONIUM IN A PRIMED RAT MODEL SO LABORATORY ANIMAL SCIENCE LA English DT Article ID DIETHYL-ETHER; LAUDANOSINE; DRUGS; LIVER; ALLYLISOPROPYLACETAMIDE; CYTOCHROME-P-450; BIOSYNTHESIS; HEPATOCYTES; MECHANISM; INDUCTION AB Steroidal muscle relaxants might theoretically be contraindicated in acute hepatic porphyrias. Atracurium, on the other hand, has been proposed as the muscle relaxant of choice because of its extrahepatic degradation. To further investigate this problem, equipotent doses of atracurium, vecuronium, and pancuronium were determined in male Sprague Dawley rats, using evoked electromyography. After this pilot study, 64 rats were anesthetized, mechanically ventilated, and randomly allocated to eight groups. Animals in groups 1 through 4 received an intraperitoneal injection of arachis-oil 20 h before the experiments. For groups 5 through 8, an experimental porphyria was induced by use of the chemical substance 3,5-dicarbethoxy-1,4-dihydrocollidine (DDC), which was dissolved in arachis-oil and given 20 h prior to the beginning of the study. Rats of groups 1 and 5 served as controls; they received saline and were not given muscle relaxants throughout the experiment. For groups 2 and 6, atracurium was administered at a dosage of 4 mg/kg of body weight, followed by a continuous infusion of 15 mg/kg/h. Animals of groups 3 and 7 received vecuronium at a dosage of 1.5 mg/kg, followed by 7.5 mg/kg/h. For groups 4 and 8, pancuronium was given (0.78 mg/kg and 2.5 mg/kg/h, respectively). At the end of the 3-h study period, the liver was perfused and excised, and urine was obtained. Activity of the hepatic enzyme delta-aminolevulinic acid synthase (ALAS) and urinary concentrations of delta-aminolevulinic acid (ALA) and porphobilinogen (PRG) were determined. There were no significant differences in the urinary ALA and PBG: concentrations and in the activities of hepatic ALAS within the nonprimed rats of groups 1 through 4. Thus, administration of the muscle relaxants did not influence these variables in the nonporphyric rats. We conclude that porphyrinogenicity testing of drugs will only be of relevance when primed animals or systems are used. Atracurium, vecuronium, and pancuronium increased ALAS activity compared with values for the porphyric control group 5; the highest values were measured in the pancuronium-treated rats. This was also reflected by the urinary findings, which followed the results of hepatic enzyme activity with a certain delay. All three muscle relaxants must, therefore, be regarded as porphyrinogenic; pancuronium had a greater porphyrinogenic potential than did atracurium or vecuronium. C1 UNIV HEIDELBERG,DEPT INTERNAL MED,CLIN LAB,W-6900 HEIDELBERG,GERMANY. UNIV DUSSELDORF,DEPT DERMATOL,W-4000 DUSSELDORF,GERMANY. RP BOHRER, H (reprint author), UNIV HEIDELBERG,DEPT ANESTHESIA,HEIDELBERG,GERMANY. NR 30 TC 4 Z9 4 PU AMER ASSOC LABORATORY ANIMAL SCIENCE PI CORDOVA PA 70 TIMBERCREEK DR, SUITE 5, CORDOVA, TN 38018 SN 0023-6764 J9 LAB ANIM SCI JI Lab. Anim. Sci. PD AUG PY 1994 VL 44 IS 4 BP 326 EP 330 PG 5 WC Veterinary Sciences; Zoology SC Veterinary Sciences; Zoology GA PD469 UT WOS:A1994PD46900005 ER PT J AU TAIVAINEN, T MERETOJA, OA ROSENBERG, PH AF TAIVAINEN, T MERETOJA, OA ROSENBERG, PH TI THE EFFECT OF EPIDURAL BUPIVACAINE ON VECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE IN CHILDREN SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE BUPIVACAINE; EPIDURAL ANESTHESIA; MUSCLE RELAXANTS; POTENCY; VECURONIUM ID PEDIATRIC-PATIENTS; LOCAL-ANESTHETICS; ATRACURIUM; PHARMACOKINETICS; REQUIREMENTS; INFUSION; INFANTS; AGE AB The effect of epidural bupivacaine on potency and duration of action of vecuronium-induced neuromuscular blockade (NMB) was evaluated in 30 general surgical paediatric patients (ASA I-II) of three to ten years of age. Premedication was midazolam 0.5 mg kg(-1) orally (max 15 mg). In addition to general anaesthesia, 15 of the children received a lumbar epidural block with 0.5% bupivacaine 2.5 mg kg(-1). Anaesthesia was induced and maintained with N2O:o(2) (2:1), propofol and alfentanil. NMB was monitored by adductor pollicis EMG with the train-of-four stimulus every 20 sec. Thirty minutes following the epidural bupivacaine injection (mean plasma concentration 0.86 mu g ml(-1)) or induction of anaesthesia a cumulative dose-response curve of vecuronium was established to achieve a 95% depression of the twitch response. Thereafter, NMB was allowed to recover spontaneously. ED doses of vecuronium were 19-22% greater in the control group than in the epidural group. ED(50) doses were 33.8 (s.e.mean 1.3) mu g kg(-1) and 28.4 (2.2) mu g kg(-1); respectively (P< 0.05). There were no differences in recovery times from NMB between control and epidural group, the recovery index (time of twitch height to recover from 25 to 75%) being 6.4 (0.4) min and 7.0 (0.9) min, respectively. However, a negative correlation was found between bupivacaine plasma concentration and an ED(50) dose of vecuronium (P=0.01). Our results indicate that vecuronium is slightly more potent in children with bupivacaine epidural block than in children without it. C1 UNIV HELSINKI,DEPT ANAESTHESIOL,HELSINKI,FINLAND. RP TAIVAINEN, T (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIOL,SF-00290 HELSINKI,FINLAND. NR 24 TC 5 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 JUL PY 1994 VL 38 IS 5 BP 453 EP 456 PG 4 WC Anesthesiology SC Anesthesiology GA NW352 UT WOS:A1994NW35200007 ER PT J AU SAYSON, SC MONGAN, PD AF SAYSON, SC MONGAN, PD TI ONSET OF ACTION OF MIVACURIUM CHLORIDE - A COMPARISON OF NEUROMUSCULAR BLOCKADE MONITORING AT THE ADDUCTOR POLLICIS AND THE ORBICULARIS OCULI SO ANESTHESIOLOGY LA English DT Article DE MONITORING, ELECTROMYOGRAM NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS, MIVACURIUM; SKELETAL MUSCLE, ADDUCTOR POLLICIS ORBICULARIS OCULI ID NITROUS-OXIDE FENTANYL; TRACHEAL INTUBATION; D-TUBOCURARINE; HUMANS; VECURONIUM; MUSCLES; ATRACURIUM; PANCURONIUM; ANESTHESIA; DIAPHRAGM AB Background: The optimal site for monitoring neuromuscular blockade for intubations facilitated with mivacurium chloride has not been established. The primary purpose of this evaluation was to determine the difference in onset of neuromuscular blockade between the orbicularis oculi and adductor pollicis in patients administered mivacurium chloride. We also evaluated intubating conditions when intubation was timed to maximal neuromuscular blockade at either the orbicularis oculi or the adductor pollicis. The results for patients administered mivacurium chloride were compared with those for a control group administered succinylcholine. Methods: In a double-blind randomized design, the time to loss of the compound muscle action potential at the orbicularis oculi and adductor pollicis was monitored in 20 patients administered mivacurium chloride and ten patients administered succinylcholine. After administration of mivacurium chloride (0.15 mg.kg(-1)), ten patients underwent tracheal intubation at maximal depression of the orbicularis oculi (group 2) and ten patients at maximal depression of the adductor pollicis (group 3). In an additional ten patients the trachea was intubated 60 s after administration of succinylcholine (1 mg.kg(-1)) (group 1, control). Intubation and evaluation of conditions was performed by one investigator blinded to patient treatments. Results: Loss of compound muscle action potential at the orbicularis oculi and adductor pollicis was more rapid in group 1, and intubation was completed at 86 +/- 26 s. In the patients administered mivacurium chloride, the orbicularis oculi compound muscle action potential was lost 3 min earlier than the adductor pollicis compound muscle action potential. Subsequently, intubation was completed at 134 +/- 50 s in the orbicularis oculi group, whereas the time to intubation was 321 +/- 57 s in the adductor pollicis group. There was no significant differences in intubation conditions between the mivacurium chloride groups. Conclusions: When monitoring 95% twitch height depression of the orbicularis oculi muscle, intubation can be accomplished in approximately 2 min after administration of mivacurium chloride (0.15 mg.kg(-1)). Because intubating conditions were comparable to the patients administered succinylcholine or intubated during monitoring of the twitch height depression of the adductor pollicis, we believe that optimal site for monitoring during intubation using mivacurium chloride is the orbicularis oculi muscle. RP SAYSON, SC (reprint author), BROOKE ARMY MED CTR,DEPT SURG,ANESTHESIOL & OPERAT SERV,FT SAM HOUSTON,TX 78234, USA. NR 21 TC 20 Z9 20 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1994 VL 81 IS 1 BP 35 EP 42 DI 10.1097/00000542-199407000-00007 PG 8 WC Anesthesiology SC Anesthesiology GA NW235 UT WOS:A1994NW23500007 ER PT J AU WRIGHT, PMC HART, P LAU, M SHARMA, ML GRUENKE, L FISHER, DM AF WRIGHT, PMC HART, P LAU, M SHARMA, ML GRUENKE, L FISHER, DM TI CUMULATIVE CHARACTERISTICS OF ATRACURIUM AND VECURONIUM - A SIMULTANEOUS CLINICAL AND PHARMACOKINETIC STUDY SO ANESTHESIOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Anesthesiologists CY OCT, 1993 CL WASHINGTON, TX SP AMER SOC ANESTHESIOLOGISTS DE NEUROMUSCULAR RELAXANTS, ATRACURIUM VECURONIUM; PHARMACOKINETICS, NEUROMUSCULAR RELAXANTS, ATRACURIUM VECURONIUM ID ISOFLURANE ANESTHESIA; PANCURONIUM; PHARMACODYNAMICS; METABOLITES; PARALYSIS; RECOVERY; INFUSION; BROMIDE; AGENTS; DRUGS AB Background: Cumulative effects (increased 25-75% recovery time with increasing dose) are evident with vecuronium but not with atracurium. Pharmacokinetic simulations suggest that vecuronium's cumulation occurs as recovery shifts from distribution to elimination whereas atracurium's recovery always occurs during elimination. The purpose of this study was to examine this pharmacokinetic explanation. Methods: We assigned 12 volunteers to receive atracurium or vecuronium on three occasions during nitrous oxide-isoflurane anesthesia. Evoked adductor pollicis twitch tension was monitored. On occasion 1, the dose expected to produce 95% block (ED(95)) was estimated for each subject. On occasions 2 and 3, 1.2 or 3.0 multiples of ED(95) were given as a bolus. Plasma was sampled for 128 min to determine muscle relaxant concentrations; pharmacodynamic modeling was used to determine effect-compartment drug concentrations (Ce). For each drug, recovery time, recovery phase half-life (rate of decrease in Ce during recovery), and Ce at 25% and 75% recovery were compared between doses. Results: Atracurium's recovery time increased 2.4 +/- 2.2 min (mean +/- SD) with the larger dose, less than the increase with vecuronium (8.2 +/- 3.8 min). Atracurium's recovery phase half-life was 14.6 +/- 1.7 and 20.1 +/- 2.3 min with the small and large doses (P < 0.05); vecuronium's recovery phase half-life increased similarly from 13.5 +/- 2.3 to 18.5 +/- 5.0 min (P < 0.05). At 75% recovery, vecuronium's Ce decreased from 65 +/- 18 ng/ml with the small dose to 55 +/- 15 ng/ml with the large dose (P < 0.05). Assuming that neuromuscular junction sensitivity was constant, this difference could be explained by considering neuromuscular effects of vecuronium's metabolite, 3-desacetylvecuronium. Conclusions: Although vecuronium was cumulative (as predicted), atracurium was also slightly cumulative. Inconsistent with our hypothesis, recovery phase half-lives for both drugs increased similarly between doses; therefore, differences in cumulation were not solely explained by pharmacokinetics of the muscle relaxant. It appears that 3-desacetylvecuronium contributes to vecuronium's cumulative effect, even after usual clinical doses. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 23 TC 29 Z9 29 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1994 VL 81 IS 1 BP 59 EP 68 DI 10.1097/00000542-199407000-00010 PG 10 WC Anesthesiology SC Anesthesiology GA NW235 UT WOS:A1994NW23500010 ER PT J AU PITTET, JF MOREL, DR MENTHA, G SCHOPFER, C BELENGER, J BENAKIS, A TASSONYI, E AF PITTET, JF MOREL, DR MENTHA, G SCHOPFER, C BELENGER, J BENAKIS, A TASSONYI, E TI VECURONIUM NEUROMUSCULAR BLOCKADE REFLECTS LIVER-FUNCTION DURING HEPATIC AUTOTRANSPLANTATION IN PIGS SO ANESTHESIOLOGY LA English DT Article DE ANIMALS, PIG; LIVER, LIVER FUNCTION TRANSPLANTATION; MONITORING TECHNIQUES, ACCELEROMETRY AMINOPYRINE BREATH TEST; NEUROMUSCULAR RELAXANTS, VECURONIUM ID AMINOPYRINE BREATH TEST; ALLOGRAFT FUNCTION; PLASMA-CONCENTRATIONS; DOSE REQUIREMENTS; RENAL-FAILURE; TRANSPLANTATION; PHARMACOKINETICS; METABOLISM; ATRACURIUM; ACIDS AB Background: Rapid assessment of hepatic function early after reperfusion of the liver graft is of great importance,because it may allow for prompt detection of incipient hepatic graft failure. The current study was undertaken to determine whether the continuous recording of neuromuscular transmission could be used as an on-line assessment of hepatic function during liver transplantation when a muscle relaxant with high hepatic uptake is used. Methods: We quantified and compared the effect of liver exclusion and graft reperfusion on the level of vecuronium-induced neuromuscular blockade in nine pigs studied twice within 3 days. During the Ist day (control session), an intravenous infusion of vecuronium was administered to maintain a constant 90-95% twitch depression during 180 min. The twitch response was then allowed to recover spontaneously to 75% of its prerelaxant value. Neuromuscular transmission was continuously measured on the right anterior leg using an acceleration transducer. During the same time period, the metabolic rate of C-14-labeled aminopyrine (a well-established quantitative test of the liver microsomal function) was determined by measuring the excretion of (CO2)-C-14 in expired air after administration of an intravenous bolus of C-14-labeled aminopyrine. Two days later, the pigs underwent a hepatic autotransplantation, during which vecuronium was administered to maintain a constant 90-95% twitch depression. After reperfusion of the liver graft, the vecuronium infusion rate was maintained at its anhepatic level, and the recovery index of the neuromuscular blockade (the time from 25% to 75% recovery of twitch height) was calculated. The aminopyrine breath test was performed during the last 30 min of the anhepatic phase, and during 3 h after reperfusion of the liver graft. Results: During control studies, the mean infusion rate of vecuronium was 1.30 +/- 0.33 mg.kg(-1).h(-1) and the recovery index was 3.4 +/- 0.5 min. During liver dissection, the infusion rate of vecuronium was similar to the control value (1.18 +/- 0.16 mg.kg(-1).h(-1)), then considerably decreased to 0.05 +/- 0.03 mg.kg(-1).h(-1) during the anhepatic phase. After reperfusion of the liver graft, the recovery index was markedly prolonged to 35.5 +/- 15.8 min, indicating a prolongation of the recovery of neuromuscular blockade by a factor of 10.4. Excretion of (CO2)-C-14 was equal to zero during the anhepatic phase and then increased to 0.19 +/- 0.11% during the Ist h after reperfusion of the liver graft, an excretion rate corresponding to 11.2% of control conditions. The relationship between individual changes in the recovery index of the neuromuscular blockade and (CO2)-C-14 excretion in expired air after reperfusion of the liver graft showed a strong significant correlation (r(2) = 0.71). Conclusions: These results indicate that, compared with the control studies, there is a similar decrease in the recovery rate of vecuronium-induced neuromuscular blockade and in the metabolic rate of C-14-labeled aminopyrine during the progressive recovery of hepatic function immediately after unclamping of the liver vessels. Metabolism of C-14-labeled aminopyrine increased progressively during the reperfusion phase. Therefore, recording of neuromuscular transmission during liver transplantation could serve as a continuous and easy to perform assessment of liver graft function provided that a muscle relaxant with a high hepatic uptake is used for neuromuscular blockade. C1 UNIV HOSP GENEVA,DEPT SURG,DIV SURG & ANESTHESIOL INVEST,GENEVA,SWITZERLAND. UNIV HOSP GENEVA,DEPT ANESTHESIOL,DIV SURG & ANESTHESIOL INVEST,GENEVA,SWITZERLAND. UNIV GENEVA,MED CTR,DEPT PHARMACOL,CH-1211 GENEVA,SWITZERLAND. NR 23 TC 11 Z9 11 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1994 VL 81 IS 1 BP 168 EP 175 DI 10.1097/00000542-199407000-00023 PG 8 WC Anesthesiology SC Anesthesiology GA NW235 UT WOS:A1994NW23500023 ER PT J AU GIOSTRA, E MAGISTRIS, MR PIZZOLATO, G COX, J CHEVROLET, JC AF GIOSTRA, E MAGISTRIS, MR PIZZOLATO, G COX, J CHEVROLET, JC TI NEUROMUSCULAR DISORDER IN INTENSIVE-CARE UNIT PATIENTS TREATED WITH PANCURONIUM-BROMIDE - OCCURRENCE IN A CLUSTER GROUP OF 7 PATIENTS AND 2 SPORADIC CASES, WITH ELECTROPHYSIOLOGIC AND HISTOLOGIC EXAMINATION SO CHEST LA English DT Article DE CURARE; MYOPATHY; NEUROPATHY; PANCURONIUM BROMIDE; PERONEAL PALSY; QUADRIPARESIS ID CRITICALLY ILL PATIENTS; MULTIPLE ORGAN FAILURE; PROLONGED PARALYSIS; POLYNEUROPATHY; VECURONIUM; MYOPATHY; SUXAMETHONIUM; VENTILATION; WEAKNESS; BLOCKADE AB During six consecutive months, seven patients admitted to our ICU (15 beds, general ICU, approximately 300 intubated patients per year) for acute respiratory failure requiring intubation and mechanical ventilation presented with a peculiar neuromuscular disorder. After the occurrence of this cluster group of patients, we detected two more similar but isolated cases in the following 18 months, ie, altogether 9 patients in 2 years of observation, or 1.55 percent of all intubated patients in our ICU. Sedation was achieved using midazolam, curarization was effected with the neuromuscular nondepolarizing agent pancuronium bromide (PB), and corticosteroids were administered to eight patients. Shortly after discontinuation of sedation and curarization, we observed a persistent tetraparetic syndrome and/or peroneal palsy with a concomitant increase of serum creatine kinase (CK). None of the patients was septic or had the multisystem organ failure. A strong association between CK increase and PB administration was found, whereas no patient suffered severe liver or kidney failure. The duration of the neurologic deficit ranged from 4 to 52 weeks, with only partial recovery for some patients; the duration of dysfunction was apparently related to the total dose of corticosteroids received. Two patients had difficulty being weaned from the respirator and required tracheostomy. Electrophysiologic studies showed signs of axonal neuropathy and myopathic changes, ie, motor units of brief duration, small amplitude, overly abundant for the voluntary effort being exerted. Muscle biopsies showed significant myopathic alterations, with foci of muscle necrosis in most patients and minimal lymphocytic inflammation in one patient. The neurologic complication described differs from the polyneuropathy in critically ill patients. Furthermore, PB or corticosteroids or both appear to be the causal agents. The duration of the neuromuscular dysfunction may be related to concomitant steroid therapy. The CK enzyme seems to be a marker of the disorder. This disorder is associated with myopathic alterations and axonal degeneration in some patients. Pancuronium bromide should be used with caution, particularly when associated with steroids therapy, and it may cause difficulty in weaning patients from the respirator. C1 UNIV GENEVA,HOP CANTONAL,DIV NEUROPHYSIOL CLIN,CH-1211 GENEVA,SWITZERLAND. UNIV GENEVA,HOP CANTONAL,INST PATHOL CLIN,CH-1211 GENEVA,SWITZERLAND. UNIV GENEVA,HOP CANTONAL,SOINS INTENS MED,CH-1211 GENEVA,SWITZERLAND. RP GIOSTRA, E (reprint author), UNIV GENEVA,HOP CANTONAL,MED CLIN 1,CH-1211 GENEVA,SWITZERLAND. NR 51 TC 49 Z9 52 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 SN 0012-3692 J9 CHEST JI Chest PD JUL PY 1994 VL 106 IS 1 BP 210 EP 220 DI 10.1378/chest.106.1.210 PG 11 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA NX372 UT WOS:A1994NX37200038 ER PT J AU MARSHALL, RJ MUIR, AW SLEIGH, T SAVAGE, DS AF MARSHALL, RJ MUIR, AW SLEIGH, T SAVAGE, DS TI AN OVERVIEW OF THE PHARMACOLOGY OF ROCURONIUM BROMIDE IN EXPERIMENTAL-ANIMALS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; RESEARCH, ANIMALS; PHARMACOLOGY, DOSE RESPONSES; POTENCY AB In various animal species anaesthetized with a-chloralose (cats and pigs) or pentobarbitone (Beagle dogs and Rhesus monkeys), rocuronium has been shown to be a readily reversible, non-depolarizing neuromuscular blocking agent with a similar duration of action as vecuronium but a 6-10 fold lower potency. The outstanding features of its action is rapidity of onset. It is not expected to have any marked cardiovascular or autonomic side-effects when used in the neuromuscular blocking dose range. There is no evidence of any selective pre-junctional effect and there is no clinically relevant inhibition of acetycholinesterase. Screening in rats has not demonstrated any oestrogenic, androgenic, anabolic, glucocorticoid-like or gonad-inhibiting properties, although there was a slight increase in pituitary weight in male rats. RP MARSHALL, RJ (reprint author), ORGANON RES LABS LTD,SCI DEV GRP,NEWHOUSE,SCOTLAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 9 EP 15 PG 7 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700003 ER PT J AU BOOIJ, LHDJ AF BOOIJ, LHDJ TI A DOSE-FINDING STUDY WITH ROCURONIUM BROMIDE (REPRINTED FROM ANESTHESIA, VOL 66, PG 341, 1991) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANT, ROCURONIUM; PHARMACOLOGY, DOSE-RESPONSE CURVE AB Rocuronium bromide was studied in 30 anaesthetized (thiopentone, fentanyl, nitrous oxide) male patients, ASA I or II. A dose-response curve was constructed and the ED90, mean (SD), was found to be 0.36 (0.031 ) mg kg-1. The onset of action was 3.8 (1,8) min, the clinical duration 17.4 (3.2) min, the total duration of action 31.9(6.2) min. and the recovery time 9.96 (3.2) min. No signs of histamine release or cardiovascular effects were observed. Rocuronium thus has a faster onset of action than vecuronium or atracurium. RP BOOIJ, LHDJ (reprint author), CATHOLIC UNIV NIJMEGEN,INST ANAESTHESIOL,NIJMEGEN,NETHERLANDS. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 16 EP 19 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700004 ER PT J AU MELLINGHOFF, H DIEFENBACH, C BISCHOFF, A GROND, S BUZELLO, W AF MELLINGHOFF, H DIEFENBACH, C BISCHOFF, A GROND, S BUZELLO, W TI DOSE-RESPONSE RELATIONSHIP OF ROCURONIUM BROMIDE DURING INTRAVENOUS ANESTHESIA SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; POTENCY ED(50), ED(95); PHARMACOLOGY, DOSE RESPONSE CURVE AB The dose-response relationship and time course of neuromuscular block following bolus injections of rocuronium was determined in four groups of nine patients each under nitrous oxide-narcotic anaesthesia. Each patient received a total of 800 mug kg-1 rocuronium in two divided doses, i.e. 1 20 and 680, 200 and 600, 250 and 550, or 300 and 500 mug kg-1. The respective second dose was injected when, following the first dose, the evoked twitch tension had recovered to 95% of its control value. The mean ED50 and ED95 values, calculated from the first doses, were 1 03 and 271 mug kg-1, respectively. The DUR25 ranged between 11+/-4 (200 mug kg-1) to 14+/-3 min (300 mug kg-1) following the first and from 30+/-6 (500 mug kg-1) to 43+/-11 min (680 mug kg-1) following the second doses. The recovery index following the second doses varied between 14+/-5 (500 mug kg-1) and 24+/-20 min (600 mug kg-1), more than twice as long as following the first doses. We conclude that rocuronium is a muscle relaxant of low potency with an intermediate duration of action. RP MELLINGHOFF, H (reprint author), UNIV COLOGNE,DEPT ANAESTHESIOL,W-5000 COLOGNE 41,GERMANY. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 20 EP 24 PG 5 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700005 ER PT J AU KHUENLBRADY, KS PUHRINGER, F MITTERSCHIFFTHALER, G AF KHUENLBRADY, KS PUHRINGER, F MITTERSCHIFFTHALER, G TI EVALUATION OF CUMULATIVE PROPERTIES OF ROCURONIUM BROMIDE UNDER HALOTHANE ANESTHESIA (REPRINTED FROM ACTA-ANAESTHESIOL-SCAND, VOL 37, PG 137, 1993) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE ANESTHETICS VOLATILE, HALOTHANE; NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACOLOGY, CUMULATION AB The time-course of action of rocuronium was compared using three different sizes of maintenance doses after at least three subsequent administrations of the same repeat dose in each patient under halothane anaesthesia. Following endotracheal intubation facilitated with 0.6 mg kg-1 rocuronium, muscle relaxation was maintained in three groups each consisting of 10 patients, using increments of equal repeat doses of either 75 mug kg-1, 150 mug kg-1 or 225 mug kg-1 equivalent to 1/4, 1/2 and 3/4 of the ED95 of rocuronium respectively. Maintenance doses were administered when the twitch height depression induced by the previous dose returned to 25% of its control value. The clinical duration of the intubating dose averaged 27+/-7.5 min (mean+/-S.D.) The time-course of action of the various maintenance doses depended on their size, but not on the number of administrations. The durations of repeat doses averaged 8-9 min, 14-16 min and 19-23 min after the low, medium and high maintenance doses, respectively. No overt cumulative effects were observed. RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK, ANAESTHESIA & GEN INTENS CARE MED CLIN, A-6020 INNSBRUCK, AUSTRIA. NR 0 TC 0 Z9 0 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 JUL PY 1994 SU 9 BP 25 EP 27 PG 3 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700006 ER PT J AU VIBYMOGENSEN, J AF VIBYMOGENSEN, J TI DOSE-RESPONSE RELATIONSHIP AND TIME-COURSE OF ACTION OF ROCURONIUM BROMIDE IN PERSPECTIVE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOLOGY, DOSE RESPONSE CURVES; NEUROMUSCULAR RELAXANTS, ROCURONIUM; POTENCY, AGE, ED(50); ED(90) AB The available evidence indicates that rocuronium is one of the least potent non-depolarizing muscle relaxants, having a clinical duration, recovery index and reversal time similar to those of atracurium and vecuronium. The onset time, however, is significantly shorter than that of currently used non-depolarizing muscle relaxants. Rocuronium seems to be potentiated by the inhalational anaesthetics to the same degree as vecuronium. This effect is clinically most significant when using a continuous infusion of rocuronium. There is no difference in potency of rocuronium between adult and elderly patients, but it is not clear yet whether the potency differs between adults and neonates, infants or children. The onset time, duration of action, and recovery index are prolonged in elderly patients and the onset time, duration of action, and recovery index are longer in infants than in children. RP VIBYMOGENSEN, J (reprint author), UNIV COPENHAGEN,RIGSHOSP,DEPT ANAESTHESIA,DK-2100 COPENHAGEN,DENMARK. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 28 EP 32 PG 5 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700007 ER PT J AU MEISTELMAN, C PLAUD, B DONATI, F AF MEISTELMAN, C PLAUD, B DONATI, F TI A COMPARISON OF THE NEUROMUSCULAR BLOCKING EFFECTS OF ROCURONIUM BROMIDE AT THE ADDUCTOR-POLLICIS AND LARYNGEAL ADDUCTOR MUSCLES (REPRINTED FROM CAN-J-ANAESTH, VOL 39, PG 665, 1992) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE MONITORING, NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS, ROCURONIUM; SKELETAL MUSCLE, ADDUCTOR POLLICIS, LARYNX AB The effects of rocuronium, 0.25 or 0.5 mg kg-1, were measured simultaneously on the adductor muscles of the larynx and adductor pollicis in 1 4 adult patients. Anaesthesia was induced and maintained with propofol and fentanyl. Tracheal intubation was performed without muscle relaxants. The recurrent laryngeal and ulnar nerves were both stimulated supramaximally, at the notch of the thyroid cartilage and at the wrist respectively, using train-of-four stimulation. The laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords. Onset time, intensity of blockade and duration of action were less at the larynx than at the adductor pollicis. After rocuronium, 0.25 mg kg-1, the onset time (interval between injection and maximal T1 blockade) was 1.6+/-0.1 min and 3.0+/-0.3 min (mean+/-SEM) at the laryngeal muscles and adductor pollicis, respectively (P<0.01 between muscles). Maximum blockade was 37+/-8% and 69+/-8%, respectively (P<0.05), and time to 90% T1 recovery was 7+/-1 min and 20+/-4min, respectively (P<0.05). With 0.5 mg kg-1, the onset time was also more rapid at the vocal cords (1.4+/-0.1 min) than at the adductor pollicis (2.4+/-0.2min, P<0.001). Maximum blockade was 77+/-5% and 98+/-1%, respectively (P<0.01), and time to 90% T1 recovery was 22 min. RP MEISTELMAN, C (reprint author), INST GUSTAVE ROUSSY,DEPT ANAESTHESIA,F-94805 VILLEJUIF,FRANCE. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 33 EP 36 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700008 ER PT J AU DEMEY, JC DEBROCK, M ROLLY, G AF DEMEY, JC DEBROCK, M ROLLY, G TI EVALUATION OF THE ONSET AND INTUBATION CONDITIONS OF ROCURONIUM BROMIDE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; MEASUREMENT TECHNIQUE, ELECTROMYOGRAPHY, NEUROMUSCULAR BLOCKADE; MONITORING, NEUROMUSCULAR FUNCTION; INTUBATION, TRACHEAL AB Rocuronium 0.6, 0.75, or 0.9 mg kg-1, was given after supramaximal train-of-four stimulation of the ulnar nerve, measuring the compound action potential of the hypothenar muscles. Intubation conditions, onset time, recovery to 25% and recovery index of the three doses of rocuronium bromide were determined in 60 ASA I or II consenting patients, who were receiving propofol, alfentanil and N2O/O2 for ophthalmic surgery. Intubation conditions were randomly assessed either 45 s or 60 s after injection. In general, intubation conditions were excellent or good; in only three patients were poor conditions obtained, always at 45 s. For total intubation score a borderline difference was found in favour of the 60 s subgroups. No difference could be shown between the three dose groups. The onset time was longer (P<0.01) in the 0.6 mg kg-1 group, compared to that in the 0.9 mg kg-1 group. The recovery to 25% and spontaneous recovery index were shorter in the 0.6 mg kg-1 group (P<0.01). RP DEMEY, JC (reprint author), STATE UNIV GHENT HOSP,DEPT ANAESTHESIOL,B-9000 GHENT,BELGIUM. NR 0 TC 1 Z9 1 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 37 EP 40 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700009 ER PT J AU MIRAKHUR, RK COOPER, AR CLARKE, RSJ AF MIRAKHUR, RK COOPER, AR CLARKE, RSJ TI ONSET AND INTUBATING CONDITIONS OF ROCURONIUM BROMIDE COMPARED TO THOSE OF SUXAMETHONIUM (REPRINTED FROM BR-J-ANAESTH, VOL 69, PG 269, 1992) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE INTUBATION TRACHEAL, INTUBATING CONDITIONS; NEUROMUSCULAR RELAXANTS, SUXAMETHONIUM, ROCURONIUM AB We have assessed intubating conditions after administration of rocuronium 600 mug kg-1 at 60 or 90 s in groups of 20 patients anaesthetized with thiopentone, nitrous oxide in oxygen and small doses of fentanyl, and compared the data with those obtained after suxamethonium 1 mg kg-1 in similar groups of patients. Intubating conditions after rocuronium were found to be clinically acceptable (good or excellent) in 95% of patients at 60 s and in all patients at 90 s and in all patients at both times after suxamethonium. The average time for the onset of block following rocuronium at this dose was 89 s; the duration of clinical relaxation (25% recovery of twitch height) 30 min. RP MIRAKHUR, RK (reprint author), QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 41 EP 43 PG 3 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700010 ER PT J AU TRYBA, M ZORN, A THOLE, H ZENZ, M AF TRYBA, M ZORN, A THOLE, H ZENZ, M TI RAPID-SEQUENCE OROTRACHEAL INTUBATION WITH ROCURONIUM - A RANDOMIZED DOUBLE-BLIND COMPARISON WITH SUXAMETHONIUM - PRELIMINARY COMMUNICATION SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, SUXAMETHONIUM, ROCURONIUM; INTUBATION TRACHEAL, TIMING AB Eighty ASA I-III patients were randomly assigned to four groups. Group I patients received rocuronium 0.6 mg kg-1 immediately prior to thiopentone, while patients in group II received the same dose immediately after the induction agent. In groups III and IV a priming dose of rocuronium 0.04 mg kg-1 was administered prior to induction. Group III patients received rocuronium immediately prior to thiopentone. In group IV, suxamethonium 1.5 mg kg-1 was administered immediately after thiopentone. Intubation conditions were scored by a blinded investigator. An intubation time of >60s was defined as a failure. All patients could be intubated within 60s. Priming with rocuronium did not improve intubation conditions. Total intubation scores >6 occurred significantly more often in group II (P<0.01 vs. all other groups). A single bolus dose of rocuronium 0.6 mg kg-1 (2 x ED95) administered immediately prior to thiopentone 6 mg kg-1 offers the same intubation conditions as suxamethonium 1.5 mg kg-1. RP TRYBA, M (reprint author), RUHR UNIV BOCHUM,HOSP BERGMANNSHEIL,DEPT ANESTHESIOL INTENS CARE MED & PAIN THERAPY,W-4630 BOCHUM,GERMANY. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 44 EP 48 PG 5 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700011 ER PT J AU FELDMAN, SA AF FELDMAN, SA TI ROCURONIUM - ONSET TIMES AND INTUBATING CONDITIONS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; INTUBATION, TRACHEAL, TIMING AB Many factors influence the minimum time required to achieve an easy and successful tracheal intubation after a non-depolarizing relaxant. The ideal study design has never been achieved in practice: an overall picture of the efficacy of rocuronium depends on careful interpretation of studies with different methodologies, which have usually compared the new drug with vecuronium or suxamethonium, currently the best alternatives. Despite lack of supporting animal data, the rapidity of onset of rocuronium in man appears to be due to an early presynaptic effect. Observations which are difficult to explain are that increasing the dose above about 2xED90 does not shorten the time to onset and 'priming' also has no beneficial effect. Although some studies have produced evidence that rocuronium can produce smooth easy intubation conditions in 60 s, 90 s would appear to be closer to the time when excellent conditions can be guaranteed. Whether this is an acceptable alternative to the 45 s or so needed after suxamethonium is a matter of clinical judgement which only testing in practice will answer. RP FELDMAN, SA (reprint author), CHELSEA & WESTMINSTER HOSP,MAGILL DEPT ANAESTHET,LONDON,ENGLAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 49 EP 52 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700012 ER PT J AU ALVAREZGOMEZ, JA ESTELLES, ME FABREGAT, J PEREZ, F BRUGGER, AJ AF ALVAREZGOMEZ, JA ESTELLES, ME FABREGAT, J PEREZ, F BRUGGER, AJ TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ROCURONIUM BROMIDE IN ADULT PATIENTS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOKINETICS; NEUROMUSCULAR RELAXANTS, ROCURONIUM; INTUBATION TRACHEAL AB In seven patients (M/F: 4:3) rocuronium 0.6 mg kg-1 was given after the induction of anaesthesia with propofol, and during maintenance with N2O/O2, halothane 0.5% and alfentanil 60-90 mug kg-1 h-1. Intubation conditions were scored at 60 s and lag time, onset time, maximal block achieved, recovery to 25% of T1, and Recovery Index, were measured using a Relaxograph. Blood samples were taken over a 300 min period and analysed for rocuronium. Intubating conditions at 60s were excellent in all patients. Mean clearance was 5.2 ml kg-1 min-1, the terminal half-life was 69 min and distribution volume at steady state was 0.22 litre kg-1. Cumulative urinary excretion was around 18% within 24 h. RP ALVAREZGOMEZ, JA (reprint author), SANTA MARIA ROSELL HOSP,CARTAGENA,SPAIN. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 53 EP 56 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700013 ER PT J AU OKELLY, B FISET, P MEISTELMAN, C ECOFFEY, C AF OKELLY, B FISET, P MEISTELMAN, C ECOFFEY, C TI PHARMACOKINETICS OF ROCURONIUM BROMIDE IN PEDIATRIC-PATIENTS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOKINETICS, MODELS, AGE FACTORS; NEUROMUSCULAR RELAXANTS, ROCURONIUM AB Rocuronium 0.8 mg kg-1 was given to 22 children between the ages of 3 months and 8 years during anaesthesia with N2O/O2, 60:40, and halothane. Blood samples were collected for 360 min for determination of rocuronium concentrations. The pharmacokinetics were best described by a two-compartment model. Two models were fitted, one proportional to weight and the other adjusted for age. Using the first model, volumes and clearances were all proportional to weight: in the second model, only the volume of the second compartment and clearance from the central compartment were proportional to age. The results do not support the use of body surface area, rather than weight for the calculation of paediatric doses of rocuronium. In this study, the volume of the central compartment was larger than the figure obtained in an adult population. RP OKELLY, B (reprint author), HOP BICETRE,DEPT ANAESTHESIA,LE KREMLIN BICETR,FRANCE. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 57 EP 58 PG 2 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700014 ER PT J AU ORNSTEIN, E MATTEO, RS AF ORNSTEIN, E MATTEO, RS TI PHARMACOKINETICS OF ROCURONIUM IN ELDERLY SURGICAL PATIENTS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE AGE FACTORS, DRUG CLEARANCE; PHARMACOKINETICS, AGE FACTORS AB The effects of age on the pharmacokinetic and pharmacodynamic responses to rocuronium were studied in 20 elderly (>70 years) and 20 younger control patients (<60 years) during N2O/O2, fentanyl anaesthesia. The onset times were the same for both the elderly and younger control group, but the duration of action of rocuronium was significantly prolonged in the elderly patients. Elderly patients, when compared with the younger, also exhibited a significant decrease in plasma clearance (3.67+/-1.0 vs. 5.03+/-1.5 ml kg-1 min-1, mean+/-SD) and volume of distribution (399+/-122 vs. 553+/-279 ml kg-1, mean+/-SD). During the recovery phase of paralysis, no significant difference was seen in the log plasma concentration vs. twitch tension response relationship between 20% and 80% paralysis in young and elderly patients receiving rocuronium. The differences in action of rocuronium between the elderly and younger groups can be fully explained by the observed differences in the distribution and elimination of rocuronium between the two groups. The decreased total body water and decreased liver mass which normally accompany ageing are the probable explanation for the pharmacokinetic changes found in the elderly in this study. We conclude that the action of rocuronium is prolonged in patients over 70 years of age because of decreased elimination of the drug. RP ORNSTEIN, E (reprint author), COLUMBIA UNIV COLL PHYS & SURG,NEW YORK,NY 10032, USA. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 59 EP 62 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700015 ER PT J AU SPARR, HJ KHUENLBRADY, KS ERIKSSON, LI AF SPARR, HJ KHUENLBRADY, KS ERIKSSON, LI TI PHARMACODYNAMICS AND PHARMACOKINETICS OF ROCURONIUM FOLLOWING CONTINUOUS-INFUSION IN PATIENTS DURING INTRAVENOUS ANESTHESIA SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE PHARMACOKINETICS, STEADY STATE; PHARMACODYNAMICS; NEUROMUSCULAR RELAXANTS, ROCURONIUM AB After an initial bolus dose (0.6 mg kg-1), 10 patients received a continuous infusion of rocuronium, initially at 0.5 mg kg-1 h-1, and then adjusted to maintain 90% twitch depression. Blood samples were analysed for 420 min after switching off the infusion. The dose required to maintain the block was 595+/-146 mug kg-1 h-1, 7-9 times that reported for vecuronium under similar conditions. The pharmacokinetic parameters (volume of distribution at steady state, 309+/-80 ml kg-1, plasma clearance 4.5+/-1.96 ml kg-1 min-1, and elimination half-life 107+/-37 min) were similar to those previously reported after a large single bolus. RP SPARR, HJ (reprint author), UNIV INNSBRUCK, ANAESTHESIA & GEN INTENS CARE MED CLIN, A-6020 INNSBRUCK, AUSTRIA. NR 0 TC 0 Z9 0 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 JUL PY 1994 SU 9 BP 63 EP 65 PG 3 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700016 ER PT J AU WIERDA, JMKH PROOST, JH SCHIERE, S HOMMES, FDM AF WIERDA, JMKH PROOST, JH SCHIERE, S HOMMES, FDM TI PHARMACOKINETICS AND PHARMACOKINETIC DYNAMIC RELATIONSHIP OF ROCURONIUM BROMIDE IN HUMANS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOKINETICS, ROCURONIUM, DOSE EFFECTS, MODELS; PHARMACODYNAMICS, ROCURONIUM, POTENCY, AGE EFFECTS AB The existing human pharmacokinetic studies have been reviewed and compared with data derived from animals. The earliest study confirms the similarity of rocuronium to vecuronium with respect to the variables derived from the plasma concentration decay curves and the proportion excreted renally. Other studies led to the conclusion that concurrent administration of volatile anaesthetics did not significantly influence rocuronium pharmacokinetics and that the potentiation must be due to an increased sensitivity of the neuromuscular junction. These studies do not provide an explanation for the clinical observation of a more rapid onset of action. One possible explanation was the finding of a more rapid onset of block in the laryngeal muscles than in the adductor pollicis. However, no pharmacokinetic explanation for this observation has emerged. Alternative concepts need to be modelled. There is a need for comparative pharmacokinetic studies which focus on the period immediately following administration of rocuronium and vecuronium. RP WIERDA, JMKH (reprint author), UNIV HOSP GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,GRONINGEN,NETHERLANDS. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 66 EP 74 PG 9 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700017 ER PT J AU MOTSCH, J LEUWER, M PFAU, M ZIMMERMAN, J MARTIN, E AF MOTSCH, J LEUWER, M PFAU, M ZIMMERMAN, J MARTIN, E TI TIME-COURSE OF ACTION AND RECOVERY OF ROCURONIUM BROMIDE IN CHILDREN DURING HALOTHANE ANESTHESIA - A PRELIMINARY-REPORT SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; POTENCY, AGE FACTORS; NEUROMUSCULAR TRANSMISSION, TRAIN-OF-4 AB In this preliminary study, two groups of 1 5 patients, aged 1-4 years and 5-10 years respectively, received one of four doses of rocuronium (0.1 2, 0.17, 0.22 or 0.27 mg kg-1) and when block was maximal a supplementary dose to bring them all to a total of 0.5 mg kg-1. In half the patients, the block was reversed with atropine and neostigmine at a T1 recovery of 25%. The remainder were allowed to recover spontaneously, The total dose produced a block of 95-100% in all patients. The clinical duration of action was shorter under halothane anaesthesia in children (mean 1 5 min approximately) than has previously been reported in adults under intravenous anaesthesia. Mean spontaneous recovery time from T1 25% to a train-of-four ratio of 0.7 was about 11 min. Neostigmine doubled the rate of recovery. There was a moderate increase in heart rate in the younger age range. RP MOTSCH, J (reprint author), UNIV HEIDELBERG,DEPT ANAESTHESIOL,W-6900 HEIDELBERG,GERMANY. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 75 EP 77 PG 3 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700018 ER PT J AU CORNET, JP ABIAD, M CORIAT, P SAADA, M GOSGNACH, ML VIARS, P AF CORNET, JP ABIAD, M CORIAT, P SAADA, M GOSGNACH, ML VIARS, P TI EVALUATION OF THE EFFECTS OF ROCURONIUM BROMIDE ON HEMODYNAMICS AND LEFT-VENTRICULAR FUNCTION IN PATIENTS UNDERGOING ABDOMINAL AORTIC-SURGERY SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE SURGERY, ABDOMINAL AORTIC; NEUROMUSCULAR RELAXANTS, ROCURONIUM, PANCURONIUM; MEASUREMENT TECHNIQUE, TRANSESOPHAGEAL ECHOCARDIOGRAPHY; HEART, TRANSESOPHAGEAL ECHOCARDIOGRAPHY AB In an open study of 26 patients undergoing abdominal aortic surgery, the effects of rocuronium 0.6 mg kg-1 (eight patients) and 0.9 mg kg-1, (nine patients) were compared with those of pancuronium 0.085 mg kg-1 (eight patients) on haemodynamic parameters and transoesophageal echocardiography. The anaesthetic technique was based on a benzodiazepine and low dose fentanyl (6 mug kg-1). Pancuronium was associated with a significant increase in mean arterial pressure, end-diastolic area and heart rate, none of which were seen after rocuronium at either dose level. RP CORNET, JP (reprint author), HOSP GRP PITIE SALPETRIERE,DEPT ANAESTHESIA & REANIMAT,PARIS,FRANCE. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 78 EP 81 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700019 ER PT J AU COOPER, AR WIERDA, JMKH MIRAKHUR, RK MADDINENI, VR AF COOPER, AR WIERDA, JMKH MIRAKHUR, RK MADDINENI, VR TI PHARMACODYNAMICS AND PHARMACOKINETICS OF ROCURONIUM BROMIDE IN PATIENTS WITH AND WITHOUT RENAL-FAILURE (REPRINTED FROM BR-J-ANAESTH, VOL 71, PG 222, 1993) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACODYNAMICS, RENAL FAILURE; PHARMACOKINETICS AB We have studied the onset and duration of action and pharmacokinetics of rocuronium bromide during anaesthesia with nitrous oxide, fentanyl and isoflurane after a single bolus dose of rocuronium 0.6 mg kg-1 in nine patients with chronic renal failure requiring regular haemodialysis, and in nine healthy control patients. Blood samples were collected over 390 min and concentrations of rocuronium and its putative metabolites measured using HPLC. Onset time for maximum block, duration of clinical relaxation DUR25 and recovery index, were 61 (SD 25.0) s and 65 (16.4) s, 55 (26.9) min and 42 (9.3) min and 28 (1 2.3) min and 1 9 (8.8) min, respectively, for patients with and without renal failure. The time for train-of-four ratio to return spontaneously to 0.7 was 99 (41.1 ) min and 73 (24.2) min, respectively, in the two groups. None of these differences was significant. The pharmacokinetic data were best described by a three-exponential equation. There were significant differences between patients with and without renal failure in the rates of clearance (2.5 (1.1 ) ml kg-1 min-1 and 3.7 (1.4) ml kg-1 min-1, respectively) and the mean residence times (97.1 (48.7) min and 58.3 (9.6) min) (P<0.05). The differences in other kinetic parameters were not significant. We conclude that the effects of rocuronium may be prolonged in patients with renal disease because of a decreased clearance of the drug. RP COOPER, AR (reprint author), QUEENS UNIV BELFAST,DEPT HEPATOL,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 82 EP 84 PG 3 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700020 ER PT J AU KHALIL, M DHONNEUR, G DUVALDESTIN, P SLAVOV, V DEHYS, C GOMENI, R AF KHALIL, M DHONNEUR, G DUVALDESTIN, P SLAVOV, V DEHYS, C GOMENI, R TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ROCURONIUM IN PATIENTS WITH CIRRHOSIS (REPRINTED FROM ANESTHESIOLOGY, VOL 80, 1994) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOKINETICS; NEUROMUSCULAR RELAXANTS, ROCURONIUM; LIVER, CIRRHOSIS AB The pharmacokinetics of rocuronium in 1 0 patients with proven cirrhosis were compared with those in eight normal patients. Patients with cirrhosis had an increased volume of the central compartment and this was associated with a lower maximum block in several patients with a slower onset and longer recovery index. Other pharmacokinetic parameters did not differ significantly between the groups, suggesting that hepatic elimination is not a significant factor in the removal of rocuronium. RP KHALIL, M (reprint author), HOSP HENRI MONDOR,DEPT ANAESTHESIA & INTENS CARE,CRETEIL,FRANCE. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 85 EP 86 PG 2 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700021 ER PT J AU BEVAN, DR AF BEVAN, DR TI ROCURONIUM BROMIDE AND ORGAN FUNCTION SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE KIDNEY, FUNCTION; LIVER, FUNCTION; NEUROMUSCULAR RELAXANTS, ROCURONIUM AB Neuromuscular blocking drugs can be divided into those that are: (i) excreted entirely by the kidney; (ii) predominantly by the kidney but also by the liver; (iii) mainly by the liver but also by the kidney or; (iv) removed by other metabolic pathways. Rocuronium is mainly excreted by the liver and pharmacokinetic and pharmacodynamic studies in humans suggest that its duration of action may be prolonged to a greater extent in patients with hepatic disease than in patients with renal disease. The effect is likely to be modest and not a contra-indication to its use. RP BEVAN, DR (reprint author), UNIV BRITISH COLUMBIA,FAC MED,DEPT ANAESTHESIA,VANCOUVER V6T 1W5,BC,CANADA. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 87 EP 91 PG 5 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700022 ER PT J AU MUIR, AW ANDERSON, KA POW, E AF MUIR, AW ANDERSON, KA POW, E TI INTERACTION BETWEEN ROCURONIUM BROMIDE AND SOME DRUGS USED DURING ANESTHESIA SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOLOGY, DRUG INTERACTIONS; NEUROMUSCULAR RELAXANTS, ROCURONIUM; ANESTHETICS, INTRAVENOUS, THIOPENTONE, PROPOFOL, KETAMINE; ANALGESICS, ALFENTANIL, MORPHINE; ATARACTICS, CHLORPROMAZINE, DIAZEPAM; ANTIBIOTICS, STREPTOMYCIN; POTENCY, DOSE RESPONSE CURVES AB In cats anaesthetized with i.p. chloralose and pentobarbitone, neuromuscular blockade produced by various doses of rocuronium was measured and dose response curves constructed in the presence of halothane, enflurane, nitrous oxide, propofol, alfentanil, thiopentone, ketamine, diazepam, chlorpromazine, morphine or streptomycin. In general, when a shift in the dose response curve was produced, it was a parallel shift to the left, indicating potentiation. Both halothane and enflurane produced a left shift and a small increase in the time from maximum block to 90% recovery. Nitrous oxide had no effect on the depth of block but delayed recovery. Thiopentone and ketamine potentiated the blocking effect of rocuronium but propofol and alfentanil had no effect. Chlorpromazine and morphine caused potentiation which took 1-1 .5 h to develop. Streptomycin had a potentiating effect in four cats but not in two others. Diazepam displaced the dose-response curve to the right in four cats. Prior treatment with suxamethonium had no effect. RP MUIR, AW (reprint author), ORGANON RES LABS LTD,DEPT PHARMACOL,SCI DEV GRP,NEWHOUSE,SCOTLAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 93 EP 98 PG 6 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700023 ER PT J AU OLKKOLA, KT TAMMISTO, T AF OLKKOLA, KT TAMMISTO, T TI QUANTITATION OF THE INTERACTION OF ROCURONIUM BROMIDE WITH ETOMIDATE, FENTANYL, MIDAZOLAM, PROPOFOL, THIOPENTONE, AND ISOFLURANE USING CLOSED-LOOP FEEDBACK-CONTROL OF INFUSION OF ROCURONIUM SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE ANESTHETICS INTRAVENOUS, ETOMIDATE, PROPOFOL, THIOPENTONE; ATARACTICS, MIDAZOLAM; ANALGESICS, FENTANYL; NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACOLOGY, DRUG INTERACTION; MEASUREMENT TECHNIQUE, NEUROMUSCULAR BLOCKADE AB Sixty patients were randomly assigned to one of six groups (n=10 in each case) in which anaesthesia was induced and maintained with etomidate, fentanyl, midazolam, propofol or with thiopentone and N2O, or isoflurane and N2O. After obtaining control measurements, rocuronium 0.6 mg kg-1 was given for intubation followed by an infusion, controlled by closed-loop feedback at 90% block. The steady-state rates of infusion were (in the same order) 0.64+/-0.22, 0.60+/-0.15, 0.61+/-0.21, 0.67+/-0.31, 0.63+/-0.15 and 0.39+/-0.17 mg kg-1 h-1 (Mean+/-SD). The intravenous agents did not interact with recuronium to any clinically significant degree. Isoflurane reduced the requirements by 35-40%. RP OLKKOLA, KT (reprint author), UNIV HELSINKI,DEPT ANAESTHESIA,SF-00100 HELSINKI 10,FINLAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 99 EP 100 PG 2 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700024 ER PT J AU VANAKEN, H ORIS, B CRUL, JF AF VANAKEN, H ORIS, B CRUL, JF TI MUSCLE PARALYSIS BY ROCURONIUM BROMIDE DURING HALOTHANE, ENFLURANE, ISOFLURANE AND TOTAL INTRAVENOUS ANESTHESIA (REPRINTED FROM ANESTH-ANALG, VOL 77, PG 570, 1993) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; POTENCY ANESTHETIC, ED(50) ANESTHETICS GENERAL, HALOTHANE, ENFLURANE, ISOFLURANE; ANESTHETICS INTRAVENOUS, PROPOFOL; ANALGESICS, ALFENTANIL AB Eighty patients were equally randomized to four different groups (n=20) receiving 0.5-1% halothane, 1.5-2% enflurane, 1.2-1.8% isoflurane end-tidal concentration in 34%/66% O2/N2O, or 6.0 mg kg-1 h-1 propofol without N2O for anaesthesia and alfentanil for analgesia. Strength of thumb adduction in response to single and train-of-four stimulation of the ulnar nerve was quantitated. Rocuronium 0.15, 0.2, 0.25, and 0.3 mg kg-1 were given intravenously. When maximal depression of twitch tension occurred, supplementary doses up to a total of 0.5 mg kg-1 were given. If required, additional doses of 0.15 mg kg-1 were given at 25% recovery of control twitch tension. Standard haemodynamics, end-tidal CO2, and anaesthetic gas concentrations were monitored continuously. The mean ED50 (SD) was 0.133 (+/-0.009) mg kg-1 for the halothane group, 0.118 (+/-0.012) mg kg-1 for the enflurane group, 0.069 (+/-0.026) mg kg-1 for the isoflurane group, and 0.167 (+/-0.007) mg kg-1 for the total intravenous anaesthesia (TIVA) group, respectively. There was a statistically significant difference between the halothane and TIVA, and between the enflurane and TIVA groups (P<0.05). The neuromuscular blocking potency and pharmacodynamic profile of rocuronium are moderately influenced by volatile anaesthetics. RP VANAKEN, H (reprint author), KATHOLIEKE UNIV LEUVEN HOSP,DEPT ANAESTHESIOL,LOUVAIN,BELGIUM. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 101 EP 102 PG 2 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700025 ER PT J AU MIRAKHUR, RK COOPER, AR MADDINENI, VR AF MIRAKHUR, RK COOPER, AR MADDINENI, VR TI AN EVALUATION OF THE INTERACTIONS OF ROCURONIUM BROMIDE WITH ANTIBIOTICS (REPRINTED FROM EUR-J-ANAESTH, VOL 10, PG 331, 1993) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACODYNAMICS, ANTIBIOTICS, NETILMICIN, CEFUROXIME, METRONIDAZOLE AB The onset and duration of clinical relaxation and reversibility of rocuronium bromide 0.6 mg kg-1 were studied following administration of netilmicin 2 mg kg-1 (n=10) or cefuroxime 200 mg kg-1 (n=10) in patients undergoing urological surgery; and cefuroxime 20 mg kg 1 (n=10), metronidazole 7.5 mg kg-1 (n=10), metronidazole 7.5 mg kg-1 and cefuroxime 20 mg kg-1 (n=10), or placebo (n=10), in patients undergoing abdominal surgery under anaesthesia with thiopentone, nitrous oxide in oxygen, fentanyl and halothane. The antimicrobial agents were administered intravenously 5 min before rocuronium. Neuromuscular function was monitored using mechanomyography and train-of-four (TOF) mode of stimulation. Onset of neuromuscular block occurred in approximately 60 s with all patients achieving complete block. The mean clinical duration (+/-SD) was 50+/-10.7 and 44+/-6.7 min following netilmicin and cefuroxime respectively in patients undergoing urological surgery; and 49+/-13.7, 44+/-11.1, 48+/-11.1 and 38+/-7.3 min in the groups undergoing abdominal surgery receiving cefuroxime, metronidazole, cefuroxime and metronidazole combination and placebo respectively. There were no statistically significant differences between the groups in either the onset or the duration of clinical relaxation. Reversal of neuromuscular block with neostigmine carried out at spontaneous recovery of T1 (first response in the TOF) of 25% or more was easily achieved in all groups in 2-4 min. It is concluded that there is no significant interaction between rocuronium and single doses of the antimicrobial agents used in the present study. RP MIRAKHUR, RK (reprint author), QUEENS UNIV BELFAST,DEPT ANAESTHESIA,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 103 EP 106 PG 4 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700026 ER PT J AU AGOSTON, S AF AGOSTON, S TI INTERACTIONS OF VOLATILE ANESTHETICS WITH ROCURONIUM BROMIDE IN PERSPECTIVE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACOLOGY, DRUG INTERACTION; ANESTHETICS VOLATILE, ENFLURANE, HALOTHANE, ISOFLURANE AB A review of several publications shows that there is general agreement that inhalational anaesthetic agents potentiate the neuromuscular effects of rocuronium in the same order as other similar agents, namely: enflurane and isoflurane > halothane > intravenous anaesthetics. However, such potentiation is not evident during induction and only becomes significant as anaesthesia becomes more prolonged. It is manifest as a prolongation in the duration of action of maintenance doses and a decrease in the recovery rate. During long-lasting procedures in which enflurane or isoflurane are used, smaller than usual maintenance doses or lower infusion rates should be employed. RP AGOSTON, S (reprint author), UNIV HOSP GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,GRONINGEN,AUSTRALIA. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 107 EP 111 PG 5 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700027 ER PT J AU NITSCHMANN, P OBERKOGLER, W HERTSIG, M SCHWARZ, S AF NITSCHMANN, P OBERKOGLER, W HERTSIG, M SCHWARZ, S TI COMPARISON OF HEMODYNAMIC-EFFECTS OF ROCURONIUM BROMIDE WITH THOSE OF VECURONIUM IN PATIENTS UNDERGOING CABG SURGERY SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM, VECURONIUM; MEASUREMENT TECHNIQUES, BLOOD PRESSURE, CARDIAC OUTPUT; HEART, CARDIAC OUTPUT, VASCULAR PRESSURES, VASCULAR RESISTANCE, PULSE RATE AB In a double-blind study, cardiovascular parameters (cardiac output, heart rate, systolic and diastolic arterial pressure, pulmonary and systemic vascular resistances) were measured invasively in two groups of patients receiving 3xED90 of rocuronium or vecuronium. Measurements were made at 2, 5 and 7 min after administration and 10 and 15 min after subsequent intubation. Systemic vascular resistance mostly increased, sometimes quite markedly, although, because of the variability, rarely statistically significantly. However, heart rate, arterial pressure and cardiac output were not altered to a clinically relevant degree. RP NITSCHMANN, P (reprint author), ORGANON TEKN NV,CLIN SERV GRP,TURNHOUT,BELGIUM. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 113 EP 115 PG 3 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700028 ER PT J AU ROBERTSON, EN HULL, JM VERBEEK, AM BOOIJ, LHDJ AF ROBERTSON, EN HULL, JM VERBEEK, AM BOOIJ, LHDJ TI A COMPARISON OF ROCURONIUM AND VECURONIUM - THE PHARMACODYNAMIC, CARDIOVASCULAR AND INTRAOCULAR EFFECTS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, VECURONIUM; ROCURONIUM; HEART RATE; BLOOD PRESSURE, DRUG EFFECTS; EYE, INTRAOCULAR PRESSURE AB The aim of this study was to compare, in 30 patients, the pharmacodynamics of equipotent intubating doses of rocuronium and vecuronium and to compare their effects on heart rate, arterial pressure and intra-ocular pressure under steady state propofol anaesthesia. Baseline readings of heart rate and arterial pressure, using a Dinamap, and intra-ocular pressure, using a Tonopen, were made after induction of anaesthesia. The effects of the administration of the relaxants on these parameters were measured, recorded and compared. Rocuronium had a faster onset time than vecuronium, but had a similar duration of action. Vecuronium had no significant cardiovascular effects. Rocuronium caused a rise in mean arterial pressure (10-15%) and a slight rise in heart rate (5-10%). Both vecuronium and rocuronium caused similar falls in intra-ocular pressure. With its rapid onset time and lack of intra-ocular pressure effects, rocuronium is perhaps the relaxant of choice in patients with penetrating eye injuries requiring emergency endotracheal anaesthesia where a longer-acting relaxant is not contraindicated. RP ROBERTSON, EN (reprint author), UNIV HOSP NIJMEGEN,DEPT ANESTHESIOL,NIJMEGEN,NETHERLANDS. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 116 EP 121 PG 6 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700029 ER PT J AU NAGUIB, M ABDULATIF, M ALGHAMDI, A AF NAGUIB, M ABDULATIF, M ALGHAMDI, A TI EVALUATION OF EDROPHONIUM AND NEOSTIGMINE AS ANTAGONISTS OF ROCURONIUM BROMIDE (REPRINTED FROM ANESTHESIOLOGY, VOL 79, PG 739, 1993) SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE ANTAGONISTS, EDROPHONIUM; NEOSTIGMINE; NEUROMUSCULAR RELAXANTS, ROCURONIUM; MEASUREMENT TECHNIQUE, NEUROMUSCULAR BLOCKADE AB Seventy-two ASA I or II adults were given 0.6 mg kg-1 rocuronium bromide during thiopentone-fentanyl-nitrous oxide-isoflurane anaesthesia. 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. Each dose of antagonist was given to eight patients. Neuromuscular function in another eight subjects was allowed to recover spontaneously. Assisted recovery was defined as actual recovery minus mean spontaneous recovery in patients who were not given antagonists. The dose-response curves for neostigmine and edrophonium-assisted antagonism of rocuronium blockade for the single twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% and 80% recovery (ED50 and ED80, respectively) of the first twitch after 10 min were 0.01 7 (0.001 ) and 0.033 (0,001 ) mg kg-1 (mean [standard error of estimate for the mean]), respectively. Corresponding ED50 and ED80 values for edrophonium were 0.1 61 (0.001 ) and 0.690 (0.001 ) mg kg-1, respectively. These values corresponded to neostigmine: edrophonium potency ratios of 9.5 (0.56) and 21 (0.67) for the first twitch (ED50 and ED80) height, respectively. The calculated doses producing ED50) of the train-of-four ratio at 10 min were 0.017 (0.001) and 0.469 (0.001 ) mg kg-1 for neostigmine and edrophonium, respectively. These values corresponded to a potency ratio of 27.5 (1 .66). If reversal was attempted at 1 0% twitch recovery, edrophonium was thus less capable than neostigmine of reversing train-of-four induced fade than first twitch. RP NAGUIB, M (reprint author), KING SAUD UNIV,KING KHALID HOSP,DEPT ANAESTHESIOL,POB 7805,RIYADH 11472,SAUDI ARABIA. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 122 EP 127 PG 6 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700030 ER PT J AU VANDENBROEK, L PROOST, JH WIERDA, JMKH AF VANDENBROEK, L PROOST, JH WIERDA, JMKH TI EARLY AND LATE REVERSIBILITY OF ROCURONIUM BROMIDE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE PHARMACOKINETICS, MODELS; NEUROMUSCULAR RELAXANTS, ROCURONIUM AB A computer simulation has been developed based on pharmacodynamic-pharmacokinetic modelling of the effect of neostigmine on rocuronium-induced neuromuscular blockade. The results of a previous study involving 60 patients were used as a test of the model. The model predicts that administration of neostigmine 40 mug kg-1 within 20 min of the administration of rocuronium does not decrease the duration of the block until 90% recovery has taken place. The optimum dose of neostigmine depends on the degree of block at the time of administration: for a more intense block the optimum dose is 80 mug kg-1 and for a less intense block is about 30 mug kg-1. The pharmacokinetic behaviour rather than the potency of the relaxant determines its reversibility. RP VANDENBROEK, L (reprint author), UNIV HOSP GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,GRONINGEN,NETHERLANDS. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 128 EP 132 PG 5 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700031 ER PT J AU MIRAKHUR, RK AF MIRAKHUR, RK TI SAFETY ASPECTS OF NONDEPOLARIZING NEUROMUSCULAR BLOCKING-AGENTS WITH SPECIAL REFERENCE TO ROCURONIUM BROMIDE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article; Proceedings Paper CT Investigators Workshop on Org 9426: Rocuronium Bromide CY NOV 15-16, 1993 CL GRONINGEN, NETHERLANDS DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; COMPLICATIONS; ALLERGIES AB The safety of neuromuscular relaxants can be assessed according to their cardiovascular and autonomic effects, their liability to release histamine, their tendency to cause anaphylactic/anaphylactoid reactions, their effect on cholinesterase, on intra-ocular and intracranial pressure, their tendency to cumulation and their reversibility. Any adverse effects of metabolites are also potential problems. Against these standards, rocuronium may have some mild vagolytic activity. Apart from that, its safety profile is indistinguishable from that of vecuronium. RP MIRAKHUR, RK (reprint author), QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 0 TC 2 Z9 2 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1994 SU 9 BP 133 EP 140 PG 8 WC Anesthesiology SC Anesthesiology GA PB247 UT WOS:A1994PB24700032 ER PT J AU VANDENBROEK, L WIERDA, JMKH SMEULERS, NJ VANSANTEN, GJ LECLERCQ, MGL HENNIS, PJ AF VANDENBROEK, L WIERDA, JMKH SMEULERS, NJ VANSANTEN, GJ LECLERCQ, MGL HENNIS, PJ TI CLINICAL-PHARMACOLOGY OF ROCURONIUM (ORG-9426) - STUDY OF THE TIME-COURSE OF ACTION, DOSE REQUIREMENT, REVERSIBILITY, AND PHARMACOKINETICS SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; ROCURONIUM-DOSE REQUIREMENT, PHARMACOKINETICS, REVERSIBILITY, TIME COURSE OF ACTION AB Study Objective: To evaluate the time course of action, dose requirement, reversibility, and pharmacokinetics of rocuronium (Org 9426) under 3 anesthetic techniques (nitrous oxide-fentanyl supplemented with propofol halothane, or isoflurane). Design: Prospective, randomized study. Setting: Operating suite at a university hospital. Patients: 36 ASA physical status I-III patients aged 18 to 65 years who were scheduled for elective surgery. Interventions: The time course of action of an intubation, close of rocuronium 600 mu g/kg was investigated in 36 patients. In 18 of these patients, the maintenance dose requirement of rocuronium and reversibility by neostigmine were evaluated. In the remaining 18 patients, the pharmacokinetics of rocuronium rocuronium after the intubating dose were studied. Neuromuscular transmission was monitored by mechanomyography. Venous blood samples and urine were analyzed by high-performance liquid chromatography. Measurements and Main Results: With the exception of a longer clinical duration of rocuronium-induced neuromuscular block in the isoflurane group compared with the propofol group (p = 0.03), time course of action variables were similar in the 3 groups. In patients receiving maintenance doses of rocuronium, the dose requirement until reversal was 636 +/- 191 mu/g/kg/hr, 496 +/- 107 mu g/kg/hr, and 384 +/- 127 mu g/kg/hr for the propofol halothane, and isoflurane groups, respectively (p = 0.02 for the isoflurane group vs. the propofol group). With respect to the reversal of a rocuronium-induced neuromuscular block, there were no differences in the percentage recovery or rate of recovery among the 3 groups. Pharmacokinetic analysis showed no significant differences for rocuronium during the 3 anesthetic techniques. Conclusion: Isoflurane potentiates the rocuronium-induced neuromuscular block resulting in a longer clinical duration and lower maintenance dose requirement. This difference is not explained by differences in pharmacokinetics but is probably due to increased sensitivity of the neuromuscular junction to rocuronium during isoflurane anesthesia. C1 UNIV GRONINGEN,DEPT ANESTHESIOL,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,GRONINGEN,NETHERLANDS. NR 0 TC 34 Z9 34 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD JUL-AUG PY 1994 VL 6 IS 4 BP 288 EP 296 DI 10.1016/0952-8180(94)90075-2 PG 9 WC Anesthesiology SC Anesthesiology GA PC222 UT WOS:A1994PC22200004 ER PT J AU MILLER, J LAW, AB PARKER, RA SUNDELL, H SILBERBERG, AR COTTON, RB AF MILLER, J LAW, AB PARKER, RA SUNDELL, H SILBERBERG, AR COTTON, RB TI EFFECTS OF MORPHINE AND PANCURONIUM ON LUNG-VOLUME AND OXYGENATION IN PREMATURE-INFANTS WITH HYALINE-MEMBRANE DISEASE SO JOURNAL OF PEDIATRICS LA English DT Article ID RESPIRATORY-DISTRESS SYNDROME; VENTILATED NEWBORN-INFANTS; PULMONARY MECHANICS; PRETERM INFANTS; EXOGENOUS SURFACTANT; MAINTENANCE; PRESSURE; BROMIDE; THERAPY; FLOW AB To determine the effect of analgesia and paralysis on lung volume and oxygenation in premature infants supported by mechanical ventilation because of hyaline membrane disease, functional residual capacity (FRC), and arterial/alveolar oxygen tension ratio were measured in nine premature infants with hyaline membrane disease before and after the administration of morphine sulfate and pancuronium bromide. Without a change of positive end-expiratory pressure, ventilator rate and peak inspiratory pressure were increased before the first set of measurements to minimize the contribution of the infants' own respiratory effort to total ventilation. These ventilator settings were then held constant (except fraction of inspired oxygen) before and after the administration of the drugs. The FRC was measured with a multiple-breath N-2 washout technique by means of whole-body plethysmography to measure airway flow. The FRC and the ratio of arterial to alveolar oxygen tension decreased in seven of nine patients after treatment with morphine and pancuronium. The decrease in FRC for all patients was significant (2.4 +/- 2.9 ml/kg; p <0.05), and a significant correlation was demonstrated between the change in the arterial/alveolar oxygen tension ratio and the change in FRC (r = 0.82; p <0.01). Gestational age, birth weight, postnatal age, severity of lung disease, and time after the administration of morphine and pancuronium were not significantly correlated with the change in FRC. We believe that a decrease in oxygenation caused by alveolar derecruitment occurred even though the ventilator settings had been increased before the first set of measurements. The decrease in FRC in these infants, who are thought to have alveolar instability because of surfactant deficiency, may have resulted from the loss of expiratory braking mechanisms. We conclude that analgesia and paralysis should be used with caution under these circumstances. C1 VANDERBILT UNIV,SCH MED,DEPT PEDIAT & PREVENT MED,NASHVILLE,TN 37212. CHALMERS UNIV TECHNOL,DEPT APPL ELECTR,S-41296 GOTHENBURG,SWEDEN. NR 29 TC 19 Z9 19 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0022-3476 J9 J PEDIATR JI J. Pediatr. PD JUL PY 1994 VL 125 IS 1 BP 97 EP 103 DI 10.1016/S0022-3476(94)70133-4 PG 7 WC Pediatrics SC Pediatrics GA NW317 UT WOS:A1994NW31700020 ER PT J AU THOMAREIS, O TRIANTAPHYLLIDIS, C GIALA, M AF THOMAREIS, O TRIANTAPHYLLIDIS, C GIALA, M TI PANCURONIUM EFFECT ON THE NEUROMUSCULAR FUNCTION OF HYPOGLYCEMIC RATS SO METHODS AND FINDINGS IN EXPERIMENTAL AND CLINICAL PHARMACOLOGY LA English DT Article DE HYPOGLYCEMIA; INSULIN; NEUROMUSCULAR JUNCTION; PANCURONIUM; RATS AB An unexpected response in a hypoglycemic patient to a muscle relaxant formed the basis for the research presented in this study. There was no information available in the accessible literature and references gave no data on this subject. Bur because perioperative hypoglycemia is not unusual, we scheduled this experimental work. Four groups of 6 white adult Wistar albino rats were used in the study. Group A was the normoglycemia control group, with blood glucoce levels of 80-120 mg/dl. Groups B, C and D were made hypoglycemic by i.v. injection of insulin 1 IU/100 g b.w. Blood glucose levels were reduced to 50% of the control values in hypoglycemic animals, which were sacrificed 40 min later. Phrenic nerve-hemidiaphragm preparations were placed in a 100 ml bath containing Paradelis-Zai-mis solution, 37 degrees C, pH 7.2, aerated with O-2/CO2:95/5%. After stabilization and recording of neuromuscular activity pancuronium bromide was administered in doses of 1.5 x 10(-9) M in groups A and B, 3 x 10(-9) M in group C and 5 x 10(-9) M in group D. Statistical analysis between A-B, A-C, A-D groups was done with Student's paired t test. Results showed that under hypoglycemic conditions the amount of pancuronium bromide needed for complete neuromuscular blockade was 2.5-fold greater than that needed in normoglycemic conditions. These findings suggest that the integrity of the neuromuscular junction is altered during hypoglycemia. C1 DEMOCRITUS UNIV THRACE,SCH MED,DEPT PHARMACOL,THRACE,GREECE. RP THOMAREIS, O (reprint author), ARISTOTELIAN UNIV THESSALONIKI,SCH MED,DEPT ANESTHESIOL,GR-54006 THESSALONIKI,GREECE. NR 11 TC 0 Z9 0 PU J R PROUS SA PI BARCELONA PA APARTADO DE CORREOS 540, PROVENZA 388, 08025 BARCELONA, SPAIN SN 0379-0355 J9 METHOD FIND EXP CLIN JI Methods Find. Exp. Clin. Pharmacol. PD JUL-AUG PY 1994 VL 16 IS 6 BP 413 EP 417 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA PK632 UT WOS:A1994PK63200006 ER PT J AU SANDKER, GW WEERT, B OLINGA, P WOLTERS, H SLOOFF, MJH MEIJER, DKF GROOTHUIS, GMM AF SANDKER, GW WEERT, B OLINGA, P WOLTERS, H SLOOFF, MJH MEIJER, DKF GROOTHUIS, GMM TI CHARACTERIZATION OF TRANSPORT IN ISOLATED HUMAN HEPATOCYTES - A STUDY WITH THE BILE-ACID TAUROCHOLIC ACID, THE UNCHARGED OUABAIN AND THE ORGANIC CATIONS VECURONIUM AND ROCURONIUM SO BIOCHEMICAL PHARMACOLOGY LA English DT Article DE HUMAN HEPATOCYTES; DRUG TRANSPORT; IN VITRO IN VIVO CORRELATION; INTERSPECIES DIFFERENCES; PLASMA MEMBRANE VESICLES; SODIUM DEPENDENCY ID ISOLATED RAT HEPATOCYTES; CARRIER-MEDIATED TRANSPORT; PLASMA-MEMBRANE VESICLES; NEUROMUSCULAR BLOCKING; ANESTHETIZED PATIENTS; HEPATIC TRANSPORT; DRUG TRANSPORT; UPTAKE SYSTEM; LIVER-CELLS; NA+ AB The uptake and efflux of three categories of substrates were measured in isolated human hepatocytes and compared to those in rat hepatocytes. In addition, the extent to which the in vitro experiments quantitatively reflect liver function in vivo in both species was investigated. The anionic bile acid taurocholic acid was taken up by isolated human hepatocytes at a considerably lower rate than observed in isolated rat hepatocytes. Taurocholic acid uptake both in human hepatocytes and in liver plasma membrane vesicles showed sodium dependency. The uptake rate of taurocholic acid in isolated hepatocytes of both species was quantitatively compatible with the reported liver clearance of the bile acid in vivo. Ouabain uptake rate in isolated human hepatocytes was lower than in rat hepatocytes. This species difference was in accordance with pharmacokinetic studies in vivo on hepatic clearance of ouabain in man and rat. Uptake of vecuronium into human hepatocytes was about a factor of 10 lower than that in rat hepatocytes. Uptake into and efflux from human hepatocytes was comparable for the two short acting muscle relaxants vecuronium and rocuronium. Since distribution to the liver is considered to be a major factor in termination of action of vecuronium and rocuronium these observations were in line with the human pharmacokinetic profiles. In conclusion, the uptake rate of the studied model compounds in human hepatocytes appeared to be lower than that in rat hepatocytes. These observed transport rates reflected the relative hepatic transport rates observed in these species in the intact organism, but the absolute Values in both species for some substrates may have been somewhat lower than calculated from in vivo data. It is concluded that transport studies in isolated hepatocytes are suitable for comparative drug transport studies, but are less precise in the prediction of quantitative membrane transport. C1 UNIV GRONINGEN,CTR PHARM,DEPT PHARMACOL & THERAPEUT,9713 AW GRONINGEN,NETHERLANDS. UNIV GRONINGEN,CTR PHARM,DEPT PEDIAT,9713 AW GRONINGEN,NETHERLANDS. UNIV GRONINGEN,CTR PHARM,DEPT SURG,9713 AW GRONINGEN,NETHERLANDS. NR 47 TC 57 Z9 58 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 0006-2952 J9 BIOCHEM PHARMACOL JI Biochem. Pharmacol. PD JUN 15 PY 1994 VL 47 IS 12 BP 2193 EP 2200 DI 10.1016/0006-2952(94)90255-0 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA NU164 UT WOS:A1994NU16400010 ER PT J AU CAMPKIN, NTA HOOD, JR FELDMAN, SA AF CAMPKIN, NTA HOOD, JR FELDMAN, SA TI RECOVERY OF MIVACURIUM AND DOXACURIUM VERSUS VECURONIUM IN THE ISOLATED FOREARM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, MIVACURIUM, DOXACURIUM, VECURONIUM ID ANESTHESIA C1 CHELSEA & WESTMINSTER HOSP,DEPT ANAESTHET,LONDON SW10 9NH,ENGLAND. RP CAMPKIN, NTA (reprint author), ROYAL HAMPSHIRE CTY HOSP,DEPT ANAESTHET,ROMSEY RD,WINCHESTER,HANTS,ENGLAND. NR 9 TC 3 Z9 3 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUN PY 1994 VL 49 IS 6 BP 501 EP 502 DI 10.1111/j.1365-2044.1994.tb03520.x PG 2 WC Anesthesiology SC Anesthesiology GA NQ328 UT WOS:A1994NQ32800007 ER PT J AU KHUENLBRADY, KS REITSTATTER, B SCHLAGER, A SCHREITHOFER, D LUGER, T SEYR, M MUTZ, N AGOSTON, S AF KHUENLBRADY, KS REITSTATTER, B SCHLAGER, A SCHREITHOFER, D LUGER, T SEYR, M MUTZ, N AGOSTON, S TI LONG-TERM ADMINISTRATION OF PANCURONIUM AND PIPECURONIUM IN THE INTENSIVE-CARE UNIT SO ANESTHESIA AND ANALGESIA LA English DT Article ID CRITICALLY ILL PATIENTS; PROLONGED NEUROMUSCULAR BLOCKADE; VECURONIUM BROMIDE; STATUS-ASTHMATICUS; WEAKNESS; INFUSION; ATROPHY; POLYNEUROPATHY; PARALYSIS; FAILURE AB This study was performed to determine the optimum dose of pancuronium (n = 30) and pipecuronium (n = 30) under continuous sedation and analgesia in the intensive care unit (ICU). This was an open clinical investigation in 60 critically ill patients with head injury, multiple trauma (in some complicated with sepsis and multi-organ failure), requiring neuromuscular block for ventilation for at least 48 h. Emphasis was placed on the neuromuscular monitoring with a peripheral nerve stimulator and adequate sedation and analgesia. Satisfactory block was achieved in all cases with an average dose of 3 mg/h with either compound. None of the patients experienced prolonged paralysis, muscle weakness, or other neuromuscular dysfunctions in the postventilatory period. We suggest that adequate use of sedative hypnotics and opioids plus neuromuscular monitoring allowed us to optimize the dose of muscle relaxants according to the need of individual patients. C1 UNIV GRONINGEN, CLIN PHARMACOL & EXPTL ANAESTHESIA RES GRP, GRONINGEN, NETHERLANDS. RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK, ANAESTHESIA & GEN INTENS CARE MED CLIN, ANICHSTR 35, A-6020 INNSBRUCK, AUSTRIA. NR 21 TC 28 Z9 29 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 1994 VL 78 IS 6 BP 1082 EP 1086 PG 5 WC Anesthesiology SC Anesthesiology GA NN595 UT WOS:A1994NN59500008 ER PT J AU KHALIL, M DHONNEUR, G DUVALDESTIN, P SLAVOV, V DEHYS, C GOMENI, R AF KHALIL, M DHONNEUR, G DUVALDESTIN, P SLAVOV, V DEHYS, C GOMENI, R TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ROCURONIUM IN PATIENTS WITH CIRRHOSIS SO ANESTHESIOLOGY LA English DT Article DE COMPLICATIONS, CIRRHOSIS; LIVER, FAILURE; NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACODYNAMICS, ROCURONIUM; PHARMACOKINETICS, ROCURONIUM ID TUBOCURARINE; VECURONIUM; ORG-9426; PANCURONIUM; AGENT AB Background: Rocuronium, like other steroidal nondepolarizing muscle relaxants, 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 rocuronium in patients with cirrhosis. Methods: Eighteen patients undergoing elective surgery, 10 with cirrhosis and 8 with normal liver function, were studied. Anesthesia was induced with intravenous thiopental 5-7 mg . kg(-1) and maintained with 60% nitrous oxide in oxygen and repeated doses of fentanyl 2 mu g . kg(-1). The force of thumb adduction in response to supramaximal ulnar nerve stimulation was monitored and recorded. An intravenous bolus of rocuronium 0.6 mg . kg(-1) was administered and venous blood sampled at frequent intervals for 6 h. Plasma concentrations of rocuronium was measured by high-pressure liquid chromatography. Data were fitted to both a pharmacokinetic and a pharmacodynamic model by using a two-compartment open model and an effect compartment model. Data were analyzed by least-squares regression. Results: The onset of neuromuscular blockade was longer (P < 0.01) in patients with cirrhosis (158 +/- 56 s) than in normal patients (108 +/- 33 s). Recovery of the thumb twitch to 75 and 90% of its control value was 77 +/- 25 and 88 +/- 23 min in cirrhotic patients versus 57 +/- 11 and 64 +/- 13 min, respectively, in normal patients (P < 0.05). The central volume of distribution of rocuronium was 104 +/- 21 in cirrhotic patients and 78 +/- 24 ml . kg(-1) in normal patients (P < 0.05). No significant difference in elimination kinetics was observed between the two groups. The elimination half-life was 87.5 +/- 17.5 min in normal patients and 96.0 +/- 36.8 min in cirrhotic patients (difference not significant). This increased onset time was linearly correlated to the increased central volume of distribution of rocuronium in cirrhosis. Conclusion: Rocuronium onset time is longer in cirrhotic patients than in those with normal liver function; this can be explained by an increase in the volume in which rocuronium initially distributes. Although elimination kinetics are unchanged in patients with cirrhosis, rocuronium recovery time is prolonged in cirrhotic patients. C1 HOP HENRI MONDOR,DEPT ANESTHESIOL,SERV ANESTHESIE REANIMAT,F-94010 CRETEIL,FRANCE. NR 17 TC 43 Z9 51 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUN PY 1994 VL 80 IS 6 BP 1241 EP 1247 DI 10.1097/00000542-199406000-00011 PG 7 WC Anesthesiology SC Anesthesiology GA NR926 UT WOS:A1994NR92600010 ER PT J AU LIEN, CA SCHMITH, VD EMBREE, PB BELMONT, MR WARGIN, WA SAVARESE, JJ AF LIEN, CA SCHMITH, VD EMBREE, PB BELMONT, MR WARGIN, WA SAVARESE, JJ TI THE PHARMACOKINETICS AND PHARMACODYNAMICS OF THE STEREOISOMERS OF MIVACURIUM IN PATIENTS RECEIVING NITROUS OXIDE/OPIOID/BARBITURATE ANESTHESIA SO ANESTHESIOLOGY LA English DT Article DE PHARMACODYNAMICS, NEUROMUSCULAR RELAXANTS, MIVACURIUM; PHARMACOKINETICS, STEREOISOMERS ID CHLORIDE BW B1090U; RENAL-FAILURE; ATRACURIUM; VECURONIUM; PHARMACOLOGY AB Background: Mivacurium consists of a mixture of three stereoisomers: cis-trans (34-40%), trans-trans (52-60%), and cis-cis (4-8%). These isomers differ in potency (the trans-traits and the cis-transisomers are equipotent and the cis-cis isomer is 1/13th as potent a neuromuscular blocking agent) and in rates of in vitro hydrolysis (in vitro half-lives are less than 2 min for the cis-trans and trans-trans isomers and 276 min for the cis-cis isomer). The current study was undertaken to determine the pharmacokinetic profile of the individual stereoisomers of mivacurium, to evaluate the dose-proportionality of the more potent trails-trans and cis-trans isomers, and to evaluate the pharmacodynamics of mivacurium in healthy adult patients receiving a consecutive two-step infusion of mivacurium. Methods: Eighteen ASA physical status 1 or 2 adult male patients undergoing elective surgery under nitrous oxide/oxygen/fentanyl anesthesia were studied. Neuromuscular function was monitored using a mechanomyograph at a frequency of 0.15 Hz. An infusion of mivacurium was begun at 5 mu g . kg(-1) . min(-1). Sixty minutes later, the infusion rate was doubled to 10 mu g . kg(-1) . min(-1), and, 60 min after that, the infusion was discontinued. All patients were allowed to recover spontaneously from mivacurium-induced neuromuscular block. Venous blood samples were drawn for the determination of the plasma concentrations of each isomer of mivacurium by a stereospecific high performance liquid chromatographic method. Pharmacokinetic parameters were determined using noncompartmental analysis. Results: During the 5-mu g . kg(-1) . min(-1) Infusion, patients developed 83.2 +/- 13.6% neuromuscular block. Increasing the infusion to 10 mu g . kg(-1) . min(-1) increased the depth of block to 99.0 +/- 2.0% After discontinuation of the infusion, patients returned to 25% of their baseline muscle strength in 9.3 +/- 3.7 min and had 25-75% and 5-95% recovery indexes of 7.2 +/- 1.8 and 16.8 +/- 3.7 min, respectively. The volumes of distribution (V-beta) of the cis-trans, trails-trans, and cis-cis isomers were 0.29 +/- 0.24, 0.15 +/- 0.05, and 0.34 +/- 0.08 l/kg, respectively. During the 5-mu g . kg(-1) . min(-1) infusion, the steady-state clearances of the potent cis-trans and trans-trans isomers were 106 +/- 67 and 63 +/- 34 ml . min(-1) . kg(-1), respectively; the clearance of the less potent cis-cis isomer was 4.6 +/- 1.1 ml . min(-1) . kg(-1). The elimination half-lives of the cis-trans and trans-trans isomers were 1.8 +/- 1.1 and 1.9 +/- 0.7 min, respectively, and that of the cis-cis isomer was 52.9 +/- 19.8 min. Clearance of the cis-trans and trans-trans isomers did not vary with infusion rate. Conclusions: The short elimination half-lives and high metabolic clearances of the potent cis-trans and trans-trans isomers are consistent with the short duration of action of mivacurium. The cis-cis isomer does not appear to produce significant neuromuscular block as evident by the return of twitch height to baseline despite persistent cis-cis isomer concentrations. RP LIEN, CA (reprint author), CORNELL UNIV,MED CTR,NEW YORK HOSP,525 E 68TH ST,NEW YORK,NY 10021, USA. NR 14 TC 65 Z9 66 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUN PY 1994 VL 80 IS 6 BP 1296 EP 1302 DI 10.1097/00000542-199406000-00017 PG 7 WC Anesthesiology SC Anesthesiology GA NR926 UT WOS:A1994NR92600016 ER PT J AU ABDULATIF, M HEGAZY, M AF ABDULATIF, M HEGAZY, M TI THENAR MUSCLE BLOOD-FLOW AND NEUROMUSCULAR EFFECTS OF VECURONIUM IN PATIENTS RECEIVING BALANCED OR ISOFLURANE ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHETICS, VOLATILE, ISOFLURANE; NEUROMUSCULAR BLOCK, VECURONIUM; MEASUREMENT TECHNIQUES, FLOWMETRY ID HALOTHANE ANESTHESIA; LARYNGEAL MASK; TISSUE; PANCURONIUM; RESPONSES AB We have tested the hypothesis that isoflurane potentiates non-depolarizing neuromuscular block via an increase in muscle blood flow. Anaesthesia was induced with thiopentone 4-5 mg kg(-1) in 30 adult male patients of ASA physical status I or II and was maintained with 70% nitrous oxide in oxygen supplemented with either a bolus dose of fentanyl 4 mu g kg(-1) followed by an infusion of 1 mu g kg(-1) h(-1) (balanced anaesthesia group, n = 15) or 1.1% end-tidal isoflurane (isoflurane group, n = 15). Vecuronium 0.1 mg kg(-1) was given for neuromuscular block. The force of contraction of the adductor pollicis of the thumb in response to ulnar nerve stimulation was recorded. Thenar muscle blood flow was measured continuously with a laser Doppler flowmeter. Times required for the first twitch in the train-of-four (TI) to recover to 25%, 75% and 90% of its control value were mean 26.3 (SD 5), 35.3 (10), 43.5 (7) min and 39.2 (15), 53 (12.5), 61.2 (10) min in the balanced anaesthesia and isoflurane groups, respectively (P < 0.01). Recovery index (time between TI 25% and 75%) was prolonged significantly in the isoflurane group. Administration of thiopentone significantly increased thenar muscle blood flow from 2.6 (1.9) and 2.2 (1.5) ml min(-1)/100 g to 19.2 (14) and 21.7 (16) ml min(-1)/100 g in the balanced anaesthesia and isoflurane groups, respectively (P < 0.001). The addition of fentanyl (balanced) or isoflurane to the anaesthetic mixture produced further increases in thenar muscle blood flow to reach, respectively, 26.2 (16) and 26.8 (13.6) ml min(-1)/100 g during steady state anaesthesia. Thenar muscle blood flow was comparable in she two groups throughout the study. We conclude that isoflurane prolonged vecuronium-induced neuromuscular block. This prolongation was not related primarily to increase in muscle blood flow. C1 CAIRO UNIV,FAC MED,DEPT ANAESTHESIA,CAIRO,EGYPT. KING FAISAL UNIV,FAC MED,DEPT PLAST SURG,DAMMAM,SAUDI ARABIA. NR 18 TC 4 Z9 4 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 JUN PY 1994 VL 72 IS 6 BP 650 EP 653 DI 10.1093/bja/72.6.650 PG 4 WC Anesthesiology SC Anesthesiology GA NR734 UT WOS:A1994NR73400008 ER PT J AU YONEDA, I GOTO, H NISHIZAWA, M UNRUH, GK ARAKAWA, K AF YONEDA, I GOTO, H NISHIZAWA, M UNRUH, GK ARAKAWA, K TI EFFECT OF ATRACURIUM, VECURONIUM, PANCURONIUM AND TUBOCURARINE ON RENAL SYMPATHETIC-NERVE ACTIVITY IN BARORECEPTOR DENERVATED DOGS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, ATRACURIUM; NEUROMUSCULAR BLOCK, TUBOCURARINE; NEUROMUSCULAR BLOCK, PANCURONIUM; NEUROMUSCULAR BLOCK, VECURONIUM; SYMPATHETIC NERVOUS SYSTEM; DOG ID CLINICAL-PHARMACOLOGY AB The mechanism of arterial hypotension induced by non-depolarizing neuromuscular blocking agents may be multifactorial and differ between drugs. The purpose of this study was to evaluate the effect of high-dose atracuricum and equivalent doses of other non-depolarizing neuromuscular blocking agents on haemodynamic state and sympathetic nervous activity. In studies on 24 mongrel dogs anaesthetized with alpha-chloralose, the left kidney was exposed retreperitoneally and renal sympathetic nerve activity was recorded continuously after bilateral sine-aortic denervation and cervical vagi section. The dogs were allocated to four groups, atracurium 1.5 mg kg(-1), tubocurarine 0.3 mg kg(-1), pancuronium 0.3 mg kg(-1) or vecuronium 0.3 mg kg(-1) was administered to six dogs in each group. Histamine 1 mu g kg(-1) was given to two dogs in each group, 1 h before administration of neuromuscular blocking agents. We observed that atracurium and tubocurarine significantly decreased arterial pressure, heart rate and renal sympathetic nerve activity (P < 0.05), but pancuronium and vecuronium did not Histamine-induced arterial hypotension but did not affect heart rate or renal sympathetic nerve activity. As both arterial and cardiopulmonary baroreflex pathways were inactivated in these animals, we conclude that atracurium decreased arterial pressure by suppressing efferent sympathetic nerve activity in a manner similar to that of tubocurarine. C1 UNIV KANSAS,MED CTR,DEPT ANESTHESIOL,KANSAS CITY,KS 66160. NR 14 TC 4 Z9 4 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 JUN PY 1994 VL 72 IS 6 BP 679 EP 682 DI 10.1093/bja/72.6.679 PG 4 WC Anesthesiology SC Anesthesiology GA NR734 UT WOS:A1994NR73400014 ER PT J AU NEIDHART, PP CHAMPION, P VOGEL, J ZSIGMOND, EK TASSONYI, E AF NEIDHART, PP CHAMPION, P VOGEL, J ZSIGMOND, EK TASSONYI, E TI A COMPARISON OF PIPECURONIUM WITH PANCURONIUM ON HEMODYNAMIC VARIABLES AND PLASMA-CATECHOLAMINES IN CORONARY-ARTERY BYPASS PATIENTS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHESIA, CARDIAC; HEART, STIMULATION, ISCHEMIA; NEUROMUSCULAR RELAXANTS, PANCURONIUM, PIPECURONIUM; SYMPATHETIC NERVOUS SYSTEM, ANESTHESIA ID DOSE FENTANYL ANESTHESIA; LIQUID-CHROMATOGRAPHY; NEURONAL UPTAKE; NOREPINEPHRINE; INTUBATION; BROMIDE; PHARMACOKINETICS; NORADRENALINE; RAT AB Pipecuronium bromide, a new neuromuscular relaxant with steroidal structure, is devoid of effects on the autonomic nervous system and may be useful in patients where haemodynamic stability is mandatory. However, tracheal intubation may alter this haemodynamic profile. Therefore, we carried out a prospective double-blind study in 30 patients undergoing coronary artery bypass surgery with the purpose (1) of determining if intubation influenced the haemodynamic stability in patients paralyzed with pipecuronium and (2) of comparing plasma catecholamine concentrations after pipecuronium with those after pancuronium. Thirty patients were randomized into two groups receiving either pipecuronium 100 mu g . kg(-1) or pancuronium 150 mu g . kg(-1) after induction of anaesthesia with midazolam and fentanyl. Haemodynamic variables and plasma catecholamines were measured before and after induction, after the muscle relaxant three times and twice after intubation. After anaesthesia induction decreases in heart rate (HR), mean arterial pressure (MAP) and cardiac index (CI) were observed in both groups. These haemodynamic variables were unchanged C1 UNIV ILLINOIS,DEPT ANESTHESIOL,CHICAGO,IL. RP NEIDHART, PP (reprint author), UNIV HOSP GENEVA,DEPT ANAESTHESIOL,24 RUE MICHELI DU CREST,CH-1211 GENEVA 14,SWITZERLAND. NR 26 TC 8 Z9 9 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUN PY 1994 VL 41 IS 6 BP 469 EP 474 PG 6 WC Anesthesiology SC Anesthesiology GA NT246 UT WOS:A1994NT24600003 ER PT J AU NISHIZAWA, M GOTO, H OTAGIRI, T NAKAJIMA, K HARASHIMA, N SAKAKI, J AF NISHIZAWA, M GOTO, H OTAGIRI, T NAKAJIMA, K HARASHIMA, N SAKAKI, J TI EFFECT OF PRIOR ADMINISTRATION OF SUCCINYLCHOLINE ON DURATION OF ACTION OF VECURONIUM DURING ENFLURANE ANESTHESIA SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHETICS, ENFLURANE; MUSCLE RELAXANTS; DURATION OF ACTION; SUCCINYLCHOLINE, VECURONIUM ID INDUCED NEUROMUSCULAR BLOCKADE; PANCURONIUM; SUXAMETHONIUM; ATRACURIUM AB The effects of succinylcholine, which,vas given to facilitate tracheal intubation on the duration of action of subsequently administered vecuronium bromide, were evaluated in 54 adult patients who underwent abdominal surgeries under enflurane anaesthesia. The electromyographic response to train-of-four ulnar nerve stimulation was measured. Twenty-seven patients received 1 mg.kg(-1) of succinylcholine, followed by 0.15 mg.kg(-1) of vecuronium when the electromyographic response recovered to 50% of control after succinylcholine-induced neuromuscular blockade. The other 27 patients served as the control group, receiving 0.15 mg.kg(-1) of vecuronium without prior administration of succinylcholine. In both groups, administration of supplemental 0.04 mg.kg(-1) of vecuronium was repeated whenever the electromyographic response recovered to 25% of control during surgical procedures. The duration of blockade induced by the initial 0.15 mg.kg(-1) of vecuronium was 56.5 +/- 12.8 (mean +/- s.d.) min for the group with succinylcholine, and 58.5 +/- 21.5 min for the control group. In both groups, the average duration of four consecutive supplemental doses of vecuronium was approximately 35 min. No significant differences between groups were found in the duration of neuromuscular blockade induced by initial and supplemental doses of vecuronium. C1 SHINSHU UNIV,SCH MED,DEPT ANAESTHESIOL,MATSUMOTO,NAGANO 390,JAPAN. RP NISHIZAWA, M (reprint author), UNIV KANSAS,MED CTR,DEPT ANAESTHESIOL,3901 RAINBOW BLVD,KANSAS CITY,KS 66160, USA. NR 20 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 MAY PY 1994 VL 38 IS 4 BP 380 EP 383 PG 4 WC Anesthesiology SC Anesthesiology GA NN580 UT WOS:A1994NN58000014 ER PT J AU DOENICKE, A MOSS, J LORENZ, W HOERNECKE, R GOTTARDIS, M AF DOENICKE, A MOSS, J LORENZ, W HOERNECKE, R GOTTARDIS, M TI ARE HYPOTENSION AND RASH AFTER ATRACURIUM REALLY CAUSED BY HISTAMINE-RELEASE SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANTIHISTAMINES; ANTAGONISTS; ANESTHESIA; INHIBITION; H-1 AB A prospective, randomized, double-blind study was performed in 40 patients (ASA class I-III) treated with atracurium to ascertain whether histamine release caused hemodynamic or cutaneous changes. The treated group of 20 patients was premedicated with the H-1 antagonist dimetindene (0.2 mg/kg) and the H-2 antagonist ranitidine (1.25 mg/kg); the control group of 20 patients received saline. Six minutes after the induction of anesthesia with thiopental/fentanyl, patients received atracurium 0.5 mg/kg over 5 s. Plasma histamine levels were measured fluorometrically 5 min after administration of thiopental/fentanyl and 2 and 5 min after atracurium. Arterial blood pressure and heart rate were recorded every 2 min. Histamine levels (0.24 ng/mL) did not change significantly after thiopental/fentanyl. In the control group, 2 min after injection of atracurium, plasma histamine levels were 0.76 +/- 0.76 ng/mL, and in the antihistamine-treated group, 0.39 +/- 0.24 ng/mL (P < 0.05 control Versus treated), suggesting that pretreatment with antihistamines may attenuate atracurium-induced histamine release. Systolic and diastolic blood pressure decreased significantly in both groups after thiopental (P < 0.05), but did not decrease further after the administration of atracurium. There were cutaneous manifestations in 7 of 20 patients in the control group and in none of the 20 patients treated with H-1 and H-2 antagonists (P < 0.0005). We conclude that atracurium caused modest histamine release in our patients but that the decrease in arterial blood pressure may have been due, in part, to thiopental. Cutaneous manifestations of histamine release did not correlate with hemodynamic events or with plasma histamine levels, but were prevented with antihistamine pretreatment. C1 UNIV CHICAGO,DEPT ANESTHESIA & CRIT CARE,CHICAGO,IL 60637. UNIV MUNICH,INST ANESTHESIOL,MUNICH,GERMANY. UNIV MARBURG,INST THEORET SURG,W-3550 MARBURG,GERMANY. NR 19 TC 23 Z9 24 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 1994 VL 78 IS 5 BP 967 EP 972 PG 6 WC Anesthesiology SC Anesthesiology GA NJ087 UT WOS:A1994NJ08700023 ER PT J AU HEIER, T CALDWELL, JE SHARMA, ML GRUENKE, LD MILLER, RD AF HEIER, T CALDWELL, JE SHARMA, ML GRUENKE, LD MILLER, RD TI MILD INTRAOPERATIVE HYPOTHERMIA DOES NOT CHANGE THE PHARMACODYNAMICS (CONCENTRATION-EFFECT RELATIONSHIP) OF VECURONIUM IN HUMANS SO ANESTHESIA AND ANALGESIA LA English DT Article ID NITROUS-OXIDE ISOFLURANE; POLLICIS TWITCH TENSION; D-TUBOCURARINE; PHARMACOKINETICS; PANCURONIUM; ANESTHESIA; TEMPERATURE; SURFACE; SKIN; CAT AB To investigate the effect of mild hypothermia on the neuromuscular junction sensitivity to vecuronium, we determined the pharmacodynamics (concentration-effect relationship) of vecuronium in 10 patients (ASA physical class I or II; age range, 21-46 yr; weight range, 54-104 kg), during isoflurane-nitrous oxide-fentanyl anesthesia. Five were cooled to a mean temperature of 34.4 degrees C and five were maintained normothermic at a mean temperature of 36.8 degrees C. Neuromuscular function was monitored by measuring the evoked mechanical response of the adductor pollicis muscle after supramaximal train-of-four stimulation of the ulnar nerve at the wrist. Vecuronium, 3 mu g.kg(-1) min(-1), was infused for 10 min, venous blood sampled for 60 min, and twitch tension and plasma concentration data were used to determine pharmacodynamic variables in each patient. Results for the hypothermic and normothermic groups were compared by Mann-Whitney U-test. There were no differences in any pharmacodynamic variable between the hypothermic and normothermic patients. For the hypothermic and normothermic patients, respectively, steady-state plasma concentrations of vecuronium producing 50% neuromuscular block (C-ss50) were 73 +/- 13 ng/mL (mean +/- SD) and 79 +/- 31 ng/mL; the rate constants for equilibration of vecuronium between the plasma and the neuromuscular junction (K-eo) were 0.27 +/- 0.14 per min(-1) and 0.26 +/- 0.11 per min, and the power functions representing the slope of the concentration-effect relationship (gamma) were 5.7 +/- 1.9 and 4.4 +/- 1.8. We conclude that the pharmacodynamics (concentration-effect relationship) of vecuronium are similar at 34.4 and 36.8 degrees C and that pharmacodynamic factors do not explain the prolongation of action of vecuronium previously observed during mild hypothermia. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 16 TC 20 Z9 25 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 1994 VL 78 IS 5 BP 973 EP 977 PG 5 WC Anesthesiology SC Anesthesiology GA NJ087 UT WOS:A1994NJ08700024 ER PT J AU HILDEBRAND, SV HILL, T AF HILDEBRAND, SV HILL, T TI INTERACTION OF GENTAMICIN AND ATRACURIUM IN ANESTHETIZED HORSES SO EQUINE VETERINARY JOURNAL LA English DT Article DE HORSE; ANESTHESIA; MUSCLE RELAXANTS; ANTIBIOTICS ID HALOTHANE-ANESTHETIZED HORSES; ANTIBIOTICS; ANESTHESIA; GENTAMICIN; AMINOGLYCOSIDE AB Evoked hind limb digital extensor tension (hoof twitch) was maintained at 40% of baseline for 1 h by atracurium infusion in 7 horses anaesthetised with halothane. After 1 h, atracurium was discontinued and hoof twitch allowed to recover to 75%. Atracurium was again given by infusion to maintain 40% twitch for a second hour, then 2 mg gentamycin/kg bwt were given i.v. Atracurium infusion was continued for a third hour, and then hoof twitch was again allowed to recover spontaneously to 75%. Gentamycin reduced twitch strength from 40 +/- 1 % (mean +/- sem) to 29 +/- 4% within 7.0 +/- 1.5 min (P = 0.02). Twitch gradually returned to pre-gentamycin strength over the course of the next hour. Recovery of hoof twitch from 50% to 75% took 7.7 +/- 0.7 min for atracurium alone and 11.5 +/- 2.7 min for atracurium plus gentamycin (P = 0.03). Recovery from 50% twitch to 75% fade recovery took 13.8 +/- 0.8 min for atracurium alone and 13.7 +/- 1.2 min for atracurium plus gentamycin. At 75% recovery of fade, hoof twitch was 87 +/- 3% for atracurium alone and 82 +/- 4% for atracurium plus gentamycin. Reversal of the block with edrophonium and subsequent recovery of the horses from anaesthesia were uneventful. It was concluded that, although gentamycin did augment the neuromuscular blockade of atracurium, the effect was minimal. RP HILDEBRAND, SV (reprint author), UNIV CALIF DAVIS,SCH VET MED,DEPT SURG,DAVIS,CA 95616, USA. NR 17 TC 7 Z9 7 PU EQUINE VETERINARY JOURNAL LTD PI NEWMARKET PA GRASEBY HOUSE, ENXING ROAD, NEWMARKET, SUFFOLK, ENGLAND CB8 0AU SN 0425-1644 J9 EQUINE VET J JI Equine Vet. J. PD MAY PY 1994 VL 26 IS 3 BP 209 EP 211 PG 3 WC Veterinary Sciences SC Veterinary Sciences GA NJ011 UT WOS:A1994NJ01100009 ER PT J AU FAN, SZ SUSETIO, L TSAI, MC AF FAN, SZ SUSETIO, L TSAI, MC TI NEUROMUSCULAR BLOCKADE OF THE FETUS WITH PANCURONIUM OR PIPECURONIUM FOR INTRAUTERINE PROCEDURES SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, PANCURONIUM, PIPECURONIUM; INTRAUTERINE INSTRUMENTATION, FETAL THERAPY ID ACETYLCHOLINE-RECEPTORS; JUNCTION C1 NATL TAIWAN UNIV,COLL MED,DEPT PHARMACOL,TAIPEI 10018,TAIWAN. RP FAN, SZ (reprint author), NATL TAIWAN UNIV HOSP,DEPT ANESTHESIOL,7 CHUNG SHAN S RD,TAIPEI 10016,TAIWAN. NR 14 TC 3 Z9 5 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD APR PY 1994 VL 49 IS 4 BP 284 EP 286 DI 10.1111/j.1365-2044.1994.tb14174.x PG 3 WC Anesthesiology SC Anesthesiology GA NH709 UT WOS:A1994NH70900002 ER PT J AU INMAN, SR STOWE, NT ALBANESE, J MEEHAN, M RYCKMAN, J ZANETTIN, GG SCHUBERT, A KHAIRALLAH, PA AF INMAN, SR STOWE, NT ALBANESE, J MEEHAN, M RYCKMAN, J ZANETTIN, GG SCHUBERT, A KHAIRALLAH, PA TI CONTRASTING EFFECTS OF VECURONIUM AND SUCCINYLCHOLINE ON THE RENAL MICROCIRCULATION IN RODENTS SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKING; MUSCLE-RELAXANTS; ANESTHETIZED CAT; RAT AB We assessed the effects of succinylcholine and vecuronium on renal function and on the renal microcirculation in a rodent model. Vecuronium (0.02 mg/kg followed by 0.2 mg.kg-1-h-1) caused a significant decrease of 16.1% +/- 3.87% in inulin clearance from 0.92 +/- 0.07 to 0.71 +/- 0.05 mL.min-1.gKW-1 (gram of kidney weight), and a decrease in paraaminohippuric acid clearance by 21.6% +/- 4.69% from 1.58 +/- 0.26 to 1.31 +/-0.20 mL.min-1.gKW-1 (P < 0.05), whereas succinylcholine (0.45 mg/kg followed by 2 mg.kg-1.h-1) altered neither. The effect of these muscle relaxants was also determined on the renal microcirculation in separate experiments using videomicroscopy. Succinylcholine (n = 10; 10(-10) to 10(-6) M) and its parent compound, acetylcholine (n = 10, 10(-10) to 10(-6) M) used as a control, caused a significant vasodilation from baseline diameter in the interlobular, afferent, and efferent arterioles. The vasodilation caused by succinylcholine was significantly less than that observed with acetylcholine. Atropine blocked the response to succinylcholine, indicating the latter has a muscarinic effect. In contrast, vecuronium caused a significant, selective vasoconstriction from baseline diameter in the preglomerular vessels, but not in the postglomerular vessels. The vasoconstriction caused by vecuronium was significantly different than the vasodilation caused by succinylcholine. The preglomerular vasoconstriction observed with vecuronium may contribute to the decrease in renal plasma flow and glomerular filtration rate observed experimentally. The choice of a neuromuscular blocking drug can therefore have the potential to influence renal function by altering the renal microcirculation. C1 CLEVELAND CLIN EDUC FDN,DEPT HYPERTENS,DIV ANESTHESIOL,CLEVELAND,OH 44106. CLEVELAND CLIN EDUC FDN,DEPT UROL,DIV ANESTHESIOL,CLEVELAND,OH 44106. RP INMAN, SR (reprint author), CLEVELAND CLIN FDN,DEPT NEPHROL,DIV ANESTHESIOL,9500 EUCLID AVE,CLEVELAND,OH 44195, USA. RI Schubert, Armin/D-3589-2011 NR 24 TC 4 Z9 4 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1994 VL 78 IS 4 BP 682 EP 686 PG 5 WC Anesthesiology SC Anesthesiology GA ND582 UT WOS:A1994ND58200011 ER PT J AU OLKKOLA, KT TAMMISTO, T AF OLKKOLA, KT TAMMISTO, T TI QUANTIFYING THE INTERACTION OF ROCURONIUM (ORG-9426) WITH ETOMIDATE, FENTANYL, MIDAZOLAM, PROPOFOL, THIOPENTAL, AND ISOFLURANE USING CLOSED-LOOP FEEDBACK-CONTROL OF ROCURONIUM INFUSION SO ANESTHESIA AND ANALGESIA LA English DT Article ID PANCURONIUM; ANESTHESIA; PHARMACOKINETICS; SUCCINYLCHOLINE; VECURONIUM; AGENTS; HUMANS; ONSET; TIME AB The present study was designed to evaluate the interactions of rocuronium with etomidate, fentanyl, midazolam, propofol, thiopental, and isoflurane using closed-loop feedback control of infusion of rocuronium. Sixty patients were randomly assigned to one of six sequences where anesthesia was maintained with etomidate, fentanyl, midazolam, propofol, or thiopental and nitrous oxide, or with isoflurane and nitrous oxide. The possible interaction of rocuronium with the anesthetics was quantified by determining the asymptotic steady-state rate of infusion (I(ss)) of rocuronium necessary to produce a constant 90% neuromuscular block. This was accomplished by applying nonlinear curve fitting to data on the cumulative dose requirement during the initial 90-min period after bolus administration of rocuronium. Patient characteristics and controller performance, i.e., the ability of the controller to maintain the neuromuscular block constant at the set-point, did not differ significantly between the groups. I(ss) values calculated per lean body mass were 0.64 +/- 0.22, 0.60 +/- 0.15, 0.61 +/- 0.21, 0.67 +/- 0.31, 0.63 +/- 0.15, and 0.39 +/- 0.17 mg.kg-1.h-1 in the etomidate, fentanyl, midazolam, propofol, thiopental, and isoflurane groups, respectively. The isoflurane group had a lower steady-state rate of infusion of rocuronium than the other five groups (P < 0.05). Compared to intravenous anesthetics, etomidate, fentanyl, midazolam, propofol, or thiopental, isoflurane reduced the infusion requirement of rocuronium by 35%-40%. RP OLKKOLA, KT (reprint author), UNIV HELSINKI,DEPT ANAESTHESIA,HAARTMANINKATU 4,SF-00290 HELSINKI 29,FINLAND. NR 23 TC 24 Z9 33 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1994 VL 78 IS 4 BP 691 EP 696 PG 6 WC Anesthesiology SC Anesthesiology GA ND582 UT WOS:A1994ND58200013 ER PT J AU PROSKA, J TUCEK, S AF PROSKA, J TUCEK, S TI MECHANISMS OF STERIC AND COOPERATIVE ACTIONS OF ALCURONIUM ON CARDIAC MUSCARINIC ACETYLCHOLINE-RECEPTORS SO MOLECULAR PHARMACOLOGY LA English DT Article ID NEUROMUSCULAR BLOCKING-DRUGS; ALLOSTERIC INTERACTION; RADIOLIGAND BINDING; GALLAMINE; INHIBITION; HETEROGENEITY; PANCURONIUM; PIRENZEPINE; SUBTYPES; SITES AB Kinetics of the interactions between the neuromuscular blocker alcuronium, the specific muscarinic antagonist N-[methyl-H-3] methyl scopolamine ([H-3]NMS), and muscarinic receptors were investigated in homogenates of rat heart atria. Two effects of alcuronium on the binding of [H-3]NMS could be distinguished. (a) Alcuronium concentration-dependently slowed the association of [H-3]NMS with receptors and the dissociation of [H-3]NMS from receptors so that, at high alcuronium concentrations, equilibrium binding could not be reached, even after 20 hr, without special precautions. (b) Alcuronium increased the affinity of receptors for [H-3]NMS, which was manifested by a decrease of the apparent K-d (>3-fold) With no change in the B-max for [H-3]NMS binding. The effects of alcuronium on the rates of [H-3]NMS association and dissociation can be explained only by a reaction mechanism in which [H-3]NMS binds only to free receptors (not occupied by alcuronium), whereas alcuronium binds both to free receptors and to receptors occupied by [H-3]NMS. Similarly, [H-3]NMS cannot dissociate from receptors as long as alcuronium is attached to them. Experimental data agree with corresponding mathematical models. It is proposed that alcuronium blocks entry to the pocket containing the [H-3]NMS binding site. In addition to this blocking effect, alcuronium has a positive allosteric effect on [H-3]NMS binding, presumably by inducing a conformational change of the orthosteric muscarinic binding site. Earlier observations suggesting that, at high concentrations, alcuronium also competes for [H-3]NMS binding sites can be explained by insufficient equilibration of the system. C1 ACAD SCI CZECH REPUBL,INST PHYSIOL,CR-14220 PRAGUE,CZECH REPUBLIC. RI Proska, Jan/C-5695-2009 NR 28 TC 92 Z9 94 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0026-895X J9 MOL PHARMACOL JI Mol. Pharmacol. PD APR PY 1994 VL 45 IS 4 BP 709 EP 717 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA NH460 UT WOS:A1994NH46000019 ER PT J AU DING, YF FREDMAN, B WHITE, PF AF DING, YF FREDMAN, B WHITE, PF TI USE OF MIVACURIUM DURING LAPAROSCOPIC SURGERY - EFFECT OF REVERSAL DRUGS ON POSTOPERATIVE RECOVERY SO ANESTHESIA AND ANALGESIA LA English DT Article ID PROPOFOL; NAUSEA AB We studied the influence of mivacurium on the recovery profile following outpatient laparoscopic tubal ligation in 60 healthy, nonpregnant women. After administration of midazolam 2 mg intravenously (IV), anesthesia was induced with fentanyl, 2 mu g/kg, and thiopental, 4 mg/kg, IV. When the patient became unresponsive (loss of eyelid reflex), either succinylcholine 1 mg/kg, IV (Group I), or mivacurium 0.2 mg/kg, IV (Groups II and III), was administered to facilitate tracheal intubation. Anesthesia was maintained with isoflurane (0.5%-2% inspired concentration) in combination with 67% N2O in oxygen. Muscle relaxation was maintained in all three groups with intermittent bolus doses of mivacurium, 2-4 mg, IV. In Group m, residual neuromuscular block was reversed with a combination of neostigmine, 2.5 mg, and glycopyrrolate, 0.5 mg, IV, at the end of the operation. In the postanesthesia care unit (PACU), patients in Group III had a significantly increased incidence of postoperative nausea and vomiting compared to Group II. The use of succinylcholine (versus mivacurium) was also associated with more frequent postoperative nausea and vomiting. However, these emetic sequelae did not delay postoperative recovery times. In addition, a comparable number of patients in each treatment group required analgesic medication for postoperative pain. Although patients who received succinylcholine complained of significantly more neck pain during the 24-h period after discharge, nausea, vomiting, and shoulder pain were similar in all three groups during this period. We conclude that neostigmine and glycopyrrolate may contribute to the development of postoperative emesis when used for reversal of residual neuromuscular block. The use of mivacurium without reversal drugs was associated with a decreased incidence of nausea and vomiting in the PACU. C1 UNIV TEXAS,SW MED CTR,DEPT ANESTHESIOL & PAIN MANAGEMENT,DALLAS,TX 75235. NR 15 TC 60 Z9 62 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1994 VL 78 IS 3 BP 450 EP 454 PG 5 WC Anesthesiology SC Anesthesiology GA NA403 UT WOS:A1994NA40300005 ER PT J AU FU, C MISHRA, Y RAMZAN, I AF FU, C MISHRA, Y RAMZAN, I TI OMEPRAZOLE POTENTIATES ATRACURIUM AND SUCCINYLCHOLINE PARALYSIS IN-VIVO IN RATS SO ANESTHESIA AND ANALGESIA LA English DT Article ID CESAREAN-SECTION; ASPIRATION; ANESTHESIA; RANITIDINE; CIMETIDINE; PH AB We examined the effect of proton pump inhibitor omeprazole on neuromuscular paralysis induced with either nondepolarizing or depolarizing neuromuscular blocking drugs in anesthetized and mechanically ventilated rats. Neuromuscular paralysis, as judged by tibialis anterior muscle twitch tension in response to sciatic nerve stimulation, was maintained at about 50% with intravenous (IV) bolus and infusion regimens of either atracurium or succinylcholine. Omeprazole, 0.5, 1, and 10 mg/kg IV, was then administered at 10-min intervals while the infusion of the neuromuscular blocker was continued. Omeprazole at all three doses increased the steady-state neuromuscular paralysis produced with either atracurium (preomeprazole versus final postomeprazole paralysis; mean +/- se, n = 6, 53.0% +/- 2.3% vs 80.0% +/- 5.3%) or succinylcholine (50.8% +/- 1.5% vs 86.4% +/-:5.1%). Omeprazole, 0.5, 1.0, and 10 mg/kg IV, given directly and without any neuromuscular blocker, produced approximately 5% depression of the muscle twitch response. Omeprazole, IV at human therapeutic doses, alters neuromuscular function and enhances the action of both atracurium and succinylcholine in vivo in rats. C1 UNIV SYDNEY,DEPT PHARM,SYDNEY,NSW 2006,AUSTRALIA. NR 16 TC 6 Z9 7 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1994 VL 78 IS 3 BP 527 EP 530 PG 4 WC Anesthesiology SC Anesthesiology GA NA403 UT WOS:A1994NA40300019 ER PT J AU IWASAKI, H IGARASHI, M NAMIKI, A OMOTE, K AF IWASAKI, H IGARASHI, M NAMIKI, A OMOTE, K TI DIFFERENTIAL NEUROMUSCULAR EFFECTS OF VECURONIUM ON THE ADDUCTOR AND ABDUCTOR LARYNGEAL MUSCLES AND TIBIALIS ANTERIOR MUSCLE IN DOGS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE LARYNX, VOCAL CORDS; LARYNX, ANATOMY; MONITORING, NEUROMUSCULAR FUNCTION; NEUROMUSCULAR BLOCK, VECURONIUM ID POLLICIS; BLOCKING; ATRACURIUM; DIAPHRAGM; BLOCKADE; CAT AB We have studied in dogs the neuromuscular blocking effects of vecuronium on the cricothyroid (CT) (a tenser muscle of the vocal folds) and posterior cricoarytenoid (PCA) (sole abductor muscle of the vocal folds) muscles of the larynx and the tibialis anterior (TA) muscle. The lungs of the animals were ventilated mechanically with 0.2% halothane and oxygen. Electromyography (EMG) was performed on the CT, PCA and TA muscles by inserting fine wire electrodes The evoked compound EMG responses of the three muscles were measured simultaneously in an identical manner by stimulating supramaximally the superior laryngeal, recurrent and sciatic nerves at 0.1 Hz and 0.2 ms. Vecuronium was infused continuously at a rate of 0.01 mg kg(-1) min(-1) for 8 min. Vecuronium produced more intense neuromuscular block in the CT than in the PCA and TA muscles. The rate of recovery was significantly slowly in the CT compared with the PCA and TA muscles. This study confirms the difference in sensitivity between laryngeal and peripheral muscles, demonstrating that the intrinsic laryngeal muscles do not all behave similarly after administration of vecuronium. RP IWASAKI, H (reprint author), SAPPORO MED COLL & HOSP,DEPT ANESTHESIOL,SAPPORO,JAPAN. NR 13 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 MAR PY 1994 VL 72 IS 3 BP 321 EP 323 DI 10.1093/bja/72.3.321 PG 3 WC Anesthesiology SC Anesthesiology GA NB939 UT WOS:A1994NB93900014 ER PT J AU BURGMANN, H RECKENDORFER, H SPERLICH, M TUCHY, GL SPIECKERMANN, PG WEINDLMAYRGOTTEL, M SCHWARZ, S AF BURGMANN, H RECKENDORFER, H SPERLICH, M TUCHY, GL SPIECKERMANN, PG WEINDLMAYRGOTTEL, M SCHWARZ, S TI INFLUENCE OF INCUBATED ATRACURIUM ON RAT-LIVER FUNCTION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, ATRACURIUM; TOXICITY, HEPATIC ID RENAL-FAILURE; PHARMACOKINETICS; DEGRADATION; METABOLITES; HEPATOCYTES; BESYLATE; TOXICITY; PLASMA AB Degradation of atracurium by Hofmann elimination and ester hydrolysis depends mainly on pH and temperature and is said to be independent of liver and kidney function. Consequently atracurium is used widely in patients with liver failure. However, there is evidence that incubation of atracurium at 37 degrees C and pH 8 leads to leakage of LDH from hepatocyte cell cultures. We have tested the hepatotoxic effects of incubated atracurium in an isolated perfused rat liver model. After equilibration, atracurium 2010 mu mol ml(-1) (preincubated at pH 8 and 37 degrees C for 120 min) was administered over a period of 10 min followed by perfusion of Krebs-Henseleit bicarbonate buffer for 60 min. We found that incubation resulted in considerable degradation of atracurium and formation of laudanosine. Administration of incubated atracurium did not produce either biochemical or morphological damage to liver cells, but caused considerable increase in bile flow. We conclude thar administration of preincubated atracurium did nor produce impairment of liver cell function. The increase in bile flow could be beneficial if it occurs clinically. C1 UNIV VIENNA,DEPT MED PHYSIOL,A-1090 VIENNA,AUSTRIA. UNIV VIENNA,DEPT ANAESTHESIOL,A-1090 VIENNA,AUSTRIA. UNIV VIENNA,DEPT PATHOL,A-1090 VIENNA,AUSTRIA. RP BURGMANN, H (reprint author), UNIV VIENNA,DEPT INFECT DIS,WAHRINGERGURTEL 18-20,A-1090 VIENNA,AUSTRIA. RI Burgmann, Heinz/N-2409-2013 NR 21 TC 3 Z9 3 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 1994 VL 72 IS 3 BP 324 EP 327 DI 10.1093/bja/72.3.324 PG 4 WC Anesthesiology SC Anesthesiology GA NB939 UT WOS:A1994NB93900015 ER PT J AU NIGROVIC, V AF NIGROVIC, V TI NEUROMUSCULAR BLOCK BY VECURONIUM - SIMULATION WITH A FLOW-VOLUME MODEL SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM; PHARMACODYNAMICS, MODELS AB The time profile of the neuromuscular block produced by a single bolus administration of vecuronium was simulated by a new model for the access of the relaxant to the receptors on the motor end plates. The receptors were assumed to be kinetically a part of the interstitial space of the muscle. The time course of the neuromuscular block was defined by the time course of the vecuronium concentration in the interstitial space. The concentration there was derived from the plasma flow to muscle, the volume of the interstitial space in muscle, and the time profile of vecuronium concentrations in plasma. The model describes well the time lag needed to reach the peak submaximal block, its magnitude, as well as the time course of recovery from the maximal block. The limits of the model, evident in less than optimal simulation of the neuromuscular block by two doses of vecuronium in rapid succession, were attributed to the inadequate description of the vecuronium concentrations in plasma immediately after the bolus injection. RP NIGROVIC, V (reprint author), MED COLL OHIO,DEPT ANESTHESIOL,POB 10008,TOLEDO,OH 43699, USA. NR 0 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD MAR PY 1994 VL 11 IS 2 BP 65 EP 74 PG 10 WC Anesthesiology SC Anesthesiology GA MZ446 UT WOS:A1994MZ44600001 ER PT J AU MIGUEL, RV BARLOW, IK DOMBROWSKI, DL AF MIGUEL, RV BARLOW, IK DOMBROWSKI, DL TI THE EFFECT OF D-TUBOCURARINE PRIMING ON AN ED(95) DOSE OF VECURONIUM BROMIDE SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE D-TUBOCURARINE; NONDEPOLARIZING NEUROMUSCULAR RELAXANTS; VECURONIUM AB Study Objective: To examine how priming with ED(10) d-tubocurarine prior to the administration of ED(95) vecuronium bromide affects onset and duration of neuromuscular blockade. Design: Prospective, randomized, observer-blinded study. Setting: Operating room at a university cancer center. Patients: 40 ASA physical status I and II patients undergoing ambulatory surgical procedures. Interventions: Patients were randomized to one of two groups. Group I patients received d-tubocurarine 50 mu g/kg intravenously (IV), followed by vecuronium 60 mu g/kg IV. Group 2 patients received vecuronium 60 mu g/kg IV without priming. All patients received a total IV anesthetic consisting of alfentanil and propofol for induction of anesthesia and propofol alone for maintenance of anesthesia. Measurements and Main Results: Onset of muscle relaxation was determined with an electromyograph (Datex Relaxograph), documenting time to 80% depression of the first twitch in a train-of-four (T(1)8O%), percent depression of T-1 at 60 and 90 seconds (T(1)60 and T(1)90, respectively), T-4:T-1 ratio at 90 seconds, and time to achieve maximal blockade (B-max). Recovery was evaluated by measuring she time required for return of T, to 25% of the baseline value. Intubating conditions were assessed at 90 seconds after vecuronium administration and graded on a 1 (jaw tight, impossible to intubate) to 4 Claw relaxed, vocal cords immobile) scale. All criteria measuring onset of neuromuscular blockade (i.e., T(1)8O%, T(1)60, T(1)90, T-4:T-1, and B-max) were significantly shorter (p < 0.05) in patients who received d-tubocurarine. Recovery was similar in both groups. Intubation scores were significantly better 90 seconds after priming (p < 0. 05). Conclusions: These results indicate that crossover dosing of nondepolarizing muscle relaxants may have synergistic effects. Priming with ED(10) d-tubocurarine prior to an ED(95) dose of vecuronium shortens the time to 80% T-1 depression and produces satisfactory intubating conditions at 90 seconds, without prolonging the duration of the block. Therefore, d-tubocurarine is an attractive drug for priming vecuronium in short operative procedures that require muscle relaxation. RP MIGUEL, RV (reprint author), UNIV S FLORIDA,H LEE MOFFIT CANC CTR & RES INST,ANESTHESIOL SERV,12902 MAGNOLIA DR,SUITE 2149,TAMPA,FL 33612, USA. NR 0 TC 0 Z9 0 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR-APR PY 1994 VL 6 IS 2 BP 106 EP 109 DI 10.1016/0952-8180(94)90005-1 PG 4 WC Anesthesiology SC Anesthesiology GA NG205 UT WOS:A1994NG20500004 ER PT J AU MISHRA, Y TORDA, T RAMZAN, I GRAHAM, G AF MISHRA, Y TORDA, T RAMZAN, I GRAHAM, G TI IN-VITRO INTERACTION BETWEEN H-2 ANTAGONISTS AND VECURONIUM SO JOURNAL OF PHARMACY AND PHARMACOLOGY LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; RANITIDINE; CIMETIDINE; ATRACURIUM; BIOAVAILABILITY; PREMEDICATION; RATS AB The interaction between histamine H-2 antagonists and the neuromuscular blocking drug vecuronium was investigated in the rat phrenic nerve-hemidiaphragm preparation. Cimetidine alone, in the concentration range 800-4000 mu M produced between 14 and 74% neuromuscular paralysis with an EC50 (mean +/- s.e.) of 2900 +/- 100 mu M. Ranitidine augmented the indirectly-evoked muscle response at concentrations between 30 and 160 mu M but at higher concentrations, between 300 and 1800 mu M, produced neuromuscular paralysis. Famotidine produced negligible and statistically insignificant (0-5%) neuromuscular paralysis at concentrations between 0.3 and 300 mu M. Cimetidine (800 mu M) shifted the neuromuscular concentration-effect curve of vecuronium to the left in a parallel manner, while ranitidine (160 mu M) shifted it to the right. The potentiation ratio was 1.90+/-0.14 for cimetidine and 0.62+/-0.05 for ranitidine. Famotidine (30 mu M) did not alter the response to vecuronium. These data indicate that higher than clinically relevant concentrations of cimetidine and ranitidine produce neuromuscular paralysis and may potentiate the action of vecuronium. Low concentrations of ranitidine may antagonize the action of vecuronium. Famotidine, in contrast, lacks significant neuromuscular effects. C1 UNIV SYDNEY,DEPT PHARM,SYDNEY,NSW 2006,AUSTRALIA. UNIV NEW S WALES,DEPT PHYSIOL & PHARMACOL,SYDNEY,NSW,AUSTRALIA. NR 19 TC 1 Z9 1 PU ROYAL PHARMACEUTICAL SOC GREAT BRITAIN PI LONDON PA 1 LAMBETH HIGH ST, LONDON, ENGLAND SE1 7JN SN 0022-3573 J9 J PHARM PHARMACOL JI J. Pharm. Pharmacol. PD MAR PY 1994 VL 46 IS 3 BP 205 EP 208 PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA NB141 UT WOS:A1994NB14100011 ER PT J AU KUNZER, T BUZELLO, CW THEISOHN, M DIEFENBACH, C AF KUNZER, T BUZELLO, CW THEISOHN, M DIEFENBACH, C TI SIMPLE AND RAPID HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHY METHOD FOR THE DETERMINATION OF ALCURONIUM IN HUMAN PLASMA AND URINE SO JOURNAL OF CHROMATOGRAPHY B-BIOMEDICAL APPLICATIONS LA English DT Article ID LAUDANOSINE; ATRACURIUM; KINETICS AB A simple and quick HPLC assay for alcuronium is presented. Its characteristics are: precipitation of plasma proteins by acetonitrile; Spherisorb 5-CN column; acetonitrile-water (46:54, v/v) as mobile phase; flow-rate 1 ml/min; laudanosine 0.06 mg/l as internal standard with plasma; external standard with urine; UV detection at 294 nm; retention time 5.4 min; detection limit 0.025 mg/l; documented linearity: 0.025-2.0 mg/l for plasma and 1.0-80 mg/l for urine; intra- and inter-assay variability below 4%. None of nine drugs used in perioperative pharmacotherapy interfered with the assay. Satisfactory performance was exemplified in a 12-h pharmacokinetic evaluation of two patients. C1 UNIV COLOGNE,DEPT PHARMACOL,D-50924 COLOGNE,GERMANY. UNIV COLOGNE,DEPT ANAESTHESIOL,D-50924 COLOGNE,GERMANY. NR 10 TC 2 Z9 2 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-Biomed. Appl. PD FEB 18 PY 1994 VL 653 IS 1 BP 63 EP 68 DI 10.1016/0378-4347(93)E0426-Q PG 6 WC Biochemical Research Methods; Chemistry, Analytical SC Biochemistry & Molecular Biology; Chemistry GA ND222 UT WOS:A1994ND22200009 ER PT J AU BISSINGER, U LENZ, G AF BISSINGER, U LENZ, G TI PROLONGED NEUROMUSCULAR BLOCKADE AND DIFFERENT REVERSAL EFFECTS FOLLOWING SUCCESSIVE EXPOSURE TO COMBINED VECURONIUM AND SUCCINYLCHOLINE IN A PATIENT WITH ATYPICAL PLASMA CHOLINESTERASE SO ANAESTHESIST LA German DT Article DE ATYPICAL PLASMA CHOLINESTERASE; SUCCINYLCHOLINE-INDUCED PHASE-II BLOCK; ANTAGONISM ID SUXAMETHONIUM; PANCURONIUM; PHARMACOKINETICS; NEOSTIGMINE; ANTAGONISM; ANESTHESIA; APNEA AB An 81-year-old patient had prolonged competitive neuromuscular blockade with train-of-four ratios of 0.1 and 0.5, respectively, after two successive anaesthesia procedures (enflurane-N20/02; vecuronium-succinylcholine-sequence) for transurethral prostate resection. Although antagonism with neostigmine was promptly successful after the first, 65-min period of anaesthesia (1.5 mg vecuronium for precurarization, 100 mg succinylcholine for intubation, 3 mg vecuronium), repetitive and chronologically staggered administration of neostigmine after the second, 30-min period of anaesthesia (1 mg vecuronium for precurarization, 100 mg succinylcholine for intubation) had hardly any effect, so that the patient had to be ventilated mechanically for a total of 4.5 h. Laboratory analysis revealed homozygous, atypical, plasma cholinesterase (790 U/1; dibucaine number 23; genotype E1(a)E1a). This retrospectively confirmed a succinylcholine-induced phase II block in both instances, as had already been suspected following the second anaesthetic procedure. The degree of block transformation, and thus the available time, are decisive in explaining the diverse effects of antagonism here. it must be assumed that a complete phase II block developed after the first succinylcholine exposure owing to the longer duration of anaesthesia; the purely competitive component (train-of-four ratio 0.1) was easily antagonized by neostigmine. At the time of the attempted antagonism after the second, shorter period of anaesthesia, however, block transformation was still incomplete (train-of-four ratio 0.5). The administration of neostigmine therefore rather intensified the depolarization segment of the mixed block, so that repeated attempts at antagonism then inhibited any further block transformation. RP BISSINGER, U (reprint author), UNIV TUBINGEN,ANAESTHESIOL & TRANSFUSIONSMED KLIN,ANAESTHESIOL ABT,HOPPE SEYLER STR 3,D-72076 TUBINGEN,GERMANY. NR 29 TC 1 Z9 1 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD FEB PY 1994 VL 43 IS 2 BP 82 EP 86 DI 10.1007/s001010050035 PG 5 WC Anesthesiology SC Anesthesiology GA NA120 UT WOS:A1994NA12000002 ER PT J AU NAGUIB, M ABDULATIF, M AF NAGUIB, M ABDULATIF, M TI DOSE-RESPONSE RELATIONSHIPS FOR EDROPHONIUM AND NEOSTIGMINE ANTAGONISM OF PIPECURONIUM-INDUCED NEUROMUSCULAR BLOCK SO ANESTHESIA AND ANALGESIA LA English DT Article ID NICOTINIC ACETYLCHOLINE-RECEPTOR; IONIC CHANNEL COMPLEX; PYRIDOSTIGMINE; ATRACURIUM AB We have studied the dose-response relationships for neostigmine and edrophonium during antagonism of neuromuscular block induced by pipecuronium bromide. Fifty-six ASA physical status I or II adults were given pipecuronium 70 mu g/kg during fentanyl thiopental-nitrous oxide-halothane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. When spontaneous recovery of first twitch height reached 20% of its initial control value, edrophonium (0.125, 0.25, 0.75, or 1 mg/kg) or neostigmine (0.015, 0.03, 0.045, or 0.06 mg/kg) was administered by random allocation. Neuromuscular function in another seven subjects was allowed to recover spontaneously. This study demonstrated that the dose-response curves for these two drugs for reversal of first twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% (ED(50)) and 80% (ED(80)) recovery of the first twitch after 10 min were 8.5 (7.3-9.7) and 17.4 (16.2-18.7) mu g/kg [mean (95% confidence intervals)], respectively. Corresponding ED(50) and ED(80) values for edrophonium were 84.1 (72.9-96.9) and 233 (215.7-253.3) mu g/kg, respectively. These values corresponded to neostigmine:edrophonium potency ratios of 9.89 (7.4-12.3) and 13.4 (11.8-14.9) for first twitch ED(50) and ED(80) height, respectively. The calculated doses producing 50% (ED,,) recovery of the TOF ratio at 10 min were 18.8 (17.5-20.2) and 271.3 (246.5-298.6) mu g/kg for neostigmine and edrophonium, respectively. These values corresponded to a potency ratio of 14.4 (12.8-15.9). We conclude that both edrophonium and neostigmine were able to reverse a pipecuronium neuromuscular block although their dose-response curves were not parallel. RP NAGUIB, M (reprint author), UNITED ARAB EMIRATES UNIV,FAC MED & HLTH SCI,DEPT ANAESTHESIA & CRIT CARE MED,POB 17666,AL AIN,U ARAB EMIRATES. NR 16 TC 4 Z9 5 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 1994 VL 78 IS 2 BP 306 EP 311 DI 10.1213/00000539-199402000-00018 PG 6 WC Anesthesiology SC Anesthesiology GA NA399 UT WOS:A1994NA39900018 ER PT J AU HEIER, T CALDWELL, JE ERIKSSON, LI SESSLER, DI MILLER, RD AF HEIER, T CALDWELL, JE ERIKSSON, LI SESSLER, DI MILLER, RD TI THE EFFECT OF HYPOTHERMIA ON ADDUCTOR POLLICIS TWITCH TENSION DURING CONTINUOUS-INFUSION OF VECURONIUM IN ISOFLURANE-ANESTHETIZED HUMANS SO ANESTHESIA AND ANALGESIA LA English DT Article ID NITROUS-OXIDE ISOFLURANE; D-TUBOCURARINE; ANESTHESIA; PHARMACOKINETICS; TEMPERATURE; PHARMACODYNAMICS; PANCURONIUM; BLOCKADE; SURFACE; SKIN AB The effect of total body cooling on force of contraction of the adductor pollicis was determined during a constant rate infusion of vecuronium. Anesthesia was induced with thiopental and maintained with isoflurane/nitrous oxide in eight volunteers (study group) and seven surgical patients (control group). After train-of-four (TOF) stimulation of the ulnar nerve, we measured the amplitude of the first response (T1) in the train and the ratio of the fourth-to-first response (TOF ratio). Vecuronium was then administered as an intravenous (IV) bolus, 25 mu g/kg, followed by continuous IV infusion, 25 mu g kg(-1) h(-1); central body (core) temperature was maintained stable for 60 min, at the end of which T1 and TOF responses were constant. In the study group, core temperature was then reduced (using circulating-water blankets) by a mean of 2.6 degrees C, decreasing the T1 and TOF ratio, respectively, by 19% and 18% per degrees C reduction in adductor pollicis temperature. Normothermia was maintained in the control group for a mean of 111 min, with no significant change in T1 and TOF responses. We conclude that, during a constant-rate infusion of vecuronium, the magnitude of neuromuscular block increases significantly when adductor pollicis temperature decreases secondary to core cooling. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 14 TC 13 Z9 14 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 1994 VL 78 IS 2 BP 312 EP 317 DI 10.1213/00000539-199402000-00019 PG 6 WC Anesthesiology SC Anesthesiology GA NA399 UT WOS:A1994NA39900019 ER PT J AU LEVY, JH DAVIS, GK DUGGAN, J SZLAM, F AF LEVY, JH DAVIS, GK DUGGAN, J SZLAM, F TI DETERMINATION OF THE HEMODYNAMICS AND HISTAMINE-RELEASE OF ROCURONIUM (ORG-9426) WHEN ADMINISTERED IN INCREASED DOSES UNDER N2O/O2-SUFENTANIL ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKING-DRUGS; N-METHYLTRANSFERASE; ORG-9426; MIVACURIUM; HUMANS; RELAXANTS; AGENT AB The cardiovascular effects, histamine release potential, and pharmacodynamics of rocuronium were determined in adult patients randomized to receive rapid (5 s) intravenous (TV) bolus doses of 600, 900, or 1200 mu g/kg (2.0, 3.0, and 4.0 times the ED(95)) with maintenance doses of 150 mu g/kg. There were no statistically significant hemodynamic effects (heart rate, blood pressure, mean arterial pressure [MAP] or electrocardiogram [ECG]) after administration of rocuronium. There were no increases in plasma histamine levels at 1, 3, and 5 min after the rapid IV bolus of rocuronium as determined by a new radioimmunoassay (RIA) with a sensitivity for histamine quantification of 0.05 ng/mL. Endotracheal intubation was successfully performed 6 min after rocuronium administration (and after plasma samples were obtained). The mean +/- so clinical durations of 600-, 900-, and 1200-mu g/kg intubating doses of rocuronium under N2O/O-2-sufentanil anesthesia were 45 +/- 20 min, 66 +/- 16 min, and 85 +/- 22 min, respectively. We conclude that rocuronium can be administered safely over a wide range of doses (2-4 x ED(95)), with minimum hemodynamic effects or histamine release. RP LEVY, JH (reprint author), EMORY UNIV HOSP,SCH MED,DEPT ANESTHESIOL,1364 CLIFTON RD NE,ATLANTA,GA 30322, USA. NR 21 TC 46 Z9 51 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 1994 VL 78 IS 2 BP 318 EP 321 DI 10.1213/00000539-199402000-00020 PG 4 WC Anesthesiology SC Anesthesiology GA NA399 UT WOS:A1994NA39900020 ER PT J AU CAULDWELL, CB LAU, M FISHER, DM AF CAULDWELL, CB LAU, M FISHER, DM TI IS INTRAMUSCULAR MIVACURIUM AN ALTERNATIVE TO INTRAMUSCULAR SUCCINYLCHOLINE SO ANESTHESIOLOGY LA English DT Article DE ANESTHESIA, PEDIATRIC; MUSCLE RELAXANTS, MIVACURIUM; RESPIRATORY EFFECTS, MUSCLE RELAXANTS ID VECURONIUM NEUROMUSCULAR BLOCKADE; CHLORIDE BW B1090U; ADDUCTOR POLLICIS; DOSE-RESPONSE; CHILDREN; ANESTHESIA; MUSCLES; PANCURONIUM; DIAPHRAGM; INFANTS AB Background: Mivacurium's rapid onset and short duration of action in children suggests that intramuscular administration might treat laryngospasm and facilitate tracheal intubation without producing prolonged paralysis. Accordingly, the authors measured the neuromuscular effects of intramuscular mivacurium in anesthetized infants and children. Methods: Twenty unpremedicated infants and children (3 months to 5 yr of age) were anesthetized with nitrous oxide and halothane and permitted to breathe spontaneously. When anesthetic conditions were stable, mivacurium was injected into the quadriceps or deltoid muscle. Minute ventilation and adductor pollicis twitch tension were measured. The initial mivacurium dose was 250 mu g/kg and was increased (to a maximum of 800 mu g/kg, at which dose the trial was ended) or decreased according to the response of the previous patient, the goal being to bracket the dose producing 80-90% twitch depression within 5 min of drug administration. Results: No patient achieved >80% twitch depression within 5 min of mivacurium administration, Peak twitch depression was 90 +/- 13% (mean +/- SD) for infants and 88 +/- 15% for children at 15.0 +/- 4.6 min and 18.4 +/- 6.4 min, respectively. Ventilatory depression (a 50% decrease in minute ventilation or a 10-mmHg increase in end-tidal carbon dioxide tension) occurred at 9.0 +/- 4.4 min in nine infants and 13.6 +/- 7.5 min in 10 children; ventilatory depression did not develop in one infant given a dose of 350 mu g/kg. Time to peak twitch depression or ventilatory depression was not faster with larger doses. Conclusions: Although ventilatory depression preceded twitch depression, both occurred later with intramuscular mivacurium than would be expected after intravenous mivacurium or intramuscular succinylcholine. The authors speculate that the onset of intramuscular mivacurium is too slow to treat laryngospasm or to facilitate routine tracheal intubation in infants or children, despite administration of large doses. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 21 TC 10 Z9 10 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD FEB PY 1994 VL 80 IS 2 BP 320 EP 325 DI 10.1097/00000542-199402000-00012 PG 6 WC Anesthesiology SC Anesthesiology GA MX446 UT WOS:A1994MX44600011 ER PT J AU SEMPLE, P HOPE, DA CLYBURN, P RODBERT, A AF SEMPLE, P HOPE, DA CLYBURN, P RODBERT, A TI RELATIVE POTENCY OF VECURONIUM IN MALE AND FEMALE-PATIENTS IN BRITAIN AND AUSTRALIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCK, VECURONIUM, POTENCY ID AGE AB We compared the potency of vecuronium when given to similar patients in Brisbane, Australia, and Cardiff, United Kingdom. Forty patients in each centre were anaesthetized using the same technique with propofol, fentanyl, nitrous oxide and vecuronium either 20 or 30 mu g kg(-1) by random allocation. Neuromuscular block was measured with similar Datex Relaxographs. There was no significant difference in potency between British and Australian patients. The ED,, and ED, for a British male of average weight were 29.5 mu g kg(-1) (95% confidence limits 27.3-32.3 mu g kg(-1) and 51.3 mu g kg(-1) (44.3-63.9 mu g kg(-1)), respectively. ED,, and ED,, for Australians were 5.5% greater, with confidence limits from 4% less to 17% greater. Females were significantly more sensitive to vecuronium than males, requiring 22% less drug to achieve the same degree of neuromuscular block (confidence limits 12-32%). The results are consistent with the ED(50) being independent of body weight when the dose is expressed as mu g kg(-2/3), but not as mu g or mu g kg(-1). C1 UNIV HOSP WALES,CARDIFF CF4 4XW,S GLAM,WALES. MARYBOURGH BASE HOSP,MARYBOURGH,QLD 4650,AUSTRALIA. PRINCESS ALEXANDRA HOSP,BRISBANE,QLD 4102,AUSTRALIA. NR 16 TC 22 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 FEB PY 1994 VL 72 IS 2 BP 190 EP 194 DI 10.1093/bja/72.2.190 PG 5 WC Anesthesiology SC Anesthesiology GA MX273 UT WOS:A1994MX27300012 ER PT J AU DUCHARME, J VARIN, F DONATI, F AF DUCHARME, J VARIN, F DONATI, F TI VECURONIUM PHARMACOKINETIC-PHARMACODYNAMIC MODELING WITH AND WITHOUT A RECEPTOR CONCENTRATION IN THE EFFECT COMPARTMENT IN ANESTHETIZED PATIENTS SO DRUG INVESTIGATION LA English DT Article ID PANCURONIUM; PLASMA AB The pharmacokinetic-pharmacodynamic (PK-PD) relationship of vecuronium administered as a 0.1 mg/kg intravenous bolus was evaluated during both the onset of and recovery from neuromuscular block in 9 anaesthetised patients. Sigmoid E(max) modelling of neuromuscular block versus vecuronium effect compartment concentrations indicated comparable effective concentrations at 50% block (EC(50)) for both onset and recovery (146 +/- 12 vs 144 +/- 13 ng/ml, respectively). However, during onset, the sigmoid was systematically steeper (gamma of 6.41 +/- 0.32 vs 4.17 +/- 0.36, respectively). Including a finite receptor concentration in the effect compartment (0.27 +/- 0.04 mu mol/L) led to a faster equilibration rate constant, K-eo (0.097 +/- 0.009 vs 0.058 +/- 0.005 min-l) and to lower EC(50) (120 +/- 13 ng/ml) and gamma values (3.62 +/- 0.22). The neuromuscular block predicted by this model was similar to the one obtained from a separate PK-PD analysis over each phase. Therefore, to be adequate, the PK-PD modelling of non-depolarising neuromuscular blockers should involve a separate analysis of onset or recovery data, or account for the safety margin of neuromuscular transmission by adding a receptor concentration in the effect compartment. C1 UNIV MONTREAL,FAC PHARM,MONTREAL H3C 3J7,PQ,CANADA. MCGILL UNIV,ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,MONTREAL,PQ,CANADA. NR 20 TC 4 Z9 4 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 0114-2402 J9 DRUG INVEST PD FEB PY 1994 VL 7 IS 2 BP 74 EP 83 PG 10 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA MY244 UT WOS:A1994MY24400003 ER PT J AU DHONNEUR, G AF DHONNEUR, G TI DIPRIVAN(R) - INTUBATION WITHOUT CURARE SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article AB To intubate under ideal conditions, i.e. with the vocal cords abducted and no motor response to the insertion of the endotracheal tube, the anaesthetist has two alternatives : to use muscle relaxants or to anaesthetize the patient deeply. Apart from cases where muscle relaxants are contra-indicated or required by the type of procedure: Intubation using muscle relaxants means: - maintaining the option of varying the depth of anaesthesia, while keeping optimal conditions for intubation; - reducing the risk of airways trauma. Intubation without muscle relaxants means: - avoiding the risk of allergic complications; - producing deep anaesthesia and controlling any resulting haemodynamic effects. The recommended induction agent is propofol, given as a bolus injection at a dose equal to or greater than 2.5 mg . kg-1 in adults and 3.5 mg . kg-1 in children. Alfentanil is the opioid of choice, the dose being between 30 and 40 mug . kg-1. Lidocaine, injected as premediation at a dose of 1.5 mg . kg-1 potentiates the effect of alfentanil. The order of injection of the induction agents is important, as it determines the exact moment for laryngoscopy and intubation. RP DHONNEUR, G (reprint author), HOP HENRI MONDOR,F-94010 CRETEIL,FRANCE. NR 0 TC 3 Z9 3 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1994 VL 13 IS 4 BP 600 EP 604 DI 10.1016/S0750-7658(05)80708-7 PG 5 WC Anesthesiology SC Anesthesiology GA PG111 UT WOS:A1994PG11100042 ER PT J AU HARPER, NJN WALLACE, M HALL, IA AF HARPER, NJN WALLACE, M HALL, IA TI OPTIMUM DOSE OF NEOSTIGMINE AT 2 LEVELS OF ATRACURIUM-INDUCED NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM; ANTAGONISTS; NEUROMUSCULAR RELAXANTS, NEOSTIGMINE ID ANTAGONISM; VECURONIUM; RECOVERY AB There is controversy about the optimum dose of neostigmine for antagonizing neuromuscular block. We have studied 57 patients undergoing gynaecological surgery to establish a dose-response relationship when neostigmine was given to antagonize atracurium-induced block. Anaesthesia was induced with thiopentone and fentanyl and maintained with nitrous oxide and enflurane in oxygen and neuromuscular block was produced with a bolus of atracurium 0.5 mg kg(-1). At the time of antagonism of block, three groups received neostigmine 20, 40 or 80 mu g kg(-1) at 5-10% recovery of the compound muscle action potential of the adductor pollicis (profound block) and three groups received one of these doses at 40-50% neuromuscular recovery (light block). At profound block, antagonism was prolonged by reducing the dose of neostigmine from 40 mu g kg(-1) to 20 mu g kg(-1), but not shortened by increasing the dose from 40 mu g kg(-1) to 80 mu g kg(-1). At light block, there was no significant difference between the three groups in the time taken to reach a train-of-four ratio of 0.7. There was little benefit in increasing the dose of neostigmine from 40 mu g kg(-1) to 80 mu g kg(-1) when antagonizing profound neuromuscular block. When light block was antagonized, neostigmine 20 mu g kg(-1) was the optimum dose. We suggest that smaller doses of neostigmine than are given commonly produce adequate antagonism of atracurium-induced neuromuscular block. C1 CAIRNS BASE HOSP,CAIRNS,QLD 4870,AUSTRALIA. RP HARPER, NJN (reprint author), MANCHESTER ROYAL INFIRM,DEPT ANAESTHESIA,OXFORD RD,MANCHESTER M13 9WL,LANCS,ENGLAND. NR 10 TC 13 Z9 16 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 1994 VL 72 IS 1 BP 82 EP 85 DI 10.1093/bja/72.1.82 PG 4 WC Anesthesiology SC Anesthesiology GA MR339 UT WOS:A1994MR33900019 ER PT J AU RECKENDORFER, H SPERLICH, M BURGMANN, H WEINDLMAYRGOTTEL, M SPIECKERMANN, PG SCHWARZ, S AF RECKENDORFER, H SPERLICH, M BURGMANN, H WEINDLMAYRGOTTEL, M SPIECKERMANN, PG SCHWARZ, S TI ADMINISTRATION OF ATRACURIUM DURING REPERFUSION OF RAT LIVERS AFTER 21 H OF COLD ISCHEMIC STORAGE IN DIFFERENT SOLUTIONS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM; LIVER, METABOLISM ID RENAL-FAILURE; VIABILITY; PHARMACOKINETICS; TRANSPLANTATION; LAUDANOSINE; HEPATOCYTES; INFUSION; TOXICITY AB The pharmacokinetics of atracurium are not altered by impaired hepatic function. The drug is therefore used widely in liver transplant patients. In previous work on the hepatotoxic effects of atracurium in an isolated, perfused rat liver model, we could nor detect biochemical (release of lactate dehydrogenase or aspartate aminotransferase) or histological evidence of liver cell damage, except a reduction in hepatic tissue ATP content. In the present study, rat livers were reperfused with Krebs-Henseleit bicarbonate buffer with or without atracurium after 21 h of cold ischaemic storage in University of Wisconsin (UW), Bretschneider's HTK or Eurocollins solution. UW-protected livers showed a complete restoration of ATP, total adenine nucleotides and energy charge during reperfusion, but the addition of atracurium diminished the regeneration capacity to about 50%. The energy charge (an index for determination of liver viability) was also reduced markedly. C1 UNIV VIENNA,DEPT MED PHYSIOL,VIENNA,AUSTRIA. UNIV VIENNA,DEPT INFECT DIS & CHEMOTHERAPY,VIENNA,AUSTRIA. UNIV VIENNA,DEPT ANESTHESIOL,VIENNA,AUSTRIA. KRANKENHAUS LAINZ,DEPT ANESTHESIOL,VIENNA,AUSTRIA. RP RECKENDORFER, H (reprint author), DONAUSPITAL,SMZO,DEPT PATHOL,LANGOBARDENSTR 122,A-1220 VIENNA,AUSTRIA. RI Burgmann, Heinz/N-2409-2013 NR 20 TC 2 Z9 2 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 1994 VL 72 IS 1 BP 89 EP 92 DI 10.1093/bja/72.1.89 PG 4 WC Anesthesiology SC Anesthesiology GA MR339 UT WOS:A1994MR33900021 ER PT J AU MAESTRONE, E MAGNELLI, V NOBILE, M USAI, C AF MAESTRONE, E MAGNELLI, V NOBILE, M USAI, C TI EXTRACELLULAR PANCURONIUM AFFECTS SODIUM CURRENT IN CHICK-EMBRYO SENSORY NEURONS SO BRITISH JOURNAL OF PHARMACOLOGY LA English DT Article DE PANCURONIUM; MUSCLE RELAXANTS; SODIUM CHANNEL; DORSAL ROOT GANGLION; PATCH-CLAMP; CHICK EMBRYO; SENSORY NEURONS ID SQUID AXON-MEMBRANES; CHANNELS AB 1 The action of pancuronium on transmembrane sodium conductance was investigated in dorsal root ganglion neurones of chick embryos. The Na+ current was measured by use of the patch-clamp technique in whole-cell configuration. 2 Externally perfused pancuronium (50 mu M to 1mM) reversibly inhibited the current by a fast mechanism of action. Inhibition was concentration-dependent (with a half-effective dose of 170 mu M) but not voltage-dependent. 3 The activation and inactivation kinetics of the Na+ current were estimated in pancuronium and in control solution by fitting experimental data with a Hodgkin-Huxley theoretical model. 4 The activation time constant tau(m), at negative membrane voltages, was larger in the presence of pancuronium than in the control. In contrast, the inactivation time constant tau(h) was smaller during drug perfusion at membrane voltages < - 10 mV. The steady-state inactivation h infinity was not affected by pancuronium. 5 These results suggest that pancuronium may reduce the sodium current by interacting with the sodium channels in both the resting and open states. C1 CNR,IST CIBERNET & BIOFIS,I-16146 GENOA,ITALY. UNIV TORINO,IST ANAT & FISIOL UMANA,I-10125 TURIN,ITALY. OSPED CIVILE SONDRIO,CTR STUDIO FUNZ NEUROMUSCULARE,I-23100 SONDRIO,ITALY. NR 19 TC 1 Z9 1 PU STOCKTON PRESS PI BASINGSTOKE PA HOUNDMILLS, BASINGSTOKE, HAMPSHIRE, ENGLAND RG21 6XS SN 0007-1188 J9 BRIT J PHARMACOL JI Br. J. Pharmacol. PD JAN PY 1994 VL 111 IS 1 BP 283 EP 287 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA MR098 UT WOS:A1994MR09800044 ER PT J AU WHALLEY, DG LEWIS, B BEDOCS, NM AF WHALLEY, DG LEWIS, B BEDOCS, NM TI RECOVERY OF NEUROMUSCULAR FUNCTION AFTER ATRACURIUM AND PANCURONIUM MAINTENANCE OF PANCURONIUM BLOCK SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MONITORING, NEUROMUSCULAR FUNCTION; NEUROMUSCULAR RELAXANTS, ATRACURIUM PANCURONIUM ID RESIDUAL CURARIZATION; MUSCLE-RELAXANTS; VECURONIUM; TUBOCURARINE; DRUGS AB The study was undertaken to determine whether a neuromuscular blockade induced with pancuronium but maintained with atracurium was associated with a shorter time to complete recovery after administration of neostigmine than if the blockade was maintained with pancuronium alone. Anaesthesia consisted of thiopentone, N2O/O-2/enflurane and fentanyl, and the neuromuscular blockade, induced by pancuronium 0.1 mg(.)kg(-1) was monitored by the force of contraction of adductor pollicis during major abdominal surgery lasting 2-5 hr. In 24 patients - Group 1 - atracurium 0.07 mg(.)kg(-1) was repeated when the first twitch of the train-of-four (TOF) returned to 25% of control (T-I/TC 25). In 28 patients - Group 2 - pancuronium 0.015 mg(.)kg(-1) was given at similar recovery of T-1/TC. At the end of surgery neostigmine 0.07 mg(.)kg(-1) and glycopyrrolate 0.015 mg(.)kg(-1) were given to reverse the residual neuromuscular blockade which was indicated by a T-1/TC of less than 25% in all patients. The time from injection of the reversal drugs to a TOF ratio of 70% was similar in both groups (Group 1, 11.6 +/- 7.6 min; Group 2, 10.1 +/- 6 min; P = NS), but the recovery index was smaller in Group 2 (Group 1, 4 +/- 2.6 min; Group 2, 2.61 +/- 1.2 min; P < 0.05). Furthermore, there was no difference between groups in the duration of action of each redose. The study showed that when compared with pancuronium, equipotent doses of atracurium were not associated with (a) a shorter time to complete recovery from a neuromuscular blockade induced with pancuronium or (b) a shorter duration of action. RP WHALLEY, DG (reprint author), CLEVELAND CLIN FDN,DEPT GEN ANESTHESIOL,9500 EUCLID AVE,M-26,CLEVELAND,OH 44195, USA. NR 19 TC 3 Z9 4 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1994 VL 41 IS 1 BP 31 EP 35 PG 5 WC Anesthesiology SC Anesthesiology GA MP730 UT WOS:A1994MP73000007 ER PT J AU IBEBUNJO, C HALL, LW AF IBEBUNJO, C HALL, LW TI SUCCINYLCHOLINE AND VECURONIUM BLOCKADE OF THE DIAPHRAGM, LARYNGEAL AND LIMB MUSCLES IN THE ANESTHETIZED GOAT SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE NEUROMUSCULAR BLOCKING DRUGS, SUCCINYLCHOLINE VECURONIUM; MUSCLE SKELETAL, CRICOARYTENOIDEUS DORSALIS THYROARYTENOIDEUS DIAPHRAGM ULNARIS LATERALIS ID ADDUCTOR POLLICIS MUSCLES; NEUROMUSCULAR BLOCKADE; D-TUBOCURARINE; PANCURONIUM; ATRACURIUM; HUMANS; TRAIN-OF-4; RESPONSES; MASSETER; RECOVERY AB The purpose of the study was to compare the response of the cricoarytenoideus dorsalis muscle (CD) to neuromuscular blocking drugs with those of the thyroarytenoideus (TA), diaphragm (DI) and ulnaris lateralis (UL) muscles. Evoked electromyographic response to indirect supramaximal stimulation at 1 Hz was monitored in ten adult goats under thiopentone-halothane anaesthesia. The onset time and duration of neuromuscular blockade after intravenous administration of 500 mu g(.)kg(-1) of succinylcholine or 4 mu g(.)kg(-1) of vecuronium were determined. Times to 100% paralysis in CD, TA, DI and UL after succinylcholine were (mean +/- SD) 39 +/- 11, 39 +/- 11, 42 +/- 8 and 57 +/- 8 seconds, respectively; the corresponding times for vecuronium were 5.6 +/- 2.3, 4.6 +/- 1.7, 6.0 +/- 1.9 and 9.6 +/- 1.7 min. The order of recovery to 25% spontaneous EMG activity was TA, CD, DI and UL after succinylcholine (durations: 9.7 +/- 3.6, 11.0 +/- 3.0, 15.3 +/- 1.3 and 22.0 +/- 1.2 min, respectively) but DI, CD, TA and UL after vecuronium (durations: 31.9 +/- 18.6, 35.2 +/- 19.5, 47.1 +/- 19.9 and 71.7 +/- 16.1 minutes, respectively). Thus, as in the diaphragm and thyroarytenoideus muscles, onset time and duration of succinylcholine or vecuronium blockade were shorter in the abductor muscle of the glottis, cricoarytenoideus dorsalis, than in the limb muscle. C1 UNIV CAMBRIDGE,DEPT CLIN VET MED,CAMBRIDGE CB3 0ES,ENGLAND. NR 36 TC 6 Z9 6 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1994 VL 41 IS 1 BP 36 EP 42 PG 7 WC Anesthesiology SC Anesthesiology GA MP730 UT WOS:A1994MP73000008 ER PT J AU JIANG, H BISPLINGHOFF, B LAUE, C BRANDT, R AF JIANG, H BISPLINGHOFF, B LAUE, C BRANDT, R TI DETERMINATION OF SEPARATED PLUTONIUM, AMERICIUM AND CURIUM IN ENVIRONMENTAL-SAMPLES BY SEQUENTIAL EXTRACTION TECHNIQUES SO ISOTOPENPRAXIS LA English DT Article DE AM-241; CURIUM-242; CURIUM-244; ENVIRONMENTAL SAMPLES; EXTRACTION; ISOTOPE ANALYSIS; PU-238; PLUTONIUM 239-240 ID ELECTRODEPOSITION AB A simple, reliable and practical radiochemical method for sequential isolation and determination of plutonium, americium and curium in a wide variety of environmental samples including soils, river sediments and water was developed. The isotopes determined are: Pu-238, Pu-239,240, Am-241, Cm-242 and Cm-244. The methods involve leaching of soil or sedimental samples with concentrated nitric acid using a pressure digestion technique. Subsequent concentration and separation of nuclides of interest from major matrix elements and other interfering alpha-emitters are carried out by coprecipitation with ferric hydroxide and solvent extractions. Sources suitable for alpha-spectrometry are prepared by electrodeposition from acidic ammonium chloride solution. Pu-242 and Am-243 are used as tracer isotopes of plutonium and americium-curium elements, respectively. Some results of analysis of soils, sediments and water are given. The alpha peaks from Pu-238, Pu-239,240 and Pu-242 as well as Am-241, Cm-244, Cm-242 and Am-243 are well resolved. The entire analytical procedures for plutonium, americium and curium are completed in less than sixteen hours. C1 PHILIPPS UNIV,FACHBEREICH 14,HANS MEERWEIN STR,D-35032 MARBURG,GERMANY. NR 41 TC 0 Z9 0 PU GORDON BREACH SCI PUBL LTD PI READING PA C/O STBS LTD PO BOX 90, READING, BERKS, ENGLAND RG1 8JL SN 0021-1915 J9 ISOTOPENPRAXIS PY 1994 VL 30 IS 4 BP 367 EP 377 DI 10.1080/00211919408046751 PG 11 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA QG392 UT WOS:A1994QG39200007 ER PT J AU IWASAKI, H IGARASHI, M OMOTE, K NAMIKI, A AF IWASAKI, H IGARASHI, M OMOTE, K NAMIKI, A TI VECURONIUM NEUROMUSCULAR BLOCKADE AT THE CRICOTHYROID AND POSTERIOR CRICOARYTENOID MUSCLES OF THE LARYNX AND AT THE ADDUCTOR POLLICIS MUSCLE IN HUMANS SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE LARYNGEAL MUSCLES CRICOTHYROID, CRICOARYTENOID; MONITORING NEUROMUSCULAR BLOCKADE; VECURONIUM; VOCAL CORDS AB Study Objective: To compare the sensitivity to vecuronium in the cricothyroid (CT) and posterior cricoarytenoid (PCA) muscles of the larynx and the adductor pollicis muscles. Design: Prospective, nonrandomized study. Setting: Operating room at Sapporo Medical College and Hospital. Patients: 9 ASA status I and II adult patients scheduled for total laryngectomy to resect laryngeal cancer of essentially unilateral involvement. Interventions: During surgery electromyographic (EMG) recording wire electrodes were inserted into the CT and PCA muscles with nitrous oxide, oxygen, and fentanyl anesthesia. The evoked compound EMG responses of the CT and PCA muscles were quantified simultaneously in an identical manner by supramaximally stimulating the superior laryngeal and recurrent nerves at 0.1 Hz. and 0.2 millisecond. The ulnar nerve also was stimulated, and the adduction force of the thumb was measured. Vecuronium was infused continuously at a rate of 0.01 mg/kg/min. The evoked responses (percentage of control, means +/- so) of the adductor pollicis, CT and PCA muscles were 12.0 +/- 4.2, 22.0 +/- 5.3, and 32. 9 +/- 7.8, respectively G minutes after vecuronium administration. Measurements and Main Results: Vecuronium produced significantly more intense neuromuscular blockade in the adductor pollicis than in the laryngeal muscles (p < 0.05). In comparing the laryngeal muscles, the depression of EMG at the CT was significantly greater than that at the PCA (p < 0.05). Conclusions: The laryngeal (CT and PCA) muscles are more resistant to vecuronium than is the adductor pollicis, and the PCA muscle is more resistant to vecuronium than is the CT muscle. This finding suggests that partially paralyzed patients are able to maintain laryngeal patency despite the apparent impaired neuromuscular transmission in the adductor pollicis muscle. RP IWASAKI, H (reprint author), SAPPORO MED COLL & HOSP,DEPT ANESTHESIOL,CHUO KU,SOUTH 1,WEST 16,SAPPORO,HOKKAIDO 060,JAPAN. NR 0 TC 6 Z9 6 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD JAN-FEB PY 1994 VL 6 IS 1 BP 14 EP 17 DI 10.1016/0952-8180(94)90111-2 PG 4 WC Anesthesiology SC Anesthesiology GA MV004 UT WOS:A1994MV00400004 ER PT J AU MATTEO, RS ORNSTEIN, E SCHWARTZ, AE OSTAPKOVICH, N STONE, JG AF MATTEO, RS ORNSTEIN, E SCHWARTZ, AE OSTAPKOVICH, N STONE, JG TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ROCURONIUM (ORG-9426) IN ELDERLY SURGICAL PATIENTS SO ANESTHESIA AND ANALGESIA LA English DT Article ID AGE; ELIMINATION; VECURONIUM; MASS AB The effects of age on the pharmacokinetic and pharmacodynamic responses to rocuronium (Org 9426) were studied in 20 elderly (>70 vr) and 20 younger control patients (<60 yr) during N2O/O2, fentanyl anesthesia. The onset times were the same for both the elderly and younger control group, but the duration of action of rocuronium was significantly prolonged in the elderly patients. Elderly patients, when compared with the younger, also exhibited a significant decrease in plasma clearance (3.67 +/- 1.0 vs 5.03 +/- 1.5 mL . kg-1 . min-1, mean +/- SD) and volume of distribution (399 +/- 122 vs 553 +/- 279 mL/kg, mean +/- SD). During the recovery phase of paralysis, no significant difference was seen in the log plasma concentration versus twitch ten ion response relationship between 20% and 80% paralysis in young and elderly patients receiving rocuronium. The differences in action of rocuronium between the elderly and younger groups can be fully explained by the observed differences in the distribution and elimination of rocuronium between the two groups. The decreased total body water and decreased liver mass which normally accompany aging are likely explanations for the pharmacokinetic changes found in the elderly in this study. We conclude that the action of rocuronium is prolonged in patients aged more than 70 yr because of decreased elimination of the drug. C1 PRESBYTERIAN HOSP,ANESTHESIOL SERV,NEW YORK,NY 10032. RP MATTEO, RS (reprint author), COLUMBIA UNIV COLL PHYS & SURG,DEPT ANESTHESIOL,630 W 168TH ST,NEW YORK,NY 10032, USA. NR 21 TC 45 Z9 51 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1993 VL 77 IS 6 BP 1193 EP 1197 PG 5 WC Anesthesiology SC Anesthesiology GA MK048 UT WOS:A1993MK04800019 ER PT J AU MAHAJAN, RP HENNESSY, N AITKENHEAD, AR AF MAHAJAN, RP HENNESSY, N AITKENHEAD, AR TI EFFECT OF PRIMING DOSE OF VECURONIUM ON LUNG-FUNCTION IN ELDERLY PATIENTS SO ANESTHESIA AND ANALGESIA LA English DT Article ID RAPID-SEQUENCE INDUCTION; NEUROMUSCULAR-TRANSMISSION; RESPIRATORY MECHANICS; PARTIAL CURARIZATION; PULMONARY-FUNCTION; PRINCIPLE; PRECURARIZATION; PRETREATMENT; PREVENTION; ATRACURIUM AB We questioned whether the side effects outweighed the advantages of priming doses of nondepolarizing neuromuscular relaxants in awake patients. We have assessed lung function and clinical evidence of muscle weakness in 10 elderly patients, eight women and two men, aged 67-78 yr, ASA grade I or II, before and 3 min after a priming dose (0.01 mg/kg) of vecuronium. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximum midexpiratory flow rate (MMEF), peak expiratory flow rate (PEFR), inspiratory capacity (IC), functional residual capacity (FRC), expiratory reserve volume (ERV), residual volume (RV), slow vital capacity (SVC), and total lung capacity (TLC) were measured by using a Morgan transfer test machine and oxygen saturation (SpO2) was measured by pulse oximetery. All the patients developed ptosis, six had diplopia and were unable to perform the Valsalva maneuver for 10 s, and four were unable to swallow or lift their head for >4 s, demonstrating significant muscle weakness. Significant reductions occurred in FVC, FEV1, FRC, ERV, SVC, and TLC. SpO2 decreased in 8 of 10 patients, and in 4 the decrease exceeded 4%. We conclude that priming with vecuronium 0.01 mg/kg in elderly patients causes significant impairment of lung function and a significant decrease in oxygen saturation. RP MAHAJAN, RP (reprint author), UNIV NOTTINGHAM,QUEENS MED CTR,DEPT ANAESTHESIA,NOTTINGHAM NG7 2UH,ENGLAND. RI Mahajan, Ravi/G-9960-2011 NR 27 TC 10 Z9 11 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1993 VL 77 IS 6 BP 1198 EP 1202 PG 5 WC Anesthesiology SC Anesthesiology GA MK048 UT WOS:A1993MK04800020 ER PT J AU DHONNEUR, G KHALIL, M DOMINIQUE, C HABERER, JP KLEEF, UW DUVALDESTIN, P AF DHONNEUR, G KHALIL, M DOMINIQUE, C HABERER, JP KLEEF, UW DUVALDESTIN, P TI PHARMACOKINETICS AND PHARMACODYNAMICS OF PIPECURONIUM IN PATIENTS WITH CIRRHOSIS SO ANESTHESIA AND ANALGESIA LA English DT Article ID RENAL-FAILURE; VECURONIUM; BROMIDE; PANCURONIUM; LIVER; CHROMATOGRAPHY; DISPOSITION AB To determine the effect of liver cirrhosis on the pharmacokinetics and pharmacodynamics of pipecuronium, the authors administered 100 mug/kg of pipecuronium intravenously to eight patients with liver cirrhosis and eight patients with normal liver and renal function undergoing elective abdominal surgery. All patients were anesthetized with thiopental (5-7 mg/kg), nitrous oxide (50-70% in oxygen), and fentanyl in repeated doses (2 mug/kg). Plasma concentrations of pipecuronium were determined by high-pressure liquid chromatography. A two-compartment open model was used for pharmacokinetic analysis. Thumb-elicited mechanical response to single-twitch ulnar nerve stimulation was also measured. Total plasma clearance did not differ between controls (2.96 +/- 1.05 mL.min-1.kg-1, mean +/- SD) and cirrhotics (2.61 +/- 1.16 mL.min-1.kg-1). Terminal elimination half-life was 111 +/- 46 min in controls and 143 +/- 25 min in cirrhotics. The total apparent volume of distribution at steady state did not differ between controls (350 +/- 81 mL/kg) and cirrhotics (452 +/- 222 mL/kg). The volume of the central compartment was not different between the two groups. The onset of neuromuscular blocking effect was longer in cirrhotics (233 +/- 112 s) (P < 0.05) than in controls (170 +/- 33 s). The clinical duration (injection until single twitch returned to 25%) was similar between the two groups: 167 +/- 41 min in controls and 165 +/- 48 min in cirrhotics. The authors conclude that hepatic insufficiency due to cirrhosis does not alter the pharmacokinetics and pharmacodynamics of pipecuronium (100 mug/kg). C1 UNIV PARIS 12,HENRI MONDOR HOSP,DEPT ANESTHESIA,F-94010 CRETEIL,FRANCE. BRABOIS HOSP,DEPT ANESTHESIA,VANDOEUVRE NANCY,FRANCE. UNIV GRONINGEN,EXPTL & CLIN PHARMACOL RES GRP,9700 AB GRONINGEN,NETHERLANDS. NR 15 TC 5 Z9 5 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1993 VL 77 IS 6 BP 1203 EP 1206 PG 4 WC Anesthesiology SC Anesthesiology GA MK048 UT WOS:A1993MK04800021 ER PT J AU KALMAN, SH ERIKSSON, LI LENNMARKEN, C BENGTSSON, M AF KALMAN, SH ERIKSSON, LI LENNMARKEN, C BENGTSSON, M TI HALOTHANE-DIETHYL ETHER AZEOTROPE ANESTHESIA UNDER PRIMITIVE CONDITIONS - GUIDELINES FOR NEUROMUSCULAR BLOCKADE WITH VECURONIUM SO MILITARY MEDICINE LA English DT Article AB The dose-response relationship for vecuronium during anesthesia with the azeotropic mixture of halothane and diethyl ether (HE] (66 ml of halothane mixed with 34 ml of ether in the same bottle) / oxygen was compared with halothane/nitrous oxide/ oxygen anesthesia. The HE is not explosive and has preserved many of the advantageous properties of diethyl ether, making it an attractive anesthetic drug under difficult circumstances such as war or civil disaster. If muscular relaxation is needed in military anesthesia, it is essential to use a short- to medium-acting compound that can be stored without refrigeration. Veeuronium bromide fulfills these criteria. The study was conducted on 20 young (mean 24 years, range 18-31), ASA I patients. Using adductor pollicis mechanomyography and a cumulative dose technique, individual dose-response curves for vecuronium were constructed. Care was taken to keep peripheral and cole temperatures normal and the times of exposure to inhalational gases equal. The results were analyzed by the log-probit method. During HE anesthesia, ED(50) for vecuronium was 22 +/- 2 mu g kg(-1) (mean +/- SE) and ED(90) was 49 +/- 8 mu g kg(-1). During halothane/nitrous oxide anesthesia, ED(50) for vecuronium was 18 +/- 2 mu g kg(-1) (mean +/- SE) and ED(90) was 39 +/- 7 mu g kg(-1). The dose-response relationships for vecuronium were similar during HE anesthesia and halothane/nitrous oxide anesthesia. RP KALMAN, SH (reprint author), UNIV LINKOPING HOSP,FAC HLTH SCI,DEPT ANAESTHESIA,S-58185 LINKOPING,SWEDEN. NR 0 TC 1 Z9 1 PU ASSN MILITARY SURG US PI BETHESDA PA 9320 OLD GEORGETOWN RD, BETHESDA, MD 20814 SN 0026-4075 J9 MIL MED JI Milit. Med. PD DEC PY 1993 VL 158 IS 12 BP 778 EP 781 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA MQ208 UT WOS:A1993MQ20800009 ER PT J AU KLEEF, UW PROOST, JH ROGGEVELD, J AF KLEEF, UW PROOST, JH ROGGEVELD, J TI DETERMINATION OF ROCURONIUM AND ITS PUTATIVE METABOLITES IN BODY-FLUIDS AND TISSUE-HOMOGENATES SO JOURNAL OF CHROMATOGRAPHY-BIOMEDICAL APPLICATIONS LA English DT Article ID PERFORMANCE LIQUID-CHROMATOGRAPHY; VECURONIUM; ORG-9426; PLASMA; AGENT AB A sensitive and selective HPLC method was developed for the quantification of the neuromuscular blocking agent rocuronium and its putative metabolites (the 17-desacetyl derivative and the N-desallyl derivative of rocuronium) in plasma, urine, bile, tissue homogenates and stoma fluid. Samples were prepared by extraction of the biological matrix with dichloromethane, after mixing with a KI-glycine buffer. After evaporation of the organic solvent the samples were chromatographed on a reversed-phase HPLC column, using an aqueous buffer-dioxane (84:16, v/v) as the mobile phase. The aqueous buffer consisting of 0.1 M sodium dihydrogen phosphate, 0.11 mM 9,10-dimethoxyanthracene-2-sulphonate (DAS), 0.11 mM 1-heptane-sulfonic acid, was adjusted to pH 3 with orthophosphoric acid. After separation, the eluent was extracted with dichloroethane, and the organic phase was led to a fluorimetric detector, operating at 385 nm (excitation) and 452 nm (emission). The method was validated for the assay in plasma, urine, bile, tissue homogenates and stoma fluid, by determination of the repeatability, reproducibility, accuracy, lower limit of quantification, lower limit of detection, extraction recovery, effect of sample volume, and stability in the biological matrix. The method was found to be sensitive (lower limit of quantification for rocuronium in plasma is 10 ng/ml) and accurate. The interference of concomitant drugs with the assay of rocuronium and its putative metabolites has been studied extensively. In order to confirm the identity of rocuronium and its putative metabolites, a TLC method was developed. The method has been applied successfully in several pharmacokinetic studies with rocuronium. C1 UNIV GRONINGEN,UNIV CTR PHARM,DEPT PHARMACOL & THERAPEUT,9713 AW GRONINGEN,NETHERLANDS. RP KLEEF, UW (reprint author), UNIV HOSP GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,OOSTERSINGEL 59,9713 EZ GRONINGEN,NETHERLANDS. NR 11 TC 42 Z9 45 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0378-4347 J9 J CHROMATOGR-BIOMED JI J. Chromatogr.-Biomed. Appl. PD NOV 17 PY 1993 VL 621 IS 1 BP 65 EP 76 DI 10.1016/0378-4347(93)80077-H PG 12 WC Chemistry, Analytical SC Chemistry GA MP719 UT WOS:A1993MP71900009 ER PT J AU ENGBAEK, J SKOVGAARD, LT FRIES, B KANN, T VIBYMOGENSEN, J AF ENGBAEK, J SKOVGAARD, LT FRIES, B KANN, T VIBYMOGENSEN, J TI MONITORING OF NEUROMUSCULAR-TRANSMISSION BY ELECTROMYOGRAPHY .2. EVOKED COMPOUND EMG AREA, AMPLITUDE AND DURATION COMPARED TO MECHANICAL TWITCH RECORDING DURING ONSET AND RECOVERY OF PANCURONIUM-INDUCED BLOCKADE IN THE CAT SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE MONITORING, NERVE, ELECTROMYOGRAPHY, MECHANOMYOGRAPHY; NEUROMUSCULAR RELAXANT, PANCURONIUM; NEUROMUSCULAR TRANSMISSION ID ADDUCTOR POLLICIS; ATRACURIUM; VECURONIUM; RESPONSES; TUBOCURARINE; ANESTHESIA; CHILDREN; INFANTS; FADE AB The feasibility Of the compound electromyogram (EMG) was evaluated during onset and recovery from pancuronium block in the tibialis anterior muscle of ten cats. The evoked EMG area, amplitude and duration of the total response and of the major negative deflection were evaluated and compared to the mechanomyogram during 0.1 Hz and train-of-four (TOF) stimulation. EMG areas and amplitudes were found to be linearly and similarly related to the mechanomyogram during onset and recovery. Slopes of the regression lines ranged between 1.00-1.02 and between 1.10-1.22 during onset and recovery, respectively, with high individual correlation coefficients (> 0.95). The TOF ratio of the mechanomyogram was linearly related to the EMG TOF ratio during onset and to the square root of the EMG TOF ratio during recovery, with no differences between EMG areas and amplitudes, suggesting a higher initial recovery of the TOF ratio of the mechanomyogram during recovery. EMG duration increased as the level of block increased but was unsuitable for neuromuscular monitoring. Evaluation of the agreement between the two methods showed that the EMG may be from 15% below to 10% above the mechanomyogram during onset and from 40% below to 45% above the mechanomyogram during recovery, in spite of high correlation coefficients. In contrast, agreement between EMG parameters was found to be high. In conclusion, EMG is more reliable than the mechanomyogram for evaluation of neuromuscular transmission in the cat. EMG amplitudes and areas both reflect the degree of neuromuscular blockade equally well. C1 UNIV COPENHAGEN,RIGSHOSP,DEPT ANAESTHESIA,DK-2100 COPENHAGEN,DENMARK. PANUM INST,STAT RES UNIT,COPENHAGEN,DENMARK. HERLEV HOSP,DEPT ANAESTHESIA,DK-2730 HERLEV,DENMARK. NR 38 TC 12 Z9 12 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 1993 VL 37 IS 8 BP 788 EP 798 PG 11 WC Anesthesiology SC Anesthesiology GA MJ509 UT WOS:A1993MJ50900014 ER PT J AU MADDINENI, VR MIRAKHUR, RK MCCOY, EP FEE, JPH CLARKE, RSJ AF MADDINENI, VR MIRAKHUR, RK MCCOY, EP FEE, JPH CLARKE, RSJ TI NEUROMUSCULAR EFFECTS AND INTUBATING CONDITIONS FOLLOWING MIVACURIUM - A COMPARISON WITH SUXAMETHONIUM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR; RELAXANTS, MIVACURIUM; SUXAMETHONIUM; INTUBATION, TRACHEAL ID NITROUS-OXIDE FENTANYL; CHLORIDE BW B1090U; ENFLURANE ANESTHESIA; CLINICAL-PHARMACOLOGY; SURGICAL PATIENTS; ATRACURIUM; BLOCKADE; SUCCINYLCHOLINE; THIOPENTONE; ISOFLURANE C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. NR 30 TC 35 Z9 35 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD NOV PY 1993 VL 48 IS 11 BP 940 EP 945 PG 6 WC Anesthesiology SC Anesthesiology GA MF659 UT WOS:A1993MF65900002 ER PT J AU MAGORIAN, T FLANNERY, KB MILLER, RD AF MAGORIAN, T FLANNERY, KB MILLER, RD TI COMPARISON OF ROCURONIUM, SUCCINYLCHOLINE, AND VECURONIUM FOR RAPID-SEQUENCE INDUCTION OF ANESTHESIA IN ADULT PATIENTS SO ANESTHESIOLOGY LA English DT Article DE ANESTHETIC TECHNIQUES, RAPID-SEQUENCE INDUCTION; NEUROMUSCULAR RELAXANTS, ORG-9426 (ROCURONIUM); SUCCINYLCHOLINE; VECURONIUM ID TRACHEAL INTUBATION; MUSCLE-RELAXANTS; ORG-9426; PROPOFOL; PHARMACOKINETICS; PANCURONIUM; THIOPENTONE; AGENT AB Background: Succinylcholine has been the agent of choice when clinical conditions require emergency airway protection during a rapid-sequence induction of anesthesia. Rocuronium, a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reactions associated with succinylcholine, may be an alternative to succinylcholine. To test this hypothesis, the authors compared rocuronium with succinylcholine and vecuronium for rapid-sequence induction of anesthesia. Methods. Fifty patients, ASA 1-3, were randomly designated to receive one of three intravenous doses of rocuronium (0.6, 0.9, and 1.2 mg/kg), vecuronium (0.1 mg/kg), or succinylcholine (1.0 mg/kg). Patients were premedicated with midazolam and fentanyl, and received 2-7 mg/kg thiopental for induction of anesthesia. Sixty seconds after receiving a muscle relaxant, intubation of the trachea was attempted by a clinician who was blinded to the muscle relaxant administered. Neuromuscular monitoring was established before administration of the muscle relaxant. The time from injection of muscle relaxant until complete ablation of T1 (onset) and recovery of Tl to 25% (duration) were recorded. Tracheal intubating conditions were evaluated, and the presence or absence of fasciculations was noted. Results: Onset times for patients receiving 0.9 mg/kg (75 +/-28 s) and 1.2 mg/kg rocuronium (55 +/- 14 s), and succinylcholine 50 +/- 17 s) were similar. Onset times for the groups given 0.6 mg/kg rocuronium (89 +/- 33 s) and vecuronium (144 +/- 39 s) were significantly longer. Clinical duration of action was longest with 1.2 mg/kg rocuronium, similar with 0.6 and 0.9 mg/kg rocuronium, and vecuronium, and least with succinylcholine. Conclusions: There is a dose-dependent decrease in onset time with rocuronium. The onset times for the two larger doses of rocuronium were similar to that for succinylcholine, but clinical duration of action with rocuronium was significantly longer. The brief onset time achieved with rocuronium indicates that administration of 0.9-1.2 mg/kg is an acceptable alternative to succinylcholine for rapid-sequence induction of anesthesia. RP MAGORIAN, T (reprint author), UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,MT ZION,BOX 1610,1600 DIVISADERO,SAN FRANCISCO,CA 94115, USA. NR 13 TC 181 Z9 193 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1993 VL 79 IS 5 BP 913 EP 918 DI 10.1097/00000542-199311000-00007 PG 6 WC Anesthesiology SC Anesthesiology GA MF835 UT WOS:A1993MF83500006 ER PT J AU GOUDSOUZIAN, NG DENMAN, W SCHWARTZ, A SHORTEN, G FOSTER, V SAMARA, B AF GOUDSOUZIAN, NG DENMAN, W SCHWARTZ, A SHORTEN, G FOSTER, V SAMARA, B TI PHARMACODYNAMIC AND HEMODYNAMIC-EFFECTS OF MIVACURIUM IN INFANTS ANESTHETIZED WITH HALOTHANE AND NITROUS-OXIDE SO ANESTHESIOLOGY LA English DT Article DE ANESTHESIA, PEDIATRIC; INFANTS; NEUROMUSCULAR RELAXANTS; MIVACURIUM ID VECURONIUM INFUSION REQUIREMENTS; CHLORIDE BW B1090U; CLINICAL-PHARMACOLOGY; NARCOTIC ANESTHESIA; PEDIATRIC-PATIENTS; CHILDREN; BW-B1090U; ATRACURIUM; DURATION; AGENTS AB Background: The newly developed neuromuscular blocking agent, mivacurium, has been evaluated in adults and children, but there are no data on its effects in infants. This study was designed to evaluate the neuromuscular effects of mivacurium by dose-response analysis, and its cardiovascular effects in 90 infants 2-11 months of age anesthetized with 1% halothane and nitrous oxide:oxygen. Methods: The neuromuscular response was measured by recording the force of contraction of the adductor pollicis during train-of-four stimulation at 0.1 Hz. The infants were divided according to age into two equal groups of 45; group A infants were 2-6 months of age, and group B infants were 7-11 months of age. Each group was further subdivided into five subgroups of nine. Infants in group A received mivacurium at sequential doses of 40, 50, 55, 75, and 150 mug/kg, while those in group B received mivacurium at doses 40, 50, 60, 75, and 150 mug/kg. The first four doses in each group were used to determine dose-response relationships. The last two doses of 75 and 150 mug/kg were based on the observed preceding dose-response data to approximate the ED95 and 2XED95. Heart rate and blood pressure were determined every minute for a minimum of 3 min after mivacurium. Results. The effective doses for 50% depression of the first twitch response of the train-of-four (ED50) were 44-50 mug/kg (confidence limits 29-74 mug/kg), without any significant difference between groups A and B. In both groups, a larger dose of mivacurium, 150 mug/kg, caused complete ablation of the twitch response in 1.3 +/- 0.2 min (mean +/- SE) with recovery to 5, 25, and 95% of control in 7,6 +/- 0.5, 9.4 +/- 0.6, and 16.2 +/-0.9 min, respectively. In infants, the 25-75% recovery index was 3.8 +/- 0.4 min, and the 5-95% recovery index was 8.5 +/-0.8 min. In 28 infants, in whom surgical relaxation was required for more than 20 min, the infusion requirements to maintain 90-99% neuromuscular block in infants 2-6 and 7-11 months of age were 12.1 +/- 1 and 9.9 +/- 1 mug - kg-1 . min-1, respectively (NS). No significant changes of heart rate or blood pressure occurred in infants, except in the subgroup of infants 7-11 months of age who received 150 mug/kg mivacurium. In this group, a 13-mmHg increase in mean systolic blood pressure was seen without any significant change in diastolic pressure or heart rate. In addition, in 7 of 36 patients receiving 75-150 mug/kg mivacurium, a greater than 29% change in systolic or diastolic pressure occurred. One infant with cholinesterase deficiency had a prolonged neuromuscular block from mivacurium. Conclusions. The ED50 duration of action and infusion requirements of mivacurium in infants 2-6 months of age are comparable with those of infants 7-11 months of age. C1 BURROUGHS WELLCOME CO,RES TRIANGLE PK,NC 27709. RP GOUDSOUZIAN, NG (reprint author), HARVARD UNIV,MASSACHUSETTS GEN HOSP,SCH MED,BOSTON,MA 02114, USA. NR 20 TC 13 Z9 13 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1993 VL 79 IS 5 BP 919 EP 925 DI 10.1097/00000542-199311000-00008 PG 7 WC Anesthesiology SC Anesthesiology GA MF835 UT WOS:A1993MF83500007 ER PT J AU NAGUIB, M ABDULATIF, M ALGHAMDI, A HAMO, I NOUHEID, R AF NAGUIB, M ABDULATIF, M ALGHAMDI, A HAMO, I NOUHEID, R TI DOSE-RESPONSE RELATIONSHIPS FOR EDROPHONIUM AND NEOSTIGMINE ANTAGONISM OF MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, EDROPHONIUM; NEOSTIGMINE; MONITORING, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, MIVACURIUM CHLORIDE ID CHLORIDE BW B1090U; ATRACURIUM AB We have studied the dose-response relationships for neostigmine and edrophonium during antagonism of neuromuscular block induced by mivacurium chloride. Sixty-four ASA group I or II adults were given mivacurium 0.15 mg kg-1 during fentanyl-thiopentone-nitrous oxide-isoflurane anaesthesia. Train-of-four stimulation (TOF) was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. 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 16 subjects was allowed to recover spontaneously. Spontaneous recovery from 90% mivacurium block to 95% twitch height and TOF ratio 0. 75 occurred within 15 min. This study demonstrated that the dose-response, curves for these two drugs for antagonism of neuromuscular block (first twitch and train-of-four ratio) were parallel. The doses of neostigmine required to achieve 50% (ED50) and 70% (ED70) recovery of the first twitch after 10 min were 2 (1.5-2.5) mug kg-1 and 4.7 (4.1-5.4) mug kg-1 (mean (95% confidence intervals)), respectively. Corresponding ED50 and ED70 values for edrophonium were 2.8 (0.75-10.2) mug kg-1 and 9.2 (3.6-23.6) mug kg-1, respectively. These values corresponded to neostigmine:edrophonium potency ratios bf 1.4 (0.4-2.4) and 1.95 (0.9-2.9) for first twitch ED50 and ED70 height, respectively. The calculated doses producing 50% (ED50) recovery of the TOF ratio at 10 min were neostigmine 2.57 (1.8-3.6) mug kg-1 and edrophonium 26.9 (14.6-49.6) mug kg-1. These values corresponded to a potency ratio of 10.4 (0.7-20). RP NAGUIB, M (reprint author), UNITED ARAB EMIRATES UNIV,FAC MED & HLTH SCI,DEPT ANAESTHESIA & CRIT CARE MED,POB 17666,AL AIN,U ARAB EMIRATES. NR 18 TC 40 Z9 40 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 1993 VL 71 IS 5 BP 709 EP 714 DI 10.1093/bja/71.5.709 PG 6 WC Anesthesiology SC Anesthesiology GA ME830 UT WOS:A1993ME83000019 ER PT J AU BION, JF BOWDEN, MI CHOW, B HONISBERGER, L WEATHERLEY, BC AF BION, JF BOWDEN, MI CHOW, B HONISBERGER, L WEATHERLEY, BC TI ATRACURIUM INFUSIONS IN PATIENTS WITH FULMINANT HEPATIC-FAILURE AWAITING LIVER-TRANSPLANTATION SO INTENSIVE CARE MEDICINE LA English DT Article DE NEUROMUSCULAR RELAXANTS; ATRACURIUM; LAUDANOSINE; PHARMACOKINETICS; PHARMACODYNAMICS; LIVER FAILURE; RENAL FAILURE; DIALYSIS; INTENSIVE CARE; CRITICAL ILLNESS ID INTENSIVE-CARE; RENAL-FAILURE; LAUDANOSINE; PLASMA; PHARMACOKINETICS; SEDATION AB Objective: To determine the pharmacokinetics and pharmacodynamics of the neuromuscular blocking agent atracurium besylate in patients with fulminant hepatic failure (FHF). Design: Open study of patients receiving atracurium infusions to facilitate mechanical ventilation. Setting: Intensive care unit in a tertiary referral university teaching hospital. Patients: Ten encephalopathic patients with FHF requiring mechanical ventilation while awaiting orthotopic liver transplantation. Three patients died before transplantation could be performed, three died after transplantation, and four survived following successful transplantation. Methods: Plasma, urine and dialysate fluid were analysed for atracurium and its metabolites using HPLC. Neuromuscular blockade was measured using transcutaneous ulnar nerve stimulation and an accelerometer. Electroencephalography and liver function tests were performed daily. Results: Patients received atracurium infusions for a period ranging from 38 to 217 h. Six patients required continuous arteriovenous haemodiafiltration (CAVHD) to replace renal function. Atracurium mean steady state clearance was 8.6 ml/min/kg, and train-of-four recovery ratio to 75% took 63 min (range 32-108). Laudanosine clearance was markedly reduced in the non-survivors; the half-life was 38.5 hrs compared with 5.3 h in the 4 patients who underwent successful transplantation. Laudanosine accumulation could be observed in all patients before transplantation, but kinetics returned to normal after successful transplantation. The highest laudanosine level recorded was 6,860 ng/ml. There was no evidence of adverse central neurological effects attributable to laudanosine. CAVHD did not contribute significantly to clearance of atracurium or its metabolites. Conclusions: Atracurium kinetics and dynamics are near-normal even in patients with fulminant hepatic failure and renal failure; laudanosine accumulation will occur, but this is not associated with measurable central neurological effects. Implantation of a functioning liver graft results in clearance of laudanosine, which seems to be independent of renal function. Atracurium is an appropriate choice for producing neuromuscular blockade for periods of several days in patients with fulminant hepatic failure and renal impairment. C1 QUEEN ELIZABETH HOSP,INTENS CARE UNIT,BIRMINGHAM B15 2TH,W MIDLANDS,ENGLAND. QUEEN ELIZABETH HOSP,DEPT EEG & NEUROPHYSIOL,BIRMINGHAM B15 2TH,W MIDLANDS,ENGLAND. WELLCOME RES LABS,DEPT CLIN PHARMACOL,BECKENHAM BR3 3BS,KENT,ENGLAND. RP BION, JF (reprint author), UNIV BIRMINGHAM,QUEEN ELIZABETH HOSP,DEPT ANAESTHESIA & INTENS CARE,BIRMINGHAM B15 2TH,W MIDLANDS,ENGLAND. NR 14 TC 13 Z9 14 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0342-4642 J9 INTENS CARE MED JI Intensive Care Med. PD NOV PY 1993 VL 19 SU 2 BP S94 EP S98 DI 10.1007/BF01708809 PG 5 WC Critical Care Medicine SC General & Internal Medicine GA MK302 UT WOS:A1993MK30200013 ER PT J AU HUNTER, JM AF HUNTER, JM TI ATRACURIUM AND LAUDANOSINE PHARMACOKINETICS IN ACUTE-RENAL-FAILURE SO INTENSIVE CARE MEDICINE LA English DT Article ID INFUSION; PLASMA; HEMOFILTRATION; VECURONIUM; DRUGS; UNIT RP HUNTER, JM (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL UNIV HOSP,DEPT ANAESTHESIA,POB 147,LIVERPOOL L69 3BX,MERSEYSIDE,ENGLAND. NR 22 TC 5 Z9 5 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0342-4642 J9 INTENS CARE MED JI Intensive Care Med. PD NOV PY 1993 VL 19 SU 2 BP S91 EP S93 DI 10.1007/BF01708808 PG 3 WC Critical Care Medicine SC General & Internal Medicine GA MK302 UT WOS:A1993MK30200012 ER PT J AU SINE, SM AF SINE, SM TI MOLECULAR DISSECTION OF SUBUNIT INTERFACES IN THE ACETYLCHOLINE-RECEPTOR - IDENTIFICATION OF RESIDUES THAT DETERMINE CURARE SELECTIVITY SO PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA LA English DT Article ID GAMMA-SUBUNIT; DELTA-SUBUNIT; CDNA SEQUENCE; TORPEDO-CALIFORNICA; CELL-LINE; MUSCLE; BINDING; EXPRESSION; PRECURSOR; KINETICS AB The acetylcholine receptor from vertebrate skeletal muscle is a transmembrane channel that binds nerve-released acetylcholine to elicit rapid transport of small cations. Composed of two alpha subunits and one beta, one gamma, and one delta subunit, the receptor is a cooperative protein containing two sites that bind agonists, curariform antagonists, and snake alpha-toxins. Until recently the two binding sites were thought to reside entirely within each of the two alpha subunits, but affinity labeling and expression studies have demonstrated contributions by the gamma and delta subunits. Affinity labeling and mutagenesis studies have identified residues of the alpha subunit that contribute to the binding site, but the corresponding gamma- and delta-subunit residues remain unknown. By making gamma-delta chimeras and following the nearly 100-fold difference in curare affinity for the two binding sites, the present work identified residues of the gamma and delta subunits likely to be near the binding site. Two sets of binding determinants were identified in homologous positions of the gamma and delta subunits. The determinants lie on either side of a disulfide loop found within the major extracellular domain of the subunits. This loop is common to all acetylcholine, gamma-aminobutyrate, and glycine receptor subunits. RP SINE, SM (reprint author), MAYO CLIN & MAYO FDN,DEPT PHYSIOL & BIOPHYS,200 1ST ST SW,ROCHESTER,MN 55905, USA. NR 27 TC 172 Z9 172 PU NATL ACAD SCIENCES PI WASHINGTON PA 2101 CONSTITUTION AVE NW, WASHINGTON, DC 20418 SN 0027-8424 J9 P NATL ACAD SCI USA JI Proc. Natl. Acad. Sci. U. S. A. PD OCT 15 PY 1993 VL 90 IS 20 BP 9436 EP 9440 DI 10.1073/pnas.90.20.9436 PG 5 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA MC570 UT WOS:A1993MC57000043 ER PT J AU CHAN, KH YANG, MW HUANG, MH HSEU, SS CHANG, CC LEE, TY LIN, CY AF CHAN, KH YANG, MW HUANG, MH HSEU, SS CHANG, CC LEE, TY LIN, CY TI A COMPARISON BETWEEN VECURONIUM AND ATRACURIUM IN MYASTHENIA-GRAVIS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ELECTROMYOGRAPHY, TRAIN-OF-4 FADE; MUSCLE RELAXANTS, ATRACURIUM BESYLATE, VECURONIUM BROMIDE; MYASTHENIA GRAVIS; NEUROMUSCULAR JUNCTION, PREJUNCTIONAL EFFECT ID NEUROMUSCULAR-TRANSMISSION; REPETITIVE STIMULATION; TRAIN-OF-4 FADE; BLOCKING-DRUGS; TETANIC FADE; RAT; TUBOCURARINE; BLOCKADE; RECOVERY; PATIENT AB We evaluated the effect of vecuronium bromide and atracurium besylate on the train-of-four response in the management of muscle relaxation in 20 patients with myasthenia gravis (MG) who were undergoing thymectomy. We confirmed the safe use of these two non-depolarizing muscle relaxants in MG patients. Vecuronium (0.04 mg . kg-1) demonstrated a lesser clinical duration than did atracurium (0.2 mg . kg-1) (38 +/- 19 vs 50 +/- 21 min, mean +/- s.e.mean). The recovery time for vecuronium patients was shorter than that for atracurium patients (22 +/- 18 vs 38 +/- 18 min), but the time until onset of neuromuscular blockade was longer with vecuronium (246 +/- 105 vs 107 +/- 103 s). During spontaneous recovery from neuromuscular relaxation, at Tl/C of 25% and 100%, the train-of-four fade with vecuronium was significantly greater than that with atracurium (0.04 +/- 0.02, 0.16 +/- 0.03 vs 0.17 +/- 0.01, 0.83 +/- 0.03), suggesting that vecuronium had a greater prejunctional effect than did atracurium. C1 VET GEN HOSP,DEPT SURG,TAIPEI 11217,TAIWAN. UNIV CHICAGO HOSP & CLIN,DEPT ANAESTHESIA & CRIT CARE,CHICAGO,IL 60637. RP CHAN, KH (reprint author), VET GEN HOSP,DEPT ANAESTHESIOL,201 SHIH PAI RD,SECT 2,PEI TOU,TAIPEI 11217,TAIWAN. NR 24 TC 4 Z9 4 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 OCT PY 1993 VL 37 IS 7 BP 679 EP 682 PG 4 WC Anesthesiology SC Anesthesiology GA MA322 UT WOS:A1993MA32200009 ER PT J AU MANGAT, PS EVANS, DEN HARMER, M LUNN, JN AF MANGAT, PS EVANS, DEN HARMER, M LUNN, JN TI A COMPARISON BETWEEN MIVACURIUM AND SUXAMETHONIUM IN CHILDREN SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; MIVACURIUM, SUXAMETHONIUM; SURGERY; CHILDREN, OTORHINOLARYNGEAL ID SUCCINYLCHOLINE; ATRACURIUM; INFUSION; CHLORIDE C1 UNIV WALES COLL MED,DEPT ANAESTHET,CARDIFF CF4 4XN,S GLAM,WALES. RP MANGAT, PS (reprint author), ADDENBROOKES HOSP,DEPT ANAESTHET,HILLS RD,CAMBRIDGE CB2 2QQ,ENGLAND. NR 13 TC 10 Z9 10 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD OCT PY 1993 VL 48 IS 10 BP 866 EP 869 DI 10.1111/j.1365-2044.1993.tb07415.x PG 4 WC Anesthesiology SC Anesthesiology GA MA055 UT WOS:A1993MA05500006 ER PT J AU GOPINATH, S HOOD, JR ULHAQ, M CAMPKIN, NT FELDMAN, SA AF GOPINATH, S HOOD, JR ULHAQ, M CAMPKIN, NT FELDMAN, SA TI EFFECT OF VOLUNTARY TETANUS ON RECOVERY OF VECURONIUM BLOCK IN THE ISOLATED FOREARM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; VECURONIUM; NEUROMUSCULAR TRANSMISSION; TETANUS RP GOPINATH, S (reprint author), CHELSEA & WESTMINSTER HOSP,MAGILL DEPT ANAESTHET,369 FULHAM RD,LONDON SW10 9HN,ENGLAND. NR 7 TC 0 Z9 0 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD OCT PY 1993 VL 48 IS 10 BP 870 EP 872 DI 10.1111/j.1365-2044.1993.tb07416.x PG 3 WC Anesthesiology SC Anesthesiology GA MA055 UT WOS:A1993MA05500007 ER PT J AU KHUENLBRADY, KS POMAROLI, A PUHRINGER, F MITTERSCHIFFTHALER, G KOLLER, J AF KHUENLBRADY, KS POMAROLI, A PUHRINGER, F MITTERSCHIFFTHALER, G KOLLER, J TI THE USE OF ROCURONIUM (ORG-9426) IN PATIENTS WITH CHRONIC-RENAL-FAILURE SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; ROCURONIUM; COMPLICATIONS; RENAL FAILURE ID NITROUS-OXIDE; PHARMACOKINETICS; VECURONIUM; TIME; PHARMACODYNAMICS; ATRACURIUM; ISOFLURANE; HALOTHANE; DURATION; BROMIDE RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK, ANAESTHESIA & GEN INTENS CARE MED CLIN, ANICHSTR 35, A-6020 INNSBRUCK, AUSTRIA. NR 19 TC 21 Z9 22 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD OCT PY 1993 VL 48 IS 10 BP 873 EP 875 DI 10.1111/j.1365-2044.1993.tb07417.x PG 3 WC Anesthesiology SC Anesthesiology GA MA055 UT WOS:A1993MA05500008 ER PT J AU WOELFEL, SK BRANDOM, BW MCGOWAN, FX COOK, DR AF WOELFEL, SK BRANDOM, BW MCGOWAN, FX COOK, DR TI CLINICAL-PHARMACOLOGY OF MIVACURIUM IN PEDIATRIC-PATIENTS LESS-THAN 2 YEARS OLD DURING NITROUS OXIDE-HALOTHANE ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANESTHETIZED INFANTS; NARCOTIC ANESTHESIA; NEUROMUSCULAR BLOCKADE; CONTINUOUS INFUSION; SURGICAL PATIENTS; CHILDREN; ATRACURIUM; VECURONIUM; PHARMACOKINETICS; REQUIREMENTS AB We determined the dose-response relationship of mivacurium in infants 2-6 and 7-11 mo of age during nitrous oxide-halothane anesthesia. The neuromuscular and cardiovascular effects of a bolus dose of mivacurium larger than the ED95 in infants and young children from 2-23 mo of age were observed. The infusion rate of mivacurium required to maintain approximately 95% neuromuscular block was determined. There was no significant difference between the estimated dose-response relationship in infants 2-6 mo and that in infants 7-11 mo. The ED50 and ED95 were 44 mug/kg and 85 mug/kg for infants 2-11 mo (n = 70), r = 0.53. A bolus dose of 150 mug/kg mivacurium in infants (2-6 mo) produced 100% depression of the initial twitch height (T1) in 8 out of 9 infants and 85% depression in 1 infant. The time to onset of maximum block was 1.6 +/- 0.3 (0.7-2.7) (mean, SEM [range]) min, and time to recovery to 25% of T1 (T25) was 7.5 +/- 0.7 (5.5-11) min after 150 mug/kg in these patients. A bolus dose of 200 mug/kg mivacurium in infants and young children (7-23 mo) produced 100% depression of T1 in 14 of 17 patients, 97% depression in 2, and 90% depression in 1. The time to onset of maximum block was 1.5 +/- 0.1 (0.8-3) min and T25 was 10.3 +/- 1.5 (4.8-30.5) min after 200 mug/kg in these patients. Statistically significant cardiovascular changes were a small decrease in diastolic blood pressure and a small increase in heart rate in the 5-min interval after administration of 200 mug/kg mivacurium. The average infusion rate required to maintain approximately 95% depression of T1 in 20 patients (2-23 mo) during the first 15 min of infusion was 15.6 +/- 1.0 (7-25.9) mug-kg-1.min-1 and 13.6 +/- 1.0 (4.1-26) mug.kg-1.min-1 thereafter. After termination of the infusion, spontaneous recovery of T1 from 25% to 75% (T25-75) occurred in 3.6 +/- 0.2 (2.7-5.2) n-dn, and time to train-of-four ratio more than or equal to 0.75 (T4/T1 greater-than-or-equal-to 0.75) was 8.0 +/- 0.6 (6-11.5) min. The average plasma cholinesterase activity was 6.0 +/- 0.2 (2.7-13.3) U/L. One child with plasma cholinesterase activity more than 3 SD above the mean (13.3 U/L) received an average of 32 mug.kg-1.min-1 mivacurium infusion without achieving 89% block. Mivacurium is a relatively short-acting nondepolarizing muscle relaxant that has minimal cardiovascular effects when administered in doses up to and including 200 mug/kg in infants and young children. There were no significant differences in-the neuromuscular effects of a bolus or infusion of mivacurium in patients aged between 2 mo and 10 yr in pediatric patients anesthetized with halothane and nitrous oxide. RP WOELFEL, SK (reprint author), CHILDRENS HOSP PITTSBURGH,DEPT ANESTHESIOL,3705 5TH AVE DESOTO ST,PITTSBURGH,PA 15213, USA. NR 27 TC 10 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 1993 VL 77 IS 4 BP 713 EP 720 PG 8 WC Anesthesiology SC Anesthesiology GA MA357 UT WOS:A1993MA35700010 ER PT J AU UNGUREANU, D MEISTELMAN, C FROSSARD, J DONATI, F AF UNGUREANU, D MEISTELMAN, C FROSSARD, J DONATI, F TI THE ORBICULARIS OCULI AND THE ADDUCTOR POLLICIS MUSCLES AS MONITORS OF ATRACURIUM BLOCK OF LARYNGEAL MUSCLES SO ANESTHESIA AND ANALGESIA LA English DT Article ID VECURONIUM NEUROMUSCULAR BLOCKADE; NERVE-STIMULATION; DIAPHRAGM; PANCURONIUM; POTENCY; HUMANS AB The aim of this study was to determine whether atracurium-induced neuromuscular block at the laryngeal adductor muscles could be predicted by visual inspection of either adductor pollicis or orbicularis oculi responses. Twenty-one ASA Class I or II patients were anesthetized with propofol (2-2.5 mg/kg) and fentanyl (2-5 mug/kg). Tracheal intubation was performed without neuromuscular blocking drugs. Patients were assigned randomly to receive atracurium 0.3 or 0.5 mg/kg intravenously. Train-of-four stimulation was applied to the ulnar, facial, and recurrent laryngeal nerves. Laryngeal response was measured as the pressure change in the tracheal tube cuff positioned between the vocal cords. The response at the adductor pollicis and orbicularis oculi was evaluated visually by two observers who detected if and when block was complete. Twelve patients, including all those receiving 0.5 mg/kg, had complete orbicularis oculi block. The same patients, except one, also had 100% laryngeal block. Adductor pollicis response was abolished in the same 12 patients plus an additional 4 patients. In patients receiving atracurium 0.5 mg/kg, laryngeal and orbicularis oculi responses were abolished faster (mean +/- SD: 132 +/- 80 and 146 +/- 58 s, respectively) than the adductor pollicis muscle (243 +/- 55 s; P < 0.05). There was a significant correlation (r = 0.94; P < 0.001) between neuromuscular block onset time at the laryngeal adductor and orbicularis oculi muscles but not between laryngeal and thumb muscles. The authors conclude that, after injection of atracurium, laryngeal adductor and orbicularis oculi blocks have similar intensities and time courses. Thus, the orbicularis oculi is a better monitor of the onset of atracurium block at the vocal cords than the adductor pollicis. C1 INST GUSTAVE ROUSSY,DEPT ANESTHESIA,RUE CAMILLE DESMOULINS,F-94805 VILLEJUIF,FRANCE. MCGILL UNIV,DEPT ANESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 19 TC 30 Z9 30 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 1993 VL 77 IS 4 BP 775 EP 779 PG 5 WC Anesthesiology SC Anesthesiology GA MA357 UT WOS:A1993MA35700021 ER PT J AU NAGUIB, M ABDULATIF, M ALGHAMDI, A AF NAGUIB, M ABDULATIF, M ALGHAMDI, A TI DOSE-RESPONSE RELATIONSHIPS FOR EDROPHONIUM AND NEOSTIGMINE ANTAGONISM OF ROCURONIUM BROMIDE (ORG-9426)-INDUCED NEUROMUSCULAR BLOCKADE SO ANESTHESIOLOGY LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, EDROPHONIUM; NEOSTIGMINE; MONITORING, TRAIN-OF-4 NEUROMUSCULAR RELAXANTS, ROCURONIUM BROMIDE (ORG-9426) ID ENFLURANE ANESTHESIA; ATRACURIUM; REVERSAL; ORG-9426; PHARMACOKINETICS; PANCURONIUM; ISOFLURANE; ORG9426; AGENT AB Background. Rocuronium bromide (ORG 9426) is a new nondepolarizing muscle relaxant with a rapid onset but an intermediate duration of action. The dose-response relationships for neostigmine and edrophonium were studied during antagonism of neuromuscular block induced by rocuronium bromide. Methods: Sixty-four ASA physical status 1 or 2 adults were given 0.6 mg/kg rocuronium bromide during thiopental-fentanyl-nitrous oxide-isoflurane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. 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) or neostigmine (0.005, 0.01, 0.02, or 0.05 mg/kg) was administered by random allocation. Neuromuscular function in another eight subjects was allowed to recover spontaneously. Assisted recovery was defined as actual recovery minus mean spontaneous recovery in patients who were not given antagonists. Results: The dose-response curves for neostigmine- and edrophonium-assisted antagonism of rocuronium bromide neuromuscular blockade for the single twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% and 80% recovery (ED50 and ED80, respectively) of the first twitch after 10 min were 0.017 (0.001) and 0.033 (0.001) mg/kg (mean (standard error of estimate for the mean)), respectively. Corresponding ED50 and ED80 values for edrophonium were 0.161 (0.001) and 0.690 (0.001) mg/kg. respectively. These values corresponded to neostigmine:edrophonium potency ratios of 9.5 (0.56) and 21 (0.67) for first twitch ED50 and ED50 height, respectively. The calculated doses producing ED50 of the TOF ratio at 10 min were 0.017 (0.001) and 0.469 (0.001) mg/kg for neostigmine and edrophonium, respectively. These values corresponded to a potency ratio of 27.5 (1.66). Conclusions. Under the conditions described in this study, if reversal was attempted at 10% first twitch recovery, edrophonium was less capable than neostigmine of reversing fade (potency ratio of 19.2 and 27.5 at 5 and 10 min, respectively) than first twitch (potency ratio of 6.7 and 9.5 at 5 and 10 min, respectively) during antagonism of rocuronium bromide-induced blockade. Edrophonium was found to be less effective than neostigmine at reversing rocuronium bromide-induced TOF fade. RP NAGUIB, M (reprint author), UNITED ARAB EMIRATES UNIV,FAC MED & HLTH SCI,DEPT ANAESTHESIA & CRIT CARE MED,POB 17666,AL AIN,U ARAB EMIRATES. NR 24 TC 19 Z9 19 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 1993 VL 79 IS 4 BP 739 EP 745 DI 10.1097/00000542-199310000-00016 PG 7 WC Anesthesiology SC Anesthesiology GA MA814 UT WOS:A1993MA81400015 ER PT J AU FLORMANN, P SHAW, A AF FLORMANN, P SHAW, A TI MINIMIZATION OF COMPOSITION SENSITIVITY WITH A STRONTIUM-90/CURIUM-244 (X-RAY) THICKNESS GAUGE IN THE MEASURING RANGE 0-2 MM SO APPLIED RADIATION AND ISOTOPES LA English DT Article; Proceedings Paper CT 2ND TOPICAL MEETING ON INDUSTRIAL RADIATION AND RADIOISOTOPE MEASUREMENT APPLICATIONS CY SEP 08-11, 1992 CL RALEIGH, NC SP AMER NUCL SOC, ISOTOPES & RADIAT DIV, AMER NUCL SOC, E CAROLINAS SECT, N CAROLINA STATE UNIV, CTR ENGN APPLICAT RADIOISOTOPES, TROXLER ELECTR LABS, TELEDYNE CORP, INT BUSINESS MACHINES, REUTER STOKES, SCHLUMBERGER DOLL RES AB A method of automatically correcting errors caused by variations in the composition of aluminium strip, thickness range 0-2 mm, passing through a rolling mill is described in this paper. RP FLORMANN, P (reprint author), ISOTOPE MEASURING SYST LTD,22 QUARRY PK CLOSE,MOULTON PK IND ESTATE,NORTHAMPTON NN3 1QB,ENGLAND. NR 0 TC 0 Z9 0 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 0969-8043 J9 APPL RADIAT ISOTOPES JI Appl. Radiat. Isot. PD OCT-NOV PY 1993 VL 44 IS 10-11 BP 1255 EP 1261 PG 7 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging SC Chemistry; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging GA LZ642 UT WOS:A1993LZ64200002 ER PT J AU NAGUIB, M ABDULATIF, M AF NAGUIB, M ABDULATIF, M TI ISOBOLOGRAPHIC AND DOSE-RESPONSE ANALYSIS OF THE INTERACTION BETWEEN PIPECURONIUM AND VECURONIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE INTERACTIONS (DRUG), PIPECURONIUM; VECURONIUM; NEUROMUSCULAR RELAXANTS, PIPECURONIUM; VECURONIUM; POTENCY, ED(50) ID INDUCED NEUROMUSCULAR BLOCKADE; HALOTHANE ANESTHESIA; D-TUBOCURARINE; NITROUS-OXIDE; PANCURONIUM; ISOFLURANE; POTENTIATION; COMBINATION; ENFLURANE; FENTANYL AB We have studied the neuromuscular effects of pipecuronium, vecuronium and their combination in 130 ASA group I or II patients. Patients were anaesthetized with 0.8 % halothane and 60 % nitrous oxide in oxygen. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 10-s intervals). The dose-response curves were determined by probit analysis. The calculated doses producing 50 % depression of the first twitch height were 15.6, 16.9 and 15.0 mug kg-1 for the pipecuronium, vecuronium and pipecuronium-vecuronium combination groups, respectively. Isobolographic and algebraic (fractional) analyses were used to assess quantitatively the combined neuromuscular effect of pipecuronium and vecuronium and to define the type of interaction between these drugs. The interaction between pipecuronium and vecuronium was found to be additive. RP NAGUIB, M (reprint author), UNITED ARAB EMIRATES UNIV,FAC MED & HLTH SCI,DEPT ANAESTHESIA & CRIT CARE MED,POB 17666,AL AIN,U ARAB EMIRATES. NR 23 TC 17 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 OCT PY 1993 VL 71 IS 4 BP 556 EP 560 DI 10.1093/bja/71.4.556 PG 5 WC Anesthesiology SC Anesthesiology GA MA831 UT WOS:A1993MA83100019 ER PT J AU YOUSSEF, SAH RAMADAN, A IBRAHIM, EIS AF YOUSSEF, SAH RAMADAN, A IBRAHIM, EIS TI COMPARATIVE NEUROMUSCULAR BLOCKING POTENCY OF PIPECURONIUM AND PANCURONIUM SO DEUTSCHE TIERARZTLICHE WOCHENSCHRIFT LA English DT Article AB The effects of pipecuronium bromide (Pi.) and pancuronium bromide (Pa.) on the contractile response of rat-phrenic nerve diaphragm and frog's musculus rectus adominis preparation were studied. Pi. and Pa. were found to have a dose-dependent reduction in the contractile response of the tested preparation. Trials were made to estimate the potency of Pi. in a comparison with Pa. In this respect Pi. exhibited a more potent effect than Pa. The duration of action is about twice as long as that of Pa. in equieffective doses. Neostigmine rapidly and completely antagonises the neuromuscular blockade caused by Pi. and Pa. C1 CAIRO UNIV,FAC VET MED,DEPT PHARMACOL,GIZA,EGYPT. AL-AZHAR UNIV,DEPT ANAESTHESIA,CAIRO,EGYPT. NR 6 TC 0 Z9 0 PU M H SCHAPER GMBH CO KG PI ALFELD PA POSTFACH 16 42 16 52 KALANDSTRASSE 4, W-3220 ALFELD, GERMANY SN 0341-6593 J9 DEUT TIERARZTL WOCH JI Dtsch. Tierarztl. Wochenschr. PD OCT PY 1993 VL 100 IS 10 BP 396 EP 398 PG 3 WC Veterinary Sciences SC Veterinary Sciences GA MH344 UT WOS:A1993MH34400003 ER PT J AU MANGAR, D TURNAGE, WS CONNELL, GR GRAUBERT, D AF MANGAR, D TURNAGE, WS CONNELL, GR GRAUBERT, D TI PANCURONIUM, VECURONIUM, AND HEART-RATE DURING ANESTHESIA FOR AORTOCORONARY BYPASS OPERATIONS SO EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY LA English DT Article DE MUSCLE RELAXANTS; PANCURONIUM; VECURONIUM; FENTANYL; HEART RATE; CARDIAC ANESTHESIA AB To determine the effects of pancuronium and vecuronium on heart rate, 90 patients scheduled for aortocoronary bypass were randomly assigned to one of three groups (30 patients each) which received vencuronium 100 mug[sdot ]kg-1, pancuronium 100 mug[sdot ]kg-1, or a mixture of vecuronium (50 mug[sdot ]kg-1) and pancuronium (50 mug[sdot ]kg-1) in a double-blind fashion during induction of anesthesia. All patients were premedicated with lorazepam prior to surgery, hence avoiding the effects of scopolamine. Our results showed no significant increase in heart rate from the administration of pancuronium, following administration of this drug the heart rate increased by only four beats per minute. The heart rate was unchanged after the mixture, but decreased by twelve beats per minute after vecuronium (P < 0.05). The heart rate response differed by 16 beats per minute between pancuronium and vecuronium. All patients who received either of the neuromuscular relaxants and who were on beta blockers showed a decrease in heart rate. In this study, the administration of pancuronium after an adequate induction dose of fentanyl did not cause tachycardia. We therefore feel that pancuronium still has a role in cardiac anesthesia, especially as the newer muscle relaxants such as vecuronium, pipecuronium and doxacurium are significantly more expensive. RP MANGAR, D (reprint author), UNIV S FLORIDA,COLL MED,DEPT ANESTHESIOL,BOX 59,TAMPA,FL 33612, USA. NR 0 TC 0 Z9 0 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 1010-7940 J9 EUR J CARDIO-THORAC JI Eur. J. Cardio-Thorac. Surg. PD OCT PY 1993 VL 7 IS 10 BP 524 EP 527 DI 10.1016/1010-7940(93)90050-L PG 4 WC Cardiac & Cardiovascular Systems; Respiratory System; Surgery SC Cardiovascular System & Cardiology; Respiratory System; Surgery GA MC710 UT WOS:A1993MC71000006 ER PT J AU PIOTROWSKI, A AF PIOTROWSKI, A TI COMPARISON OF ATRACURIUM AND PANCURONIUM IN MECHANICALLY VENTILATED NEONATES SO INTENSIVE CARE MEDICINE LA English DT Article DE NEONATE; NEUROMUSCULAR BLOCKING AGENTS; ATRACURIUM; PANCURONIUM; MECHANICAL VENTILATION; GAS EXCHANGE; CIRCULATORY EFFECTS ID HYALINE-MEMBRANE DISEASE; PRETERM INFANTS; BLOOD-PRESSURE; HEART-RATE; PARALYSIS; CATECHOLAMINE; HYPERTENSION; FAILURE; BROMIDE AB Objective: To compare haemodynamic and gas exchange effects after either atracurium or pancuronium given to ventilated neonates with respiratory failure. Design: In this prospective study neonates were alternately assigned to receive either atracurium or pancuronium, intravenously. Setting: Paediatric and neonatal ICU in a teaching hospital. Patients: 21 ventilated neonates with mean birth weight of 2293 g, suffering from respiratory distress syndrome, meconium aspiration syndrome or pneumonia were included in the study. Patients were entered if they were breathing out of phase with the ventilator and required FIO2 > 0.4 and peak inspiratory pressure (PIP) > 15 cm H2O. Exclusion criteria were unstable haemodynamics or a pneumothorax. Interventions: Heart rate, respiratory rate, invasive blood pressure and transcutaneous oxygen tension were monitored continuously. IV atracurium (0.3 mg/kg) or pancuronium (0. 1 mg/kg) were administered. Arterial blood gas analysis was performed before and 10 min after injection of muscle relaxant. Measurements and results: Atracurium caused a significant decrease in heart rate (p < 0.05), systolic and mean blood pressure (p < 0.01). There was also a slight decrease in PaO2 and PaCO2 (n.s.). Administration of pancuronium resulted in an increase in heart rate (p < 0.01) and a slight decrease of blood pressure (n.s.). PaCO2 remained unchanged, whereas PaO2 increased slightly (n.s.). The PtcO2 index (PtCO2/PaO2) decreased after atracurium and did not change after pancuronium (both n.s.). With both drugs a slight increase in alveolar to arterial oxygen tension difference was observed (n.s.). There was one episode of hypotension and one of hypoxaemia - both after pancuronium. Conclusion: Both drugs may be used for muscle relaxation in neonates with respiratory failure. Atracurium however causes more cardiovascular depression, whereas the effect of pancuronium may be difficult to predict. RP PIOTROWSKI, A (reprint author), UNIV LODZ,HOSP PAEDIAT,MED ACAD LODZ,DEPT ANAESTHESIA & INTENS CARE,INTENS CARE UNIT,PL-91738 LODZ,POLAND. NR 33 TC 3 Z9 3 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0342-4642 J9 INTENS CARE MED JI Intensive Care Med. PD OCT PY 1993 VL 19 IS 7 BP 401 EP 405 DI 10.1007/BF01724880 PG 5 WC Critical Care Medicine SC General & Internal Medicine GA MB595 UT WOS:A1993MB59500009 ER PT J AU MAYER, M DOENICKE, A NEBAUER, AE ROSENBERGER, C LORENZ, W PETER, K AF MAYER, M DOENICKE, A NEBAUER, AE ROSENBERGER, C LORENZ, W PETER, K TI MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK IS NOT PROLONGED BY H-1/H-2-ANTAGONISTS SO ANAESTHESIST LA German DT Article DE NEUROMUSCULAR RELAXANTS; MIVACURIUM CHLORIDE; PHARMACODYNAMICS; H-1/H-2 ANTAGONISTS; RANITIDINE; DIMETINDENE ID HISTAMINE-RELEASE; CHLORIDE BW-B1090U; ATRACURIUM; ANESTHESIA; INFUSION; VECURONIUM; SUXAMETHONIUM; PHARMACOLOGY; RANITIDINE AB Duration of neuromuscular block may be prolonged by H-1/H-2 antagonists. This study was designed to determine the influence of H-1/H-2 antagonist treatment on onset, duration and recovery after mivacurium chloride (MIV), a new nondepolarizing neuromuscular blocking agent with a relatively short duration of action, which is metabolized by human plasma cholinesterase (PChE). Methods. After approval from the hospital ethical committee and written informed consent, 48 ASA I-II patients of either sex (ages 18-65 years, weight 45-100 kg) were included in this double blind study and randomly allocated to four groups of 12 each: group A, 0.105 mg/kg MIV (1.5 x ED95) and H-1/H-2 antagonist; group B, 0.105 mg/kg MIV and placebo; group C, 0.21 mg/kg MIV (3 x ED95) and H-1/H-2 antagonist; Group D 0.21 mg/kg MIV and placebo. Premedication consisted of 2 mg lormetazepam p.o., 300 mg ranitidine and 0.1 mg/kg dimetindene, or placebo p.o. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with N2O/O2 at a 65/35 ratio, enflurane (0.8-1.5%) and supplements of fentanyl. The ulnar nerve was stimulated with supramaximal 2 Hz train-of-four (TOF) every 10 s. Neuromuscular twitch response was recorded with EMG. Onset time (time from end of injection to maximal or total block), maximal block (%), T1 25 (time from end of injection to 25% recovery) were recorded after each dose, and recovery index (T1 from 25% to 75% recovery) and TOF70 (time from end of injection to TOF ratio of 70%), after the last dose. Results. The four groups did not differ with respect to age, weight or height. There was no difference in the pharmacodynamics of mivacurium between the groups receiving H-1/H-2 antagonists and those receiving placebo. Following 1.5 x ED95 the onset was at 3.7+/-1.2 (H-1/H-2) and 3.8+/-0.9 min (placebo), respectively. Clinical duration (T1 25) was 13.1+/-3.4 and 12.8+/-3.4 min. 3 x ED95 led to a significant faster onset and longer duration (P less-than-or-equal-to 0.05). Onset was at 1.9+/-0.7 (H-1/H-2) and 2.1+/-0.5 min (placebo), respectively, and clinical duration 19.1+/-6.1 and 19.3+/-3.8 min. Duration of repetitive doses (10.1+/-5.3 min), recovery index (6.8+/-2.9 min) and interval from last dose to spontaneous recovery (22.4+/-7.0 min) did not differ between groups. Three patients in group D (placebo and 0.21 mg/kg MIV) had haemodynamic changes of over 20% from baseline. Flush and erythema were significantly less pronounced after H-1/H-2 premedication than after placebo (4 vs 12 pts). Conclusions. Our results suggest that time of onset and clinical duration of effects of MIV are not altered by dimetindene and ranitidine. The duration depends more heavily on the dose of MIV. The recovery of neuromuscular function, once it has begun, is prolonged neither by MIV nor by H-1/H-2 antagonists. As MIV is mainly broken down by PChE, it is evident that its duration of action is more prolonged by atypical PChE activity than by interaction with other drugs. Oral H-1/H-2 premedication may diminish haemodynamic side-effects and clinical signs of histamine release. C1 UNIV MUNICH,INST ANAESTHESIOL,W-8000 MUNICH 2,GERMANY. UNIV MARBURG,INST THEORET CHIRURG,W-3550 MARBURG,GERMANY. NR 18 TC 5 Z9 6 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD SEP PY 1993 VL 42 IS 9 BP 592 EP 596 PG 5 WC Anesthesiology SC Anesthesiology GA LX416 UT WOS:A1993LX41600002 ER PT J AU DIEFENBACH, C AF DIEFENBACH, C TI ALCURONIUM, ATRACURIUM AND MIVACURIUM - A COMPARISON OF 3 MUSCLE-RELAXANTS OF THE BENZYLISOQUINOLINE TYPE SO ANASTHESIOLOGIE & INTENSIVMEDIZIN LA German DT Article DE NEUROMUSCULAR BLOCKING; AGENTS; ALCURONIUM; ATRACURIUM; MIVACURIUM; PHARMACODYNAMICS; COMPLICATIONS AB Residual postoperative neuromuscular blockade from nondepolarizing muscle relaxants continues to be a hazard in anaesthesia. The danger of undesired prolonged muscle paralysis depends mainly on the pharmacological properties of the muscle relaxant. The use of neuromuscular blocking agents of the benzylisoquinoline type undergoing enzymatic degradation permits accurate control of depth and duration of neuromuscular blockade and reduces the frequency of residual curariqzation in the recovery room. RP DIEFENBACH, C (reprint author), UNIV COLOGNE,ANASTHESIOL & OPERAT INTENS MED,D-50924 COLOGNE,GERMANY. NR 0 TC 1 Z9 1 PU BLACKWELL WISSENSCHAFTS-VERLAG GMBH PI BERLIN PA KURFURSTENDAMM 57, D-10707 BERLIN, GERMANY SN 0170-5334 J9 ANASTH INTENSIVMED JI Anasthesiol. Intensivmed. PD SEP PY 1993 VL 34 IS 9 BP 280 EP 283 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA MD889 UT WOS:A1993MD88900004 ER PT J AU ORIS, B CRUL, JF VANDERMEERSCH, E VANAKEN, H VANEGMOND, J SABBE, MB AF ORIS, B CRUL, JF VANDERMEERSCH, E VANAKEN, H VANEGMOND, J SABBE, MB TI MUSCLE PARALYSIS BY ROCURONIUM DURING HALOTHANE, ENFLURANE, ISOFLURANE, AND TOTAL INTRAVENOUS ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article ID VECURONIUM; ATRACURIUM; ORG-9426; HUMANS AB We determined the dose-response relationship, the onset time, the duration, and the recovery time of a rocuronium neuromuscular block under four anesthesia techniques. Patients were equally randomized to four different groups (n = 20) receiving 0.5%-l% halothane, 1.5%-2% enflurane, 1.2%-1.8% isoflurane end-tidal concentration in 34%/66% O2/N2O, or 6.0 mg.kg-1.h-1 propofol without N2O for anesthesia and alfentanil for analgesia. Strength of thumb adduction in response to single and train-of-four stimulation of the ulnar nerve was quantitated. Rocuronium 0.15, 0.2, 0.25, and 0.3 mg/kg were given intravenously. When maximal depression of twitch tension occurred, supplemental doses up to a total of 0.5 mg/kg were given. If required, additional doses of 0.15 mg/kg were given at 25% recovery of control twitch tension. Standard hemodynamics, end-tidal CO2, and anesthetic gas concentrations were monitored continuously. The mean ED50 (SD) was 0.133 (+/-0.009) mg/kg for the halothane group, 0.118 (+/-0.012) mg/kg for the enflurane group, 0.069 (+/-0.026) mg/kg for the isoflurane group, and 0.167 (+/-0.007) mg/kg for the total intravenous anesthesia (TIVA) group, respectively There was a statistically significant difference between the halothane and TIVA, and between the enflurane and TIVA groups (P < 0.05). Rocuronium has a short onset time and an intermediate duration of action. The neuromuscular blocking potency and pharmacodynamic profile are moderately influenced by volatile anesthetics. C1 CATHOLIC UNIV LEUVEN,ZIEKENHUIS GASTHUISBERG,DEPT ANESTHESIOL,HERESTR 49,B-3000 LOUVAIN,BELGIUM. CATHOLIC UNIV NIJMEGEN,DEPT ANESTHESIOL,NIJMEGEN,NETHERLANDS. CATHOLIC UNIV LEUVEN,DEPT EMERGENCY MED,B-3000 LOUVAIN,BELGIUM. NR 13 TC 37 Z9 43 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 1993 VL 77 IS 3 BP 570 EP 573 PG 4 WC Anesthesiology SC Anesthesiology GA LW216 UT WOS:A1993LW21600024 ER PT J AU BARTKOWSKI, RR WITKOWSKI, TA AZAD, S LESSIN, J MARR, A AF BARTKOWSKI, RR WITKOWSKI, TA AZAD, S LESSIN, J MARR, A TI ROCURONIUM ONSET OF ACTION - A COMPARISON WITH ATRACURIUM AND VECURONIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKING; INTUBATING CONDITIONS; D-TUBOCURARINE; ORG-9426; ANESTHESIA; PANCURONIUM; POTENCY; SPEED AB The onset, maximal neuromuscular block, and duration of rocuronium were compared with atracurium and vecuronium during enflurane anesthesia. Sixty patients received rocuronium (80,100,120, or 160 mug/kg). Enflurane enhanced a rocuronium neuromuscular block in a dose-related manner; the ED50 was 104 +/- 11 and 83 +/- 7 mug/kg (SEM) during 1% and 2% enflurane anesthesia, respectively. Patients receiving atracurium (0.12 mg/kg) or vecuronium (0.02 mg/kg) were studied during 1% enflurane anesthesia until seven in each group qualified by achieving a maximal block between 85% and 97%. These patients were matched with each other and with patients who had received rocuronium. Seven groups of three patients (rocuronium, vecuronium, and atracurium) were obtained. The average difference in maximal block was less than 2% between matched patients. The ratio of dose used to achieve a similar final block suggests potency ratios of 1, 8.5, and 1.2 for rocuronium, vecuronium, and atracurium. Rocuronium's onset time (time from drug administration to 50%, 75%, and 90% of final block) was significantly faster than either of the other two muscle relaxants (P < 0.01). Time to 90% of final block was 1.35 min for rocuronium, 3.06 min for atracurium, and 3.71 min for vecuronium. Using these equipotent doses, atracurium also had a shorter time to develop neuromuscular block than vecuronium (P < 0.05). For these three intermediate duration neuromuscular blockers, speed of onset was inversely related to their potency, confirming a relationship that had been demonstrated for the long-acting drugs pancuronium, d-tubocurarine, and gallamine. RP BARTKOWSKI, RR (reprint author), THOMAS JEFFERSON UNIV,JEFFERSON MED COLL,DEPT ANESTHESIOL,111 S 11TH ST,6420 GIBBON BLDG,PHILADELPHIA,PA 19107, USA. NR 15 TC 51 Z9 52 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 1993 VL 77 IS 3 BP 574 EP 578 PG 5 WC Anesthesiology SC Anesthesiology GA LW216 UT WOS:A1993LW21600025 ER PT J AU HENNING, RH HOUWERTJES, MC SCAF, AHJ DENHERTOG, A AGOSTON, S AF HENNING, RH HOUWERTJES, MC SCAF, AHJ DENHERTOG, A AGOSTON, S TI PROLONGED PARALYSIS AFTER LONG-TERM, HIGH-DOSE INFUSION OF PANCURONIUM IN ANESTHETIZED CATS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, PANCURONIUM; PHARMACOKINETICS ID NEUROMUSCULAR BLOCKADE; BROMIDE; ATROPHY; VECURONIUM; MECHANISMS; WEAKNESS AB We have studied the neuromuscular effects of a 48-h infusion of high-dose pancuronium (400 mug kg-1 h-1) in four cats anaesthetized with pentobarbitone, using contraction of tibialis anterior muscles after direct and indirect stimulation. After cessation of the pancuronium infusion, prolonged paralysis existed. The first twitch in the train-of-four stimuli (TOF) reappeared 8-12 h after termination of the pancuronium infusion. Twenty-four hours after termination of the infusion, TOF ratios were less than 0.08 and twitch contraction averaged 39 (SE 8) % of initial values. Twitch contraction after direct stimulation did not differ from initial values. Antagonism of paralysis was accomplished with neostigmine 60 mug kg-1 in two animals and neostigmine 90 mug kg-1 and 4-aminopyridine 500 mug kg-1 in the others. Steady-state plasma concentration of pancuronium (2000 ng ml-1) decreased rapidly after termination of the infusion, but then stabilized at about 130 ng ml-1. These results indicate that prolonged paralysis after long-term administration of high-dose pancuronium is caused primarily by failure of neuromuscular transmission, most likely caused by the persistent plasma concentrations of the drug in the pharmacologically active range. C1 UNIV GRONINGEN HOSP,DEPT PHARMACOL & CLIN PHARMACOL,9700 RB GRONINGEN,NETHERLANDS. RP HENNING, RH (reprint author), UNIV GRONINGEN HOSP,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,POB 30001,9700 RB GRONINGEN,NETHERLANDS. NR 22 TC 5 Z9 5 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 1993 VL 71 IS 3 BP 393 EP 397 DI 10.1093/bja/71.3.393 PG 5 WC Anesthesiology SC Anesthesiology GA LX190 UT WOS:A1993LX19000013 ER PT J AU SALIB, YM DONATI, F BEVAN, DR AF SALIB, YM DONATI, F BEVAN, DR TI EDROPHONIUM ANTAGONISM OF VECURONIUM AT VARYING DEGREES OF 4TH TWITCH RECOVERY SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANTAGONIST, NEUROMUSCULAR RELAXANTS; EDROPHONIUM; MONITORING; TRAIN-OF-4; NEUROMUSCULAR RELAXANTS; VECURONIUM ID INDUCED NEUROMUSCULAR BLOCKADE; NERVE-STIMULATION; NEOSTIGMINE; ATRACURIUM; PANCURONIUM; TACTILE AB The purpose of this study was to determine the optimal dose of edrophonium needed for successful antagonism (train-of-four ratio, or T4/T1 > 0.7) of vecuronium-induced blockade when all four twitches were visible in response to indirect train-of-four (TOF) stimulation. Forty patients, scheduled for elective surgical procedures not exceeding 120 min, received vecuronium, 0.08 mg-kg-1, during thiopentone-N2O-isoflurane anaesthesia. Train-of-four stimulation was applied every 20 sec and the force of contraction of the adductor pollicis muscle was recorded Increments of vecuronium, 0.015 mg . kg-1, were given as required. At the end of surgery, and provided that neuro-muscular activity had recovered to four visible twitches, edrophonium, 0.1 mg . kg-1, was given. Two minutes later, edrophonium, 0.1 mg . kg-1, was given if T4/T1 did not reach 0.7. After another two minutes, edrophonium, 0.2 mg . kg-1, was given if T4/T1 did not reach 0.7 or more. Finally, if T4/T1 was still < 0.7, a dose of 0.4 mg . kg-1 way given. Seventeen patients (42.5%) required 0.1 mg . kg-1 of edrophonium for successful reversal, sixteen patients (40%) needed a cumulative dose of 0.2 mg . kg-1 and six patients (15%) required 0.4 mg . kg-1. Only one patient received 0.8 mg . kg-1. There was a good correlation between T4/T1 two minutes after the first dose of edrophonium and pre-reversal T4/T1 (r = 0.6, P = 0.00014). All patients with pre-reversal T4/T1 > 0.23 required at most 0.2 mg . kg-1 of edrophonium for successful reversal. We conclude that when all four twitches are clearly visible following train-of-four stimulation, small doses of edrophonium (0.1-0.2 mg . kg-1) might be sufficient to antagonize vecuronium neuromuscular blockade. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,SUITE S505,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 1A1,QUEBEC,CANADA. NR 12 TC 4 Z9 4 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1993 VL 40 IS 9 BP 839 EP 843 PG 5 WC Anesthesiology SC Anesthesiology GA LV839 UT WOS:A1993LV83900009 ER PT J AU COOPER, R MADDINENI, VR MIRAKHUR, RK AF COOPER, R MADDINENI, VR MIRAKHUR, RK TI CLINICAL-STUDY OF INTERACTION BETWEEN ROCURONIUM AND SOME COMMONLY USED ANTIMICROBIAL AGENTS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; PHARMACODYNAMICS; ANTIBIOTICS, NETILMICIN, CEFUROXIME, METRONIDAZOLE AB The onset and duration of clinical relaxation and reversibility of rocuronium bromide (ORG 9426) 0.6 mg kg-1 were studied following administration of netilmicin 2 mg kg-1 (n=10) or cefuroxime 20 mg kg-1 (n=10) in patients undergoing urological surgery; and cefuroxime 20 mg kg-1 (n=10) metronidazole 7.5 mg kg-1 (n=10), metronidazole 7.5 mg kg-1 and cefuroxime 20 mg kg-1 (n=10), or placebo (n=10) in patients undergoing abdominal surgery under anaesthesia with thiopentone, nitrous oxide in oxygen, fentanyl and halothane. The antimicrobial agents were administered intravenously 5 min before rocuronium. Neuromuscular function was monitored using mechanomyography and train-of-four (TOF) mode of stimulation. Onset of neuromuscular block occurred in approximately 60 s with all patients achieving complete block. The mean clinical duration (+/-SD) was 50+/-10.7 and 44+/-6.7 min following netilmicin and cefuroxime respectively in patients undergoing urological surgery; and 49+/-13.7, 44+/-11.1, 48+/-11.1 and 38+/-7.3 min in the groups undergoing abdominal surgery receiving cefuroxime, metronidazole, cefuroxime and metronidazole combination and placebo respectively. There were no statistically significant differences between the groups in either the onset or the duration of clinical relaxation. Reversal of neuromuscular block with neostigmine carried out at spontaneous recovery of T1 (first response in the TOF) of 25% or more was easily achieved in all groups in 2-4 min. It is concluded that there is no significant interaction between rocuronium and single doses of the antimicrobial agents used in the present study. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD SEP PY 1993 VL 10 IS 5 BP 331 EP 335 PG 5 WC Anesthesiology SC Anesthesiology GA LW738 UT WOS:A1993LW73800002 ER PT J AU LIEN, CA GADALLA, F KUDLAK, TT EMBREE, PB SHARP, GJ SAVARESE, JJ AF LIEN, CA GADALLA, F KUDLAK, TT EMBREE, PB SHARP, GJ SAVARESE, JJ TI THE EFFECT OF ONDANSETRON ON ATRACURIUM-INDUCED NEUROMUSCULAR BLOCKADE SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE ANTIEMETICS; ATRACURIUM; 5-HT(3) BLOCKERS; NEUROMUSCULAR NONDEPOLARIZING AGENTS; ONDANSETRON; SEROTONIN AB Study Objective: To determine whether treatment with ondansetron, a new antiemetic drug, affects nondepolarizing neuromuscular blockade. Design: Randomized, double-blind, prospective study. Setting: Operating room at a university medical center. Patients: 30 ASA physical status I and II patients scheduled for elective surgery. Interventions: After the induction of anesthesia with midazolam 2 to 4 mg/kg, sodium thiopental 6 to 8 mg/kg, and fentanyl 4 to 8 mug/kg, the ulnar nerve was stimulated at the wrist through subcutaneous needle electrodes at a frequency of 0.15 Hz. The response to stimulation was measured and recorded with a force-displacement transducer applied to the thumb. Patients were randomized to one of three treatment groups. A steady baseline to ulnar nerve stimulation with nitrous oxide-oxygen-opioid-thiopental anesthesia was established. The first study group (Group 1) received a placebo, the second group (Group 2) received 8 mg of ondansetron, and the third group (Group 3) received 16 mg of ondansetron as an intravenous infusion over 5 minutes. Patients were then given incremental doses of atracurium 0.05 mg/kg at 3-minute intervals to establish approximately 95% twitch inhibition so as to construct a dose-response curve. An atracurium infusion was then begun to maintain a constant degree of neuromuscular blockade. At the end of surgery, patients were allowed to recover spontaneously, or pharmacologic antagonism of residual neuromuscular blockade was achieved with neostigmine 0.05 mg/kg and glycopyrrolate 0.01 mg/kg. Mechanomyographic response to train-of-four stimuli (2 Hz for 2 seconds) every 20 seconds was monitored during the atracurium infusion and recovery from neuromuscular blockade. Measurements and Main Results: Log dose-response curves were determined for the study groups and compared using analysis of variance (ANOVA). The 50%, 75%, and 95% effective doses (ED50, ED75, and ED95) were calculated from the equation describing the log dose-response. Maintenance infusion rates were determined, and the neostigmine-accelerated recovery index of 25% to 75% was measured for each group. The results were compared using ANOVA. There were no significant differences among the treatment groups with respect to maintenance infusion rate (7.8 +/- 1.8 mug/kg/min for Group 1, 7.7 +/- 2.5 mug/kg/min for Group 2, and 7.3 +/- 2.3 mug/kg/min for Group 3) or neostigmine-accelerated recovery interval of 25% to 75% (4.5 +/- 2.3 minutes, 4.4 +/- 3.1 minutes, 6.6 +/- 3.9 minutes in Groups 1, 2, and 3, respectively). The log dose-response data for Groups 1, 2, and 3 did not differ significantly (p = 0.068), and the calculated ED95 in each treatment group demonstrated no dose-related change (0.254 +/- 0.022, 0.279 +/- 0.033, and 0.240 +/- 0.022 for Groups 1, 2, and 3, respectively). Conclusions: Ondansetron is an antiemetic drug that can be used in the perioperative period without concern for potentiation Of nondepolarizing neuromuscular blockade, change in atracurium maintenance dose, or change in rate Of neostigmine-induced recovery from neuromuscular blockade with atracurium. RP LIEN, CA (reprint author), CORNELL UNIV,MED CTR,NEW YORK HOSP,DEPT ANESTHESIOL,525 E 68TH ST,NEW YORK,NY 10021, USA. NR 0 TC 3 Z9 3 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD SEP-OCT PY 1993 VL 5 IS 5 BP 399 EP 403 DI 10.1016/0952-8180(93)90104-M PG 5 WC Anesthesiology SC Anesthesiology GA LZ131 UT WOS:A1993LZ13100009 ER PT J AU BOHRER, H SCHMIDT, H BACH, A MARTIN, E KOHL, B BOLSEN, K GOERZ, G AF BOHRER, H SCHMIDT, H BACH, A MARTIN, E KOHL, B BOLSEN, K GOERZ, G TI INHIBITION OF HEPATIC-MICROSOMAL DRUG-METABOLISM BY ATRACURIUM ADMINISTRATION IN THE RAT SO PHARMACOLOGY & TOXICOLOGY LA English DT Article ID DIETHYL-ETHER; INVITRO DEGRADATION; PROTEIN-SYNTHESIS; HUMAN-PLASMA; LIVER; LAUDANOSINE; ENZYMES; CYTOCHROME-P-450; PURIFICATION; ANESTHETICS AB The muscle relaxant atracurium is known to undergo extrahepatic degradation via Hofmann elimination and ester hydrolysis. The purpose of the present study was to evaluate the effects of atracurium on hepatic P450-dependent enzyme activities. Thirty-two male Sprague-Dawley rats were anaesthetized, mechanically ventilated, and randomly allocated to one of four study groups: group 1 received saline, group 2 atracurium, group 3 vecuronium, and group 4 pancuronium intravenously for a period of 3 hr. Equipotent doses of the muscle relaxants were applied; the doses had been obtained in a pilot study using evoked electromyography. At the end of the study period, the livers were removed and analyzed. All three muscle relaxants may lead to inhibition of hepatic drug metabolism. Atracurium influences hepatic P450, although it is predominantly degraded in extrahepatic tissues. Further studies are needed to evaluate the contribution of the major metabolite laudanosine to this inhibitory action. C1 UNIV HEIDELBERG,DEPT INTERNAL MED,CLIN LAB,W-6900 HEIDELBERG,GERMANY. UNIV DUSSELDORF,DEPT DERMATOL,W-4000 DUSSELDORF 1,GERMANY. RP BOHRER, H (reprint author), UNIV HEIDELBERG,DEPT ANAESTHESIA,NEUENHEIMER FELD 110,D-69120 HEIDELBERG,GERMANY. NR 33 TC 5 Z9 5 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 SEP PY 1993 VL 73 IS 3 BP 137 EP 141 PG 5 WC Pharmacology & Pharmacy; Toxicology SC Pharmacology & Pharmacy; Toxicology GA MB701 UT WOS:A1993MB70100003 ER PT J AU REVEL, MP PONS, JC LELAIDIER, C FOURNET, P VIAL, M MUSSET, D LABRUNE, M FRYDMAN, R AF REVEL, MP PONS, JC LELAIDIER, C FOURNET, P VIAL, M MUSSET, D LABRUNE, M FRYDMAN, R TI MAGNETIC-RESONANCE-IMAGING OF THE FETUS - A STUDY OF 20 CASES PERFORMED WITHOUT CURARIZATION SO PRENATAL DIAGNOSIS LA English DT Article DE MAGNETIC RESONANCE IMAGING; CURARIZATION; BRAIN ABNORMALITIES; SURFACE COILS ID PRENATAL-DIAGNOSIS; FETAL ANOMALIES; EXPERIENCE AB Twenty patients underwent magnetic resonance imaging (MRI) at a mean gestational age of 32 weeks. There were 12 patients with suspected fetal brain abnormality and four with intrauterine growth retardation (IUGR), while the remaining four cases were studied for other reasons. The MRI examinations were performed on a 0.5 Tesla machine, with surface coils. One minute acquisition time T1 sequences were used. All the studies were performed without fetal curarization. and only under maternal sedation using flunitrazepam given per os 1 h before MRI examination. Three examinations were incomplete because of fetal movement artefacts. In the remaining cases, MRI allowed the examination of fetal brain anatomy. In five cases, it helped to differentiate iso at d hydrocephalus and corpus callosum agenesis. Sub-ependymal nodules were depicted in a case of fetal tuberous sclerosis. One suspected arachnoid cyst was proved to be an ultrasound artefact. Decreased fetal fat on MR images was correlated with low birth weight in cases of IUGR. Due to its better spatial resolution, ultrasonography was more accurate for the diagnosis of facial and lumbar anomalies. Fetal MRI may be performed without curarization. Surface coils allow the detailed analysis of brain parenchyma, and thus MRI is especially useful in the difficult prenatal diagnosis of fetal brain abnormalities. C1 A BECLERE HOSP,DEPT OBSTET & GYNECOL,F-92141 CLAMART,FRANCE. A BECLERE HOSP,DEPT NEONATOL,F-92141 CLAMART,FRANCE. RP REVEL, MP (reprint author), A BECLERE HOSP,DEPT RADIOL,157 RUE PORTE TRIVAUX,F-92141 CLAMART,FRANCE. NR 23 TC 42 Z9 42 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX, ENGLAND PO19 1UD SN 0197-3851 J9 PRENATAL DIAG JI Prenat. Diagn. PD SEP PY 1993 VL 13 IS 9 BP 775 EP 799 DI 10.1002/pd.1970130902 PG 25 WC Genetics & Heredity; Obstetrics & Gynecology SC Genetics & Heredity; Obstetrics & Gynecology GA MB884 UT WOS:A1993MB88400001 ER PT J AU KOSCIELNIAKNIELSEN, ZJ BEVAN, JC POPOVIC, V BAXTER, MRN DONATI, F BEVAN, DR AF KOSCIELNIAKNIELSEN, ZJ BEVAN, JC POPOVIC, V BAXTER, MRN DONATI, F BEVAN, DR TI ONSET OF MAXIMUM NEUROMUSCULAR BLOCK FOLLOWING SUCCINYLCHOLINE OR VECURONIUM IN 4 AGE-GROUPS SO ANESTHESIOLOGY LA English DT Article DE AGE, SUCCINYLCHOLINE; VECURONIUM; MONITORING, ELECTROMYOGRAM; NEUROMUSCULAR BLOCKADE, ONSET TIME; NEUROMUSCULAR RELAXANTS, SUCCINYLCHOLINE; VECURONIUM ID DOSE-RESPONSE CURVES; HALOTHANE ANESTHESIA; PANCURONIUM; ATRACURIUM; CHILDREN; INFANTS; SUXAMETHONIUM; RECOVERY; SINGLE; HUMANS AB Background. Increasing age appears to be associated with a slower onset of neuromuscular blockade, but such an effect has not been studied with the same doses of the same drugs across pediatric and adult age groups. Methods. The authors measured the evoked compound action potential of the adductor pollicis muscle in response to 0.1-Hz stimulation of the ulnar nerve, during fentanyl-thiopental-oxygen anesthesia, in 160 patients aged 1-3 yr, 3-10 yr, 20-40 yr, or 60-80 yr. Subparalyzing doses of vecuronium (0.03 mg/kg) or succinylcholine (0.3 mg/kg), or paralyzing doses of vecuronium (0.1 mg/kg) or succinylcholine (1.0 mg/kg), were administered to ten patients in each age group. Results: Onset time, defined as the time from injection to maximum depression of response with a subparalyzing dose or the time from injection to ablation of visible response with a paralyzing dose, varied with age in all groups (P < 0.001). For 0.3 mg/kg succinylcholine, it increased from 49 +/- 6 s in 1-3-yr-old patients, to 104 +/- 9 s in 60-80-yr-old patients (P < 0.00001). For 0.03 mg/kg vecuronium, onset time was 3.6-5.9 times longer than for succinylcholine, increasing from 219 +/- 15 s in 3-10-yr-old patients to 473 +/- 30 s in 60-80-yr-old patients (P < 0.00001 by linear regression). For paralyzing doses, succinylcholine 1.0 mg/kg had an onset time of 58 +/- 7 s and 95 +/- 7 s, in 1-3-yr-old and 60-80-yr-old patients, respectively (P < 0.001). For 0.1 mg/kg vecuronium, onset time varied between 125 +/- 19 s in 1-3-yr-old patients to 295 +/- 31 s in 60-80-yr-old patients (P < 0.00001), and was 2.1-3.3 times longer than 1 mg/kg succinylcholine. Conclusions. Increasing age is associated with slower onset for both succinylcholine and vecuronium. When equipotent, subparalyzing doses of succinylcholine and vecuronium are compared, onset time is 4.5 times as long with vecuronium. C1 ROYAL VICTORIA HOSP,DEPT ANESTHESIA,S505,687 PINE AVE W,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,ROYAL VICTORIA & MONTREAL CHILDRENS HOSP,DEPT ANESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 24 TC 18 Z9 19 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD AUG PY 1993 VL 79 IS 2 BP 229 EP 234 DI 10.1097/00000542-199308000-00006 PG 6 WC Anesthesiology SC Anesthesiology GA LP761 UT WOS:A1993LP76100005 ER PT J AU COOPER, RA MADDINENI, VR MIRAKHUR, RK WIERDA, JMKH BRADY, M FITZPATRICK, KTJ AF COOPER, RA MADDINENI, VR MIRAKHUR, RK WIERDA, JMKH BRADY, M FITZPATRICK, KTJ TI TIME-COURSE OF NEUROMUSCULAR EFFECTS AND PHARMACOKINETICS OF ROCURONIUM BROMIDE (ORG-9426) DURING ISOFLURANE ANESTHESIA IN PATIENTS WITH AND WITHOUT RENAL-FAILURE SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM (ORG-9426); PHARMACODYNAMICS, RENAL FAILURE; PHARMACOKINETICS ID ORG 9426; VECURONIUM; PHARMACODYNAMICS; ORG9426; AGENT AB We have studied the onset and duration of action and pharmacokinetics of rocuronium bromide (Org 9426) during anaesthesia with nitrous oxide, fentanyl and isoflurane after a single bolus dose of rocuronium 0.6 mg kg-1 in nine patients with chronic renal failure requiring regular haemodialysis, and in nine healthy control patients. Blood samples were collected over 390 min and concentrations of rocuronium and its putative metabolites measured using HPLC. Onset time for maximum block, duration of clinical relaxation (T1(25)) and recovery index, were 61 (SD 25.0) s and 65 (16.4) s, 55 (26.9) min and 42 (9.3) min and 28 (12.3) min and 19 (8.8) min, respectively, for patients with and without renal failure. The time for TOF ratio to return spontaneously to 0. 7 was 99 (4 1. 1) min and 73 (24.2) min, respectively, in the two groups. None of these differences was significant The pharmacokinetic data were best described by a three-exponential equation. There were significant differences between patients with and without renal failure in the rates of clearance (2.5 (1. 1) ml kg-1 min-1 and 3.7 (1.4) ml kg-1 min-1, respectively) and the mean residence times (97.1 (48.7) min and 58.3 (9.6) min) (P < 0.05). The differences in other kinetic parameters were not significant We conclude that the effects of rocuronium may be prolonged in patients with renal disease, because of a decreased clearance of the drug. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. BELFAST CITY HOSP,BELFAST BT9 7AD,ANTRIM,NORTH IRELAND. UNIV GRONINGEN,9700 AB GRONINGEN,NETHERLANDS. NR 16 TC 59 Z9 65 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 1993 VL 71 IS 2 BP 222 EP 226 DI 10.1093/bja/71.2.222 PG 5 WC Anesthesiology SC Anesthesiology GA LR045 UT WOS:A1993LR04500009 ER PT J AU DEVLIN, JC HEADRAPSON, AG PARKER, CJR HUNTER, JM AF DEVLIN, JC HEADRAPSON, AG PARKER, CJR HUNTER, JM TI PHARMACODYNAMICS OF MIVACURIUM CHLORIDE IN PATIENTS WITH HEPATIC CIRRHOSIS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, MIVACURIUM; PHARMACODYNAMICS, LIVER DISEASE ID PLASMA CHOLINESTERASE ACTIVITY; INDUCED NEUROMUSCULAR BLOCKADE; BW B1090U; PHARMACOKINETICS; ATRACURIUM; VECURONIUM; INFUSION; SUCCINYLCHOLINE; PHARMACOLOGY AB Ten healthy patients and 25 patients with cirrhosis of the fiver (1 0 Child's A, 1 0 Child's B and 5 Child's C) received a bolus dose of mivacurium chloride 150 mug kg-1. The electromyographic response was monitored throughout anaesthesia until recovery of the first twitch of the train-of-four (TOF) (T1/T0) to at least 85% and the TOF ratio (T4:T1) to at least 80%. There was no significant difference between the two groups in the onset of neuromuscular block, but recovery was prolonged in the cirrhotic group compared with the healthy patients (respective mean times to recovery of T1/TO: to 5% = 20.2 vs 11. 2 min (P < 0.05); to 10% = 23.8 vs 13.4 min (P < 0.005); to 25% = 28.4 vs 16.6 min (P < 0.005); to 50% = 4 1. 1 vs 20. 1 min (P < 0.005); to 75% = 43.8 vs 24.9 min (P < 0. 005). Recovery of T4:T1 to 70% = 48. 1 vs 27.4 min (P < 0.005)). Recovery was most prolonged in the Child's C patients. Mean plasma cholinesterase activity was less in the cirrhotic compared with the healthy group (mean 582 (SD 254) iu litre-1 vs 1 125 (303) iu litre-1) (P < 0.001) and there was a significant negative correlation between plasma cholinesterase activity and a# the indices of recovery (P < 0.001 for all except recovery index (P < 0.01)). We conclude that patients with hepatic cirrhosis may be sensitive to mivacurium, which could be explained, at least in part, by the lesser plasma cholinesterase activity. RP DEVLIN, JC (reprint author), ROYAL LIVERPOOL UNIV HOSP,DEPT ANAESTHESIA,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 24 TC 33 Z9 34 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 1993 VL 71 IS 2 BP 227 EP 231 DI 10.1093/bja/71.2.227 PG 5 WC Anesthesiology SC Anesthesiology GA LR045 UT WOS:A1993LR04500010 ER PT J AU MERETOJA, OA OLKKOLA, KT AF MERETOJA, OA OLKKOLA, KT TI PHARMACODYNAMICS OF MIVACURIUM IN CHILDREN, USING A COMPUTER-CONTROLLED INFUSION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHESIA, PEDIATRIC; EQUIPMENT, COMPUTERS; NEUROMUSCULAR RELAXANTS, MIVACURIUM ID INDUCED NEUROMUSCULAR BLOCKADE; OXIDE-NARCOTIC ANESTHESIA; LOOP FEEDBACK-CONTROL; CHLORIDE BW B1090U; PEDIATRIC-PATIENTS; CLINICAL-PHARMACOLOGY; BLOCKING-AGENTS; ATRACURIUM; INFANTS; PHARMACOKINETICS AB A computerized infusion system was used to determine requirement for a mivacurium infusion to maintain a 95% and a 50% neuromuscular block in 21 children aged 1-15 yr. Neuromuscular block was measured by adductor pollicis EMG and anaesthesia maintained with 66% nitrous oxide in oxygen and alfentanil 50-100 mug kg-1 h-1. The targeted neuromuscular block was reached within mean 5 (SD 3) min from initiation of an infusion. Mivacurium requirement for 95% neuromuscular block was 950 (350) mug kg-1 h-1, which represented an hourly requirement of 6.8 (1.6) individual ED95 doses. Infusion requirement for 50% neuromuscular block averaged 350 (150) mug kg-1 h-1. There was a significant negative correlation between infusion rate and age of a patient. Great individual variation of the infusion rate makes a computerized infusion an easy method to achieve and maintain a desired level of neuromuscular block. No side effects of mivacurium were noticed. C1 UNIV HELSINKI,DEPT ANAESTHESIA,SF-00290 HELSINKI 29,FINLAND. RP MERETOJA, OA (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIA,SF-00290 HELSINKI 29,FINLAND. NR 29 TC 24 Z9 24 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 1993 VL 71 IS 2 BP 232 EP 237 DI 10.1093/bja/71.2.232 PG 6 WC Anesthesiology SC Anesthesiology GA LR045 UT WOS:A1993LR04500011 ER PT J AU BEAUVOIR, C PERAY, P DAURES, JP PESCHAUD, JL DATHIS, F AF BEAUVOIR, C PERAY, P DAURES, JP PESCHAUD, JL DATHIS, F TI PHARMACODYNAMICS OF VECURONIUM IN PATIENTS WITH AND WITHOUT RENAL-FAILURE - A METAANALYSIS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE COMPLICATIONS, RENAL FAILURE; NEUROMUSCULAR RELAXANTS, VECURONIUM; STATISTICS ID CLINICAL-TRIALS; ATRACURIUM; PHARMACOLOGY; PHARMACOKINETICS; METAANALYSIS; PREVENTION; ANESTHESIA; RECOVERY AB Eight trials comparing the effects of vecuronium in patients with either normal renal function or renal failure were subjected to a meta-analysis. Vecuronium doses were similar in the different trials, identical in the two patient groups of any given trial, and ranged from 0.05 to 0.14 mg . kg-1. Neuromuscular blockade was assessed by TOF or single twitch stimulation, and recorded by either mechanomyography or electromyography. Indices of blockade included onset time (from injection to maximal twitch depression), duration of action (from injection to recovery to 25% of control twitch) and 25-75% recovery index. Statistical analysis used Hedges method. effect size and variance were calculated for each relevant outcome, then the global effect size was estimated by pooling the effect sizes of each trial. Three separate meta-analyses were conducted. No differences were found either in onset time, or in recovery index between the two groups, whereas the duration of action was longer in the renal failure group. It is concluded that renal function is likely involved in the pharmacokinetic parameters of vecuronium. C1 HOP LAPEYRONIE,DEPT INFORMAT MED,F-34059 MONTPELLIER,FRANCE. RP BEAUVOIR, C (reprint author), HOP LAPEYRONIE,DEPT ANESTHESIE REANIMAT A,F-34059 MONTPELLIER,FRANCE. NR 36 TC 10 Z9 10 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD AUG PY 1993 VL 40 IS 8 BP 696 EP 702 PG 7 WC Anesthesiology SC Anesthesiology GA LT810 UT WOS:A1993LT81000002 ER PT J AU MCCOY, EP MADDINENI, VR ELLIOTT, P MIRAKHUR, RK CARSON, IW COOPER, RA AF MCCOY, EP MADDINENI, VR ELLIOTT, P MIRAKHUR, RK CARSON, IW COOPER, RA TI HEMODYNAMIC-EFFECTS OF ROCURONIUM DURING FENTANYL ANESTHESIA - COMPARISON WITH VECURONIUM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE BLOOD PRESSURE, DRUG EFFECTS; HEART, CARDIAC OUTPUT; MONITORING, ECG; BLOOD PRESSURE; VENOUS PRESSURE; NEUROMUSCULAR RELAXANTS, ROCURONIUM; VECURONIUM; SURGERY, CARDIAC ID NEUROMUSCULAR BLOCKING-DRUGS; PANCURONIUM; ATRACURIUM; ORG-9426; ANESTHESIA; POTENCY; SURGERY; ARREST; AGENT AB Haemodynamic variables were measured following administration of rocuronium 0.6 mg . kg-1 or vecuronium 0.08 mg . kg-1 (approximately equivalent to 2 X ED95 doses) in patients anaesthetized with fentanyl 50 mug . kg-1 and scheduled to undergo elective coronary artery bypass grafting. There were increases in stroke volume index (+15%) and cardiac index (+11%), and a decrease in pulmonary capillary wedge pressure (-25%) following administration of rocuronium (P < 0.05). The changes in heart rate (+7%), mean arterial pressure (-5%), systemic vascular resistance (-12%) and other measured or derived indices were insignificant In comparison the administration of vecuronium was associated with decreases in heart rate (-7%), mean pulmonary artery pressure (-17%), central venous pressure (-15%) and the rate-pressure product (-9%) (P < 0.05). 7 he changes in mean arterial pressure (-7%), cardiac index (-6%) and systemic vascular resistance (-8%) following vecuronium were insignificant. There were no differences in any of the variables between rocuronium and vecuronium. The absolute values of all variables were, however, within acceptable clinical limits. There was no evidence of histamine release in any patient. The present study shows that rocuronium 0.6 mg . kg-1 is associated with changes of only small magnitude in haemodynamic variables. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,NORTH IRELAND. ROYAL VICTORIA HOSP,BELFAST BT12 6BA,NORTH IRELAND. NR 27 TC 38 Z9 42 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD AUG PY 1993 VL 40 IS 8 BP 703 EP 708 PG 6 WC Anesthesiology SC Anesthesiology GA LT810 UT WOS:A1993LT81000003 ER PT J AU YOUSSEF, SAH AFIFI, NA RAMADAN, A IBRAHIM, EIS AF YOUSSEF, SAH AFIFI, NA RAMADAN, A IBRAHIM, EIS TI COMPARATIVE HEMODYNAMIC-ALTERATIONS INDUCED BY PIPECURONIUM AND PANCURONIUM SO DEUTSCHE TIERARZTLICHE WOCHENSCHRIFT LA English DT Article ID DEPOLARIZING MUSCLE-RELAXANTS; ISOLATED RABBIT HEART AB Haemodynamic effects of pipecuronium bromide (Pi.) and pancuronium bromide (Pa.) were studied on isolated rabbit's heart, guinea pig's tracheal chain as well as the blood pressure in pentobarbital anaesthetized dogs. Pi. induced negative inotropic and chronotropic effects on the isolated rabbit's heart especially in lower concentrations. However, higher concentrations provoked two opposite effects, negative chronotropic and positive inotropic activity. In addition, Pa. in lower concentrations caused positive inotropic and negative chronotropic activity, while higher concentrations induced negative inotropic and chronotropic activity. Cardioinhibitory actions of both tested drugs are not due to either cholinergic or beta1-adrenergic blocking effect but it may be due to nicotine-like activity. In anaesthetized dogs, i. v. injections of both tested drugs produced a tansient decrease in systolic and diastolic pressure in doses above the therapeutic level. This effect may be referred to the partial ganglion blocking effect of both tested drugs. C1 AL-AZHAR UNIV,FAC MED,DEPT ANAESTHESIA,CAIRO,EGYPT. RP YOUSSEF, SAH (reprint author), CAIRO UNIV,FAC VET MED,DEPT PHARMACOL,CAIRO,EGYPT. NR 14 TC 0 Z9 0 PU M H SCHAPER GMBH CO KG PI ALFELD PA POSTFACH 16 42 16 52 KALANDSTRASSE 4, W-3220 ALFELD, GERMANY SN 0341-6593 J9 DEUT TIERARZTL WOCH JI Dtsch. Tierarztl. Wochenschr. PD AUG PY 1993 VL 100 IS 8 BP 316 EP 318 PG 3 WC Veterinary Sciences SC Veterinary Sciences GA LY963 UT WOS:A1993LY96300004 ER PT J AU KOLLER, ME HUSBY, P AF KOLLER, ME HUSBY, P TI HIGH-DOSE VECURONIUM MAY BE AN ALTERNATIVE TO SUXAMETHONIUM FOR RAPID-SEQUENCE INTUBATION SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE SUCCINYLCHOLINE; TRACHEAL INTUBATION; VECURONIUM ID NEUROMUSCULAR BLOCKADE; PRIMING PRINCIPLE; ANESTHESIA; INDUCTION; ONSET AB Endotracheal intubation conditions 60 s after intravenous administration of either high-dose vecuronium (0.3 mg kg-1; n=25) or suxamethonium (1.0 mg kg-1; n = 25) were compared in a blind, randomised study. No significant differences were found between the two drugs. In 96% of the patients intubation conditions were characterized as excellent or good. In only one patient (4%) in each group were intubation conditions unsatisfactory. According to our findings, high-dose vecuronium provides satisfactory intubation conditions after 60 s and may be used instead of suxamethonium for rapid sequence intubation when a long duration of neuromuscular blockade is acceptable. RP KOLLER, ME (reprint author), UNIV BERGEN,HAUKELAND SYKEHUS,INST SURG RES,DEPT ANAESTHESIOL,N-5014 BERGEN,NORWAY. NR 19 TC 8 Z9 9 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 1993 VL 37 IS 5 BP 465 EP 468 PG 4 WC Anesthesiology SC Anesthesiology GA LK293 UT WOS:A1993LK29300005 ER PT J AU RORVIK, K HUSBY, P GRAMSTAD, L VAMNES, JS BOE, OE AF RORVIK, K HUSBY, P GRAMSTAD, L VAMNES, JS BOE, OE TI DURATION OF VECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE PREDICTED BY DOSE AND ONSET TIME SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE PREDICTION OF ACTION; VECURONIUM ID COUNT PTC AB We investigated the adequacy of using dose and onset time as variables to predict the duration of action of vecuronium in patients. The onset time until 95% twitch depression and the duration until 25% twitch recovery were measured for doses ranging from 0.1 to 0.3 mg kg-1. Statistical analyses were performed by simple and multiple regressions. The duration of action was better predicted by dose (r2 = 0.61) than by onset time (r2 = 0.51). However, the predictability was significantly improved by a multiple regression model of the variables, and the explanatory power was largest when using the square root of duration as the dependent variable (r2 = 0.69). We conclude that the duration of neuromuscular blockade after vecuronium can be predicted more accurately by the combined use of dose and onset time than by dose alone. C1 UNIV BERGEN,DEPT DENT,N-5021 BERGEN,NORWAY. UNIV HOSP OSLO,RIKSHOSP,DEPT ANAESTHESIA,OSLO,NORWAY. RP RORVIK, K (reprint author), UNIV BERGEN,HAUKELAND SYKEHUS,DEPT ANAESTHESIOL,N-5021 BERGEN,NORWAY. NR 6 TC 0 Z9 0 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 1993 VL 37 IS 5 BP 481 EP 483 PG 3 WC Anesthesiology SC Anesthesiology GA LK293 UT WOS:A1993LK29300008 ER PT J AU SHORTEN, GD GOUDSOUZIAN, NG ALI, HH AF SHORTEN, GD GOUDSOUZIAN, NG ALI, HH TI HISTAMINE-RELEASE FOLLOWING ATRACURIUM IN THE ELDERLY SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; ATRACURIUM; HISTAMINE; AGE FACTORS; ELDERLY ID HUMANS C1 MASSACHUSETTS GEN HOSP,BOSTON,MA 02114. RP GOUDSOUZIAN, NG (reprint author), HARVARD UNIV,SCH MED,FRUIT ST,BOSTON,MA 02114, USA. NR 14 TC 3 Z9 3 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUL PY 1993 VL 48 IS 7 BP 568 EP 571 DI 10.1111/j.1365-2044.1993.tb07117.x PG 4 WC Anesthesiology SC Anesthesiology GA LK877 UT WOS:A1993LK87700003 ER PT J AU CAMPKIN, NTA HOOD, JR FAUVEL, NJ FELDMAN, SA AF CAMPKIN, NTA HOOD, JR FAUVEL, NJ FELDMAN, SA TI THE EFFECT OF RESIDUAL RECEPTOR OCCUPANCY ON SENSITIVITY TO REPEATED VECURONIUM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; VECURONIUM; PHARMACODYNAMIC RP CAMPKIN, NTA (reprint author), CHELSEA & WESTMINSTER HOSP,MAGILL DEPT ANAESTHET,FULHAM RD,LONDON SW1O 9NH,ENGLAND. NR 5 TC 8 Z9 8 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUL PY 1993 VL 48 IS 7 BP 572 EP 574 DI 10.1111/j.1365-2044.1993.tb07118.x PG 3 WC Anesthesiology SC Anesthesiology GA LK877 UT WOS:A1993LK87700004 ER PT J AU CAMPKIN, NTA HOOD, JR FELDMAN, SA AF CAMPKIN, NTA HOOD, JR FELDMAN, SA TI RESISTANCE TO DECAMETHONIUM NEUROMUSCULAR BLOCK AFTER PRIOR ADMINISTRATION OF VECURONIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID PHRENIC-NERVE; RELEASE; SUCCINYLCHOLINE; SUXAMETHONIUM; RELAXANTS; JUNCTION AB Prior administration of nondepolarizing neuromuscular blocking drugs reduces the potency of subsequently administered succinylcholine. To assess whether this interaction is also observed with the depolarizing drug, decamethonium, the potency of decamethonium alone and decamethonium after vecuronium (10 mug/kg) were assessed using a cumulative dose-response technique in two groups of six healthy patients each. Patients were premedicated with meperidine and promethazine and anesthetized with thiopental, isoflurane, and nitrous oxide in oxygen. Twitch tension was monitored using adductor pollicis mechanomyography in response to ulnar nerve stimulation at 0.1 Hz. The mean (SEM) dose of decamethonium producing 80% twitch tension depression (ED80) when administered alone was 37 (4.0) mug/kg. After recovery of twitch tension (but persistence of train-of-four fade) from vecuronium, the mean (SEM) ED80 for decamethonium was increased to 89 (4.4) mug/kg (P < 0.01). The shift to the right of the dose-response curve for decamethonium was nonparallel. Antagonism is observed when decamethonium is administered after a small dose of vecuronium; this interaction, which is also seen with succinylcholine, is likely to be a feature of depolarizing block. Nonparallel shift of the dose-response curve to decamethonium indicates that this is not likely to be a simple agonist-antagonist effect at a single site. RP CAMPKIN, NTA (reprint author), WESTMINSTER MED SCH & HOSP,MAGILL DEPT ANAESTHET,PAGE ST,LONDON SW1P 2AP,ENGLAND. NR 12 TC 3 Z9 3 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1993 VL 77 IS 1 BP 78 EP 80 PG 3 WC Anesthesiology SC Anesthesiology GA LL119 UT WOS:A1993LL11900015 ER PT J AU KULYAKO, YM TROFIMOV, TI MALIKOV, DA LEBEDEV, IA MYASOEDOV, BF AF KULYAKO, YM TROFIMOV, TI MALIKOV, DA LEBEDEV, IA MYASOEDOV, BF TI ON CURIUM(III) FERRICYANIDE SO RADIOCHEMISTRY LA English DT Article AB Precipitation of Cm(III) from HNO3 Solution by potassium ferricyanide solution is investigated. A compound of formula Cm[Fe(CN)6] separates as a dark red precipitate. The precipitation is accompanied by partial peptization of the precipitate. Adding up to 40 vol.% C2H5OH to the mother liquor ensures precipitation of 95-98% of the Cm. Aging of the precipitate probably radiolytically reduces Cm ferricyanide to form the double salt KCm[Fe(CN)6]. NR 3 TC 2 Z9 2 PU MAIK NAUKA/INTERPERIODICA PI NEW YORK PA C/O PLENUM/CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 SN 1066-3622 J9 RADIOCHEMISTRY+ JI Radiochemistry PD JUL-AUG PY 1993 VL 35 IS 4 BP 399 EP 401 PG 3 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear SC Chemistry GA MY692 UT WOS:A1993MY69200006 ER PT J AU TEVIOTDALE, BM AF TEVIOTDALE, BM TI VECURONIUM-THIOPENTONE INDUCTION FOR EMERGENCY CESAREAN-SECTION UNDER GENERAL-ANESTHESIA SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE ANESTHESIA-ACID ASPIRATION, CESAREAN SECTION, THIOPENTONE; NEUROMUSCULAR RELAXANTS-SUXAMETHONIUM, VECURONIUM ID PLACENTAL-TRANSFER; CESAREAN-SECTION AB Induction of general anaesthesia for emergency caesarean section has always been hazardous. Acid aspiration syndrome1 and adverse reactions to suxamethonium2,3 are well recognised problems, in spite of which ''crash'' induction using thiopentone and suxamethonium remains a common induction technique.4 Recent case reports5-7 suggest that the use of medium duration nondepolarising relaxants in place of suxamethonium achieves satisfactory intubating conditions in the emergency caesarean section patient. This study was undertaken to investigate the following aspects of rapid-sequence vecuronium-thiopentone induction for emergency caesarean section. 1. To establish whether 8 mg of vecuronium provides effective intubating conditions. 2. To establish whether placental transfer of vecuronium used in the above dosage has any clinically detectable effect upon the newborn. 3. To establish the limit of lead time by which vecuronium may precede thiopentone to minimise the dangerous period between loss of consciousness and intubation. 4. To detect instances of acid regurgitation or aspiration. 5. To confirm that relaxant reversal is clinically effective at the completion of surgery. In this series of thirty cases, vecuronium 8 mg preceding thiopentone 250 mg and atropine 0. 6 mg by 20 seconds provided effective induction and easy intubating conditions without clinical effects on the newborn, maternal acid aspiration, or clinical signs of persistent paralysis after reversal. RP TEVIOTDALE, BM (reprint author), ROTORUA HOSP,DEPT ANAESTHESIA,PRIVATE BAG 3023,ROTORUA,NEW ZEALAND. NR 17 TC 5 Z9 5 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 1993 VL 21 IS 3 BP 288 EP 291 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA LJ024 UT WOS:A1993LJ02400005 ER PT J AU BEEMER, GH BJORKSTEN, AR AF BEEMER, GH BJORKSTEN, AR TI PHARMACODYNAMICS OF ATRACURIUM IN CLINICAL-PRACTICE - EFFECT OF PLASMA POTASSIUM, PATIENT DEMOGRAPHICS, AND CONCURRENT MEDICATION SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; RAT PHRENIC-NERVE; BLOCKING-DRUGS; D-TUBOCURARINE; PHARMACOKINETICS; ANESTHESIA; SENSITIVITY; ANTIBIOTICS; PANCURONIUM; METOCURINE AB To determine which factors influenced the pharmacodynamics of atracurium in clinical practice, the steady-state plasma concentration of atracurium for 90% paralysis (Cpss90) was measured in 100 adult patients. Neuromuscular block was maintained at 88%-92% of the control response by adjusting the target concentration being delivered by preprogramed intravenous atracurium infusion. The Cpss90 was measured empirically from plasma samples taken when the block had been stable for 15 min with no adjustment in the infusion rate for 20 min. To describe how factors influenced the Cpss90 of atracurium, a model was developed by multiple stepwise linear regression analysis. Influencing variables retained in the final model were plasma potassium concentration, intraoperative administration of gentamicin, and premedication with papaveretum and hyoscine. The model predicted that the Cpss90 of atracurium would decrease with decreasing serum potassium according to the relationship log10(Cpss90) = 2.380 + 0.171 x [K mmol/L] (n = 100; ANOVA, P < 0.001). Intraoperative administration of gentamicin modified this relationship resulting in a 25.1% decrease in the predicted Cpss90 (n = 15; ANOVA, P < 0.001). Premedication with papaveretum and hyoscine also modified this relationship resulting in a 21.2% decrease in predicted Cpss90 (n = 30; ANOVA, P < 0.001). The model predicted that administration of both would decrease the Cpss90 by 41.0%. Patients aged greater-than-or-equal-to 70 yr had a slight, but statistically insignificant, increase in the Cpss90 compared to younger adult patients. No other factor was found to influence the Cpss90, including patient sex, body build, and other drugs administered in the perioperative period, including calcium channel antagonists and ranitidine. These findings should assist anesthesiologists in more accurately predicting dosage of atracurium in clinical practice. RP BEEMER, GH (reprint author), ROYAL MELBOURNE HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3050,AUSTRALIA. NR 49 TC 3 Z9 3 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUN PY 1993 VL 76 IS 6 BP 1288 EP 1295 DI 10.1213/00000539-199376060-00018 PG 8 WC Anesthesiology SC Anesthesiology GA LE957 UT WOS:A1993LE95700018 ER PT J AU BEEMER, GH BJORKSTEN, AR CRANKSHAW, DP AF BEEMER, GH BJORKSTEN, AR CRANKSHAW, DP TI EFFECT OF BODY BUILD ON THE CLEARANCE OF ATRACURIUM - IMPLICATION FOR DRUG DOSING SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKADE; PHARMACOKINETICS; PHARMACODYNAMICS; ANESTHESIA; INFUSION; PLASMA; ALFENTANIL; OBESITY AB To determine factors that influenced the clearance (Cl) of atracurium, 80 adult patients of varying body build were given an atracurium infusion according to a predetermined profile, which was scaled by lean body mass (LBM). Cl was estimated at 50-60 min by the constant infusion rate required to maintain the steady-state plasma concentrations. The efficacy of scaling the absolute Cl estimates by body build variables, in which the absolute Cl estimate is divided by the body build variable to achieve similar scaled estimates in all patients, was assessed by the bias and precision of the individual scaled Cl estimates to those in patients with a ''normal'' body build (23%-27% body fat). The efficacy of scaling the dose of atracurium by differing body build variables to achieve similar plasma concentrations was also assessed by bias and precision, in which the plasma concentrations from an infusion scaled by other body build variables were generated by linear simulation. Body size, as quantified by LBM, total body mass (TBW), height, and body surface area, had a significant influence on Cl, with the effect best described by LBM (respective R2, 0.487, 0.368, 0.265, 0.445). No other factors could be identified, including blood pH, serum creatinine, and drugs given during the perioperative period. The efficacy of scaling Cl by TBW (absolute Cl estimate divided by patient TBW) to achieve similar estimates in all patients was poor; Cl.TBW estimates varied inversely with patient body fat content and resulted in obese patients having smaller estimates, a mean bias of -29%, compared with those in patients with a normal body build (P = 0.002). Scaling Cl by LBM seemed optimal; it had the best precision compared to the other methods of scaling (LBM versus TBW, height; P < 0.05) and Cl.LBM estimates had no relationship with patient body fat content. LBM also seemed optimal for dosing with the best precision (LBM versus TBW, height, body surface area; P < 0.05). Dosing by TBW underdosed lean patients and overdosed obese patients (P < 0.001). We conclude that body size and build are important determinants of the disposition of atracurium. Dosage of atracurium, particularly in patients at the extremes of body build, should be adjusted by LBM. RP BEEMER, GH (reprint author), ROYAL MELBOURNE HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3050,AUSTRALIA. NR 34 TC 9 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUN PY 1993 VL 76 IS 6 BP 1296 EP 1303 DI 10.1213/00000539-199376060-00019 PG 8 WC Anesthesiology SC Anesthesiology GA LE957 UT WOS:A1993LE95700019 ER PT J AU MADDINENI, VR MIRAKHUR, RK COOPER, R MCCOY, E AF MADDINENI, VR MIRAKHUR, RK COOPER, R MCCOY, E TI POTENCY ESTIMATION OF MIVACURIUM - COMPARISON OF 2 DIFFERENT MODES OF NERVE-STIMULATION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, MIVACURIUM; MONITORING, SINGLE TWITCH, TRAIN-OF-4 ID SINGLE TWITCH; ATRACURIUM; TRAIN-OF-4 AB We have assessed the potency of mivacurium, a new non-depolarizing neuromuscular blocker, using two different modes of nerve stimulation in patients anaesthetized with thiopentone, fentanyl and nitrous oxide in oxygen. The force of contraction of adductor pollicis was measured after single twitch stimulation at 0. 1 Hz or train-of-four stimulation (TOF) at 2 Hz every 10 s. Dose-response curves were constructed using a single-dose method for each mode of stimulation. The ED50 and ED95 were 43 mug kg-1 and 83 mug kg-1, respectively, for the single twitch responses and 34 mug kg-1 and 66 mug kg-1, respectively, for the first response of the TOF stimulation. The difference between the ED95 doses was not significant (P = 0.051), but the difference between the ED50 doses was significant (P = 0. 03), suggesting greater sensitivity of the neuromuscular junction using TOF stimulation. The results show that the information obtained using single twitch stimulation at 0. 1 Hz is not the same as that obtained from the first response of the TOF stimulation. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. NR 6 TC 20 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 JUN PY 1993 VL 70 IS 6 BP 694 EP 695 DI 10.1093/bja/70.6.694 PG 2 WC Anesthesiology SC Anesthesiology GA LF317 UT WOS:A1993LF31700021 ER PT J AU FRAMPTON, JE MCTAVISH, D AF FRAMPTON, JE MCTAVISH, D TI MIVACURIUM - A REVIEW OF ITS PHARMACOLOGY AND THERAPEUTIC POTENTIAL IN GENERAL-ANESTHESIA SO DRUGS LA English DT Article ID CHLORIDE BW B1090U; OXIDE ENFLURANE ANESTHESIA; NITROUS-OXIDE; NEUROMUSCULAR BLOCKADE; CLINICAL-PHARMACOLOGY; NARCOTIC ANESTHESIA; SURGICAL PATIENTS; CONTINUOUS INFUSION; CHILDREN; FENTANYL AB Mivacurium is a potent nondepolarising neuromuscular blocking agent which is structurally related to the benzylisoquinolinium compound, atracurium. Mivacurium has a short duration of action due to its rapid elimination by plasma cholinesterase. when administered to essentially healthy adult patients receiving nitrous oxide-narcotic anaesthesia, the recommended intubating dose (2 X ED95) usually provides clinically effective neuromuscular block for approximately 15 to 20 minutes and spontaneous recovery is 95% complete within about 25 to 30 minutes. When administered to paediatric patients aged 2 to 12 years, the recommended intubating dose of mivacurium produces approximately 10 minutes of clinically effective neuromuscular block. The clinical duration of action of mivacurium is shorter than that of the other nondepolarising blockers atracurium and vecuronium, although it is still longer than that of the depolarising blocker suxamethonium (succinylcholine). The recommended intubating dose usually produces good or excellent conditions for tracheal intubation within 2 to 2.5 minutes in adult patients, although intubation times are longer than those for a standard intubating dose of suxamethonium. Thus far, mivacurium has not demonstrated a cumulative neuromuscular blockade when administered to patients with normal plasma cholinesterase activity. Furthermore, due to the intrinsically faster rate of recovery, pharmacological reversal with anticholinesterases is less likely to be indicated with mivacurium than for other, longer-acting, nondepolarising blockers. Benzylisoquinolinium compounds such as mivacurium have the potential to release histamine and cause cardiovascular instability. Interpatient variability in the susceptibility to histamine release is to be expected, although the recommended intubating dose has produced minimal haemodynamic effects in clinical trials to date. Prolonged neuromuscular block is likely in patients with markedly reduced plasma cholinesterase activity. In particular, patients homozygous for the atypical plasma cholinesterase gene are extremely sensitive to the neuromuscular blocking effects of mivacurium and should not receive the drug. In summary, a single bolus dose of mivacurium can be recommended for use in adult and paediatric patients undergoing nonemergency tracheal intubation and/or during short surgical procedures. For maintenance of neuromuscular block, mivacurium can be administered as multiple bolus doses or as a continuous infusion. In particular, the lack of a significant cumulative effect renders the drug suitable for the maintenance of neuromuscular blockade during extended surgical procedures of unpredictable length. RP FRAMPTON, JE (reprint author), ADIS INT LTD,41 CENTORIAN DR,PRIVATE BAG 659018MAIRANGI BAY,AUCKLAND 10,NEW ZEALAND. NR 60 TC 25 Z9 26 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 0012-6667 J9 DRUGS JI Drugs PD JUN PY 1993 VL 45 IS 6 BP 1066 EP 1089 DI 10.2165/00003495-199345060-00009 PG 24 WC Pharmacology & Pharmacy; Toxicology SC Pharmacology & Pharmacy; Toxicology GA LK141 UT WOS:A1993LK14100011 ER PT J AU OMOTE, K IWASAKI, H NAMIKI, A AF OMOTE, K IWASAKI, H NAMIKI, A TI CERVICOTHORACIC EPIDURAL-ANESTHESIA BLUNTS PANCURONIUM-INDUCED INCREASE IN HEART-RATE IN HUMANS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE EPIDURAL; PANCURONIUM; PULSE RATE; SYMPATHETIC NERVOUS SYSTEM ID BROMIDE AB This study was conducted to evaluate the effects of cervico-thoracic epidural anaesthesia upon pancuronium-induced tachvcardia in surgical patients. In the control (no blockade) group (n=8) and the lumbar epidural group (n=8), pancuronium produced significant increases in heart rate (P<0.01 and P<0.01, respectively) and no significant changes in mean arterial pressure. In the cervico-thoracic epidural group (n=8), no increase in heart rate and a significant decrease in mean arterial pressure were seen following pancuronium. The lack of an increase in heart rate following pancuronium with cervico-thoracic epidural anaesthesia might be due to cardiac sympathetic denervation. The authors concluded that tachycardia after pancuronium administration was attenuated by cervico-thoracic epidural anaesthesia in humans and that the pancuronium-induced tachycardia seemed to be a cardiac sympathomimetic effect. RP OMOTE, K (reprint author), SAPPORO MED COLL & HOSP,DEPT ANESTHESIOL,SOUTH-1,WEST-16,CHUO KU,SAPPORO,HOKKAIDO 060,JAPAN. NR 15 TC 0 Z9 0 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 1993 VL 37 IS 4 BP 415 EP 418 PG 4 WC Anesthesiology SC Anesthesiology GA LD779 UT WOS:A1993LD77900017 ER PT J AU HOUGHTON, IT AUN, CST GIN, T LAU, JTF OH, TE AF HOUGHTON, IT AUN, CST GIN, T LAU, JTF OH, TE TI SUXAMETHONIUM MYALGIA - AN ETHNIC COMPARISON WITH AND WITHOUT PANCURONIUM PRETREATMENT SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, SUXAMETHONIUM, PANCURONIUM; COMPLICATIONS, MYALGIA; GENETIC FACTORS, RACE, ETHNIC ORIGIN C1 CHINESE UNIV HONG KONG,FAC MED,CTR CLIN TRIALS & EPIDEMIOL,DEPT ANAESTHESIA & INTENS CARE,SHA TIN,HONG KONG. RP HOUGHTON, IT (reprint author), BRITISH MIL HOSP,DEPT ANAESTHESIA & RESUSCITAT,HONG KONG,HONG KONG. RI GIN, Tony/J-2521-2013 OI GIN, Tony/0000-0001-7283-6761 NR 22 TC 4 Z9 4 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAY PY 1993 VL 48 IS 5 BP 377 EP 381 DI 10.1111/j.1365-2044.1993.tb07007.x PG 5 WC Anesthesiology SC Anesthesiology GA KZ643 UT WOS:A1993KZ64300004 ER PT J AU SLOAN, TB ERIAN, R AF SLOAN, TB ERIAN, R TI EFFECT OF ATRACURIUM-INDUCED NEUROMUSCULAR BLOCK ON CORTICAL MOTOR-EVOKED POTENTIALS SO ANESTHESIA AND ANALGESIA LA English DT Article ID TRANSCRANIAL ELECTRICAL-STIMULATION; MAGNETIC STIMULATION; NITROUS-OXIDE; CORTEX STIMULATION; SCOLIOSIS SURGERY; RESPONSES; ANESTHETICS; PATHWAYS; MONKEY AB The effect of nondepolarizing neuromuscular block (NMB) with atracurium on transcranial magnetic motor-evoked potentials (tcMMEP) was examined in 10 adult cynomologous monkeys. The monkeys were anesthetized initially with ketamine (15 mg/kg intramuscularly) and maintained with a continuous ketamine infusion (10-15 mg.kg-1.h-1). NMB was then adjusted from no block to profound block and then back to no detectable block by adjustment of an atracurium infusion (0-7.25 mg.kg-1.min-1). NMB was assessed by measuring the peak-to-peak amplitude of the evoked electromyographic (EMG) activity of the thenar muscles and by measuring the ratio of the 4th to 1st peak in the train of four (TOF) of the mechanical action from direct stimulation of the median nerve (direct EMG). NMB was adjusted incrementally, whereas cortical magnetic motor-evoked potentials were assessed by measuring the onset latency and amplitude of the thenar EMG response. Cortical stimulation was accomplished with a Cadwell MES-10 magnetic stimulator. tcMMEP and direct EMG amplitude and the mechanical response were reduced with increasing NMB. The average tcMMEP amplitude remained near baseline values (no NMB) until the direct EMG decreased <0.4 of the unblocked value and when the TOF ratio decreased <0.3. Further increases in NMB resulted in decreasing amplitude with a statistically significant reduction below baseline when the direct EMG decreased <0.2 of baseline and TOF ratio decreased <0.1. The tcMMEP onset latency was unchanged from baseline with TOF or with direct EMG reductions above 0.1 of baseline. This study suggests that NMB has its greatest effect on tcMMEP amplitude and that a controlled, partial pharmacologic paralysis may be acceptable when monitoring tcMMEP amplitude and onset latency. RP SLOAN, TB (reprint author), UNIV TEXAS,HLTH SCI CTR,DEPT ANESTHESIOL,7703 FLOYD CURL DR,SAN ANTONIO,TX 78284, USA. NR 28 TC 12 Z9 14 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 1993 VL 76 IS 5 BP 979 EP 984 PG 6 WC Anesthesiology SC Anesthesiology GA LA490 UT WOS:A1993LA49000011 ER PT J AU BRANDOM, BW MERETOJA, OA TAIVAINEN, T WIRTAVUORI, K AF BRANDOM, BW MERETOJA, OA TAIVAINEN, T WIRTAVUORI, K TI ACCELERATED ONSET AND DELAYED RECOVERY OF NEUROMUSCULAR BLOCK INDUCED BY MIVACURIUM PRECEDED BY PANCURONIUM IN CHILDREN SO ANESTHESIA AND ANALGESIA LA English DT Article ID CHLORIDE BW B1090U; CLINICAL-PHARMACOLOGY; ANESTHETIZED INFANTS; D-TUBOCURARINE; PHARMACOKINETICS; ATRACURIUM; PHARMACODYNAMICS; POTENTIATION AB The goal of this study was to describe a technique which could shorten the time from mivacurium administration to peak neuromuscular block (NMB) after administration of the maximum recommended dose of mivacurium. Forty-eight pediatric patients were randomized into three groups and studied during nitrous oxide-alfentanil-thiopental anesthesia. Every patient received two blinded injections 3 min apart: either 15 mug/kg of pancuronium in 1 mL of saline followed by 170 or 200 mug/kg of mivacurium or saline followed by 200 mug/kg of mivacurium. Intravenous induction of anesthesia followed the first injection. Thenar electromyogram response to supramaximum train-of-four stimulation of the ulnar nerve at 10-s intervals was used for neuromuscular monitoring. Pretreatment with pancuronium significantly shortened the time to NMB and prolonged spontaneous recovery from NMB in comparison to the temporal course of NMB after administration of 200 mug/kg of mivacurium. Time from injection to 90% NMB averaged 116 (SEM 11) s after administration of 200 mug/kg of mivacurium, and 71 (7) s and 94 (11) s when 200 mug/kg or 170 mug/kg of mivacurium, respectively, was preceded by pancuronium (P = 0.0095). Mean times from injection to recovery of neuromuscular function to >25% of baseline (T25) and to train-of-four ratio of 0.75 were 9.1 (0.7) and 15.8 (1.2) min, respectively, after administration of 200 mug/kg of mivacurium alone. T25 and train-of-four of 0.75 occurred significantly later at 21.9 (1.8) and 35.0 (2.8) min, respectively (P = 0.0001), when 200 mug/kg of mivacurium was preceded by 15 mug/kg of pancuronium. Given the short elimination half-life of mivacurium, these data suggest that the neuromuscular blocking effects of pancuronium and mivacurium are synergistic. C1 CHILDRENS HOSP HELSINKI,HELSINKI,FINLAND. UNIV HELSINKI,SF-00100 HELSINKI 10,FINLAND. RP BRANDOM, BW (reprint author), CHILDRENS HOSP PITTSBURGH,DEPT ANESTHESIOL,3705 5TH AVE & DESOTO ST,PITTSBURGH,PA 15213, USA. NR 21 TC 19 Z9 20 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 1993 VL 76 IS 5 BP 998 EP 1003 PG 6 WC Anesthesiology SC Anesthesiology GA LA490 UT WOS:A1993LA49000014 ER PT J AU SLOAN, TB ERIAN, R AF SLOAN, TB ERIAN, R TI EFFECT OF VECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE ON CORTICAL MOTOR EVOKED-POTENTIALS SO ANESTHESIOLOGY LA English DT Article DE MONITORING, CORTICAL MOTOR EVOKED POTENTIALS; MAGNETIC; NEUROMUSCULAR RELAXANTS, VECURONIUM ID MAGNETIC STIMULATION; SCOLIOSIS SURGERY; NITROUS-OXIDE; RESPONSES; CORTEX; ANESTHETICS; PATHWAYS; MUSCLES; BRAIN AB Background. Neuromuscular blockade (NMB) is a frequent component of anesthetic techniques used during surgery in which monitoring of the nervous system is desirable. Because NMB should affect the evoked muscle response to transcranial magnetic stimulation (tcMMEP), their relationship in a primate model was characterized. Methods. Transcranial magnetic stimulation was characterized during NMB using an infusion of vecuronium in ten adult cynomologous monkeys during anesthesia with a continuous ketamine infusion. Neuromuscular blockade was measured by peak-to-peak amplitude of the evoked muscular activity (compound muscle action potential [m-response]) of the thenar muscles and mechanical muscle action (ratio of the fourth to first peak in the train of four [TOF]) after direct stimulation of the median nerve. Neuromuscular blockade was increased incrementally to complete block and then allowed to decrease until complete resolution of measurable block. Transcranial magnetic stimulation was assessed by measuring the onset latency (time from stimulation to beginning response) and amplitude of the thenar EMG response. Cortical stimulation was accomplished using a Cadwell MES-10 magnetic stimulator at 80% of full output (1.6 Tesla). Results: The tcMMEP, m-response amplitude, and mechanical muscle action, unblocked, were reduced with increasing NMB. Transcranial magnetic stimulation amplitude was more variable than was onset latency. Transcranial magnetic stimulation amplitude reduction from the baseline value did not achieve statistical significance until the m-response amplitude was reduced to 0.2 of baseline or until the TOF ratio was reduced to 0.1. Transcranial magnetic stimulation onset latency prolongation from baseline was not significantly affected by declining TOF ratios, but was prolonged when the m-response declined to 0.1 of baseline. Conclusions: This study indicates that tcMMEP onset latency is not significantly affected by NMB if the degree of blockade in the muscles used for tcMMEP monitoring is not extreme (greater than 0.2 of baseline by m-response amplitude or a TOF ratio of 0.1 or greater). If monitoring of tcMMEP amplitude is desired, partial neuromuscular blockade may be acceptable. However, amplitude reduction may occur during partial NMB. Maintenance of a constant degree of NMB is suggested to minimize amplitude fluctuations. RP SLOAN, TB (reprint author), UNIV TEXAS,HLTH SCI CTR,DEPT ANESTHESIOL,7703 FLOYD CURL DR,SAN ANTONIO,TX 78284, USA. NR 26 TC 9 Z9 10 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAY PY 1993 VL 78 IS 5 BP 966 EP 973 DI 10.1097/00000542-199305000-00022 PG 8 WC Anesthesiology SC Anesthesiology GA LA777 UT WOS:A1993LA77700021 ER PT J AU DEGOUW, NE CRUL, JF VANDERMEERSCH, E MULIER, JP VANEGMOND, J VANAKEN, H AF DEGOUW, NE CRUL, JF VANDERMEERSCH, E MULIER, JP VANEGMOND, J VANAKEN, H TI INTERACTION OF ANTIBIOTICS ON PIPECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE ANTIBIOTICS; CLINDAMYCIN; COLISTIN; NEUROMUSCULAR BLOCKING AGENTS; PIPECURONIUM BROMIDE AB Study Objective: To measure the interaction of two antibiotics (clindamycin and colistin) on neuromuscular blockade induced by pipecuronium bromide (a new long-acting, steroidal, nondepolarizing neuromuscular blocking drug). Design: Prospective, randomized, placebo-controlled study. Setting: Inpatient gynecologic and gastroenterologic service at a university medical center. Patients: Three groups of 20 ASA physical status I and II patients with normal kidney and liver function, taking no medication, and undergoing elective surgery under general anesthesia. Interventions: Anesthesia was induced with propofol and alfentanil intravenously (IV) and maintained with a propofol infusion and 60% nitrous oxide in oxygen. Pipecuronium bromide 50 mug/kg was administered after reaching a stable baseline of single-twitch response. At 25% recovery of pipecuronium-induced neuromuscular blockade, patients received one of two antibiotics, clindamycin 300 mg or colistin 1 million IU, or a placebo. Measurements and Main Results: The recovery index (RI, defined as time from 25% to 75% recovery of neuromuscular blockade) was measured using the single-twitch response of the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve at the wrist. RI after administration of an antibiotic (given at 25% recovery) was measured and compared with RI of the control group using Student's unpaired t-test. Statistical analyses of the results showed a significant prolongation of the recovery time (from 25% to 75% recovery) of 40 minutes for colistin. Conclusions: When this type of antibiotic is used during anesthesia with pipecuronium as a muscle relaxant, one must be aware of a significant prolongation of an already long-acting neuromuscular blockade and (although not observed in this study) possible problems in antagonism. RP DEGOUW, NE (reprint author), KATHOLIEKE UNIV LEUVEN HOSP,DEPT ANESTHESIOL,HERESTR 49,B-3000 LOUVAIN,BELGIUM. NR 0 TC 5 Z9 5 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAY-JUN PY 1993 VL 5 IS 3 BP 212 EP 215 DI 10.1016/0952-8180(93)90017-9 PG 4 WC Anesthesiology SC Anesthesiology GA LF822 UT WOS:A1993LF82200006 ER PT J AU OSTERGAARD, D JENSEN, FS JENSEN, E SKOVGAARD, LT VIBYMOGENSEN, J AF OSTERGAARD, D JENSEN, FS JENSEN, E SKOVGAARD, LT VIBYMOGENSEN, J TI MIVACURIUM-INDUCED NEUROMUSCULAR BLOCKADE IN PATIENTS WITH ATYPICAL PLASMA CHOLINESTERASE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS; ENZYMES; CHOLINESTERASE, PSEUDOCHOLINESTERASE; NEUROMUSCULAR RELAXANTS; MIVACURIUM ID NITROUS-OXIDE FENTANYL; CHLORIDE BW B1090U; SUCCINYLCHOLINE; PHARMACOLOGY; ANESTHESIA; ATRACURIUM AB The duration of action of mivacurium was evaluated during a modified neurolept anaesthesia in 17 patients heterozygous for the usual and the atypical plasma cholinesterase (pChe) gene (E1(u)E1a) and in five patients homozygous for the atypical gene (E1(a)E1a). The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Five heterozygous patients were given a small dose of mivacurium 0.03 mg kg bw-1 intravenously (Group 1). The mean (range) suppression of the first twitch in the train-of-four response (T1) was 91% (69-100%). The time to 90% T1 recovery was 23.9 min (14.0-31.3 min). Twelve other heterozygous patients (Group 2) received mivacurium 0.2 mg kg bw-1 (2.5 x ED95). In these patients the time to 100% T1 suppression was 1.4 min (1.1-2.0 min). The time to reappearance of the T1 response, to 90% T1 recovery, and the recovery index (25.3 min (14.5-34.5), 45.5 min (30.9-59.2), and 9.8 min (6.8-19.6), respectively) were significantly longer than reported in phenotypically normal patients. Five patients homozygous for the atypical gene (Group 3) were given 0.03 mg kg bw-1 mivacurium. The time to reappearance of T1 response following this low dose of mivacurium ranged from 26-128 min. In all five patients the neuromuscular block was successfully antagonized with neostigmine preceded by atropine. In conclusion, mivacurium-induced neuromuscular blockade was moderately prolonged in patients heterozygous for the usual and the atypical gene for plasma cholinesterase. Patients homozygous for the atypical plasma cholinesterase gene appear to be markedly sensitive to mivacurium. C1 RIGSHOSP,DEPT ANAESTHESIA,DANISH CHOLINESTERASE RES UNIT,DK-2100 COPENHAGEN,DENMARK. BISPEBJERG HOSP,DEPT CLIN CHEM,DK-2400 COPENHAGEN,DENMARK. GENTOFTE UNIV HOSP,DEPT ANAESTHESIA,DK-2900 COPENHAGEN,DENMARK. UNIV COPENHAGEN,STAT RES UNIT,DK-1168 COPENHAGEN,DENMARK. NR 14 TC 56 Z9 58 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 APR PY 1993 VL 37 IS 3 BP 314 EP 318 PG 5 WC Anesthesiology SC Anesthesiology GA KZ675 UT WOS:A1993KZ67500015 ER PT J AU WERBA, A KLEZL, M SCHRAMM, W LANGENECKER, S MULLER, C GOSCH, M SPISS, CK AF WERBA, A KLEZL, M SCHRAMM, W LANGENECKER, S MULLER, C GOSCH, M SPISS, CK TI THE LEVEL OF NEUROMUSCULAR BLOCK NEEDED TO SUPPRESS DIAPHRAGMATIC MOVEMENT DURING TRACHEAL SUCTION IN PATIENTS WITH RAISED INTRACRANIAL-PRESSURE - A STUDY WITH VECURONIUM AND ATRACURIUM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; ATRACURIUM, VECURONIUM; CEREBROSPINAL FLUID; PRESSURE; MUSCLE, SKELETAL; DIAPHRAGM ID HEAD-INJURY; STIMULATION; COUNT RP WERBA, A (reprint author), UNIV VIENNA,DEPT ANAESTHESIA & GEN INTENS CARE,NEUROANAESTHESIA RES GRP,A-1090 VIENNA,AUSTRIA. NR 16 TC 20 Z9 21 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD APR PY 1993 VL 48 IS 4 BP 301 EP 303 DI 10.1111/j.1365-2044.1993.tb06947.x PG 3 WC Anesthesiology SC Anesthesiology GA KV712 UT WOS:A1993KV71200006 ER PT J AU PLATT, PR THACKRAY, NM AF PLATT, PR THACKRAY, NM TI PHENYTOIN-INDUCED RESISTANCE TO VECURONIUM SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE NEUROMUSCULAR RELAXANTS; SUCCINYLCHOLINE; VECURONIUM; ANTICONVULSANTS; PHENYTOIN; COMPLICATIONS; DRUG INTERACTION; HYPERKALEMIA ID INDUCED NEUROMUSCULAR BLOCKADE; PATIENTS RECEIVING PHENYTOIN; MUSCLE-RELAXANTS; ACETYLCHOLINE RECEPTORS; INDUCTION-AGENTS; SKELETAL-MUSCLE; HYPERKALEMIA; PANCURONIUM; SUCCINYLCHOLINE; TUBOCURARINE AB Chronic phenytoin therapy causes resistance to some nondepolarising muscle relaxants. We have confirmed that this resistance is seen with vecuronium and suggest that at least a week of phenytoin therapy is required for a significant effect to develop. The mechanism of this resistance is not known. We have shown that an exaggerated rise in serum potassium after succinylcholine does not occur in patients with demonstrated resistance to vecuronium from chronic phenytoin therapy. This would suggest that significant extrajunctional acetylcholine receptor proliferation is an unlikely mechanism. C1 SIR CHARLES GAIRDNER HOSP,DEPT ANAESTHESIA,PERTH,WA,AUSTRALIA. NR 57 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 APR PY 1993 VL 21 IS 2 BP 185 EP 191 PG 7 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA KZ434 UT WOS:A1993KZ43400009 ER PT J AU KENEALLY, JP GOONETILLEKE, PH RAMZAN, IM AF KENEALLY, JP GOONETILLEKE, PH RAMZAN, IM TI DELAYED ONSET OF ALCURONIUM EFFECT IN CHILDREN WITH CYANOTIC CONGENITAL HEART-DISEASE SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE NEUROMUSCULAR RELAXANTS; ALCURONIUM; ANESTHESIA; PEDIATRIC; CARDIAC DISEASE; CONGENITAL AB The effect of alcuronium dichloride (0.3 mg/kg) was studied in seven normal children (Group A), nine with acyanotic congenital heart disease (Group B) and eight with cyanotic disease (Group C). The onset of action was recorded using an integrated electromyograph and blood samples taken for later estimation of plasma concentrations of the drug. The mean time (SD) taken to 75% suppression of twitch height was 1.3(0.8), 1.7(1.0) and 3.8(2.8) minutes, respectively, in each of the three groups. This was significantly slower in Group C compared with both other groups (P < 0.05). While six of the Group A patients and seven from Group B reached 95% paralysis within ten minutes, only two of the cyanosed children achieved this level of relaxation. However if times to 95% relaxation were extrapolated, there was no significant difference between the groups at 4.5(3.9), 5.8(5.7) and 10.9(6.5) minutes respectively. There was a weak but statistically significant relationship between haematocrit and time to 75% blockade. Maximum twitch depression was similar in all three groups with plasma concentrations at this time being 1.6(0.7), 1.8(0.5) and 2.3(1.4) mug/ml respectively. Again, there was no statistically significant difference between these values. These results confirm that the clinical onset of relaxation is delayed in children with cyanotic congenital heart disease, possibly because of delayed distribution of alcuronium. C1 CHILDRENS HOSP,DEPT ANAESTHESIA,CAMPERDOWN,AUSTRALIA. UNIV SYDNEY,DEPT PHARM,SYDNEY,NSW 2006,AUSTRALIA. NR 8 TC 1 Z9 2 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 1993 VL 21 IS 2 BP 197 EP 200 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA KZ434 UT WOS:A1993KZ43400011 ER PT J AU MANGAR, D KIRCHHOFF, GT ROSE, PL CASTELLANO, FC AF MANGAR, D KIRCHHOFF, GT ROSE, PL CASTELLANO, FC TI PROLONGED NEUROMUSCULAR BLOCK AFTER MIVACURIUM IN A PATIENT WITH END-STAGE RENAL-DISEASE SO ANESTHESIA AND ANALGESIA LA English DT Article ID SUXAMETHONIUM RP MANGAR, D (reprint author), UNIV S FLORIDA,COLL MED,DEPT ANESTHESIOL,MDC BOX 59,TAMPA,FL 33612, USA. NR 9 TC 7 Z9 7 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1993 VL 76 IS 4 BP 866 EP 867 PG 2 WC Anesthesiology SC Anesthesiology GA KY041 UT WOS:A1993KY04100030 ER PT J AU DIEFENBACH, C LYNCH, J ABEL, M BUZELLO, W AF DIEFENBACH, C LYNCH, J ABEL, M BUZELLO, W TI VECURONIUM FOR MUSCLE-RELAXATION IN PATIENTS WITH DYSTROPHIA-MYOTONICA SO ANESTHESIA AND ANALGESIA LA English DT Article ID INDUCED NEUROMUSCULAR BLOCKADE; ISOFLURANE; ATRACURIUM; ANESTHESIA; HUMANS RP DIEFENBACH, C (reprint author), UNIV COLOGNE,DEPT ANESTHESIOL,JOSEPH STELZMANN STR 9,W-5000 COLOGNE 41,GERMANY. NR 12 TC 10 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1993 VL 76 IS 4 BP 872 EP 874 PG 3 WC Anesthesiology SC Anesthesiology GA KY041 UT WOS:A1993KY04100032 ER PT J AU SHANKS, CA FRAGEN, RJ LING, D AF SHANKS, CA FRAGEN, RJ LING, D TI CONTINUOUS INTRAVENOUS-INFUSION OF ROCURONIUM (ORG-9426) IN PATIENTS RECEIVING BALANCED, ENFLURANE, OR ISOFLURANE ANESTHESIA SO ANESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, ORG-9426; ROCURONIUM ID PHARMACOKINETICS; AGENT AB Background: Rocuronium (ORG 9426) is a new nondepolarizing neuromuscular blocking agent with a rapid onset and an intermediate duration of action. This study obtains the infusion requirements of rocuronium in 30 patients in whom anesthesia was maintained with barbiturate-nitrous oxide-opioid, nitrous oxide and enflurane, of nitrous oxide and isoflurane. Methods: For all 30 patients, anesthesia was induced with intravenous thiopental and fentanyl, followed by 0.45 mg/kg rocuronium. Patients were randomly allocated to receive either: 1) nitrous oxide in 40% oxygen supplemented with fentanyl, thiopental, and droperidol (balanced anesthesia), 2) 1.25 MAC enflurane-nitrous oxide, or 3) 1.25 MAC isoflurane-nitrous oxide. Once blockade had recovered to 95% depression of twitch height, muscle relaxation was maintained by continuous infusion of rocuronium, adjusted to maintain mechanical twitch response at 95% depression. Results: At 90 and 120 min, the enflurane and isoflurane groups had lower infusion requirements than those receiving barbiturate-nitrous oxide-opioid anesthesia (P < 0.02), but these did not differ significantly between the two volatile agents. Final infusion requirements (mean +/- SD) were 9.8 +/- 3.7, 5.9 +/- 3.1, and 6.1 +/- 2.7 mug . kg-1 . min-1 for the groups receiving barbiturate-nitrous oxide-opioid, enflurane, and isoflurane anesthesia, respectively. Spontaneous recovery began soon after termination of the infusion; in all patients, twitch tension equaled 10% of control within 5 min. Conclusions: The infusion requirements to maintain 95% twitch depression approximated 10 mug . kg-1 . min-1 during barbiturate-nitrous oxide-opioid anesthesia. These requirements were reduced by 40% during anesthesia involving enflurane or isoflurane. RP SHANKS, CA (reprint author), NORTHWESTERN UNIV,DEPT ANESTHESIA,303 E CHICAGO AVE,CHICAGO,IL 60611, USA. NR 11 TC 46 Z9 52 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 1993 VL 78 IS 4 BP 649 EP 651 DI 10.1097/00000542-199304000-00006 PG 3 WC Anesthesiology SC Anesthesiology GA KV589 UT WOS:A1993KV58900005 ER PT J AU ERIKSSON, LI SATO, M SEVERINGHAUS, JW AF ERIKSSON, LI SATO, M SEVERINGHAUS, JW TI EFFECT OF A VECURONIUM-INDUCED PARTIAL NEUROMUSCULAR BLOCK ON HYPOXIC VENTILATORY RESPONSE SO ANESTHESIOLOGY LA English DT Article DE CARBON DIOXIDE, VENTILATORY RESPONSE; CHEMORECEPTORS, PERIPHERAL, CAROTID; NEUROMUSCULAR RELAXANTS, VECURONIUM; OXYGEN, HYPOXIC VENTILATORY RESPONSE; RECEPTORS, ACETYLCHOLINE; REGULATION OF RESPIRATION ID CAROTID-BODY; HUMANS; TUBOCURARINE; PARALYSIS; RECOVERY; DOPAMINE; ADULTS AB Background: A previous study has demonstrated a decrease in the hypoxic ventilatory response in volunteers partially paralyzed with vecuronium. However, in this study, hypocapnia was allowed to occur. Because hypocapnia counteracts the ventilatory response to hypoxia during partial vecuronium-induced neuromuscular block and isocapnia, the hypoxic ventilatory response (HVR) was tested in 10 awake volunteers. Methods: To avoid hypocapnia, the resting hyperoxic control end-tidal P(CO2) was increased to 43.3 +/- 2.4 mmHg, raising inspiratory minute ventilation (V(I)) to 140 ml . kg-1 . min-1. Hypoxic ventilatory response (DELTAV(I)/DELTASp(O2), L . min-1 . %-1) was measured during a 5-min isocapnic step reduction to a mean arterial hemoglobin oxygen saturation (Sp(O2)) of 84.8 +/- 1.4%. Immediately thereafter, hypercapnic ventilatory response (HCVR; DELTAV(I)/DELTAPET(CO2) L . min-1 . mmHg-1) was determined at the end of a 6-min step increase of PET(CO2), to 50.5 +/- 2.7 mmHg. During a subsequent 30-40-min pause, an intravenous infusion of vecuronium was adjusted to reduce the adductor pollicis train-of-four ratio to 0.70, as monitored using mechanomyography. Ventilatory parameters, HVR and HCVR, were then redetermined. Results: Resting V(I), PET(CO2), and Sp(O2) were unchanged by drug infusion. Hypoxic ventilatory response decreased from control (a) of 0.97 +/- 0.43 to 0.74 +/- 0.41 L . min-1 . %-1 (P < 0.02) during drug infusion (b), while HCVR was unchanged (a = 1.91 +/- 0.82, b 1.62 +/- 0.46 L . min-1 . mmHg-1; NS). To correct HVR for possible vecuronium-induced respiratory muscle weakness or otherwise altered central nervous system reactivity, the drug/control ratio (HVR(b/a)) was divided by the associated HCVR(b/a) ratio. This HVR index, F(HVR) was 0.84 +/- 0.12 (P < 0.01). Conclusions: We conclude that a vecuronium-induced partial neuromuscular block impairs HVR more than it does HCVR in humans, suggesting an effect of vecuronium on carotid body hypoxic chemosensitivity. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,1386-HSE,SAN FRANCISCO,CA 94143. UNIV CALIF SAN FRANCISCO,CARDIOVASC RES INST,SAN FRANCISCO,CA 94143. NR 20 TC 81 Z9 86 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 1993 VL 78 IS 4 BP 693 EP 699 DI 10.1097/00000542-199304000-00012 PG 7 WC Anesthesiology SC Anesthesiology GA KV589 UT WOS:A1993KV58900011 ER PT J AU SAITOH, Y TOYOOKA, H AMAHA, K AF SAITOH, Y TOYOOKA, H AMAHA, K TI RECOVERIES OF POSTTETANIC TWITCH AND TRAIN-OF-4 RESPONSES AFTER ADMINISTRATION OF VECURONIUM WITH DIFFERENT INHALATION ANESTHETICS AND NEUROLEPTANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE MONITORING, POST-TETANIC-TWITCH, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, VECURONIUM ID INDUCED NEUROMUSCULAR BLOCKADE; HALOTHANE ANESTHESIA; PANCURONIUM; ATRACURIUM; ISOFLURANE; ENFLURANE; COUNT AB We have studied recovery of post-tetanic twitch (PTT) and train-of-four (TOF) responses after administration of vecuronium in 100 patients under different inhalation anaesthetics and neuroleptanaesthesia. Patients were allocated randomly to five groups of 20 patients each to receive: neuroleptanaesthesia (droperidol and fentanyl), halothane, isoflurane, enflurane or sevoflurane (1 MAC in nitrous oxide and oxygen). The times from initial administration of vecuronium 0.2 mg kg-1 to the first appearances of Tl, T2, T3 and T4 differed significantly between groups. However, the intervals to the first appearance of PTT1, PTT10 and PTT20 did not differ significantly between groups. RP SAITOH, Y (reprint author), TOKYO MED & DENT UNIV,FAC MED,DEPT ANAESTHESIOL & CRIT CARE MED,5-45 YUSHIMA,1 CHOME,BUNKYO KU,TOKYO 113,JAPAN. NR 23 TC 33 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 APR PY 1993 VL 70 IS 4 BP 402 EP 404 DI 10.1093/bja/70.4.402 PG 3 WC Anesthesiology SC Anesthesiology GA KW402 UT WOS:A1993KW40200005 ER PT J AU EASA, D UYEHARA, CFT STEVENS, EL FINN, KC BALARAMAN, V SIM, H AF EASA, D UYEHARA, CFT STEVENS, EL FINN, KC BALARAMAN, V SIM, H TI PANCURONIUM DOES NOT ALTER THE HEMODYNAMIC STATUS OF PIGLETS AFTER NORMOXIA OR HYPOXIA SO PEDIATRIC RESEARCH LA English DT Article ID VENTILATED INFANTS; BLOOD-PRESSURE; PULMONARY-HYPERTENSION; NEWBORN-INFANTS; HEART-RATE; BROMIDE; CATECHOLAMINE; MECHANICS; PARALYSIS; SEPSIS AB Pancuronium is a neuromuscular blocking agent commonly used to eliminate agitation in sick newborn infants requiring mechanical ventilation. Experimental data supporting this method of intervention are controversial, and hemodynamic studies in newborn infants report conflicting results. This study was designed to determine the hemodynamic effects of pancuronium administered under conditions of normoxia, hypoxia, and preexposure to hypoxia in neonatal piglets with normal lungs. After baseline hemodynamic and blood gas measurements were obtained, pancuronium was administered in two i.v. bolus injections of 0.1 mg/kg. Tidal volume and minute ventilation were maintained constant during the experimental procedure by adjusting ventilator settings. Twenty min after pancuronium, no changes from baseline values were found in arterial blood gases, heart rate, cardiac output, mean arterial pressure, systemic vascular resistance, pulmonary artery pressure, pulmonary vascular resistance, central venous pressure, or pulmonary capillary wedge pressure in any of the three conditions studied. In conclusion, pancuronium administered during normoxia, hypoxia, or after preexposure to hypoxia while controlled ventilation is maintained does not alter systemic or pulmonary hemodynamic status of the newborn piglet. C1 TRIPLER ARMY MED CTR,DEPT CLIN INVEST,HONOLULU,HI 96859. TRIPLER ARMY MED CTR,DEPT PEDIAT,HONOLULU,HI 96859. RP EASA, D (reprint author), JOHN A BURNS SCH MED,KAPIOLANI MED CTR WOMEN & CHILDREN,DEPT PEDIAT,1319 PUNAHOU ST,HONOLULU,HI 96826, USA. NR 37 TC 8 Z9 8 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 1993 VL 33 IS 4 BP 365 EP 372 PN 1 PG 8 WC Pediatrics SC Pediatrics GA KV791 UT WOS:A1993KV79100011 ER PT J AU SPERLICH, M RECKENDORFER, H BURGMANN, H WEINDLMAYRGOTTEL, M TUCHY, GL SCHWARZ, S SPIECKERMANN, PG AF SPERLICH, M RECKENDORFER, H BURGMANN, H WEINDLMAYRGOTTEL, M TUCHY, GL SCHWARZ, S SPIECKERMANN, PG TI ALTERED HEPATIC-FUNCTION BY ATRACURIUM OR ITS BREAKDOWN PRODUCTS SO TRANSPLANTATION PROCEEDINGS LA English DT Article C1 ALLGEMEINE POLIKLIN,DEPT PATHOL,VIENNA,AUSTRIA. KH LAINZ,DEPT ANESTHESIOL,VIENNA,AUSTRIA. UNIV VIENNA,DEPT INFECT CHEMOTHERAPY,A-1090 VIENNA,AUSTRIA. UNIV VIENNA,DEPT ANESTHESIOL & GEN INTENS CARE,A-1090 VIENNA,AUSTRIA. RP SPERLICH, M (reprint author), UNIV VIENNA,DEPT MED PHYSIOL,SCHWARZSPANIERSTR 17,A-1090 VIENNA,AUSTRIA. RI Burgmann, Heinz/N-2409-2013 NR 7 TC 4 Z9 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 SN 0041-1345 J9 TRANSPLANT P JI Transplant. Proc. PD APR PY 1993 VL 25 IS 2 BP 1851 EP 1852 PG 2 WC Immunology; Surgery; Transplantation SC Immunology; Surgery; Transplantation GA KY219 UT WOS:A1993KY21900065 ER PT J AU HILDEBRAND, SV HILL, T AF HILDEBRAND, SV HILL, T TI NEUROMUSCULAR BLOCKADE BY USE OF ATRACURIUM IN ANESTHETIZED ILAMAS SO AMERICAN JOURNAL OF VETERINARY RESEARCH LA English DT Article ID HALOTHANE; HORSES AB Anesthesia was induced in 8 healthy llamas by administration of guaifenesin and ketamine, and was maintained with halothane in oxygen. On 2 separate experimental days, atracurium was given to induce 95 to 99% reduction of evoked hind limb digital extensor tension (twitch). For the first part of the study, atracurium was given IV as repeat boluses, with muscle twitch strength being allowed to return without intervention to 75% of baseline after each bolus before the subsequent bolus was given. A total of 5 bolus doses of atracurium was given. For the first bolus, 0.15 mg/kg of body weight IV, and for subsequent boluses, 0.08 mg/kg, induced desired relaxation. Onset of relaxation was slightly more rapid for repeat, compared with initial, bolus. Duration of relaxation and recovery time were similar to initial and repeat doses. Maximal twitch reduction was observed in 4 +/- 0.2 minutes (mean +/- SEM). Duration from maximal twitch reduction to 10% recovery was 6.3 +/- 0.4 minutes. Twitch recovery from 10 to 50% of baseline took 11.6 +/- 0.6 minutes. Twitch recovery from 10 to 75% recovery took 19.5 +/- 1.1 minutes. Recovery from 10% twitch to 50% fade took 12.8 +/- 0.5 minutes. Fade at 50% recovery of twitch was 39 +/- 0.02%. Significant (P < 0.05) animal-to-animal variation was observed in twitch recovery times. For the second part of the study, atracurium was initially given IV as a 0.15-mg/kg bolus, followed by infusion for 1 to 2 hours. Infusion rate required some early adjustment to maintain desired relaxation, but the rate that prevailed was 1.07 +/- 0.07 ml/kg/h (0.4 mg of atracurium/ml of saline solution). Recovery of muscle twitch was similar to that previously mentioned for repeat bolus administration. At the end of the study, edrophonium (0.5 mg/kg) with atropine (0.01 mg/kg, IV) was effective in antagonizing residual neuromuscular blockade by atracurium. All llamas recovered without injury from anesthesia, although 1 llama had a rough recovery. It was concluded that atracurium can provide neuromuscular blockade by either repeat bolus administration or continuous infusion in Ilamas. RP HILDEBRAND, SV (reprint author), UNIV CALIF DAVIS,SCH VET MED,DEPT SURG,DAVIS,CA 95616, USA. NR 11 TC 2 Z9 3 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 SN 0002-9645 J9 AM J VET RES JI Am. J. Vet. Res. PD MAR PY 1993 VL 54 IS 3 BP 429 EP 433 PG 5 WC Veterinary Sciences SC Veterinary Sciences GA KP187 UT WOS:A1993KP18700013 ER PT J AU ROBERTS, SP RAMSAY, TM HEALY, TEJ WILSON, A POLLARD, BJ AF ROBERTS, SP RAMSAY, TM HEALY, TEJ WILSON, A POLLARD, BJ TI EXTENDING A PIPECURONIUM NEUROMUSCULAR BLOCK - INCREMENTS OF ATRACURIUM OR VECURONIUM AS AN ALTERNATIVE TO PIPECURONIUM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, PIPECURONIUM; ATRACURIUM; VECURONIUM; PHARMACODYNAMICS, NEUROMUSCULAR RELAXANTS; INTERACTIONS ID NITROUS-OXIDE; TUBOCURARINE; PANCURONIUM; BROMIDE; ISOFLURANE; HALOTHANE; FENTANYL C1 UNIV MANCHESTER,WITHINGTON HOSP,DEPT ANAESTHESIA,MANCHESTER M20 8LR,ENGLAND. NR 11 TC 2 Z9 3 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 1993 VL 48 IS 3 BP 196 EP 199 DI 10.1111/j.1365-2044.1993.tb06899.x PG 4 WC Anesthesiology SC Anesthesiology GA KP802 UT WOS:A1993KP80200004 ER PT J AU FAWCETT, WJ FAUVEL, NJ FELDMAN, SA AF FAWCETT, WJ FAUVEL, NJ FELDMAN, SA TI COMPARISON OF RECOVERY INDEX OF ROCURONIUM OR VECURONIUM WITH SIMULTANEOUSLY ADMINISTERED PANCURONIUM IN THE ISOLATED FOREARM SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; VECURONIUM; PANCURONIUM C1 WESTMINSTER MED SCH & HOSP,MAGILL DEPT ANAESTHET,LONDON SW1P 2AP,ENGLAND. NR 3 TC 5 Z9 5 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD MAR PY 1993 VL 48 IS 3 BP 200 EP 201 DI 10.1111/j.1365-2044.1993.tb06900.x PG 2 WC Anesthesiology SC Anesthesiology GA KP802 UT WOS:A1993KP80200005 ER PT J AU RATHMELL, JP BROOKER, RF PRIELIPP, RC BUTTERWORTH, JF GRAVLEE, GP AF RATHMELL, JP BROOKER, RF PRIELIPP, RC BUTTERWORTH, JF GRAVLEE, GP TI HEMODYNAMIC AND PHARMACODYNAMIC COMPARISON OF DOXACURIUM AND PIPECURONIUM WITH PANCURONIUM DURING INDUCTION OF CARDIAC ANESTHESIA - DOES THE BENEFIT JUSTIFY THE COST SO ANESTHESIA AND ANALGESIA LA English DT Article ID DOSE FENTANYL ANESTHESIA; CORONARY-ARTERY SURGERY; NITROUS-OXIDE; CLINICAL-PHARMACOLOGY; MYOCARDIAL-ISCHEMIA; RESPONSE RELATION; HALOTHANE; BROMIDE; OXYGEN; PHARMACOKINETICS AB We compared the pharmacodynamic effects and hospital costs of three long-acting neuromuscular blocking drugs in a prospective, randomized, double-blind manner. Each neuromuscular blocking drug was administered with fentanyl (50 mug/kg) for intravenous induction of anesthesia for coronary artery bypass surgery. Each patient received twice the 95% effective dose (ED95) of either pancuronium (0.14 mg/kg, n = 10), pipecuronium (0.10 mg/kg, n = 10), or doxacurium (0.05 mg/kg, n = 10). Hemodynamic measurements were recorded at baseline, 5 min after completion of anesthetic induction, immediately after endotracheal intubation, and 5 min after intubation. Only small hemodynamic differences between neuromuscular blocking drugs were observed. Doxacurium (but not pancuronium or pipecuronium) significantly decreased mean arterial blood pressure (from 94 +/- 4 mm Hg before induction to 83 +/- 3 mm Hg 5 min after intubation); nevertheless, there were no significant between-group differences at any time. Pancuronium increased heart rate (from 68 +/- 4 beats/min before induction to 76 +/-5 beats/min 5 min after intubation); however, pancuronium differed significantly from doxacurium and pipecuronium only 5 min after induction and 5 min after intubation. Central venous pressure, pulmonary artery occlusion pressure, cardiac index, and systemic and pulmonary vascular resistance indices did not change. Electrocardiographic abnormalities were observed in two pipecuronium patients: ST segment depression in one and premature ventricular contractions in another. No other electrocardiographic changes were observed. There were no significant between-group differences in the need for hemodynamic interventions. The time from muscle relaxant administration to 95% twitch depression was significantly longer for doxacurium (530 +/- 49 s) than for either pancuronium (264 +/-31 s) or pipecuronium (234 +/- 23 s). The cost to a 70-kg patient of twice the ED95 dose was: pancuronium, $1.69; pipecuronium, $22.88; and doxacurium, $19.60. We conclude that whereas doxacurium and pipecuronium may be less likely than pancuronium to increase heart rate during induction of anesthesia, these two neuromuscular blocking drugs are no less likely to produce hemodynamic aberrations requiring drug interventions and are considerably more expensive. C1 WAKE FOREST UNIV,MED CTR,DEPT ANESTHESIA,CARDIAC ANESTHESIA SECT,WINSTON SALEM,NC 27109. NR 31 TC 21 Z9 22 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1993 VL 76 IS 3 BP 513 EP 519 PG 7 WC Anesthesiology SC Anesthesiology GA KY040 UT WOS:A1993KY04000010 ER PT J AU LAWHEAD, RG MATSUMI, M PETERS, KR LANDERS, DF BECKER, GL EARL, RA AF LAWHEAD, RG MATSUMI, M PETERS, KR LANDERS, DF BECKER, GL EARL, RA TI PLASMA LAUDANOSINE LEVELS IN PATIENTS GIVEN ATRACURIUM DURING LIVER-TRANSPLANTATION SO ANESTHESIA AND ANALGESIA LA English DT Article AB Atracurium, a nondepolarizing muscle relaxant, does not depend on the liver for clearance, but its principal metabolite, laudanosine, is eliminated primarily by the liver and is potentially neurotoxic. We measured atracurium and laudanosine levels in 15 adult patients during the three stages of liver transplantation to assess the effect of major impairment of liver function. Atracurium was given in a bolus dose of 0.5 mg/kg followed by continuous infusion at a rate adjusted to maintain 95-99% of total neuromuscular block, as judged by train of four response to facial nerve stimulation. Atracurium levels remained constant at 1.4-1.8 mug/mL during the 180-min preanhepatic and 75-min anhepatic stages but decreased to a mean of 1.0 mug/mL by the end of the 180-min postanhepatic stage. In contrast, laudanosine levels increased during each stage, being 0.40 +/- 0.18, 0.50 +/- 0.22, and 0.43 +/- 0.16 mug/mL after the preanhepatic, anhepatic, and postanhepatic stages, respectively. The highest individual value recorded was 1.02 mug/mL. We conclude that, despite increases in laudanosine levels during each stage of liver transplantation in patients receiving atracurium, those levels are only about one-tenth of the maximum values previously reported in humans. C1 UNIV NEBRASKA,MED CTR,DEPT ANESTHESIOL,600 S 42ND ST,OMAHA,NE 68198. UNIV NEBRASKA,MED CTR,DEPT PATHOL & MICROBIOL,OMAHA,NE 68105. NR 12 TC 6 Z9 6 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1993 VL 76 IS 3 BP 569 EP 573 PG 5 WC Anesthesiology SC Anesthesiology GA KY040 UT WOS:A1993KY04000021 ER PT J AU FELDMAN, S FAUVEL, N AF FELDMAN, S FAUVEL, N TI POTENTIATION AND ANTAGONISM OF VECURONIUM BY DECAMETHONIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID SUCCINYLCHOLINE; SUXAMETHONIUM AB Enhancement of a vecuronium neuromuscular blockade by prior administration of succinylcholine has been attributed to both pharmacokinetic and pharmacodynamic mechanisms. This study was performed to elucidate the mechanism of this interaction using decamethonium as the agonist drug. In five healthy patients undergoing gynecologic surgery, a cumulative dose-response relationship to vecuronium was determined following recovery from a neuromuscular block produced by 0.1 mg/kg intravenous decamethonium. In a second group of five similar patients, a cumulative dose-response curve to vecuronium was obtained without previous exposure to decamethonium. In this second group, at 30% recovery from a vecuronium block, 0.1 mg/kg decamethonium was administered. The results demonstrated a sevenfold increase in sensitivity (reducing the ED50 from 24 mug/kg to 3.5 mug/kg) to vecuronium when it was administered following recovery from decamethonium block, and a partial reversal of the vecuronium block by decamethonium when the decamethonium was administered during recovery from vecuronium block. These findings support a pharmacodynamic explanation of the increased sensitivity to nondepolarizing muscle relaxants following recovery from an agonist neuromuscular block. RP FELDMAN, S (reprint author), WESTMINSTER MED SCH & HOSP,CHARING CROSS & WESTMINISTER MED SCH,MAGILL DEPT ANAESTHET,LONDON SW1P 2AP,ENGLAND. NR 12 TC 6 Z9 7 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1993 VL 76 IS 3 BP 631 EP 634 PG 4 WC Anesthesiology SC Anesthesiology GA KY040 UT WOS:A1993KY04000033 ER PT J AU MASLOV, VM AF MASLOV, VM TI CURIUM FISSION CROSS-SECTION ANALYSIS SO ANNALS OF NUCLEAR ENERGY LA English DT Article ID NUCLEI; CM-247 AB The Cm-242-248 fission cross-sections are calculated in the energy range 1-20 MeV. The parameter systematics tested in the case of U and Pu fission data analyses predict fission cross-sections which differ severely from both the JENDL-3 and ENDF/B-V data. The consistency of calculated fission cross-sections with measured data is reviewed critically. The predicted data on the n + Cm-245 reaction cross-section are partly supported by the newest measured data. RP MASLOV, VM (reprint author), RADIAT PHYS & CHEM PROBLEMS INST,MINSK 220109,BYELARUS. NR 20 TC 0 Z9 0 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 0306-4549 J9 ANN NUCL ENERGY JI Ann. Nucl. Energy PD MAR PY 1993 VL 20 IS 3 BP 163 EP 166 DI 10.1016/0306-4549(93)90099-B PG 4 WC Nuclear Science & Technology SC Nuclear Science & Technology GA KL885 UT WOS:A1993KL88500002 ER PT J AU HENNING, RH NELEMANS, A HOUWERTJES, M AGOSTON, S AF HENNING, RH NELEMANS, A HOUWERTJES, M AGOSTON, S TI REVERSAL BY SURAMIN OF NEUROMUSCULAR BLOCK PRODUCED BY PANCURONIUM IN THE ANESTHETIZED RAT SO BRITISH JOURNAL OF PHARMACOLOGY LA English DT Article DE 4-AMINOPYRIDINE; NEOSTIGMINE; NEUROMUSCULAR BLOCKADE REVERSAL AGENTS; PANCURONIUM; SUXAMETHONIUM, SURAMIN ID ATP; ANTAGONIST; ADENOSINE; AGENT AB 1 Rats were anaesthetized with sodium pentobarbitone and maximal twitches of a tibialis anterior muscle were evoked by stimulation of the motor nerve. 2 Suramin, injected intravenously in a series of cumulative bolus doses, each 15 mg kg-1, completely reversed a 90% depression of twitches maintained by a continuous intravenous infusion of pancuronium. The cumulated dose necessary to restore twitches to 50% of their control amplitude was 35 mg kg-1. Suramin did not modify a similar degree of block produced by suxamethonium, nor did it affect the amplitude of control maximal twitches, even in cumulative doses up to 150 mg kg-1. 3 The effects of bolus doses of suramin (85 mg kg-1), neostigmine (0.03 mg kg-1) and 4-aminopyridine (1.2 mg kg-1), calculated to restore pancuronium-blocked twitches to 95% of control amplitude, were compared. Suramin produced the most rapid reversal (1.1 +/- 0. 5 min), but its duration of action was the shortest (9.4 +/- 1.6 min). Suramin was without effect on heart rate or blood pressure in the doses used. 4 The results showed that suramin reversed neuromuscular block produced by nondepolarizing blocking drug, pancuronium, but was without effect on a block produced by the depolarizing blocking drug, suxamethonium. Its short duration of action suggests that suramin would probably not be of value clinically as a reversal agent. However, it is possible that it might serve as a starter compound for the synthesis and development of a new class of reversal agents for use in anaesthetic practice. C1 UNIV GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,GRONINGEN,NETHERLANDS. RP HENNING, RH (reprint author), UNIV GRONINGEN,DEPT PHARMACOL CLIN PHARMACOL,BLOEMSINGEL 1,9713 BZ GRONINGEN,NETHERLANDS. NR 17 TC 11 Z9 11 PU STOCKTON PRESS PI BASINGSTOKE PA HOUNDMILLS, BASINGSTOKE, HAMPSHIRE, ENGLAND RG21 6XS SN 0007-1188 J9 BRIT J PHARMACOL JI Br. J. Pharmacol. PD MAR PY 1993 VL 108 IS 3 BP 717 EP 720 PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA KQ248 UT WOS:A1993KQ24800026 ER PT J AU GARIEPY, LP VARIN, F DONATI, F SALIB, Y BEVAN, DR AF GARIEPY, LP VARIN, F DONATI, F SALIB, Y BEVAN, DR TI INFLUENCE OF AGING ON THE PHARMACOKINETICS AND PHARMACODYNAMICS OF DOXACURIUM SO CLINICAL PHARMACOLOGY & THERAPEUTICS LA English DT Article ID ELDERLY PATIENTS; ANESTHETIZED PATIENTS; OLD-AGE; PANCURONIUM; ATRACURIUM; VECURONIUM; ALCURONIUM; ISOFLURANE AB Doxacurium (30 mug/kg) pharmacokinetics and pharmacodynamics were evaluated in nine elderly (age range, 70 to 83 years) and nine young (age range, 19 to 39 years) patients under nitrous oxide-isoflurane anesthesia. The force of contraction of the adductor pollicis was monitored and plasma samples were collected for an 8-hour period. In the elderly group, doxacurium elimination half-life was prolonged (119.7 versus 75.9 minutes) and plasma clearance was significantly reduced (1.75 versus 2.54 ml/min/kg) without any change in volume of distribution. Onset (12.9 versus 8.9 minutes) and recovery times (113.4 versus 48.1 minutes) were longer in the elderly group. The equilibrium rate constant to the effect compartment (k(eo)) was decreased in the elderly (0.039 versus 0.051 min-1), whereas the effect compartment concentration at 50% block was similar in both groups (44.7 versus 54.1 ng/ml). An age-related reduction in muscle blood flow may be responsible for the decrease in k(eo). The pharmacokinetic changes observed in the elderly are consistent with a decreased function in the organs of elimination. C1 UNIV MONTREAL,FAC PHARM,2900 EDOUARD MONTPETIT,SUCC A,CP 6128,MONTREAL H3C 3J7,QUEBEC,CANADA. MCGILL UNIV,DEPT ANESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 38 TC 23 Z9 23 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0009-9236 J9 CLIN PHARMACOL THER JI Clin. Pharmacol. Ther. PD MAR PY 1993 VL 53 IS 3 BP 340 EP 347 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA KU553 UT WOS:A1993KU55300008 ER PT J AU LOGAN, BK CASE, GA AF LOGAN, BK CASE, GA TI IDENTIFICATION OF LAUDANOSINE, AN ATRACURIUM METABOLITE, FOLLOWING A FATAL DRUG-RELATED SHOOTING SO JOURNAL OF ANALYTICAL TOXICOLOGY LA English DT Article ID GAS-CHROMATOGRAPHY RP LOGAN, BK (reprint author), UNIV WASHINGTON,DEPT LAB MED,WASHINGTON STATE TOXICOL LAB,SEATTLE,WA 98195, USA. NR 9 TC 0 Z9 0 PU PRESTON PUBLICATIONS INC PI NILES PA 7800 MERRIMAC AVE PO BOX 48312, NILES, IL 60648 SN 0146-4760 J9 J ANAL TOXICOL JI J. Anal. Toxicol. PD MAR-APR PY 1993 VL 17 IS 2 BP 117 EP 119 PG 3 WC Chemistry, Analytical; Toxicology SC Chemistry; Toxicology GA KT374 UT WOS:A1993KT37400012 ER PT J AU JELLISH, WS MODICA, PA TEMPELHOFF, R AF JELLISH, WS MODICA, PA TEMPELHOFF, R TI ACCELERATED RECOVERY FROM PIPECURONIUM IN PATIENTS TREATED WITH CHRONIC ANTICONVULSANT THERAPY SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE ANTICONVULSANTS; CARBAMAZEPINE; DRUG INTERACTION; NONDEPOLARIZING NEUROMUSCULAR BLOCKING DRUGS; SEIZURE SURGERY AB Study Objective: To determine whether chronic anticonvulsant therapy affects recovery time from pipecuronium. Design: Open-labeled, controlled study. Setting: Inpatient neurosurgical service at a university medical center. Patients: ASA physical status II and III patients within 30% of their ideal body weight and without significant history of ethanol abuse or renal or hepatic disease. Nineteen patients were admitted into the study and were divided into three groups based on the number of anticonvulsant medications (MED) they were taking: MED = 0, control group (6 patients); MED = 1, one anticonvulsant (6 patients); MED = 2, two or more anticonvulsants (7 patients). Interventions: Intravenous (IV) administration of pipecuronium 80 mug/kg with general anesthesia after thiopental sodium 4 to 6 mg/kg IV, maintained with 70% nitrous oxide in oxygen, 0.2% to 0.3% end-tidal isoflurane, and fentanyl. Measurements and Main Results: The evoked compound electromyogram (ECEMG) of the adductor pollicis brevis muscle was measured after stimulation of the ulnar nerve by train-of-four (TOF) supramaximal impulses at 2 Hz repeated every 20 seconds. Measurements include T-1% (ECEMG signal at 25%, 50%, and 75% of baseline), TR% (TOF ratio), and recovery index (RI). Patients administered chronic anticonvulsant therapy recovered more rapidly from pipecuronium than untreated patients. For instance, time to 25% recovery of baseline (T-1 25%) was 123 +/- 13 minutes for MED = 0, 91 +/- 7 minutes for MED = 1, and 58 +/- 5 minutes for MED = 2 (p < 0.05). TOF recovery to 20% (TR 20%) and RI were similarly affected. Conclusions: Patients treated with chronic anticonvulsant therapy recovered from pipecuronium more rapidly than unmedicated patients. Furthermore, there seemed to be a dose-effect relationship between the number of anticonvulsants received and a decreased time to recovery from pipecuronium neuromuscular blockade. C1 WASHINGTON UNIV,SCH MED,DEPT ANESTHESIOL,BOX 8054,660 S EUCLID AVE,ST LOUIS,MO 63110. NR 0 TC 22 Z9 23 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD MAR-APR PY 1993 VL 5 IS 2 BP 105 EP 108 DI 10.1016/0952-8180(93)90135-2 PG 4 WC Anesthesiology SC Anesthesiology GA KY347 UT WOS:A1993KY34700003 ER PT J AU KHUENLBRADY, KS PUHRINGER, F KOLLER, J MITTERSCHIFFTHALER, G AF KHUENLBRADY, KS PUHRINGER, F KOLLER, J MITTERSCHIFFTHALER, G TI EVALUATION OF THE TIME COURSE OF ACTION OF MAINTENANCE DOSES OF ROCURONIUM (ORG-9426) UNDER HALOTHANE ANESTHESIA SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHETICS, VOLATILE, HALOTHANE; NEUROMUSCULAR RELAXANTS, ROCURONIUM, REPEAT ADMINISTRATION ID NEUROMUSCULAR BLOCKING-AGENT AB The time course of action of rocuronium was compared using three different sizes of maintenance doses after at least three subsequent administrations of the same repeat dose in each patient under halothane anaesthesia. Following endotracheal intubation facilitated with 0.6 mg . kg-1 rocuronium (ORG 9426), muscle relaxation was maintained in three groups each consisting of ten patients, using increments of equal repeat doses of either 75 mug . kg-1, 150 mug . kg-1 or 225 mug . kg-1 equivalent to 1/4, 1/2 and 3/4 of the ED95 of this new compound, respectively. Maintenance doses were administered when the twitch height depression induced by the previous dose returned to 25% of its control value. The clinical duration of the intubating dose averaged 27 +/- 7.5 min (mean +/- s.d.). The time course of action of the various maintenance doses depended on their size, but not on the number of administrations. The durations of repeat doses averaged 8-9 min, 14-16 min and 19-23 min after the low, medium and high maintenance doses, respectively. No overt cumulative effects were observed. C1 UNIV INNSBRUCK, GEN INTENS CARE MED CLIN, A-6020 INNSBRUCK, AUSTRIA. RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK, ANAESTHESIA CLIN, ANICHSTR 35, A-6020 INNSBRUCK, AUSTRIA. NR 9 TC 10 Z9 11 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 FEB PY 1993 VL 37 IS 2 BP 137 EP 139 PG 3 WC Anesthesiology SC Anesthesiology GA KM731 UT WOS:A1993KM73100003 ER PT J AU DIEFENBACH, C MELLINGHOFF, H BUZELLO, W AF DIEFENBACH, C MELLINGHOFF, H BUZELLO, W TI VARIABILITY OF PIPECURONIUM NEUROMUSCULAR BLOCKADE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE NEUROMUSCULAR BLOCKING AGENTS, PIPECURONIUM ID CLINICAL-PHARMACOLOGY; BROMIDE; PHARMACOKINETICS AB The dose-response relationship and the variability of the time variables in pipecuronium neuromuscular blockade were studied in 29 patients (ASA physical status 3) during halothane anaesthesia. The ED95 (twitch tension) was determined in 9 patients using the cumulative dose response technique. Another 20 patients received the resulting ED95 as a single bolus. The mean ED95 was 35 mug . kg-1 (95% confidence interval: 29-41 mug . kg-1). Following bolus injection of 1 . ED95, an 80 100% twitch depression was achieved within 4.6 +/- 1.3 min (mean +/- s.d.). The duration from end of injection of pipecuronium to 25% twitch recovery, the time from 25% to 75% twitch recovery, and the time from 25% twitch recovery to the train-of-four ratio (TOF) returning to 0.7 was 35 +/- 14, 37 +/- 26, and 63 +/- 27 min, respectively. The time from end of injection to TOF = 0.7 varied within a 2-h range (54-160 min). Thus, the time variables in pipecuronium neuromuscular blockade were as poorly predictable as those reported in the literature on pancuronium, alcuronium and doxacurium. RP DIEFENBACH, C (reprint author), UNIV COLOGNE,DEPT ANAESTHESIOL,JOSEPH STELEMANN STR 9,W-5000 COLOGNE 41,GERMANY. NR 17 TC 3 Z9 4 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 1993 VL 37 IS 2 BP 189 EP 191 PG 3 WC Anesthesiology SC Anesthesiology GA KM731 UT WOS:A1993KM73100012 ER PT J AU ROBERTS, SP POLLARD, BJ AF ROBERTS, SP POLLARD, BJ TI THE ONSET OF ALCURONIUM AND TUBOCURARINE - ALONE AND IN COMBINATION SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE INTERACTIONS, DRUG; NEUROMUSCULAR RELAXANTS, ALCURONIUM, TUBOCURARINE ID PANCURONIUM AB The rates of onset of neuromuscular blockade have been measured following 0.25 mg.kg-1 alcuronium (ED95), 0.51 mg.kg-1 tubocurarine (ED95), a combination of 50% of the ED95 of each and a combination of 33% of the ED95 of each. Train-of-four stimulation of the ulnar nerve was used with recording of the amplitude of the evoked compound electromyogram from the thenar prominence. The rate of increase in blockade in patients receiving the 50% combination was significantly greater than for either agent given alone, or than for the 33% combination. The mean time to 75% block of the first contraction of the train (T1) with the 50% mixture was 90 s, significantly faster than alcuronium alone (132 s), tubocurarine alone (174 s) or the 33% mixture (127 s). These latter three groups did not differ significantly. In conclusion, the rate of onset of the 50% combination resulted in a more rapid onset of neuromuscular blockade, whereas the rate of onset of the 33% combination was no different to that of either drug alone. This small degree of acceleration with agents which are known to be markedly synergistic makes it unlikely that this technique will prove to be of clinical importance. C1 UNIV MANCHESTER,MANCHESTER ROYAL INFIRM,DEPT ANAESTHESIA,OXFORD RD,MANCHESTER M13 9WL,LANCS,ENGLAND. NR 17 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 FEB PY 1993 VL 37 IS 2 BP 195 EP 198 PG 4 WC Anesthesiology SC Anesthesiology GA KM731 UT WOS:A1993KM73100014 ER PT J AU COOPER, RA MIRAKHUR, RK MADDINENI, VR AF COOPER, RA MIRAKHUR, RK MADDINENI, VR TI NEUROMUSCULAR EFFECTS OF ROCURONIUM BROMIDE (ORG-9426) DURING FENTANYL AND HALOTHANE ANESTHESIA SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; ROCURONIUM (ORG 9426); ANESTHESIA; HALOTHANE, FENTANYL; ANESTHETICS, VOLATILE; HALOTHANE; ANALGESICS; FENTANYL ID ATRACURIUM; VECURONIUM; ANESTHESIA; ORG-NC-45; PHARMACOLOGY; PANCURONIUM; BLOCKADE; ORG9426; ONSET; CAT C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 22 TC 42 Z9 50 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD FEB PY 1993 VL 48 IS 2 BP 103 EP 105 PG 3 WC Anesthesiology SC Anesthesiology GA KL842 UT WOS:A1993KL84200002 ER PT J AU KUMAR, AA THYS, J VANAKEN, HK STEVENS, E CRUL, JF AF KUMAR, AA THYS, J VANAKEN, HK STEVENS, E CRUL, JF TI SEVERE ANAPHYLACTIC SHOCK AFTER ATRACURIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID POST-MARKETING SURVEILLANCE; CARDIOPULMONARY RESUSCITATION; ANESTHETIC AGENTS; BLOOD-FLOW; EPINEPHRINE; HYPERSENSITIVITY; SWINE C1 CATHOLIC UNIV LEUVEN,UNIV ZIEKENHUIZEN,DEPT ANESTHESIOL,HERESTR 49,B-3000 LOUVAIN,BELGIUM. CATHOLIC UNIV LEUVEN,UNIV ZIEKENHUIZEN,DEPT IMMUNOL,B-3000 LOUVAIN,BELGIUM. NR 21 TC 10 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 1993 VL 76 IS 2 BP 423 EP 425 PG 3 WC Anesthesiology SC Anesthesiology GA KY037 UT WOS:A1993KY03700038 ER PT J AU SHORTEN, GD ALI, HH GOUDSOUZIAN, NG AF SHORTEN, GD ALI, HH GOUDSOUZIAN, NG TI NEOSTIGMINE AND EDROPHONIUM ANTAGONISM OF MODERATE NEUROMUSCULAR BLOCK INDUCED BY PANCURONIUM OR TUBOCURARINE SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANTAGONISTS; NEUROMUSCULAR RELAXANTS; EDROPHONIUM; NEOSTIGMINE; NEUROMUSCULAR RELAXANTS; PANCURONIUM; TUBOCURARINE ID ATRACURIUM; VECURONIUM; REVERSAL AB Edrophonium and neostigmine are anticholin-esterase drugs used commonly to antagonize competitive neuromuscular block. Although it has a faster onset of action than neostigmine, edrophonium is unreliable when used to antagonize deep neuromuscular block. We have compared the antagonist characteristics of these two drugs when used to antagonize a moderate degree of pancuronium- or tubocurarine-induced neuromuscular block. Forty ASA I or II patients undergoing surgical procedures were allocated randomly to receive either pancuronium 70 mug kg-1 or tubocurarine 0.5 mg kg-1 and to receive either edrophonium 0.5 mg kg-1 or neostigmine 0.05 mg kg-1. Antagonism was attempted when the first response to train-of-four (TOF) stimulation recovered spontaneously to 25% of the control height. Neuromuscular function was monitored using the evoked integrated electromyogram of the first dorsal interosseous muscle of the hand. Adequate recovery was defined as the achievement of a TOF ratio of 0.70 or greater. Only seven of 20 patients who received edrophonium demonstrated adequate recovery 30 min after antagonism. Under the conditions described in this study, edrophonium 0.5 mg kg-1 was less effective as an antagonist than neostigmine 0.05 mg kg-1. C1 MASSACHUSETTS GEN HOSP,DEPT ANAESTHESIA,BOSTON,MA 02114. NR 13 TC 1 Z9 1 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 FEB PY 1993 VL 70 IS 2 BP 160 EP 162 DI 10.1093/bja/70.2.160 PG 3 WC Anesthesiology SC Anesthesiology GA KK586 UT WOS:A1993KK58600010 ER PT J AU BEVAN, DR FISET, P BALENDRAN, P LAWMIN, JC RATCLIFFE, A DONATI, F AF BEVAN, DR FISET, P BALENDRAN, P LAWMIN, JC RATCLIFFE, A DONATI, F TI PHARMACODYNAMIC BEHAVIOR OF ROCURONIUM IN THE ELDERLY SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHESIA, GERIATRIC; NEUROMUSCULAR RELAXANTS, ROCURONIUM (ORG 9426) ID DOSE-RESPONSE; NEUROMUSCULAR BLOCKADE; ADDUCTOR POLLICIS; D-TUBOCURARINE; ONSET TIME; ORG NC-45; VECURONIUM; PANCURONIUM; ATRACURIUM; PHARMACOKINETICS AB This study compared the potency and time course of action of rocuronium (ORG 9426) in elderly and young patients during nitrous oxide-opioid anaesthesia. One hundred ASA physical status I-II patients (60, aged 65-80 yr, and 40, aged 20-45 yr) were studied by measuring the force of contraction of the adductor pollicis in response to train-of-four stimulation of the ulnar nerve. After induction of anaesthesia with thiopentone and maintenance with N2O/O2 and fentanyl, rocuronium 120, 160, 200, or 240 mug . kg-1 was administered to determine dose-response curves. When maximum block had been obtained, further rocuronium to a total of 300 mug . kg-1 was given. Additional doses of 100 mug . kg-1 were administered when the first twitch height (T1) had recovered to 25% control. At the end of surgery neuromuscular blockade was allowed, whenever possible, to recover spontaneously until T1 was 90% of control before administration of neostigmine. There was no difference in the potency of rocuronium in the elderly and the younger patients. The ED50 was 196 +/- 8 (SEE for the mean) in elderly, vs 215 +/- 17 mug . kg-1 in young patients (NS). When individual cumulative dose-response curves were constructed, the ED50 was 203 +/- 7 (SEM) and 201 +/- 10 mug . kg-1 in the elderly and the young respectively (NS). However, the onset of maximum neuromuscular block was slower in the elderly 3.7 +/- 1.1 (SD) vs 3.1 +/- 0.9 min, P < 0.05). The time to 25% T1 recovery was longer in the elderly (11.8 +/- 8.1 vs 8.0 +/- 6.5 min, P < 0.05) as was the recovery index, time from 25 to 75% T1 recovery (15.5 +/- 6.2 vs 11.2 +/- 4.9 min, P < 0.05). The duration of neuromuscular block after each maintenance dose was longer in the elderly (P < 0.01) and increased gradually with time. It is concluded that rocuronium is an intermediate-acting neuromuscular blocking drug with a similar potency in elderly and young patients, but the onset and recovery of neuromuscluar blockade are slower in the elderly. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 35 TC 33 Z9 34 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD FEB PY 1993 VL 40 IS 2 BP 127 EP 132 PG 6 WC Anesthesiology SC Anesthesiology GA KN037 UT WOS:A1993KN03700007 ER PT J AU NAVRATIL, JD SCHULZ, WW AF NAVRATIL, JD SCHULZ, WW TI THE PRODUCTION, RECOVERY, PROPERTIES, AND APPLICATIONS OF AMERICIUM AND CURIUM SO JOM-JOURNAL OF THE MINERALS METALS & MATERIALS SOCIETY LA English DT Article AB Nuclear reactors produce mixtures of Am-241 and Am-242, and beta decay of plutonium produces radioactively pure Am-241. Curium is a product of intense neutron exposure of Pu-239. Separation and purification processes for americium and curium include ion exchange, precipitation, and both liquid-liquid and molten-salt extraction. This article reviews the principal production, recovery, and waste treatment processes and briefly discusses the chemical properties and uses of americium and curium. RP NAVRATIL, JD (reprint author), ROCKWELL INT CORP,ROCKETDYNE DIV,CANOGA PK,CA 91304, USA. NR 6 TC 2 Z9 2 PU MINERALS METALS MATERIALS SOC PI WARRENDALE PA 420 COMMONWEALTH DR, WARRENDALE, PA 15086 SN 1047-4838 J9 JOM-J MIN MET MAT S JI JOM-J. Miner. Met. Mater. Soc. PD FEB PY 1993 VL 45 IS 2 BP 32 EP 34 PG 3 WC Materials Science, Multidisciplinary; Metallurgy & Metallurgical Engineering; Mineralogy; Mining & Mineral Processing SC Materials Science; Metallurgy & Metallurgical Engineering; Mineralogy; Mining & Mineral Processing GA KK866 UT WOS:A1993KK86600007 ER PT J AU AKESON, J MESSETER, K ROSEN, I BJORKMAN, S AF AKESON, J MESSETER, K ROSEN, I BJORKMAN, S TI CEREBRAL HEMODYNAMIC AND ELECTROCORTICAL CO2 REACTIVITY IN PIGS ANESTHETIZED WITH FENTANYL, NITROUS-OXIDE AND PANCURONIUM SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHESIA; BRAIN; CEREBRAL BLOOD FLOW; CEREBRAL METABOLIC RATE; CEREBRAL VASCULAR REACTIVITY; ELECTROENCEPHALOGRAPHY; FENTANYL; SWINE ID BRAIN BLOOD-FLOW; NEWBORN PIGLET; ISOFLURANE ANESTHESIA; HALOTHANE; DOGS; PACO2; SWINE; EEG; CHROMATOGRAPHY; AUTOREGULATION AB Cerebral haemodynamic, metabolic and electrocortical reactivity to alterations in arterial CO2 tension (PaCO2) was assessed in seven mechanically ventilated juvenile pigs to test an experimental model designed for cerebral pharmacodynamic and pharmacokinetic studies. The animals were anaesthetized with fentanyl, nitrous oxide and pancuronium and sequentially normo- and hyperventilated over a 100-min period. Five measurements were made at 25-min intervals. The cerebral blood flow (CBF) was measured with the intra-arterial Xe-133 technique and the cerebral metabolic rate for oxygen (CMRO2) determined from CBF and the cerebral arteriovenous oxygen content difference. A linear correlation (r = 0.845) was found between CBF and PaCO2. The cerebrovascular reactivity to hypocapnia (DELTACBF/DELTAPaCO2) was maintained throughout the experimental period and amounted to (95% confidence interval) 9.1 (7.1-11.1) ml.100 g-1.min-1.kPa-1 within the PaCO2 range 3.3-6.3 kPa. The CMRO2 was not influenced by hyperventilation. The baseline electroencephalographic (EEG) pattern was stable at normocapnia (mean PaCO2 5.6 kPa), whereas spectral values for delta and total average voltage increased significantly (P < 0.05) at extensive hypocapnia (3.5 kPa). Maintenance of cerebral CO2 reactivity and spectral EEG voltage at a stable plasma level of fentanyl is complementary to the cerebral haemodynamic and metabolic stability previously found at sustained normocapnia in this model. C1 UNIV LUND,MALMO GEN HOSP,DEPT EXPTL RES,S-21401 MALMO,SWEDEN. UNIV LUND,MALMO GEN HOSP,DEPT CLIN NEUROPHYSIOL,S-21401 MALMO,SWEDEN. MALMO GEN HOSP,HOSP PHARM,S-21401 MALMO,SWEDEN. RP AKESON, J (reprint author), UNIV LUND,MALMO GEN HOSP,DEPT ANAESTHESIA & INTENS CARE,04226,S-21401 MALMO,SWEDEN. NR 35 TC 13 Z9 13 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 1993 VL 37 IS 1 BP 85 EP 91 PG 7 WC Anesthesiology SC Anesthesiology GA KF036 UT WOS:A1993KF03600020 ER PT J AU LINK, J PAPADOPOULOS, G HEINE, P WOLTER, J AF LINK, J PAPADOPOULOS, G HEINE, P WOLTER, J TI ACTION OF ATRACURIUM AND VECURONIUM IN PATIENTS ON CHRONIC-HEMODIALYSIS SO ANAESTHESIST LA German DT Article DE ATRACURIUM; VECURONIUM; END-STAGE RENAL FAILURE ID NORMAL RENAL-FUNCTION; PHARMACOKINETICS; PANCURONIUM; FAILURE; METABOLITES; BESYLATE AB Reports on the duration of action of atracurium (Atr) and vecuronium (Vec) in patients with renal failure are contradictory. It is either stated that the duration is equal for both relaxants [1, 8], or that Atr acts for a longer duration [9]. Because of these conflicting results. we measured the times for latency (tL), onset (tA), duration of action (tW), and recovery (tE) for both agents. Methods. Fourty patients with end-stage renal failure on chronic haemodialysis were randomly assigned to receive either Atr (0.4 mg.kg-1 BW) or Vec (0.08 mg.kg-1 BW). After induction with thiopentone and 0.1 mg fentanyl, anaesthesia was maintained with nitrous oxide and 1 vol.% ethrane and expiratory CO2 partial pressure was kept between 4.6 and 4.9 kPa. If the twitch height of T1 regained 25% of the pre-relaxation value, 20% of the initial relaxant bolus was injected. Relaxation was monitored with a relaxograph [4] after calibration of the device. After testing for a normal distribution, statistical analysis was done by Student's t-test. A value of P less-than-or-equal-to 0.05 was chosen for statistical significance. Results. There were no significant differences regarding tL (Atr: 1.0+/-0.5 min; Vec: 1.1+/-0.5 min) and tA (Atr: 5.5+/-2.1 min; Vec 4.1+/-2.4 min); tW (Atr: 21.3+/-13.1 min; Vec 31.7+/-15.6 min) and tE (Atr: 19.0+/-9.0 min: Vec 30.1+/-19.0) were significantly different. Discussion. Our results are not in accordance with those authors who found in comparison with Atr an equal [1, 8] or shorter [9] duration of action for Vec in patients with renal failure. If the duration of action is equal [5] in subjects with no renal insufficiency, our measurements are in accordance with kinetic evaluations showing the same clearance and half-life for Atr [12, 13] in patients with and without renal insufficiency, but 40% diminished clearance and 60% prolonged half-life for Vec in renal insufficiency [10]. RP LINK, J (reprint author), FREE UNIV BERLIN,KLINIKUM STEGLITZ,ANAESTHESIOL & OPERAT INTENS MED,HINDENBURGDAMM 30,W-1000 BERLIN 45,GERMANY. NR 13 TC 1 Z9 1 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD JAN PY 1993 VL 42 IS 1 BP 34 EP 37 PG 4 WC Anesthesiology SC Anesthesiology GA KJ613 UT WOS:A1993KJ61300007 ER PT J AU FELDMAN, SA FAUVEL, NJ HOOD, JR AF FELDMAN, SA FAUVEL, NJ HOOD, JR TI RECOVERY FROM PANCURONIUM AND VECURONIUM ADMINISTERED SIMULTANEOUSLY IN THE ISOLATED FOREARM AND THE EFFECT ON RECOVERY FOLLOWING ADMINISTRATION AFTER CROSS-OVER OF DRUGS SO ANESTHESIA AND ANALGESIA LA English DT Article AB If recovery of neuromuscular block in the isolated arm is determined by biophase binding, then a significant amount of drug will still be present in the biophase at 50% recovery of twitch response. To test this hypothesis we administered pancuronium at 50% recovery from vecuronium block and vecuronium at 50% recovery from pancuronium block in the isolated forearms of volunteers. To ensure that any effect of drug released into the plasma did not affect the results, both experiments were performed simultaneously, one in each forearm, of each volunteer. Control experiments were performed to determine the effect of subsequent injections of the same drug at 50% recovery and of subsequent injections of the alternative drug (i.e., vecuronium following pancuronium and pancuronium following vecuronium) at 100% recovery of the twitch response. Prior administration of vecuronium significantly shortened the recovery from subsequent pancuronium when administered at 50% recovery, but not 100% recovery, and pancuronium significantly increased the recovery rate of vecuronium when given at 50% recovery but not 100% recovery. These findings support the concept of biophase binding of nondepolarizing neuromuscular blocking drugs. RP FELDMAN, SA (reprint author), WESTMINSTER MED SCH & HOSP,CHARING CROSS & WESTMINSTER MED SCH,MAGILL DEPT ANAESTHET,LONDON SW1,ENGLAND. NR 8 TC 10 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 1993 VL 76 IS 1 BP 92 EP 95 PG 4 WC Anesthesiology SC Anesthesiology GA KY036 UT WOS:A1993KY03600016 ER PT J AU PETERSEN, RS BAILEY, PL KALAMEGHAN, R ASHWOOD, ER AF PETERSEN, RS BAILEY, PL KALAMEGHAN, R ASHWOOD, ER TI PROLONGED NEUROMUSCULAR BLOCK AFTER MIVACURIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID CHLORIDE BW B1090U; PHARMACOLOGY; CHILDREN C1 UNIV UTAH,HLTH SCI CTR,DEPT ANESTHESIOL,50 N MED DR,SALT LAKE CITY,UT 84132. UNIV UTAH,HLTH SCI CTR,DEPT PATHOL,SALT LAKE CITY,UT 84132. NR 8 TC 56 Z9 56 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 1993 VL 76 IS 1 BP 194 EP 196 PG 3 WC Anesthesiology SC Anesthesiology GA KY036 UT WOS:A1993KY03600033 ER PT J AU PARKER, CJR HUNTER, JM SNOWDON, SL AF PARKER, CJR HUNTER, JM SNOWDON, SL TI EFFECT OF AGE, GENDER AND ANESTHETIC TECHNIQUE ON THE PHARMACODYNAMICS OF ATRACURIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE AGE FACTORS; NEUROMUSCULAR RELAXANTS, ATRACURIUM; PHARMACODYNAMICS ID D-TUBOCURARINE; NITROUS-OXIDE; ALVEOLAR CONCENTRATIONS; HALOTHANE ANESTHESIA; PHARMACOKINETICS; FORANE; PANCURONIUM; ISOFLURANE; REQUIREMENT; GALLAMINE AB We have measured in 38 patients the plasma concentration profile of atracurium and its effect on the electromyographic first response of the train-of-four. One of three techniques was used to supplement anaesthesia with 66% nitrous oxide in oxygen, 0.9% isoflurane (end-tidal), 0.5% halothane (end-tidal) or midazolam 3-10 mg. A four-parameter threshold pharmacodynamic model was fitted to the data in each patient. Compared with a group of patients anaesthetized with an iv. technique, the steady-state plasma concentration producing 50% block (C(P)ss50) was reduced by halothane, and to a greater extent by isoflurane. The rate constant for exit from the effect compartment (k(eo)) correlated negatively with age and was greater in female patients, but unaffected by anaesthetic technique. The values of gamma, the slope of the concentration-response curve, and of the threshold (C(p)SS(theta)) were not affected significantly by age, sex or anaesthetic technique. RP PARKER, CJR (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,4TH FLOOR,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 24 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 JAN PY 1993 VL 70 IS 1 BP 38 EP 41 DI 10.1093/bja/70.1.38 PG 4 WC Anesthesiology SC Anesthesiology GA KF702 UT WOS:A1993KF70200010 ER PT J AU SALIB, Y DONATI, F AF SALIB, Y DONATI, F TI POTENTIATION OF PANCURONIUM AND VECURONIUM NEUROMUSCULAR BLOCKADE BY INTRAVENOUS SALBUTAMOL SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE COMPLICATIONS, BRONCHOSPASM; INTERACTIONS (DRUG), NEUROMUSCULAR RELAXANTS; MONITORING, NEUROMUSCULAR FUNCTION; NEUROMUSCULAR RELAXANTS, PANCURONIUM; VECURONIUM; PHARMACOLOGY, SALBUTAMOL ID NEUROMUSCULAR BLOCKADE; SOLEUS MUSCLE; HALOTHANE; CATECHOLAMINES; ISOFLURANE; ANESTHESIA; ENFLURANE; JUNCTION AB Three doses of salbutamol 125 mug iv were given, over 3.5 hr, to a 28 yr old healthy, previously non asthmatic man during thiopentone-O2/N2O-isoflurane anaesthesia for treatment and prophylaxis of bronchospasm. Force of contraction of the adductor pollicis was measured before and after the last two injections. Initially, the patient was given pancuronium, 5 mg. Salbutamol, 125 mug iv, was given when T1 blockade was 45%. Blockade increased to 66% over five minutes and returned to 45% after 18 min. Vecuronium was subsequently used to maintain relaxation. At the end of surgery, salbutamol was followed by an increase in T1 blockade, from 66% to 86% over five minutes which returned to 66% after ten minutes. It is concluded that intravenous salbutamol potentiates the neuromuscular blocking effect of nondepolarizing muscle relaxants. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,SUITE S5-05,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 14 TC 1 Z9 1 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1993 VL 40 IS 1 BP 50 EP 53 PG 4 WC Anesthesiology SC Anesthesiology GA KJ146 UT WOS:A1993KJ14600011 ER PT J AU VILARDI, V SANFILIPPO, M FIERRO, G TRAVERSA, M GASPARETTO, A AF VILARDI, V SANFILIPPO, M FIERRO, G TRAVERSA, M GASPARETTO, A TI ONSET TIME FOR HIGH-DOSE VECURONIUM AFTER PROPOFOL OR THIOPENTAL ANESTHESIA SO DRUG INVESTIGATION LA English DT Article AB The effect of bolus administration of high-dose vecuronium (0.17 mg/kg) on neuromuscular blockade in terms of onset time, duration of action and recovery rate were studied in 30 patients anaesthetised with either propofol 2 mg/kg or thiopental 5 mg/kg. Neuromuscular block was registered by measuring mechanical responses of adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at 0.1 Hz and 2Hz. The onset time was significantly shorter in patients anaesthetised with propofol than in those anaesthetised with thiopental (106 vs 156 seconds; p < 0.01). However, there was no significant difference between the 2 groups in either the duration of action of vecuronium neuromuscular blockade or the recovery rate. C1 STATE UNIV LAQUILA,DIV GEN ANAESTHESIA & SPECIAL ODONTOSTOMATOL ANAESTHESIA,LAQUILA,ITALY. NR 0 TC 2 Z9 2 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 0114-2402 J9 DRUG INVEST PY 1993 VL 5 IS 1 BP 39 EP 43 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA KG832 UT WOS:A1993KG83200005 ER PT J AU HENNING, RH WIERDA, JMKH SCAF, AHJ MARESCAU, B DEDEYN, PP AGOSTON, S AF HENNING, RH WIERDA, JMKH SCAF, AHJ MARESCAU, B DEDEYN, PP AGOSTON, S TI INCREASED SENSITIVITY TO VECURONIUM IN PATIENTS WITH CHRONIC-RENAL-FAILURE SO DRUG INVESTIGATION LA English DT Article AB The sensitivity of patients with chronic renal failure (CRF) to vecuronium was examined by determining plasma concentration-effect relationships at 85% and 60% block during infusion. The log-logit vecuronium plasma concentration-effect curves were shifted to the left in 9 patients with CRF compared with 6 control subjects (p < 0.001), indicating increased sensitivity in patients with CRF. The 3-desacetyl metabolite of vecuronium was detected in plasma in 1 patient with CRF, whereas it was present in all control patients (p = 0.0014). Some guanidino compounds have been reported to increase acetylcholine release. The relationship between serum levels of guanidino compounds and the sensitivity to vecuronium was studied and guanidino-succinic acid, guanidine, methyl-guanidine and creatinine levels were elevated in patients with CRF. Urea and guanidine levels correlated with patients' sensitivity to vecuronium (r = -0.64 and r = -0.66. respectively; p < 0.01). RP HENNING, RH (reprint author), UNIV GRONINGEN,DEPT PHARMACOL CLIN PHARMACOL,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,9713 BZ GRONINGEN,NETHERLANDS. NR 0 TC 5 Z9 5 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 0114-2402 J9 DRUG INVEST PY 1993 VL 5 IS 2 BP 98 EP 107 PG 10 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA KN578 UT WOS:A1993KN57800002 ER PT J AU HARPER, NJN CHADWICK, IS LINSLEY, A AF HARPER, NJN CHADWICK, IS LINSLEY, A TI SUXAMETHONIUM AND ATRACURIUM - SEQUENTIAL AND SIMULTANEOUS ADMINISTRATION SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM, SUCCINYLCHOLINE; INTUBATION, TRACHEAL AB The interaction between suxamethonium and atracurium was investigated during anaesthesia with thiopentone, fentanyl, enflurane and nitrous oxide in oxygen with controlled ventilation. Electromyographic data (Relaxograph, Datex) from 30 patients in three, equal groups were analyzed. Group 1 received atracurium 0.23 mg kg-1. Group 2 received suxamethonium 1 mg kg-1 followed by atracurium 0.23 mg kg-1 when the EMG had recovered to 20% of its control value: a sequence intended to be representative of clinical practice. Group 3 received suxamethonium 1 mg kg-1 and atracurium 0.23 mg kg-1 in rapid succession. Plasma cholinesterase concentrations and Dibucaine and fluoride numbers were within normal limits in all patients. Suxamethonium given for endotracheal intubation (group 2) neither potentiated the subsequent atracurium blockade nor delayed spontaneous recovery. When suxamethonium and atracurium were given in rapid succession (group 3), the duration of suxamethonium blockade was reduced considerably but the recovery from the atracurium component of the blockade was not significantly different from groups 1 and 2. Although the intubation score at 60s was no worse in group 3, the duration of profound blockade suitable for intubation was reduced to such an extent that the simultaneous administration of suxamethonium and atracurium cannot be recommended in clinical practice when there is a requirement for rapid endotracheal intubation. RP HARPER, NJN (reprint author), MANCHESTER ROYAL INFIRM,DEPT ANAESTHESIA,OXFORD RD,MANCHESTER M13 9WL,LANCS,ENGLAND. NR 0 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 1993 VL 10 IS 1 BP 13 EP 17 PG 5 WC Anesthesiology SC Anesthesiology GA KK008 UT WOS:A1993KK00800003 ER PT J AU LUI, PW MA, JY CHAN, KK AF LUI, PW MA, JY CHAN, KK TI MODIFICATION OF TONIC-CLONIC CONVULSIONS BY ATRACURIUM IN MULTIPLE-MONITORED ELECTROCONVULSIVE-THERAPY SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE ATRACURIUM; ELECTROCONVULSIVE THERAPY, MULTIPLE-MONITORED; NONDEPOLARIZING MUSCLE RELAXANTS AB Study Objective: To determine the effect of two different doses of atracurium on the modification of tonic-clonic convulsions in multiple-monitored electroconvulsive therapy (MMECT). To compare recovery time and adverse reactions of these doses. Design: Clinical study. Anesthesiologist was blinded in the evaluation of post-electroconvulsive therapy (ECT) myalgia and other side effects. Setting: University-affiliated veterans general hospital. Patients: Two groups of twelve psychiatric inpatients who suffered from major depression or catatonic-type schizophrenia that failed to respond to tricyclic antidepressant therapy. Interventions: Under single-channel, prefrontal electroencephalographic (EEG) monitoring, patients were given either 0.3 mg/kg or 0.5 mg/kg of atracurium intravenously (IV) after anesthetic induction with methohexital 1 mg/kg IV. Measurements and Main Results: Evoked electromyographic responses of the adductor pollicis muscle was obtained by train-of-four stimulation of the ulnar nerVe at the wrist every 20 seconds. The first twitch depression (T1) of neuromuscular blockade was maintained within 11% to 25% (atracurium 0.3 mg/kg) or 0% to 10% (atracurium 0.5 mg/kg) of control during the entire session of MMECT. Patients pretreated with atracurium 0.5 mg/kg had significantly fewer ECT-induced moderate and vigorous convulsions when compared with patients receiving atracurium 0.3 mg/kg (16.7% vs. 78.4%, moderate; 0% vs. 8.3%, vigorous). However, patients pretreated with atracurium 0.5 mg/kg took a longer time to attain a T4 ratio of 0.5 than did patients receiving atracurium 0.3 mg/kg (9.2 +/- 0.8 minutes vs. 4.3 +/- 0.4 minutes). There was no significant difference between the two groups with respect to cumulative seizure duration or frequency of bradycardia, sialorrhea, postseizure myalgia, nausea, headache, or confusion. No patient in either group recalled any event concerning electroconvulsive shock. Conclusions: Whereas full neuromuscular blockade by atracurium 0.5 mg/kg IV is very effective in the modification of tonic-clonic convulsions induced by ECT, we suggest that a lower dose of atracurium (0.3 mg/kg IV) be used if one needs to ascertain the occurrence of ECT-induced seizures as indicated by minimum peripheral muscle activity at the time of EEG recording during MMECT. RP LUI, PW (reprint author), VET GEN HOSP TAIPEI,DEPT ANESTHESIOL,DIV NEUROANESTHESIA,SHI PAI RD,SECT 2 201,TAIPEI 11217,TAIWAN. NR 0 TC 8 Z9 8 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD JAN-FEB PY 1993 VL 5 IS 1 BP 16 EP 21 DI 10.1016/0952-8180(93)90082-P PG 6 WC Anesthesiology SC Anesthesiology GA KL136 UT WOS:A1993KL13600004 ER PT J AU NICHOLSON, A ILKIW, JE AF NICHOLSON, A ILKIW, JE TI NEUROMUSCULAR AND CARDIOVASCULAR EFFECTS OF ATRACURIUM IN ISOFLURANE-ANESTHETIZED CHICKENS SO AMERICAN JOURNAL OF VETERINARY RESEARCH LA English DT Article ID CARDIOPULMONARY DOSE-RESPONSE; CLINICAL-PHARMACOLOGY; MUSCLE-RELAXANT; BLOCKING; HALOTHANE; ANESTHESIA; VECURONIUM; REVERSAL; DUCKS; DOG AB Atracurium besylate, a nondepolarizing neuromuscular blocking agent, was administered to 24 isoflurane-anesthetized domestic chickens. Birds were randomly assigned to 4 groups, and atracurium was administered at dosage of 0.15, 0.25, 0.35 or 0.45 mg/kg of body weight. The time of onset of twitch depression, the amount of maximal twitch depression, and the duration of muscular relaxation were recorded. After return to control twitch height, atracurium was further administered to achieve > 75% twitch depression. When twitch depression reached 75% during noninduced recovery, 0.5 mg of edrophonium/kg was administered to reverse the muscle relaxation. Throughout the experimental period, cardiovascular, arterial blood gas, and acid-base variables were monitored. The effective dosage of atracurium to result in 95% twitch depression in 50% of birds, (ED95/50) was calculated, using probit analysis, to be 0.25 mg/kg, whereas the ED95/95, the dosage of atracurium to result in 95% twitch depression in 95% of birds, was calculated by probit analysis to be 0.46 mg/kg. The total duration of action at dosage of 0.25 mg/kg was 34.5 +/- 5.8 minutes; at the highest dosage (0.45 mg/kg), total duration increased to 47.8 +/- 10.3 minutes. The return to control twitch height was greatly hastened by administration of edrophonium. Small, but statistically significant changes in heart rate and systolic blood pressure, were associated with administration of atracurium and edrophonium. These changes would not be clinically relevant. In this study, atracurium was found to be safe and reliable for induction of muscle relaxation in isoflurane-anesthetized chickens. C1 UNIV CALIF DAVIS,SCH VET MED,DEPT SURG,DAVIS,CA 95616. RP NICHOLSON, A (reprint author), UNIV CALIF DAVIS,SCH VET MED,VET MED TEACHING HOSP,DAVIS,CA 95616, USA. NR 36 TC 7 Z9 7 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 SN 0002-9645 J9 AM J VET RES JI Am. J. Vet. Res. PD DEC PY 1992 VL 53 IS 12 BP 2337 EP 2342 PG 6 WC Veterinary Sciences SC Veterinary Sciences GA KA936 UT WOS:A1992KA93600025 ER PT J AU DHONNEUR, G GALL, O GERARD, A RIMANIOL, JM LAMBERT, Y DUVALDESTIN, P AF DHONNEUR, G GALL, O GERARD, A RIMANIOL, JM LAMBERT, Y DUVALDESTIN, P TI PRIMING DOSES OF ATRACURIUM AND VECURONIUM DEPRESS SWALLOWING IN HUMANS SO ANESTHESIOLOGY LA English DT Article DE AIRWAY; NEUROMUSCULAR RELAXANTS, ATRACURIUM, VECURONIUM ID PRINCIPLE; PARALYSIS; REFLEX AB The administration of low doses of muscle relaxant may cause peripheral muscular weakness including difficulty in swallowing. In the present study, the effect of priming doses of atracurium and vecuronium on swallowing was studied. Sixty patients undergoing elective surgery under general anesthesia were divided randomly into four groups of 15 patients and received as a priming dose either vecuronium (10 or 15 mug/kg) or atracurium (50 or 75 mug/kg). Swallowing muscle activity was measured hy electromyography using submental surface electrodes. Swallowing was initiated hy administration of 0.3 ml distilled water through an oral catheter. Swallowing reflex was determined hy measuring the latency time (i.e., time from water administration to start of EMG activity of glossal muscles). Swallowing activity was determined by integration of the EMG of glossal muscles during swallowing. Peripheral muscle strength was determined by hand grip strength. Swallowing reflex activity and peripheral muscle strength were measured before and 3 and 6 min after administration of vecuronium or atracurium. Latency time remained unchanged after any of the priming doses. Integrated EMG decreased significantly (P < .001) 3 and 6 min after all priming doses tested (42-75% of baseline value). Only after atracurium 75 mug/kg was the hand grip strength significantly decreased (P < .01). These results suggest that owing to its effect on swallowing, the priming dose should be used with caution. C1 UNIV PARIS 12,HENRI MONDOR HOSP,DEPT ANESTHESIA,51 AVE MARECHAL LATTRE TASSIGNY,F-94010 CRETEIL,FRANCE. RP DUVALDESTIN, P (reprint author), UNIV PARIS 12,HENRI MONDOR HOSP,DEPT ANESTHESIA,51 AVE MARECHAL LATTRE TASSIGNY,F-94010 CRETEIL,FRANCE. NR 18 TC 23 Z9 23 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 1992 VL 77 IS 6 BP 1070 EP 1073 PG 4 WC Anesthesiology SC Anesthesiology GA KC865 UT WOS:A1992KC86500004 ER PT J AU COOK, DR FREEMAN, JA LAI, AA KANG, Y STILLER, RL AGGARWAL, S HARRELSON, JC WELCH, RM SAMARA, B AF COOK, DR FREEMAN, JA LAI, AA KANG, Y STILLER, RL AGGARWAL, S HARRELSON, JC WELCH, RM SAMARA, B TI PHARMACOKINETICS OF MIVACURIUM IN NORMAL-PATIENTS AND IN THOSE WITH HEPATIC OR RENAL-FAILURE SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ENZYMES, PLASMA CHOLINESTERASE (BUTYRYLCHOLINESTERASE); KIDNEY, RENAL FAILURE; LIVER, HEPATIC FAILURE; NEUROMUSCULAR RELAXANTS, MIVACURIUM; PHARMACOKINETICS, MIVACURIUM ID SUCCINYLCHOLINE NEUROMUSCULAR BLOCKADE; PLASMA CHOLINESTERASE ACTIVITY; CHLORIDE BW B1090U; NARCOTIC ANESTHESIA; NITROUS-OXIDE; PHARMACODYNAMICS; ISOFLURANE AB We have determined the pharmacokinetics and duration of action of a bolus dose of mivacurium (0.15 mg kg-1) during isoflurane and nitrous oxide anaesthesia in nine patients with normal renal and liver function, nine patients undergoing cadaveric kidney transplantation and nine patients undergoing cadaveric liver transplantation. Total plasma concentrations of mivacurium were measured for 2.5 h after administration using a high-pressure liquid chromatographic assay. Plasma concentration vs time data for what were presumed to be the two active mivacurium isomers were analysed by a non-compartmental method based on statistical moments. Neuromuscular block was assessed by measuring the electromyographic evoked response of the adductor pollicis muscle to train-of-four stimulation of the ulnar nerve. The mean time to recovery of 25% neuromuscular transmission, T25, was greater in the patients with liver failure (57.2 min) than in control patients (18.7 min). The volume of distribution at steady rate (Vd(ss)) was comparable in the three groups. Patients with impaired liver function had significantly longer mean residence time and smaller plasma clearance than did patients with renal failure or control patients. There were significant negative correlations between plasma cholinesterase activity and both T25 (r = 0.79) and mean residence time (r 0.62). C1 PRESBYTERIAN UNIV HOSP,DEPT ANESTHESIOL,PITTSBURGH,PA. BURROUGHS WELLCOME CO,RES TRIANGLE PK,NC 27709. UNIV PITTSBURGH,SCH MED,DEPT ANESTHESIOL,PITTSBURGH,PA 15261. NR 19 TC 89 Z9 91 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 1992 VL 69 IS 6 BP 580 EP 585 DI 10.1093/bja/69.6.580 PG 6 WC Anesthesiology SC Anesthesiology GA KA087 UT WOS:A1992KA08700008 ER PT J AU SHIRAISHI, H SUZUKI, H SUZUKI, T KATSUMATA, N OGAWA, S AF SHIRAISHI, H SUZUKI, H SUZUKI, T KATSUMATA, N OGAWA, S TI FADING RESPONSES IN THE EVOKED EMG AFTER ROCURONIUM IN CATS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MEASUREMENT TECHNIQUES, ELECTROMYOGRAPHY; NEUROMUSCULAR RELAXANTS, D-TUBOCURARINE; PANCURONIUM; ROCURONIUM; VECURONIUM; NEUROMUSCULAR TRANSMISSION ID NEUROMUSCULAR-JUNCTION; TRAIN-OF-4 FADE; TUBOCURARINE; BLOCK; RAT; TRANSMISSION; PANCURONIUM; AGENTS; ONSET; FROG AB This study was performed to evaluate the inhibitry effect on motor nerve terminals by rocuronium using recovery curves of muscle compound action potentials (CAPs) and train-of-four ratios (TOFRs) in anaesthetized cats, and to compare the results with other relaxants reported previously. Recovery curves were derived from the amplitude of the CAP induced in the gastrocnemius muscle by the second of a paired stimulus (test response) to the sciatic nerve and compared with results evoked by the first component (conditioning response). The interval between the paired stimuli was increased stepwise from 7 to 1, 000 msec, and the differences in amplitude of the test and conditioning responses were plotted on a graph by relating the changes in paired intervals. The recovery curve after rocuronium was less inhibited than after pancuronium, (100.4 +/- 5.9%, 82.3 +/- 6.7% and 68.5 +/- 6.7% at 60, 100 and 500 msec intervals, compared with 70.3 +/- 3.3%, 59.0 +/- 4.7% and 46.7 +/- 4.3% after pancuronium (P < 0.05). The recovery curves with d-tubocurarine were more depressed than with pancuronium; however, the RC with vecuronium was similar to that of rocuronium. The degree of fade in TOF by rocuronium was also less than those seen with d-tubocurarine and pancuronium. The results obtained suggest that rocuronium has less inhibitory effect on motor nerve terminals than do d-tubocurarine and pancuronium, and has a similar effect to that of vecuronium. C1 SURUGADAI NIHON UNIV HOSP,DEPT ANAESTHESIOL,1-8-13 KANDA SURUGADAI,CHIYODA KU,TOKYO 101,JAPAN. NR 23 TC 3 Z9 3 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD DEC PY 1992 VL 39 IS 10 BP 1099 EP 1104 PG 6 WC Anesthesiology SC Anesthesiology GA KE016 UT WOS:A1992KE01600015 ER PT J AU MANGEL, A LEITAO, JM BATEL, R ZIMMERMANN, H MULLER, WEG SCHRODER, HC AF MANGEL, A LEITAO, JM BATEL, R ZIMMERMANN, H MULLER, WEG SCHRODER, HC TI PURIFICATION AND CHARACTERIZATION OF A PORE-FORMING PROTEIN FROM THE MARINE SPONGE TETHYA-LYNCURIUM SO EUROPEAN JOURNAL OF BIOCHEMISTRY LA English DT Article ID STAPHYLOCOCCAL ALPHA-TOXIN; ANEMONE STOICHACTIS-HELIANTHUS; ESCHERICHIA-COLI HEMOLYSIN; GEODIA-CYDONIUM LECTIN; MEMBRANE DAMAGE; STREPTOLYSIN-O; AGGREGATION FACTOR; FUNCTIONAL-CHARACTERIZATION; TRANSMEMBRANE CHANNELS; CELL-MEMBRANES AB A pore-forming protein was detected and purified for the first time from a marine sponge (Tethya lyncurium). The purified protein has a polypeptide molecular mass of 21 kDa and a pI of 6.4. Tethya pore-forming protein (also called Tethya hemolysin) rapidly lysed erythrocytes from a variety of organisms. After binding to target membranes, the hemolysin resisted elution with EDTA, salt or solutions of low ionic strength and hence resembled an integral membrane protein. Erythrocytes could be protected from hemolysis induced by Tethya hemolysin by addition of 30 mM dextran 4 (4 - 6 kDa; equivalent hydrodynamic diffusion radius, 1. 75 - 2.3 nm) to the extracellular medium, but not by addition of uncharged molecules of smaller size [sucrose, raffinose and poly(ethylene glycol) 1550; equivalent hydrodynamic diffusion radii, 0.46, 0.57 and 1.2 nm, respectively]. This result indicates that hemolysin is able to form stable transmembrane pores with an effective diameter of about 2 - 3 nm. Treatment of osmotically protected erythrocytes with Tethya hemolysin caused a rapid efflux of intracellular K+ and ATP, and a rapid influx of extracellularly added Ca2+ and sucrose. In negative-staining electron microscopy, target erythrocyte membranes exposed to purified Tethya hemolysin displayed ultrastructural lesions but without visible pores. C1 UNIV MAINZ, INST PHYSIOL CHEM, DUESBERGWEG 6, W-6500 MAINZ, GERMANY. RUDJER BOSKOVIC INST, CTR ZA ISTRAZIVANJE MORA, ROVINJ, CROATIA. UNIV FRANKFURT, INST ZOOL, W-6000 FRANKFURT, GERMANY. NR 56 TC 30 Z9 31 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0014-2956 J9 EUR J BIOCHEM JI Eur. J. Biochem. PD DEC 1 PY 1992 VL 210 IS 2 BP 499 EP 507 DI 10.1111/j.1432-1033.1992.tb17448.x PG 9 WC Biochemistry & Molecular Biology SC Biochemistry & Molecular Biology GA KF579 UT WOS:A1992KF57900017 ER PT J AU KHUENLBRADY, KS MAIR, P KOLLER, J AF KHUENLBRADY, KS MAIR, P KOLLER, J TI ANTAGONISM OF VECURONIUM BY ONE OF ITS METABOLITES INVITRO SO EUROPEAN JOURNAL OF PHARMACOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS; VECURONIUM; 3-DESACETYL VECURONIUM; 3,17-DESACETYL VECURONIUM; METABOLITES (ANTAGONISM) ID CRITICALLY ILL PATIENTS; PANCURONIUM; ORG-NC-45; BROMIDE; SYNERGY; CAT AB The neuromuscular-blocking agent vecuronium bromide undergoes hydrolysis to three pharmacologically active metabolites (3-desacetyl, 17-desacetyl and 3,17-desacetyl vecuronium) which might modify the neuromuscular-blocking action of their parent compound. In order to elucidate the possible role of the interaction between vecuronium and its metabolites in the complications reported after long-term use of vecuronium in intensive care unit (ICU) patients, the relative potency of vecuronium, 3-desacetyl and 3,17-desacetyl vecuronium was determined in the rat hemidiaphragm in vitro and the mode of interaction of the above-mentioned compounds investigated. Dose-response relationships were established for each substance alone and for combinations of vecuronium with its metabolites. The relative potency at the EDmax50 levels (% maximal effect) were in the order of 1:1.2:27 for vecuronium, the 3-desacetyl derivative and the 3,17-desacetyl derivative, respectively. The mode of interaction characterized by isobolographic and algebraic (functional) analysis showed vecuronium and 3-desacetyl vecuronium to interact in an additive fashion while the combined effect of the parent compound and its 3,17-desacetyl derivative was less than additive, indicating antagonism. C1 UNIV INNSBRUCK,GEN INTENS CARE MED CLIN,A-6020 INNSBRUCK,AUSTRIA. RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK,ANAESTHESIA CLIN,ANICHSTR 35,A-6020 INNSBRUCK,AUSTRIA. NR 15 TC 3 Z9 3 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 NOV 3 PY 1992 VL 222 IS 1 BP 153 EP 156 DI 10.1016/0014-2999(92)90828-R PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA JY363 UT WOS:A1992JY36300022 ER PT J AU DIEFENBACH, C ABEL, M BUZELLO, W AF DIEFENBACH, C ABEL, M BUZELLO, W TI GREATER NEUROMUSCULAR BLOCKING POTENCY OF ATRACURIUM DURING HYPOTHERMIC THAN DURING NORMOTHERMIC CARDIOPULMONARY BYPASS SO ANESTHESIA AND ANALGESIA LA English DT Article ID VECURONIUM; PANCURONIUM; INFUSION; BLOCKADE AB Previous studies drew attention to the greater neuromuscular blocking potency of atracurium during, than before or after, hypothermic cardiopulmonary bypass (CPB) while disregarding the periods of normothermic perfusion. We recorded the evoked twitch tension in 15 patients during nitrous oxide/narcotic anesthesia who were undergoing open heart surgery. Atracurium was injected as an initial bolus dose of 460 mug/kg. Waning neuromuscular blockade was enhanced by repeat injections of 138 mug/kg whenever the twitch tension attained 25% of control. During hypothermic (<32-degrees-C) and normothermic (>34-degrees-C) CPB, the times of onset of the maintenance doses were 57% and 18% longer, respectively, than before CPB (P < 0.05). Maintenance doses of atracurium were required every 24 +/- 4 min (mean +/- SD) before CPB, every 45 +/- 8 min (p < 0.05) during hypothermia, every 22 +/- 3 min during normothermic perfusion, and every 23+/-3 min after CPB. In conclusion, the patients' changing demand of atracurium paralleled the changes of temperature rather than the institution and cessation of CPB. RP DIEFENBACH, C (reprint author), UNIV COLOGNE,DEPT ANESTHESIOL,JOSEPH STELZMANN STR 9,W-5000 COLOGNE 41,GERMANY. NR 11 TC 17 Z9 17 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 1992 VL 75 IS 5 BP 675 EP 678 PG 4 WC Anesthesiology SC Anesthesiology GA JV698 UT WOS:A1992JV69800004 ER PT J AU SZENOHRADSZKY, J FISHER, DM SEGREDO, V CALDWELL, JE BRAGG, P SHARMA, ML GRUENKE, LD MILLER, RD AF SZENOHRADSZKY, J FISHER, DM SEGREDO, V CALDWELL, JE BRAGG, P SHARMA, ML GRUENKE, LD MILLER, RD TI PHARMACOKINETICS OF ROCURONIUM BROMIDE (ORG-9426) IN PATIENTS WITH NORMAL RENAL-FUNCTION OR PATIENTS UNDERGOING CADAVER RENAL-TRANSPLANTATION SO ANESTHESIOLOGY LA English DT Article DE KIDNEY FAILURE, MUSCLE RELAXANTS; NEUROMUSCULAR RELAXANTS, ROCURONIUM BROMIDE (ORG-9426); PHARMACOKINETICS, ROCURONIUM BROMIDE (ORG-9426); TRANSPLANTATION, KIDNEY ID FAILURE; PHARMACODYNAMICS; PIPECURONIUM; ANESTHESIA; VECURONIUM; ATRACURIUM; ORG9426; AGENT AB To determine the effect of end-stage renal disease on the pharmacokinetics of rocuronium bromide (ORG 9426), a new nondepolarizing monoquaternary steroidal neuromuscular blocking drug, the authors administered 600 mug/kg rocuronium (2 X ED95) intravenously to ten patients undergoing cadaver renal transplantation and ten healthy patients undergoing elective minor surgery (controls). All patients were anesthetized with nitrous oxide (50-70% in oxygen) and isoflurane (end-tidal concentrations of 1.2 +/- 0.5% and 0.8 +/- 0.2%, mean +/- SD, for control and transplant groups, respectively). Plasma concentrations of rocuronium were determined by capillary gas chromatography. A population-based pharmacokinetic analysis (NONMEM) was used to determine typical values, standard errors, and interindividual variability for the pharmacokinetic parameters and to determine whether these values differed between control and renal transplant patients. Total plasma clearance (2.89 +/- 0.25 ml.kg-1.min-1, mean +/- SE) and volume of the central compartment (76.9 +/- 10.6 ml/kg) did not differ between control and renal transplant patients, whereas volume of distribution at steady state was greater in renal transplant patients (264 +/- 19 ml/kg) than in control patients (207 +/- 14 ml/kg). This resulted in a longer elimination half life in renal transplant patients (97.2 +/- 17.3 min) compared to controls (70.9 +/- 4.7 min). The authors conclude that renal failure and renal transplantation alter the distribution but not the clearance of rocuronium. C1 UNIV CALIF SAN FRANCISCO,MED CTR,DEPT ANESTHESIA,BOX 0648,SAN FRANCISCO,CA 94143. NR 17 TC 70 Z9 76 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1992 VL 77 IS 5 BP 899 EP 904 DI 10.1097/00000542-199211000-00010 PG 6 WC Anesthesiology SC Anesthesiology GA JX504 UT WOS:A1992JX50400010 ER PT J AU PARKER, CJR HUNTER, JM SNOWDON, SL AF PARKER, CJR HUNTER, JM SNOWDON, SL TI EFFECT OF AGE, SEX AND ANESTHETIC TECHNIQUE ON THE PHARMACOKINETICS OF ATRACURIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE AGE FACTORS, PHARMACOKINETICS; ANESTHETICS, VOLATILE, HALOTHANE; ISOFLURANE; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID HALOTHANE ANESTHESIA; D-TUBOCURARINE; PHARMACODYNAMICS; PANCURONIUM; ISOFLURANE; PLASMA AB We have defined the pharmacokinetics of atracurium besylate 0.25 mg kg-1 in 41 patients anaesthetized with 0.9% isoflurane end-tidal, 0.5% halothane end-tidal or midazolam 3-10 mg as a supplement to 66% nitrous oxide in oxygen. The pharmacokinetic profile was affected by age, sex and anaesthetic technique. Advancing age was associated with a reduced clearance and a longer elimination half-time; clearance was greater and elimination haff-time was shorter in males than in females. Clearance was also greater in patients anaesthetized with isoflurane than with the two other techniques. Age, sex and anaesthetic technique did not significantly affect the volume of distribution. RP PARKER, CJR (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,4TH FLOOR,PRESCOTT ST,LIVERPOOL L69 3BX,ENGLAND. NR 24 TC 21 Z9 22 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 1992 VL 69 IS 5 BP 439 EP 443 DI 10.1093/bja/69.5.439 PG 5 WC Anesthesiology SC Anesthesiology GA JV940 UT WOS:A1992JV94000004 ER PT J AU MAYER, M DOENICKE, A HOFMANN, A PETER, K AF MAYER, M DOENICKE, A HOFMANN, A PETER, K TI ONSET AND RECOVERY OF ROCURONIUM (ORG-9426) AND VECURONIUM UNDER ENFLURANE ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM (ORG-9426); VECURONIUM ID NEUROMUSCULAR BLOCKING ACTION AB We have studied the onset, duration of action and recovery index of twice the ED90 of rocuronium (Org 9426) (0.6 mg kg-1) and of vecuronium (0.08 mg kg-1) in patients during enflurane anaesthesia. Rocuronium had a significantly shorter mean onset time of 1.8 (SD 0.4) min, compared with vecuronium 3.4 (0.8) min. Clinical duration (time for the first twitch in the train-of-four to recover to 25% of control) was similar for both drugs (29 (10) min vs 31 (12) min). Spontaneous recovery times (TOF ratio 70%) did not differ significantly between rocuronium (47 (10) min) and vecuronium (44 (11) min). RP MAYER, M (reprint author), UNIV MUNICH,INNENSTADTKLINIKEN,INST ANAESTHESIOL,NUSSBAUMSTR 20,W-8000 MUNICH 2,GERMANY. NR 6 TC 32 Z9 35 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 1992 VL 69 IS 5 BP 511 EP 512 DI 10.1093/bja/69.5.511 PG 2 WC Anesthesiology SC Anesthesiology GA JV940 UT WOS:A1992JV94000020 ER PT J AU BEATTIE, WS BUCKLEY, DN FORREST, JB AF BEATTIE, WS BUCKLEY, DN FORREST, JB TI CONTINUOUS INFUSIONS OF ATRACURIUM AND VECURONIUM, COMPARED WITH INTERMITTENT BOLUSES OF PANCURONIUM - DOSE REQUIREMENTS AND REVERSAL SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, ATRACURIUM; VECURONIUM; PANCURONIUM ID NEUROMUSCULAR BLOCKADE; NEOSTIGMINE ANTAGONISM; ENFLURANE ANESTHESIA; NITROUS-OXIDE; HUMANS; HALOTHANE; ISOFLURANE; RECOVERY; PARALYSIS; FENTANYL AB This study was designed to determine the effect of prolonged infusion on the ease of reversal of atracurium and vecuronium, and whether factors which potentiate the block delayed reversal In phase one, 40 patients were randomized (double blind) to determine the steady state conditions for atracurium and vecuronium. Fourteen atracurium patients and 17 vecuronium patients were evaluable. The unblinded second phase involved the steady state conditions using halothane or isoflurane and atracurium infusions. The infusion required for 95% twitch depression (TD95) for atracurium was 7.6 +/- 1.1 mug . kg-1 . min-1. The requirement for vecuronium changes with time: TD95 at 30 min was 1.01 +/- 0.16, at 60 min 0.89 +/- 0.12 and after 90 min 0.85 +/- 0.17 mug . kg-1 . min-1 (P < 0.05). The mean TD95 was 0.94 +/- 0.23 mug . kg-1 . min-1. Multivariate regression analysis of the infusion data revealed a vecuronium model predicting TD95 by the duration of infusion (P < 0.05) and weight (P = 0.05). Atracurium TD95 was predicted by age (P = 0.05). The addition of an inhalation agent to atracurium reduced the infusion rate by 2.01 +/- 0.28 mug . kg-1 . min-1 (P = 0.0001) for each increase in MAC. The mean reversal times for atracurium with three different anaesthetics and for vecuronium were not different. Reversal of pancuronium blockade, from less profound twitch depression (86.4 vs 95%) took twice as long as for atracurium and vecuronium for which the following predictors were identified: age, weight, duration of infusion, level of blockade, and type of anaesthetic, using a stepwise regression model For vecuronium: age (coeff 2.84 +/- 0.51 P = 0.0001) and duration of infusion (coeff 0.12 +/- 0.02 P = 0.0002) were significant predictors. Age was the only predictor of the time to reverse block after atracurium blockade with all types of anaesthetic (P = 0.05). RP BEATTIE, WS (reprint author), MCMASTER UNIV,DEPT ANAESTHESIA,1200 MAIN ST W,HAMILTON L8N 3Z5,ONTARIO,CANADA. RI Beattie, William /A-4352-2008 NR 36 TC 4 Z9 4 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD NOV PY 1992 VL 39 IS 9 BP 925 EP 931 PG 7 WC Anesthesiology SC Anesthesiology GA KA113 UT WOS:A1992KA11300006 ER PT J AU SCHMITH, VD FIEDLERKELLY, J ABOUDONIA, M HUFFMAN, CS GRASELA, TH AF SCHMITH, VD FIEDLERKELLY, J ABOUDONIA, M HUFFMAN, CS GRASELA, TH TI POPULATION PHARMACODYNAMICS OF DOXACURIUM SO CLINICAL PHARMACOLOGY & THERAPEUTICS LA English DT Article ID CLINICAL-PHARMACOLOGY; PHARMACOKINETICS; ISOFLURANE; ANESTHESIA AB The nonlinear mixed-effects modeling (NONMEM) computer program was used to investigate the variability in the duration of doxacurium-induced neuromuscular block in 408 patients enrolled in phase II and phase III clinical trials of doxacurium. Spontaneous recovery data in the 10% to 90% block range from all patients were pooled and fitted to a linear model. Two parameters were estimated: (1) the slope, which is related to the pharmacokinetics and to the steepness of the dose-response curve, and (2) the intercept, which is linearly related to dose but has no physiologic meaning. The primary goal was to determine the factors affecting the slope by use of univariate and multivariate analyses techniques. Estimates of the slope ranged from 0.67% to 1.1% block/min (interindividual variability, 39%). Factors with clinically significant effects on the slope included the following: age, obesity, and anesthesia type. Thus these factors influence the time course of doxacurium-induced block and may require individualization of dose. C1 SUNY BUFFALO,BUFFALO,NY 14260. RP SCHMITH, VD (reprint author), BURROUGHS WELLCOME CO,DEPT CLIN PHARMACOKINET DYNAM,3030 CORNWALLIS RD,RES TRIANGLE PK,NC 27709, USA. NR 12 TC 10 Z9 10 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0009-9236 J9 CLIN PHARMACOL THER JI Clin. Pharmacol. Ther. PD NOV PY 1992 VL 52 IS 5 BP 528 EP 536 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA KA748 UT WOS:A1992KA74800012 ER PT J AU LEE, CM TSAI, SK KWAN, WF CHEN, BJ CHENG, ML AF LEE, CM TSAI, SK KWAN, WF CHEN, BJ CHENG, ML TI DESFLURANE POTENTIATES ATRACURIUM IN HUMANS - A COMPARATIVE-STUDY WITH ISOFLURANE SO JOURNAL OF CLINICAL ANESTHESIA LA English DT Article DE ANESTHETICS, INHALATION-DESFLURANE, ISOFLURANE; DESFLURANE, NEUROMUSCULAR EFFECTS; INTERACTIONS, ATRACURIUM WITH DESFLURANE; ISOFLURANE, NEUROMUSCULAR EFFECTS; NEUROMUSCULAR RELAXANT, ATRACURIUM AB Study Objective: (1) To evaluate the neuromuscular effects of desflurane and its interactions with atracurium and (2) to compare desflurane and isoflurane in these effects. Design: Sequential entry of informed and consenting patients randomly assigned to receive desflurane (n = 25) or isoflurane (n = 25). Setting: Operating suite of a county-university medical center. Patients: Fifty adults, ASA physical status I, undergoing elective orthopedic surgery. Interventions: Following establishment of steady desflurane or isoflurane anesthesia, at 1.25 minimum alveolar concentration (MAC) exhaled for 15 minutes, a randomly predetermined dose of atracurium (0.05, 0.1, or 0.15 mg/kg) was injected intravenously (IV). At the end of surgery, neostigmine 0.04 mg/kg IV was given to reverse the residual block. The neuromuscular effects of desflurane or isoflurane alone, and the dose-response relationship, time course, and reversibility of the neuromuscular effects of atracurium with either anesthetic, were examined in detail and compared using eketromyographic quantification of the response of the first dorsal interosseous muscle to train-of-four (TOF) stimulation of the ulnar nerve. Measurements and Main Results: TOF fade and depression of the first response (T1) of the TOF were measured in response to desflurane or isoflurane, atracurium, and neostigmine. Desflurane caused more TOF fade than isoflurane prior to atracurium administration. The TOF ratios were 0.91 +/- 0.02 and 0.98 +/- 0.01, respectively (p < 0.05). For other measured neuromuscular parameters, atracurium-induced depression tended to be greater in the presence of desflurane than in the presence of isoflurane, but none of the measured differences reached the statistical significance level of p < 0.05. The ED50, ED95, and 25-75% recovery index of atracurium were 0.038 mg/kg (95% confidence level; range 0.030 to 0.047 mg/kg), 0.11 mg/kg (0.095 to 0.14 mg/kg), and 31 +/- 4 minutes (means +/- SEM) with desflurane anesthesia, versus 0.043 mg/kg (0.035 to 0.052 mg/kg), 0.13 mg/kg (0.11 to 0.16 mg/kg), and 23 +/-4 minutes with isoflurane anesthesia (p = 0.1-0.2). Continuation of either anesthetic at 1.25 MAC prevented complete recovery of neuromuscular functions spontaneously or following neostigmine 0.04 mg/kg. Conclusion: In ASA physical status I adults, 9% desflurane has neuromuscular effects equal to or slightly in excess of those of 1.6% isoflurane. RP LEE, CM (reprint author), UNIV CALIF LOS ANGELES,LOS ANGELES CTY HARBOR MED CTR,DEPT ANAESTHESIOL,1000 W CARSON ST,TORRANCE,CA 90509, USA. NR 0 TC 17 Z9 17 PU BUTTERWORTH-HEINEMANN PI WOBURN PA 225 WILDWOOD AVE #UNITB PO BOX 4500, WOBURN, MA 01801-2084 SN 0952-8180 J9 J CLIN ANESTH JI J. Clin. Anesth. PD NOV-DEC PY 1992 VL 4 IS 6 BP 448 EP 454 DI 10.1016/0952-8180(92)90217-O PG 7 WC Anesthesiology SC Anesthesiology GA KB978 UT WOS:A1992KB97800004 ER PT J AU ENGBAEK, J ROED, J AF ENGBAEK, J ROED, J TI DIFFERENTIAL EFFECT OF PANCURONIUM AT THE ADDUCTOR POLLICIS, THE 1ST DORSAL INTEROSSEOUS AND THE HYPOTHENAR MUSCLES - AN ELECTROMYOGRAPHIC AND MECHANOMYOGRAPHIC DOSE-RESPONSE STUDY SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE MONITORING, NERVE, ELECTROMYOGRAPHY, MECHANOMYOGRAPHY; NEUROMUSCULAR BLOCKING AGENT, PANCURONIUM ID ULNAR NERVE-STIMULATION; MECHANICAL RESPONSES; ATRACURIUM; TUBOCURARINE; ANESTHESIA; HUMANS; VECURONIUM; DIAPHRAGM; POTENCY AB Cumulative dose-response curves were constructed from evoked compound electromyographic (EMG) recordings in man to compare the sensitivity to pancuronium of the adductor pollicis, the hypothenar and the first dorsal interosseous muscles. Also, the EMG and mechanomyography-based sensitivity of the adductor pollicis muscle were compared. The EMG and the mechanomyogram were evaluated in random sequence in each of 21 adult thiopental, fentanyl and diazepam anesthetized patients. The EMG-based ED50 were 36-38 mug . kg-1 with no differences between muscles. The EMG-based ED90 of the adductor pollicis and the hypothenar muscles were 62-65 mug . kg-1 compared to the 60 mug . kg-1 of the first dorsal interosseous muscle (P < 0.05). ED50 (34 mug . kg-1), and ED90 (56 mug . kg-1) obtained from the adductor pollicis mechanomyogram were significantly lower than those based on the EMG (P < 0.05). It is concluded that differences in sensitivity to pancuronium exist between the three muscles when evaluated from the EMG, and that the apparent sensitivity of a given muscle to a muscle relaxant may depend upon whether the response is evaluated using EMG or mechanomyography. C1 UNIV COPENHAGEN,GLOSTRUP HOSP,DEPT ANESTHESIOL & INTENS CARE,GLOSTRUP,DENMARK. NR 31 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 OCT PY 1992 VL 36 IS 7 BP 664 EP 669 PG 6 WC Anesthesiology SC Anesthesiology GA JU885 UT WOS:A1992JU88500013 ER PT J AU OSTERGAARD, D JENSEN, FS JENSEN, E SKOVGAARD, LT VIBYMOGENSEN, J AF OSTERGAARD, D JENSEN, FS JENSEN, E SKOVGAARD, LT VIBYMOGENSEN, J TI INFLUENCE OF PLASMA CHOLINESTERASE ACTIVITY ON RECOVERY FROM MIVACURIUM-INDUCED NEUROMUSCULAR BLOCKADE IN PHENOTYPICALLY NORMAL-PATIENTS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS; ENZYMES, CHOLINESTERASE, PSEUDOCHOLINESTERASE; NEUROMUSCULAR RELAXANTS, MIVACURIUM ID CHLORIDE BW B1090U; SUCCINYLCHOLINE; SUXAMETHONIUM; PHARMACOLOGY; ATRACURIUM; LOCUS-1 AB The significance of plasma cholinesterase (pChe) activity for the duration of action of mivacurium in phenotypically normal patients was evaluated in 35 patients during neurolept anaesthesia. The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Ten patients with normal pChe (Group I) and five patients with decreased pChe activity (Group 2) were given a small test dose of mivacurium 0.03 mg kg-1. Mivacurium 0.1 mg kg-1 was administered following spontaneous recovery from the first dose. The mean suppression of the height of the first (T1) of the train-of-four responses following mivacurium 0.03 mg kg-1 patients with normal and decreased enzyme activity was 40% and 56%, respectively, and the mean T1 suppression after mivacurium 0.1 mg kg-1 was 100% in both groups. The times to different levels of twitch height recovery following the 0.1 mg kg-1 dose did not differ between the two groups of patients. Another 20 patients with normal or decreased pChe activity (Group 3) were given mivacurium 0.2 mg kg-1. In this group the time to maximum block was 1.4 min (1.0-4.0) mean (range) and the time to reappearance of the T1 response was 15.0 min (7.4-22.7) (range). An inverse relationship was found between the patients' pChe activity and the time to first response. It is concluded that mivacurium is short-acting in patients with normal pChe phenotype and normal to low-normal pChe activity. No patient with very low pChe activity was included in the study. A prolonged response to mivacurium may, however, be expected in these patients. C1 UNIV COPENHAGEN,BISPEBJERG HOSP,DEPT CLIN CHEM,DANISH CHOLINESTERASE RES UNIT,DK-2600 GLOSTRUP,DENMARK. UNIV COPENHAGEN,RIGSHOSP,DEPT ANAESTHESIA,DK-2100 COPENHAGEN,DENMARK. UNIV COPENHAGEN,STAT RES UNIT,DK-2600 GLOSTRUP,DENMARK. RP OSTERGAARD, D (reprint author), UNIV COPENHAGEN,GLOSTRUP HOSP,DEPT ANAESTHESIA,DK-2600 GLOSTRUP,DENMARK. NR 15 TC 64 Z9 64 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 OCT PY 1992 VL 36 IS 7 BP 702 EP 706 PG 5 WC Anesthesiology SC Anesthesiology GA JU885 UT WOS:A1992JU88500021 ER PT J AU ERIKSSON, LI LENNMARKEN, C WYON, N JOHNSON, A AF ERIKSSON, LI LENNMARKEN, C WYON, N JOHNSON, A TI ATTENUATED VENTILATORY RESPONSE TO HYPOXEMIA AT VECURONIUM-INDUCED PARTIAL NEUROMUSCULAR BLOCK SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE MEASUREMENT TECHNIQUES, NEUROMUSCULAR BLOCKADE, TRAIN-OF-4 STIMULATION; NEUROMUSCULAR RELAXANTS, VECURONIUM; RECEPTORS, CHEMORECEPTORS, CAROTID BODY; VENTILATION, CARBON DIOXIDE RESPONSE, HYPOXIC RESPONSE ID PARTIAL CURARIZATION; RECOVERY; ATRACURIUM; TUBOCURARINE; PARALYSIS; HUMANS AB The effect of a partial neuromuscular block on the ventilatory response to hypercarbia and to hypoxaemia was studied in 11 non-anaesthetized male subjects. Respiratory frequency, tidal volume, minute volume, respiratory timing and drive were measured during air breathing and during stimulation by hypercarbia and hypoxaemia. The ventilatory response was defined as the ratio between, respectively, tidal volume and minute volume during ventilation stimulated by hypercarbia and hypoxaemia compared to measurements during air breathing. The ventilatory measurements were repeated on three separate occasions: before neuromuscular block was established, during an infusion of vecuronium aiming at a mechanical adductor pollicis train-of-four (TOF) ratio of 0.70, and after the infusion had been stopped and the neuromuscular block had spontaneously recovered to a TOF ratio of >0.90. Resting ventilation during air breathing remained with minor variations throughout the experiment. The ventilatory response to hypercarbia was not affected at a TOF ratio of 0.70 as compared to measurements before vecuronium and at a TOF ratio of >0.90. In contrast, the ventilatory response to hypoxaemia was markedly reduced at a TOF ratio of 0.70. We conclude that a mechanical TOF ratio of 0.70 following vecuronium may be associated with an inadequate ventilatory response to hypoxaemia. C1 UNIV LINKOPING,FAC HLTH SCI,DEPT ANAESTHESIOL,LINKOPING,SWEDEN. NR 19 TC 79 Z9 84 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 OCT PY 1992 VL 36 IS 7 BP 710 EP 715 PG 6 WC Anesthesiology SC Anesthesiology GA JU885 UT WOS:A1992JU88500023 ER PT J AU ERIKSSON, LI VANDENBROM, RHG LENNMARKEN, C AGOSTON, S AF ERIKSSON, LI VANDENBROM, RHG LENNMARKEN, C AGOSTON, S TI ATRACURIUM-INDUCED NEUROMUSCULAR BLOCK IN THE ISOLATED ARM SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHESIA, ISOLATED ARM TECHNIQUE; MUSCLE CONTRACTION, MUSCLE RELAXANTS, DRUG EFFECTS; NEUROMUSCULAR BLOCKING AGENTS, ATRACURIUM, LAUDANOSINE ID HALOTHANE; HUMANS AB A modification of the isolated arm technique was applied in 10 females under opioid-based i.v. anaesthesia for comparison of the offset of an atracurium-induced neuromuscular block in an isolated arm to an arm with maintained circulation. The neuromuscular blocking effect of a bolus dose of atracurium 0.5 mg . kg-1 was measured bilaterally using the integrated adductor pollicis EMG response (integrated T1 EMG response in % of baseline value and T4/T1 ratio) after bilateral ulnar nerve train-of-four (TOF) stimulation. At 10% T1 recovery, one arm was isolated from the general circulation for 20 min by means of a tourniquet cuff (isolated arm), while normal circulation was maintained in the other arm (control arm). In both arms, the TOF response, peripheral skin temperature, mixed peripheral venous pH and plasma concentrations of atracurium and laudanosine were then measured and compared. Core and peripheral skin temperatures in both arms remained stable and normal throughout the study, and mixed peripheral venous pH stayed within physiological limits in both arms in all subjects. In the isolated arm, recovery of the neuromuscular block was markedly delayed compared to the control arm, the integrated EMG T1 response and TOF ratio being significantly reduced in the isolated arm after 20 min of isolation. The decline in plasma concentration of atracurium was less in the isolated arm than in the control arm, whereas laudanosine levels increased in the isolated and decreased in the control arm. Normal peripheral circulation is of major importance for termination of an atracurium-induced neuromuscular block. The contribution of Hofmann elimination to termination of an atracurium-induced neuromuscular block appears to be of minor importance. C1 LINKOPING UNIV,FAC HLTH SCI,DEPT ANAESTHESIOL,S-58183 LINKOPING,SWEDEN. UNIV GRONINGEN,EXPTL ANAESTHESIOL & CLIN PHARMACOL RES GRP,9700 AB GRONINGEN,NETHERLANDS. NR 18 TC 4 Z9 4 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 OCT PY 1992 VL 36 IS 7 BP 728 EP 732 PG 5 WC Anesthesiology SC Anesthesiology GA JU885 UT WOS:A1992JU88500026 ER PT J AU BOOTH, MG MARSH, B BRYDEN, FMM ROBERTSON, EN BAIRD, WLM AF BOOTH, MG MARSH, B BRYDEN, FMM ROBERTSON, EN BAIRD, WLM TI A COMPARISON OF THE PHARMACODYNAMICS OF ROCURONIUM AND VECURONIUM DURING HALOTHANE ANESTHESIA SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ROCURONIUM; VECURONIUM; ANESTHETICS, VOLATILE, HALOTHANE ID NEUROMUSCULAR BLOCKADE; MUSCLE-RELAXANT; ORG-9426; PANCURONIUM; DURATION; AGENT C1 ROYAL INFIRM,DIV ANAESTHESIA,GLASGOW G31 3ER,SCOTLAND. NR 15 TC 46 Z9 51 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD OCT PY 1992 VL 47 IS 10 BP 832 EP 834 DI 10.1111/j.1365-2044.1992.tb03139.x PG 3 WC Anesthesiology SC Anesthesiology GA JR389 UT WOS:A1992JR38900003 ER PT J AU MCCARTHY, GJ MIRAKHUR, RK PANDIT, SK AF MCCARTHY, GJ MIRAKHUR, RK PANDIT, SK TI LACK OF INTERACTION BETWEEN PROPOFOL AND VECURONIUM SO ANESTHESIA AND ANALGESIA LA English DT Article ID DIISOPROPYL PHENOL ICI-35868; SUXAMETHONIUM; ATRACURIUM AB We estimated the potency of vecuronium and measured the onset and duration of its action during total intravenous anesthesia with propofol to examine the possibility of any interaction between these two drugs. Propofol infusion was administered according to a three-step dosage scheme, and neuromuscular block was monitored by measuring the force of contraction of the adductor pollicis muscle after single-twitch stimulation of the ulnar nerve at 0.1 Hz. A control group of patients were similarly studied during anesthesia with thiopental, nitrous oxide, oxygen, and fentanyl. The ED50 and ED95 (dose required to produce a 50% and 95% depression of twitch tension, respectively) of vecuronium in patients given total intravenous anesthesia (n = 24) were 24 (22-27, 95% confidence limits) and 41 (37-48, 95% confidence limits) mug/kg, respectively, and in the control group (n = 24), 20 (17-24) and 39 (34-37) mu-g/kg, respectively. The onset of action of an 80-mu-g/kg dose (2 x ED95) of vecuronium was 3.6 +/- 1.2 and 4.1 +/- 1.7 min (mean +/- SD), in the propofol (n = 10) and control (n = 10) groups, respectively. The respective times to recovery of the twitch height to 25% of control and the recovery indices (25%-75% recovery of twitch height) in the propofol versus control groups were 28.3 +/- 6.6 and 28.0 +/- 1.7 min and 13.3 +/- 6.8 and 15.4 +/- 11.9 min, respectively. There were no significant differences in any of the measured variables between the propofol and control groups, indicating the lack of any interaction between propofol and vecuronium. C1 UNIV MICHIGAN,MED CTR,DEPT ANESTHESIOL,1500 E MED CTR DR,ANN ARBOR,MI 48109. QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 8 TC 13 Z9 14 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 1992 VL 75 IS 4 BP 536 EP 538 PG 3 WC Anesthesiology SC Anesthesiology GA JP534 UT WOS:A1992JP53400012 ER PT J AU BRULL, SJ SILVERMAN, DG AF BRULL, SJ SILVERMAN, DG TI TETANUS-INDUCED CHANGES IN APPARENT RECOVERY AFTER BOLUS DOSES OF ATRACURIUM OR VECURONIUM SO ANESTHESIOLOGY LA English DT Article DE MONITORING, NEUROMUSCULAR FADE; NERVE STIMULATOR; POSTTETANIC FACILITATION; TETANIC STIMULATION; TIME TO RECOVERY; TRAIN-OF-4; NEUROMUSCULAR RELAXANTS ATRACURIUM; VECURONIUM ID MUSCLE AB The current study evaluated the duration and magnitude of posttetanic effects in 56 patients recovering from a bolus dose of nondepolarizing relaxant to assess the impact of tetanus on monitoring in a common clinical setting. After induction of general anesthesia (thiopental, fentanyl, oxygen, nitrous oxide, and isoflurane), a baseline response to train-of-four (TOF) stimulation was recorded using an adductor pollicis force transducer, and the ratio of the fourth response (T4) to the first (T1) was calculated. Patients then received a bolus dose of either atracurium 0.50 mg . kg-1 (n = 28) or vecuronium 0.10 mg . kg-1 (n = 28). TOF was recorded at 12-s intervals between 25% and 75% recovery of T1 (time25-75%, first data set); then, block was reestablished with the same agent (atracurium 0.10 or vecuronium 0.02 mg-kg-1), and monitoring of time25-75% was repeated (second data set). Subjects were randomized such that none, one, or both sets had TOF monitoring interrupted by a 5-s, 50-Hz tetanic stimulus at 50% recovery (TET). For each drug, 7 patients were assigned to each of the four possible sequences: no tetanus (NOTET) set followed by NOTET set; NOTET-TET; TET-NOTET; and TET-TET. After either drug, the TET data sets demonstrated significant acceleration of recovery of T1 from 50% to 75% (time50-75%) of its baseline height (P < 0.05 by paired t test). After atracurium, time50-75% was shortened by the tetanic stimulation from a control of 6.3 +/- 1.1 to 5.0 +/- 1.3 min (P < 0.05). After vecuronium, time50-75% was shortened from 7.4 +/- 2.8 to 5.0 +/- 2.6 min (P < 0.05). We conclude that, when delivered at 50% recovery of single twitch height, tetanus shortens the time to 75% recovery after atracurium or vecuronium, such that the response of the tested site may no longer be representative of other muscle groups. C1 YALE NEW HAVEN MED CTR,SCH MED,DEPT ANESTHESIOL,NEW HAVEN,CT 06504. RI Brull, Sorin/E-8578-2010 NR 6 TC 9 Z9 9 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 1992 VL 77 IS 4 BP 642 EP 645 DI 10.1097/00000542-199210000-00005 PG 4 WC Anesthesiology SC Anesthesiology GA JR748 UT WOS:A1992JR74800005 ER PT J AU SCHWARTZ, AE NAVEDO, AT BERMAN, MF AF SCHWARTZ, AE NAVEDO, AT BERMAN, MF TI PANCURONIUM INCREASES THE DURATION OF ELECTROENCEPHALOGRAM BURST SUPPRESSION IN DOGS ANESTHETIZED WITH ISOFLURANE SO ANESTHESIOLOGY LA English DT Article DE ANESTHETICS, VOLATILE ISOFLURANE; BRAIN ELECTROENCEPHALOGRAPH; NEUROMUSCULAR RELAXANTS PANCURONIUM ID MINIMUM ALVEOLAR CONCENTRATION; HALOTHANE; SUCCINYLCHOLINE; REQUIREMENT; ATRACURIUM AB Earlier studies have demonstrated both a decrease as well as no effect on halothane MAC after administration of nondepolarizing neuromuscular relaxants. To clarify further the relationship between neuromuscular blocking agents and anesthetic potency, the authors studied the effect of pancuronium on steady-state electroencephalogram (EEG) burst suppression produced by isoflurane in dogs. Anesthesia was induced using isoflurane and oxygen via mask without the administration of other drugs. The trachea was intubated, and isoflurane was administered at a concentration sufficient to produce EEG burst suppression. Thereafter, end-tidal isoflurane concentration, temperature, and end-tidal P(CO2) were meticulously maintained at constant values. Dogs in group 1 (n = 6) received pancuronium 0.1 mg . kg-1. The percent of the EEG that was isoelectric increased from 21 +/- 9% (mean +/- SD) to 35 +/- 11% (P < 0.01). After the return of single-twitch response to train-of-four stimulation, neostigmine 0.05 mg . kg-1 and glycopyrrolate 0.01 mg . kg-1 were administered. This resulted in a reduction in EEG isoelectricity to 19 +/- 8% (P < 0.01), similar to the value before pancuronium administration. In group 2 dogs (n = 6), the percent isoelectricity of the EEG prior to pancuronium was 25 +/- 10%. After administration of pancuronium 0.02, 0.04, and 0.2 mg . kg-1 sequentially, the percent isoelectricity of the EEG was 29 +/- 11, 37 +/- 15, and 43 +/- 9%, respectively. This represents a dose-related increase in isoelectricity for the 0.04- and 0.2-mg . kg-1 doses (P < 0.05). The increased duration of isoelectricity during isoflurane EEG burst suppression resulting from pancuronium administration indicates that the effect of isoflurane on the brain is enhanced by nondepolarizing neuromuscular blockade. RP SCHWARTZ, AE (reprint author), COLUMBIA UNIV COLL PHYS & SURG,DEPT ANESTHESIOL,161 FT WASHINGTON AVE,ROOM 901,NEW YORK,NY 10032, USA. NR 18 TC 20 Z9 20 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 1992 VL 77 IS 4 BP 686 EP 690 DI 10.1097/00000542-199210000-00012 PG 5 WC Anesthesiology SC Anesthesiology GA JR748 UT WOS:A1992JR74800012 ER PT J AU QUINN, MW OTOO, F RUSHFORTH, JA DEAN, HG PUNTIS, JWL WILD, J LEVENE, MI AF QUINN, MW OTOO, F RUSHFORTH, JA DEAN, HG PUNTIS, JWL WILD, J LEVENE, MI TI EFFECT OF MORPHINE AND PANCURONIUM ON THE STRESS RESPONSE IN VENTILATED PRETERM INFANTS SO EARLY HUMAN DEVELOPMENT LA English DT Article DE MORPHINE; PANCURONIUM; STRESS; VENTILATION ID HUMAN NEONATE; PAIN; SURGERY; CATECHOLAMINE; ANESTHESIA; METABOLISM; FETUS AB Nintey-five premature newborns who had hyaline membrane disease and were struggling against the ventilator were randomised to one of three treatment groups: morphine (group M), pancuronium (group P) or morphine with pancuronium (group M+P). The dose of morphine was 50 mug/kg per h but was increased to 100 mug/kg per h in group M infants if they continued to struggle. The dosage of pancuronium was 100 mug/kg given as required to inhibit spontaneous respiration. Plasma catecholamine levels were measured on entry and at 24 h. Blood pressure and ventilatory requirements were determined on entry and at 6 h. The clinical outcome of the infants was documented. Group M infants (n=29) showed a significant reduction in noradrenaline levels (median change -2.2 nmols/l (range -47.2 to +7.2 nmols/1), although seven were withdrawn from this group because of failure to settle. Group P (n=28) and group M + P (n=38) showed no significant change in noradrenaline levels. Comparison between the groups showed that group M infants had a significant reduction in noradrenaline levels compared with group P. The immediate effects of treatment on blood pressure and ventilatory requirements were similar in the three groups. The clinical outcome did not differ for any of the measured parameters. When adequate sedation is achieved, morphine may reduce the stress of newborn intensive care. C1 GEN INFIRM LEEDS,DEPT CLIN MED,ACAD UNIT PAEDIAT,D FLOOR,CLARENDON WING,LEEDS LS2 9NS,ENGLAND. NR 17 TC 39 Z9 39 PU ELSEVIER SCI IRELAND LTD PI CLARE PA CUSTOMER RELATIONS MANAGER, BAY 15, SHANNON INDUSTRIAL ESTATE CO, CLARE, IRELAND SN 0378-3782 J9 EARLY HUM DEV JI Early Hum. Dev. PD OCT PY 1992 VL 30 IS 3 BP 241 EP 248 DI 10.1016/0378-3782(92)90073-P PG 8 WC Obstetrics & Gynecology; Pediatrics SC Obstetrics & Gynecology; Pediatrics GA JW790 UT WOS:A1992JW79000006 ER PT J AU HOUGHTON, IT AUN, CST OH, TE AF HOUGHTON, IT AUN, CST OH, TE TI VECURONIUM - AN ANTHROPOMETRIC COMPARISON SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM; GENETIC FACTORS, RACE ID ANESTHETIZED PATIENTS; ONSET TIME; PANCURONIUM; ORG-NC-45; AGE C1 BRITISH MIL HOSP,ANAESTHESIA & RESUSCITAT,HONG KONG,HONG KONG. CHINESE UNIV HONG KONG,FAC MED,DEPT ANAESTHESIA & INTENS CARE,SHA TIN,HONG KONG. NR 23 TC 16 Z9 18 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD SEP PY 1992 VL 47 IS 9 BP 741 EP 746 DI 10.1111/j.1365-2044.1992.tb03250.x PG 6 WC Anesthesiology SC Anesthesiology GA JL149 UT WOS:A1992JL14900004 ER PT J AU COOPER, R MIRAKHUR, RK CLARKE, RSJ BOULES, Z AF COOPER, R MIRAKHUR, RK CLARKE, RSJ BOULES, Z TI COMPARISON OF INTUBATING CONDITIONS AFTER ADMINISTRATION OF ORG 9426 (ROCURONIUM) AND SUXAMETHONIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHESIA, INTUBATING CONDITIONS; NEUROMUSCULAR RELAXANTS, SUXAMETHONIUM; ORG 9426 (ROCURONIUM) ID NEUROMUSCULAR BLOCKING ACTION; ANESTHETIZED PATIENTS; VECURONIUM; ATRACURIUM; ORG-NC-45; PANCURONIUM; ORG-9426; AGENT; PRECURARIZATION; PHARMACOLOGY AB We have assessed intubating conditions after administration of Org 9426 (rocuronium) 600-mu-g kg-1 at 60 or 90 s in groups of 20 patients anaesthetized with thiopentone, nitrous oxide in oxygen and small doses of fentanyl, and compared the data with those obtained after suxamethonium 1 mg kg-1 in similar groups of patients. The influence fluence of prior suxamethonium administration on the potency of Org 9426 was studied also by constructing a dose-response curve. Intubating conditions after Org 9426 were found to be clinically acceptable (good or excellent) in 95% of patients at 60 s and in all patients at 90 s and in all patients at both times after suxamethonium. The average time for the onset of block following Org 9426 at this dose was 89 s (which is shorter than with any of the currently available non-depolarizing neuromuscular blocking drugs); the duration of clinical relaxation (25% recovery of twitch height) 30 min. Prior administration of suxamethonium did not appear to influence the potency of Org 9426. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. ROYAL VICTORIA HOSP,DEPT ANAESTHET,BELFAST BT12 6BA,NORTH IRELAND. NR 26 TC 112 Z9 131 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 1992 VL 69 IS 3 BP 269 EP 273 DI 10.1093/bja/69.3.269 PG 5 WC Anesthesiology SC Anesthesiology GA JK840 UT WOS:A1992JK84000008 ER PT J AU PARKER, CJR HUNTER, JM AF PARKER, CJR HUNTER, JM TI RELATIONSHIP OF THE TRAIN-OF-4 RATIO TO PLASMA ATRACURIUM CONCENTRATION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM; NEUROMUSCULAR TRANSMISSION, TRAIN-OF-4 PHARMACOKINETICS, PLASMA CONCENTRATIONS ID NEUROMUSCULAR BLOCKADE; PHARMACOKINETICS; PHARMACODYNAMICS; TUBOCURARINE; PANCURONIUM AB The electromyographic response to a short infusion of atracurium 0.25 mg kg-1 was recorded using the train-of-four (TOF) technique, and the plasma atracurium concentration profile measured in 10 healthy patients. The TOF ratio (T4:T1) was depressed over a time course which did not conform to the predictions of an effect compartment model; the fit of such a model, when possible, was associated with large residual errors. In contrast, the absolute height of the fourth response of the TOF (T4:T0) may be fitted by a standard effect compartment model with smaller errors. This residual error was reduced further on fitting a threshold effect compartment model to the data set T4:T0. The parameter values of such a model were related closely to those for the first response (T1:T0). The kinetics of the effect compartments for the first and fourth response of the TOF were similar, whilst the C(P)ss50 for the fourth response was approximately 67% that for the first response. RP PARKER, CJR (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,4TH FLOOR,PRESCOT ST,LIVERPOOL L69 3BX,ENGLAND. NR 18 TC 3 Z9 3 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 1992 VL 69 IS 3 BP 274 EP 280 DI 10.1093/bja/69.3.274 PG 7 WC Anesthesiology SC Anesthesiology GA JK840 UT WOS:A1992JK84000009 ER PT J AU MCCARTHY, GJ COOPER, R STANLEY, JC MIRAKHUR, RK AF MCCARTHY, GJ COOPER, R STANLEY, JC MIRAKHUR, RK TI DOSE-RESPONSE RELATIONSHIPS FOR NEOSTIGMINE ANTAGONISM OF VECURONIUM-INDUCED NEUROMUSCULAR BLOCK IN ADULTS AND THE ELDERLY SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANTAGONISTS, ANTICHOLINESTERASES; NEOSTIGMINE; NEUROMUSCULAR RELAXANTS, VECURONIUM; PHARMACODYNAMICS, ELDERLY ID ATRACURIUM; EDROPHONIUM; PANCURONIUM AB We have studied the dose-response relationship for neostigmine in 36 adult (ages 18-50 yr) and 36 elderly (ages > 70 yr) subjects during antagonism of neuromuscular block induced by vecuronium. All patients received vecuronium 0.08 mg kg-1 and neuromuscular block was monitored mechanomyographically using the train-of-four (TOF) mode of stimulation. Six patients of each age group were allocated randomly to receive neostigmine 5, 15, 25, 35 or 45-mu-g kg-1 or saline at 10% recovery of Tl (first response in the TOF). TOF ratios were recorded continuously over the next 10 min and the values at 1-min intervals from 5 min on wards were used to construct the dose-response relationships. There was a significant difference (P < 0.05) in the time to spontaneous recovery of Tl to 10% between the adults (24 (SD 5.5) min) and the elderly (33 (7.8) min). Dose-response curves for neostigmine were parallel in the two age groups, but those for the elderly were significantly to the right of the curves for the adults. This suggests an apparently lesser relative potency of neostigmine, or the requirement of a larger dose, in the elderly for attaining antagonism of a moderately intense vecuronium block at the same time as in adults. C1 ROYAL VICTORIA HOSP,BELFAST BT12 6BA,NORTH IRELAND. RP MCCARTHY, GJ (reprint author), QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. NR 8 TC 14 Z9 16 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 1992 VL 69 IS 3 BP 281 EP 283 DI 10.1093/bja/69.3.281 PG 3 WC Anesthesiology SC Anesthesiology GA JK840 UT WOS:A1992JK84000010 ER PT J AU TIAN, L MEHTA, MP PRIOR, C MARSHALL, IG AF TIAN, L MEHTA, MP PRIOR, C MARSHALL, IG TI RELATIVE PREJUNCTIONAL AND POSTJUNCTIONAL EFFECTS OF A NEW VECURONIUM ANALOG, ORG 9426, AT THE RAT NEUROMUSCULAR-JUNCTION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR FUNCTION, PREJUNCTIONAL EFFECTS; NEUROMUSCULAR RELAXANTS, ORG 9426 ID TETANIC FADE; BLOCKING-DRUGS; DIAPHRAGM; ORG-9426; AGENT; CAT AB We have studied the relative pre- and postjunctional neuromuscular blocking effects of Org 9426 in the isolated rat hemidiaphragm muscle using twitch tension and electrophysiological recording techniques. Postjunctional effects were assessed from decreases in twitch height and from end-plate current amplitude and time constant of decay. Prejunctional effects were assessed from the fade of tetanic twitch tension and end-plate current amplitude rundown. There were no significant differences between the relative pre- and postjunctional effects of Org 9426 and those of previously studied steroidal neuromuscular blocking compounds. It is concluded, therefore, that the rapid onset and short duration of Org 9426 seen in vivo is not a consequence of a strong prejunctional, relative to postjunctional, blocking effect of the compound. C1 UNIV STRATHCLYDE,DEPT PHYSIOL & PHARMACOL,GLASGOW G1 1XW,SCOTLAND. NR 18 TC 10 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 SEP PY 1992 VL 69 IS 3 BP 284 EP 287 DI 10.1093/bja/69.3.284 PG 4 WC Anesthesiology SC Anesthesiology GA JK840 UT WOS:A1992JK84000011 ER PT J AU RECKENDORFER, H BURGMANN, H SPERLICH, M TUCHY, GL FEIGL, W SPIECKERMANN, PG WEINDLMAYRGOTTEL, M SCHWARZ, S AF RECKENDORFER, H BURGMANN, H SPERLICH, M TUCHY, GL FEIGL, W SPIECKERMANN, PG WEINDLMAYRGOTTEL, M SCHWARZ, S TI HEPATOTOXICITY TESTING OF ATRACURIUM AND LAUDANOSINE IN THE ISOLATED, PERFUSED-RAT-LIVER SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE BIOTRANSFORMATION, LAUDANOSINE; COMPLICATIONS, HEPATOTOXICITY; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID RENAL-FAILURE; PHARMACOKINETICS; HEPATOCYTES; TOXICITY AB The pharmacokinetics of atracurium, which is degraded by. Hofmann decomposition and ester hydrolysis, is not altered by impaired liver function. Atracurium should, therefore, be ideal for patients with hepatic failure, and is now widely used in clinical practice. However, some studies reported considerable hepatotoxicity after atracurium, especially from its breakdown products-for example, leakage of lactate dehydrogenase (LDH) from isolated rat hepatocytes. Therefore, we have studied, in an isolated perfused rat #ver model, biochemical and morphological changes after administration of either atracurium or its main metabolite, laudanosine. Despite using extremely high concentrations of these substances, we could not detect, biochemically (release of LDH or aspartate aminotransferase (AST)) or histologically, any signs of fiver cell damage. C1 UNIV VIENNA,DEPT INFECT CHEMOTHERAPY,A-1010 VIENNA,AUSTRIA. UNIV VIENNA,DEPT MED PHYSIOL,A-1010 VIENNA,AUSTRIA. UNIV VIENNA,DEPT ANESTHESIOL,A-1010 VIENNA,AUSTRIA. KRANKENHAUS LAINZ,VIENNA,AUSTRIA. RP RECKENDORFER, H (reprint author), ALLGEM POLIKLIN,DEPT PATHOL,MARIANNENG 10,A-1090 VIENNA,AUSTRIA. RI Burgmann, Heinz/N-2409-2013 NR 15 TC 6 Z9 6 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 1992 VL 69 IS 3 BP 288 EP 291 DI 10.1093/bja/69.3.288 PG 4 WC Anesthesiology SC Anesthesiology GA JK840 UT WOS:A1992JK84000012 ER PT J AU MEISTELMAN, C PLAUD, B DONATI, F AF MEISTELMAN, C PLAUD, B DONATI, F TI ROCURONIUM (ORG-9426) NEUROMUSCULAR BLOCKADE AT THE ADDUCTOR MUSCLES OF THE LARYNX AND ADDUCTOR POLLICIS IN HUMANS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MONITORING, NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS, ROCURONIUM; SKELETAL MUSCLE, ADDUCTOR POLLICIS; LARYNX ID ANESTHETIZED CATS; BLOCKING; VECURONIUM; PANCURONIUM; ANESTHESIA; TUBOCURARINE; AGENT; NERVE AB The effects of rocuronium, 0.25 or 0.5 mg.kg-1, were measured simultaneously on the adductor muscles of the larynx and adductor pollicis in 14 adult patients. Anaesthesia was induced and maintained with propofol and fentanyl. Tracheal intubation was performed without muscle relaxants. The recurrent laryngeal and ulnar nerves were both stimulated supramaximally, at the notch of the thyroid cartilage and at the wrist respectively using train-of-four stimulation. The laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords. Onset time, intensity of blockade and duration of action were less at the larynx than at the adductor pollicis. After rocuronium, 0.25 mg.kg-1, the onset time (interval between injection and maximal T1 blockade) was 1.6 +/- 0.1 min and 3.0 +/- 0.3 min (mean +/-SEM) at the laryngeal muscles and adductor pollicis, respectively (P < 0.01 between muscles). Maximum blockade was 37 +/- 8% and 69 +/- 8%, respectively (P < 0.05), and time to 90% T1 recovery was 7 +/- 1 min and 20 +/- 4 min, respectively (P < 0.05). With 0.5 mg.kg-1, the onset time was also more rapid at the vocal cords (1.4 +/- 0.1 min) than at the adductor pollicis (2.4 0.2 min, P < 0.001). Maximum blockade was 77 +/- 5% and 98 1%, respectively (P < 0.01), and time to 90% T1 recovery was 22 +/- 3 min and 37 +/- 4 min, respectively (P < 0.01). It is concluded that with rocuronium onset and recovery are faster at the laryngeal adductor muscles, but blockade is less intense than at the adductor pollicis. These findings are similar to the observations made previously with vecuronium, except that rocuronium had a faster onset at both muscles. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,MONTREAL H3A 1A1,QUEBEC,CANADA. INST GUSTAVE ROUSSY,SERV ANESTHESIA,F-94805 VILLEJUIF,FRANCE. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 19 TC 94 Z9 101 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1992 VL 39 IS 7 BP 665 EP 669 PG 5 WC Anesthesiology SC Anesthesiology GA JN185 UT WOS:A1992JN18500007 ER PT J AU MARTINEAU, RJ STJEAN, B KITTS, JB CURRAN, MC LINDSAY, P HULL, KA MILLER, DR AF MARTINEAU, RJ STJEAN, B KITTS, JB CURRAN, MC LINDSAY, P HULL, KA MILLER, DR TI CUMULATION AND REVERSAL WITH PROLONGED INFUSIONS OF ATRACURIUM AND VECURONIUM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHETIC TECHNIQUES, CONTINUOUS INFUSIONS; MEASUREMENT TECHNIQUES, ELECTROMYOGRAPHY; NEUROMUSCULAR BLOCKING DRUGS, ATRACURIUM; VECURONIUM ID PANCURONIUM; PHARMACOKINETICS; PHARMACODYNAMICS; RECOVERY; BOLUS; ANESTHESIA; RELAXANTS; BLOCKADE AB A randomized, double-blind study was undertaken to compare the tendencies for cumulation, and reversal characteristics of atracurium (ATR) and vecuronium (VEC) when administered by continuous infusion for long surgical procedures under balanced anaesthesia. Eligible subjects were between 50 and 75 yr of age and were free of neuromuscular disease. Patients in the ATR group (n = 25) received a loading dose of atracurium 0.25 mg.kg-1, followed by an infusion initially set at 5.0-mu-g/kg-1.min-1. In the VEC group (n = 25) patients received a loading dose of vecuronium 0.05 mg.kg-1, followed by an infusion at 1.0-mu-g.kg-1.min-1. During surgery, the infusions of both ATR and VEC were titrated in increments or decrements of 12.5% to maintain first twitch (T1) suppression of 90-95%. Neuromuscular block was measured by recording the integrated evoked electromyographic response (EMG) of the first dorsal interosseous muscle in response to supramaximal TOF stimuli on the ulnar nerve. The durations of infusion were similar for the two groups (164 +/- 42 and 183 +/- 67 min for ATR and VEC, respectively). The infusion rates of ATR (mean +/- SD) remained between 4.0 +/- 0.7 and 5.0 +/- 1.0-mu-g.kg-1.min-1 throughout the study period. In contrast, a progressive decrease (P < 0.05) in the infusion rate of VEC, from 1.0 to 0.47 +/- 0.13-mu-g.kg-1.min-1, was observed during the study period. The number of adjustments required to maintain 90-95% T1 suppression decreased between the second and fourth hours of administration, but were similar at corresponding times when comparing the two groups. The times to recover to a TOF ratio >70% following reversal with neostigmine 40-mu-g.kg-1 and atropine 15-mu-g.kg-1 were also similar for the two groups (13.4 +/- 4.9 and 14.4 +/- 8.0 min for ATR and VEC, respectively). We conclude that a constant infusion of vecuronium adjusted to maintain T1 suppression of 90-95% results in cumulation which is manifest after the second hour of administration. In contrast, atracurium shows little tendency for cumulation during infusions lasting between two and five hours. When titrated according to individual patient response, infusions of both atracurium and vecuronium are characterized by their ease of administration and their ability to be readily reversed with appropriate doses of neostigmine. C1 OTTAWA GEN HOSP,DEPT ANAESTHESIA,501 SMYTH RD,OTTAWA K1H 8L6,ONTARIO,CANADA. OTTAWA CIVIC HOSP,OTTAWA K1Y 4E9,ONTARIO,CANADA. UNIV OTTAWA,OTTAWA K1N 6N5,ONTARIO,CANADA. NR 23 TC 14 Z9 14 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1992 VL 39 IS 7 BP 670 EP 676 PG 7 WC Anesthesiology SC Anesthesiology GA JN185 UT WOS:A1992JN18500008 ER PT J AU SEGREDO, V CALDWELL, JE MATTHAY, MA SHARMA, ML GRUENKE, LD MILLER, RD AF SEGREDO, V CALDWELL, JE MATTHAY, MA SHARMA, ML GRUENKE, LD MILLER, RD TI PERSISTENT PARALYSIS IN CRITICALLY ILL PATIENTS AFTER LONG-TERM ADMINISTRATION OF VECURONIUM SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID ORG NC 45; RENAL-FAILURE; BLOCKING ACTIONS; PHARMACOKINETICS; PANCURONIUM; BROMIDE; CAT; 3-DESACETYLVECURONIUM; PHARMACODYNAMICS; PHARMACOLOGY AB Background. The muscle relaxant vecuronium is sometimes administered to facilitate mechanical ventilation. Neuromuscular paralysis lasting up to seven days may occur after the termination of long-term administration (i.e., more than two days) of vecuronium in critically ill patients. We investigated the role of clinical factors and plasma concentrations of vecuronium and its metabolite in causing this prolonged neuromuscular blockade. Methods. We studied 16 critically ill adult patients (8 women and 8 men) who had received vecuronium to facilitate mechanical ventilation for at least two consecutive days. Clinical factors and plasma concentrations of vecuronium and 3-desacetylvecuronium, the active metabolite of vecuronium, were compared in patients with and without prolonged neuromuscular blockade. In addition, we performed detailed pharmacokinetic studies in the patients without prolonged neuromuscular blockade. Results. Seven of the 16 patients had prolonged neuromuscular blockade, lasting from six hours to more than seven days, after the termination of vecuronium therapy. These seven patients, six of whom were women, had higher plasma magnesium concentrations and lower arterial blood pH values than the nine patients without prolonged neuromuscular blockade. They also had higher plasma concentrations of 3-desacetylvecuronium and a higher frequency of renal failure (seven of seven patients vs. four of nine patients, P<0.03). In the patients without prolonged neuromuscular blockade, the mean (+/-SD) plasma clearance, elimination half-life, and volume of distribution of vecuronium were 2.5+/-1.0 ml per kilogram of body weight per minute, 299+/-154 minutes, and 1.1+/-0.6 liters per kilogram, respectively. Conclusions. Prolonged neuromuscular blockade after the termination of long-term treatment with vecuronium is associated with metabolic acidosis, elevated plasma magnesium concentrations, female sex, and probably more important, the presence of renal failure and high plasma concentrations of 3-desacetylvecuronium. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 33 TC 300 Z9 306 PU MASS MEDICAL SOC PI BOSTON PA 10 SHATTUCK, BOSTON, MA 02115 SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD AUG 20 PY 1992 VL 327 IS 8 BP 524 EP 528 DI 10.1056/NEJM199208203270804 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA JJ457 UT WOS:A1992JJ45700004 ER PT J AU WRIGLEY, SR JONES, RM HARROPGRIFFITHS, AW PLATT, MW AF WRIGLEY, SR JONES, RM HARROPGRIFFITHS, AW PLATT, MW TI MIVACURIUM CHLORIDE - A STUDY TO EVALUATE ITS USE DURING PROPOFOL NITROUS-OXIDE ANESTHESIA SO ANAESTHESIA LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, EDROPHONIUM; MONITORING, NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS, MIVACURIUM CHLORIDE ID ENFLURANE ANESTHESIA; SURGICAL PATIENTS; BW-B1090U; FENTANYL; SUXAMETHONIUM; PHARMACOLOGY; ISOFLURANE; ATRACURIUM; INFUSION C1 ST MARYS HOSP,DEPT ANAESTHESIA,LONDON W2 1NY,ENGLAND. NR 14 TC 24 Z9 24 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD AUG PY 1992 VL 47 IS 8 BP 653 EP 657 DI 10.1111/j.1365-2044.1992.tb02384.x PG 5 WC Anesthesiology SC Anesthesiology GA JE867 UT WOS:A1992JE86700003 ER PT J AU NAGUIB, M SERAJ, M ABDULRAZIK, E AF NAGUIB, M SERAJ, M ABDULRAZIK, E TI PIPECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE DURING NITROUS OXIDE-FENTANYL, ENFLURANE, ISOFLURANE, AND HALOTHANE ANESTHESIA IN SURGICAL PATIENTS SO ANESTHESIA AND ANALGESIA LA English DT Article ID FORCE DISPLACEMENT TRANSDUCER; ACCELERATION TRANSDUCER; MIVACURIUM CHLORIDE; D-TUBOCURARINE; HUMANS; ATRACURIUM; TRANSMISSION AB This study was designed to determine the capacity of several anesthetics to augment pipecuronium neuromuscular blockade. The potency of pipecuronium was determined with single-bolus administration of 20-50-mu-g/kg in 160 patients. Patients were anesthetized with N2O/O2 (60:40) supplemented with fentanyl (4-5-mu-g/kg), halothane (0.8%), isoflurane (1.2%), or enflurane (1.7%). Neuromuscular blockade was measured by an acceleration-responsive transducer (the Accelograph, Biometer International, Odense, Denmark). Responses were defined in terms of percent depression in first-twitch height and train-of-four response, and the dose-response curves were constructed after probit transformation of the responses. The dose-response curves were found to be parallel for both first twitch height and train-of-four responses. The dose-response lines for the enflurane and isoflurane groups were displaced significantly (P < 0.01) to the left of the line for the fentanyl-N2O group. The calculated doses producing 50% depression of first twitch height were 21.9, 21.2, 18.9, and 17.8-mu-g/kg for the N2O-fentanyl, halothane, isoflurane, and enflurane groups, respectively. Corresponding calculated doses for 50% depression of train-of-four response were significantly smaller (15.5, 14.4, 13.7, 11.9-mu-g/kg, respectively). The enhancing effects of the volatile anesthetics were reflected by significant prolongation of the clinical duration of neuromuscular blockade by pipecuronium. It is concluded that the potency of pipecuronium is enhanced more by enflurane and isoflurane than halothane or fentanyl-N2O anesthesia. C1 KING SAUD UNIV, KING KHALID UNIV HOSP, DEPT ANESTHESIA, RIYADH, SAUDI ARABIA. RP NAGUIB, M (reprint author), UNITED ARAB EMIRATES UNIV, FAC MED & HLTH SCI, DEPT CRIT CARE MED, POB 17666, AL AIN, U ARAB EMIRATES. NR 27 TC 11 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 AUG PY 1992 VL 75 IS 2 BP 193 EP 197 PG 5 WC Anesthesiology SC Anesthesiology GA JE573 UT WOS:A1992JE57300007 ER PT J AU KOENIG, KL AF KOENIG, KL TI RAPID-SEQUENCE INTUBATION OF HEAD TRAUMA PATIENTS - PREVENTION OF FASCICULATIONS WITH PANCURONIUM VERSUS MINIDOSE SUCCINYLCHOLINE SO ANNALS OF EMERGENCY MEDICINE LA English DT Article DE PANCURONIUM; SUCCINYLCHOLINE; TRAUMA, HEAD AB Introduction: Fasciculations during rapid-sequence intubation may lead to increased intracranial pressure and emesis with aspiration. Standard rapid-sequence intubation requires a nondepolarizing blocking agent before succinylcholine administration. Hypothesis: Prevention of fasciculations during rapid-sequence intubation of head trauma patients can be accomplished as safely and effectively with minidose succinylcholine as with a defasciculating dose of pancuronium. Design: A prospective, randomized, double-blind study. Setting: An inner-city county trauma center with 70,000 patient visits per year. Participants: Sequential adult head trauma patients requiring rapid-sequence intubation who had no contraindications to succinylcholine or pancuronium. Interventions: Each head trauma patient requiring rapid-sequence intubation who met the inclusion criteria received standard rapid-sequence intubation maneuvers and lidocaine 1 mg/kg) IV. Patients were randomized to receive either minidose succinylcholine (0.1 mg/kg) or pancuronium (0.03 mg/kg) IV one minute prior to the full paralytic dose of succinylcholine (1.5 mg/kg) IV Fasciculations were recorded using a graded visual scale. Results: Of 46 patients, eight of 19 (42%) in the pancuronium group and six of 27 (22%) in the succinylcholine group experienced fasciculations. No statistically significant difference in fasciculations was detected between the two groups using chi-2 analysis. Complete relaxation of the cords was present in all but two patients, one in each group. No patient in either group experienced emesis or significant dysrhythmias. Conclusion: Pretreatment with minidose succinylcholine causes no greater incidence of fasciculations than pancuronium in rapid-sequence intubation of head trauma patients in an ED setting. Thus succinylcholine may be used as the sole paralytic agent in rapid-sequence intubation of head trauma patients. RP KOENIG, KL (reprint author), HIGHLAND GEN HOSP,DEPT EMERGENCY,1411 E 31ST ST,OAKLAND,CA 94602, USA. NR 0 TC 14 Z9 14 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD AUG PY 1992 VL 21 IS 8 BP 929 EP 932 DI 10.1016/S0196-0644(05)82930-0 PG 4 WC Emergency Medicine SC Emergency Medicine GA JF129 UT WOS:A1992JF12900008 ER PT J AU NARITA, M FURUKAWA, Y MURAKAMI, M TAKEI, M REN, LM CHIBA, S AF NARITA, M FURUKAWA, Y MURAKAMI, M TAKEI, M REN, LM CHIBA, S TI PARASYMPATHOLYTIC EFFECTS OF VECURONIUM ARE MEDIATED BY NICOTINIC AND MUSCARINIC RECEPTORS IN HEARTS OF ANESTHETIZED DOGS SO JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENTS; BLOOD-PERFUSED ATRIUM; DROMOTROPIC RESPONSES; PANCURONIUM-BROMIDE; INOTROPIC RESPONSES; VAGAL-STIMULATION; VAGUS STIMULATION; CANINE HEART; ORG NC45; ACETYLCHOLINE AB We investigated the blocking effects of vecuronium and pancuronium on the negative chronotropic and dromotropic responses to stimulation of the parasympathetic nerves in the anesthetized, open-chest dog. We stimulated the intracardiac parasympathetic nerves to the SA nodal region (SAP stimulation) or to the atrioventricular nodal region (AVP stimulation). SAP stimulation or AVP stimulation selectively decreased heart rate or increased atrioventricular conduction time, respectively. Vecuronium and pancuronium inhibited the chronotropic response to SAP stimulation and the dromotropic response to AVP stimulation in a dose-dependent manner. The ID50 of each drug for the dromotropic response was less than that for the chronotropic response. The blocking effect of vecuronium on the negative cardiac responses to parasympathetic stimulation was about 10-fold less potent than that of pancuronium. These results suggest that the blocking effects of vecuronium and pancuronium on the negative chronotropic and dromotropic responses to parasympathetic stimulation differ from those of atropine in the heart. In the isolated right atrium perfused with blood from the support dog, vecuronium, injected into the external jugular vein of the support dog, dose-dependently inhibited the negative chronotropic and inotropic responses to carbachol or SAP stimulation and the negative followed by positive chronotropic and inotropic responses to nicotine. The ID50 values for carbachol, nicotine and SAP stimulation were not significantly different. These results suggest that parasympatholytic effects of vecuronium are mediated by not only muscarinic receptors but also neuronal nicotinic receptors in hearts of anesthetized dogs. C1 SHINSHU UNIV,SCH MED,DEPT PHARMACOL,MATSUMOTO,NAGANO 390,JAPAN. NR 39 TC 4 Z9 4 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0022-3565 J9 J PHARMACOL EXP THER JI J. Pharmacol. Exp. Ther. PD AUG PY 1992 VL 262 IS 2 BP 577 EP 583 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA JH661 UT WOS:A1992JH66100018 ER PT J AU PONCELET, L GILBERT, S SNAPS, F BALLIGAND, M AF PONCELET, L GILBERT, S SNAPS, F BALLIGAND, M TI A REGIONAL CURARE TEST FOR EVALUATION OF MYOTONIA IN DOGS SO JOURNAL OF SMALL ANIMAL PRACTICE LA English DT Article ID LABRADOR RETRIEVERS; CHOW CHOW; MYOPATHY AB This paper describes a regional curare test performed in a dog suffering from myotonia and hyperadrenocorticism. The test prevented innervation to the pronator teres muscle of the left limb and allowed electrical activity to be observed in the muscle without the need for a general neuromuscular blockade; various types of spontaneous activity other than myotonic discharges were also observed. Details of the method are given and its usefulness in the evaluation of myopathies is discussed. C1 UNIV LIEGE,FAC VET MED,DEPT SMALL ANIM INTERNAL MED,B-4000 LIEGE,BELGIUM. UNIV LIEGE,FAC VET MED,DEPT RADIOL,B-4000 LIEGE,BELGIUM. RP PONCELET, L (reprint author), UNIV LIEGE,FAC VET MED,DEPT SMALL ANIM SURG,BAT 44,B-4000 LIEGE,BELGIUM. NR 21 TC 1 Z9 1 PU BRITISH VETERINARY ASSOC PI LONDON PA 7 MANSFIELD ST, LONDON, ENGLAND W1M 0AT SN 0022-4510 J9 J SMALL ANIM PRACT JI J. Small Anim. Pract. PD AUG PY 1992 VL 33 IS 8 BP 385 EP 388 DI 10.1111/j.1748-5827.1992.tb01180.x PG 4 WC Veterinary Sciences SC Veterinary Sciences GA JJ961 UT WOS:A1992JJ96100007 ER PT J AU OIKKONEN, M AF OIKKONEN, M TI ALFENTANIL COMBINED WITH VECURONIUM OR PANCURONIUM - HEMODYNAMIC IMPLICATIONS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANALGESICS, ALFENTANIL; ANESTHESIA, CARDIOVASCULAR; NEUROMUSCULAR RELAXANTS, VECURONIUM, PANCURONIUM ID CARDIAC-ARREST; HEMODYNAMIC-RESPONSES; BRADYCARDIA; INTUBATION; FENTANYL AB Forty-two fit, anticholinergized patients, induced with thiopentone, received either vecuronium (V) or pancuronium (P) 0.1 mg/kg, followed by alfentanil 15-mu-g/kg. The mean heart rate in the Group V was significantly lower than that in the Group P. The difference, 10-15 bpm, appeared after alfentanil administration, and lasted for 5 min postintubation, when under N2O anaesthesia. The Group P patients maintained their arterial pressure closer to the preinduction level than did the Group V patients, but a statistically significant inter-group difference appeared only at two recording stages. Four Group V patients, contrasted to none of the Group P patients (P<0.05), were put in head-down tilt, or were given atropine, and/or etilephrine for an undue decrease in arterial pressure. Compared to vecuronium, pancuronium increased heart rate, and protected from arterial hypotension, when combined with low-dose alfentanil. RP OIKKONEN, M (reprint author), TAMPERE UNIV HOSP,DEPT ANAESTHESIA,SF-33520 TAMPERE,FINLAND. NR 17 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 JUL PY 1992 VL 36 IS 5 BP 406 EP 409 PG 4 WC Anesthesiology SC Anesthesiology GA JA510 UT WOS:A1992JA51000004 ER PT J AU HUIZINGA, ACT VANDENBROM, RHG WIERDA, JMKH HOMMES, FDM HENNIS, PJ AF HUIZINGA, ACT VANDENBROM, RHG WIERDA, JMKH HOMMES, FDM HENNIS, PJ TI INTUBATING CONDITIONS AND ONSET OF NEUROMUSCULAR BLOCK OF ROCURONIUM (ORG-9426) - A COMPARISON WITH SUXAMETHONIUM SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE INTUBATING CONDITIONS; MONITORING, MECHANOMYOGRAPHY; NEUROMUSCULAR BLOCKING AGENTS, ORG-9426, ROCURONIUM, SUXAMETHONIUM ID CLINICAL OBSERVATIONS; SUCCINYLCHOLINE; VECURONIUM; RELAXANTS; AGENT AB The intubating conditions and neuromuscular blocking profile following 600-mu-g.kg-1 rocuronium (Org 9426) have been investigated in patients under various experimental conditions. They were compared with conditions following 1.5 mg.kg-1 suxamethonium, preceded by a precurarising dose (10 mg) of gallamine, and with those in a control group in the absence of a muscle relaxant. Rocuronium produced good to excellent intubating conditions at 60 as well as at 90 s after administration, even though there was only a partial blockade of the adductor pollicis muscle. Intubating conditions following suxamethonium were comparable with those after rocuronium. Half of the control patients could not be intubated. The clinical duration and the recovery time of 600-mu-g.kg-1 of rocuronium were 24(4) and 9(3) min (mean(s.d.)), respectively. Rocuronium may have a major advantage over existing non-depolarising muscle relaxants due to the early presence of excellent intubating conditions. The results indicate that rocuronium may replace suxamethonium in procedures in which rapid sequence induction is required. C1 UNIV GRONINGEN,EXPTL ANESTHESIOL & CLIN PHARMACOL RES GRP,9700 AB GRONINGEN,NETHERLANDS. NR 22 TC 75 Z9 76 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 1992 VL 36 IS 5 BP 463 EP 468 PG 6 WC Anesthesiology SC Anesthesiology GA JA510 UT WOS:A1992JA51000013 ER PT J AU MEDINA, FA AF MEDINA, FA TI RAPID SEQUENCE INDUCTION INTUBATION USING INTRAOSSEOUS INFUSION OF VECURONIUM BROMIDE IN CHILDREN SO AMERICAN JOURNAL OF EMERGENCY MEDICINE LA English DT Article DE INTRAOSSEOUS INFUSION; INTUBATION; RAPID SEQUENCE INTUBATION; VECURONIUM; RESUSCITATION; PEDIATRICS RP MEDINA, FA (reprint author), BAPTIST HOSP MIAMI,DEPT EMERGENCY PEDIAT,8900 N KENDALL DR,MIAMI,FL 33176, USA. NR 0 TC 1 Z9 1 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 SN 0735-6757 J9 AM J EMERG MED JI Am. J. Emerg. Med. PD JUL PY 1992 VL 10 IS 4 BP 359 EP 360 DI 10.1016/0735-6757(92)90019-T PG 2 WC Emergency Medicine SC Emergency Medicine GA JB224 UT WOS:A1992JB22400019 ER PT J AU MADDINENI, VR COOPER, R STANLEY, JC MIRAKHUR, RK CLARKE, RSJ AF MADDINENI, VR COOPER, R STANLEY, JC MIRAKHUR, RK CLARKE, RSJ TI CLINICAL-EVALUATION OF DOXACURIUM CHLORIDE SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; DOXACURIUM ID DOSE-RESPONSE CURVES; NEUROMUSCULAR BLOCKING; NITROUS-OXIDE; ANESTHESIA; PANCURONIUM; ATRACURIUM; SINGLE; ONSET C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. ROYAL VICTORIA HOSP,DEPT ANAESTHET,BELFAST BT12 6BA,NORTH IRELAND. NR 18 TC 9 Z9 9 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD JUL PY 1992 VL 47 IS 7 BP 554 EP 557 DI 10.1111/j.1365-2044.1992.tb02322.x PG 4 WC Anesthesiology SC Anesthesiology GA JA050 UT WOS:A1992JA05000003 ER PT J AU PUHRINGER, FK KHUENLBRADY, KS KOLLER, J MITTERSCHIFFTHALER, G AF PUHRINGER, FK KHUENLBRADY, KS KOLLER, J MITTERSCHIFFTHALER, G TI EVALUATION OF THE ENDOTRACHEAL INTUBATING CONDITIONS OF ROCURONIUM (ORG-9426) AND SUCCINYLCHOLINE IN OUTPATIENT SURGERY SO ANESTHESIA AND ANALGESIA LA English DT Article AB The time-course of action and tracheal intubating conditions of rocuronium and succinylcholine under intravenous anesthesia with propofol, alfentanil, and nitrous oxide were studied in 30 patients undergoing outpatient surgery. The neuromuscular effects of both drugs were quantified by recording the indirectly evoked twitch response of the adductor pollicis muscle after ulnar nerve stimulation (0.1 Hz, 0.2 ms supramaximal stimuli). Patients were given either 0.6 mg/kg rocuronium (n = 20) or 1 mg/kg succinylcholine (n = 10) intravenously. Sixty seconds after the administration of the muscle relaxant, the trachea was intubated and the intubating conditions were scored by a "blinded" assessor. Intubating conditions were not different (P = 0.34) between the rocuronium and succinylcholine groups. The onset and duration of neuromuscular blockade were shorter with succinylcholine than with rocuronium. The depression of the twitch response to 5% of control value occurred in 0.8 +/- 0.1 min with 1 mg/kg succinylcholine and 1.2 +/- 0.5 min with 0.6 mg/kg rocuronium (P < 0.01). The recovery of the twitch response to 25%, 75%, and 90% of its control value was shorter after succinylcholine (P < 0.001) and occurred at 8.1 +/- 2.6, 10.3 +/- 3.9, 11.3 +/- 4.6 and 25.3 +/- 5.0, 33.1 +/- 5.9, 36.1 +/- 6.3 min after succinylcholine and rocuronium, respectively. Also the time required for spontaneous recovery from 25% to 75% of the control twitch response was significantly shorter (P < 0.001) after succinylcholine (2.2 +/- 1.4 min) than after rocuronium (7.8 +/- 2.1 min). It is concluded that in spite of the pharmacodynamic differences between succinylcholine and rocuronium, the intubating conditions after administration of both compounds are similar and develop at the same rate. RP PUHRINGER, FK (reprint author), UNIV INNSBRUCK,ANAESTHESIA & GEN INTENS CARE MED CLIN,ANICHSTR 35,A-6020 INNSBRUCK,AUSTRIA. NR 8 TC 97 Z9 102 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1992 VL 75 IS 1 BP 37 EP 40 PG 4 WC Anesthesiology SC Anesthesiology GA JB522 UT WOS:A1992JB52200007 ER PT J AU BAURAIN, MJ DERNOVOI, BS DHOLLANDER, AA BARVAIS, L AF BAURAIN, MJ DERNOVOI, BS DHOLLANDER, AA BARVAIS, L TI THE INFLUENCE OF ATROPINE DOSE ON RECOVERY FROM VECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ANESTHESIOLOGY LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, NEOSTIGMINE; NEUROMUSCULAR RELAXANTS, VECURONIUM; PARASYMPATHETIC NERVOUS SYSTEM, ATROPINE ID ACETYLCHOLINE-RELEASE; TRANSMISSION; OXOTREMORINE; STIMULATION; ANESTHESIA; ANTAGONISM; HALOTHANE; RECEPTORS; PARALYSIS; HUMANS AB To determine whether the dose of atropine affects the rate of neostigmine-induced recovery from vecuronium-induced neuromuscular blockade, the authors monitored isometric adductor pollicis mechanical activity in 36 anesthetized (thiopental, fentanyl, nitrous oxide) adult patients (ASA physical status 1 or 2). Once surgery was completed and twitch height had spontaneously regained 25% of its initial value, the patients were randomly allocated into three groups (A1O, A15, A20; n = 12 in each group) according to the dose of atropine (10, 15, or 20-mu-/kg) that was mixed with 40-mu-g/kg neostigmine. Twitch height, train-of-four, and 50- and 100-Hz tetanic fade were recorded for 15 min after the administration of the reversal agents. No significant differences were found among the three groups in the final twitch height (95% +/- 2%), train-of-four (87% +/- 1%, 88% +/- 2%, 89% +/- 1%), and 50-Hz tetanic fade (90% +/- 1%, 94% +/- 1%, 93% +/- 1%) (mean +/- SEM). Fifteen minutes after reversal, fade in response to 100-Hz tetanus was statistically greater in the A10 group than in the two other groups (70% +/- 3% of control versus 84% +/- 4% and 81% +/- 2%) (mean +/- SEM, P < 0.05). The present results demonstrate that larger doses of atropine facilitate neostigmine's reversal of vecuronium neuromuscular blockade. The clinical implications of the differences observed in this study remain to be determined. C1 UNIV LIBRE BRUXELLES,UNIV HOSP ERASME,DEPT ANESTHESIOL,B-1050 BRUSSELS,BELGIUM. UNIV HOSP BRUGMANN,DEPT ANESTHESIOL,BRUSSELS,BELGIUM. NR 22 TC 11 Z9 12 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1992 VL 77 IS 1 BP 17 EP 20 DI 10.1097/00000542-199207000-00004 PG 4 WC Anesthesiology SC Anesthesiology GA JB534 UT WOS:A1992JB53400004 ER PT J AU MISHRA, Y RAMZAN, I AF MISHRA, Y RAMZAN, I TI ENHANCEMENT BY CIMETIDINE OF NEUROMUSCULAR PARALYSIS INDUCED WITH ATRACURIUM IN RATS SO ARCHIVES INTERNATIONALES DE PHARMACODYNAMIE ET DE THERAPIE LA English DT Article ID POSTPARTUM PATIENTS; VECURONIUM; RANITIDINE; BLOCKADE; PREMEDICATION; METABOLISM AB The neuromuscular action of cimetidine, the prototype of H-2 antagonists, was examined in urethane-anaesthetized and mechanically ventilated rats that were paralyzed with the non-depolarizing agent atracurium. Cimetidine, administered i.v. at doses of 3.2 to 56.2 mg/kg (13 to 223 muM/kg), produced an immediate potentiation of a steady 50 % atracurium paralysis which was observed within 28 +/- 5 sec and which plateaued after 24 +/- 3 min. The dose of cimetidine that produced a 50 % potentiation during peak effect was 14.5 mg/kg (58 muM/kg) and was associated with a serum cimetidine concentration of 47.5 mug/ml (or 188 muM). In a separate experiment, cimetidine, administered i.v. in a dose of 56.2 mg/kg (223 muM/kg), shifted the atracurium dose-effect curve to the left by 1.32-fold. Cimetidine alone, at either 10 or 100 mg/kg, did not affect the neuromuscular function by itself. These results suggest that high doses of cimetidine potentiate the neuromuscular paralysis induced with atracurium. This effect is opposite to that noted previously with ranitidine, a newer H-2 antagonist which reverses atracurium neuromuscular paralysis in rats. C1 UNIV SYDNEY,DEPT PHARM,SYDNEY,NSW 2006,AUSTRALIA. NR 19 TC 7 Z9 7 PU ARCH INT PHARMACODYNAMIE PI GHENT PA DE PINTELAAN 185, B-9000 GHENT, BELGIUM SN 0003-9780 J9 ARCH INT PHARMACOD T JI Arch. Int. Pharmacodyn. Ther. PD JUL-AUG PY 1992 VL 318 BP 97 EP 106 PG 10 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA JV066 UT WOS:A1992JV06600010 ER PT J AU SADDLER, JM MARKS, LF NORMAN, J AF SADDLER, JM MARKS, LF NORMAN, J TI COMPARISON OF ATRACURIUM-INDUCED NEUROMUSCULAR BLOCK IN RECTUS-ABDOMINIS AND HAND MUSCLES OF MAN SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE MUSCLE, SKELETAL, RECTUS-ABDOMINIS; NEUROMUSCULAR RELAXANTS, ATRACURIUM AB We have compared neuromuscular block in the rectus abdominis and the hand muscles in 11 adult patients. Atracurium 0.5 mg kg-1 was administered by single bolus and anaesthesia maintained with isoflurane and nitrous oxide in oxygen. Train-of-four (TOF) stimulation was applied to the 10th intercostal space in the anterior axillary line and to the ulnar nerve at the wrist. Electromyographic (EMG) responses were recorded over the rectus abdominis and hypothenar muscles. Neuromuscular block had a significantly faster onset in the rectus abdominis (mean 1.6 (SEM 0.2) min) than in the hand (2.4 (0.3) min) (P < 0.001). Recovery occurred more rapidly in the rectus abdominis: time to 25% TOF recovery was 39 (3) min at rectus abdominis and 51 (4) min at the hand (P < 0.001). Time to 75% TOF recovery was 56 (4) min at rectus abdominis and 72 (6) min at the hand (P < 0.001). RP SADDLER, JM (reprint author), SOUTHAMPTON GEN HOSP,SHACKLETON DEPT ANAESTHET,TREMONA RD,SOUTHAMPTON SO9 4XY,HANTS,ENGLAND. NR 8 TC 13 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 JUL PY 1992 VL 69 IS 1 BP 26 EP 28 DI 10.1093/bja/69.1.26 PG 3 WC Anesthesiology SC Anesthesiology GA JA823 UT WOS:A1992JA82300007 ER PT J AU CRUISE, C MACKINNON, J TOUGH, J HOUSTON, P AF CRUISE, C MACKINNON, J TOUGH, J HOUSTON, P TI COMPARISON OF MEPERIDINE AND PANCURONIUM FOR THE TREATMENT OF SHIVERING AFTER CARDIAC-SURGERY SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANALGESICS, MEPERIDINE; CARBON DIOXIDE, PRODUCTION; HYPOTHERMIA, SHIVERING; NEUROMUSCULAR RELAXANTS, PANCURONIUM; OXYGEN, CONSUMPTION; SURGERY, CARDIOVASCULAR; TEMPERATURE, BODY ID CRITICALLY ILL PATIENTS; CARDIOPULMONARY BYPASS; TEMPERATURE; VALIDATION; MORPHINE AB Shivering after cardiac surgery can produce adverse haemodynamic and metabolic sequelae. In this study, the metabolic effects of shivering and the efficacy of treatment with meperidine or pancuronium were studied, using a metabolic cart, in 61 patients who had undergone cardiac surgery. The patients received premedication with morphine, perphenazine and diazepam or lorazapam, and were anaesthetised with fentanyl or sufentanil and diazepam. Muscle relaxation was achieved with pancuronium. Patients were monitored with a radial arterial line, pulmonary artery catheter and oesophageal and urinary bladder temperature probes. Rewarming to an oesophageal temperature of 38-degrees-C was achieved before the termination of CPB and was maintained for a minimum of 15 min reperfusion time. Every 15 min after surgery, the patients' temperature at three sites (pulmonary artery, oesophagus, bladder) and shivering scores were monitored Hourly measurements were made of haemodynamic variables (MAP, PAOP, CVP, SVR, PVR, CI), carbon dioxide production, oxygen consumption and respiratory quotient. If the patient shivered, the measurements were recorded prior to drug treatment and repeated 30 min later following randomization to either: meperidine 0.25 mg . kg-1 (Group 1), meperidine 0.5 mg . kg-1 (Group 2) or pancuronium 0.06 mg . kg-1 intravenously (Group 3). Thirty-two patients shivered and mean VO2 and VCO2 values were greater in the shivering group than in the nonshivering patients (VO2 334.8 +/- 17.6 vs. 240.5 +/- 8.8 ml . min-1; VCO2 238.8 +/- 17.2 vs 199.2 +/- 8.4 ml . min-1, P = 0.0001). Thirty minutes following treatment the mean VO2 in Group 3 was less (215.9 +/- 24.3 ml . min-1) than in Groups 1 (295.9 +/- 22.0 ml . min-1) and 2 (322.7 +/- 2 1.0 ml . min-1)(P < 0. 01). It is concluded that drug treatment with meperidine is not as effective as pancuronium in alleviating the metabolic effects of shivering in these patients. C1 TORONTO WESTERN HOSP,DEPT CARDIOVASC SURG,TORONTO M5T 2S8,ONTARIO,CANADA. RP CRUISE, C (reprint author), TORONTO WESTERN HOSP,DEPT ANAESTHESIA,399 BATHURST ST,TORONTO M5T 2S8,ONTARIO,CANADA. NR 18 TC 11 Z9 11 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUL PY 1992 VL 39 IS 6 BP 563 EP 568 PG 6 WC Anesthesiology SC Anesthesiology GA JE477 UT WOS:A1992JE47700009 ER PT J AU HELFINSTINE, SY GUILMETTE, RA SCHLAPPER, GA AF HELFINSTINE, SY GUILMETTE, RA SCHLAPPER, GA TI INVITRO DISSOLUTION OF CURIUM OXIDE USING A PHAGOLYSOSOMAL SIMULANT SOLVENT SYSTEM SO ENVIRONMENTAL HEALTH PERSPECTIVES LA English DT Article; Proceedings Paper CT INTERNATIONAL SYMP ON THE ROLE OF THE ALVEOLAR MACROPHAGE IN THE CLEARANCE OF INHALED PARTICLES CY SEP 19-21, 1990 CL OXFORD, ENGLAND SP EUROPEAN LATE EFFECTS PROJECT ID ALVEOLAR MACROPHAGES; PARTICLES AB Detailed study of actinide oxide behavior in alveolar macrophages (AM) in vitro is limited because of the short life span of these cells in culture. We created an in vitro dissolution system that could mimic the acidic phagolysosomal environment for the actinide and be maintained for an indefinite period so that dissolution of more insoluble materials could be measured. The dissolution system for this investigation, consisting of nine different solutions of HCl and the chelating agent diethylenetriamine pentaacetate (DTPA) in distilled water, is called the phagolysosomal simulant solvent (PSS). In this system, both the pH and the amount of DTPA were varied. We could observe the effect of altering pH within a range of 4.0-6.0 (similar to that of the phagolysosome) and the effect of the molar ratio of DTPA to curium at 1000:1, 100:1, or 10:1. We chose curium sesquioxide ((Cm2O3)-Cm-244) to validate the PSS for actinide dissolution versus that occurring in AM in vitro because it dissolves significantly in less than 1 week. The polydisperse (Cm2O3)-Cm-244 aerosol was generated, collected on filters, resuspended, and added to the PSS solutions and to cultured canine AM. By comparing dissolution in the two systems directly, we hoped to arrive at an optimum PSS for future dissolution studies. PSS and cell culture samples were taken daily for 7 days after exposure and tested for the solubilized curium. The amount of soluble material was determined by ultracentrifugation to separate the insoluble Cm2O3 from the soluble curium in the PSS solutions and filtration for the cell-containing material. After separating the soluble and insoluble fractions, the samples were analyzed using alpha liquid scintillation counting. Time-dependent dissolution measurements from the PSS/AM showed that the Cm2O3 dissolution was similar for both the PSS solutions and the cultured AM. C1 LOVELACE BIOMED & ENVIRONM RES INST,INHALAT TOXICOL RES INST,POB 5890,ALBUQUERQUE,NM 87185. TEXAS A&M UNIV SYST,DEPT NUCL ENGN,COLL STN,TX 77843. NR 13 TC 5 Z9 5 PU US DEPT HEALTH HUMAN SERVICES PUBLIC HEALTH SERVICE PI RES TRIANGLE PK PA NATL INST HEALTH, NATL INST ENVIRONMENTAL HEALTH SERVICES, PO BOX 12233, RES TRIANGLE PK, NC 27709-2233 SN 0091-6765 J9 ENVIRON HEALTH PERSP JI Environ. Health Perspect. PD JUL PY 1992 VL 97 BP 131 EP 137 PG 7 WC Environmental Sciences; Public, Environmental & Occupational Health SC Environmental Sciences & Ecology; Public, Environmental & Occupational Health GA JL411 UT WOS:A1992JL41100018 ER PT J AU DUTRE, P ROLLY, G VERMEULEN, H AF DUTRE, P ROLLY, G VERMEULEN, H TI EFFECT OF INTRAVENOUS HYPNOTICS ON THE ACTIONS OF PIPECURONIUM SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, PIPECURONIUM; HYPNOTICS, PROPOFOL, ETOMIDATE, MIDAZOLAM, METHOHEXITONE AB Seventy-five ASA Grades I-III patients (18-85 years, 45-90 kg) were randomized into five groups. All patients received N2O/O2 (2/1) and alfentanil: loading dose (LD) 0.015 mg kg-1 and maintenance dose (MD) 0.045 mg kg-1 h-1 (groups 1-4). Group 1 received propofol (LD 2 mg kg-1 and MD 6 mg kg-1 h-1); Group 2 etomidate (LD 0.3 mg kg-1 and MD 0.6 mg kg-1 h-1); Group 3 midazolam (LD 0.2 mg kg-1 and MD 0.120 mg kg-1 h-1); Group 4 methohexitone (LD 1.5 mg kg-1 and MD 4 mg kg-1 h-1); Group 5 dehydrobenzperidol 0.05-0.23 mg kg-1 and alfentanil (LD 0.100 mg kg-1 and MD 0.060 mg kg-1 h-1). The neuromuscular block induced by pipecuronium (50-mu-g kg-1) was evaluated. No statistically significant differences were found between the five groups as concerned degree of block (expressed as % twitch amplitude in response to the first of the TOF stimuli (Ta1) at intubation, T1 minimum and recovery to Ta1 = 20%, 25% and 75%. Slightly faster intubation was possible when midazolam was used in comparison with propofol, methohexitone or NLA and when etomidate was used in comparison with propofol. A wide range of individual values of maximal neuromuscular blocking activity was found. C1 STATE UNIV GHENT HOSP,DEPT ANAESTHESIOL,DE PINTELAAN 185,B-9000 GHENT,BELGIUM. NR 0 TC 1 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JUL PY 1992 VL 9 IS 4 BP 313 EP 317 PG 5 WC Anesthesiology SC Anesthesiology GA JC257 UT WOS:A1992JC25700005 ER PT J AU ORNSTEIN, E MATTEO, RS SCHWARTZ, AE JAMDAR, SC DIAZ, J AF ORNSTEIN, E MATTEO, RS SCHWARTZ, AE JAMDAR, SC DIAZ, J TI PHARMACOKINETICS AND PHARMACODYNAMICS OF PIPECURONIUM BROMIDE (ARDUAN) IN ELDERLY SURGICAL PATIENTS SO ANESTHESIA AND ANALGESIA LA English DT Article ID RENAL-FAILURE; D-TUBOCURARINE; PANCURONIUM; DISPOSITION; METOCURINE; VECURONIUM; DURATION AB The neuromuscular response to pipecuronium bromide (Arduan), 70-mu-g/kg, was studied in 20 elderly (> 70 yr) and 10 younger patients (< 60 vr) during nitrous oxide, fentanyl, and droperidol anesthesia. The adductor pollicis response to single 0.2-ms supramaximal pulses was recorded. Although all younger patients were completely paralyzed, 2 of 20 elderly patients did not attain 90% paralysis. Onset time in the elderly was prolonged (6.9 +/- 2.6 vs 4.3 +/-1.5 min, P < 0.02). Spontaneous recovery was similar in both groups, with 75% recovery occurring at 133 +/- 52 min in the elderly and 146 +/- 46 min in the younger patients. The pharmacokinetic variables were similar for the two groups, and pharmacodynamic analysis revealed a similar sensitivity at the neuromuscular junction. The pharmacologic actions of pipecuronium in otherwise healthy patients do not differ between young and elderly adults. RP ORNSTEIN, E (reprint author), COLUMBIA UNIV COLL PHYS & SURG,DEPT ANESTHESIOL,630 W 168TH ST,NEW YORK,NY 10032, USA. NR 18 TC 10 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUN PY 1992 VL 74 IS 6 BP 841 EP 844 PG 4 WC Anesthesiology SC Anesthesiology GA HV346 UT WOS:A1992HV34600011 ER PT J AU KOSCIELNIAKNIELSEN, ZJ LAWMIN, JC DONATI, F BEVAN, DR CLEMENT, P WISE, R AF KOSCIELNIAKNIELSEN, ZJ LAWMIN, JC DONATI, F BEVAN, DR CLEMENT, P WISE, R TI DOSE-RESPONSE RELATIONS OF DOXACURIUM AND ITS REVERSAL WITH NEOSTIGMINE IN YOUNG-ADULTS AND HEALTHY ELDERLY PATIENTS SO ANESTHESIA AND ANALGESIA LA English DT Article ID CLINICAL-PHARMACOLOGY; NEUROMUSCULAR BLOCKING; NITROUS-OXIDE; MUSCLE-RELAXANT; D-TUBOCURARINE; ORG NC-45; PHARMACOKINETICS; PANCURONIUM; CHLORIDE; PHARMACODYNAMICS AB Dose-response relationships for doxacurium and neostigmine were established in 24 young (18-40 yr) and 24 elderly (70-85 yr) patients, ASA physical status I or II, anesthetized with thiopental, fentanyl, nitrous oxide, and isoflurane. Mechanomyographic response of the adductor pollicis muscle to the train-of-four stimulation of the ulnar nerve was recorded. Doxacurium (5, 10, 15, or 20-mu-g/kg IV) was administered by random allocation. After maximal blockade, an additional dose, for a total of 30-mu-g/kg, was administered. When first twitch height recovered to 25%, incremental doses of 5-mu-g/kg were administered for maintenance of relaxation. Neostigmine (5, 10, 20, or 40-mu-g/kg) was injected at 25% first twitch recovery, and neuromuscular monitoring was continued for 10 min. The doses of doxacurium (+/- SEM) required to produce a 50%, 90%, and 95% depression of twitch tension in the young patients were, respectively, 13.3 +/- 1.6, 23.6 +/- 2.8, and 28.6 +/- 3.4-mu-g/kg, not statistically different from corresponding values in the elderly, 11.8 +/- 1.3, 21.2 +/- 2.3, and 25.9 +/- 2.9-mu-g/kg, respectively. Time to 25% recovery after 30-mu-g/kg was 80.2 +/- 12.2 min in the young versus 133.0 +/- 17.1 min in the elderly (P < 0.05). Neostigmine-assisted recovery was not significantly different in both groups. The estimated doses of neostigmine to obtain 70% train-of-four recovery after 10 min were 53.6 +/- 7.5-mu-g/kg in the young and 41.6 +/- 5.8-mu-g/kg in the elderly (P = NS). It is concluded that the intensity of blockade produced by a given dose of doxacurium is similar in young and elderly adults; however, a longer duration of surgical relaxation can be expected in the elderly. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 26 TC 12 Z9 12 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUN PY 1992 VL 74 IS 6 BP 845 EP 850 PG 6 WC Anesthesiology SC Anesthesiology GA HV346 UT WOS:A1992HV34600012 ER PT J AU IWASAKI, H NAMIKI, A OMOTE, T OMOTE, K AF IWASAKI, H NAMIKI, A OMOTE, T OMOTE, K TI NEUROMUSCULAR EFFECTS OF SUBCUTANEOUS ADMINISTRATION OF PANCURONIUM SO ANESTHESIOLOGY LA English DT Article DE MONITORING, NEUROMUSCULAR, TRAIN-OF-FOUR; NEUROMUSCULAR RELAXANTS, PANCURONIUM; PHARMACOKINETICS, SUBCUTANEOUS ADMINISTRATION RP IWASAKI, H (reprint author), SAPPORO MED COLL & HOSP,DEPT ANESTHESIOL,S-1 W-16,CHUO KU,SAPPORO 060,JAPAN. NR 5 TC 6 Z9 6 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUN PY 1992 VL 76 IS 6 BP 1049 EP 1051 DI 10.1097/00000542-199206000-00026 PG 3 WC Anesthesiology SC Anesthesiology GA HY137 UT WOS:A1992HY13700026 ER PT J AU PARKER, CJR HUNTER, JM AF PARKER, CJR HUNTER, JM TI A NEW 4-PARAMETER THRESHOLD-MODEL FOR THE PLASMA ATRACURIUM CONCENTRATION RESPONSE RELATIONSHIP SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM; NEUROMUSCULAR TRANSMISSION, TRAIN-OF-4 RESPONSE; PHARMACODYNAMICS, MODEL ID D-TUBOCURARINE; PHARMACOKINETICS; PHARMACODYNAMICS; CHILDREN; INFANTS AB The plasma concentration of atracurium and the electromyographic depression of the first response of the train-of-four (T1:T0) were measured during and after recovery from a 10-min infusion of atracurium 0.25 mg kg-1 in 14 patients anaesthetized with 66% nitrous oxide and 0.9% isoflurane (end-tidal) in oxygen. A standard pharmacodynamic model was fitted to the data; a small but consistent discrepancy was found between the time and rate of onset of depression of the ratio T1:T0 and the predictions of the standard biophase model of best fit to the data. This discrepancy is reduced by the inclusion of a threshold term (C(P)SS(theta)) in the model to represent the greatest steady state plasma concentration which would just fail to evoke an effect. The values of C(P)SS(theta) correlated significantly with the values of C(P)SS50 (r = +0.627; P < 0.02). The estimates of C(P)SS50 and k(eo) from the two models are very similar; the estimate of GAMMA, the slope of the concentration-response curve, was less in the threshold model. The relationship of the present threshold model to existing knowledge of neuromuscular physiology is discussed. RP PARKER, CJR (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,4TH FLOOR,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 19 TC 13 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 JUN PY 1992 VL 68 IS 6 BP 548 EP 554 DI 10.1093/bja/68.6.548 PG 7 WC Anesthesiology SC Anesthesiology GA HX507 UT WOS:A1992HX50700002 ER PT J AU PARKER, CJR HUNTER, JM AF PARKER, CJR HUNTER, JM TI DEPENDENCE OF THE NEUROMUSCULAR BLOCKING EFFECT OF ATRACURIUM UPON ITS DISPOSITION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM; PHARMACODYNAMICS; PHARMACOKINETICS ID PHARMACOKINETICS; PHARMACODYNAMICS; PANCURONIUM; MODEL AB We have assessed the profiles of plasma concentration of atracurium and its neuromuscular blocking effect on the first response of the train-of-four measured by electromyography after a short infusion of atracurium 0.25 mg kg-1, in 38 patients anaesthetized by one of three techniques. Measures of the temporal profile of neuromuscular block were found to correlate with pharmacokinetic variables. When anaesthetic technique was taken into account in a multivariate model, the time to onset of 10% depression of T1:T0 correlated positively with the central volume of distribution (P < 0.05). The change in T1:T0 during the 1 min after 10% depression, and the logit of maximum depression were both correlated negatively with the central volume of distribution (P < 0.05 and P < 0.01, respectively). Both the times to 20% and 50% recovery of T1:T0 correlated strongly negatively with clearance (P < 0.0001 for both measures). The findings support the conclusion that the effect of atracurium is dependent upon its disposition. RP PARKER, CJR (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,4TH FLOOR,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 20 TC 10 Z9 10 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 JUN PY 1992 VL 68 IS 6 BP 555 EP 561 DI 10.1093/bja/68.6.555 PG 7 WC Anesthesiology SC Anesthesiology GA HX507 UT WOS:A1992HX50700003 ER PT J AU NARITA, M FURUKAWA, Y REN, LM KARASAWA, Y TAKEI, M MURAKAMI, M TAKAYAMA, S CHIBA, S AF NARITA, M FURUKAWA, Y REN, LM KARASAWA, Y TAKEI, M MURAKAMI, M TAKAYAMA, S CHIBA, S TI CARDIAC EFFECTS OF VECURONIUM AND ITS INTERACTION WITH AUTONOMIC NERVOUS-SYSTEM IN ISOLATED PERFUSED CANINE HEARTS SO JOURNAL OF CARDIOVASCULAR PHARMACOLOGY LA English DT Article DE VECURONIUM; INOTROPISM; CHRONOTROPISM; MUSCARINIC RECEPTOR; NICOTINIC RECEPTOR; BETA-ADRENOCEPTOR ID NEUROMUSCULAR BLOCKING-AGENTS; PANCURONIUM-BROMIDE; VAGAL-STIMULATION; NEURONAL UPTAKE; SINUS ARREST; ORG NC45; ATRIUM; BRADYCARDIA; ANESTHESIA; RESPONSES AB The chronotropic and inotropic effects of vecuronium bromide and its interaction with the autonomic nervous system were investigated in the isolated, cross-circulated right atrial and left ventricular preparations of the dog. Vecuronium, injected into the external jugular vein of the support dog, induced dose-dependent decreases in heart rate and arterial blood pressure, and increased atrial contractile force with no change in sinus rate in isolated atrial preparations. Vecuronium (1-3,000-mu-g), injected into the sinus node artery of the isolated atrium, induced dose-dependent increases in atrial contractile force with small increases in sinus rate. Vecuronium also increased the ventricular contractile force in a dose-dependent manner. The positive inotropic effect was attenuated in part by propranolol, but not by either tetrodotoxin or imipramine. Vecuronium inhibited in a dose-related manner the negative chronotropic and inotropic responses to parasympathetic nerve stimulation and carbachol (CCh) and the negative followed by positive cardiac responses to nicotine, but did not attenuate the positive responses to sympathetic nerve stimulation. The ID50s for the responses to parasympathetic stimulation, CCh, and nicotine were not significantly different. Vecuronium enhanced the positive chronotropic and inotropic responses to sympathetic nerve stimulation, tyramine, norepinephrine, and isoproterenol. These results indicate that (a) vecuronium causes the positive inotropic responses mediated by nonadrenergic mechanisms and beta-adrenoceptors, (b) vecuronium blocks ganglionic and presynaptic nicotinic and postsynaptic muscarinic receptor-mediated responses similarly, and (c) vecuronium enhances beta-adrenoceptor-mediated responses in the dog heart. C1 SHINSHU UNIV,SCH MED,DEPT PHARMACOL,MATSUMOTO,NAGANO 390,JAPAN. NR 36 TC 6 Z9 6 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0160-2446 J9 J CARDIOVASC PHARM JI J. Cardiovasc. Pharmacol. PD JUN PY 1992 VL 19 IS 6 BP 1000 EP 1008 DI 10.1097/00005344-199206000-00024 PG 9 WC Cardiac & Cardiovascular Systems; Pharmacology & Pharmacy SC Cardiovascular System & Cardiology; Pharmacology & Pharmacy GA HW169 UT WOS:A1992HW16900024 ER PT J AU POURCYROUS, M LEFFLER, CW BADA, HS KORONES, SB STIDHAM, GL BUSIJA, DW AF POURCYROUS, M LEFFLER, CW BADA, HS KORONES, SB STIDHAM, GL BUSIJA, DW TI EFFECTS OF PANCURONIUM-BROMIDE ON CEREBRAL BLOOD-FLOW CHANGES DURING SEIZURES IN NEWBORN PIGS SO PEDIATRIC RESEARCH LA English DT Article ID BICUCULLINE-INDUCED SEIZURES; PRESSURE; DOGS; SUCCINYLCHOLINE; ADENOSINE; VELOCITY; PIGLETS; RATS; PH AB We investigated the effects of pancuronium bromide pretreatment on cerebral blood flow (CBF) during bicuculline-induced seizures in anesthetized piglets. Arterial blood pressure, gases, pH, cerebral electrocortical activity, and CBF (radioactive microsphere) were monitored at baseline, 10 min after administration of pancuronium (0.3 mg/kg i.v.; n = 9) or vehicle (normal saline; n = 8), and again at 5, 15, and 60 min after bicuculline (3 mg/kg i.v.). No change in CBF from baseline was observed at 10 min after either saline or pancuronium treatment, before induction of seizures. In the saline group, CBF was 36 +/- 3 mL.min-1.100 g-1 before bicuculline and increased to 166 +/- 24 and 205 +/- 35 mL.min.1.100 g-1 at 5 and 15 min, respectively, after bicuculline, returning toward baseline by 60 min. In the pancuronium group at 5 min after bicuculline, CBF increased from 45 +/- 7 to 169 +/- 26 mL. min-1.100 g-1, but fell to 88 +/- 17 mL.min-1.100 g-1 at 15 min in contrast to saline-treated piglets. Also, at 15 min of seizures, differences between groups were observed in arterial blood pressure, gases, and pH. Although these variables were in the normal range with pancuronium treatment, the saline-treated animals had increased arterial blood pressure (81 +/- 6 mm Hg) and PCO2 (6 +/- 0.4 kPa) and decreased PO2 (7 +/- 0.5 kPa) and pH (6.91 +/- 0.06). Electrocortical activity was abnormal during seizures in both groups. At 60 min, reversal to normal activity was observed in six of nine pancuronium-treated animals versus two of eight saline-treated animals. These data suggest that pancuronium limits cerebral hyperemia during prolonged seizures by attenuating increases in blood pressure as a result of elimination of skeletal muscle activity. This leads to minimal alteration of arterial PCO2, Po2, and pH during seizures. C1 UNIV TENNESSEE CTR HLTH SCI,DEPT PEDIAT,RES NEONATAL PHYSIOL LAB,MEMPHIS,TN 38163. UNIV TENNESSEE CTR HLTH SCI,DEPT OBSTET & GYNECOL,MEMPHIS,TN 38163. UNIV TENNESSEE CTR HLTH SCI,DEPT PHYSIOL & BIOPHYS,MEMPHIS,TN 38163. NR 21 TC 9 Z9 9 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD JUN PY 1992 VL 31 IS 6 BP 636 EP 639 DI 10.1203/00006450-199206000-00019 PG 4 WC Pediatrics SC Pediatrics GA HV266 UT WOS:A1992HV26600019 ER PT J AU MCCARTHY, G ELLIOTT, P MIRAKHUR, RK COOPER, R SHARPE, TDE CLARKE, RSJ AF MCCARTHY, G ELLIOTT, P MIRAKHUR, RK COOPER, R SHARPE, TDE CLARKE, RSJ TI ONSET AND DURATION OF ACTION OF VECURONIUM IN THE ELDERLY - COMPARISON WITH ADULTS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHESIA, ELDERLY; NEUROMUSCULAR BLOCKING AGENTS, VECURONIUM ID INDUCED NEUROMUSCULAR BLOCKADE; DOSE-RESPONSE; PANCURONIUM; ATRACURIUM; AGE; ORG-NC-45 AB The onset and duration of action of vecuronium were studied in young adult (n = 30; mean age 34 +/- 11.1 (s.d.) yr), middle-aged (n = 20; mean age 60 +/- 5.8 yr) and elderly patients (n = 30; mean age 80 +/- 4.6 yr) anaesthetised with thiopentone, nitrous oxide in oxygen and halothane. Neuromuscular block was monitored by applying the train-of-four (TOF) stimulation at 2 Hz to the ulnar nerve every 12 s. Half the patients in each group received 0.08 and the other half 0.12 mg kg-1 of the relaxant. The time to return of T1 (first response in the TOF sequence) to 25% of control was 28 +/- 5.2 (s.d.), 34 +/- 7.1 and 39 +/- 10.2 min following 0.08 mg kg-1 dose (P < 0.05 between the elderly and young adults) and 45 +/- 9.2, 48 +/- 6.2 and 69 +/- 19.2 min following 0.12 mg kg-1 dose, respectively, in the three age groups (P < 0.05 between the elderly and the other two groups). The recovery indices (time for 25-75% recovery of T1) after the 0.08 mg kg-1 was 9.6 +/- 3.4, 13.6 +/- 5.1 and 17.4 +/- 6.1 min, respectively (P < 0.05 between the elderly and young adults). There was no significant difference in any of the parameters between the young adults and the middle-aged. The onset of block at each dose was not significantly different between the three age groups; however, the time to maximum effect was significantly shorter with the higher dose in the young and the middle-aged, but not in the elderly. Regression analysis of the data between age and the duration of action and recovery index suggested a significant prolongation (P < 0.05) of these parameters in the elderly. C1 QUEENS UNIV BELFAST,DEPT ANAESTHET,WHITLA MED BLDG,97 LISBURN RD,BELFAST BT9 7BL,ANTRIM,NORTH IRELAND. ROYAL VICTORIA HOSP,BELFAST BT12 6BA,NORTH IRELAND. NR 19 TC 12 Z9 12 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 1992 VL 36 IS 4 BP 383 EP 386 PG 4 WC Anesthesiology SC Anesthesiology GA HR870 UT WOS:A1992HR87000016 ER PT J AU ROBINSON, BJ LEE, E REES, D PURDIE, GL GALLETLY, DC AF ROBINSON, BJ LEE, E REES, D PURDIE, GL GALLETLY, DC TI BETAMETHASONE-INDUCED RESISTANCE TO NEUROMUSCULAR BLOCKADE - A COMPARISON OF ATRACURIUM AND VECURONIUM INVITRO SO ANESTHESIA AND ANALGESIA LA English DT Article ID CORTICOSTEROIDS; DEXAMETHASONE; TRANSMISSION; PANCURONIUM; BLOCKING AB Steroids induce resistance to neuromuscular blocking drugs. Betamethasone-induced resistance to vecuronium has been demonstrated in vitro, and a presynaptic site of interaction has been suggested. This study investigated whether atracurium is similarly affected. Rat phrenic nerve-hemidiaphragm preparations were bathed in a physiologic solution, and one-half were exposed to betamethasone (1-mu-mol/L). Dose responses were recorded for atracurium (8-13-mu-mol/L) and vecuronium (2-12-mu-mol/L) for control and betamethasone-treated preparations. In comparison to control, the betamethasone groups had significantly less depression of muscle contraction force at all concentrations of atracurium (P = 0.0004) and vecuronium (P = 0.002). The calculated ED50 (50% depression of muscle contraction force, expressed as mean +/- SEM) for atracurium was 8.83 +/- 0.62-mu-mol/L for controls and 11.19 +/- 0.54-mu-mol/L for betamethasone-treated preparations. The calculated ED50 for vecuronium was 4.72 +/- 0.41-mu-mol/L for controls and 6.84 +/- 0.66-mu-mol/L for betamethasone-treated preparations. Betamethasone therefore increased the ED50 for atracurium by 27% and vecuronium by 45%; however, the magnitudes of these differences were not significant (P = 0.74) between the neuromuscular blocking agents. These results indicate that betamethasone-induced resistance to nondepolarizing neuromuscular blockade affects both atracurium and vecuronium to similar degrees in vitro. C1 VICTORIA UNIV WELLINGTON,WELLINGTON SCH MED,ANAESTHESIA SECT,POB 7343,WELLINGTON,NEW ZEALAND. VICTORIA UNIV WELLINGTON,SCH BIOL SCI,WELLINGTON,NEW ZEALAND. VICTORIA UNIV WELLINGTON,WELLINGTON SCH MED,DEPT COMMUNITY HLTH,WELLINGTON,NEW ZEALAND. NR 25 TC 10 Z9 11 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 1992 VL 74 IS 5 BP 762 EP 765 PG 4 WC Anesthesiology SC Anesthesiology GA HQ208 UT WOS:A1992HQ20800024 ER PT J AU PHILLIPS, BJ HUNTER, JM AF PHILLIPS, BJ HUNTER, JM TI USE OF MIVACURIUM CHLORIDE BY CONSTANT INFUSION IN THE ANEPHRIC PATIENT SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE COMPLICATIONS, RENAL FAILURE; ENZYMES, CHOLINESTERASE; NEUROMUSCULAR RELAXANTS, MIVACURIUM INFUSION ID PHARMACOLOGY; VECURONIUM; ATRACURIUM; BW-B1090U; BOLUS AB Twenty anephric and 20 healthy patients received a bolus dose of mivacurium 150-mu-g kg-1. When the first EMG response (T1) of the train-of-four had recovered to 5% of control (TO), an infusion of mivacurium 10-mu-g kg-1 min-1 was started and adjusted to keep T1 at 5%. Ten patients in each group were given neostigmine 35-mu-g kg-1 when the infusion was stopped when T1/TO had recovered to 20%; in the others recovery was spontaneous. After the bolus dose of mivacurium, mean (SD) depression of T1 was greater in the anephric group than in the normal group (98.4 (3.5) vs 96.8 (4.4)%; P < 0.01) and recovery of T1/TO to 5% was slower (15.3 (6.9) vs 9.8 (3.5) min; P < 0.01). Anephric patients required a slower infusion rate (6.3 (1.9) vs 10.4 (2.8)-mu-g kg-1 min-1; P < 0. 001). Neostigmine hastened recovery of both T1/TO and T4/T1 in both groups. Spontaneous recovery of T1/TO (from 25% to 75%) after the infusion was also slower in anephric patients (12.2 (8.2) vs 7.7 (1.2) min; P < 0. 05). Plasma cholinesterase activity was less in the anephric group (785 (207) vs 943 (217) iu litre-1; P < 0.05) and there was a (negative) correlation overall between cholinesterase activity and time to 5% recovery of T1/TO after the bolus dose (r = -0.42; P < 0.02). We conclude that patients with chronic renal failure may require a reduced dose of mivacurium. RP PHILLIPS, BJ (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 19 TC 47 Z9 48 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 1992 VL 68 IS 5 BP 492 EP 498 DI 10.1093/bja/68.5.492 PG 7 WC Anesthesiology SC Anesthesiology GA HR042 UT WOS:A1992HR04200009 ER PT J AU LINSHIAU, SY HSU, KS FU, WM AF LINSHIAU, SY HSU, KS FU, WM TI STUDIES ON CURARE-LIKE ACTION OF 2,2',2''-TRIPYRIDINE IN THE MOUSE PHRENIC NERVE-DIAPHRAGM SO BRITISH JOURNAL OF PHARMACOLOGY LA English DT Article DE 2,2',2''-TRIPYRIDINE; CURARE-LIKE ACTION; ALPHA-BUNGAROTOXIN BINDING; NICOTINIC ACETYLCHOLINE RECEPTOR ID METALLOINTERCALATION REAGENTS; NEUROMUSCULAR-JUNCTION; ACETYLCHOLINE; RECEPTORS; RELEASE AB 1 The curare-like action of 2,2',2"-tripyridine (a synthetic by-product of the herbicide, paraquat) was studied in mouse phrenic nerve-diaphragm preparation. The inhibition by 2,2',2"-tripyridine of nerve-evoked twitches was dependent on the concentration, ranging from 1 to 100-mu-M, which had no significant effect on the twitch amplitudes evoked by direct muscle stimulation. 2 The twitch inhibition by 2,2',2"-tripyridine was reversible and could be antagonized by anti-cholinesterase agents such as neostigmine, physostigmine as well as ecothiophate. 3 Pretreatment with either 0.7-mu-M (+)-tubocurarine or 2.2-mu-M succinylcholine shifted the concentration-inhibition curve of 2,2',2"-tripyridine to the left. 4 2,2'2"-Tripyridine inhibited not only acetylcholine-induced contracture of the denervated mouse diaphragm but also that of the chick biventer cervicis muscle. Like (+)-tubocurarine, 2,2',2"-tripyridine protected the twitches from the inhibition by alpha-bungarotoxin and also specifically inhibited the binding of [I-125]-alpha-bungarotoxin to the mouse diaphragm. All of these findings indicate that 2,2',2"-tripyridine possesses curare-like action and inhibits the muscle contractions through binding to postsynaptic acetylcholine receptors. 5 The postsynaptic inhibition exhibited by 2,2',2"-tripyridine was also implicated in the tetanic fade, a decrease in the amplitude of miniature endplate potential (m.e.p.p.) and endplate potential (e.p.p.). 6 The clinical implication of these findings is that 2,2',2"-tripyridine may be involved in the cause of respiratory failure in paraquat-intoxicated workers since 2,2',2"-tripyridine is a by-product of paraquat synthesis. C1 NATL TAIWAN UNIV,COLL MED,INST TOXICOL,TAIPEI,TAIWAN. RP LINSHIAU, SY (reprint author), NATL TAIWAN UNIV,COLL MED,INST PHARMACOL,TAIPEI,TAIWAN. NR 22 TC 8 Z9 8 PU STOCKTON PRESS PI BASINGSTOKE PA HOUNDMILLS, BASINGSTOKE, HAMPSHIRE, ENGLAND RG21 6XS SN 0007-1188 J9 BRIT J PHARMACOL JI Br. J. Pharmacol. PD MAY PY 1992 VL 106 IS 1 BP 55 EP 60 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA HT209 UT WOS:A1992HT20900009 ER PT J AU DONNELLY, AJ GOLEMBIEWSKI, JA SKUPSKI, R WOJTYNEK, JE AF DONNELLY, AJ GOLEMBIEWSKI, JA SKUPSKI, R WOJTYNEK, JE TI CRITERIA FOR USE OF PANCURONIUM-BROMIDE, VECURONIUM BROMIDE, ATRACURIUM BESYLATE, TUBOCURARINE CHLORIDE, METOCURINE IODIDE, PIPECURONIUM BROMIDE, AND DOXACURIUM CHLORIDE IN ADULTS SO CLINICAL PHARMACY LA English DT Article C1 UNIV ILLINOIS HOSP,DEPT PHARM,CHICAGO,IL 60612. UNIV ILLINOIS HOSP,DEPT ANESTHESIOL,CHICAGO,IL 60612. RP DONNELLY, AJ (reprint author), RUSH PRESBYTERIAN ST LUKES MED CTR,DEPT PHARM,CHICAGO,IL 60612, USA. NR 0 TC 2 Z9 2 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 SN 0278-2677 J9 CLIN PHARMACY PD MAY PY 1992 VL 11 IS 5 BP 435 EP 441 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA HQ689 UT WOS:A1992HQ68900016 ER PT J AU WEINDLMAYRGOETTEL, M LANKMAYR, EP KOBERL, G GILLY, H AF WEINDLMAYRGOETTEL, M LANKMAYR, EP KOBERL, G GILLY, H TI DETERMINATION OF VECURONIUM AND PANCURONIUM AND THEIR METABOLITES IN HUMAN AND ANIMAL PLASMA USING HPLC AND POSTCOLUMN ION-PAIR EXTRACTION WITH FLUOROMETRIC DETECTION SO FRESENIUS JOURNAL OF ANALYTICAL CHEMISTRY LA English DT Article; Proceedings Paper CT 13TH INTERNATIONAL CONF ON BIOCHEMICAL ANALYSIS CY MAY 05-08, 1992 CL MUNICH, GERMANY C1 L BOLTZMANN INST EXPTL ANAESTHESIOL & RES INTENS CARE MED,A-1090 VIENNA,AUSTRIA. GRAZ UNIV TECHNOL,INST ANALYT CHEM MICROCHEM & RADIOCHEM,A-8010 GRAZ,AUSTRIA. RP WEINDLMAYRGOETTEL, M (reprint author), UNIV VIENNA,DEPT EXPTL,ANAESTHESIA & GEN INTENS CARE MED CLIN,A-1090 VIENNA,AUSTRIA. NR 2 TC 1 Z9 1 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0937-0633 J9 FRESEN J ANAL CHEM JI Fresenius J. Anal. Chem. PD MAY PY 1992 VL 343 IS 1 BP 85 EP 86 DI 10.1007/BF00332026 PG 2 WC Chemistry, Analytical SC Chemistry GA HT012 UT WOS:A1992HT01200089 ER PT J AU MIKHEEV, NB KAZAKEVICH, MZ RUMER, IA AF MIKHEEV, NB KAZAKEVICH, MZ RUMER, IA TI INTERACTION OF DIVALENT URANIUM AND CURIUM SO SOVIET RADIOCHEMISTRY LA English DT Article AB The Cm3+/Cm2+ redox potential in the presence of weighable amounts of U2+ increases by 0.15 V and reaches the U3+/U2+ redox potential. This is explained by formation of mixed Cm-U dimers or of small clusters. NR 6 TC 0 Z9 0 PU PLENUM PUBL CORP PI NEW YORK PA CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 SN 0038-576X J9 SOV RADIOCHEM+ PD MAY-JUN PY 1992 VL 34 IS 3 BP 293 EP 295 PG 3 WC Chemistry, Analytical SC Chemistry GA KA587 UT WOS:A1992KA58700006 ER PT J AU MASON, IJ MUDGE, AW AF MASON, IJ MUDGE, AW TI ONSET OF CGRP EXPRESSION AND ITS RESTRICTION TO A SUBSET OF SPINAL MOTOR-NEURON POOLS IN THE CHICK-EMBRYO IS NOT AFFECTED BY TREATMENT WITH CURARE SO NEUROSCIENCE LETTERS LA English DT Article DE CALCITONIN GENE-RELATED PEPTIDE; MOTOR NEURON; SPINAL CORD; EMBRYO; MOTOR POOL; CURARE ID GENE-RELATED PEPTIDE; MUSCLE-FIBER NUMBERS; CALCITONIN GENE; ACETYLCHOLINE-RECEPTOR; CORD MOTONEURONS; SKELETAL-MUSCLE; STRIATED-MUSCLE; NEUROMUSCULAR-JUNCTION; PRIMARY CULTURES; ALPHA-SUBUNIT AB Calcitonin gene-related peptide (CGRP) is expressed in and defines a subset of motor neuron pools in the lumbar spinal cord of the chick embryo. The onset of CGRP expression in individual pools coincides with both the period of the initial innervation of the leg and the beginning of naturally occurring cell death in the lumbar motor column. Administration of neuromuscular blocking agents at this time results in a striking reduction of normal motor neuron loss. It has been reported that such treatment also results in the abolition of CGRP expression at later stages of development. In this study, we have examined the effect of curare treatment on CGRP expression in motor neurons earlier in their development. We find that, in contrast to the effects reported at later stages, inhibition of neuromuscular activity does not affect either the onset of CGRP expression or its restriction to a subset of motor neuron pools. This demonstrates that the control of the onset of CGRP expression is unlikely to be linked to processes which are regulated by neuromuscular transmission including naturally-occurring cell death. C1 UNIV LONDON UNIV COLL,DEPT BIOL,MRC,DEV NEUROBIOL PROGRAMME,LONDON WC1E 6BT,ENGLAND. RP MASON, IJ (reprint author), GUYS & ST THOMAS HOSP,UNITED MED & DENT SCH,DIV ANAT & CELL BIOL,MRC,BRAIN DEV PROGRAMME,LONDON SE1 9RT,ENGLAND. RI Mason, Ivor/B-1859-2008 NR 39 TC 4 Z9 4 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 APR 13 PY 1992 VL 138 IS 1 BP 128 EP 132 DI 10.1016/0304-3940(92)90488-S PG 5 WC Neurosciences SC Neurosciences & Neurology GA HQ562 UT WOS:A1992HQ56200031 ER PT J AU SODERHOLM, L AF SODERHOLM, L TI CURIUM (Z = 96) AS A PROBE FOR STUDYING HIGH-TC SUPERCONDUCTIVITY SO JOURNAL OF ALLOYS AND COMPOUNDS LA English DT Article ID MAGNETIC-PROPERTIES; CUO2-LAYERED COMPOUNDS; PRBA2CU3O7; PR; SUSCEPTIBILITY; CMBA2CU3O7; ELEMENTS; CRYSTALS; ND2CUO4; PR2CUO4 AB The unique bonding properties of the Cm 5f electrons were used to study the influence of magnetic electrons on superconductivity in some high T(c) related oxides. Specifically, CmBa2Cu3O7 and Cm1.83Th0.17CuO4 were characterized structurally and magnetically. Neither compound is a superconductor, although they are both members of isostructural series, the other members of which are superconducting. The chemical and physical properties unique to curium which may explain this behavior are discussed. RP SODERHOLM, L (reprint author), ARGONNE NATL LAB,ARGONNE,IL 60439, USA. NR 31 TC 15 Z9 15 PU ELSEVIER SCIENCE SA LAUSANNE PI LAUSANNE 1 PA PO BOX 564, 1001 LAUSANNE 1, SWITZERLAND SN 0925-8388 J9 J ALLOY COMPD JI J. Alloy. Compd. PD APR 3 PY 1992 VL 181 BP 13 EP 22 DI 10.1016/0925-8388(92)90293-I PG 10 WC Chemistry, Physical; Materials Science, Multidisciplinary; Metallurgy & Metallurgical Engineering SC Chemistry; Materials Science; Metallurgy & Metallurgical Engineering GA HP963 UT WOS:A1992HP96300002 ER PT J AU SCHWARTZ, AE MATTEO, RS ORNSTEIN, E HALEVY, JD DIAZ, J AF SCHWARTZ, AE MATTEO, RS ORNSTEIN, E HALEVY, JD DIAZ, J TI PHARMACOKINETICS AND PHARMACODYNAMICS OF VECURONIUM IN THE OBESE SURGICAL PATIENT SO ANESTHESIA AND ANALGESIA LA English DT Article ID DRUGS AB The effect of obesity on the disposition and action of vecuronium was studied in 14 surgical patients. After induction of anesthesia with thiopental and maintenance of anesthesia by inhalation of nitrous oxide and halothane, seven obese patients (93.4 +/- 13.9 kg, 166% +/- 30% of ideal body weight, mean +/- SD) and seven control patients (60.9 +/- 12.3 kg, 93% +/- 6% of ideal body weight) received 0.1 mg/kg of vecuronium. Plasma arterial concentrations of muscle relaxant were determined at 1, 3, 5, 10, 15, 20, 30, 45, 60, 90, 120, 150, 180, 210, 240, 300, and 360 min by a spectrofluorometric method. Simultaneously, neuromuscular blockade was assessed by stimulation of the ulnar nerve and quantification of thumb adductor response. Times to 50% recovery of twitch were longer in the obese than in the control patients (75 +/- 8 versus 46 +/- 8 min) as were 5%-25% recovery times (14.9 +/- 4.0 versus 10.0 +/- 1.7 min) and 25%-75% recovery times (38.4 +/- 13.8 versus 16.7 +/- 10.3 min). However, vecuronium pharmacokinetics were similar for both groups. When the data were calculated on the basis of ideal body weight (IBW) for obese and control patients, total volume of distribution (791 +/- 303 versus 919 +/- 360 mL/kg IBW), plasma clearance (4.65 +/- 0.89 versus 5.02 +/- 1.13 mL.min-1.kg IBW-1), and elimination half-life (119 +/- 43 versus 133 +/- 57 min) were not different between groups. Only when total volume of distribution and clearance are divided by patient weight (a larger value for the obese) and expressed per kilogram of actual body weight do these values appear smaller in the obese (473 +/- 142 versus 993 +/- 401 mL/kg and 2.83 +/- 0.54 versus 5.36 +/- 1.14 mL.min-1.kg-1, respectively). As obesity did not alter the distribution or elimination of vecuronium, the prolonged action seen at 0.1 mg/kg is due to an overdose when vecuronium is administered on the basis of total body weight. Clinically, ideal body weight should be used for dose calculation in the obese patient. RP SCHWARTZ, AE (reprint author), COLUMBIA UNIV COLL PHYS & SURG,DEPT ANESTHESIOL,ROOM 901,161 FT WASHINGTON AVE,NEW YORK,NY 10032, USA. NR 14 TC 38 Z9 40 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1992 VL 74 IS 4 BP 515 EP 518 PG 4 WC Anesthesiology SC Anesthesiology GA HK713 UT WOS:A1992HK71300008 ER PT J AU DIEFENBACH, C MELLINGHOFF, H GROND, S BUZELLO, W AF DIEFENBACH, C MELLINGHOFF, H GROND, S BUZELLO, W TI ATRACURIUM AND VECURONIUM - REPEATED BOLUS INJECTION VERSUS INFUSION SO ANESTHESIA AND ANALGESIA LA English DT Article ID RENAL-FAILURE; RECOVERY; PHARMACOKINETICS; ANESTHESIA AB The purpose of this study was to compare the characteristics of recovery from neuromuscular blockade after either atracurium or vecuronium given by intravenous infusion or by repeated injection. Four groups of 10 patients each were studied during nitrous oxide narcotic anesthesia. An initial intravenous dose of 2 x ED95 of either muscle relaxant was followed by an intravenous infusion started at 5% recovery of control twitch tension and adjusted for 95% block or by repeated injection of 0.6 x ED95, administered whenever twitch tension had returned to 25% of control. There were no significant differences between the maintenance doses required based on method of administration: atracurium repeated injection, 1.6 +/- 0.3 x ED95 h-1; atracurium infusion, 1.7 +/- 0.3 x ED95 h-1; vecuronium repeated injection, 1.8 +/- 0.5 x ED95 h-1; and vecuronium infusion, 1.6 +/- 0.4 x ED95 h-1. Nevertheless, differences of up to 20 min were noted in the recovery indices in the following order: atracurium repeated injection = atracurium infusion < vecuronium repeated injection < vecuronium infusion. A single dose of neostigmine (7-mu-g/kg) significantly reduced the recovery indices, thereby eliminating their differences. RP DIEFENBACH, C (reprint author), UNIV COLOGNE,DEPT ANESTHESIOL,JOSEPH STELZMANN STR 9,W-5000 COLOGNE 41,GERMANY. NR 13 TC 12 Z9 12 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1992 VL 74 IS 4 BP 519 EP 522 PG 4 WC Anesthesiology SC Anesthesiology GA HK713 UT WOS:A1992HK71300009 ER PT J AU LEVEQUE, C MURAT, I TOUBAS, F POISSONNIER, MH BROSSARD, Y SAINTMAURICE, C AF LEVEQUE, C MURAT, I TOUBAS, F POISSONNIER, MH BROSSARD, Y SAINTMAURICE, C TI FETAL NEUROMUSCULAR BLOCKADE WITH VECURONIUM BROMIDE - STUDIES DURING INTRAVASCULAR INTRAUTERINE TRANSFUSION IN ISOIMMUNIZED PREGNANCIES SO ANESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM, FETAL EFFECTS; PHARMACODYNAMICS, VECURONIUM; TECHNIQUE, INTRAUTERINE EXCHANGE TRANSFUSION ID INTRAVENOUS PANCURONIUM-BROMIDE; INFANTS; ULTRASOUND; CHILDREN; MOVEMENT C1 CTR HEMOBIOL PERINATALE,PARIS,FRANCE. RP LEVEQUE, C (reprint author), HOP ST VINCENT DE PAUL,DEPT ANESTHESIE,82 AVE DENFERT ROCHEREAU,F-75674 PARIS 14,FRANCE. NR 23 TC 7 Z9 8 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 1992 VL 76 IS 4 BP 642 EP 644 DI 10.1097/00000542-199204000-00025 PG 3 WC Anesthesiology SC Anesthesiology GA HL558 UT WOS:A1992HL55800025 ER PT J AU DUREUIL, B LEBRAULT, C BOCZKOWSKI, J AUBIER, M DUVALDESTIN, P AF DUREUIL, B LEBRAULT, C BOCZKOWSKI, J AUBIER, M DUVALDESTIN, P TI DOES A SUBPARALYZING DOSE OF VECURONIUM ENHANCE DIAPHRAGM FATIGUE SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM; SUBPARALYSING DOSE; VENTILATION, DIAPHRAGM FATIGUE ID COMPETITIVE NEUROMUSCULAR BLOCK; INSPIRATORY MUSCLE FATIGUE; RECEPTOR OCCLUSION; TRANSMISSION; FAILURE AB We have examined, in six healthy volunteers, the effect of a subparalysing dose of vecuronium on the development of diaphragm fatigue. Vecuronium was given as a 0.5-mg bolus i.v. followed by 0.5 mg infused over 30 min; as a control, saline was given in random order. Diaphragm strength was assessed by measuring transdiaphragm pressure and by electromyography. Diaphragm fatigue was induced by breathing against an inspiratory resistance. The plasma concentration of vecuronium varied between 15 and 30 ng ml-1 15 min after administration of vecuronium was started. Peripheral neuromuscular block was not detected in any subject. Diaphragm fatigue developed within the same period in both groups: mean 334 (SD 166) s after saline and 345 (190) s after vecuronium. The electromyographic pattern of diaphragm fatigue and the time constant of relaxation of trans-diaphragm pressure after fatigue were similar in both groups. We conclude that, at low plasma concentrations of vecuronium, similar to those present in the postoperative period, there was no predisposition to diaphragm fatigue. C1 UNIV PARIS 12,HOP HENRI MONDOR,DEPT ANESTHESIA,F-94010 CRETEIL,FRANCE. UNIV PARIS 07,HOP BICHAT,DEPT RESP PHYSIOL,F-75018 PARIS,FRANCE. UNIV PARIS 07,HOP BICHAT,DEPT ANAESTHESIA,F-75018 PARIS,FRANCE. UNIV PARIS 07,HOP BEAUJON,PNEUMOL CLIN,INSERM,U226,F-92110 CLICHY,FRANCE. UNIV PARIS 05,HOP AMBROISE PARE,DEPT ANESTHESIA,F-92104 BOULOGNE,FRANCE. NR 18 TC 1 Z9 1 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 1992 VL 68 IS 4 BP 352 EP 355 DI 10.1093/bja/68.4.352 PG 4 WC Anesthesiology SC Anesthesiology GA HL956 UT WOS:A1992HL95600006 ER PT J AU SCHWARZ, LR WATKINS, JB AF SCHWARZ, LR WATKINS, JB TI UPTAKE OF TAUROCHOLATE, A VECURONIUM-LIKE ORGANIC CATION, ORG-9426, AND OUABAIN INTO CARCINOGEN-INDUCED DIPLOID AND POLYPLOID HEPATOCYTES OBTAINED BY CENTRIFUGAL ELUTRIATION SO BIOCHEMICAL PHARMACOLOGY LA English DT Article ID ISOLATED RAT HEPATOCYTES; BILE-ACID TRANSPORT; CARRIER-MEDIATED TRANSPORT; HEPATOMA-CELLS; FLOW-CYTOMETRY; LIVER-CELLS; CHOLIC-ACID; PRENEOPLASTIC HEPATOCYTES; PLASMA-MEMBRANE; TREATED RATS AB Bile acid uptake, an important function of differentiated hepatocytes, is decreased in hepatocellular carcinomas and gamma-glutamyltranspeptidase-positive, putatively preneoplastic hepatocytes. Whether hepatic uptake is also changed in carcinogen-induced diploid hepatocytes versus polyploid hepatocytes is unknown. The present study has determined whether the hepatic uptake of three model compounds, an anionic bile acid, an organic cation and a neutral organic compound, into diploid cells is different from that in polyploid hepatocytes. These two hepatocyte populations were separated from the parent freshly isolated hepatocyte suspension by centrifugal elutriation. Flow cytometric analysis indicated that the diploid fraction contained approximately 83% diploid cells and that the polyploid fraction had about 84% polyploid hepatocytes. Initial uptake velocity was determined for taurocholate (1-50-mu-M), ORG 9426 (20-400-mu-M), a vecuronium-like cation, and ouabain (20-500-mu-M). Apparent K(m) was not different between diploid and polyploid cells for the three tested substrates, whereas apparent V(max) was decreased in diploid hepatocytes for taurocholate and ouabain by 42 and 55%, respectively. There were no changes in the hepatic uptake of ORG 9426. These data indicate that uptake by the bile acid/multispecific carrier is compromised in carcinogen-induced diploid cells. C1 INDIANA UNIV,SCH MED,MED SCI PROGRAM,BLOOMINGTON,IN 47405. RP SCHWARZ, LR (reprint author), GESELL STRAHLEN & UMWELTFORSCH MBH,INST TOXIKOL,INGOLSTADTER LANDSTR 1,W-8042 NEUHERBERG,GERMANY. NR 48 TC 15 Z9 15 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 0006-2952 J9 BIOCHEM PHARMACOL JI Biochem. Pharmacol. PD MAR 17 PY 1992 VL 43 IS 6 BP 1195 EP 1201 DI 10.1016/0006-2952(92)90492-2 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA HM256 UT WOS:A1992HM25600004 ER PT J AU DIEFENBACH, C MELLINGHOFF, H LYNCH, J BUZELLO, W AF DIEFENBACH, C MELLINGHOFF, H LYNCH, J BUZELLO, W TI MIVACURIUM - DOSE-RESPONSE RELATIONSHIP AND ADMINISTRATION BY REPEATED INJECTION OR INFUSION SO ANESTHESIA AND ANALGESIA LA English DT Article ID NITROUS-OXIDE FENTANYL; NEUROMUSCULAR BLOCKADE; ENFLURANE ANESTHESIA; HALOTHANE ANESTHESIA; CHLORIDE BW-B1090U; VECURONIUM; PANCURONIUM; ATRACURIUM; SINGLE; BOLUS AB The dose-dependent relationship and neuromuscular blockade after infusion or repeated injection of mivacurium were studied in 65 patients in nitrous oxidenarcotic anesthesia. The ED95 (twitch tension) was determined in 45 patients by intravenous injection of a single bolus of 30, 39, 47, 54, or 60-mu-g/kg (9 patients per dose). Another 20 patients received an initial bolus of 2 x ED95 followed either by an infusion started at 5% twitch recovery (i.e., 95% depression) and adjusted to sustain 95% twitch depression (n = 10) or by repeated injection of 0.6 x ED95 whenever twitch tension had recovered to 25% of control (n = 10). Five patients in each of these two groups received 7-mu-g/kg of neostigmine at 25% twitch recovery, and the others recovered twitch tension spontaneously. The mean ED95 was 73-mu-g/kg. A 2 x ED95 bolus was followed by complete twitch depression within 2.2 +/- 0.7 min. The mean infusion rate resulted in 6 +/- 2-mu-g . kg-1 . min-1. The ensuing recovery index was 6 +/- 3 min. A 6 +/- 2 mer recovery index was found after up to 10 repeat injections given every 9 +/- 3 min. There was no significant effect of neostigmine in both groups. In conclusion, the recovery indices after the infusion or repeat injection of near-equal doses of mivacurium were identical. RP DIEFENBACH, C (reprint author), UNIV COLOGNE,DEPT ANESTHESIOL,JOSEPH STELZMANN STR 9,W-5000 COLOGNE 41,GERMANY. NR 23 TC 44 Z9 44 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1992 VL 74 IS 3 BP 420 EP 423 PG 4 WC Anesthesiology SC Anesthesiology GA HF475 UT WOS:A1992HF47500018 ER PT J AU MEHR, EH HIRSHMAN, CA LINDEMAN, KS AF MEHR, EH HIRSHMAN, CA LINDEMAN, KS TI MECHANISM OF ACTION OF ATRACURIUM ON AIRWAYS SO ANESTHESIOLOGY LA English DT Article DE ANTAGONISTS, HISTAMINE, CHLORPHENIRAMINE; RANITIDINE; BRONCHOCONSTRICTION, DRUG EFFECTS; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID HISTAMINE-RELEASE; COLLATERAL VENTILATION; PULMONARY RESISTANCE; MUSCLE-RELAXANTS; METHACHOLINE; DOGS; PANCURONIUM; ASTHMA; HYPERRESPONSIVENESS; H-2-RECEPTORS AB Histamine-releasing drugs may produce significant effects on airways in high-risk populations. To determine if clinically relevant doses of atracurium produce adverse effects on airways, we measured changes in airway resistance in the lung periphery of anesthetized Basenji-Greyhound dogs before and after intravenous (iv) administration of atracurium. A wedged bronchoscope technique was used to measure collateral system resistance (R(cs)). After a stable baseline was obtained, atracurium (1.2 or 0.5 mg/kg) or histamine (200-mu-g) were administered as an iv bolus, and percent increase in R(cs) was calculated. On separate days dogs were pretreated with the histamine 1 receptor antagonist, chlorpheniramine (0.2 mg/kg iv), with or without atropine (0.2 mg/kg iv) and ranitidine (0.75 mg/kg iv) and the experiment repeated. Histamine (200-mu-g) increased R(cs) 97 +/- 24% at 30 s (8 sublobar segments), whereas a second dose increased R(cs) 77 +/- 15%. Pretreatment with chlorpheniramine (0.2 mg/kg iv) totally prevented increases in R(cs) (9 sublobar segments). Atracurium (1.2 mg/kg) increased R(cs) to 174 +/- 35% at 3 min (14 sublobar segments), whereas 0.5 mg/kg had little effect (10 sublobar segments). A second bolus of atracurium (1.2 mg/kg) increased R(cs). to only 54 +/- 14% (P < 0.01). Chlorpheniramine pretreatment (0.2 mg/kg iv) reduced the response to the initial dose of atracurium to only 26 +/- 14% (10 sublobar segments). Pretreatment with a combination of atropine and chlorpheniramine (4 sublobar segments), or ranitidine and chlorpheniramine (5 sublobar segments), did not attenuate the increase in R(cs) significantly more than chlorpheniramine pretreatment alone. We conclude that atracurium produces airway constriction in Basenji-Greyhound dogs and that release of histamine acting on histamine1 receptors in the airways is important for this effect. C1 JOHNS HOPKINS MED INST,SCH HYG & PUBL HLTH,DEPT ANESTHESIOL,DIV PHYSIOL,ROOM 7006,615 N WOLFE ST,BALTIMORE,MD 21205. JOHNS HOPKINS MED INST,SCH HYG & PUBL HLTH,DEPT CRIT CARE MED,BALTIMORE,MD 21205. JOHNS HOPKINS MED INST,SCH HYG & PUBL HLTH,DEPT ENVIRONM HLTH SCI,BALTIMORE,MD 21205. NR 30 TC 11 Z9 11 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1992 VL 76 IS 3 BP 448 EP 454 DI 10.1097/00000542-199203000-00019 PG 7 WC Anesthesiology SC Anesthesiology GA HG476 UT WOS:A1992HG47600019 ER PT J AU ISONO, S KOCHI, T IDE, T SUGIMORI, K MIZUGUCHI, T NISHINO, T AF ISONO, S KOCHI, T IDE, T SUGIMORI, K MIZUGUCHI, T NISHINO, T TI DIFFERENTIAL-EFFECTS OF VECURONIUM ON DIAPHRAGM AND GENIOHYOID MUSCLE IN ANESTHETIZED DOGS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR BLOCKING AGENTS; VECURONIUM; RESPIRATORY MUSCLES; DIAPHRAGM; UPPER AIRWAY MUSCLES; GENIOHYOID ID ADDUCTOR POLLICIS; D-TUBOCURARINE; PANCURONIUM; HUMANS; SUCCINYLCHOLINE; CURARIZATION; HALOTHANE; ENFLURANE; RECOVERY; POTENCY AB We have examined the sensitivity of the geniohyoid, an upper airway dilating muscle, to vecuronium in 12 anaesthetized dogs undergoing mechanical ventilation of the lungs and compared it with that of the diaphragm. Dogs were allocated randomly to two groups: pentobarbitone alone (group 1, n = 7); pentobarbitone combined with 0.2 MAC (0.44%) of enflurane anaesthesia (group 2, n = 5). Supramaximal single twitch stimulations (0.1 Hz) were applied to the phrenic nerves in the upper thorax and the geniohyoid branches of the hypoglossal nerves at the neck. The evoked responses were assessed by the transdiaphragmatic pressure (Pdi) and the isometric force of the geniohyoid muscles (Tgh) until complete recovery of these variables after i.v. administration of vecuronium 0.02 mg kg-1. In both groups, the magnitude of the depression of twitch response was greater and time required to reach control amplitude was longer in the geniohyoid than the diaphragm. The depression of Tgh was significantly greater in group 2 than in group 1, whereas no change was observed in Pdi between the two groups. We conclude that the geniohyoid is more sensitive to vecuronium than the diaphragm and the differential effects of vecuronium are facilitated by a low concentration of enflurane. C1 NATL CANC HOSP,DEPT ANAESTHESIOL,TOKYO,JAPAN. CHIBA UNIV,SCH MED,DEPT ANAESTHESIOL,CHIBA,JAPAN. NR 27 TC 21 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 MAR PY 1992 VL 68 IS 3 BP 239 EP 243 DI 10.1093/bja/68.3.239 PG 5 WC Anesthesiology SC Anesthesiology GA HG234 UT WOS:A1992HG23400003 ER PT J AU LEBEDA, MD WEGRZYNOWICZ, ES WACHTEL, RE AF LEBEDA, MD WEGRZYNOWICZ, ES WACHTEL, RE TI PROPOFOL POTENTIATES BOTH PRESYNAPTIC AND POSTSYNAPTIC EFFECTS OF VECURONIUM IN THE RAT HEMIDIAPHRAGM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHETICS, INTRAVENOUS, PROPOFOL; NEUROMUSCULAR RELAXANTS, VECURONIUM; NEUROMUSCULAR TRANSMISSION, DRUG INTERACTION ID DIISOPROPYL PHENOL ICI-35868; PHARMACOKINETICS; DIPRIVAN; PHARMACODYNAMICS; SUXAMETHONIUM; PANCURONIUM; ANESTHETICS; ATRACURIUM AB We have measured twitch tension in response to train-of-four stimulation in rat isolated phrenic nerve-hemidiaphragm preparations. Propofol inhibited nerve evoked twitch tension, with 50% inhibition occurring at 420 (SD 29)-mu-mol litre-1. Although propofol 100-mu-mol litre-1 by itself had no effect on nerve evoked twitch tension, it potentiated the neuromuscular blocking effects of vecuronium. The decrease in train-of-four ratio with vecuronium was directly proportional to the degree of twitch inhibition, regardless of whether twitch was depressed by vecuronium alone or in combination with propofol. The finding that the train-of-four ratio was a function of the degree of block, rather than simply a function of vecuronium concentration, indicates that propofol also contributed to train-of-four fade and potentiated both pre- and postsynaptic effects of the neuromuscular blocker. The concentrations of propofol used in this study are much greater than human therapeutic blood concentrations, which are typically 25-35-mu-mol litre-1 (4-6-mu-g ml-1) immediately after a bolus dose of 2 mg kg-1, suggesting that neither muscle weakness nor potentiation of vecuronium-induced neuromuscular block should be of concern at propofol concentrations occurring clinically. C1 UNIV IOWA,COLL MED,DEPT ANESTHESIA,IOWA CITY,IA 52242. RP LEBEDA, MD (reprint author), VET ADM MED CTR,IOWA CITY,IA 52246, USA. NR 14 TC 15 Z9 16 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 1992 VL 68 IS 3 BP 282 EP 285 DI 10.1093/bja/68.3.282 PG 4 WC Anesthesiology SC Anesthesiology GA HG234 UT WOS:A1992HG23400013 ER PT J AU KLEYKAMP, H AF KLEYKAMP, H TI X-RAY-EMISSION WAVELENGTHS OF ARGON, KRYPTON, XENON, AND CURIUM SO ZEITSCHRIFT FUR NATURFORSCHUNG SECTION A-A JOURNAL OF PHYSICAL SCIENCES LA English DT Article AB The wavelengths of the L series of argon, krypton and xenon, the K series of argon, and the M series of curium were measured by means of wavelength dispersive X-ray microanalysis. The specimens for the investigations were TiC layers which had been HF sputtered under reduced argon pressure by the PVD method, krypton and xenon implanted zeolites, and a curium doped borosilicate glass. The obtained relative intensities of the X-ray emission lines were normalized to the maximum intensity of the line of the respective series. RP KLEYKAMP, H (reprint author), KERNFORSCHUNGSZENTRUM KARLSRUHE GMBH,INST MAT FORSCH,POSTFACH 3640,W-7500 KARLSRUHE 1,GERMANY. NR 5 TC 0 Z9 0 PU VERLAG Z NATURFORSCH PI TUBINGEN PA POSTFACH 2645, W-7400 TUBINGEN, GERMANY SN 0932-0784 J9 Z NATURFORSCH A JI Z. Naturfors. Sect. A-J. Phys. Sci. PD MAR PY 1992 VL 47 IS 3 BP 460 EP 462 PG 3 WC Chemistry, Physical; Physics, Multidisciplinary SC Chemistry; Physics GA HN678 UT WOS:A1992HN67800002 ER PT J AU HARROPGRIFFITHS, W FAUVEL, N PLUMLEY, M FELDMAN, S AF HARROPGRIFFITHS, W FAUVEL, N PLUMLEY, M FELDMAN, S TI PIPECURONIUM VERSUS HIGH-DOSE VECURONIUM .1. A COMPARISON OF SPEED OF ONSET AND CUMULATION DURING ISOFLURANE ANESTHESIA SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; PIPECURONIUM; VECURONIUM; ANESTHETICS; VOLATILE; ISOFLURANE ID INDUCED NEUROMUSCULAR BLOCKADE; HALOTHANE ANESTHESIA; NITROUS-OXIDE; PANCURONIUM; DURATION; FENTANYL; BROMIDE; HUMANS C1 WESTMINSTER MED SCH & HOSP,MAGILL DEPT ANAESTHESIA,LONDON SW1P 2AP,ENGLAND. RP HARROPGRIFFITHS, W (reprint author), ST MARYS HOSP,DEPT ANESTHESIA,PRAED ST,LONDON W2 1NY,ENGLAND. NR 9 TC 1 Z9 1 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD FEB PY 1992 VL 47 IS 2 BP 105 EP 106 DI 10.1111/j.1365-2044.1992.tb02003.x PG 2 WC Anesthesiology SC Anesthesiology GA HD327 UT WOS:A1992HD32700004 ER PT J AU HARROPGRIFFITHS, W PLATT, M HIRSCH, N FELDMAN, S AF HARROPGRIFFITHS, W PLATT, M HIRSCH, N FELDMAN, S TI PIPECURONIUM VERSUS HIGH-DOSE VECURONIUM .2. A COMPARISON OF SPEED OF ONSET AND CUMULATION DURING PROPOFOL ANESTHESIA SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR; RELAXANTS; PIPECURONIUM; VECURONIUM; ANESTHETICS; INTRAVENOUS; PROPOFOL ID INDUCED NEUROMUSCULAR BLOCKADE; HALOTHANE ANESTHESIA; NITROUS-OXIDE; ISOFLURANE; BROMIDE; FENTANYL; HUMANS C1 UCL NATL HOSP NEUROL & NEUROSURG, LONDON WC1, ENGLAND. WESTMINSTER MED SCH & HOSP, MAGILL DEPT ANAESTHESIA, LONDON SW1P 2AP, ENGLAND. RP HARROPGRIFFITHS, W (reprint author), ST MARYS HOSP, DEPT ANESTHESIA, PRAED ST, LONDON W2 1NY, ENGLAND. NR 8 TC 2 Z9 2 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD FEB PY 1992 VL 47 IS 2 BP 107 EP 109 DI 10.1111/j.1365-2044.1992.tb02004.x PG 3 WC Anesthesiology SC Anesthesiology GA HD327 UT WOS:A1992HD32700005 ER PT J AU CHEMTOB, S BARNA, T BEHARRY, K ARANDA, JV VARMA, DR AF CHEMTOB, S BARNA, T BEHARRY, K ARANDA, JV VARMA, DR TI ENHANCED CEREBRAL BLOOD-FLOW AUTOREGULATION IN THE NEWBORN PIGLET BY D-TUBOCURARINE AND PANCURONIUM BUT NOT BY VECURONIUM SO ANESTHESIOLOGY LA English DT Article DE BRAIN; BLOOD FLOW; NEUROMUSCULAR RELAXANTS, NONDEPOLARIZING; PANCURONIUM; D-TUBOCURARINE; VECURONIUM; SWINE; NEWBORN; SYMPATHETIC NERVOUS SYSTEM, GANGLION BLOCKERS; HEXAMETHONIUM ID AUTO-REGULATION; INTRAVENTRICULAR HEMORRHAGE; HYPERTENSION; RESPONSES; ARTERIES; HUMANS; NOREPINEPHRINE; PROSTAGLANDINS; HYPOTENSION; MECHANISMS AB Neuromuscular blockers may affect cerebral blood flow (CBF) regulation in the newborn. We studied the effects of d-tubocurarine (0.1 mg.kg-1, n = 8), pancuronium (0.1 and 0.4 mg.kg-1, n = 6 and 7), and vecuronium (0.1 and 0.4 mg.kg-1, n = 6 and 7) on CBF measured over the same range of mean systemic blood pressure ([BP] 15-122 mmHg) in each group of newborn pigs; controls received normal saline (n = 7). The levels of BP during hypotension and hypertension were scaled at intervals of 5 +/- 1.6 mmHg and adjusted by inflating balloon-tipped catheters placed in the aorta. After saline, the low dose of pancuronium (0.1 mg.kg-1), and the two doses of vecuronium, CBF was constant over the BP range of 50-90 mmHg (r = -0.07-0.35, P > 0.20) but varied directly with BP beyond this range (tau = 0.38 - 0.60, P < 0.05). In contrast, in pigs treated with d-tubocurarine and high-dose pancuronium, CBF remained constant from 35 to 122 mmHg of BP (r = 0.14 - 0.37, p > 0.10) and changed minimally (4-12%) with BP > 105 mmHg compared to the other groups (41-59%, P < 0.01). When BP was reduced below 30 mmHg, CBF also decreased less (20-38%) in animals treated with d-tubocurarine and high dose-pancuronium than after the other treatments (58-67%, P < 0.05). CBF autoregulation was also determined in pigs treated with the ganglion blocker, hexamethonium (1 mg.kg-1, n = 6); the relation between CBF and BP in these animals was almost identical to that observed with d-tubocurarine and high-dose pancuronium. Hexamethonium, d-tubocurarine, and high-dose pancuronium but not the other treatments attenuated the baroreceptor-mediated BP response to common carotid artery occlusion. In summary, neuromuscular blocking agents with ganglion blocking activity (d-tubocurarine and high-dose pancuronium) as well as the specific ganglion blocker hexamethonium enhanced CBF autoregulation, but agents more selective for the neuromuscular junction (vecuronium and low-dose pancuronium) did not alter CBF autoregulation of the newborn pig. C1 MCGILL UNIV,MONTREAL CHILDRENS HOSP,DEPT PEDIAT,MONTREAL H3H 1P3,QUEBEC,CANADA. MCGILL UNIV,MONTREAL CHILDRENS HOSP,DEPT PHARMACOL & THERAPEUT,MONTREAL H3H 1P3,QUEBEC,CANADA. UNIV IOWA,DEPT PEDIAT,IOWA CITY,IA 52242. UNIV MONTREAL,HOP ST JUSTINE,DEPT PHARMACOL,MONTREAL H3T 1C5,QUEBEC,CANADA. NR 49 TC 14 Z9 14 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD FEB PY 1992 VL 76 IS 2 BP 236 EP 244 DI 10.1097/00000542-199202000-00013 PG 9 WC Anesthesiology SC Anesthesiology GA HC458 UT WOS:A1992HC45800013 ER PT J AU ADT, M BAUMERT, JH REIMANN, HJ AF ADT, M BAUMERT, JH REIMANN, HJ TI THE ROLE OF HISTAMINE IN THE CARDIOVASCULAR EFFECTS OF ATRACURIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE COMPLICATIONS, CARDIOVASCULAR; HISTAMINE, RELEASE; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID H2-RECEPTOR ANTAGONISTS; RELEASE; ANESTHESIA; SURGERY; PREMEDICATION; H1-RECEPTOR; VECURONIUM; DRUGS; PANCURONIUM; INDUCTION AB We have investigated the effect of a bolus injection of atracurium 0.6 mg kg-1 on the cardiovascular system in 16 patients undergoing aortocoronary bypass surgery. H-1- and H-2-receptor antagonists were administered to eight patients before the neuromuscular blocker. A standard anaesthetic was used comprising fentanyl, flunitrazepam, etomidate and enflurane. After administration of atracurium, haemodynamic changes and plasma histamine concentrations were measured at frequent intervals. In the first group, who received only atracurium, a brief but marked decrease in SVR and MAP occurred, accompanied by an increase in Cl, together with a marked increase in plasma concentration of histamine. In the second group, who received H-1- and H-2-receptor block, there was no decrease in MAP and only a small increase in plasma histamine concentration. However, there were significant changes in SVR and Cl similar to those in the atracurium group. C1 UNIV WITTEN HERDECKE, FAK MED, WITTEN, GERMANY. RP ADT, M (reprint author), DEUTSCH HERZZENTRUM BERLIN, INST ANAESTHESIOL, AUGUSTENBERGER PLATZ 1, W-1000 BERLIN 65, GERMANY. NR 34 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 FEB PY 1992 VL 68 IS 2 BP 155 EP 160 DI 10.1093/bja/68.2.155 PG 6 WC Anesthesiology SC Anesthesiology GA HB892 UT WOS:A1992HB89200010 ER PT J AU BARAKA, A JABBOUR, S TABBOUSH, Z SIBAI, A BIJJANI, A KARAM, K AF BARAKA, A JABBOUR, S TABBOUSH, Z SIBAI, A BIJJANI, A KARAM, K TI ONSET OF VECURONIUM NEUROMUSCULAR BLOCK IS MORE RAPID IN PATIENTS UNDERGOING CESAREAN-SECTION SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHESIA, OBSTETRICAL; ANESTHETIC TECHNIQUES, INDUCTION; NEUROMUSCULAR RELAXANTS, VECURONIUM ID CESAREAN-SECTION; ORG NC-45; INTUBATION; SEQUENCE; KETAMINE; INDUCTION; WOMEN AB This investigation was carried out in ten patients undergoing elective Caesarean section and the results were compared with those of a control group of ten nonpregnant females of the same age group. The study investigated the onset of vecuronium neuromuscular block and the conditions of tracheal intubation when ketamine (1.5 mg.kg-1)-vecuronium 100-mu-g.kg-1) sequence was used for rapid-sequence induction of anaesthesia. The ulnar nerve was stimulated supra-maximally at the wrist with train-of-four stimuli every 20 sec, and the electromyographic response of the adductor pollicis muscle was displayed. The onset of 50% neuromuscular block as monitored by electromyography was shorter in the Caesarean group (80 +/- 30 sec) than in the control group (144 +/- 43 sec). The conditions of intubation at 50% block were adequate in both groups. Also, the onset of 90% block was shorter in the Caesarean group. The time of recovery to T1/control ratio of 25% was longer in the Caesarean group (46 +/- 10 min) than in the control patients (28 +/- 10 min). The results show that administration of vecuronium according to body weight results in a more rapid onset and delayed recovery of neuromuscular block in pregnant women undergoing Caesarean section than in the nonpregnant control patients. C1 AMER UNIV BEIRUT,DEPT OBSTET & GYNAECOL,BEIRUT,LEBANON. AMER UNIV BEIRUT,DEPT EPIDEMIOL & BIOSTAT,BEIRUT,LEBANON. RP BARAKA, A (reprint author), AMER UNIV BEIRUT,DEPT ANAESTHESIOL,BEIRUT,LEBANON. NR 23 TC 11 Z9 12 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD FEB PY 1992 VL 39 IS 2 BP 135 EP 138 PG 4 WC Anesthesiology SC Anesthesiology GA HC453 UT WOS:A1992HC45300007 ER PT J AU VANDERHEYDEN, BA REYNOLDS, HN GEROLD, KB EMANUELE, T AF VANDERHEYDEN, BA REYNOLDS, HN GEROLD, KB EMANUELE, T TI PROLONGED PARALYSIS AFTER LONG-TERM VECURONIUM INFUSION SO CRITICAL CARE MEDICINE LA English DT Article DE VECURONIUM; PARALYSIS; CRITICAL CARE; DRUG INTERACTIONS; NEUROMUSCULAR BLOCKING AGENTS; RESPIRATORY FAILURE; ADULT RESPIRATORY DISTRESS SYNDROME; BLOOD GAS ANALYSIS; INTENSIVE CARE UNIT; PERIPHERAL NERVE STIMULATORS ID INTENSIVE-CARE UNIT; NEUROMUSCULAR BLOCKADE; MUSCLE-RELAXATION; PANCURONIUM; PHARMACOKINETICS; DIAPHRAGM; BROMIDE C1 UNIV MARYLAND,MARYLAND INST EMERGENCY MED SERV SYST,MED SYST,DEPT CRIT CARE MED,BALTIMORE,MD 21201. RP VANDERHEYDEN, BA (reprint author), UNIV MARYLAND,DEPT PHARM SERV,MED SYST,22 S GREENE ST,BALTIMORE,MD 21201, USA. NR 23 TC 32 Z9 36 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD FEB PY 1992 VL 20 IS 2 BP 304 EP 307 DI 10.1097/00003246-199202000-00019 PG 4 WC Critical Care Medicine SC General & Internal Medicine GA HC983 UT WOS:A1992HC98300019 ER PT J AU MITAMURA, H MATSUMOTO, S HART, KP MIYAZAKI, T VANCE, ER TAMURA, Y TOGASHI, Y WHITE, TJ AF MITAMURA, H MATSUMOTO, S HART, KP MIYAZAKI, T VANCE, ER TAMURA, Y TOGASHI, Y WHITE, TJ TI AGING EFFECTS ON CURIUM-DOPED TITANATE CERAMIC CONTAINING SODIUM-BEARING HIGH-LEVEL NUCLEAR WASTE SO JOURNAL OF THE AMERICAN CERAMIC SOCIETY LA English DT Article ID SYNROC; DISSOLUTION; DAMAGE; PHASE; PEROVSKITE AB Curium-doped titanate ceramic containing sodium-rich high-level nuclear waste showed a gradual decrease in density up to a dose of 8.5 x 10(17) alpha decays.g-1. After that, the rate of density change increased apparently because of crack formation. Optical microscopy showed cracks > 0.1 mm long and > 1-mu-m wide after a dose of 7.9 x 10(17) alpha decays.g-1. Leach tests suggested that the dissolution-control phases for sodium and cesium changed from freudenbergite and hollandite, respectively, to intergranular phases after significant cracking. Aging also enhanced strontium losses, relative to calcium, indicating that strontium may also be partitioned to the intergranular phases. After the fresh surfaces produced by cracking were exposed to leachant, and the dissolution of soluble intergranular surfaces was complete, the leaching of nonradioactive elements from the samples having a dose of 12.3 x 10(17) alpha decays.g-1 was limited by the following dissolution-control phases: freudenbergite (Na), hollandite (Cs and Ba), perovskite and/or zirconolite (Sr and Ca), and alloys (Mo). The leaching behavior of the nonradioactive indicator elements revealed that chemical durability was reduced by two main factors: (1) increasing the effective surface area by crack formation and (2) decreasing the stability of the actinide-host phases by alpha-recoil damage. In combination these factors increased longer-term (> 7 days) leach rates of sodium and cesium, and strontium and calcium by 1 and 2 orders of magnitude, respectively. In spite of deterioration of the actinide-host phases, the curium leach rate after a dose of 12.3 x 10(17) alpha decays.g-1 decreased by 2 orders of magnitude, possibly as a result of precipitation of curium hydrolysis products. C1 JAPAN ATOM ENERGY RES INST,TOKAI,IBARAKI 31911,JAPAN. JAPAN ATOM ENERGY RES INST,DEPT HOT LABS,TOKAI,IBARAKI 31911,JAPAN. AUSTRALIAN NUCL SCI & TECHNOL ORG,LUCAS HEIGHTS RES LABS,ADV MAT PROGRAM,SUTHERLAND,NSW,AUSTRALIA. CHIYODA MAINTENANCE LTD,IBARAKI CTR,DEPT NUCL BUSINESS,ASAHI,IBARAKI 31414,JAPAN. UNIV QUEENSLAND,CTR ELECTRON MICROSCOPE,ST LUCIA,QLD 4067,AUSTRALIA. RP MITAMURA, H (reprint author), JAPAN ATOM ENERGY RES INST,DEPT ENVIRONM SAFETY RES,TOKAI,IBARAKI 31911,JAPAN. RI White, Tim/A-8145-2008 NR 36 TC 16 Z9 16 PU AMER CERAMIC SOC PI WESTERVILLE PA 735 CERAMIC PLACE, PO BOX 6136, WESTERVILLE, OH 43081-6136 SN 0002-7820 J9 J AM CERAM SOC JI J. Am. Ceram. Soc. PD FEB PY 1992 VL 75 IS 2 BP 392 EP 400 DI 10.1111/j.1151-2916.1992.tb08192.x PG 9 WC Materials Science, Ceramics SC Materials Science GA HE103 UT WOS:A1992HE10300018 ER PT J AU DUCHARME, J VARIN, F BEVAN, DR DONATI, F THEORET, Y AF DUCHARME, J VARIN, F BEVAN, DR DONATI, F THEORET, Y TI HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHY ELECTROCHEMICAL DETECTION OF VECURONIUM AND ITS METABOLITES IN HUMAN PLASMA SO JOURNAL OF CHROMATOGRAPHY-BIOMEDICAL APPLICATIONS LA English DT Article ID SOLID-PHASE EXTRACTION; ORG NC 45; ANESTHETIZED PATIENTS; PANCURONIUM-BROMIDE; BIOLOGICAL-FLUIDS; MASS-SPECTROMETRY; PHARMACOKINETICS; PHARMACODYNAMICS; DISPOSITION; ASSAY AB A high-performance liquid chromatographic assay coupled with electrochemical detection has been developed for the determination of vecuronium and its three putative deacetylated metabolites in human plasma. A novel solid-phase extraction procedure allowed good recovery of both vecuronium and its metabolites, together with ease and speed of execution. This method was sensitive, reproducible and accurate over the therapeutic range of concentrations of vecuronium and its metabolites, and was applied successfully to a study of the pharmacokinetics of vecuronium in anaesthetized patients. C1 UNIV MONTREAL,FAC PHARM,2900 EDOUARD MONTPETIT,SUCC A,CP 6128,MONTREAL H3C 3J7,QUEBEC,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 1A1,QUEBEC,CANADA. UNIV MONTREAL,DEPT PHARMACOL,MONTREAL H3C 3J7,QUEBEC,CANADA. NR 21 TC 22 Z9 24 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0378-4347 J9 J CHROMATOGR-BIOMED JI J. Chromatogr.-Biomed. Appl. PD JAN 3 PY 1992 VL 573 IS 1 BP 79 EP 86 DI 10.1016/0378-4347(92)80477-8 PG 8 WC Chemistry, Analytical SC Chemistry GA GZ453 UT WOS:A1992GZ45300012 ER PT J AU GOMEZIGLESIAS, E GARCIA, E SUAREZ, E MARTINEZ, R RODRIGUEZSASIAIN, JM CALVO, R AF GOMEZIGLESIAS, E GARCIA, E SUAREZ, E MARTINEZ, R RODRIGUEZSASIAIN, JM CALVO, R TI INVIVO POTENTIATION OF ATRACURIUM NEUROMUSCULAR BLOCKADE BY NIMODIPINE IN RABBITS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE DRUG INTERACTIONS; NIMODIPINE; NEUROMUSCULAR BLOCKING AGENTS; ATRACURIUM; RABBITS ID CONTROLLED TRIAL; VERAPAMIL; VECURONIUM; REVERSAL; PANCURONIUM; NEOSTIGMINE; EDROPHONIUM; NIFEDIPINE; CATS AB The interaction between nimodipine, a calcium channel blocker, used for the treatment of subarachnoid haemorrhage, and atracurium, was studied in rabbits. An intravenous dose of 0.1 mg.kg-1 of nimodipine given over 3 min caused a potentiation of the neuromuscular blocking action of atracurium (administered at an infusion rate of 7.5-mu-g.kg-1.min-1), measured on the indirectly stimulated tibialis-anterior muscle of the animal. (ED50)inf and (ED95)inf were significantly reduced (30.7% and 23.3%) in nimodipine-treated animals (P < 0.05 and P < 0.02, respectively). No changes were observed in recovery rate. RP GOMEZIGLESIAS, E (reprint author), UNIV BASQUE COUNTRY,FAC MED,DEPT PHARMACOL,LEIOA,SPAIN. NR 21 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 JAN PY 1992 VL 36 IS 1 BP 67 EP 69 PG 3 WC Anesthesiology SC Anesthesiology GA GZ923 UT WOS:A1992GZ92300013 ER PT J AU LEVY, JH ADELSON, D AF LEVY, JH ADELSON, D TI EFFECTS OF VECURONIUM-INDUCED HISTAMINE N-METHYLTRANSFERASE INHIBITION ON CUTANEOUS RESPONSES TO HISTAMINE SO AGENTS AND ACTIONS LA English DT Article; Proceedings Paper CT 20TH ANNUAL MEETING OF THE EUROPEAN HISTAMINE RESEARCH SOC CY MAY, 1991 CL MARBURG, GERMANY SP EUROPEAN HISTAMINE RES SOC AB All muscle relaxants inhibit histamine N-methyltransferase in vitro, but vecuronium, a steroid-derived muscle relaxant, is the most potent inhibitor. It has been suggested that administration of vecuronium prior to giving a drug that releases histamine may exaggerate the hemodynamic or vascular effects. Volunteers were injected intradermally with 5 x 10(-4) M concentrations of histamine, and the combination of vecuronium and histamine, to evaluate the in vivo significance. Vecuronium did not alter the measured wheal and flare responses to injected histamine at 5, 15, 30, 40, 50 and 60 mins. There is no evidence that inhibition of histamine N-methyltransferase in vivo will alter the vascular effects of histamine. C1 EMORY UNIV,SCH MED,DEPT ANESTHESIOL,ATLANTA,GA 30322. EMORY UNIV,SCH MED,DEPT DERMATOL,ATLANTA,GA 30322. EMORY UNIV CLIN,DIV CARDIOTHORAC ANESTHESIA,ATLANTA,GA 30322. NR 4 TC 0 Z9 0 PU BIRKHAUSER VERLAG AG PI BASEL PA PO BOX 133 KLOSTERBERG 23, CH-4010 BASEL, SWITZERLAND SN 0065-4299 J9 AGENTS ACTIONS JI Agents Actions PY 1992 SI CI BP C211 EP C212 PG 2 WC Chemistry, Multidisciplinary; Pharmacology & Pharmacy SC Chemistry; Pharmacology & Pharmacy GA JL227 UT WOS:A1992JL22700020 ER PT J AU TSAI, SK LIAO, KT LEE, CM AF TSAI, SK LIAO, KT LEE, CM TI MODIFICATION BY KETAMINE ON THE NEUROMUSCULAR ACTIONS OF MAGNESIUM, VECURONIUM, PANCURONIUM AND ALPHA-BUNGAROTOXIN IN THE PRIMATE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM; PANCURONIUM; INTERACTION, KETAMINE-RELAXANTS; ALPHA-BUNGAROTOXIN; AND MAGNESIUM SULFATE ID SUCCINYLCHOLINE; ACETYLCHOLINE; MUSCLE; BLOCK; RAT AB The neuromuscular effects of ketamine, at cumulative doses of 2.5 and 10 mg.kg-1 iv, were studied by electromyographically quantifying the thumb response evoked by ulnar nerve stimulation in 25 monkeys anaesthetized with pentobarbital-N2O-O2. Ketamine alone at these doses had no neuromuscular effects. When the EMG response was maintained at 50% of control by a continuous infusion of magnesium, vecuronium, or pancuronium, ketamine depressed the responses by an additional 13 +/- 3%, 34 +/- 7% and 32.5 +/- 3.3% (mean +/- SEM), respectively, at the highest dose, P < 0.05. In contrast, ketamine had no effect on the neuromuscular block produced by incremental doses of alpha-bungarotoxin. These results indicate that ketamine does not act on the postjunctional acetylcholine receptor. It plays a secondary role in neuromuscular block, possibly by prejunctional or postjunctional effects independent of receptor occupation. C1 UNIV CALIF LOS ANGELES,LOS ANGELES CTY HARBOR MED CTR,DEPT ANESTHESIOL,1000 W CARSON ST,TORRANCE,CA 90509. YANG MING MED COLL,TAIPEI,TAIWAN. VET GEN HOSP,TAIPEI,TAIWAN. NR 19 TC 1 Z9 2 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JAN PY 1992 VL 39 IS 1 BP 79 EP 82 PG 4 WC Anesthesiology SC Anesthesiology GA GX666 UT WOS:A1992GX66600017 ER PT J AU VANSTRAATEN, HLM RADEMAKER, CMA DEVRIES, LS AF VANSTRAATEN, HLM RADEMAKER, CMA DEVRIES, LS TI COMPARISON OF THE EFFECT OF MIDAZOLAM OR VECURONIUM ON BLOOD-PRESSURE AND CEREBRAL BLOOD-FLOW VELOCITY IN THE PREMATURE NEWBORN SO DEVELOPMENTAL PHARMACOLOGY AND THERAPEUTICS LA English DT Article DE CEREBRAL BLOOD FLOW VELOCITY; NEONATE; MIDAZOLAM; VECURONIUM ID PRETERM INFANTS; PULSED DOPPLER; PHARMACOKINETICS; ARTERY AB The effect of midazolam and vecuronium on mean arterial pressure (MAP) and mean cerebral blood flow velocity (MCBFV) was evaluated in premature infants (birthweight 550-2,560 g; gestational age 26-36 weeks) randomised to receive either 0.1 mg/kg midazolam (n = 7) or 0.05 mg/kg vecuronium (n = 8) intravenously. MAP, by means of an indwelling arterial cathether, and MCBFV, by means of noninvasive pulsed-Doppler of the middle cerebral artery, were measured every 5 min, starting at 10 min prior to until 1 h after drug administration. A transient 25-43% decrease in MCBFV (mean 0.06 m/s) dependent on a 8-23% decrease in blood pressure (mean 9 mm Hg) was noted in all patients within 15 min following administration of midazolam, which returned to baseline values within 1 h. In 2 out of 7 infants, a plasma expander was required. In contrast, vecuronium only decreased the MCBFV in 3 of 8 infants. Thus, a bolus of midazolam transiently decreased blood pressure and MCBFV, and should be used cautiously in sick preterm infants. C1 UNIV UTRECHT,CHILDRENS HOSP HET WILHELMINA KINDERZIEKENHUIS,DEPT NEONATOL,UTRECHT,NETHERLANDS. UNIV UTRECHT,CHILDRENS HOSP HET WILHELMINA KINDERZIEKENHUIS,DEPT HOSP PHARM,UTRECHT,NETHERLANDS. NR 15 TC 24 Z9 25 PU KARGER PI BASEL PA ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND SN 0379-8305 J9 DEV PHARMACOL THERAP JI Dev. Pharmacol. Ther. PY 1992 VL 19 IS 4 BP 191 EP 195 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA ML214 UT WOS:A1992ML21400004 ER PT J AU SANFILIPPO, M FIERRO, G VILARDI, V ROSA, G DEGREGORIO, AL GASPARETTO, A AF SANFILIPPO, M FIERRO, G VILARDI, V ROSA, G DEGREGORIO, AL GASPARETTO, A TI CLINICAL-EVALUATION OF DIFFERENT DOSES OF PIPECURONIUM BROMIDE DURING NITROUS-OXIDE FENTANYL ANESTHESIA IN ADULT SURGICAL PATIENTS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANT; PIPECURONIUM AB The neuromuscular and cardiovascular effects of three different doses of pipecuronium were studied in 60 adult patients. Neuromuscular blockade was measured using electromyographic activity of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at 0.1 Hz and 2 Hz. Three subgroups (A,B,C) of 20 patients received pipecuronium doses of 60, 80 and 100-mu-g kg-1, respectively, as an intubating dose and, when necessary, maintenance doses were administered at 25% single twitch recovery in a dose of one-quarter of the initial one. The onset time was 5.4 +/- 2.0 min for 60-mu-g kg-1 and similar for 80 and 100-mu-g kg-1 (3.9 +/- 1.1 and 3.6 +/- 1.1 min). The duration of action was 45 +/- 10 min for 60-mu-g kg-1, 74 +/- 25 and 94 +/- 21 for 80 and 100-mu-g kg-1, respectively. The recovery indices were measured in all patients after neostigmine administration (Groups B and C) and after neostigmine and edrophonium (Subgroup A, 10 patients each). TOF ratio was significant only 2 min after edrophonium administration in Group A patients. Variations of heart rate and blood pressure were not significant. RP SANFILIPPO, M (reprint author), POLICLIN ROME UMBERTO 1,IST ANESTESIA & RIANIMAZ,VIALE POLICLIN,I-00161 ROME,ITALY. NR 0 TC 2 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 1992 VL 9 IS 1 BP 49 EP 53 PG 5 WC Anesthesiology SC Anesthesiology GA GW650 UT WOS:A1992GW65000008 ER PT J AU OCANA, M DELPOZO, E CARLOS, R BAEYENS, JM AF OCANA, M DELPOZO, E CARLOS, R BAEYENS, JM TI DIFFERENTIAL POTENTIATION BY CALCIUM-ANTAGONISTS OF NEUROMUSCULAR BLOCKADE INDUCED BY PANCURONIUM AND SUCCINYLCHOLINE IN CATS INVIVO SO JOURNAL OF NEURAL TRANSMISSION-GENERAL SECTION LA English DT Article DE CALCIUM ANTAGONISTS; NEUROMUSCULAR BLOCKING DRUGS; CALCIUM CHANNELS; VERAPAMIL; DILTIAZEM; NICARDIPINE; PANCURONIUM; SUCCINYLCHOLINE ID NERVE-HEMIDIAPHRAGM PREPARATION; CHANNEL BLOCKERS; BAY K-8644; VERAPAMIL; ACETYLCHOLINE; SUXAMETHONIUM; NICARDIPINE; VECURONIUM; RESPONSES; MUSCLE AB The effects of several calcium antagonists (verapamil, nicardipine and two diltiazem isomers, d-cis and l-cis diltiazem) alone and associated to non-depolarizing (pancuronium) and depolarizing (succinylcholine) neuromuscular blockers, were evaluated on sciatic nerve-tibialis anterior muscle preparations from cats in vivo. The calcium antagonists used (at 0.1 and 0.5 mg/kg iv) did not modify the height of muscular twitches elicited indirectly. However, these agents potentiated in a dose-dependent way the neuromuscular blockade induced by iv pancuronium (2-40-mu-g/kg) and succinylcholine (6-200-mu-g/kg). The order of potency in increasing the effects of pancuronium was nicardipine much greater than d-cis diltiazem greater-than-or-equal-to verapamil, whereas the order of potency in enhancing succinylcholine effects was d-cis diltiazem greater-than-or-equal-to verapamil much greater than nicardipine. The effects of diltiazem were stereoselective, thus the potentiation induced by d-cis diltiazem was significantly greater in all cases than that induced by l-cis diltiazem, which suggests that calcium channel blockade plays a role in these interactions. However, other mechanisms such as calcium antagonists-induced nicotinic receptor desensitization may also be involved. C1 UNIV GRANADA,DEPT PHARMACOL,AVDA S-N,E-18012 GRANADA,SPAIN. NR 44 TC 0 Z9 0 PU SPRINGER-VERLAG WIEN PI VIENNA PA SACHSENPLATZ 4-6, PO BOX 89, A-1201 VIENNA, AUSTRIA SN 0300-9564 J9 J NEURAL TRANSM-GEN JI J. Neural Transm.-Gen. Sect. PY 1992 VL 88 IS 3 BP 223 EP 234 DI 10.1007/BF01244734 PG 12 WC Neurosciences SC Neurosciences & Neurology GA JD606 UT WOS:A1992JD60600005 ER PT J AU LATROUS, H OLIVER, J AF LATROUS, H OLIVER, J TI SELF-DIFFUSION COEFFICIENTS AND STRUCTURE OF THE TRIVALENT TRANSPLUTONIUM ION CURIUM AND GADOLINIUM IN AQUEOUS-SOLUTION SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY-ARTICLES LA English DT Article; Proceedings Paper CT 3RD INTERNATIONAL CONF ON LOW-LEVEL MEASUREMENTS OF ACTINIDES AND LONG-LIVED RADIONUCLIDES IN BIOLOGICAL AND ENVIRONMENTAL SAMPLES CY JAN 29-FEB 02, 1990 CL BOMBAY, INDIA SP NATL SCI FDN, COUNCIL SCI & IND RES INDIA, BOMBAY UNIV, US DOE, MAHARASHTRA GOVT, DEPT ATOM ENERGY INDIA, NUCL POWER COMMISS INDIA, INDIAN ASSOC NUCL CHEMISTS & ALLIED SCI, DEPT SCI & TECHNOL INDIA, UNIV GRANTS COMMISS INDIA ID ELECTROLYTE-SOLUTIONS; HYDRATED RADII; ACTINIDE IONS AB Self-diffusion coefficients D of the trivalent aquo ion Cm3+ have been determined in aqeous Nd(ClO4)3-HClO4 solutions (pH 2.5) at 25-degrees-C, by the open-end capillary method (O. E. C. M.). The variation of D versus the square root of the concentration of inactive solution is an exponential form in the studied range of concentration. The limiting value D0 at zero ionic strength is 6.0.10(-6) cm2.s-1. The curve D = f(square-root c) relating to Cm3+ can be compared to those of Am-241(3+) and Gd-153(3+) obtained under similar conditions. We find a similar ionic structure of Cm3+ with Am3+ and Gd3+. They have the same hydration as a tripositive of 5f and 4f ions in the absence of hydrolysis, complexing, or pairing at pH 2.5. The present study contributes to show the analogy of the solvation structure of trivalent actinide ions in aqueous solution at pH 2.5 with that of the trivalent lanthanide ions as a help for predicting the thermodynamic properties. C1 OAK RIDGE NATL LAB,OAK RIDGE,TN 37830. RP LATROUS, H (reprint author), FAC SCI TUNIS,CHIM ANALYT & DIFFUS LAB,TUNIS,TUNISIA. NR 24 TC 8 Z9 8 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0236-5731 J9 J RADIOAN NUCL CH AR JI J. Radioanal. Nucl. Chem.-Artic. PD JAN PY 1992 VL 156 IS 2 BP 291 EP 296 DI 10.1007/BF02038345 PG 6 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA HD796 UT WOS:A1992HD79600005 ER PT J AU LARIJANI, GE GRATZ, I MINASSIAN, SS HUGHES, DL AFSHAR, M KARAYANNIS, BN AF LARIJANI, GE GRATZ, I MINASSIAN, SS HUGHES, DL AFSHAR, M KARAYANNIS, BN TI COMPARATIVE-EVALUATION OF THE NEUROMUSCULAR AND CARDIOVASCULAR EFFECTS OF PIPECURONIUM, PANCURONIUM, ATRACURIUM, AND VECURONIUM UNDER ISFLURANE ANESTHESIA SO PHARMACOTHERAPY LA English DT Article ID CLINICAL-PHARMACOLOGY; BLOCKING-AGENTS; ORG NC45; PHARMACOKINETICS; HALOTHANE; BROMIDE; PHARMACODYNAMICS; ISOFLURANE; HUMANS AB The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80-mu-g/kg, pancuronium 100-mu-g/kg, atracurium 500-mu-g/kg, and vecuronium 100-mu-g/kg were compared in 62 patients Under isoflurane (end-tidal concentration = 0.5-1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular-blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular-blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium. C1 MED COLL PENN,DEPT ANESTHESIOL,PHILADELPHIA,PA 19129. MED COLL PENN,DEPT OBSTET & GYNECOL,PHILADELPHIA,PA 19129. MED COLL PENN,DEPT PHARMACOL,PHILADELPHIA,PA 19129. NR 23 TC 11 Z9 12 PU PHARMACOTHERAPY PUBLICATIONS INC PI BOSTON PA NEW ENGLAND MEDICAL CENTER BOX 806 171 HARRISON AVE, BOSTON, MA 02111 SN 0277-0008 J9 PHARMACOTHERAPY JI Pharmacotherapy PY 1992 VL 12 IS 4 BP 278 EP 282 PG 5 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA JH556 UT WOS:A1992JH55600003 ER PT J AU WIMMER, H KLENZE, R KIM, JI AF WIMMER, H KLENZE, R KIM, JI TI A STUDY OF HYDROLYSIS REACTION OF CURIUM(III) BY TIME RESOLVED LASER FLUORESCENCE SPECTROSCOPY SO RADIOCHIMICA ACTA LA English DT Article DE CM3+; FLUORESCENCE; TIME RESOLVED LASER SPECTROSCOPY; HYDROLYSIS CONSTANTS ID AM(III); CONSTANTS AB The hydrolysis reaction of Cm3+ has been investigated by time resolved laser fluorescence spectroscopy (TRLFS) in 0.1 M NaClO4 at 25-degrees-C under argon atmosphere. The experiment is carried out in the pH range from 6 to 10 for Cm(III) concentrations from 1.21 x 10(-7) mol/l down to 3 x 10(-9) mol/l, which are substantially lower than solubility limits of the curium hydroxide at each given pH. The primary and secondary hydrolysis constants determined are: log-beta-11 = 6.67 +/- 0.18 for CmOH2+ and log-beta-12 = 12.06 +/- 0.28 for Cm(OH)2+. These values are found to be in good agreement with the corresponding hydrolysis constants of Am3+ determined previously in our laboratory by the solubility experiment. However, the present values are one or many orders of magnitude smaller than the data known for Cm(III) in the literature. RP WIMMER, H (reprint author), TECH UNIV MUNICH,INST RADIOCHEM,W-8046 GARCHING,GERMANY. NR 25 TC 55 Z9 55 PU R OLDENBOURG VERLAG PI MUNICH 80 PA ROSENHEIMER STR 145 POSTFACH 801360, W-8000 MUNICH 80, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 1992 VL 56 IS 2 BP 79 EP 83 PG 5 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA HQ990 UT WOS:A1992HQ99000004 ER PT J AU DONALDSON, LL HOLLAND, M KOCH, SA AF DONALDSON, LL HOLLAND, M KOCH, SA TI ATRACURIUM AS AN ADJUNCT TO HALOTHANE-OXYGEN ANESTHESIA IN A LLAMA UNDERGOING INTRAOCULAR SURGERY - A CASE-REPORT SO VETERINARY SURGERY LA English DT Article ID PSEUDOCHOLINESTERASE ACTIVITY; PANCURONIUM; NEOSTIGMINE; EDROPHONIUM; PHARMACOLOGY; ANTAGONISTS; HYDROLYSIS; REVERSAL; XYLAZINE; HORSES AB Atracurium (0.2 mg/kg intravenously [IV]) was administered to a llama anesthetized with halothane in oxygen, to insure immobilization of the globe during intraocular surgery. Recovery of neuromuscular function was facilitated by administration of edrophonium (0.5 mg/kg IV). C1 VIRGINIA MARYLAND REG COLL VET MED,BLACKSBURG,VA. ANIM EYE CLIN,SPRINGFIELD,VA. RP DONALDSON, LL (reprint author), MARION DUPONT SCOTT EQUINE MED CTR,POB 1938,LEESBURG,VA 22075, USA. NR 20 TC 5 Z9 5 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 SN 0161-3499 J9 VET SURG JI Vet. Surg. PD JAN-FEB PY 1992 VL 21 IS 1 BP 76 EP 79 DI 10.1111/j.1532-950X.1992.tb00016.x PG 4 WC Veterinary Sciences SC Veterinary Sciences GA GZ527 UT WOS:A1992GZ52700012 ER PT J AU OKELLY, B JAYAIS, P VEROLI, P LHUISSIER, C ECOFFEY, C AF OKELLY, B JAYAIS, P VEROLI, P LHUISSIER, C ECOFFEY, C TI DOSE REQUIREMENTS OF VECURONIUM, PANCURONIUM, AND ATRACURIUM DURING ORTHOTOPIC LIVER-TRANSPLANTATION SO ANESTHESIA AND ANALGESIA LA English DT Article ID ANESTHETIZED HUMANS; RENAL-FAILURE; ORG NC45; PHARMACOKINETICS; PHARMACODYNAMICS; DISPOSITION; CIRRHOSIS; KINETICS; BROMIDE AB To further elucidate the role of the liver in the clearance of vecuronium, atracurium, and pancuronium, 30 patients undergoing orthotopic liver transplantation were randomly assigned to three comparable groups to receive a continuous infusion of vecuronium, atracurium, or pancuronium. The evoked integrated compound action potential of the hypothenar eminence in response to train-of-four ulnar nerve stimulation was measured and recorded. Anesthesia was induced with 3-5 mg/kg of thiopental, 50-mu-g/kg of midazolam, and 1-5-mu-g/kg of fentanyl IV and was maintained with continuous infusions of midazolam and fentanyl while the lungs were ventilated with an air-oxygen mixture. The infusion rates of vecuronium, atracurium, and pancuronium were adjusted to achieve a T1/Tc ratio of between 0.02 and 0.10 (T1 = height of first twitch, Tc = height of control twitch). Vecuronium and pancuronium requirements, which were 0.072 +/- 0.022 and 0.042 +/- 0.015 mg.kg-1.h-1 (mean +/- standard deviation) respectively during the dissection phase, decreased significantly during the anhepatic phase to 0.036 +/- 0.021 and 0.018 +/- 0.012 mg.kg-1.h-1 and returned toward the initial values in the postreperfusion phase (0.055 +/- 0.018 and 0.032 +/- 0.012 mg.kg.1.h-1); whereas atracurium requirements remained unchanged during the three phases (0.667 +/- 0.199, 0.567 +/- 0.142, and 0.692 +/- 0.254 mg.kg-1.h-1). These data suggest that the liver has an important role in the elimination of vecuronium and pancuronium, whereas the elimination of atracurium is unaltered during exclusion of the liver from the circulation. C1 UNIV PARIS SUD,HOP PAUL BROUSSE,DEPT ANESTHESIE REANIMAT,VILLEJUIF,FRANCE. NR 22 TC 12 Z9 12 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1991 VL 73 IS 6 BP 794 EP 798 PG 5 WC Anesthesiology SC Anesthesiology GA GR648 UT WOS:A1991GR64800020 ER PT J AU HORROW, JC ABRAMS, JT VANRIPER, DF LAMBSON, DL STORELLA, RJ AF HORROW, JC ABRAMS, JT VANRIPER, DF LAMBSON, DL STORELLA, RJ TI VENTILATORY COMPLIANCE AFTER 3 SUFENTANIL PANCURONIUM INDUCTION SEQUENCES SO ANESTHESIOLOGY LA English DT Article DE ANALGESICS, OPIOID, SUFENTANIL; COMPLICATIONS, AIRWAY OBSTRUCTION; CHEST RIGIDITY; LUNGS, COMPLIANCE; NEUROMUSCULAR RELAXANTS, PANCURONIUM; VENTILATION, AIRWAY PRESSURE ID DOSE FENTANYL ANESTHESIA; INDUCED MUSCLE RIGIDITY; NITROUS-OXIDE; ALFENTANIL AB Poor ventilatory compliance, a predictable side effect of high-dose opioid induction techniques, is purportedly blunted by pretreatment with nondepolarizing muscle relaxant. This study used both total compliance and a subjective compliance score to compare three different sequences of opioid induction using a 2-min infusion of sufentanil 3-mu-g.kg-1. Nineteen patients in each of three groups received a total of 100-mu-g.kg-1 of pancuronium, in the following randomized double-blinded fashion: control, all pancuronium 1 min after sufentanil; pretreated, 1 mg pancuronium 1 min before sufentanil and the balance of pancuronium 1 min after sufentanil; and mixed, all pancuronium mixed with sufentanil. Topical lidocaine prior to induction permitted early oral airway insertion midway through the sufentanil infusion. Immediately at the conclusion of sufentanil infusion, a tightly fitted mask, anterior jaw thrust, and mechanical ventilator permitted measurement of plateau airway pressure and exhaled volume in five replicates. Pressure and volume measurements were repeated 5 min later. Total compliance was calculated as the median plateau airway pressure divided into its associated exhaled volume. Groups did not differ in demographics. In one control patient and two pretreated patients hemoglobin oxygen saturation as measured by pulse oximetry decreased below 90%. Immediately after sufentanil infusion, the total compliance for control patients of 4.1 mg.cmH2O-1 (mean [2.6-6.5, 95% confidence interval]) did not differ from that of the pretreated group (6.3 [3.5-11.4] ml.cmH2O-1), but the mixed group exhibited higher compliance (40.3 [33.8-47.9] ml.cmH2O-1) than the other groups (P < 10(-8). All groups achieved similar total compliances several minutes after a total of 100-mu-g.kg-1 pancuronium had been administered. Subjective compliance scores (0, 1, 2, or 3) agreed with objective data in all comparisons. Pretreatment with pancuronium did not effectively prevent the difficulty in ventilation associated with anesthesia induction using moderate-dose sufentanil. However, concomitant infusion of sufentanil and pancuronium substantially improved compliance, measured both subjectively and objectively, without causing early paralysis in suitably premedicated patients. RP HORROW, JC (reprint author), HAHNEMANN UNIV,DEPT ANESTHESIOL,BROAD & VINE ST,PHILADELPHIA,PA 19102, USA. NR 25 TC 12 Z9 12 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD DEC PY 1991 VL 75 IS 6 BP 969 EP 974 DI 10.1097/00000542-199112000-00007 PG 6 WC Anesthesiology SC Anesthesiology GA GV115 UT WOS:A1991GV11500007 ER PT J AU ROSSITER, A SOUNEY, PF MCGOWAN, S CARVAJAL, P AF ROSSITER, A SOUNEY, PF MCGOWAN, S CARVAJAL, P TI PANCURONIUM-INDUCED PROLONGED NEUROMUSCULAR BLOCKADE SO CRITICAL CARE MEDICINE LA English DT Article DE PANCURONIUM; PARALYSIS; ATROPHY; DRUG INTERACTIONS; NEUROMUSCULAR BLOCKING AGENT; MUSCLE RELAXATION; MECHANICAL VENTILATION; GUILLAIN BARRE SYNDROME; ELECTROMYOGRAPHY; CRITICAL CARE ID GUILLAIN-BARRE-SYNDROME; STATUS-ASTHMATICUS; BLOCKING; BROMIDE; MUSCLE; CORTICOSTEROIDS; JUNCTION; ATROPHY; FAILURE; THERAPY C1 HARVARD UNIV,SCH MED,DEPT BIOL CHEM & MOLEC BIOL,BOSTON,MA 02115. HARVARD UNIV,SCH MED,DEPT PHARM SERV,BOSTON,MA 02115. HARVARD UNIV,SCH MED,DEPT RISK MANAGEMENT & PHYS SERV,BOSTON,MA 02115. BRIGHAM & WOMENS HOSP,DEPT PHYS THERAPY,BOSTON,MA 02115. RP SOUNEY, PF (reprint author), BRIGHAM & WOMENS HOSP,DEPT PHARM,75 FRANCIS ST,BOSTON,MA 02115, USA. NR 31 TC 50 Z9 54 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD DEC PY 1991 VL 19 IS 12 BP 1583 EP 1587 DI 10.1097/00003246-199112000-00023 PG 5 WC Critical Care Medicine SC General & Internal Medicine GA GV376 UT WOS:A1991GV37600023 ER PT J AU ROSA, G SANFILIPPO, M ORFEI, P DIGIUGNO, G VILARDI, V OPPIDO, PA GASPARETTO, A AF ROSA, G SANFILIPPO, M ORFEI, P DIGIUGNO, G VILARDI, V OPPIDO, PA GASPARETTO, A TI THE EFFECTS OF PIPECURONIUM BROMIDE ON INTRACRANIAL-PRESSURE AND CEREBRAL PERFUSION-PRESSURE SO JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY LA English DT Article DE MUSCULAR RELAXANTS; PIPECURONIUM; ICP; CPP ID NEUROSURGICAL PATIENTS; ATRACURIUM; VECURONIUM; PANCURONIUM AB Twenty patients with expansive pathologic intracranial lesions, who were anesthetized with thiopental, nitrous oxide in oxygen, and fentanyl and mechanically ventilated to ensure normocarbia, received pipecuronium bromide 70-mu-g/kg i.v. Intracranial pressure (ICP), heart rate, arterial pressure, central venous pressure (CVP), EKG, and end-tidal CO2 were simultaneously recorded for 5 min before and for 15 min after administration of the muscle relaxant. No statistically significant changes in ICP and cerebral perfusion pressure were observed after administration of pipecuronium bromide. Cardiovascular stability was maintained during the study period except for a small, although significant, decrease of the CVP from 5.7 +/- 2.5 (SEM) to 5.0 +/- 2.5 mm Hg. These results, together with the long-lasting muscular effect of pipecuronium bromide, suggest that this new neuromuscular blocking agent may be used for muscle relaxation during neurosurgical operations in patients who have normal intracranial pressure at the time of administration of the drug. C1 STATE UNIV ROME LA SAPIENZA,DEPT ANESTHESIOL & INTENS CARE,ROME,ITALY. NR 24 TC 0 Z9 0 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0898-4921 J9 J NEUROSURG ANESTH JI J. Neurosurg. Anesthesiol. PD DEC PY 1991 VL 3 IS 4 BP 253 EP 257 DI 10.1097/00008506-199112000-00002 PG 5 WC Anesthesiology; Clinical Neurology; Surgery SC Anesthesiology; Neurosciences & Neurology; Surgery GA GR921 UT WOS:A1991GR92100002 ER PT J AU BESSER, R VOGT, T GUTMANN, L WESSLER, I AF BESSER, R VOGT, T GUTMANN, L WESSLER, I TI HIGH PANCURONIUM SENSITIVITY OF AXONAL NICOTINIC-ACETYLCHOLINE RECEPTORS IN HUMANS DURING ORGANOPHOSPHATE INTOXICATION SO MUSCLE & NERVE LA English DT Article DE ORGANOPHOSPHATES; NEUROMUSCULAR TRANSMISSION; ACETYLCHOLINESTERASE INHIBITION; PANCURONIUM ID RAT PHRENIC-NERVE; DIAPHRAGM PREPARATIONS; TWITCH POTENTIATION; PARAOXON AB The effect of low-dose pancuronium on neuromuscular transmission was studied in 2 patients during the early and late stages of severe organophosphate intoxication. Single evoked compound muscle action potentials (CMAP) were followed by repetitive discharges and a decrement-increment (D-I) phenomenon with 10-, 20-, and 50-Hz supramaximal nerve stimulation. Intravenous pancuronium, 1 mg, abolished the D-I phenomenon, while the repetitive discharges of the CMAP were only partially reduced. It is postulated, that the disappearance of the D-I phenomenon with persistence of the CMAP repetitive discharges results from blockade of nicotinic-acetylcholine receptors located on the terminal axon responsible for stimulus-induced antidromic backfiring. This response to a very low dose of pancuronium indicates a high sensitivity of the axonal nicotinic-acetylcholine receptor to pancuronium in humans, as had been previously postulated from animal experiments. C1 UNIV MAINZ,INST PHARMACOL,W-6500 MAINZ,GERMANY. W VIRGINIA UNIV,MED CTR,SCH MED,DEPT NEUROL,MORGANTOWN,WV 26506. RP BESSER, R (reprint author), UNIV MAINZ,DEPT NEUROL,LANGENBECKSTR 1,W-6500 MAINZ,GERMANY. NR 15 TC 8 Z9 8 PU JOHN WILEY & SONS INC PI NEW YORK PA 605 THIRD AVE, NEW YORK, NY 10158-0012 SN 0148-639X J9 MUSCLE NERVE JI Muscle Nerve PD DEC PY 1991 VL 14 IS 12 BP 1197 EP 1201 DI 10.1002/mus.880141210 PG 5 WC Clinical Neurology; Neurosciences SC Neurosciences & Neurology GA GU248 UT WOS:A1991GU24800008 ER PT J AU MOULIN, C DECAMBOX, P MAUCHIEN, P AF MOULIN, C DECAMBOX, P MAUCHIEN, P TI DETERMINATION OF CURIUM AT 0.1 NG 1-1 LEVELS IN A MICELLAR MEDIUM BY TIME-RESOLVED LASER-INDUCED SPECTROFLUORIMETRY SO ANALYTICA CHIMICA ACTA LA English DT Article DE FLUOROMETRY; CURIUM; MICELLAR MEDIA ID INDUCED FLUORESCENCE; URANIUM; EUROPIUM; SAMARIUM; TERBIUM; OXIDE; IONS AB Time-resolved laser-induced spectrofluorimetry was used for the determination of curium complexed with thenoyltrifluoroacetone (TTA) and tri-n-octylphosphine oxide (TOPO) in a non-ionic micellar medium (Triton X-100). The results obtained were compared with those obtained in carbonate medium. With suitable complexing reagents concentration and pH, curium can be determined at concentrations down to 5 x 10(-13) M. This limit of detection corresponds to 0.1 ng l-1 or 2 x 10(7) molecules in the interaction volume. Limitations and improvements to the system in terms of limit of detection are discussed. RP MOULIN, C (reprint author), CEA,DCC,DPE,SPEA,SPS LASER SPECTROSCOPY GRP,BP 6,F-92265 FONTENAY ROSES,FRANCE. RI Moulin, christophe/G-3895-2010 NR 23 TC 24 Z9 24 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 NOV 20 PY 1991 VL 254 IS 1-2 BP 145 EP 151 DI 10.1016/0003-2670(91)90020-6 PG 7 WC Chemistry, Analytical SC Chemistry GA GT069 UT WOS:A1991GT06900019 ER PT J AU SHEARER, ES OSULLIVAN, EP HUNTER, JM AF SHEARER, ES OSULLIVAN, EP HUNTER, JM TI CLEARANCE OF ATRACURIUM AND LAUDANOSINE IN THE URINE AND BY CONTINUOUS VENOVENOUS HEMOFILTRATION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE INTENSIVE CARE, HEMOFILTRATION; KIDNEY, URINARY CLEARANCE; LAUDANOSINE; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID CONTINUOUS ARTERIOVENOUS HEMOFILTRATION; PHARMACOKINETICS; REMOVAL; FAILURE; PLASMA; DRUGS AB We have measured the steady state urinary clearances of atracurium, given by constant infusion, and laudanosine in eight patients undergoing artificial ventilation; all had normal renal function (mean creatinine clearance 81 ml min-1). Mean (SD) urinary clearance of atracurium was 0.55 (0.5) ml kg-1 min-1; that of laudanosine was 0.33 (0.2) ml kg-1 min-1. Simultaneous plasma clearances were 7.1 (1.4) ml kg-1 min-1 and 3.8 (1.5) ml kg-1 min-1, respectively. Notional haemofiltration clearances of the two substances were measured also in seven critically ill patients with renal and respiratory failure undergoing continuous venovenous haemofiltration. Mean (SD) clearances of atracurium and laudanosine in the haemofiltrate fluid were 0.11 (0.06) ml kg-1 min-1 and 0.09 (0.02) ml kg-1 min-1, respectively whilst plasma clearances were atracurium 6.7 (1.8) ml kg-1 min-1 and laudanosine 4.5 (1.8) ml kg-1 min-1. There were no significant differences between the plasma clearances of the drugs in the two groups, despite the difference in severity of sickness. Urinary clearance rates of atracurium and laudanosine were approximately 8 and 9% of that in the plasma, but the haemofiltration clearance of both substances was only 2%. RP SHEARER, ES (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 15 TC 18 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 NOV PY 1991 VL 67 IS 5 BP 569 EP 573 DI 10.1093/bja/67.5.569 PG 5 WC Anesthesiology SC Anesthesiology GA GP137 UT WOS:A1991GP13700011 ER PT J AU BRAUDE, N VYVYAN, HAL JORDAN, MJ AF BRAUDE, N VYVYAN, HAL JORDAN, MJ TI INTRAOPERATIVE ASSESSMENT OF ATRACURIUM-INDUCED NEUROMUSCULAR BLOCK USING DOUBLE BURST STIMULATION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE MEASURING TECHNIQUES, NEUROMUSCULAR BLOCK; MONITORING, NEUROMUSCULAR FUNCTION; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID POST-TETANIC COUNT; TRAIN-OF-4 RESPONSE; VECURONIUM; TACTILE AB Paired train-of-four (TOF) and double burst stimuli (DBS) were administered to the ulnar nerve at the wrist in 25 patients (group 1) paralysed with atracurium 0.5 mg kg-1; responses were measured mechanically (except every third DBS response which was manually evaluated). Another 30 patients (group 2) received a DBS every 60 s. A post-tetanic count (PTC) was performed when the first response (D1) was palpated. There was a significant correlation between the twitch heights of the first TOF response (T1) and D1 and likewise between the twitch heights of both second responses (r = 0.9; P < 0.001), but there was a significant difference in regression coefficients of these two correlations (P < 0.001). D1 was palpable first with a median PTC of 7. Our results showed that palpation of a single response implied a satisfactory level of paralysis. DBS may be useful for intraoperative clinical monitoring of neuromuscular block. RP BRAUDE, N (reprint author), ST BARTHOLOMEWS HOSP,DEPT CNRS,WEST SMITHFIELD,LONDON EC1A 7BE,ENGLAND. NR 15 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 1991 VL 67 IS 5 BP 574 EP 578 DI 10.1093/bja/67.5.574 PG 5 WC Anesthesiology SC Anesthesiology GA GP137 UT WOS:A1991GP13700012 ER PT J AU TATMAN, AJ WRIGLEY, SR JONES, RM AF TATMAN, AJ WRIGLEY, SR JONES, RM TI RESISTANCE TO ATRACURIUM IN A PATIENT WITH AN INCREASE IN PLASMA ALPHA1 GLOBULINS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM; COMPLICATIONS, DRUG RESISTANCE; PROTEIN, ALPHA1 GLOBULINS ID NEUROMUSCULAR BLOCK; PANCURONIUM-BROMIDE; D-TUBOCURARINE; LIVER-DISEASE; BINDING; DISPOSITION; PROPRANOLOL; PROTEINS; MUSCLE AB We observed that a female patient with a poorly differentiated adenocarcinoma of the stomach undergoing gastrectomy was markedly resistant to the action of the neuromuscular blocking drug atracurium. There was no evidence of tumour metastasis and her liver function tests were normal. Electrophoresis of plasma proteins revealed a marked increase in alpha1 globulin. Alpha1 acid glycoprotein is an acute phase reactant that is increased in patients with cancer and is present in the alpha1 globulin electrophoresis pattern. It is likely that the mechanism for the resistance to neuromuscular block in the patient was an increase in drug binding to alpha1 acid glycoprotein. C1 ST MARYS HOSP,DEPT ANAESTHESIA,LONDON W2 1NY,ENGLAND. LEWISHAM HOSP,LONDON SE13,ENGLAND. NR 25 TC 12 Z9 12 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 1991 VL 67 IS 5 BP 623 EP 625 DI 10.1093/bja/67.5.623 PG 3 WC Anesthesiology SC Anesthesiology GA GP137 UT WOS:A1991GP13700022 ER PT J AU WIERDA, JMKH SZENOHRADSZKY, J DEWIT, APM ZENTAI, G AGOSTON, S KAKAS, M KLEEF, UW MEIJER, DKF AF WIERDA, JMKH SZENOHRADSZKY, J DEWIT, APM ZENTAI, G AGOSTON, S KAKAS, M KLEEF, UW MEIJER, DKF TI THE PHARMACOKINETICS, URINARY AND BILIARY-EXCRETION OF PIPECURONIUM BROMIDE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE DRUG METABOLISM, PIPECURONIUM; NEUROMUSCULAR RELAXANTS, PIPECURONIUM; PHARMACOKINETICS, DISTRIBUTION, URINARY AND BILIARY EXCRETION; PHARMACOLOGY, DYNAMIC KINETIC RELATIONSHIP; SURGERY, CHOLEDOCHOTOMY, LARYNGECTOMY AB The pharmacodynamics and -kinetics of pipecuronium were studied in 12 patients, six of whom received 100-mu-g kg-1 for laryngectomy (Group L), and six who underwent choledochotomy after insertion of the T-drain and were given 50-mu-g kg-1 (Group C). Onset time and clinical duration were 2.3 and 109 min and 2.8 and 39 min in Groups L and C, respectively. All patients could be sufficiently reversed with neostigmine. Terminal half-lives were 101.5 min (Group L) and 179 min (Group C) in a three-exponent decay; the distribution volumes at steady state 0.339 1 kg-1 (Group L) and 0.506 1 kg-1 (Group C); the plasma clearance 3.4 ml kg-1 min-1 (Group L) and 2.5 ml kg-1 min-1 (Group C). Within 24 h, 38.6% and 37% were excreted unchanged in the urine and 4.4% and 1% as 3-desacetyl pipecuronium in Groups L and C, respectively. Within 24 h only 2% was excreted into the bile in Group C. Distribution volume and terminal half-life in Group C were positively correlated with pre-operative serum aminotransferase levels (P < 0.005). RP WIERDA, JMKH (reprint author), UNIV GRONINGEN HOSP,DEPT ANAESTHESIOL,POB 30001,9700 RB GRONINGEN,NETHERLANDS. NR 0 TC 13 Z9 13 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD NOV PY 1991 VL 8 IS 6 BP 451 EP 457 PG 7 WC Anesthesiology SC Anesthesiology GA GR084 UT WOS:A1991GR08400004 ER PT J AU DANON, MJ CARPENTER, S AF DANON, MJ CARPENTER, S TI MYOPATHY WITH THICK FILAMENT (MYOSIN) LOSS FOLLOWING PROLONGED PARALYSIS WITH VECURONIUM DURING STEROID TREATMENT SO MUSCLE & NERVE LA English DT Article DE VERCURONIUM; THICK FILAMENT; MYOSIN; CORTICOSTEROIDS; MYOPATHY ID PANCURONIUM-BROMIDE; ATROPHY AB A 20-year-old female hospitalized with status asthmaticus was treated with bronchodilators, antibiotics, and high-dose corticosteroids, and was paralyzed with vecuronium for 10 days to facilitate mechanical ventilation. When this was discontinued, she was found to have a flaccid quadriplegia with areflexia and 4-fold elevation in serum creatine kinase. A muscle biopsy showed extensive loss of thick (myosin) myofilaments, sometimes in core-like distribution, with relative preservation of thin (actin) filaments and Z-discs. Muscle strength returned to normal after 2 months. The pathological lesion in this patient's muscle fibers resemble those in rats treated with high doses of corticosteroids following denervation. C1 MCGILL UNIV,MONTREAL NEUROL INST,DEPT NEUROSURG,MONTREAL H3A 2T5,QUEBEC,CANADA. UNIV ILLINOIS,COLL MED,DEPT PATHOL,CHICAGO,IL 60612. ILLINOIS MASON MED CTR,CHICAGO,IL 60657. MCGILL UNIV,MONTREAL NEUROL INST,DEPT NEUROL,MONTREAL H3A 2T5,QUEBEC,CANADA. RP DANON, MJ (reprint author), UNIV ILLINOIS,COLL MED,DEPT NEUROL,912 S WOOD ST,CHICAGO,IL 60612, USA. NR 15 TC 164 Z9 164 PU JOHN WILEY & SONS INC PI NEW YORK PA 605 THIRD AVE, NEW YORK, NY 10158-0012 SN 0148-639X J9 MUSCLE NERVE JI Muscle Nerve PD NOV PY 1991 VL 14 IS 11 BP 1131 EP 1139 DI 10.1002/mus.880141115 PG 9 WC Clinical Neurology; Neurosciences SC Neurosciences & Neurology GA GL606 UT WOS:A1991GL60600014 ER PT J AU FONSMARK, L WOLFF, J AF FONSMARK, L WOLFF, J TI ISORHYTHMIC ATRIOVENTRICULAR DISSOCIATION FOLLOWING PANCURONIUM SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHESIA, GENERAL; ARRHYTHMIA, ISORHYTHMIC ATRIOVENTRICULAR DISSOCIATION; NEUROMUSCULAR BLOCKING AGENT; PANCURONIUM ID JUNCTIONAL RHYTHMS; ANESTHESIA AB We report a case of isorhythmic atrio-ventricular dissociation caused by pancuronium. The possible mechanism of the rhythm disorder is discussed and the haemodynamic consequences are described. It will be useful to realise that the circulatory effects of the arrhythmia may be pronounced in patients with decreased cardiovascular reserve. RP FONSMARK, L (reprint author), BISPEBJERG HOSP,DEPT ANAESTHESIA & INTENS CARE,DK-2400 COPENHAGEN,DENMARK. NR 10 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 OCT PY 1991 VL 35 IS 7 BP 680 EP 681 PG 2 WC Anesthesiology SC Anesthesiology GA GL771 UT WOS:A1991GL77100025 ER PT J AU KOPMAN, AF AF KOPMAN, AF TI TACTILE EVALUATION OF TRAIN-OF-FOUR COUNT AS AN INDICATOR OF RELIABILITY OF ANTAGONISM OF VECURONIUM-INDUCED OR ATRACURIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ANESTHESIOLOGY LA English DT Article DE MONITORING, NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR ANTAGONISTS, EDROPHONIUM; NEUROMUSCULAR RELAXANTS, ATRACURIUM; VECURONIUM ID EDROPHONIUM; NEOSTIGMINE; RECOVERY; PANCURONIUM; REVERSAL; TIMES AB Recent evidence suggests that edrophonium is not the agent of choice to reverse profound neuromuscular blockade but remains an efficacious drug when the level of neuromuscular blockade to be antagonized is modest. We studied 90 healthy adults in an attempt to address the questions: 1) How much variability in such neuromuscular parameters as single twitch height and the train-of-four (TOF) fade ratio (T4/T1) exist when the TOF count first returns to four palpable responses? 2) Is edrophonium a reliable antagonist at this measured point of recovery? 3) What is the optimal dose of edrophonium needed to produce prompt (< 10 min) and satisfactory (T4/T1 > 0.7) reversal when the fourth response of the thumb to indirect TOF stimulation just becomes palpable? Patients were given a bolus atracurium or vecuronium (n = 45 in each group) followed by an iv infusion sufficient to maintain single twitch as measured by electromyography at 10-15% of control values. At the end of surgery, the infusion was terminated and spontaneous recovery was allowed to begin. Once the tactile TOF count was four, edrophonium 0.3, 0.5, or 0.75 mg/kg was administered. At a count-of-four the first twitch averaged 37% of control (+/- 8.5% standard deviation; pooled data from all groups) and the mean T4/T1 ratio was 0.14 +/- 0.049. After atracurium neuromuscular blockade, edrophonium 0.3 mg/kg produced adequate antagonism in 10 min. At this time the mean T4/T1 ratio was 0.79 +/- 0.07 and the lowest observed value was 0.67. Increasing the edrophonium dose to 0.75 mg/kg accelerated recovery by 4-5 min. At a TOF count-of-four after vecuronium administration, edrophonium 0.75 mg/kg produced similar results. However, 0.3 and 0.5 mg/kg of edrophonium resulted in less consistent reversal of vecuronium. In these groups, 2 and 3 individuals respectively had T4/T1 ratios < 0.60 at 10 min postantagonism despite mean values of 0.70. For reversal of residual vecuronium blockade at the point of return of the TOF count to four, therefore, the recommended dose of edrophonium is 0.75 mg/kg. Under similar conditions after atracurium, as little as 0.3 mg/kg of edrophonium will produce reliable antagonism if 10 min is allowed for recovery. RP KOPMAN, AF (reprint author), LONG ISL JEWISH MED CTR,DEPT ANESTHESIOL,NEW HYDE PK,NY 11042, USA. NR 24 TC 18 Z9 18 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 1991 VL 75 IS 4 BP 588 EP 593 DI 10.1097/00000542-199110000-00008 PG 6 WC Anesthesiology SC Anesthesiology GA GH568 UT WOS:A1991GH56800007 ER PT J AU PARR, SM ROBINSON, BJ REES, D GALLETLY, DC AF PARR, SM ROBINSON, BJ REES, D GALLETLY, DC TI INTERACTION BETWEEN BETAMETHASONE AND VECURONIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE INTERACTIONS, BETAMETHASONE, VECURONIUM; NEUROMUSCULAR RELAXANTS, VECURONIUM ID CORTICOSTEROIDS; DEXAMETHASONE; PANCURONIUM; MODULATION; RELEASE; RAT AB A possible interaction between betamethasone and vecuronium was examined in 20 rat phrenic nerve-hemidiaphragm preparations. Ten preparations were bathed in a physiological solution with betamethasone 1-mu-mol litre-1 added and, after a 30-min period were exposed to vecuronium at concentrations of 4, 6, 8 and 10-mu-mol litre-1 with vecuronium free washings between each exposure. Ten control experiments were performed also using a betamethasone-free bathing solution. In comparison with control, the betamethasone group had significantly (P = 0.0008) less depression of muscle contraction (twitch) force at all concentrations of vecuronium. The calculated ED50 (50% depression of muscle contraction force) was 5.65-mu-mol litre-1 for controls and 7.39-mu-mol litre-1 for betamethasone-pretreated preparations. This study confirms our previous clinical observations that an interaction occurs between vecuronium and betamethasone which is characterized by resistance to neuromuscular block. C1 WELLINGTON SCH MED,ANAESTHESIA SECT,POB 7343,WELLINGTON,NEW ZEALAND. VICTORIA UNIV WELLINGTON,SCH BIOL SCI,WELLINGTON,NEW ZEALAND. NR 26 TC 10 Z9 10 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 OCT PY 1991 VL 67 IS 4 BP 447 EP 451 DI 10.1093/bja/67.4.447 PG 5 WC Anesthesiology SC Anesthesiology GA GH872 UT WOS:A1991GH87200016 ER PT J AU FISET, P BALENDRAN, P BEVAN, DR DONATI, F AF FISET, P BALENDRAN, P BEVAN, DR DONATI, F TI NITROUS-OXIDE POTENTIATES VECURONIUM NEUROMUSCULAR BLOCKADE IN HUMANS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHETICS, GASES, NITROUS OXIDE; DRUG INTERACTIONS, NITROUS OXIDE; VECURONIUM; MONITORING, NEUROMUSCULAR FUNCTION; TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, VECURONIUM ID DOSE-RESPONSE CURVES; SINGLE BOLUS; ATRACURIUM; ANESTHESIA; ENFLURANE; HALOTHANE; POTENCY AB This study was designed to measure the potency of vecuronium with and without nitrous oxide. Anaesthesia was induced with thiopentone and fentanyl in 56 adult patients. The subjects were randomly assigned to receive nitrous oxide, 70%, or intermittent boluses of thiopentone and fentanyl for maintenance of anaesthesia. Train-of-four stimulation was applied to the ulnar nerve every 20 sec, and the force of contraction of the adductor pollicis muscle was measured. Vecuronium, 20, 30 or 40-mu-g.kg-1 was given by random allocation five minutes after induction of anaesthesia. Maximum depression of the first response (T1) in the train-of-four was measured, and dose-response curves were constructed. In the absence of nitrous oxide, the ED50 and ED95 were mean +/- standard error of the mean (SEM), 29.2 +/- 1.8 and 59.3 +/- 3.6-mu-g.kg-1, respectively. In the group receiving nitrous oxide, these values were 25.3 +/- 1.2 and 42.3 +/- 2.0-mu-g.kg-1 respectively. By analysis of covariance, the dose-response curves were shown to be shifted with respect to one another (P < 0.05). Administration of nitrous oxide was associated with a 19.5% increase in potency (95%) confidence limits: 1.7 to 40.4%). It is concluded that nitrous oxide has a slight potentiating effect on neuromuscular blockade, and that this effect occurs within five to ten minutes after the beginning of its administration. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 19 TC 8 Z9 8 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD OCT PY 1991 VL 38 IS 7 BP 866 EP 869 PG 4 WC Anesthesiology SC Anesthesiology GA GJ721 UT WOS:A1991GJ72100011 ER PT J AU JONES, RS YOUNG, LE AF JONES, RS YOUNG, LE TI VECURONIUM INFUSION IN THE DOG SO JOURNAL OF SMALL ANIMAL PRACTICE LA English DT Article ID REQUIREMENTS; ANESTHESIA AB The non-depolarising muscle relaxant vecuronium bromide was administered to 20 dogs undergoing a variety of surgical procedures under general anaesthesia. An initial dose of 0.1 mg/kg was administered and followed by an infusion of 0.1 mg/kg/hour. Reversal of the neuromuscular block was carried out with neostigmine and atropine. RP JONES, RS (reprint author), UNIV LIVERPOOL, DEPT ANAESTHESIA, POB 147, LIVERPOOL L69 3BX, ENGLAND. NR 12 TC 5 Z9 5 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0022-4510 J9 J SMALL ANIM PRACT JI J. Small Anim. Pract. PD OCT PY 1991 VL 32 IS 10 BP 509 EP 512 DI 10.1111/j.1748-5827.1991.tb00867.x PG 4 WC Veterinary Sciences SC Veterinary Sciences GA GM494 UT WOS:A1991GM49400005 ER PT J AU KOOIJMAN, H VANGEERESTEIN, VJ VANDERSLUIS, P KANTERS, JA KROON, J FUNKE, CW KELDER, J AF KOOIJMAN, H VANGEERESTEIN, VJ VANDERSLUIS, P KANTERS, JA KROON, J FUNKE, CW KELDER, J TI MOLECULAR-STRUCTURE OF VECURONIUM BROMIDE, A NEUROMUSCULAR BLOCKING-AGENT - CRYSTAL-STRUCTURE, MOLECULAR MECHANICS AND NMR INVESTIGATIONS SO JOURNAL OF THE CHEMICAL SOCIETY-PERKIN TRANSACTIONS 2 LA English DT Article ID ORG AB The crystal and molecular structure of vecuronium bromide {1 - [2-beta,3-alpha,5-alpha,16-beta,17-beta)-3,17-bis(acetyloxy)-2-(piperidin-1-yl)androstan-16-yl]-1-methylpiperidinium bromide}, a potent non-depolarizing neuromuscular blocking agent, has been determined by single-crystal X-ray diffraction analysis. The compound crystallizes in the orthorhombic system, space group P2(1)2(1)2(1). The observed axial conformation of the A ring acetoxy and piperidinyl substituents at positions 2 and 3 of the steroid skeleton is also present in solution, as is indicated by NMR experiments. After protonation of the piperidinyl group at position 2 this conformation changes into an equatorial conformation similar to the one observed in the N-methylated analogue pancuronium bromide. Molecular mechanics calculations have been performed to explain these observations. C1 ORGANON INT BV,SCI DEV GRP,5340 BH OSS,NETHERLANDS. RP KOOIJMAN, H (reprint author), UNIV UTRECHT,VAKGRP KRISTAL & STRUCT CHEM,PADUALAAN 8,3584 CH UTRECHT,NETHERLANDS. NR 22 TC 6 Z9 6 PU ROYAL SOC CHEMISTRY PI CAMBRIDGE PA THOMAS GRAHAM HOUSE, SCIENCE PARK MILTON ROAD, CAMBRIDGE, CAMBS, ENGLAND CB4 4WF SN 0300-9580 J9 J CHEM SOC PERK T 2 JI J. Chem. Soc.-Perkin Trans. 2 PD OCT PY 1991 IS 10 BP 1581 EP 1586 DI 10.1039/p29910001581 PG 6 WC Chemistry, Organic; Chemistry, Physical SC Chemistry GA GK055 UT WOS:A1991GK05500023 ER PT J AU MOORTHY, SS KRISHNA, G DIERDORF, SF AF MOORTHY, SS KRISHNA, G DIERDORF, SF TI RESISTANCE TO VECURONIUM IN PATIENTS WITH CEREBRAL-PALSY SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCK; SENSITIVITY; ATRACURIUM AB To determine the electromyographic response of patients with cerebral palsy to vecuronium, 10 children (mean age, 6 yr 10 mo) without cerebral palsy and 11 children with cerebral palsy (mean age, 10 yr 3 mo) were studied. All patients were undergoing abdominal or orthopedic surgery and were anesthetized with isoflurane and nitrous oxide. The time from intravenous administration of 0.1 mg/kg of vecuronium to 25% recovery of control twitch height was 43.9 +/- 5.3 and 18.9 +/- 1.7 min (mean +/- SEM) in children without and with cerebral palsy, respectively (P < 0.01). The authors conclude that patients with cerebral palsy are either resistant to vecuronium or have a rapid clearance as evidenced by the rapid recovery from neuromuscular blockade. C1 INDIANA UNIV,JAMES WHITCOMB RILEY HOSP CHILDREN,MED CTR,DEPT ANESTHESIOL,INDIANAPOLIS,IN 46223. NR 10 TC 23 Z9 26 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 1991 VL 73 IS 3 BP 275 EP 277 PG 3 WC Anesthesiology SC Anesthesiology GA GC346 UT WOS:A1991GC34600008 ER PT J AU GOLDHILL, DR WHITEHEAD, JP EMMOTT, RS GRIFFITH, AP BRACEY, BJ FLYNN, PJ AF GOLDHILL, DR WHITEHEAD, JP EMMOTT, RS GRIFFITH, AP BRACEY, BJ FLYNN, PJ TI NEUROMUSCULAR AND CLINICAL EFFECTS OF MIVACURIUM CHLORIDE IN HEALTHY ADULT PATIENTS DURING NITROUS-OXIDE ENFLURANE ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; MIVACURIUM ID BW B1090U; ATRACURIUM; ANESTHESIA; INFUSION; HUMANS; SUXAMETHONIUM; PHARMACOLOGY; TRANSMISSION; VECURONIUM; BW-B1090U AB We have studied the effects of mivacurium after induction of anaesthesia with alfentanil-propofol in healthy adult oral surgical patients. Anaesthesia was maintained with nitrous oxide and 0.75% (end-tidal) enflurane in oxygen after nasotracheal intubation. Recordings were made of the rectified compound adductor pollicis electromyogram in response to train-of-four (TOF) ulnar nerve stimulation. First and fourth TOF responses were defined as T1 and T4, with T1 suppression referenced to pre-mivacurium T1 height (Tc). Onset times (mean (SEM)) to 90% T1 suppression were 2.5 (0.2), 2.1 (0.3) and 1.6 (0.1) min, respectively, after mivacurium 0.15 mg kg-1 (n = 18) and 0.2 mg kg-1 (n = 18) as 5-s boluses and 0.2 mg kg-1 over 30 s (n = 9). Intubating conditions 2 min after 0.15 mg kg-1 were good to excellent and not improved by a further 30-s delay or by use of a 0.2-mg kg-1 dose. Recovery to T1/Tc of 5% occurred on average in 12-13 min irrespective of dose. Thereafter, mivacurium infusions commenced at 8-10-mu-g kg-1 min-1 were adjusted at intervals of at least 3 min to achieve T1/Tc in the range 1-10%. Mean duration of infusion was 58 (3.4) min and mean infusion rate after a 15-min stabilization period was 6.6 (range 2.3-12.9)-mu-g kg-1 min-1. On cessation of infusions, spontaneous recovery from T1/Tc 8% (1.0%) to T4:T1 = 0.7 took 17 (1.2) min. Neostigmine 0.04 mg kg-1 or edrophonium 0.75 mg kg-1 evoked recovery from T1/Tc 9% (SEM 1.2% and 1.0%, respectively) to T4:T1 = 0.7 in 11 (0.6) and 8 (0.9) min (both P < 0.001 vs spontaneous recovery). RP GOLDHILL, DR (reprint author), ROYAL LONDON HOSP,ANAESTHET UNIT,LONDON E1 1BB,ENGLAND. NR 15 TC 37 Z9 38 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 1991 VL 67 IS 3 BP 289 EP 295 DI 10.1093/bja/67.3.289 PG 7 WC Anesthesiology SC Anesthesiology GA GF219 UT WOS:A1991GF21900011 ER PT J AU FISET, P DONATI, F BALENDRAN, P MEISTELMAN, C LIRA, E BEVAN, DR AF FISET, P DONATI, F BALENDRAN, P MEISTELMAN, C LIRA, E BEVAN, DR TI VECURONIUM IS MORE POTENT IN MONTREAL THAN IN PARIS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MONITORING, NEUROMUSCULAR FUNCTION; NEUROMUSCULAR RELAXANTS, VECURONIUM ID INDUCED NEUROMUSCULAR BLOCKADE; DOSE-RESPONSE CURVES; D-TUBOCURARINE; CLINICAL-PHARMACOLOGY; SINGLE BOLUS; ANESTHESIA; HALOTHANE; SUXAMETHONIUM; PANCURONIUM; ATRACURIUM AB This study was undertaken to compare the potency of vecuronium in patients anaesthetized in Montreal or Paris. Anaesthesia was induced with thiopentone and maintained with N2O, and intermittent boluses of thiopentone and fentanyl in 18 patients in Paris and 19 in Montreal. Neuromuscular blockade was measured using train-of-four stimulation of the ulnar nerve. The force of contraction of the adductor pollicis muscle was measured. Single doses of vecuronium, 20, 30, or 40-mu-g.kg-1 were given by random allocation. Dose response curves were constructed by obtaining the linear regression of the logit of the first response (T1) neuromuscular blockade versus log dose. The patients in Paris required 27% more vecuronium (95% confidence limits 5-53%; P = 0.01) for the same intensity of blockade. In Montreal, the ED50 and ED90 (+/- SEE for the mean) values were 26.0 +/- 1.4 and 44.2 +/- 2.5-mu-g.kg-1 compared with 33.0 +/- 3.3 and 71.9 +/- 7.2-mu-g.kg-1 in Paris respectively. The patients were comparable with respect to age, sex, height and weight. These results confirm, for vecuronium, the transatlantic difference in potency of neuromuscular blocking drugs which was previously observed with d-tubocurarine between London and New York. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,MONTREAL H3A 2T5,QUEBEC,CANADA. INST GUSTAVE ROUSSY,SERV ANESTHESIA,F-94805 VILLEJUIF,FRANCE. NR 32 TC 15 Z9 16 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1991 VL 38 IS 6 BP 717 EP 721 PG 5 WC Anesthesiology SC Anesthesiology GA GE336 UT WOS:A1991GE33600006 ER PT J AU NAGUIB, M ABDULATIF, M AF NAGUIB, M ABDULATIF, M TI EDROPHONIUM PRIMING ALTERS THE COURSE OF NEUROMUSCULAR RECOVERY FROM A PIPECURONIUM NEUROMUSCULAR BLOCKADE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, EDROPHONIUM; MONITORING; NEUROMUSCULAR, TRAIN-OF-FOUR; NEUROMUSCULAR RELAXANTS, PIPECURONIUM; PHARMACODYNAMICS, PRIMING PRINCIPLE ID ATRACURIUM BLOCKADE; NEOSTIGMINE ANTAGONISM; ACCELERATED REVERSAL; ENFLURANE ANESTHESIA; HALOTHANE; ANTICHOLINESTERASES; TRANSMISSION; PANCURONIUM; ISOFLURANE; FENTANYL AB This study was designed to investigate the effect of divided administration of edrophonium on the course of neuromuscular recovery from a pipecuronium neuromuscular blockade. During thiopentone-nitrous oxide-halothane anaesthesia 48 patients were given pipecuronium 70-mu-g.kg-1. Patients were randomly assigned to one of four groups (n = 12 in each) to receive either edrophonium 1 mg.kg-1 (Groups I and II) or edrophonium 0.75 mg.kg-1 (Groups III and IV). In Groups I and III (single-dose groups), edrophonium was administered as a single bolus dose. In Groups II and IV (divided-dose groups) edrophonium was administered as an initial dose of 0.25 mg.kg-1 followed three minutes later by either 0.75 or 0.50 mg.kg-1 respectively. Reversal was attempted at 20% spontaneous recovery of twitch height. Administration of edrophonium in divided doses (Groups II and IV) accelerated the reversal of the pipecuronium neuromuscular blockade. At ten minutes post-reversal, train-of-four (TOF) ratio recovery reached 0.75 or more in 12 (100%) and in ten (83%) patients in Groups II and IV respectively. Similarly, times to attain a TOF of 0.75 (SEM) were shorter in the divided-dose groups than in the single-dose groups (P < 0.05), being 354.5 (38.7) and 398.3 (49.1) sec in Groups II and IV vs 705.4 (66.6) and 651.2 (54.3) sec in Groups I and III respectively. Time was counted from the first administration of edrophonium. It is concluded that administration of edrophonium in divided doses produced a faster reversal of residual pipecuronium-induced neuromuscular blockade than single bolus administration. Also, administration in divided doses reduced the requirements of edrophonium needed for reversal of pipecuronium neuromuscular blockade. C1 UNIV CAIRO,AL KASR EL ANI HOSP,DEPT ANAESTHESIA,CAIRO,EGYPT. RP NAGUIB, M (reprint author), UNITED ARAB EMIRATES UNIV,FAC MED & HLTH SCI,DEPT CRIT CARE MED,POB 17666,AL AIN,U ARAB EMIRATES. NR 18 TC 0 Z9 0 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1991 VL 38 IS 6 BP 722 EP 727 PG 6 WC Anesthesiology SC Anesthesiology GA GE336 UT WOS:A1991GE33600007 ER PT J AU LINES, D SHIPTON, EA AF LINES, D SHIPTON, EA TI SEVERE BRADYCARDIA AND SINUS ARREST AFTER ADMINISTRATION OF VECURONIUM, FENTANYL AND HALOTHANE - A CASE-REPORT SO SOUTH AFRICAN MEDICAL JOURNAL LA English DT Article AB A severe bradycardia leading to sinus arrest in an 18-year-old girl anaesthetised for a bilateral breast reduction is described. The probable precipitating factors and the specific problems are discussed. C1 UNIV WITWATERSRAND,JOHANNESBURG 2001,SOUTH AFRICA. RP LINES, D (reprint author), HILLBROW HOSP,DEPT ANAESTHESIA,JOHANNESBURG,SOUTH AFRICA. NR 12 TC 2 Z9 2 PU MED ASSOC S AFRICA PI JOHANNESBURG PA MED HOUSE CENTRAL SQ 7430 PINELANDS JOHANNESBURG, SOUTH AFRICA SN 0038-2469 J9 S AFR MED J JI S. Afr. Med. J. PD AUG 17 PY 1991 VL 80 IS 4 BP 200 EP 201 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA GC445 UT WOS:A1991GC44500019 ER PT J AU OSTERGAARD, D VIBYMOGENSEN, J HANEL, HK SKOVGAARD, LT AF OSTERGAARD, D VIBYMOGENSEN, J HANEL, HK SKOVGAARD, LT TI PRETREATMENT WITH PANCURONIUM BEFORE SUXAMETHONIUM ADMINISTRATION IN PATIENTS HETEROZYGOUS FOR THE USUAL AND THE ATYPICAL PLASMA CHOLINESTERASE GENE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ENZYMES, ATYPICAL CHOLINESTERASE, NORMAL CHOLINESTERASE; NEUROMUSCULAR RELAXANTS, SUCCINYLCHOLINE, PANCURONIUM; NEUROMUSCULAR TRANSMISSION, STIMULATOR, NERVE, PHASE-II BLOCK; PRETREATMENT, PANCURONIUM ID SUCCINYLCHOLINE NEUROMUSCULAR BLOCKADE; SERUM-CHOLINESTERASE; INHIBITION; LOCUS-1 AB The object of this study was to investigate whether pretreatment with pancuronium before i.v. injection of suxamethonium could cause prolonged neuromuscular blockade in patients heterozygous for the usual and the atypical plasma cholinesterase gene (E(1u)E(1a)). Forty-three patients, 23 with genotype E(1u)E(1a) and 20 with normal genotype (E(1u)E(1u)), were pretreated with pancuronium 0.01 mg.kg-1 followed by suxamethonium 1.5 mg.kg-1, and received either neurolept anaesthesia or halothane anaesthesia. Seven patients (E(1u)E(1a)) were given suxamethonium 1.5 mg.kg-1 without pretreatment. The duration and type of neuromuscular block were evaluated using train-of-four (TOF) nerve stimulation. Type of anaesthesia did not significantly influence the results. The duration of block following pretreatment was significantly longer in heterozygous patients than in normal patients. Time to 90% twitch height recovery was 10.7 +/- 1.2 min (mean +/- s.d) in genotypically normal patients, and 18.0 +/- 4.2 min in patients with genotype E(1u)E(1a). Pretreatment with pancuronium caused a significantly slower recovery of the TOF ratio (phase II block). Thus, a TOF ratio of 0.7 was always reached within 13 min in genotypically normal patients. In genotypically abnormal patients, the same TOF ratio was reached within 20 min in all but three patients. In these three patients time to 90% twitch height recovery was prolonged (18-31 min), and TOF ratio did not return to normal, but stabilized at about 0.35, 0.50, and 0.65, respectively. Injection of edrophonium restored normal neuromuscular function in 10 min. It is concluded that in patients heterozygous for the usual and the atypical gene, pretreatment with pancuronium in combination with an increased dose of suxamethonium may cause a phase II block and thus a prolonged neuromuscular block. C1 UNIV COPENHAGEN,RIGSHOSP,DEPT ANAESTHESIA,DK-2100 COPENHAGEN,DENMARK. UNIV COPENHAGEN,BISPEBJERG HOSP,DEPT CLIN CHEM,DK-1168 COPENHAGEN,DENMARK. UNIV COPENHAGEN,DANISH MED RES COUNCIL,STAT RES UNIT,DK-1168 COPENHAGEN,DENMARK. UNIV COPENHAGEN,DANISH SOCIAL SCI RES COUNCIL,STAT RES UNIT,DK-1168 COPENHAGEN,DENMARK. RP OSTERGAARD, D (reprint author), UNIV COPENHAGEN,GLOSTRUP HOSP,DEPT ANAESTHESIA,DK-2600 GLOSTRUP,DENMARK. NR 20 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 AUG PY 1991 VL 35 IS 6 BP 502 EP 507 PG 6 WC Anesthesiology SC Anesthesiology GA FX808 UT WOS:A1991FX80800008 ER PT J AU ERIKSSON, LI VIBYMOGENSEN, J LENNMARKEN, C AF ERIKSSON, LI VIBYMOGENSEN, J LENNMARKEN, C TI THE EFFECT OF PERIPHERAL HYPOTHERMIA ON A VECURONIUM-INDUCED NEUROMUSCULAR BLOCK SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ANESTHESIA; HYPOTHERMIA INDUCED; MONITORING; NEUROMUSCULAR FUNCTION; NEUROMUSCULAR RELAXANTS; MEASUREMENT OF RESPONSE, VECURONIUM ID ANESTHETIZED PATIENTS; POSTTETANIC COUNT; PANCURONIUM; TEMPERATURE; PTC AB Seven healthy patients were investigated during midazolam-fentanyl nitrous oxide-oxygen anaesthesia. The mechanical twitch response of the adductor pollicis muscle was recorded simultaneously during bilateral supramaximal train-of-four (TOF) stimulation of the ulnar nerves at the wrist. Intense neuromuscular block was evaluated using the post-tetanic count (PTC) method. Core temperature and the peripheral skin temperature of one arm were kept normal and stable. Following cooling of the other arm to a peripheral hand skin temperature of 27-degrees-C, vecuronium was administered in a bolus dose of 0.05 mg.kg-1 followed by maintenance doses of 0.02 mg.kg-1. In the hypothermic and the normothermic arm the onset time following the bolus dose was 180 +/- 40 (mean +/- s.d.) seconds and 140 +/- 30 s, respectively, the duration of action was 26.4 +/- 4.5 and 16.5 +/- 4.0 min and the recovery time was 265 +/- 90 and 130 +/- 60 s (P < 0.01). The time course of action following maintenance doses showed a similar marked difference between the hypothermic and the normothermic arm. In the normothermic arm a close correlation was found between the number of post-tetanic twitches and the time to first response to TOF stimulation. In contrast, in the hypothermic arm the number of post-tetanic twitches showed great variation with a poor correlation to the duration of intense neuromuscular block. It is concluded that the time course of action of a vecuronium-induced neuromuscular block is markedly prolonged during peripheral hypothermia and intense neuromuscular block cannot reliably be assessed using the PTC method at low peripheral temperature. Normal core and peripheral temperature is essential for correct evaluation of a neuromuscular block. C1 UNIV COPENHAGEN,RIGSHOSP,DEPT ANAESTHESIA,DK-2100 COPENHAGEN,DENMARK. RP ERIKSSON, LI (reprint author), LINKOPING UNIV HOSP,FAC HLTH SCI,DEPT ANAESTHESIA & INTENS CARE,S-58185 LINKOPING,SWEDEN. NR 15 TC 14 Z9 14 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 1991 VL 35 IS 5 BP 387 EP 392 PG 6 WC Anesthesiology SC Anesthesiology GA FV716 UT WOS:A1991FV71600003 ER PT J AU OLKKOLA, KT SCHWILDEN, H APFFELSTAEDT, C AF OLKKOLA, KT SCHWILDEN, H APFFELSTAEDT, C TI MODEL-BASED ADAPTIVE CLOSED-LOOP FEEDBACK-CONTROL OF ATRACURIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE ATRACURIUM; COMPUTERS; EQUIPMENT; MODELS; NEUROMUSCULAR RELAXANTS; PHARMACOKINETICS ID PHARMACOKINETICS; PHARMACODYNAMICS; INFUSION AB Closed-loop control of atracurium-induced neuromuscular blockade by a model-based adaptive feedback algorithm is described. Mean offsets (+/- s.d.) from setpoints at 50, 70 and 90% neuromuscular blocks using the Relaxograph(R) were 1.1 +/- 1.3, 0.2 +/- 0.7 and 0.1 +/- 0.4%, respectively. Correspondingly, the mean steady-state rates of infusion of atracurium were 0.20 +/- 0.06, 0.25 +/- 0.03 and 0.39 +/- 0.10 mg.kg-1.h-1. The described controller provides reasonable control of atracurium dosing at different degrees of neuromuscular blockade. It gives a solution to the problem of adapting pharmacokinetic and pharmacodynamic data to individuals when using population mean data as starting values for drug therapy. C1 UNIV BONN,DEPT ANESTHESIOL,W-5300 BONN,GERMANY. RP OLKKOLA, KT (reprint author), UNIV HELSINKI,DEPT CLIN PHARMACOL,PAASIKIVENKATU 4,SF-00250 HELSINKI,FINLAND. NR 14 TC 21 Z9 21 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 1991 VL 35 IS 5 BP 420 EP 423 PG 4 WC Anesthesiology SC Anesthesiology GA FV716 UT WOS:A1991FV71600009 ER PT J AU LOEWINGER, J FRIEDMANNNEIGER, I COHEN, M LEVI, E AF LOEWINGER, J FRIEDMANNNEIGER, I COHEN, M LEVI, E TI EFFECTS OF ATRACURIUM AND PANCURONIUM ON THE OCULOCARDIAC REFLEX IN CHILDREN SO ANESTHESIA AND ANALGESIA LA English DT Article ID VECURONIUM AB The authors compare the effect of two muscle relaxants, atracurium and pancuronium, on the bradycardia resulting from the oculocardiac reflex during eye surgery for strabismus in children. Two groups, each composed of 15 children, received either pancuronium or atracurium during strabismus operations. Heart rate and rhythm were observed at several points during the operations, and the changes that occurred in the two groups were compared. We found that the incidence and severity of the bradycardia, the incidence of dysrhythmias, and the need for atropine administration were significantly greater in the atracurium group than in the pancuronium group. C1 TEL AVIV UNIV,SACKLER SCH MED,TEL AVIV,ISRAEL. RP LOEWINGER, J (reprint author), BEILINSON MED CTR,DEPT ANESTHESIA & INTENS CARE,IL-49100 PETAH TIQWA,ISRAEL. NR 9 TC 10 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1991 VL 73 IS 1 BP 25 EP 28 PG 4 WC Anesthesiology SC Anesthesiology GA FV092 UT WOS:A1991FV09200005 ER PT J AU WOELFEL, SK DONG, ML BRANDOM, BW SARNER, JB COOK, DR AF WOELFEL, SK DONG, ML BRANDOM, BW SARNER, JB COOK, DR TI VECURONIUM INFUSION REQUIREMENTS IN CHILDREN DURING HALOTHANE-NARCOTIC-NITROUS OXIDE, ISOFLURANE-NARCOTIC-NITROUS OXIDE, AND NARCOTIC-NITROUS OXIDE ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKADE; ATRACURIUM; BOLUS; PANCURONIUM AB We were interested in determining the infusion rate of vecuronium required to maintain approximately 95% neuromuscular blockade in children during halothane-narcotic-nitrous oxide (0.8% end-tidal concentration), isoflurane-narcotic-nitrous oxide (1.0% end-tidal concentration), or narcotic-nitrous oxide anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity (Datex NMT) of the adductor pollicis muscle resulting from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 s at 10-s intervals. Effective vecuronium infusion requirements averaged 1.5 +/- 0.1-mu-g.kg-1.min-1 (mean +/- SEM) during isoflurane-narcotic-nitrous oxide anesthesia, 1.9 +/- 0.1-mu-g.kg-1.min-1 during halothane-narcotic-nitrous oxide anesthesia, and 2.4 +/- 0.3-mu-g.kg-1.min-1 during narcotic-nitrous oxide anesthesia. Infusion requirements significantly decreased after the first 30 min of infusion in the presence of both potent inhalation anesthetics, but did not change with time during narcotic-nitrous oxide anesthesia. There was no evidence of decreasing infusion requirements during prolonged vecuronium infusion (2.5 h). There was no difference in the rate of spontaneous or pharmacologically induced recovery between anesthetic groups. The mean recovery index (T25-75) after termination of the infusion was 13.7 min. C1 UNIV PITTSBURGH,SCH MED,PITTSBURGH,PA 15261. CHILDRENS HOSP PITTSBURGH,DEPT CRIT CARE MED,PITTSBURGH,PA. RP WOELFEL, SK (reprint author), CHILDRENS HOSP PITTSBURGH,DEPT ANESTHESIOL,3705 5TH AVE & DESOTO ST,PITTSBURGH,PA 15213, USA. NR 13 TC 7 Z9 8 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1991 VL 73 IS 1 BP 33 EP 38 PG 6 WC Anesthesiology SC Anesthesiology GA FV092 UT WOS:A1991FV09200007 ER PT J AU LIEN, CA MATTEO, RS ORNSTEIN, E SCHWARTZ, AE DIAZ, J AF LIEN, CA MATTEO, RS ORNSTEIN, E SCHWARTZ, AE DIAZ, J TI DISTRIBUTION, ELIMINATION, AND ACTION OF VECURONIUM IN THE ELDERLY SO ANESTHESIA AND ANALGESIA LA English DT Article ID DOSE-RESPONSE; PANCURONIUM; PHARMACOKINETICS; PHARMACODYNAMICS; BROMIDE; ADULTS; AGE AB The effects of age on the pharmacokinetics and pharmacodynamics of vecuronium in eight elderly patients aged 72-86 yr and eight younger adults aged 26-48 yr undergoing elective surgical procedures under nitrous oxide-fentanyl anesthesia were studied. Vecuronium (0.1 mg/kg) was given as an intravenous bolus, and the ulnar nerve was stimulated with a square-wave impulse of 0.2-ms duration. The response to stimulation at a frequency of 0.1 Hz was measured and recorded with a force displacement transducer applied to the thumb. Spontaneous recovery was significantly longer in elderly patients than in younger patients (50% recovery time, 97.1 +/- 29 vs 39.8 +/- 14 min, mean +/- SD; recovery index [25%-75%], 49.4 +/- 11 vs 15.0 +/- 8 min). In addition, in elderly patients elimination half-life of vecuronium was significantly prolonged (125 +/- 55 vs 78 +/- 21 min, P = 0.04) and plasma clearance reduced (2.6 +/- 0.6 vs 5.6 +/- 3.2 mL.kg-1.min-1, P = 0.049). The prolonged duration of action of vecuronium in the elderly surgical patients thus appears to be secondary to altered pharmacokinetics consistent with an age-related decrease in renal and hepatic functions. C1 COLUMBIA UNIV COLL PHYS & SURG,DEPT ANESTHESIOL,NEW YORK,NY 10032. NR 15 TC 31 Z9 34 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1991 VL 73 IS 1 BP 39 EP 42 PG 4 WC Anesthesiology SC Anesthesiology GA FV092 UT WOS:A1991FV09200008 ER PT J AU HOGUE, CW MARTYN, J BAKER, TR VOUROS, P AF HOGUE, CW MARTYN, J BAKER, TR VOUROS, P TI RECOVERY OF PANCURONIUM FROM PERITONEAL DIALYSATE IN A SEVERELY BURNED CHILD SO ANESTHESIA AND ANALGESIA LA English DT Article ID NEUROMUSCULAR BLOCKADE; PHARMACOKINETICS; TUBOCURARINE; VECURONIUM; BINDING; BROMIDE C1 HARVARD UNIV,SCH MED,DEPT ANESTHESIOL,BOSTON,MA 02115. SHRINERS BURN INST,BOSTON,MA. MASSACHUSETTS GEN HOSP,ANESTHESIA SERV,BOSTON,MA 02114. NORTHEASTERN UNIV,DEPT CHEM,BARNETT INST,BOSTON,MA 02115. NR 18 TC 1 Z9 1 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1991 VL 73 IS 1 BP 83 EP 86 PG 4 WC Anesthesiology SC Anesthesiology GA FV092 UT WOS:A1991FV09200015 ER PT J AU GWINNUTT, CL WALKER, RWM MEAKIN, G AF GWINNUTT, CL WALKER, RWM MEAKIN, G TI ANTAGONISM OF INTENSE ATRACURIUM INDUCED NEUROMUSCULAR BLOCK IN CHILDREN SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHESIA; PEDIATRIC; ANTAGONISTS; NEUROMUSCULAR RELAXANTS, EDROPHONIUM, NEOSTIGMINE; MONITORING; NEUROMUSCULAR FUNCTION ID TRAIN-OF-4 RATIO; EDROPHONIUM; NEOSTIGMINE; PANCURONIUM; RECOVERY; PYRIDOSTIGMINE; VECURONIUM; INFANTS AB Antagonism of intense neuromuscular block induced by atracurium 0.5 mg kg-1 was attempted in four groups of six children using one of two doses of neostigmine (0.05 mg kg-1 and 0.1 mg kg-1) or of edrophonium (0.5 mg kg-1 and 1.0 mg kg-1) when the first twitch of the post-tetanic count (PTC1) was 10% of control. For comparison with normal practice, a fifth group received neostigmine 0.05 mg kg-1 when the first twitch of the train-of-four was 10% of control. Total recovery time from PTC1 10% to a train-of-four ratio of 0.8 was not reduced by early administration of the anticholinesterases, compared with conventional administration of neostigmine at T1 10%. However, recovery from intense block was faster after neostigmine than edrophonium (P < 0.01). Doubling the doses of the anticholinesterases did not reduce the recovery time and had the effect of increasing variability. We conclude that there is no clinical advantage in attempting to antagonize intense neuromuscular block in children using normal or increased doses of neostigmine or edrophonium. C1 ROYAL MANCHESTER CHILDRENS HOSP,DEPT ANAESTHESIA,MANCHESTER M27 1HA,LANCS,ENGLAND. RP GWINNUTT, CL (reprint author), HOPE HOSP,DEPT ANAESTHESIA,ECCLES OLD RD,SALFORD M6 8HD,LANCS,ENGLAND. NR 20 TC 10 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 JUL PY 1991 VL 67 IS 1 BP 13 EP 16 DI 10.1093/bja/67.1.13 PG 4 WC Anesthesiology SC Anesthesiology GA FW817 UT WOS:A1991FW81700004 ER PT J AU PERREAULT, C GUAY, J GAUDREAULT, P CYRENNE, L VARIN, F AF PERREAULT, C GUAY, J GAUDREAULT, P CYRENNE, L VARIN, F TI RESIDUAL CURARIZATION IN THE NEONATE AFTER CESAREAN-SECTION SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHESIA, OBSTETRICAL; MEASUREMENT TECHNIQUES, APGAR; NACS SCORE; NEUROMUSCULAR RELAXANTS, ATRACURIUM; D-TUBOCURARINE ID CESAREAN-SECTION; ATRACURIUM; PHARMACOKINETICS; LAUDANOSINE; PHARMACODYNAMICS; INFUSION; PLASMA AB The transplacental transfer and the neonatal effects of atracurium 0.3 mg.kg-1 (ED95) were compared with those of d-tubocurarine at the usual clinical dose of 0.3 mg.kg-1 (ED90) in 46 patients undergoing elective Caesarean section. The atracurium group (25 patients) was similar to the d-tubocurarine group (21 patients) as far as age, parity and time intervals between precurarization, induction, skin incision, muscle relaxant administration, hysterotomy and birth. The transplacental transfer of atracurium was lower than that of d-tubocurarine, with a feto-maternal ratio of 9 +/- 3% for atracurium and 12 +/- 5% for d-tubocurarine (P < 0.05). The transplacental transfer of laudanosine was low at 14 +/- 5%, with blood levels of 0.101 +/- 0.032-mu-M.L-1 in the umbilical vein. Newborns in the two groups were comparable in terms of Apgar scores at one, five and ten minutes, as well as for NACS scores (neurological and adaptive capacity scoring test) at two and 24 hours after birth. However, at 15 min after birth, only 55% of newborns in whom the mothers received atracurium had a normal NACS score (greater-than-or-equal-to 35/40) compared with 83% of newborns in whom the mothers received d-tubocurarine (P < 0.05). Further analysis of the five variables related to active muscle tone revealed that the modal score for active extension of the neck of newborns from the atracurium group was lower than for newborns from the d-tubocurarine group (P < 0.01). This was compatible with the effect of residual curarization among newborns in whom the mothers received atracurium. However, this effect was transient since there was no difference found between the two groups at two and 24 hr after birth. Furthermore, no newborn had clinical signs of respiratory distress. In conclusion, atracurium given at a dose of 0.3 mg.kg-1 for Caesarean section may lead to partial residual curarization of neonates 15 min after birth. C1 STE JUSTINE HOSP,MONTREAL H3T 1C5,QUEBEC,CANADA. UNIV MONTREAL,DEPT PEDIAT,MONTREAL H3C 3J7,QUEBEC,CANADA. UNIV MONTREAL,DEPT ANESTHESIA,MONTREAL H3C 3J7,QUEBEC,CANADA. UNIV MONTREAL,FAC PHARM,MONTREAL H3C 3J7,QUEBEC,CANADA. NR 11 TC 10 Z9 10 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUL PY 1991 VL 38 IS 5 BP 587 EP 591 PG 5 WC Anesthesiology SC Anesthesiology GA FV856 UT WOS:A1991FV85600007 ER PT J AU DALLER, JA ERSTAD, B ROSADO, L OTTO, C PUTNAM, CW AF DALLER, JA ERSTAD, B ROSADO, L OTTO, C PUTNAM, CW TI AMINOPHYLLINE ANTAGONIZES THE NEUROMUSCULAR BLOCKADE OF PANCURONIUM BUT NOT VECURONIUM SO CRITICAL CARE MEDICINE LA English DT Article DE AMINOPHYLLINE; PANCURONIUM; VECURONIUM; ANTAGONISTS; NEUROMUSCULAR BLOCKING AGENTS; CRITICAL CARE; PHOSPHODIESTERASE INHIBITORS; PARALYSIS; THEOPHYLLINE C1 UNIV ARIZONA,ARIZONA HLTH SCI CTR,COLL MED,DEPT ANESTHESIOL,TUCSON,AZ 85724. UNIV ARIZONA,ARIZONA HLTH SCI CTR,COLL MED,DEPT PHARM,TUCSON,AZ 85724. RP DALLER, JA (reprint author), UNIV ARIZONA,ARIZONA HLTH SCI CTR,COLL MED,DEPT SURG,1501 N CAMPBELL AVE,TUCSON,AZ 85724, USA. NR 8 TC 10 Z9 9 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD JUL PY 1991 VL 19 IS 7 BP 983 EP 985 DI 10.1097/00003246-199107000-00028 PG 3 WC Critical Care Medicine SC General & Internal Medicine GA FW198 UT WOS:A1991FW19800028 ER PT J AU WERBA, A WEINSTABL, C PETRICEK, W PLAINER, B SPISS, CK AF WERBA, A WEINSTABL, C PETRICEK, W PLAINER, B SPISS, CK TI VECURONIUM PREVENTS INCREASES IN INTRACRANIAL-PRESSURE DURING ROUTINE TRACHEOBRONCHIAL SUCTIONING IN NEUROSURGICAL PATIENTS SO ANAESTHESIST LA German DT Article ID NEUROMUSCULAR BLOCKADE; HEAD-INJURY; STIMULATION; PANCURONIUM; COUNT; DOGS AB Coordination of respiratory care with protection of the brain is critical in neurosurgical intensive care. Therefore, in addition to hyperventilation, adequate sedation and muscle relaxation are applied to mitigate the difficulties with control of intracranial pressure (ICP) during routine tracheobronchial suctioning (TBS). Although hypnotics have been shown to be effective in mitigating increases in ICP in response to endotracheal suctioning in paralyzed patients, brisk bucking and coughing with further increases in ICP may occur without muscle relaxation. Long-term neuromuscular (nm) paralysis may be undesirable in neurosurgical critical care because clinical evaluation with early detection of neurological deterioration will be impossible in the paralyzed patient. Therefore, the effects of TBS without and after nm blockade with an intermediate-acting nondepolarizing muscle relaxant on ICP were studied. Patients and Methods. Nine patients with moderate increases in mean ICP of 19.2 +/- 8 mmHg due to head injuries and spontaneous subarachnoid hemorrhage were investigated. All patients were on-line sedated with midazolam and sufentanil and controlled ventilation was adjusted to maintain a paCO2 of 30 +/- 2 mmHg. Respiratory and hemodynamic parameters and ICP (epidural probe) were continuously monitored and recorded on an integrated data bank. After a bolus dose of propofol, routine TBS was performed without the use of muscle relaxants. Before the next TBS, nm monitoring was initiated and train-of-four (TOF) stimulation was imposed at the ulnar nerve using supramaximal pulses. The response of the adductor pollicis muscle was recorded by accelerometry. After supramaximal stimulation had been achieved, a bolus dose of 2 times the ED95 of vecuronium (0.12 mg/kg) was given. Depth of nm blockade was quantified by the posttetanic count (PTC). ICP and CPP were measured before, during, and after TBS. Diaphragmatic movement, bucking, and coughing were registered by visual observation and graded as absent, slight, moderate, or severe. Statistics. Student's t-test and the Wilcoxon test for paired data (P < 0.05; values as xBAR +/- SD) were used. Results (see Table and Figure). Despite adequate sedation, moderate to severe diaphragmatic movements in response to carinal stimulation with significant increases in ICP (18.2 +/- 7 to 24 +/- 8 mmHg) and subsequent decreases in cerebral perfusion pressure (CPP) (68.9 +/- 2 to 62.4 +/- 8 mmHg) could be observed without muscle relaxation. After a bolus of vercuronium, profound nm paralysis quantified by a PTC of 5 was observed after an onset time of 4.2 +/- 1 min. ICP (20.2 +/- 8 vs. 20.1 +/- 8 mmHg) and CPP (64.9 +/-13 vs. 64.8 +/- 13 mmHg) remained unchanged. Slight diaphragmatic movements could be elicited in only two patients during TBS. Discussion. TBS is a potent trigger of diaphragmatic movement, bucking, and coughing by reflex activation of the phrenic nerve. A major determinant of the magnitude of ICP increase during TBS is the transmission of the cough-induced increase in intrathoracic pressure to the cerebral venous system. Vecuronium was utilized for nm blockade because of its proven lack of cerebral and cardiovascular side effects, its relatively short onset, and its intermediate duration of action. Despite the postulated faster onset of nm blockade in the diaphragm, suppression of thumb-twitch response to TOF stimulation does not necessarily predict absence of diaphragmatic movement elicited by excessive tracheal stimulation. As demonstrated, intense nm blockade quantified by a PTC of 5 is necessary to rule out any bucking and coughing, i.e., to ensure total diaphragmatic paralysis in response to tracheal stimulation. On-line neurological evaluation, one of the essentials in the approach to the neurosurgical patient, will not be prevented by the intermittent bolus regime utilized in this study. RP WERBA, A (reprint author), UNIV VIENNA,ANASTHESIE & ALLGEMEINE INTENS MED KLIN,SPITALGASSE 23,A-1090 VIENNA,AUSTRIA. NR 16 TC 12 Z9 12 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD JUN PY 1991 VL 40 IS 6 BP 328 EP 331 PG 4 WC Anesthesiology SC Anesthesiology GA FR874 UT WOS:A1991FR87400004 ER PT J AU BARAKA, A TABBOUSH, Z AF BARAKA, A TABBOUSH, Z TI NEUROMUSCULAR RESPONSE TO SUCCINYLCHOLINE-VECURONIUM SEQUENCE IN 3 MYASTHENIC PATIENTS UNDERGOING THYMECTOMY SO ANESTHESIA AND ANALGESIA LA English DT Article DE COMPLICATIONS, MYASTHENIA GRAVIS; NEUROMUSCULAR RELAXANTS, SUCCINYLCHOLINE, VECURONIUM ID DOSE-RESPONSE; GRAVIS; SUXAMETHONIUM; CHOLINESTERASE; NEOSTIGMINE; ATRACURIUM; HALOTHANE C1 AMER UNIV BEIRUT,DEPT ANESTHESIOL,BEIRUT,LEBANON. NR 17 TC 8 Z9 8 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUN PY 1991 VL 72 IS 6 BP 827 EP 830 PG 4 WC Anesthesiology SC Anesthesiology GA FN042 UT WOS:A1991FN04200021 ER PT J AU SEGREDO, V SHIN, YS SHARMA, ML GRUENKE, LD CALDWELL, JE KHUENLBRADY, KS AGOSTON, S MILLER, RD AF SEGREDO, V SHIN, YS SHARMA, ML GRUENKE, LD CALDWELL, JE KHUENLBRADY, KS AGOSTON, S MILLER, RD TI PHARMACOKINETICS, NEUROMUSCULAR EFFECTS, AND BIODISPOSITION OF 3-DESACETYLVECURONIUM (ORG-7268) IN CATS SO ANESTHESIOLOGY LA English DT Article DE KIDNEY, DRUG ELIMINATION; LIVER, FULMINANT HEPATITIS; DRUG ELIMINATION; NEUROMUSCULAR RELAXANT, 3-DESACETYL, VECURONIUM; PHARMACOKINETICS, 3-DESACETYLVECURONIUM ID FULMINANT HEPATIC-FAILURE; VECURONIUM BROMIDE; BLOCKING ACTIONS; PANCURONIUM; METABOLITES; SYSTEM; MODEL AB The pharmacokinetics, biodisposition, and neuromuscular blocking properties of 3-desacetylvecuronium were studied in 17 adult cats. Animals were divided into three groups: five cats with kidney failure induced by bilateral ligation of the renal pedicles, six cats with galactosamine-induced fulminant hepatitis, and six control cats. An intravenous bolus of 300-mu-g.kg-1 of 3-desacetylvecuronium was rapidly injected into the jugular vein. Arterial blood, urine, and bile samples were collected at regular intervals for 6 h in control cats and for 8 h in cats with kidney or liver failure. The liver was excised for analysis at the end of the experiment. In cats with renal failure, 3-desacetylvecuronium pharmacokinetic and pharmacodynamic variables did not differ from those in control cats. In cats with liver failure, plasma clearance was significantly less and mean residence time greater than in control cats (2.8 +/- 0.6 vs. 14.1 +/- 6.5 ml.kg-1.min-1 and 334 +/- 225 vs. 49 +/- 29 min, mean +/- SD, respectively). Volume of distribution at steady state in cats with liver failure and in control cats was not different. Also, in cats with liver failure, the duration of action and recovery index of 3-desacetylvecuronium was significantly greater than in control cats (168 +/- 62 vs. 82 +/- 32 min, and 39 +/- 19 vs. 10 +/- 4 min, respectively). Onset time of neuromuscular blockade was similar in all three groups. Total recovery of 3-desacetylvecuronium, for all three groups, in urine, bile, and liver was 90 +/- 11% (mean +/- SD). In control cats, 70 +/- 18% of 3-desacetylvecuronium was recovered in bile and liver and 19 +/- 14% in urine. No 3,17-bidesacetylvecuronium (a putative 3-desacetylvecuronium metabolite) was detected. In conclusion, 3-desacetylvecuronium is eliminated predominantly by the liver and to a lesser extent by the kidney. Hepatic failure, but not kidney failure, significantly prolonged 3-desacetylvecuronium-induced neuromuscular blockade and mean residence time and signficantly decreased plasma clearance. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,ROOM S-455,SAN FRANCISCO,CA 94143. NR 16 TC 12 Z9 12 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUN PY 1991 VL 74 IS 6 BP 1052 EP 1059 DI 10.1097/00000542-199106000-00013 PG 8 WC Anesthesiology SC Anesthesiology GA FR380 UT WOS:A1991FR38000013 ER PT J AU POPPLEWELL, DS HARRISON, JD HAM, GJ AF POPPLEWELL, DS HARRISON, JD HAM, GJ TI GASTROINTESTINAL ABSORPTION OF NEPTUNIUM AND CURIUM IN HUMANS SO HEALTH PHYSICS LA English DT Article ID ENVIRONMENTAL PLUTONIUM; HUMAN GUT; TISSUE DISTRIBUTION; AMERICIUM; EXCRETION; URANIUM; RODENTS; TRACT AB The gastrointestinal absorption of Np and Cm has been determined in five male adult volunteers. The Np and Cm, which were in citrate solution, were taken with food. An initial experiment with each individual determined the fraction of each element excreted in the urine following intravenous administration. Subsequently, the results for urinary excretion for the two routes of administration were used to calculate the fractional absorption (f1) of ingested Np and Cm. The mean f1 values were: Np (2.0 +/- 0.2) x 10(-4), range (1.2-2.9) x 10(-4), and Cm (1.7 +/- 0.3) x 10(-4), range (0.95-3.0) x 10(-4), the quoted uncertainties being the standard error of the means. Currently, the International Commission on Radiological Protection recommends a value of 10(-3) for both elements. Cumulative urinary excretion over 1 wk after intravenous injection accounted for about 20%-40% of administered Np and 7%-10% of Cm. At the conclusion of the experiment, the total committed effective dose equivalent for each volunteer was calculated to be in the range 130-250-mu-Sv, based on the individual f1 values, and, in some cases, a knowledge of the rate of clearance of Np-239 through the gut as measured by whole-body counting. RP POPPLEWELL, DS (reprint author), NATL RADIOL PROTECT BOARD,DIDCOT OX11 0RQ,OXON,ENGLAND. NR 20 TC 14 Z9 14 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0017-9078 J9 HEALTH PHYS JI Health Phys. PD JUN PY 1991 VL 60 IS 6 BP 797 EP 805 DI 10.1097/00004032-199106000-00005 PG 9 WC Environmental Sciences; Environmental Studies; Public, Environmental & Occupational Health; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging SC Environmental Sciences & Ecology; Public, Environmental & Occupational Health; Nuclear Science & Technology; Radiology, Nuclear Medicine & Medical Imaging GA FN604 UT WOS:A1991FN60400005 ER PT J AU CHARI, P GROVER, VK CHAWLA, S GUJRAL, JS AF CHARI, P GROVER, VK CHAWLA, S GUJRAL, JS TI CARDIOVASCULAR EFFECTS OF VECURONIUM AND PANCURONIUM IN PATIENTS UNDERGOING ELECTIVE CLOSED MITRAL VALVOTOMY SO INDIAN JOURNAL OF MEDICAL RESEARCH SECTION B-BIOMEDICAL RESEARCH OTHER THAN INFECTIOUS DISEASES LA English DT Article ID NEUROMUSCULAR BLOCKING-AGENTS; ORG NC45; ORG-NC-45 AB Vecuronium, a monoquaternary analogue of pancuronium, the neuromuscular blocker, was compared with pancuronium in 50 patients undergoing elective closed mitral valvotomy. The patients were randomly divided into two groups of 25 each, and the muscle relaxants were administered in a dose of 0.1 mg/kg body weight. Both the agents produced identical intubating conditions at 3 min. Vecuronium showed a significantly shorter onset of action, as compared to pancuronium. The latter significantly increased the heart rate throughout the period of study whereas vecuronium significantly decreased the heart rate, 25 min after administration. There was significant increase in the mean arterial pressure (MAP) at tracheal intubation in both the groups, which persisted throughout the period of study in pancuronium group. There was a significant fall in MAP at 30 min after relaxant in vecuronium group. The incidence of arrythmias was similar and significant in both the groups. Vecuronium, thus showed a quicker onset of action with minimal haemodynamic effects, as compared to pancuronium in patients undergoing closed mitral valvotomy. C1 POSTGRAD INST MED EDUC & RES,DEPT ANAESTHESIA,CHANDIGARH 160012,INDIA. POSTGRAD INST MED EDUC & RES,DEPT CARDIOTHORAC,CHANDIGARH 160012,INDIA. NR 33 TC 0 Z9 0 PU INDIAN COUNCIL MEDICAL RES PI NEW DELHI PA PO BOX 4508 ANSARI NAGAR, NEW DELHI 110029, INDIA SN 0019-5340 J9 INDIAN J MED RES-B PD JUN PY 1991 VL 94 BP 211 EP 216 PG 6 WC Medicine, Research & Experimental SC Research & Experimental Medicine GA FV152 UT WOS:A1991FV15200007 ER PT J AU WIESEL, S BEVAN, JC SAMUEL, J DONATI, F AF WIESEL, S BEVAN, JC SAMUEL, J DONATI, F TI VECURONIUM NEUROMUSCULAR BLOCKADE IN A CHILD WITH MITOCHONDRIAL MYOPATHY SO ANESTHESIA AND ANALGESIA LA English DT Article DE COMPLICATIONS, MITOCHONDRIAL MYOPATHY ID DUCHENNE MUSCULAR-DYSTROPHY; MALIGNANT HYPERTHERMIA; PEDIATRIC-PATIENTS; DOSE-RESPONSE; ANESTHESIA; DISORDERS; SENSITIVITY; INFUSION; CURARE C1 MONTREAL CHILDRENS HOSP,DEPT ANAESTHESIA,MONTREAL H3H 1P3,QUEBEC,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 30 TC 9 Z9 9 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAY PY 1991 VL 72 IS 5 BP 696 EP 696 PG 1 WC Anesthesiology SC Anesthesiology GA FH753 UT WOS:A1991FH75300020 ER PT J AU HEIER, T CALDWELL, JE SESSLER, DI MILLER, RD AF HEIER, T CALDWELL, JE SESSLER, DI MILLER, RD TI MILD INTRAOPERATIVE HYPOTHERMIA INCREASES DURATION OF ACTION AND SPONTANEOUS-RECOVERY OF VECURONIUM BLOCKADE DURING NITROUS-OXIDE ISOFLURANE ANESTHESIA IN HUMANS SO ANESTHESIOLOGY LA English DT Article DE ANESTHETICS, GASES; NITROUS OXIDE; ANESTHETICS, INTRAVENOUS; FENTANYL; ANESTHETICS, VOLATILE; ISOFLURANE; MUSCLE, FORCE OF CONTRACTION; MUSCLE RELAXANTS, VECURONIUM; NEUROMUSCULAR TRANSMISSION, ADDUCTOR POLLICIS; TWITCH RESPONSE; TEMPERATURE, CENTRAL, SKIN ID INDUCED NEUROMUSCULAR BLOCKADE; D-TUBOCURARINE; CARDIOPULMONARY BYPASS; PANCURONIUM; TEMPERATURE; PHARMACOKINETICS; PHARMACODYNAMICS; NEOSTIGMINE; ANTAGONISM; POTENCY AB We compared the duration of action and recovery times for vecuronium in normothermic and mildly hypothermic patients. Ten patients were actively cooled to a central body temperature near 34.5-degrees-C, and ten were maintained at a normothermic central temperature (> 36.5-degrees-C); temperature was measured in the distal esophagus. Vecuronium 0.1 mg/kg was administered as an intravenous (iv) bolus to all patients, and the evoked mechanical response to train-of-four stimulation was recorded. Five hypothermic and five normothermic patients were allowed to recover spontaneously. In the remaining five in each group, neostigmine (40-mu-g/kg) and atropine (20-mu-g/kg) was administered when the first twitch (T1) height spontaneously recovered to 10% of control (T1 = 10% of the prevecuronium twitch tension). Vecuronium's duration of action (from injection of drug until T1 = 10%) was 28 +/- 4 and 62 +/- 8 min during normothermia and hypothermia, respectively (P < 0.05). The corresponding values for spontaneous recovery from T1 = 10% to TOF ratio > 75% were 37 +/- 15 and 80 +/- 24 min (P < 0.05), and for neostigmine-induced recovery were 10 +/- 3 and 16 +/- 11 min (difference not significant). We conclude that mild hypothermia increases the duration of action of and time for spontaneous recovery from vecuronium-induced neuromuscular blockade. C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,ROOM S-436,SAN FRANCISCO,CA 94143. NR 27 TC 142 Z9 146 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAY PY 1991 VL 74 IS 5 BP 815 EP 819 DI 10.1097/00000542-199105000-00003 PG 5 WC Anesthesiology SC Anesthesiology GA FJ905 UT WOS:A1991FJ90500003 ER PT J AU DONATI, F MEISTELMAN, C PLAUD, B AF DONATI, F MEISTELMAN, C PLAUD, B TI VECURONIUM NEUROMUSCULAR BLOCKADE AT THE ADDUCTOR MUSCLES OF THE LARYNX AND ADDUCTOR POLLICIS SO ANESTHESIOLOGY LA English DT Article DE LARYNX, VOCAL CORDS; MONITORING, NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS, VECURONIUM; SKELETAL MUSCLE, ADDUCTOR POLLICIS; LARYNX ID ATRACURIUM; MASSETER; PANCURONIUM; STIMULATION; DIAPHRAGM; HUMANS AB The differences between neuromuscular blockade of the adductor muscles of the vocal cords and the adductor pollicis were examined in 20 adult women anesthetized with fentanyl and propofol. Vecuronium 0.04 or 0.07 mg/kg was given as a single bolus by random allocation. The force of contraction of the adductor pollicis was recorded. Laryngeal response was measured as pressure changes in the cuff of the tracheal tube positioned between the vocal cords. Train-of-four stimulation was applied to the recurrent laryngeal nerve at the notch of the thyroid cartilage and to the ulnar nerve at the wrist. Neuromuscular blockade had a faster onset, was less intense, and recovered more rapidly at the vocal cords. With 0.04 mg/kg, maximum blockade of first twitch (T1) was 55 +/- 8 (mean +/- standard error of the mean [SEM]) and 88 +/- 4% at the vocal cords and the adductor pollicis, respectively (P = 0.0006). Onset time was 3.3 +/- 0.1 and 5.7 +/- 0.2 min, respectively (P = 0.000001), and time to 90% T1 recovery was 11.3 +/- 1.6 and 26.1 +/- 1.8 min, respectively (P = 0.001). With 0.07 mg/kg, onset time was unchanged; maximum blockade was more intense, being 88 +/- 4 and 98 +/- 1%, respectively (P = 0.04 between muscles); and time to 90% T1 recovery was 23.3 +/- 1.8 min at the vocal cords versus 40.3 +/- 2.9 min at the adductor pollicis (P = 0.001). Approximately 1.73 times as much vecuronium was required at the larynx compared with the dose required at the adductor pollicis for the same intensity of blockade. It is concluded that total relaxation of the vocal cords requires large doses of vecuronium, but that maximal effect is reached more rapidly than at the adductor pollicis. C1 INST GUSTAVE ROUSSY,SERV ANESTHESIE,F-94805 VILLEJUIF,FRANCE. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. NR 19 TC 108 Z9 112 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAY PY 1991 VL 74 IS 5 BP 833 EP 837 DI 10.1097/00000542-199105000-00006 PG 5 WC Anesthesiology SC Anesthesiology GA FJ905 UT WOS:A1991FJ90500006 ER PT J AU SHEARER, ES FAHY, LT OSULLIVAN, EP HUNTER, JM AF SHEARER, ES FAHY, LT OSULLIVAN, EP HUNTER, JM TI TRANSPLACENTAL DISTRIBUTION OF ATRACURIUM, LAUDANOSINE AND MONOQUATERNARY ALCOHOL DURING ELECTIVE CESAREAN-SECTION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE ANESTHESIA, OBSTETRIC; PHARMACOKINETICS, ATRACURIUM, LAUDANOSINE, MONOQUATERNARY ALCOHOL ID CESAREAN-SECTION; PLACENTAL-TRANSFER; PHARMACOKINETICS AB Maternal venous (MV), umbilical venous (UV) and umbilical arterial (UA) blood samples were obtained for assay of atracurium, laudanosine and monoquaternary alcohol concentrations in 22 healthy patients undergoing elective Caesarean section under general anaesthesia. At delivery (at a mean time of 8.2 min after atracurium 0.3 mg kg-1), the mean UV concentrations were 103 ng ml-1 (range 44-189 ng ml-1) for atracurium, 26 ng ml-1 (range 6-60 ng ml-1) for laudanosine and 59 ng ml-1 (range 21-148 ng ml-1) for monoquaternary alcohol. The ratios of UV:MV, UA:MV and UA:UV blood concentrations were related positively to time since injection of atracurium for all three substances (P < 0.01 in each instance). The UV:MV ratio at delivery was greatest for laudanosine: mean 19.4% (range 1-35%), compared with 7% (range 2-21%) for atracurium and 10% (range 0-15%) for monoquaternary alcohol. These low values confirm that, although atracurium crosses the placental barrier and its metabolites may be found in the fetus, the drug is safe to use during Caesarean section. C1 LIVERPOOL MATERN HOSP,LIVERPOOL L7 7BN,ENGLAND. RP SHEARER, ES (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,4TH FLOOR,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 17 TC 10 Z9 10 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 1991 VL 66 IS 5 BP 551 EP 556 DI 10.1093/bja/66.5.551 PG 6 WC Anesthesiology SC Anesthesiology GA FL170 UT WOS:A1991FL17000005 ER PT J AU DONATI, F GILL, SS BEVAN, DR DUCHARME, J THEORET, Y VARIN, F AF DONATI, F GILL, SS BEVAN, DR DUCHARME, J THEORET, Y VARIN, F TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ATRACURIUM WITH AND WITHOUT PREVIOUS SUXAMETHONIUM ADMINISTRATION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE DRUG INTERACTIONS, ATRACURIUM, SUXAMETHONIUM; PHARMACODYNAMICS, ATRACURIUM; PHARMACOKINETICS, ATRACURIUM; NEUROMUSCULAR RELAXANTS, ATRACURIUM, SUXAMETHONIUM ID RENAL-FAILURE; LAUDANOSINE; BOLUS; SUCCINYLCHOLINE; PANCURONIUM; VECURONIUM; HALOTHANE AB Suxamethonium increases neuromuscular block produced by non-depolarizing agents administered subsequently. To determine if this effect has a pharmacokinetic or pharmacodynamic origin, 18 ASA physical status I or II adults received atracurium 0.2 mg kg-1, with (n = 10) or without (n = 8) previous injection of suxamethonium 1 mg kg-1, during a thiopentone-nitrous oxide-isoflurane (0.5% end-tidal) anaesthetic. Arterial blood samples were obtained and plasma atracurium concentration measured by HPLC. Train-of-four stimulation was applied to the ulnar nerve and the force of contraction of the adductor pollicis muscle was recorded. Mean (SEM) volume of distribution was slightly greater with previous suxamethonium (143 (13) ml kg-1) than without (109 (5) ml kg-1) (P < 0.04). Mean elimination half-life was unaffected (20.3 (0.8) min and 20.4 (1.6) min, respectively). Neuromuscular block was more intense and recovery was slower with previous administration of suxamethonium. Atracurium concentration at 50% block (C(P)ss50) was 305 (30) ng ml-1 with and 454 (25) ng ml-1 without previous suxamethonium (P < 0.01). It is concluded that suxamethonium may be associated with a slight increase in the volume of distribution of atracurium, but this effect is more than compensated by a decrease in atracurium concentration required for a given effect. C1 MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. UNIV MONTREAL,FAC PHARM,MONTREAL H3C 3J7,QUEBEC,CANADA. UNIV MONTREAL,DEPT PHARM,MONTREAL H3C 3J7,QUEBEC,CANADA. RP DONATI, F (reprint author), ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,MONTREAL H3A 1A1,QUEBEC,CANADA. NR 20 TC 19 Z9 20 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 1991 VL 66 IS 5 BP 557 EP 561 DI 10.1093/bja/66.5.557 PG 5 WC Anesthesiology SC Anesthesiology GA FL170 UT WOS:A1991FL17000006 ER PT J AU BENAD, G HOFMOCKEL, R AF BENAD, G HOFMOCKEL, R TI PIPECURONIUM BROMIDE SO BRITISH JOURNAL OF HOSPITAL MEDICINE LA English DT Article RP BENAD, G (reprint author), UNIV ROSTOCK,ANAESTHESIOL & INTENS THERAPY CLIN,O-2500 ROSTOCK,GERMANY. NR 9 TC 0 Z9 0 PU MARK ALLEN PUBLISHING LTD PI LONDON PA CROXTED MEWS, 286A-288 CROXTED ROAD, LONDON, ENGLAND SE24 9BY SN 0007-1064 J9 BRIT J HOSP MED JI Br. J. Hosp. Med. PD MAY PY 1991 VL 45 IS 5 BP 308 EP 308 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA FN579 UT WOS:A1991FN57900021 ER PT J AU DONATI, F VARIN, F DUCHARME, J GILL, SS THEORET, Y BEVAN, DR AF DONATI, F VARIN, F DUCHARME, J GILL, SS THEORET, Y BEVAN, DR TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ATRACURIUM OBTAINED WITH ARTERIAL AND VENOUS-BLOOD SAMPLES SO CLINICAL PHARMACOLOGY & THERAPEUTICS LA English DT Article ID D-TUBOCURARINE; RENAL-FAILURE; HALOTHANE ANESTHESIA; HUMAN-PLASMA; PANCURONIUM; LAUDANOSINE; ISOFLURANE; VECURONIUM; HYDROLYSIS; POTENCY AB To determine the influence of sampling site on atracurium pharmacokinetic-pharmacodynamic relationships, blood was drawn simultaneously from the radial artery and a peripheral vein during a 20-minute period after injection of atracurium, 0.2 mg/kg, in eight patients. Atracurium and laudanosine concentrations were measured by HPLC. Neuromuscular blockade was measured at the adductor pollicis, after stimulation of the ulnar nerve. Venous levels were lower than corresponding arterial values for up to 20 minutes, and this difference was marked for the early samples. Neuromuscular blockade was maximum after 5 to 7 minutes, much later than the peak venous concentration (1 to 3 minutes). Nonparametric analysis yielded (mean +/- SEM) a rate constant, concentration for 50% blockade, and slope of the effect-concentration relationship of 0.092 +/- 0.01 min-1, 379 +/- 27 ng/ml, and 7.3 +/- 1.67, respectively, when based on arterial samples. The values were statistically different (0.135 +/- 0.011 min-1, 235 +/- 42 ng/ml, and 3.41 +/- 0.37, respectively) when venous levels were used (p < 0.05). It is concluded that forearm venous levels do not correspond to adductor pollicis neuromuscular blockade and the kinetics and kinetic-dynamic relationship for atracurium are heavily dependent on sampling site. C1 MCGILL UNIV,MONTREAL H3A 2T5,QUEBEC,CANADA. UNIV MONTREAL,FAC PHARM,MONTREAL H3C 3J7,QUEBEC,CANADA. UNIV MONTREAL,DEPT PHARMACOL,MONTREAL H3C 3J7,QUEBEC,CANADA. RP DONATI, F (reprint author), ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,MONTREAL H3A 1A1,QUEBEC,CANADA. NR 33 TC 42 Z9 45 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0009-9236 J9 CLIN PHARMACOL THER JI Clin. Pharmacol. Ther. PD MAY PY 1991 VL 49 IS 5 BP 515 EP 522 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA FP117 UT WOS:A1991FP11700005 ER PT J AU SCHOPFER, C PITTET, JF TASSONYI, E BENAKIS, A AF SCHOPFER, C PITTET, JF TASSONYI, E BENAKIS, A TI NEW TECHNIQUE USING [I-125] LABELED ROSE-BENGAL FOR THE QUANTIFICATION IN BLOOD-SAMPLES OF PIPECURONIUM BROMIDE, A MUSCLE-RELAXANT DRUG SO JOURNAL OF LABELLED COMPOUNDS & RADIOPHARMACEUTICALS LA English DT Article DE I-125; ROSE BENGAL; PIPECURONIUM; PHARMACOKINETICS AB A new technique involving the use of [I-125]labeled rose bengal for the quantification of pipecuronium bromide (a muscle relaxant drug) is presented. This technique, which is based on the ability of rose bengal to react with pipecuronium and then form a complex which can be extracted into an organic solvent, involves two steps: the purification and labeling of rose bengal with I-125, and the quantification of pipecuronium. The specific activity of the compound (106-mu-Ci/mg) allows for the quantification of pipecuronium in biological samples at concentrations as low as 5 ng/ml. C1 UNIV GENEVA,CTR MED,DEPT SURG & ANAESTHESIOL,EXPTL SURG LAB,CH-1211 GENEVA 4,SWITZERLAND. RP SCHOPFER, C (reprint author), UNIV GENEVA,CTR MED,DEPT PHARMACOL,DRUG METAB LAB,9 AVE CHAMPEL,CH-1211 GENEVA 4,SWITZERLAND. NR 5 TC 1 Z9 1 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX, ENGLAND PO19 1UD SN 0362-4803 J9 J LABELLED COMPD RAD JI J. Label. Compd. Radiopharm. PD MAY PY 1991 VL 29 IS 5 BP 547 EP 556 DI 10.1002/jlcr.2580290506 PG 10 WC Biochemical Research Methods; Chemistry, Medicinal; Chemistry, Analytical; Pharmacology & Pharmacy SC Biochemistry & Molecular Biology; Pharmacology & Pharmacy; Chemistry GA FL002 UT WOS:A1991FL00200005 ER PT J AU STANLEY, JC CARSON, IW GIBSON, FM MCMURRAY, TJ ELLIOTT, P LYONS, SM MIRAKHUR, RK AF STANLEY, JC CARSON, IW GIBSON, FM MCMURRAY, TJ ELLIOTT, P LYONS, SM MIRAKHUR, RK TI COMPARISON OF THE HEMODYNAMIC-EFFECTS OF PIPECURONIUM AND PANCURONIUM DURING FENTANYL ANESTHESIA SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE HEMODYNAMICS, HEART RATE, BLOOD PRESSURE, CARDIAC OUTPUT; NEUROMUSCULAR BLOCKING AGENTS,PIPECURONIUM,PANCURONIUM,SURGERY,CORONARY ARTERY ID CORONARY-ARTERY DISEASE; MYOCARDIAL ISCHEMIA; ANESTHESIA; VECURONIUM; BROMIDE; METOCURINE; ATRACURIUM; PRESSURE; SURGERY; DRUGS AB Haemodynamic variables were measured following administration of pipecuronium 70-mu-g.kg-1 and pancuronium 90-mu-g.kg-1 (approximately equivalent to 1.5 x ED95) in patients anaesthetised with fentanyl 50-mu-g.kg-1 and scheduled to undergo coronary artery bypass grafting. There were significant increases in heart rate (22%), mean arterial pressure (10%), cardiac index (16%), and the rate pressure product (35%) following administration of pancuronium. The absolute values of these parameters were, however, within acceptable clinical limits. Administration of pipecuronium produced minimal and insignificant changes in these parameters. Other measured or derived indices showed only small changes with both agents and these were generally insignificant. There were no incidences of significant bradycardia following pipecuronium administration. The results from the present study suggest that pipecuronium would have advantages for use in patients with significant cardiovascular disease. C1 ROYAL VICTORIA HOSP,DEPT CLIN ANAESTHESIA,BELFAST BT12 6BA,NORTH IRELAND. QUEENS UNIV BELFAST,DEPT CLIN ANAESTHESIA,BELFAST BT7 1NN,ANTRIM,NORTH IRELAND. NR 24 TC 12 Z9 13 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 APR PY 1991 VL 35 IS 3 BP 262 EP 266 PG 5 WC Anesthesiology SC Anesthesiology GA FG668 UT WOS:A1991FG66800016 ER PT J AU KENT, AP HUNTER, JM AF KENT, AP HUNTER, JM TI THE PHARMACODYNAMICS OF ALCURONIUM IN THE ELDERLY SO ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, ALCURONIUM; PHARMACODYNAMICS; AGE FACTORS, GERIATRIC ID NEUROMUSCULAR BLOCKADE; DOSE-RESPONSE; PHARMACOKINETICS; PANCURONIUM; TUBOCURARINE; ANESTHESIA; VECURONIUM; ATRACURIUM; ONSET RP KENT, AP (reprint author), UNIV LIVERPOOL,ROYAL LIVERPOOL HOSP,DEPT ANAESTHESIA,PRESCOT ST,POB 147,LIVERPOOL L69 3BX,ENGLAND. NR 16 TC 10 Z9 10 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD APR PY 1991 VL 46 IS 4 BP 271 EP 274 DI 10.1111/j.1365-2044.1991.tb11494.x PG 4 WC Anesthesiology SC Anesthesiology GA FE440 UT WOS:A1991FE44000004 ER PT J AU WITHINGTON, DE DONATI, F BEVAN, DR VARIN, F AF WITHINGTON, DE DONATI, F BEVAN, DR VARIN, F TI POTENTIATION OF ATRACURIUM NEUROMUSCULAR BLOCKADE BY ENFLURANE - TIME-COURSE OF EFFECT SO ANESTHESIA AND ANALGESIA LA English DT Article DE ANESTHETICS; VOLATILE ENFLURANE; INTERACTIONS; DRUG ATRACURIUM; ENFLURANE; NEUROMUSCULAR RELAXANTS; ATRACURIUM ID D-TUBOCURARINE; HALOTHANE ANESTHESIA; VOLATILE ANESTHETICS; CONTINUOUS INFUSION; HUMANS; PANCURONIUM; PHARMACOKINETICS; SUCCINYLCHOLINE; VECURONIUM; MUSCLE AB This study was designed to determine the time required for potentiation of atracurium neuromuscular blockade after the introduction of enflurane. Ten ASA physical status I and II adults anesthetized with thiopental, nitrous oxide, and alfentanil were given 0.4 mg/kg atracurium besylate. The force of contraction of the adductor pollicis muscle in response to train-of-four stimulation of the ulnar nerve was recorded. When the first twitch (T1) of the train-of-four recovered to 10% of control, an atracurium infusion was started and adjusted to keep the level of blockade constant. After 15 min of stable blockade, 1.6% - 1.7% end-tidal enflurane was started and maintained for up to 2 h. Venous blood samples were drawn and plasma atracurium concentrations were measured 15 min before and 0, 5, 10, 15, 30, 45, 60, 90, and 120 min after the introduction of enflurane. Atracurium plasma concentrations were 730 +/- 127 (SEM) ng/mL at time 0. During the first 30 min, no significant decrease in plasma levels occurred; but at 45 min, concentrations were only 67% +/- 8% of their initial value (P < 0.01) and 48% +/- 2% at 120 min (P < 0.01). This suggests that the interaction between enflurane and atracurium is time-dependent. Clinically, the interaction between atracurium and enflurane is negligible during procedures of less than 45 min. C1 ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,MONTREAL H3A 1A1,QUEBEC,CANADA. MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. UNIV MONTREAL,FAC PHARM,MONTREAL H3C 3J7,QUEBEC,CANADA. NR 25 TC 21 Z9 27 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD APR PY 1991 VL 72 IS 4 BP 469 EP 473 PG 5 WC Anesthesiology SC Anesthesiology GA FE157 UT WOS:A1991FE15700009 ER PT J AU SLOAN, MH LERMAN, J BISSONNETTE, B AF SLOAN, MH LERMAN, J BISSONNETTE, B TI PHARMACODYNAMICS OF HIGH-DOSE VECURONIUM IN CHILDREN DURING BALANCED ANESTHESIA SO ANESTHESIOLOGY LA English DT Article DE ANESTHESIA, PEDIATRIC; ANESTHETIC TECHNIQUES, BALANCED; MEASUREMENT TECHNIQUES, ELECTROMYOGRAPHY; NEUROMUSCULAR RELAXANTS, SUCCINYLCHOLINE; VECURONIUM; PHARMACODYNAMICS ID INDUCED NEUROMUSCULAR BLOCKADE; CLINICAL-PHARMACOLOGY; MECHANICAL RESPONSES; ATRACURIUM; SUCCINYLCHOLINE; ONSET; PANCURONIUM; INTUBATION; RELAXANTS; PRESSURE AB To compare the speed of onset, intubating conditions, duration of action, and recovery from neuromuscular blockade with vecuronium to those with succinylcholine, 40 ASA physical status 1 or 2 children (ages 2-9 yr) were studied during N2O-O2-opioid anesthesia. Each child was randomly assigned to receive a bolus dose of one of the following muscle relaxants: succinylcholine 2.0 mg/kg (n = 10), vecuronium 0.1 mg/kg (n = 10), vecuronium 0.2 mg/kg (n = 10), or vecuronium 0.4 mg/kg (n = 10). The evoked electromyogram of the abductor digiti minimi to train-of-four stimulation was monitored. We found that with succinylcholine, the time to 95% twitch depression (speed of onset, mean +/- SD), 24 +/- 7 s, was significantly less than that with each dose of vecuronium: 0.1 mg/kg, 83 +/- 21 s; 0.2 mg/kg, 58 +/- 17 s; and 0.4 mg/kg, 39 +/- 11 s, respectively (P < 0.05). The time to laryngoscopy and intubation did not differ significantly between succinylcholine (48 +/- 10 s) and vecuronium 0.4 mg/kg (57 +/- 13 s); however, both were significantly less than than with vecuronium 0.1 and 0.2 mg/kg (P < 0.005). The intubating conditions were excellent in 100% of patients. The duration of action was least with succinylcholine (5.7 +/- 1.5 min) and increased with increasing doses of vecuronium: 0.1 mg/kg, 23.9 +/- 5.1 min; 0.2 mg/kg, 55.2 +/- 11.6 min; and 0.4 mg/kg, 74.6 +/- 9.9 min, respectively (P < 0.001). The recovery index was most rapid with succinylcholine (1.6 +/- 0.4 min) and was slowest with vecuronium 0.4 mg/kg (22.6 +/- 2.1 min) (P < 0.005). In conclusion, vecuronium 0.4 mg/kg reliably depresses the twitch response to 5% of control within 60 s in 95% of children. The rapid speed of onset is associated with an increased duration of action, which is less than 90 min. C1 UNIV TORONTO,HOSP SICK CHILDREN,DEPT ANAESTHESIA,555 UNIV AVE,TORONTO M5G 1X8,ONTARIO,CANADA. UNIV TORONTO,HOSP SICK CHILDREN,RES INST,TORONTO M5G 1X8,ONTARIO,CANADA. NR 23 TC 18 Z9 19 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD APR PY 1991 VL 74 IS 4 BP 656 EP 659 DI 10.1097/00000542-199104000-00006 PG 4 WC Anesthesiology SC Anesthesiology GA FE106 UT WOS:A1991FE10600006 ER PT J AU SHARPE, MD MOOTE, CA LAM, AM MANNINEN, PH AF SHARPE, MD MOOTE, CA LAM, AM MANNINEN, PH TI COMPARISON OF INTEGRATED EVOKED EMG BETWEEN THE HYPOTHENAR AND FACIAL MUSCLE GROUPS FOLLOWING ATRACURIUM AND VECURONIUM ADMINISTRATION SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MEASUREMENT TECHNIQUES, ELECTROMYOGRAPHY, NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS, ATRACURIUM, VECURONIUM ID RESIDUAL ANTIDEPOLARIZING BLOCK; ADDUCTOR POLLICIS MUSCLES; NEUROMUSCULAR BLOCKADE; QUANTITATIVE ASSESSMENT; MECHANICAL RESPONSES; RECOVERY; HUMANS; TUBOCURARINE; PANCURONIUM; TRANSMISSION AB In 17 healthy patients undergoing O2.N2O. isoflurane anaesthesia, following atracurium or vecuronium administration, we compared simultaneous integrated evoked electromyograms (IEEMGs) during spontaneous recovery of the adductor digiti minimi (ADM) and orbicularis oris (OOM) muscle groups in response to train-of-four (TOF) stimulation of the ulnar and facial nerves, respectively. In all patients, the onset of neuromuscular recovery occurred first in the OOM. The time required to recover to a T4/T1 = 0.70 +/- 0.01 (SD) was earlier in the OOM compared with the ADM muscles in both the atracurium (33.4 +/- 5 vs 46.5 +/- 8, P < 0.005) and vecuronium (46.5 +/- 12 vs 60.3 +/- 20, P < 0.005) groups. When the OOM attained a T4/T1 = 0.70 +/- 0.01, the simultaneous T4/T1 in the ADM was 0.29 +/- 0.15 (P < 0.05) in the atracurium group and 0.41 +/- 0.16 (P < 0.01) in the vecuronium group. We conclude that (1) the facial muscles (OOM) recover earlier than the hypothenar muscles (ADM) and (2) an EMG T4/T1 = 0.70 in the facial muscles may not indicate adequate recovery of neuromuscular function. RP SHARPE, MD (reprint author), UNIV WESTERN ONTARIO HOSP,DEPT ANAESTHESIA,339 WINDERMERE RD,LONDON N6A 5A5,ONTARIO,CANADA. NR 27 TC 9 Z9 9 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 1991 VL 38 IS 3 BP 318 EP 323 PG 6 WC Anesthesiology SC Anesthesiology GA FE589 UT WOS:A1991FE58900010 ER PT J AU DUBOIS, MY FLEMING, NW LEA, DE AF DUBOIS, MY FLEMING, NW LEA, DE TI EFFECTS OF SUCCINYLCHOLINE ON THE PHARMACODYNAMICS OF PIPECURONIUM AND PANCURONIUM SO ANESTHESIA AND ANALGESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, PIPECURONIUM, PANCURONIUM, SUCCINYLCHOLINE; PHARMACODYNAMICS, NEUROMUSCULAR RELAXANTS ID DOSE-RESPONSE; BROMIDE; SUXAMETHONIUM; VECURONIUM; HALOTHANE; BLOCKADE AB To study the effects of succinylcholine on subsequent pharmacodynamics of nondepolarizing muscle relaxants, a comparative pharmacodynamic study was carried out in patients having balanced anesthesia (thiopental, fentanyl, nitrous oxide/oxygen) in whom equipotent doses of pipecuronium (80-mu-g/kg) and pancuronium (100-mu-g/kg) were given with or without prior administration of succinylcholine (1 mg/kg). Fifty-two patients were randomly assigned to one of the following four groups: 1, pancuronium (100-mu-g/kg); 2, pipecuronium (80-mu-g/kg); 3, succinylcholine (1 mg/kg) plus pancuronium (100-mu-g/kg); and 4, succinylcholine (1 mg/kg) plus pipecuronium (80-mu-g/kg). In groups 3 and 4, the nondepolarizing relaxant was given after succinylcholine when the twitch height recovered to 75% of its control value. For maintenance of neuromuscular blockade, additional increments of pancuronium (20-mu-g/kg) or pipecuronium (15-mu-g/kg) were given. Neuromuscular function was monitored throughout induction, maintenance, spontaneous recovery, and pharmacologic reversal of the neuromuscular block. Mean onset times for pancuronium (group 1) and pipecuronium (group 2) given without succinylcholine were (mean +/- SEM) 2.5 +/- 0.3 and 2.8 +/- 0.2 min, respectively. Mean onset times (times to maximum twitch depression) of the two drugs given after succinylcholine (groups 3 and 4) were significantly shorter (1.4 +/- 0.4 and 1.6 +/- 0.1 min, respectively). Clinical durations (i.e., until 25% twitch recovery of pancuronium and pipecuronium) were not significantly different among the four groups, varying from 81.1 +/- 5.4 (group 4) to 107.0 +/- 17.0 (group 2) min. Incremental doses used for maintenance of neuromuscular blockade had durations of action ranging from 44.5 +/- 5.1 min (group 1) to 52.8 +/- 7.3 min (group 3) and were not altered by the prior administration of succinylcholine. After the administration of nondepolarizing relaxant, times for spontaneous recovery of twitch height from 10% to 25% of baseline levels were comparable in all groups (from 15.1 +/- 1.7 to 19.8 +/- 2.2 min). The response to reversal of residual neuromuscular blockade with neostigmine (2.5 mg) and glycopyrrolate (0.5 mg) was identical in all groups. We conclude that during balanced anesthesia, the use of succinylcholine for intubation does not necessitate subsequent alteration in doses of pancuronium or pipecuronium. C1 UNIV CALIF DAVIS,SCH MED,DEPT ANESTHESIOL,DAVIS,CA 95616. RP DUBOIS, MY (reprint author), GEORGETOWN UNIV,MED CTR,DEPT ANESTHESIA,3800 RESERVOIR RD NW,WASHINGTON,DC 20007, USA. NR 23 TC 9 Z9 10 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD MAR PY 1991 VL 72 IS 3 BP 364 EP 368 PG 5 WC Anesthesiology SC Anesthesiology GA EY859 UT WOS:A1991EY85900014 ER PT J AU CALDWELL, JE LASTER, MJ MAGORIAN, T HEIER, T YASUDA, N LYNAM, DP EGER, EI WEISKOPF, RB AF CALDWELL, JE LASTER, MJ MAGORIAN, T HEIER, T YASUDA, N LYNAM, DP EGER, EI WEISKOPF, RB TI THE NEUROMUSCULAR EFFECTS OF DESFLURANE, ALONE AND COMBINED WITH PANCURONIUM OR SUCCINYLCHOLINE IN HUMANS SO ANESTHESIOLOGY LA English DT Article DE ACID BASE EQUILIBRIUM, ACIDOSIS, RESPIRATORY; ALKALOSIS, RESPIRATORY; ANESTHETICS, GASES, N2O; ANESTHETICS, VOLATILE, DESFLURANE; ISOFLURANE; NEUROMUSCULAR TRANSMISSION, ADDUCTOR POLLICIS TWITCH RESPONSE; PHARMACOLOGY, DOSE RESPONSE CURVE ID D-TUBOCURARINE; ANESTHETIZED MAN; DOSE TECHNIQUES; ANESTHESIA; HALOTHANE; POTENCY; MUSCLE; SINGLE; I-653; SEVOFLURANE AB The neuromuscular effects of desflurane administered alone were studied in ten healthy human volunteers aged 20-27 yr. Also, the dose-response relationships of pancuronium and succinylcholine in surgical patients during anesthesia with desflurane (n = 13) were compared to those during isoflurane anesthesia (n = 14). In the volunteers, we measured the mechanical response of the adductor pollicis muscle to stimulation of the ulnar nerve in a train-of-four (TOF) sequence at 2 Hz and at tetanic frequencies of 50, 100, and 200 Hz, each administered for 5 s. Amplitudes of the first response (T1) in each TOF sequence and the ratios of the fourth TOF response (T4) to the first were similar at 3, 6, and 9% desflurane and decreased significantly only at 12% (P < 0.05). Desflurane concentrations of 3-12% caused tetanic fade (> 10% decrement in amplitude) at 50, 100, and 200 Hz. The addition of N2O and the duration of anesthetic exposure did not alter desflurane's neuromuscular effects. The only neuromuscular variable influenced by CO2 was T1 amplitude, which decreased as arterial CO2 tension (Pa(CO2)) increased. The doses of pancuronium that depressed T1 amplitude by 50% (ED50) were similar during anesthesia with 1.25 MAC desflurane, 10.5 +/- 2.8-mu-g/kg (mean +/- SD) and 1.25 MAC isoflurane, 12.3 +/- 5.0-mu-g/kg. The ED50 doses of succinylcholine were similar during anesthesia with desflurane 132 +/- 76-mu-g/kg and isoflurane 123 +/- 36-mu-g/kg. We conclude that desflurane significantly depresses neuromuscular function and augments the action of pancuronium and succinylcholine to a degree similar to that of isoflurane. C1 UNIV CALIF SAN FRANCISCO,CARDIOVASC RES INST,SAN FRANCISCO,CA 94143. RP CALDWELL, JE (reprint author), UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,ROOM S436,SAN FRANCISCO,CA 94143, USA. NR 24 TC 35 Z9 35 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1991 VL 74 IS 3 BP 412 EP 418 DI 10.1097/00000542-199103000-00004 PG 7 WC Anesthesiology SC Anesthesiology GA FA443 UT WOS:A1991FA44300004 ER PT J AU NIGROVIC, V FOX, JL AF NIGROVIC, V FOX, JL TI ATRACURIUM DECAY AND THE FORMATION OF LAUDANOSINE IN HUMANS SO ANESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS, ATRACURIUM, LAUDANOSINE; PHARMACOKINETICS ID RENAL-FAILURE; PHARMACOKINETICS; GLUTATHIONE; CIRRHOSIS AB Several groups of investigators have reported that the plasma concentrations of laudanosine, a metabolite of atracurium, are high immediately after administration of atracurium and thereafter decline. Such a time profile of a metabolite in plasma is very unusual. The authors describe a model of atracurium decay and laudanosine disposition that satisfactorily explains these data. The model reveals the following: 1) each atracurium molecule is degraded into two of laudanosine; 2) the generation of laudanosine occurs through two processes-a rapid one, involving approximately 31% of the atracurium dose and proceeding with a half-life of 0.25 min, and a slower one, involving the residual 69% and proceeding with a half-life of 51 min; 3) atracurium degradation by Hofmann elimination proceeds in the central and the noncentral compartments; 4) laudanosine formed from atracurium gains access to its central compartment and disappears from plasma in a biexponential pattern; 5) in cirrhotic patients, only 18% of the atracurium dose is degraded rapidly and laudanosine is disposed of more slowly. The authors propose that the rapid degradation of atracurium in plasma proceeds through a nucleophilic substitution reaction, with plasma nucleophiles substituting for the laudanosine moiety in atracurium. Because both laudanosine moieties in atracurium are required to establish and sustain plasma concentrations of laudanosine, excretion of atracurium or its degradation through pathways not generating laudanosine must be small. C1 COLL PHARM,DEPT PHARMACEUT,SALT LAKE CITY,UT. RP NIGROVIC, V (reprint author), MED COLL OHIO,DEPT ANESTHESIOL,3000 ARLINGTON AVE,TOLEDO,OH 43614, USA. NR 20 TC 15 Z9 15 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1991 VL 74 IS 3 BP 446 EP 454 DI 10.1097/00000542-199103000-00010 PG 9 WC Anesthesiology SC Anesthesiology GA FA443 UT WOS:A1991FA44300010 ER PT J AU BAURAIN, MJ DHOLLANDER, AA MELOT, C DERNOVOI, BS BARVAIS, L AF BAURAIN, MJ DHOLLANDER, AA MELOT, C DERNOVOI, BS BARVAIS, L TI EFFECTS OF RESIDUAL CONCENTRATIONS OF ISOFLURANE ON THE REVERSAL OF VECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ANESTHESIOLOGY LA English DT Article DE ANESTHETICS, VOLATILE, ISOFLURANE; ANTAGONISTS, NEUROMUSCULAR RELAXANTS, NEOSTIGMINE; NEUROMUSCULAR RELAXANTS, VECURONIUM; NEUROMUSCULAR TRANSMISSION, TESTS, TWITCH HEIGHT, TRAIN-OF-FOUR, TETANIC FADE ID D-TUBOCURARINE; ALVEOLAR CONCENTRATIONS; NITROUS-OXIDE; HALOTHANE; ANESTHESIA; ENFLURANE; PARALYSIS; FORANE; BLOOD; PANCURONIUM AB Thirty-six anesthetized patients (ASA physical status 1 or 2) undergoing elective surgery were monitored (isometric adductor pollicis mechanical activity) to detect the effects of discontinuing isoflurane anesthesia upon the reversal of vecuronium-induced neuromuscular blockade. Neuromuscular blockade was produced by vecuronium 100-mu-g/kg and additional doses of 20-mu-g/kg until completion of surgery. The patients were randomly divided into three groups: in the control group (n = 12), only fentanyl/N2O was given; in the "isostable" group (n = 12), isoflurane at an end-tidal concentration of 1.25% was maintained throughout anesthesia; in the "isostop" group (n = 12), isoflurane 1.25% was discontinued before neostigmine administration. In all groups, paralysis was antagonized with 15-mu-g/kg intravenous (iv) atropine and 40-mu-g/kg iv neostigmine when the twitch height (0.1 Hz) had regained 25% of its control value. The measured parameters were twitch height, train-of-four, and 50-100-Hz tetanic fade. No significant differences were found among the three groups with respect to the final twitch heights and tetanic fades at 50 Hz. In the isostable group, final mean train-of-four was significantly less (75%) than in the other patients (88%) (P < 0.01). Mean tetanic fade at 100 Hz was significantly less in the isostable group (31%) than in the isostop group (57%) (P < 0.01) and control group (84%) (P < 0.01). We conclude that discontinuing isoflurane anesthesia for 15 min improves the reversal of a vecuronium paralysis. In addition, after the antagonism of vecuronium-induced neuromuscular blockade, tetanic fade at 100 Hz appears useful to detect the slight impairment of the neuromuscular transmission that is induced by residual isoflurane concentrations and that is undetected by train-of-four measurements. C1 FREE UNIV BRUSSELS,UNIV LIBRE BRUXELLES,HOP ERASME,DEPT INTENS CARE MED,B-1070 BRUSSELS,BELGIUM. FREE UNIV BRUSSELS,UNIV LIBRE BRUXELLES,HOSP BRUGMANN,DEPT ANESTHESIOL,B-1070 BRUSSELS,BELGIUM. RP BAURAIN, MJ (reprint author), FREE UNIV BRUSSELS,UNIV LIBRE BRUXELLES,HOSP ERASME,DEPT ANESTHESIOL,ROUTE LENNIK 808,B-1070 BRUSSELS,BELGIUM. NR 25 TC 39 Z9 40 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1991 VL 74 IS 3 BP 474 EP 478 DI 10.1097/00000542-199103000-00014 PG 5 WC Anesthesiology SC Anesthesiology GA FA443 UT WOS:A1991FA44300014 ER PT J AU TURNER, GA WILLIAMS, JD BAKER, DJ AF TURNER, GA WILLIAMS, JD BAKER, DJ TI EFFECT OF PRETREATMENT WITH ORAL PYRIDOSTIGMINE ON SUBSEQUENT ACTIVITY OF ALCURONIUM IN NON-ANESTHETIZED SUBJECTS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR FUNCTION, PYRIDOSTIGMINE TREATMENT; NEUROMUSCULAR RELAXANTS, ALCURONIUM AB We have studied the effects of alcuronium in 10 healthy, non-anaesthetized volunteers after they had been taking oral pyridostigmine 30 mg 8 hourly. The responses of adductor pollicis were recorded using an isolated forearm procedure (IFP) during onset and recovery of neuromuscular block produced by 1.5 mg of relaxant. Previously-noted disparities between mechanomyogram and electromyogram measurement of the first response of the train-of-four (T1) and the ratio of the fourth (T4) to the first response (TOF ratio) were found in most cases, but were unaffected by pyridostigmine. Pyridostigmine did not affect significantly the overall characteristics of neuromuscular block, but repeated IFP after a placebo unexpectedly produced marginally less depression of T1 and more rapid recovery. The hysteresis relationship between T1 and T4 during onset and recovery of block was confirmed, but was not affected by pyridostigmine. Clinically, the results may indicate that pyridostigmine pretreatment is unlikely to have significant effects on the subsequent use of alcuronium. C1 ROYAL NAVAL HOSP,DEPT ANAESTHET,GOSPORT PO12 2AA,HANTS,ENGLAND. UNIV SOUTHAMPTON,SOUTHAMPTON GEN HOSP,SOUTHAMPTON S09 4XY,ENGLAND. RP TURNER, GA (reprint author), ROYAL W SUSSEX HOSP,DEPT ANAESTHET,CHICHESTER PO19 4SE,W SUSSEX,ENGLAND. NR 10 TC 2 Z9 2 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 1991 VL 66 IS 3 BP 365 EP 369 DI 10.1093/bja/66.3.365 PG 5 WC Anesthesiology SC Anesthesiology GA FB816 UT WOS:A1991FB81600016 ER PT J AU ABDULATIF, M NAGUIB, M AF ABDULATIF, M NAGUIB, M TI NEOSTIGMINE AND EDROPHONIUM FOR REVERSAL OF PIPECURONIUM NEUROMUSCULAR BLOCKADE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANTAGONISTS, NEUROMUSCULAR RELAXANTS, EDROPHONIUM, NEOSTIGMINE; NEUROMUSCULAR RELAXANTS, PIPECURONIUM; NEUROMUSCULAR TRANSMISSION, TRAIN-OF-4 ID TWITCH DEPRESSION; TRAIN-OF-4 RATIO; PANCURONIUM; ATRACURIUM; ANTAGONISM; PYRIDOSTIGMINE; VECURONIUM; TRANSMISSION; HALOTHANE; RECOVERY AB Neostigmine 0.06 mg . kg-1 or edrophonium 1 mg . kg-1 were administered to two groups of 15 patients each for antagonism of pipecuronium-induced neuromuscular block at 20% spontaneous recovery of the first twitch (T1) of the train-of-four (TOF) stimulation. The mean onset of action (+/- SEM) of edrophonium (18.1 +/- 2.4 sec) was significantly more rapid (P < 0.01) than that of neostigmine (47.6 +/- 4 sec), as were the times taken to attain a TOF ratio of 0.25 and 0.5. Nevertheless, the reversal time (time taken from the end of injection of the antagonist until TOF ratio value had reached 0.75) was significantly shorter (P < 0.01) in the neostigmine than in the edrophonium group (499.3 +/- 62 vs 767 +/- 52 sec respectively). The TOF ratio ten minutes after reversal was greater in the neostigmine group than in the edrophonium group (P < 0.01), 0.78 +/- 0.02 vs 0.68 +/- 0.02 min respectively. At that time, 33% (5 out of 15) and 80% (12 out of 15) patients failed to be reversed adequately (TOF ratio of 0.75) after neostigmine 0.06 mg . kg-1 and edrophonium 1 mg . kg-1, respectively. Administration of one additional dose (one-third of the initial dose) of the same antagonist resulted in adequate antagonism in the remaining five patients in the neostigmine group and in nine patients in the edrophonium group. Two such doses were required in the remaining three patients in the latter group. The mean total dose of neostigmine and edrophonium employed in this study was 0.067 +/- 0.002 and 1.3 +/- 0.05 mg . kg-1, respectively. Under the conditions of this study, edrophonium in a dose of 1 mg . kg-1 did not consistently antagonize residual neuromuscular blockade induced by pipecuronium at 20% recovery of T1. C1 UNIV CAIRO,AL KASR EL ANI HOSP,DEPT ANESTHESIA,CAIRO,EGYPT. UNITED ARAB EMIRATES UNIV,FAC MED & HLTH SCI,DEPT CRIT CARE MED,AL AIN,U ARAB EMIRATES. NR 22 TC 9 Z9 9 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 1991 VL 38 IS 2 BP 159 EP 163 PG 5 WC Anesthesiology SC Anesthesiology GA FA002 UT WOS:A1991FA00200004 ER PT J AU BRULL, SJ EHRENWERTH, J CONNELLY, NR SILVERMAN, DG AF BRULL, SJ EHRENWERTH, J CONNELLY, NR SILVERMAN, DG TI ASSESSMENT OF RESIDUAL CURARIZATION USING LOW-CURRENT STIMULATION SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE MEASUREMENT TECHNIQUES, NEUROMUSCULAR BLOCKADE, TRAIN-OF-4; NEUROMUSCULAR RELAXANTS, PANCURONIUM, VECURONIUM; RECOVERY, RESIDUAL CURARIZATION ID DOUBLE BURST STIMULATION; NERVE-STIMULATION; PANCURONIUM; ATRACURIUM; TRAIN-OF-4; RECOVERY; CURARE AB The present study employed train-of-four (TOF) stimulation at a current of 20 mA to assess the incidence and degree of residual neuromuscular blockade in 64 randomly selected Post Anesthesia Care Unit (PACU) patients. Group C (Control, n = 10) had received anaesthesia without nondepolarizing muscle relaxant; Group V (n = 25) had received vecuronium; and Group P (n = 29) had received pancuronium. At the end of surgery, each patient had been considered by his anaesthetist to have adequate neuromuscular function on the basis of clinical signs and tactile or visual evaluation of responses to TOF stimulation. However, upon testing in the PACU 15 min later, 45% (13 of 29) of Group P patients and 8% (2 of 25) of Group V patients had a TOF ratio < 0.70. This study indicates that residual curarization may be commonly encountered following long-acting relaxants despite qualitative intraoperative TOF monitoring. The present incidence, detected at a current of 20 mA, is consistent with previous reports which employed supramaximal TOF stimulation. We conclude that despite intraoperative monitoring, residual curarization following long-acting nondepolarizing agents is common and that it may be detected with TOF at a low stimulating current (20 mA). RP BRULL, SJ (reprint author), YALE UNIV,NEW HAVEN HOSP,SCH MED,DEPT ANESTHESIOL,T3,333 CEDAR ST,POB 3333,NEW HAVEN,CT 06510, USA. RI Brull, Sorin/E-8578-2010 NR 17 TC 26 Z9 27 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 1991 VL 38 IS 2 BP 164 EP 168 PG 5 WC Anesthesiology SC Anesthesiology GA FA002 UT WOS:A1991FA00200005 ER PT J AU FITZPATRICK, KTJ BLACK, GW CREAN, PM MIRAKHUR, RK AF FITZPATRICK, KTJ BLACK, GW CREAN, PM MIRAKHUR, RK TI CONTINUOUS VECURONIUM INFUSION FOR PROLONGED MUSCLE-RELAXATION IN CHILDREN SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article DE ANESTHESIA, PEDIATRIC; INTENSIVE CARE, VENTILATION; NEUROMUSCULAR RELAXANTS, VECURONIUM ID NEUROMUSCULAR BLOCKADE; D-TUBOCURARINE; RENAL-FAILURE; INFANTS; PHARMACOKINETICS; PHARMACODYNAMICS; ATRACURIUM; DURATION AB Facilitation of mechanical ventilation of the lungs using an infusion of vecuronium in 11 infants and children and four neonates in an intensive care unit is described. A loading dose of vecuronium of 0.1 mg . kg-1 was followed by an infusion at an initial rate of 0.1 mg . kg-1 . hr-1. The infusion rate was adjusted to maintain a neuromuscular block of approximately 90% as assessed by the presence of one response to a train-of-four stimulation. The duration of the infusions varied from 9.5 to 179 hr. The mean dose of vecuronium administered was 0.14 mg . kg-1 . hr-1 (+/- 0.05, SD) in the children and 0.11 mg . kg-1 . hr-1 (+/- 0.05) in the neonates. Mean recovery times from the time of stopping the infusion until absence of apparent fade in response to tetanic stimulation were 51.7 (+/- 17.6) and 46.8 (+/- 16.5) min for the children and neonates respectively. No adverse cardiovascular or toxic effects were noted. This technique of vecuronium infusion to facilitate mechanical ventilation of the lungs is feasible and satisfactory in clinical use. C1 ROYAL BELFAST HOSP SICK CHILDREN,INTENS CARE UNIT,BELFAST BT12 6BE,NORTH IRELAND. NR 20 TC 4 Z9 4 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 1991 VL 38 IS 2 BP 169 EP 174 PG 6 WC Anesthesiology SC Anesthesiology GA FA002 UT WOS:A1991FA00200006 ER PT J AU LINDSAY, J AF LINDSAY, J TI GRIFFITH,HAROLD AND THE INTRODUCTION OF CURARE SO CANADIAN MEDICAL ASSOCIATION JOURNAL LA English DT Article NR 4 TC 2 Z9 2 PU CANADIAN MEDICAL ASSOCIATION PI OTTAWA PA 1867 ALTA VISTA DR, OTTAWA ON K1G 3Y6, CANADA SN 0820-3946 J9 CAN MED ASSOC J JI Can. Med. Assoc. J. PD MAR 1 PY 1991 VL 144 IS 5 BP 588 EP 589 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA FA864 UT WOS:A1991FA86400026 ER PT J AU STANLEY, JC MIRAKHUR, RK BELL, PF SHARPE, TDE CLARKE, RSJ AF STANLEY, JC MIRAKHUR, RK BELL, PF SHARPE, TDE CLARKE, RSJ TI NEUROMUSCULAR EFFECTS OF PIPECURONIUM BROMIDE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS; PIPECURONIUM BROMIDE; PANCURONIUM BROMIDE; MEASUREMENT TECHNIQUES; NEUROMUSCULAR BLOCKADE AB The neuromuscular effects of pipecuronium bromide have been evaluated in 90 adult patients anaesthetized with thiopentone, nitrous oxide in oxygen and intravenous fentanyl with or without halothane. Eighty patients received pipecuronium 45-mu-g kg-1 and the remaining ten 70-mu-g kg-1. A separate group of 10 patients received pancuronium in a dose of 60-mu-g kg-1 (equipotent to pipecuronium 45-mu-g kg-1). Neuromuscular block was measured using a single-twitch or train-of-four mode of stimulation. The time to onset of maximum block with pipecuronium 45-mu-g kg-1 varied between 3.5 and 5.7 min depending on the mode of stimulation and the anaesthetic technique used. The time to 25% recovery of this dose varied between 41 and 54 min. The recovery index (time from 25 to 75% recovery) averaged 29 min. These values were generally similar in the group receiving pancuronium 60-mu-g kg-1. The time to onset of complete block with 70-mu-g kg-1 of pipecuronium averaged 2.5 min and the duration to 25% recovery 95 min. There were no significant changes in heart rate and arterial pressure with the use of pipecuronium. The results show pipecuronium to be a drug resembling pancuronium in its neuromuscular effects when used in equipotent doses. C1 ROYAL VICTORIA HOSP,DEPT CLIN ANAESTHESIA,BELFAST BT12 6BA,NORTH IRELAND. NR 0 TC 8 Z9 9 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD MAR PY 1991 VL 8 IS 2 BP 151 EP 156 PG 6 WC Anesthesiology SC Anesthesiology GA FC610 UT WOS:A1991FC61000009 ER PT J AU RAMSEY, FM AF RAMSEY, FM TI TRACRIUM INFUSION EXPERIENCE SURVEY - A SURVEY OF CLINICAL USE OF ATRACURIUM BESYLATE BY CONTINUOUS INFUSION SO SEMINARS IN ANESTHESIA LA English DT Article RP RAMSEY, FM (reprint author), WINCHESTER HOSP,DEPT ANESTHESIOL,41 HIGHLAND AVE,WINCHESTER,MA 01890, USA. NR 5 TC 0 Z9 0 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 SN 0277-0326 J9 SEMIN ANESTH JI Semin. Anesth. PD MAR PY 1991 VL 10 IS 1 BP 48 EP 60 PG 13 WC Anesthesiology SC Anesthesiology GA FB425 UT WOS:A1991FB42500007 ER PT J AU CHAN, KH MUI, WC YANG, MW LEE, TY AF CHAN, KH MUI, WC YANG, MW LEE, TY TI INFLUENCE OF CONTROLLED HYPOTENSION BY ADENOSINE-TRIPHOSPHATE OR NITROGLYCERIN ON THE NEUROMUSCULAR BLOCKING EFFECT OF ATRACURIUM IN DOGS SO NEUROSCIENCE LETTERS LA English DT Article DE ATRACURIUM; NEUROMUSCULAR BLOCKADE; CONTROLLED HYPOTENSION; ADENOSINE TRIPHOSPHATE; NITROGLYCERIN ID SODIUM-NITROPRUSSIDE; ANEURYSM SURGERY; RELEASE; AGENT; NERVE AB The neuromuscular blocking effect of atracurium under the influence of controlled hypotension by adenosine triphosphate (ATP) or nitroglycerine (NTG) was studied in mongrel dogs under halothane anesthesia. Under hypotensive state (60 +/- 5 mmHg) elicited by ATP (0.5 mg/kg/min) or NTG (1-mu-g/kg/min), the neuromuscular blockade produced by atracurium (30-mu-g/kg, i.v.) was significantly potentiated and prolonged. The maximal depression of twitch contraction of the gastrocnemius-soleus muscle increased from 10 +/- 3% to 36 +/- 10% (ATP group) and 56.0 +/- 2.4% (NTG group), while the duration of neuromuscular blockade was prolonged from 663 +/- 96 s to 1060 +/- 277 s (ATP group), and 1375 +/- 441 s (NTG group). The potentiation and prolongation of neuromuscular blockade by atracurium was still apparent upon reversal of the hypotensive effect of ATP, but not of NTG, by dopamine infusion. We suggest that ATP may prolong and augment the effect of atracurium by reducing the presynaptic release of acetylcholine at the neuromuscular junction. C1 NATL YANG MING MED COLL,TAIPEI,TAIWAN. RP CHAN, KH (reprint author), VET GEN HOSP,DEPT ANESTHESIOL,TAIPEI 11217,TAIWAN. NR 20 TC 2 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 FEB 25 PY 1991 VL 123 IS 2 BP 226 EP 228 DI 10.1016/0304-3940(91)90936-N PG 3 WC Neurosciences SC Neurosciences & Neurology GA FC479 UT WOS:A1991FC47900022 ER PT J AU RILEY, DP MCBRIDE, LJ AF RILEY, DP MCBRIDE, LJ TI KETAMINE, MIDAZOLAM AND VECURONIUM INFUSION - ANESTHESIA FOR DOWNS-SYNDROME AND CONGENITAL HEART-DISEASE SO ANAESTHESIA LA English DT Article DE ANESTHESIA, INTRAVENOUS; KETAMINE, MIDAZOLAM, VECURONIUM; ANESTHETIC TECHNIQUES; CONTINUOUS INFUSION; CONGENITAL HEART DISEASE ID ANESTHESIA RP RILEY, DP (reprint author), ROYAL NEWCASTLE HOSP,DEPT ANAESTHESIA & INTENS CARE,NEWCASTLE,NSW 2300,AUSTRALIA. NR 6 TC 5 Z9 5 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD FEB PY 1991 VL 46 IS 2 BP 122 EP 123 DI 10.1111/j.1365-2044.1991.tb09356.x PG 2 WC Anesthesiology SC Anesthesiology GA EW824 UT WOS:A1991EW82400014 ER PT J AU GIBBS, NM RUNG, GW BRAUNEGG, PW MARTIN, DE AF GIBBS, NM RUNG, GW BRAUNEGG, PW MARTIN, DE TI THE ONSET AND DURATION OF NEUROMUSCULAR BLOCKADE USING COMBINATIONS OF ATRACURIUM AND VECURONIUM SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE NEUROMUSCULAR RELAXANTS; INTERACTION; ATRACURIUM; VECURONIUM; NEUROMUSCULAR BLOCKADE; DURATION; ONSET ID INTUBATION; RESPONSES AB The effect of atracurium-vecuronium combinations on the onset and duration of neuromuscular blockade was investigated in 30 adult patients undergoing general anaesthesia for elective surgery. The patients were randomized to receive either atracurium 0.6 mg.kg-1, vecuronium 0.1 mg.kg-1, or quarter-dose, half-dose, or full-dose combinations of the two drugs. Neuromuscular blockade was assessed by measuring the evoked electromyographic response of the abductor digit minimi to transcutaneous stimulation of the ulnar nerve. It was found that half-dose combinations of atracurium and vecuronium did not produce a shorter onset time, but did result in a longer duration of neuromuscular blockade than full-doses of either drug alone (P < 0.01). The quarter-dose combinations did not reduce onset time or increase duration. The full-dose combinations produced both a shorter onset time (P < 0.01) and a longer duration (P < 0.001). The results indicate that atracurium-vecuronium combinations are supra-additive in terms of the duration of the neuromuscular blockade produced. However, the inability of atracurium-vecuronium combinations to reduce onset time without increasing duration suggests that there is little advantage in combining the two drugs in clinical practice. C1 PENN STATE UNIV,COLL MED,DEPT ANESTHESIA,UNIVERSITY PK,PA 16802. NR 17 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 FEB PY 1991 VL 19 IS 1 BP 96 EP 100 PG 5 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EX074 UT WOS:A1991EX07400018 ER PT J AU PARR, SM GALLETLY, DC ROBINSON, BJ AF PARR, SM GALLETLY, DC ROBINSON, BJ TI BETAMETHASONE-INDUCED RESISTANCE TO VECURONIUM - A POTENTIAL PROBLEM IN NEUROSURGERY SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article DE ANESTHESIA; COMPLICATIONS; BETAMETHASONE; NEUROMUSCULAR RELAXANTS; VECURONIUM; RESISTANCE TO ID RAT DIAPHRAGM; NEUROMUSCULAR-TRANSMISSION; CORTICOSTEROIDS; DEXAMETHASONE; PREDNISOLONE; PANCURONIUM; JUNCTION; BLOCKING C1 WELLINGTON SCH MED,DEPT SURG,ANAESTHESIA SECT,POB 7343,WELLINGTON,NEW ZEALAND. NR 16 TC 17 Z9 17 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 1991 VL 19 IS 1 BP 103 EP 105 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EX074 UT WOS:A1991EX07400020 ER PT J AU COOK, DR FREEMAN, JA LAI, AA ROBERTSON, KA KANG, YG STILLER, RL AGGARWAL, S ABOUDONIA, MM WELCH, RM AF COOK, DR FREEMAN, JA LAI, AA ROBERTSON, KA KANG, YG STILLER, RL AGGARWAL, S ABOUDONIA, MM WELCH, RM TI PHARMACOKINETICS AND PHARMACODYNAMICS OF DOXACURIUM IN NORMAL-PATIENTS AND IN THOSE WITH HEPATIC OR RENAL-FAILURE SO ANESTHESIA AND ANALGESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, DOXACURIUM; PHARMACOKINETICS, DOXACURIUM; KIDNEY, RENAL FAILURE DOXACURIUM; LIVER, HEPATIC FAILURE DOXACURIUM ID NITROUS-OXIDE; PANCURONIUM; VECURONIUM; CIRRHOSIS; CHLORIDE; BROMIDE AB We determined the pharmacokinetics and duration of action of a bolus dose of doxacurium (15-mu-g/kg) in 27 patients anesthetized with isoflurane and nitrous oxide. Nine patients had normal renal and liver functions and were undergoing a variety of surgical procedures, nine were undergoing cadaveric kidney transplantation because of end-stage renal disease, and nine were undergoing cadaveric liver transplantation because of end-stage hepatocellular disease. Plasma concentrations of doxacurium were measured for 6 h after administration using a sensitive and specific capillary gas chromatographic assay. Plasma concentration versus time data were analyzed by a noncompartmental method based on statistical moments. Neuromuscular blockade was assessed by measuring the electromyographic evoked response of the adductor pollicis muscle to train-of-four stimulation of the ulnar nerve. The degree of neuromuscular blockade after doxacurium administration was described as the percent of control of the first train-of-four response. The pharmacokinetic variables were (normal vs hepatic failure vs renal failure, respectively): volume of distribution at steady state (220 +/- 110 vs 290 +/- 60 vs 270 +/- 130 mL/kg [mean +/- SD]), plasma clearance (2.7 +/- 1.6 vs 2.3 +/- 0.4 vs 1.2 +/- 0.7 mL.kg-1.min-1), mean residence time (95.2 +/- 57 vs 129.4 +/- 30 vs 270 +/- 210 min), and elimination half-life (99 +/- 54 vs 115 +/- 31 vs 221 +/- 156 min). Plasma clearance and mean residence time differed significantly between patients with renal failure and control patients. There was no significant difference in the onset times or in clinical effective duration, although the clinical duration tended to be longer and more variable in the patients with renal failure. This unpredictable response and the possibility of prolonged blockade should be borne in mind if doxacurium is to be used in patients with renal failure. C1 PRESBYTERIAN UNIV HOSP,DEPT ANESTHESIOL,PITTSBURGH,PA. UNIV PITTSBURGH,SCH MED,DEPT ANESTHESIOL,PITTSBURGH,PA 15261. BURROUGHS WELLCOME CO,RES TRIANGLE PK,NC 27709. NR 13 TC 39 Z9 39 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD FEB PY 1991 VL 72 IS 2 BP 145 EP 150 PG 6 WC Anesthesiology SC Anesthesiology GA EU711 UT WOS:A1991EU71100002 ER PT J AU OHARA, DA DERBYSHIRE, GJ OVERDYK, FJ BOGEN, DK MARSHALL, BE AF OHARA, DA DERBYSHIRE, GJ OVERDYK, FJ BOGEN, DK MARSHALL, BE TI CLOSED-LOOP INFUSION OF ATRACURIUM WITH 4 DIFFERENT ANESTHETIC TECHNIQUES SO ANESTHESIOLOGY LA English DT Article DE ANESTHETICS, VOLATILE-ENFLURANCE-HALOTHANE-ISOFLURANE; EQUIPMENT-COMPUTERS; MEASUREMENT TECHNIQUES-ELECTROMYOGRAPHY-NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR RELAXANTS-ATRACURIUM-CONTINUOUS INFUSION ID INDUCED MUSCLE-RELAXATION; D-TUBOCURARINE; ALVEOLAR CONCENTRATIONS; CARDIOPULMONARY BYPASS; NEUROMUSCULAR BLOCK; AUTOMATIC-CONTROL; VECURONIUM; ENFLURANE; SURGERY; SUXAMETHONIUM AB A new proportional-integral-derivative (PID) controller for the automated closed-loop delivery of atracurium was tested in 32 patients. Groups of 8 patients received halothane, enflurane, isoflurane, or N2O/morphine anesthesia. After induction of anesthesia with sodium thiopental 3-5 mg.kg-1, a bolus of atracurium 0.2 mg.kg-1 was delivered by the controller; this was followed by an infusion calculated by the controller to maintain the electromyogram (EMG) at a setpoint of 90% neuromuscular blockade. The average overshoot for the controller was 10.1% and the mean steady-state error 3.0%. The mean infusion rates for atracurium to maintain 90% blockade were calculated for each anesthetic group, with the inhalation anesthetics at 1 MAC. Infusion rates for N2O/morphine, halothane 0.8%, enflurane 1.7%, and isoflurane 1.4% at 90% blockade were 5.7 +/- 0.6, 4.9 +/- 0.3, 3.5 +/- 0.3, and 4.1 +/- 0.5 mu-g.kg-1.min-1, respectively (mean +/- SE). The infusion rate for atracurium at 90% blockade under N2O/morphine anesthesia was in general agreement with published values. The other infusion rates at 90% blockade have not been reported previously, but correspond to the known potencies of these inhalation anesthetics for augmentation of neuromuscular blockade. This controller performed well in comparison to previously developed controllers, and in addition was used as a research tool for rapid estimation of infusion rates. C1 UNIV MED & DENT NEW JERSEY,COOPER HOSP,CAMDEN,NJ. UNIV PENN,DEPT ANESTHESIA,PHILADELPHIA,PA 19104. UNIV PENN,DEPT BIOENGN,PHILADELPHIA,PA 19104. NR 27 TC 22 Z9 23 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD FEB PY 1991 VL 74 IS 2 BP 258 EP 263 DI 10.1097/00000542-199102000-00011 PG 6 WC Anesthesiology SC Anesthesiology GA EV645 UT WOS:A1991EV64500011 ER PT J AU JAMES, MFM SCHENK, PA VANDERVEEN, BW AF JAMES, MFM SCHENK, PA VANDERVEEN, BW TI PRIMING OF PANCURONIUM WITH MAGNESIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS; PANCURONIUM; NEUROMUSCULAR TRANSMISSION; MAGNESIUM AB Magnesium inhibits the release of acetylcholine from the motor nerve terminal and thus potentiates the action of the non-depolarizing neuromuscular blocking drugs. We have examined the possibility that this effect might enhance the speed of onset of non-depolarizing block with pancuronium. Following the administration of pancuronium 100-mu-g kg-1, 95% depression of thumb twitch occurred in 68.3 (SD 25.9) s in magnesium-pretreated subjects and in 73.7 (19.5) s in a group given a priming dose (10-mu-g kg-1) of pancuronium. Tracheal intubation was performed after 97.8 (22.5) s in the magnesium group and in 121.0 (37.5) s in the control group (ns). It is concluded that pretreatment with magnesium does not usefully increase the speed of onset of action of pancuronium. C1 UNIV WITWATERSRAND,DEPT ANAESTHESIA,JOHANNESBURG 2001,SOUTH AFRICA. RP JAMES, MFM (reprint author), UNIV CAPE TOWN,SCH MED,DEPT ANAESTHESIA,CAPE TOWN 7925,SOUTH AFRICA. NR 6 TC 17 Z9 20 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 FEB PY 1991 VL 66 IS 2 BP 247 EP 249 DI 10.1093/bja/66.2.247 PG 3 WC Anesthesiology SC Anesthesiology GA EX033 UT WOS:A1991EX03300018 ER PT J AU COSTAKOS, DT BLACKWELL, CE KRAUSS, AN EISEN, C VIOLARIS, K WIERCINSKI, AE AULD, PAM AF COSTAKOS, DT BLACKWELL, CE KRAUSS, AN EISEN, C VIOLARIS, K WIERCINSKI, AE AULD, PAM TI AORTIC ROOT BLOOD-FLOW INCREASES AFTER PANCURONIUM IN NEONATES WITH HYALINE-MEMBRANE DISEASE SO CRITICAL CARE MEDICINE LA English DT Article DE PANCURONIUM; BLOOD FLOW; HYALINE MEMBRANE DISEASE; CARDIAC OUTPUT; INFANT; PREMATURE; MUSCLE RELAXANTS; VASCULAR RESISTANCE; VENTILATORS; MECHANICAL; AORTA ID CARDIAC-OUTPUT; VENTILATED INFANTS; BROMIDE; TUBOCURARINE; DOGS AB Objective: To determine the effects of muscle paralysis on aortic root blood flow in preterm infants with hyaline membrane disease. Design: Each patient served as his/her own control in a prospectively controlled trial. Setting: Neonatal ICU in a university hospital. Patients: Ten ventilator-dependent preterm infants weighing 800 to 2820 g, 0 to 8 days of age, with hyaline membrane disease and seven control patients. Interventions: Noninvasive measurement of aortic root blood flow by Doppler echocardiography 30 min before and 60 min after respiratory paralysis with 0.1 to 0.5 mg/ kg of iv pancuronium, or following ventilator changes in control subjects. Results: Mean aortic root blood flow increased significantly (p < .001), from 212 to 276 mL/min.kg, accompanied by significant increases in stroke volume and heart rate. Conclusions: Pancuronium bromide may have a direct beneficial effect on the circulation of preterm infants with hyaline membrane disease. C1 CORNELL UNIV,MED CTR,NEW YORK HOSP,DEPT PEDIAT,DIV PERINATAL MED,1300 YORK AVE,NEW YORK,NY 10021. NR 19 TC 3 Z9 3 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD FEB PY 1991 VL 19 IS 2 BP 187 EP 190 DI 10.1097/00003246-199102000-00013 PG 4 WC Critical Care Medicine SC General & Internal Medicine GA EW990 UT WOS:A1991EW99000013 ER PT J AU MUIR, AW ANDERSON, K MARSHALL, RJ BOOIJ, LHDJ CRUL, JF PRIOR, C BOWMAN, WC MARSHALL, IG AF MUIR, AW ANDERSON, K MARSHALL, RJ BOOIJ, LHDJ CRUL, JF PRIOR, C BOWMAN, WC MARSHALL, IG TI THE EFFECTS OF A 16-N-HOMOPIPERIDINO ANALOG OF VECURONIUM ON NEUROMUSCULAR-TRANSMISSION IN ANESTHETIZED CATS, PIGS, DOGS AND MONKEYS, AND IN ISOLATED PREPARATIONS SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article DE AUTONOMIC NERVOUS SYSTEM; NEUROMUSCULAR BLOCK; NONDEPOLARIZING; ORG-7617; ORG-9991; VECURONIUM ID BLOCKING; PANCURONIUM; TUBOCURARINE; RAT AB Org 9991, a 16-N-homopiperidinium substituted vecuronium analogue, has been tested for neuromuscular blocking activity in anaesthetized cats, pigs, dogs and monkeys, and in isolated nerve-muscle preparations. Org 9991 exhibited non-depolarizing neuromuscular blocking activity of the competitive type, being reversible by neostigmine and showing no endplate channel blocking action in isolated preparations. In cats, 50% vagal block was observed at doses of Org 9991 approximately 10 times those producing 50% neuromuscular block; no ganglion block was seen at these doses. Effects on blood pressure or heart rate at 90% twitch blocking doses were either minor or absent. The potency and time course of action of Org 9991 remained similar in all four species: i.e. 90% block at ca 200-300-mu-g kg-1; onset time ca 1.2-1.9 min; duration 90% ca 4.5-8.9 min. This study suggests that 16-N-homopiperidinium analogues of vecuronium may provide leads in the quest for a potent non-depolarizing replacement for suxamethonium. C1 UNIV STRATHCLYDE,DEPT PHYSIOL & PHARMACOL,204 GEORGE ST,GLASGOW G1 1XW,SCOTLAND. ORGANON RES LABS LTD,DEPT PHARMACOL,ORGANON SCI DEV GRP,NEWHOUSE ML1 5SH,LANARK,SCOTLAND. CATHOLIC UNIV NIJMEGEN,DEPT ANAESTHESIOL,NIJMEGEN,NETHERLANDS. NR 15 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 JAN PY 1991 VL 35 IS 1 BP 85 EP 90 PG 6 WC Anesthesiology SC Anesthesiology GA EU348 UT WOS:A1991EU34800016 ER PT J AU WALI, FA MAKINDE, V AF WALI, FA MAKINDE, V TI COMPARATIVE EFFECTS OF VECURONIUM AND PANCURONIUM ON RELEASE OF LACTATE-DEHYDROGENASE IN RAT ISOLATED DIAPHRAGM, LIVER, KIDNEY AND HEART SO ACTA PHYSIOLOGICA HUNGARICA LA English DT Article DE VECURONIUM; PANCURONIUM; LACTATE DEHYDROGENASE; ISOLATED DIAPHRAGM; LIVER; KIDNEY; HEART; MUSCLE RELAXANTS ID MUSCLE-RELAXANTS; ATRACURIUM; TUBOCURARINE AB The comparative effects of two muscle relaxants, namely pancuronium and vecuronium, on the release of intracellular lactate dehydrogenase (LDII), released from four different types of tissues, namely, the heart, liver, kidney and diaphragm, were studied in the rat in vitro. The LDH and its leakage into extracellular space, was used as an indicator for cellular membrane damage, and the aim was to see if the two muscle relaxants enhanced the release of LDH, and hence, by implication, caused adverse effects, i.e., damage to cell membrane. The total amount of LDH, the neat (LDH), and the increase in LDH release caused by different concentrations of the two muscle relaxants were measured using spectrophotometric determination at 340 nm. The results showed that both muscle relaxants, in low concentrations (0.32 or 0.34-mu-M, a concentration which is close to a clinical dose of 0.1 mg/ml), did not significantly enhance the LDH release from any of the 4 different types of tissues studied. However, in concentrations of 10-130 times the clinical dose, both drugs significantly enhanced the LDH release in all the 4 tissues, with pancuronium being more effective than vecuronium. In addition, the diaphragm and kidney were most affected, whereas the heart and liver being the least affected. The clinical relevance and/or implications of these comparative effects are discussed, and the results are compared to those previously reported by other workers. Pancuronium and vecuronium are among the non-depolarising neuromuscular blocking drugs currently-used in clinical anaesthesia. Previous reports have indicated that pancuronium is a powerful muscle relaxant, perhaps more powerful than vecuronium, in blocking neuromuscular transmission and/or muscle twitch or tetanic contraction, in both animal and human species [1, 3, 5]. In addition, it has been shown that pancuronium was more effective than vecuronium in causing the release of lactate dehydrogenase (LDII) in the rat isolated hepatocytes [9]. In the present investigation, we have extended the previous studies by analysing and comparing the effects of vecuronium and pancuronium on the release of LDH, in the rat, in a variety of tissues, namely the diaphragm, liver, kidney and the heart. C1 ST GEORGE HOSP,SCH MED,DEPT CELLULAR & MOLEC SCI,LONDON,ENGLAND. RP WALI, FA (reprint author), HOSP SICK CHILDREN,RESP & ANAESTHET UNIT,GREAT ORMOND ST,LONDON WC1N 3JH,ENGLAND. NR 12 TC 0 Z9 0 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0231-424X J9 ACTA PHYSIOL HUNG JI Acta Physiol. Hung. PY 1991 VL 78 IS 2 BP 127 EP 133 PG 7 WC Physiology SC Physiology GA HB471 UT WOS:A1991HB47100004 ER PT J AU OSHITA, S DENDA, S FUJIWARA, Y TAKESHITA, H KOSAKA, F AF OSHITA, S DENDA, S FUJIWARA, Y TAKESHITA, H KOSAKA, F TI PRETREATMENT WITH D-TUBOCURARINE, VECURONIUM, AND PANCURONIUM ATTENUATES SUCCINYLCHOLINE-INDUCED INCREASES IN PLASMA NOREPINEPHRINE CONCENTRATIONS IN HUMANS SO ANESTHESIA AND ANALGESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, SUCCINYLCHOLINE, D-TUBOCURARINE, VECURONIUM, PANCURONI; SYMPATHETIC NERVOUS SYSTEM, CATECHOLAMINES AB We studied in patients the effect of d-tubocurarine, which has sympathetic ganglion blocking action, on succinylcholine-induced increases in plasma levels of catecholamines, and compared it with the effects of vecuronium and pancuronium, which have little sympathetic ganglion blocking action. Thirty-two patients were divided into five groups: seven were given 3 mL saline; seven received 1 mg/kg succinylcholine; and six, seven, and five patients were given 0.08 mg/kg d-tubocurarine, 0.01 mg/kg vecuronium, and 0.01 mg/kg pancuronium, respectively, all of which were injected 5 min before 1 mg/kg succinylcholine. Succinylcholine alone significantly increased plasma norepinephrine concentrations, systolic blood pressure, and heart rate from 187 +/- 39 pg/mL (mean +/- SEM), 93 +/- 2 mm Hg, and 77 +/- 4 beats/min to 429 +/- 61 pg/mL, 120 +/- 7 mm Hg, and 102 +/- 6 beats/min, respectively, with onset of fasciculations. Pretreatment with d-tubocurarine, vecuronium, and pancuronium significantly and equally attenuated both the fasciculations and the cardiovascular responses to succinylcholine. These results suggest that the sympathetic ganglion blocking action of neuromuscular relaxants when given before succinylcholine is not an important factor in attenuation of succinylcholine-induced increases in plasma levels of catecholamines. C1 OKAYAMA UNIV HOSP,DEPT ANESTHESIOL RESUSCITOL,OKAYAMA,JAPAN. RP OSHITA, S (reprint author), YAMAGUCHI UNIV,DEPT ANESTHESIOL RESUSCITOL,UBE,YAMAGUCHI 755,JAPAN. NR 12 TC 5 Z9 5 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 1991 VL 72 IS 1 BP 84 EP 88 PG 5 WC Anesthesiology SC Anesthesiology GA EN965 UT WOS:A1991EN96500015 ER PT J AU KHUENLBRADY, KS KOLLER, J MAIR, P PUHRINGER, F MITTERSCHIFFTHALER, G AF KHUENLBRADY, KS KOLLER, J MAIR, P PUHRINGER, F MITTERSCHIFFTHALER, G TI COMPARISON OF VECURONIUM-INDUCED AND ATRACURIUM-INDUCED NEUROMUSCULAR BLOCKADE IN POSTPARTUM AND NONPREGNANT PATIENTS SO ANESTHESIA AND ANALGESIA LA English DT Article DE NEUROMUSCULAR RELAXANTS, VECURONIUM, ATRACURIUM; ANESTHESIA, OBSTETRICS ID PREGNANCY; BROMIDE; LIVER AB The time-course of action of 0.1 mg/kg vecuronium and 0.5 mg/kg atracurium was investigated in nonpregnant and in postpartum patients within 4 days after delivery. The clinical duration of vecuronium, but not that of atracurium, was significantly prolonged in the latter group (P < 0.001) and averaged 36 +/- 6 and 37 +/- 4 min for atracurium and 32 +/- 6 and 49 +/- 10 min for vecuronium in nonpregnant and in postpartum patients, respectively (mean +/- SD). In additional in vitro experiments in the rat phrenic nerve-hemidiaphragm preparation no difference could be observed in the neuromuscular blocking effects of vecuronium in postpartum and nonpregnant female rats. It is concluded that pregnancy-induced changes in liver blood flow and/or competition for the liver uptake of sexual hormones might interfere with the hepatic clearance of vecuronium in postpartum patients and thereby cause the observed prolongation of neuromuscular blockade. RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK,ANAESTHESIA & GEN INTENS CARE MED CLIN,ANICHSTR 35,A-6020 INNSBRUCK,AUSTRIA. NR 14 TC 13 Z9 13 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JAN PY 1991 VL 72 IS 1 BP 110 EP 113 PG 4 WC Anesthesiology SC Anesthesiology GA EN965 UT WOS:A1991EN96500020 ER PT J AU BRULL, SJ CONNELLY, NR OCONNOR, TZ SILVERMAN, DG AF BRULL, SJ CONNELLY, NR OCONNOR, TZ SILVERMAN, DG TI EFFECT OF TETANUS ON SUBSEQUENT NEUROMUSCULAR MONITORING IN PATIENTS RECEIVING VECURONIUM SO ANESTHESIOLOGY LA English DT Article DE MONITORING; NEUROMUSCULAR; DOUBLE-BURST STIMULATION; FADE; NERVE STIMULATOR ID POSTTETANIC COUNT PTC; NERVE-STIMULATION; BLOCK; SUXAMETHONIUM; RECOVERY; TACTILE; FADE AB The current study evaluated the effects of tetanic stimulation on neuromuscular responses to serial train-of-four (TOF) and double-burst stimulation (DBS). For TOF monitoring (n = 13), a degree of neuromuscular blockade was achieved with an intravenous vecuronium infusion such that the ratio of fourth twitch (T4) to first twitch (T1), T4/T1, was stable at a value between 0.1 and 0.7. Four seconds after a 5-s, 50-Hz tetanic stimulus was delivered, TOF monitoring was resumed at 10-s intervals. Significant changes were noted for T1, T4, and T4/T1, with median increases of 38, 250, and 93%, respectively. The median times for T1, T4, and T4/T1 to return to within 10% of their pretetanic (baseline) values were 34, 43, and 34 s, respectively (P = nonsignificant [NS] among times to recovery). A 100-Hz tetanic stimulus induced 50, 300, and 178% median increases of T1, T4, and T4/T1, while corresponding values for recovery times were 53, 73, and 54 s. For DBS monitoring (n = 14), tetanic stimulation (50-Hz, 5-s) induced 38, 300, and 153% median increases of the DBS(3,3) parameters (first response [D1], second response [D2], and their ratio [D2 not-equal D1], respectively). The posttetanic effects on D1, D2, and D2/D1 persisted for 43, 66, and 46 s, respectively. For DBS(3,2), median posttetanic (50-Hz, 5-s) increases were 41, 275, and 176%, while corresponding times to recovery were 43, 43, and 43 s. Although the data indicate that the posttetanic percent increase was at least 10 times larger at greater degrees of blockade (T4/T1 = 0.1) than at lesser degrees (T4/T1 = 0.7), all T4/T1 and D2/D1 ratios returned to within 10% of baseline in 125 s or less after 5-s tetanic stimulation. RP BRULL, SJ (reprint author), YALE UNIV,YALE NEW HAVEN HOSP,SCH MED,DEPT ANESTHESIOL,333 CEDAR ST,NEW HAVEN,CT 06510, USA. RI Brull, Sorin/E-8578-2010 NR 22 TC 18 Z9 18 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JAN PY 1991 VL 74 IS 1 BP 64 EP 70 DI 10.1097/00000542-199101000-00011 PG 7 WC Anesthesiology SC Anesthesiology GA ET504 UT WOS:A1991ET50400011 ER PT J AU BOULOT, P NICOLAS, J QUI, C VAGNY, C VIALA, JL AF BOULOT, P NICOLAS, J QUI, C VAGNY, C VIALA, JL TI FETAL CURARIZATION OBTAINED BY PUNCTURE OF THE UMBILICAL-CORD DURING PREGNANCY SO ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION LA French DT Article AB Two cases of foetal neuromuscular blockade carried out to obtain foetal immobility during long procedures (in utero foetal exchange transfusion, foetal imaging) are reported. The blockade was carried out in the operating theatre, the mother being awake. Foetal weight had been estimated according to usual echographic parameters. After a long needle had been inserted in the umbilical vein under the guidance of ultrasonography, 0.1 mg . kg-1 vecuronium was injected. Muscle paralysis lasted for about 2 hours in both cases, foetal movements returning spontaneously. There were no side effects due to this technique, a transient foetal bradycardia excepted. Foetal neuromuscular blockade by direct cord injection of muscle relaxants seems to be a simpler, and perhaps safer, technique than obtaining foetal immobility by maternal anaesthesia. RP BOULOT, P (reprint author), CTR HOSP REG UNIV MONTPELLIER,CTR FOETOL,SERV GYNECOL OBSTET,F-34059 MONTPELLIER,FRANCE. NR 0 TC 0 Z9 0 PU EDITIONS SCIENTIFIQUES ELSEVIER PI PARIS CEDEX 15 PA 141 RUE JAVEL, 75747 PARIS CEDEX 15, FRANCE SN 0750-7658 J9 ANN FR ANESTH JI Ann. Fr. Anest. Reanim. PY 1991 VL 10 IS 2 BP 151 EP 153 DI 10.1016/S0750-7658(05)80455-1 PG 3 WC Anesthesiology SC Anesthesiology GA FH094 UT WOS:A1991FH09400010 ER PT J AU PLATT, M HAYWARD, A COOPER, A HIRSCH, N AF PLATT, M HAYWARD, A COOPER, A HIRSCH, N TI EFFECT OF ARTERIAL CARBON-DIOXIDE TENSION ON THE DURATION OF ACTION OF ATRACURIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article DE BIOTRANSFORMATION, ATRACURIUM; CARBON DIOXIDE, ARTERIAL TENSION; NEUROMUSCULAR RELAXANTS, ATRACURIUM ID NEUROMUSCULAR BLOCKING-AGENT; INVITRO DEGRADATION; HUMAN-PLASMA; PHARMACOLOGY AB The duration of action of atracurium was studied in two groups of patients. In group I (n = 15), patients' lungs were hyperventilated to a mean Pa(co2) of 3.3 kPa and in group II (n = 15) lungs were ventilated to maintain a mean Pa(co2) of 5.3 kPa. Anaesthesia was maintained using an infusion of propofol. The time taken to return to a T1 twitch height of 10% of control was measured following each incremental dose of atracurium 0.15 mg kg-1. It was found that the duration of action of atracurium was significantly (P < 0.0005) shorter in the hypocapnic group. C1 NATL HOSP,LONDON WC1N 3BG,ENGLAND. NR 12 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 JAN PY 1991 VL 66 IS 1 BP 45 EP 47 DI 10.1093/bja/66.1.45 PG 3 WC Anesthesiology SC Anesthesiology GA ER326 UT WOS:A1991ER32600010 ER PT J AU KHUENLBRADY, KS SCHARZ, S RICHARDSON, FJ MITTERSCHIFFTHALER, G AF KHUENLBRADY, KS SCHARZ, S RICHARDSON, FJ MITTERSCHIFFTHALER, G TI MAINTENANCE OF SURGICAL MUSCLE-RELAXATION BY REPEAT DOSES OF VECURONIUM AND ATRACURIUM AT 3 DIFFERENT DOSE LEVELS SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE NEUROMUSCULAR RELAXANTS; VECURONIUM; ATRACURIUM; MULTIPLE DOSING; CUMULATION AB The time-course of the neuromuscular effects of vecuronium (n = 25) and atracurium (n = 25) has been compared at three different levels of maintenance dose in anaesthetized patients. Following intubation with vecuronium 0.1 mg kg-1 or atracurium 0.5 mg kg-1, surgical muscle relaxation was maintained by using increments of equipotent maintenance doses equivalent to 0.5, 1.0 and 1.5 x ED95 for each drug. Repeat doses were administered each time the twitch height, depressed by the previous dose, returned to 25% of its control value. The apparent increase in the duration of action, i.e. the difference between the duration of the last and the first maintenance dose, did not reach statistical significance and approximated 3 +/ 2, 6 +/- 4, 11 +/- 5 and 3 +/- 2, 8 +/- 13, 5 +/- 7 min following the low, medium and high maintenance doses of vecuronium and atracurium, respectively. RP KHUENLBRADY, KS (reprint author), UNIV INNSBRUCK,ANAESTHESIA & GEN INTENS CARE MED CLIN,ANICHSTR 35,A-6020 INNSBRUCK,AUSTRIA. NR 0 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 1991 VL 8 IS 1 BP 1 EP 6 PG 6 WC Anesthesiology SC Anesthesiology GA ET427 UT WOS:A1991ET42700001 ER PT J AU OLKKOLA, KT SCHWILDEN, H AF OLKKOLA, KT SCHWILDEN, H TI ADAPTIVE CLOSED-LOOP FEEDBACK-CONTROL OF VECURONIUM-INDUCED NEUROMUSCULAR RELAXATION SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article DE COMPUTERS; AUTOMATIC CONTROL; NEUROMUSCULAR RELAXANTS; VECURONIUM; PHARMACOKINETICS; MODELS AB An adaptive closed-loop control of neuromuscular block by pharmacokinetic dynamic model-based feedback is described. Mean (+/-SD) offsets from setpoints at 70, 80 and 90% neuromuscular blockade were 2.2+/-1.1, 1.8+/-0.6 and 0.4+/-0.4%, respectively. Correspondingly, the mean standard deviations from mean neuro-muscular blockade were 3.9+/-2.3, 2.7+/-0.6 and 1.3+/-0.2% and the mean average vecuronium requirements 0.5+/-0.2, 0.7+/-0.2 and 1.0+/-0.5-mu-g kg-1 min-1. The described closed-loop vecuronium administration system gives a solution to the problem of adapting pharmacokinetic and pharmacodynamic data to individuals when using mean data as starting values for drug therapy. RP OLKKOLA, KT (reprint author), UNIV HELSINKI,DEPT CLIN PHARMACOL,PAASIKIVENKATU 4,SF-00250 HELSINKI,FINLAND. NR 0 TC 15 Z9 15 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD JAN PY 1991 VL 8 IS 1 BP 7 EP 12 PG 6 WC Anesthesiology SC Anesthesiology GA ET427 UT WOS:A1991ET42700002 ER PT J AU SCHWILDEN, H OLKKOLA, KT AF SCHWILDEN, H OLKKOLA, KT TI USE OF A PHARMACOKINETIC-DYNAMIC MODEL FOR THE AUTOMATIC FEEDBACK-CONTROL OF ATRACURIUM SO EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY LA English DT Article DE ATRACURIUM; NEUROMUSCULAR BLOCKADE, PHARMACOKINETIC-DYNAMIC MODEL, AUTOMATIC CONTROL ID NEUROMUSCULAR BLOCKADE; INFUSION; PHARMACODYNAMICS; SYSTEM AB A control algorithm for the closed-loop control of atracurium-induced neuromuscular blockade based on pharmacokinetic-dynamic model-based adaptive feedback is described. Mean offset from setpoint at 90% neuromuscular block was 0.04% and the mean standard deviation from mean neuromuscular block was 1.9%. The mean average atracurium requirement was 0.37 mg.kg-1.h-1. The model-based adaptive closed-loop control of atracurium infusion provided reasonable control of muscle relaxation. It offers a solution to the problem of adapting pharmacokinetic and pharmacodynamic data to individuals when using mean data as starting values for drug therapy. C1 UNIV HELSINKI,DEPT CLIN PHARMACOL,PAASIKIVENKATU 4,SF-00250 HELSINKI,FINLAND. UNIV BONN,INST ANASTHESIOL,W-5300 BONN,GERMANY. NR 13 TC 14 Z9 15 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0031-6970 J9 EUR J CLIN PHARMACOL JI Eur. J. Clin. Pharmacol. PY 1991 VL 40 IS 3 BP 293 EP 296 DI 10.1007/BF00315212 PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA FD264 UT WOS:A1991FD26400017 ER PT J AU KIM, JI KLENZE, R WIMMER, H AF KIM, JI KLENZE, R WIMMER, H TI FLUORESCENCE SPECTROSCOPY OF CURIUM(III) AND APPLICATION SO EUROPEAN JOURNAL OF SOLID STATE AND INORGANIC CHEMISTRY LA English DT Article; Proceedings Paper CT 1ST INTERNATIONAL CONF ON F-ELEMENTS : NEW DEVELOPMENTS IN F-ELEMENTS CY SEP 04-07, 1990 CL LEUVEN, BELGIUM ID ELECTRONIC-ENERGY LEVEL; ACTINIDE AQUO IONS; INTENSITY CORRELATIONS; SPECTRA AB The present state of development of fluorescence spectroscopy of Curium(III) is briefly summarized with an emphasis on its application as a high sensitive method for the analytical detection and direct speciation of Cm(III) in aqueous solutions. Reference is made to the complexation of Cm(III) in aqueous solution and also to related work on other actinides and lanthanides. RP KIM, JI (reprint author), TECH UNIV MUNICH,INST RADIOCHEM,W-8046 GARCHING,GERMANY. NR 31 TC 37 Z9 37 PU GAUTHIER-VILLARS PI PARIS PA S P E S-JOURNAL DEPT, 120 BD ST GERMAIN, F-75006 PARIS, FRANCE SN 0992-4361 J9 EUR J SOL STATE INOR JI Eur. J. Solid State Inorg. Chem. PY 1991 VL 28 SU S BP 347 EP 356 PG 10 WC Chemistry, Inorganic & Nuclear; Chemistry, Physical SC Chemistry GA FD293 UT WOS:A1991FD29300068 ER PT J AU WALI, FA MAKINDE, V AF WALI, FA MAKINDE, V TI EFFECTS OF PANCURONIUM AND VECURONIUM ON CREATINE-PHOSPHOKINASE IN RAT ISOLATED HEART, LIVER, KIDNEY AND DIAPHRAGM SO GENERAL PHARMACOLOGY LA English DT Article ID MUSCLE-RELAXANTS; ATRACURIUM; TUBOCURARINE AB 1. The effects of two muscle relaxants, namely, pancuronium and vecuronium, on creatine phosphokinase (CPK) release from four different types of tissues, namely, heart, liver, kidney and diaphragm, were studied in the rat in vitro. 2. The total, neat and CKP levels (units/ml), released by muscle relaxants were measured using spectrophotometric determination at 340 nm. 3. The results showed that both muscle relexants, in low concentrations, i.e. 0.34 or 0.32-mu-M, close to a clinical dose of 0.1 mg/kg, had no significant effect on CPK leakage in all four types of tissues studied. However, in concentrations 12-122 times clinical dose, the two muscle relaxants produced differential adverse effects in the tissues studied. 4. In most concentrations, pancuronium and vecuronium produced significant increases in the CPK release in the kidney and diaphragm. In contrast, pancuronium had no significant effect on CPK release in the liver and the lowest effect in the heart. Similar results were obtained with vecuronium. 5. The clinical relevance and/or implications of the present results are discussed and the results are compared to those previously reported by other workers in other preparations. C1 ST GEORGE HOSP,SCH MED,DEPT CELLULAR & MOLEC SCI,LONDON SW17,ENGLAND. RP WALI, FA (reprint author), HOSP SICK CHILDREN,RESP & ANAESTHET UNIT,GREAT ORMOND ST,LONDON WC1N 3JH,ENGLAND. NR 9 TC 1 Z9 1 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 0306-3623 J9 GEN PHARMACOL JI Gen. Pharmacol. PY 1991 VL 22 IS 2 BP 301 EP 304 DI 10.1016/0306-3623(91)90453-D PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA EY115 UT WOS:A1991EY11500020 ER PT J AU YUSOV, AB FEDOSEEV, AM AF YUSOV, AB FEDOSEEV, AM TI CURIUM AND AMERICIUM CHEMILUMINESCENCE IN REDOX REACTIONS SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY-ARTICLES LA English DT Article ID STATE AB The results of curium chemiluminescence investigations are generalized and the results of search for americium chemiluminescence are described. Some chemiluminescence reactions of americium, where the initial and the final forms were Am(IV) or (VI) and Am(III), respectively, were discovered. The Am(III) ion was the emitter of chemiluminescence, probably, only in the reduction reaction of Am(IV) decatungstate by reductants such as N2H4, some of its derivatives, EDTA and DTPA. The yield of chemiluminescence was estimated as 10(-9)-10(-10) quanta per reaction act. In other chemiluminescent reactions discovered, the emitter of chemiluminescence was probably the oxidation products of the reductant. RP YUSOV, AB (reprint author), ACAD SCI USSR,INST PHYS CHEM,MOSCOW V-71,USSR. NR 16 TC 3 Z9 3 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0236-5731 J9 J RADIOAN NUCL CH AR JI J. Radioanal. Nucl. Chem.-Artic. PD JAN PY 1991 VL 147 IS 1 BP 201 EP 206 DI 10.1007/BF02039582 PG 6 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA EY339 UT WOS:A1991EY33900022 ER PT J AU MARTYNOV, IV KRUGLYAK, YL GRUZDEVA, VL LEIBOVSKAYA, GA SHITOV, LN GORDYBAYEV, OV DOBRYANSKY, VS KASHNIKOVA, II AF MARTYNOV, IV KRUGLYAK, YL GRUZDEVA, VL LEIBOVSKAYA, GA SHITOV, LN GORDYBAYEV, OV DOBRYANSKY, VS KASHNIKOVA, II TI SYNTHESIS AND CURARE-LIKE ACTIVITY OF BETA-(TRIALKYLAMMONIUM)ETHYL ETHERS OF THIOCYANURIC ACID .2. SO KHIMIKO-FARMATSEVTICHESKII ZHURNAL LA Russian DT Article AB Mono-, di-, and tris-beta-(dialkylbenzylammonium) ethylthiol ethers of cyanuric acid were synthesized and tested for their toxicity and curare-like activity in the experiments with mice and rabbits. Dithiol ethers were demonstrated to have clear-cut myoparalytic properties and to display a wide range of curare-like action, being substantially superior to tubocurarine chloride in this parameter. M-cholinomimetic effects were also ascertained to be present when the compounds acted on the whole body. RP MARTYNOV, IV (reprint author), MOSCOW ORGAN CHEM & TECHNOL RES INST,MOSCOW,USSR. NR 8 TC 0 Z9 0 PU IZD VO MEDITSINA PI MOSCOW PA PETROVERIGSKII PER 6-8, K-142 MOSCOW, RUSSIA SN 0023-1134 J9 KHIM FARM ZH+ PD JAN PY 1991 VL 25 IS 1 BP 38 EP 40 PG 3 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA FB846 UT WOS:A1991FB84600010 ER PT J AU MUSILKOVA, J STARSHINOVA, LA SHELKOVNIKOV, SA TUCEK, S AF MUSILKOVA, J STARSHINOVA, LA SHELKOVNIKOV, SA TUCEK, S TI INTERACTION OF THE NEUROMUSCULAR BLOCKING DRUG ATRACURIUM WITH MUSCARINIC ACETYLCHOLINE-RECEPTORS SO PHYSIOLOGICAL RESEARCH LA English DT Article DE MUSCARINIC RECEPTORS; ATRACURIUM ID RAT-BRAIN; N-METHYLSCOPOLAMINE; GALLAMINE; BINDING; DIFFERENTIATION; PANCURONIUM; ANTAGONISTS; INHIBITION; ALCURONIUM; M1 AB On isolated rat heart atria, atracurium competitively antagonized the negative chronotropic effect of methylfurmethide, shifting the concentration-response curve to the right without diminishing the agonist's maximal effect; K(d) calculated from dose ratios was 3.0-mu-mol/l. On the longitudinal muscle of rat ileum, atracurium antagonized the effect of methylfurmethide in a non-competitive manner; at 50-mu-mol/l atracurium, the maximum response to methylfurmethide was diminished by about 50%. Atracurium antagonized the binding of (H-3)quinuclidinyl benzilate ((H-3)QNB) to muscarinic binding sites in the atria, ileal longitudinal muscle and cerebellum with IC50 values of 5-8-mu-mol/l, and in brain cortex of 25-mu-mol/l. Atracurium was little efficient, however, in antagonizing the binding of N-(H-3-methyl) scopolamine ((H-3)NMS) to muscarinic binding sites. Complete blockade was not achieved at concentrations up to 1 mmol/l. Concentrations required to diminish the binding by 50% were 10 - 1000 times higher for (H-3)NMS than for (H-3)QNB. Atracurium brought about the dissociation of (H-3)QNB-receptor complexes, but its effect was considerably stronger at a concentration of 30-mu-mol/l than at 1 mmol/l. Atracurium slowed down the dissociation of (H-3)QNB-receptor complexes observed after the addition of atropine. The effects of atracurium on the dissociation of (H-3)NMS-receptor complexes were similar to those on (H-3)QNB-receptor complexes, but a high concentration of atracurium (1 mmol/l) produced a transient increase in (H-3)NMS binding preceding its subsequent dissociation. Although the observations of the antagonism by atracurium of the effect of methylfurmethide on the heart atria, and of the inhibition of the specific binding of (H-3)QNB to the atria, ileal smooth muscle, cerebellum and brain cortex are compatible with the assumption of a competitive interaction, and the discrepancy between the effects of atracurium on the binding of (H-3)QNB and (H-3)NMS indicates that atracurium does not bind to the same binding site as (H-3)QNB and (H-3)NMS. It appears that most effects of atracurium on muscarinic receptors are allosteric and that both negative and positive cooperativities play a role in interactions between atracurium and muscarinic ligands. C1 IM SECHENOV EVOLUT PHYSIOL & BIOCHEM INST,LENINGRAD,USSR. RP MUSILKOVA, J (reprint author), CZECHOSLOVAK ACAD SCI,INST PHYSIOL,CS-11142 PRAGUE 1,CZECHOSLOVAKIA. RI Musilkova, Jana/D-1280-2012 NR 27 TC 5 Z9 5 PU CZECHOSLOVAK ACAD SCIENCES INST PHYSIOLOGY PI PRAGUE 4 PA VIDENSKA 1083, PRAGUE 4, CZECH REPUBLIC 142 20 SN 0862-8408 J9 PHYSIOL RES JI Physiol. Res. PY 1991 VL 40 IS 3 BP 293 EP 304 PG 12 WC Physiology SC Physiology GA GC768 UT WOS:A1991GC76800004 ER PT J AU APPELMAN, EH DIAMOND, H HORWITZ, EP SULLIVAN, JC AF APPELMAN, EH DIAMOND, H HORWITZ, EP SULLIVAN, JC TI CESIUM FLUOROXYSULFATE, CSSO4F - A NOVEL REAGENT FOR THE RAPID OXIDATION OF AMERICIUM AT AMBIENT-TEMPERATURE AND ITS SEPARATION FROM CURIUM SO RADIOCHIMICA ACTA LA English DT Article DE AMERICIUM; CURIUM; FLUOROXYSULFATE; SO4F- ID AQUEOUS FLUOROXYSULFATE; DIOXIDE AB In the presence of Ag+ as a catalyst, the fluoroxysulfate ion, an ionic hypofluorite of the formula O3SOF-, rapidly oxidizes trivalent americium in 0.4-1 M HNO3 at ambient temperature to the +6 oxidation state, which can be readily extracted into a dodecane solution of the highly hindered dialkyl phosphoric acid extractant, bis(2,6-dimethyl-4-heptyl) phosphoric acid, HD(DIBM)P. This provides a facile separation of americium from curium in acidic solution. RP APPELMAN, EH (reprint author), ARGONNE NATL LAB,DIV CHEM,ARGONNE,IL 60439, USA. NR 15 TC 4 Z9 4 PU R OLDENBOURG VERLAG PI MUNICH 80 PA ROSENHEIMER STR 145 POSTFACH 801360, W-8000 MUNICH 80, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 1991 VL 55 IS 2 BP 61 EP 64 PG 4 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA GN641 UT WOS:A1991GN64100002 ER PT J AU KIM, JI WIMMER, H KLENZE, R AF KIM, JI WIMMER, H KLENZE, R TI A STUDY OF CURIUM(III) HUMATE COMPLEXATION BY TIME RESOLVED LASER FLUORESCENCE SPECTROSCOPY (TRLFS) SO RADIOCHIMICA ACTA LA English DT Article DE CURIUM; HUMIC ACID COMPLEXES; LASER FLUORESCENCE ID HUMIC-ACID; IONS; AMERICIUM(III); EUROPIUM(III); AM(III) AB The complexation of Cm(III) with humic acid extracted from one of the Gorleben groundwaters has been investigated by time resolved laser fluorescence spectroscopy (TRLFS) in 0.1 M NaClO4 at pH = 6.0. The Cm(III) concentration range studied is from 2.2 x 10(-8) mol l-1 to 10.1 x 10(-8) mol l-1, which allows a precise spectroscopic quantification of the complexation process. The experiment verifies that a tridentate complexation is prevalent. The complexed and non-complexed species of Cm(III) are characterized by radiative relaxation energies from the A state (6D7/2) at 601.0 nm and 593.8 nm, respectively. The average complexation constant determined by TRLFS is log beta = 6.22 +/- 0.07 l mol-1. This value is found to be in good agreement with the values determined for Am(III) previously by other spectroscopic methods. RP KIM, JI (reprint author), TECH UNIV MUNICH,INST RADIOCHEM,W-8046 GARCHING,GERMANY. NR 26 TC 69 Z9 69 PU R OLDENBOURG VERLAG PI MUNICH 80 PA ROSENHEIMER STR 145 POSTFACH 801360, W-8000 MUNICH 80, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 1991 VL 54 IS 1 BP 35 EP 41 PG 7 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA FF626 UT WOS:A1991FF62600006 ER PT J AU MOULIN, C DECAMBOX, P MAUCHIEN, P MOULIN, V THEYSSIER, M AF MOULIN, C DECAMBOX, P MAUCHIEN, P MOULIN, V THEYSSIER, M TI ON THE USE OF LASER-INDUCED TIME-RESOLVED SPECTROFLUOROMETRY FOR INTERACTION STUDIES BETWEEN ORGANIC-MATTER AND ACTINIDES - APPLICATION TO CURIUM SO RADIOCHIMICA ACTA LA English DT Article; Proceedings Paper CT 2ND INTERNATIONAL CONF ON CHEMISTRY AND MIGRATION BEHAVIOUR OF ACTINIDES AND FISSION PRODUCTS IN THE GEOSPHERE CY NOV, 1989 CL MONTEREY, CA SP LAWRENCE LIVERMORE NATL LAB, DIV NUCL CHEM, LAWRENCE LIVERMORE NATL LAB, EARTH SCI DEPT DE COMPLEXATION; CURIUM; HUMIC SUBSTANCES; LASER-INDUCED FLUORESCENCE ID FULVIC-ACID; HUMIC-ACID; BINDING; AMERICIUM(III); EUROPIUM(III); FLUORESCENCE; URANIUM; IONS AB Natural waters are the main transport medium for radioelements in the geosphere in case of an accidental release of radioactivity from a nuclear waste repository. Complexation studies of a radioelement such as curium with organic matter present in natural aquifers are important to perform in order to predict its behaviour in natural systems. Laser-Induced Time-Resolved Spectrofluorometry (LITRS) is a powerful technique to study complex formation due to its great sensitivity particularly for curium determination in solution ( < 10-6 M). Complexation constants can be extrapolated from these preliminary results and are discussed. Furthermore, applications of this technique to other actinides seem promising. C1 CEA,IRDI,DERDCA,DRDD,SESD,F-92260 FONTENAY ROSES,FRANCE. RP MOULIN, C (reprint author), CEA,IRDI,DERDCA,DCAEA,SEA,F-92260 FONTENAY ROSES,FRANCE. RI Moulin, christophe/G-3895-2010 NR 30 TC 52 Z9 52 PU R OLDENBOURG VERLAG PI MUNICH 80 PA ROSENHEIMER STR 145 POSTFACH 801360, W-8000 MUNICH 80, GERMANY SN 0033-8230 J9 RADIOCHIM ACTA JI Radiochim. Acta PY 1991 VL 52-3 BP 119 EP 125 PN 1 PG 7 WC Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA FD512 UT WOS:A1991FD51200019 ER PT J AU CARJUZAA, A CARPENTIER, JP AF CARJUZAA, A CARPENTIER, JP TI MYORESOLUTION, ORGANOPHOSPHOROUS NERVE AGENTS AND CHEMICAL WARFACE AGENTS - CURARE PROBLEMS SO MEDECINE ET ARMEES LA French DT Article DE ATRACURIUM; CHEMICAL-WARFACE AGENTS, PYRIDOSTIGMINE; CURARIZATION; ORGANOPHOSPHOROUS NERVE AGENTS; PANCURONIUM; PRALIDOXIME; VECURONIUM AB Curarization during anaesthesia for combined combat injury is a crucial point. Serum cholinesterase activity after pre-treatment by pyridostigxime bromure, pralidoxime what is the occurence is hardly valuable. What are interferences with curares, pyridostigmine of atracurium divesilate new competitive neuromuscular blocking agent? Pharmacological evaluation of competitive neuromuscular blocking agents during recent and acute intoxication by organophosphorous nerve agent; with pre-treatment, regeneration of cholinesterase or not, may value their effectiveness and their safety. RP CARJUZAA, A (reprint author), CHA R LE BAS,SERV REANIMAT ANESTHESIE,F-50115 CHERBOURG NAVAL,FRANCE. NR 0 TC 1 Z9 1 PU ASSN DEVEL DIFF INFOR MILIT PI PARIS PA 6 RUE SAINT-CHARLES, 75015 PARIS, FRANCE SN 0300-4937 J9 MED ARMEES PY 1991 VL 19 IS 2 BP 97 EP 98 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA FX389 UT WOS:A1991FX38900007 ER PT J AU TEMPELHOFF, R MODICA, PA JELLISH, WS SPITZNAGEL, EL AF TEMPELHOFF, R MODICA, PA JELLISH, WS SPITZNAGEL, EL TI RESISTANCE TO ATRACURIUM-INDUCED NEUROMUSCULAR BLOCKADE IN PATIENTS WITH INTRACTABLE SEIZURE DISORDERS TREATED WITH ANTICONVULSANTS SO ANESTHESIA AND ANALGESIA LA English DT Article C1 WASHINGTON UNIV,SCH MED,DEPT NEUROL SURG,ST LOUIS,MO 63110. WASHINGTON UNIV,SCH MED,DEPT MATH,ST LOUIS,MO 63110. WASHINGTON UNIV,SCH MED,DEPT BIOSTAT,ST LOUIS,MO 63110. RP TEMPELHOFF, R (reprint author), WASHINGTON UNIV,SCH MED,DEPT ANESTHESIOL,BOX 8054,660 S EUCLID AVE,ST LOUIS,MO 63110, USA. NR 13 TC 52 Z9 53 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD DEC PY 1990 VL 71 IS 6 BP 665 EP 669 PG 5 WC Anesthesiology SC Anesthesiology GA EK582 UT WOS:A1990EK58200015 ER PT J AU SIMPSON, DS SOUTER, AJ AF SIMPSON, DS SOUTER, AJ TI A COMPUTER DESIGNED GRAPH FOR ADMINISTRATION OF ATRACURIUM BY IV INFUSION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article RP SIMPSON, DS (reprint author), FALKIRK & DIST ROYAL INFIRM,DEPT ANAESTHESIA,FALKIRK FK1 SQE,SCOTLAND. NR 13 TC 2 Z9 2 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 1990 VL 65 IS 6 BP 770 EP 778 DI 10.1093/bja/65.6.770 PG 9 WC Anesthesiology SC Anesthesiology GA EM270 UT WOS:A1990EM27000008 ER PT J AU PITTET, JF TASSONYI, E SCHOPFER, C MOREL, DR LEEMANN, P MENTHA, G LECOULTRE, C STEINIG, DA BENAKIS, A AF PITTET, JF TASSONYI, E SCHOPFER, C MOREL, DR LEEMANN, P MENTHA, G LECOULTRE, C STEINIG, DA BENAKIS, A TI DOSE REQUIREMENTS AND PLASMA-CONCENTRATIONS OF PIPECURONIUM DURING BILATERAL RENAL EXCLUSION AND ORTHOTOPIC LIVER-TRANSPLANTATION IN PIGS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article C1 UNIV GENEVA,MED CTR,DEPT ANAESTHESIOL,CH-1211 GENEVA 4,SWITZERLAND. UNIV GENEVA,MED CTR,DEPT PHARMACOL,CH-1211 GENEVA 4,SWITZERLAND. UNIV GENEVA,MED CTR,DEPT SURG,CH-1211 GENEVA 4,SWITZERLAND. NR 21 TC 7 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 DEC PY 1990 VL 65 IS 6 BP 779 EP 785 DI 10.1093/bja/65.6.779 PG 7 WC Anesthesiology SC Anesthesiology GA EM270 UT WOS:A1990EM27000009 ER PT J AU GWINNUTT, CL EDDLESTON, JM EDWARDS, D POLLARD, BJ AF GWINNUTT, CL EDDLESTON, JM EDWARDS, D POLLARD, BJ TI CONCENTRATIONS OF ATRACURIUM AND LAUDANOSINE IN CEREBROSPINAL-FLUID AND PLASMA IN 3 INTENSIVE-CARE PATIENTS SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article C1 MANCHESTER ROYAL INFIRM,DEPT ANAESTHESIA,MANCHESTER M13 9WL,LANCS,ENGLAND. RP GWINNUTT, CL (reprint author), HOPE HOSP,DEPT ANAESTHESIA,ECCLES OLD RD,SALFORD M6 8HD,LANCS,ENGLAND. NR 14 TC 28 Z9 30 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 1990 VL 65 IS 6 BP 829 EP 832 DI 10.1093/bja/65.6.829 PG 4 WC Anesthesiology SC Anesthesiology GA EM270 UT WOS:A1990EM27000020 ER PT J AU MARTYNOV, IV KRUGLYAK, YL GRUZDEVA, VL DOBRYANSKY, VS KASHNIKOVA, II SOKALSKY, MA BADO, GB AF MARTYNOV, IV KRUGLYAK, YL GRUZDEVA, VL DOBRYANSKY, VS KASHNIKOVA, II SOKALSKY, MA BADO, GB TI SYNTHESIS AND CURARE-LIKE ACTIVITY OF TRIS(BETA-DIALKYLBENZYLAMMONIUM)-ETHYL ETHERS CYANURIC AND ISOCYANURIC ACIDS SO KHIMIKO-FARMATSEVTICHESKII ZHURNAL LA Russian DT Article AB Tris-(beta-dialkylbenzylammonium)-ethyl esters of cyanuric and isocyanuric acids were synthesized. Their biological study revealed a high curare-like activity of isocyanuric acid derivatives among which was an agent that was as effective as tubocurarine chloride. RP MARTYNOV, IV (reprint author), MOSCOW ORGAN CHEM & TECHNOL RES INST,MOSCOW,RUSSIA. NR 10 TC 1 Z9 1 PU IZD VO MEDITSINA PI MOSCOW PA PETROVERIGSKII PER 6-8, K-142 MOSCOW, RUSSIA SN 0023-1134 J9 KHIM FARM ZH+ PD DEC PY 1990 VL 24 IS 12 BP 24 EP 27 PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA ER517 UT WOS:A1990ER51700007 ER PT J AU TOFT, P NIELSEN, HK SEVERINSEN, I HELBOHANSEN, HS AF TOFT, P NIELSEN, HK SEVERINSEN, I HELBOHANSEN, HS TI EFFECT OF EPIDURALLY ADMINISTERED BUPIVACAINE ON ATRACURIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article RP TOFT, P (reprint author), ODENSE UNIV HOSP,DEPT ANAESTHESIOL,DK-5000 ODENSE C,DENMARK. NR 15 TC 8 Z9 12 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 1990 VL 34 IS 8 BP 649 EP 652 PG 4 WC Anesthesiology SC Anesthesiology GA EL361 UT WOS:A1990EL36100010 ER PT J AU MERETOJA, OA BROWN, TCK CLARE, D AF MERETOJA, OA BROWN, TCK CLARE, D TI DOSE-RESPONSE OF ALCURONIUM AND D-TUBOCURARINE IN INFANTS, CHILDREN AND ADOLESCENTS SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article C1 ROYAL CHILDRENS HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3052,AUSTRALIA. NR 13 TC 10 Z9 10 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 NOV PY 1990 VL 18 IS 4 BP 449 EP 451 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000004 ER PT J AU MERETOJA, OA BROWN, TCK AF MERETOJA, OA BROWN, TCK TI MAINTENANCE REQUIREMENT OF ALCURONIUM IN PEDIATRIC-PATIENTS SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article C1 ROYAL CHILDRENS HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3052,AUSTRALIA. NR 13 TC 3 Z9 3 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 NOV PY 1990 VL 18 IS 4 BP 452 EP 454 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000005 ER PT J AU MERETOJA, OA LUOSTO, T AF MERETOJA, OA LUOSTO, T TI DOSE-RESPONSE CHARACTERISTICS OF PANCURONIUM IN NEONATES, INFANTS AND CHILDREN SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article RP MERETOJA, OA (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIA,SF-00290 HELSINKI 29,FINLAND. NR 19 TC 9 Z9 9 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 NOV PY 1990 VL 18 IS 4 BP 455 EP 459 PG 5 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000006 ER PT J AU BROWN, TCK MERETOJA, OA CLARE, D BELL, B AF BROWN, TCK MERETOJA, OA CLARE, D BELL, B TI DOES SUXAMETHONIUM INFLUENCE THE SUBSEQUENT DOSE REQUIREMENTS OF ALCURONIUM AND ITS REVERSIBILITY IN CHILDREN SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article C1 HELSINKI CHILDRENS HOSP,ANAESTHESIA,HELSINKI,FINLAND. RP BROWN, TCK (reprint author), ROYAL CHILDRENS HOSP,DEPT ANAESTHET,PARKVILLE,VIC 3052,AUSTRALIA. NR 10 TC 3 Z9 3 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 NOV PY 1990 VL 18 IS 4 BP 479 EP 482 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000011 ER PT J AU MERETOJA, OA MCHUTCHISON, G BROWN, TCK AF MERETOJA, OA MCHUTCHISON, G BROWN, TCK TI ALCURONIUM REQUIREMENT IN PATIENTS RECEIVING PHENYTOIN - A CASE-REPORT SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article C1 ROYAL CHILDRENS HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3052,AUSTRALIA. UNIV HELSINKI,ANAESTHESIA,HELSINKI,FINLAND. NR 8 TC 2 Z9 2 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 NOV PY 1990 VL 18 IS 4 BP 483 EP 485 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000012 ER PT J AU MERETOJA, OA BROWN, WA CASS, NM AF MERETOJA, OA BROWN, WA CASS, NM TI SIMULTANEOUS MONITORING OF FORCE, ACCELERATION AND ELECTROMYOGRAM DURING COMPUTER-CONTROLLED INFUSION OF ATRACURIUM IN SHEEP SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article C1 MONASH UNIV,DEPT ELECT & COMP SYST ENGN,CLAYTON,VIC 3168,AUSTRALIA. UNIV HELSINKI,ANAESTHESIA,HELSINKI,FINLAND. ROYAL CHILDRENS HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3052,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 NOV PY 1990 VL 18 IS 4 BP 486 EP 489 PG 4 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000013 ER PT J AU RUSSELL, WJ MEYERWITTING, M AF RUSSELL, WJ MEYERWITTING, M TI THE STABILITY OF ATRACURIUM IN CLINICAL-PRACTICE SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article RP RUSSELL, WJ (reprint author), ROYAL ADELAIDE HOSP,DEPT ANAESTHESIA & INTENS CARE,N TERRACE,ADELAIDE,SA 5000,AUSTRALIA. NR 2 TC 4 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 NOV PY 1990 VL 18 IS 4 BP 550 EP 552 PG 3 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA EG980 UT WOS:A1990EG98000025 ER PT J AU DRESNER, DL BASTA, SJ ALI, HH SCHWARTZ, AF EMBREE, PB WARGIN, WA LAI, AA BRADY, KA SAVARESE, JJ AF DRESNER, DL BASTA, SJ ALI, HH SCHWARTZ, AF EMBREE, PB WARGIN, WA LAI, AA BRADY, KA SAVARESE, JJ TI PHARMACOKINETICS AND PHARMACODYNAMICS OF DOXACURIUM IN YOUNG AND ELDERLY PATIENTS DURING ISOFLURANE ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article C1 HARVARD UNIV,MASSACHUSETTS GEN HOSP,SCH MED,DEPT ANESTHESIA,BOSTON,MA 02114. BURROUGHS WELLCOME CO,RES TRIANGLE PK,NC 27709. NR 19 TC 28 Z9 28 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD NOV PY 1990 VL 71 IS 5 BP 498 EP 502 PG 5 WC Anesthesiology SC Anesthesiology GA EE234 UT WOS:A1990EE23400008 ER PT J AU DONATI, F MEISTELMAN, C PLAUD, B AF DONATI, F MEISTELMAN, C PLAUD, B TI VECURONIUM NEUROMUSCULAR BLOCKADE AT THE DIAPHRAGM, THE ORBICULARIS OCULI, AND ADDUCTOR POLLICIS MUSCLES SO ANESTHESIOLOGY LA English DT Article C1 INST GUSTAVE ROUSSY,SERV ANESTHESIA,F-94805 VILLEJUIF,FRANCE. NR 24 TC 127 Z9 130 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD NOV PY 1990 VL 73 IS 5 BP 870 EP 875 DI 10.1097/00000542-199011000-00013 PG 6 WC Anesthesiology SC Anesthesiology GA EG968 UT WOS:A1990EG96800013 ER PT J AU BEEMER, GH BJORKSTEN, AR CRANKSHAW, DP AF BEEMER, GH BJORKSTEN, AR CRANKSHAW, DP TI PHARMACOKINETICS OF ATRACURIUM DURING CONTINUOUS INFUSION SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article C1 UNIV MELBOURNE,DEPT SURG,PARKVILLE,VIC 3052,AUSTRALIA. RP BEEMER, GH (reprint author), ROYAL MELBOURNE HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3050,AUSTRALIA. NR 23 TC 14 Z9 15 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 1990 VL 65 IS 5 BP 668 EP 674 DI 10.1093/bja/65.5.668 PG 7 WC Anesthesiology SC Anesthesiology GA EG151 UT WOS:A1990EG15100014 ER PT J AU BEEMER, GH BJORKSTEN, AR CRANKSHAW, DP AF BEEMER, GH BJORKSTEN, AR CRANKSHAW, DP TI PHARMACODYNAMICS OF ATRACURIUM DURING PROPOFOL, THIOPENTONE AND OPIOID ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article C1 UNIV MELBOURNE,DEPT SURG,PARKVILLE,VIC 3052,AUSTRALIA. RP BEEMER, GH (reprint author), ROYAL MELBOURNE HOSP,DEPT ANAESTHESIA,PARKVILLE,VIC 3050,AUSTRALIA. NR 22 TC 6 Z9 6 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 1990 VL 65 IS 5 BP 675 EP 683 DI 10.1093/bja/65.5.675 PG 9 WC Anesthesiology SC Anesthesiology GA EG151 UT WOS:A1990EG15100015 ER PT J AU BRIGLIA, EJ DAVIS, PL KATZ, M DALCORTIVO, LA AF BRIGLIA, EJ DAVIS, PL KATZ, M DALCORTIVO, LA TI ATTEMPTED MURDER WITH PANCURONIUM SO JOURNAL OF FORENSIC SCIENCES LA English DT Article; Proceedings Paper CT 41ST ANNUAL MEETING OF THE AMERICAN ACADEMY OF FORENSIC SCIENCES CY FEB 13-18, 1989 CL LAS VEGAS, NV SP AMER ACAD FORENS SCI RP BRIGLIA, EJ (reprint author), DOCTOR SIDNEY B WEINBERG CTR FORENS SCI,DIV MED LEGAL INVEST & FORENS SCI,TOXICOL LAB,HAUPPAUGE,NY 11787, USA. NR 5 TC 10 Z9 11 PU AMER SOC TESTING MATERIALS PI W CONSHOHOCKEN PA 100 BARR HARBOR DR, W CONSHOHOCKEN, PA 19428-2959 SN 0022-1198 J9 J FORENSIC SCI JI J. Forensic Sci. PD NOV PY 1990 VL 35 IS 6 BP 1468 EP 1476 PG 9 WC Medicine, Legal SC Legal Medicine GA EJ648 UT WOS:A1990EJ64800029 ER PT J AU SHIOKAWA, Y SUZUKI, K SUZUKI, S YAGI, M AF SHIOKAWA, Y SUZUKI, K SUZUKI, S YAGI, M TI DETERMINATION OF ISOTOPIC-RATIOS OF PLUTONIUM AND CURIUM BY INTERNAL-CONVERSION ELECTRON SPECTROMETRY SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY-ARTICLES LA English DT Article; Proceedings Paper CT 1989 INTERNATIONAL CONF ON ACTINIDES ( ACTINIDES 89 ) CY SEP 24-29, 1989 CL TASHKENT, USSR SP ACAD SCI USSR AB The isotopic ratios Pu-240/Pu-239 in plutonium samples purified freshly and allowed to stand for a long time were determined by using a high resolution internal conversion electron spectrometer. As a result, it was proved that the above ratios can be determined accurately and precisely. The method was also examined further through a similar determination with curium samples. C1 JAPAN RADIOISOTOPE ASSOC,TAKIZAWA LAB,TAKIZAWA,IWATE 02001,JAPAN. RP SHIOKAWA, Y (reprint author), TOHOKU UNIV,INST MAT RES,KATAHIRA 2-1-1,SENDAI,MIYAGI 980,JAPAN. NR 13 TC 3 Z9 3 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0236-5731 J9 J RADIOAN NUCL CH AR JI J. Radioanal. Nucl. Chem.-Artic. PD NOV PY 1990 VL 143 IS 1 BP 135 EP 141 DI 10.1007/BF02117555 PG 7 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA EU875 UT WOS:A1990EU87500014 ER PT J AU MITAMURA, H MATSUMOTO, S MIYAZAKI, T WHITE, TJ NUKAGA, K TOGASHI, Y SAGAWA, T TASHIRO, S LEVINS, DM KIKUCHI, A AF MITAMURA, H MATSUMOTO, S MIYAZAKI, T WHITE, TJ NUKAGA, K TOGASHI, Y SAGAWA, T TASHIRO, S LEVINS, DM KIKUCHI, A TI SELF-IRRADIATION DAMAGE OF A CURIUM-DOPED TITANATE CERAMIC CONTAINING SODIUM-RICH HIGH-LEVEL NUCLEAR WASTE SO JOURNAL OF THE AMERICAN CERAMIC SOCIETY LA English DT Article C1 CHIYODA MAINTENANCE LTD,IBARAKI CTR,DEPT NUCL BUSINESS 2,ASAKI,IBARAKI 31414,JAPAN. UNIV QUEENSLAND,CTR ELECTRON MICROSCOPE,ST LUCIA,QLD 4067,AUSTRALIA. AUSTRALIAN NUCL SCI & TECHNOL ORG,LUCAS HTS RES LABS,ENVIRONM SCI PROGRAM,SUTHERLAND,NSW,AUSTRALIA. RP MITAMURA, H (reprint author), JAPAN ATOM ENERGY RES INST,DEPT ENVIRONM SAFETY RES,TOKAI,IBARAKI 31911,JAPAN. RI White, Tim/A-8145-2008 NR 22 TC 6 Z9 6 PU AMER CERAMIC SOC PI WESTERVILLE PA 735 CERAMIC PLACE, PO BOX 6136, WESTERVILLE, OH 43081-6136 SN 0002-7820 J9 J AM CERAM SOC JI J. Am. Ceram. Soc. PD NOV PY 1990 VL 73 IS 11 BP 3433 EP 3441 DI 10.1111/j.1151-2916.1990.tb06472.x PG 9 WC Materials Science, Ceramics SC Materials Science GA EK926 UT WOS:A1990EK92600045 ER PT J AU ILKIW, JE FORSYTH, SF HILL, T GREGORY, CR AF ILKIW, JE FORSYTH, SF HILL, T GREGORY, CR TI ATRACURIUM ADMINISTRATION, AS AN INFUSION, TO INDUCE NEUROMUSCULAR BLOCKADE IN CLINICALLY NORMAL AND TEMPORARILY IMMUNE-SUPPRESSED CATS SO JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION LA English DT Article RP ILKIW, JE (reprint author), UNIV CALIF DAVIS,SCH VET MED,DEPT SURG,DAVIS,CA 95616, USA. NR 18 TC 3 Z9 3 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 SN 0003-1488 J9 J AM VET MED ASSOC JI J. Am. Vet. Med. Assoc. PD NOV 1 PY 1990 VL 197 IS 9 BP 1153 EP 1156 PG 4 WC Veterinary Sciences SC Veterinary Sciences GA EF969 UT WOS:A1990EF96900011 ER PT J AU TUCEK, S MUSILKOVA, J NEDOMA, J PROSKA, J SHELKOVNIKOV, S VORLICEK, J AF TUCEK, S MUSILKOVA, J NEDOMA, J PROSKA, J SHELKOVNIKOV, S VORLICEK, J TI POSITIVE COOPERATIVITY IN THE BINDING OF ALCURONIUM AND N-METHYLSCOPOLAMINE TO MUSCARINIC ACETYLCHOLINE-RECEPTORS SO MOLECULAR PHARMACOLOGY LA English DT Article C1 IM SECHENOV EVOLUTIONARY PHYSIOL & BIOCHEM INST,LENINGRAD 194233,USSR. RP TUCEK, S (reprint author), CZECHOSLOVAK ACAD SCI,INST PHYSIOL,VIDENSKA 1083,CS-14220 PRAGUE,CZECHOSLOVAKIA. RI Proska, Jan/C-5695-2009; Musilkova, Jana/D-1280-2012 NR 39 TC 91 Z9 92 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0026-895X J9 MOL PHARMACOL JI Mol. Pharmacol. PD NOV PY 1990 VL 38 IS 5 BP 674 EP 680 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA EJ409 UT WOS:A1990EJ40900013 ER PT J AU FORSYTH, SF ILKIW, JE HILDEBRAND, SV AF FORSYTH, SF ILKIW, JE HILDEBRAND, SV TI EFFECT OF GENTAMICIN ADMINISTRATION ON THE NEUROMUSCULAR BLOCKADE INDUCED BY ATRACURIUM IN CATS SO AMERICAN JOURNAL OF VETERINARY RESEARCH LA English DT Article RP FORSYTH, SF (reprint author), UNIV CALIF DAVIS,SCH VET MED,DEPT SURG,DAVIS,CA 95616, USA. NR 19 TC 11 Z9 12 PU AMER VETERINARY MEDICAL ASSOC PI SCHAUMBURG PA 1931 N MEACHAM RD SUITE 100, SCHAUMBURG, IL 60173-4360 SN 0002-9645 J9 AM J VET RES JI Am. J. Vet. Res. PD OCT PY 1990 VL 51 IS 10 BP 1675 EP 1678 PG 4 WC Veterinary Sciences SC Veterinary Sciences GA EB620 UT WOS:A1990EB62000032 ER PT J AU MINGUS, ML HERLICH, A EISENKRAFT, JB AF MINGUS, ML HERLICH, A EISENKRAFT, JB TI ATTENUATION OF SUXAMETHONIUM MYALGIAS - EFFECT OF MIDAZOLAM AND VECURONIUM SO ANAESTHESIA LA English DT Article RP MINGUS, ML (reprint author), CUNY MT SINAI SCH MED,DEPT ANAESTHESIOL,1 GUSTAVE L LEVY PL,NEW YORK,NY 10029, USA. NR 30 TC 22 Z9 22 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD OCT PY 1990 VL 45 IS 10 BP 834 EP 837 DI 10.1111/j.1365-2044.1990.tb14565.x PG 4 WC Anesthesiology SC Anesthesiology GA EB848 UT WOS:A1990EB84800007 ER PT J AU PUHRINGER, F ADLER, R MITTERSCHIFFTHALER, G KOLLER, J MAIR, P KHUNLBRADY, KS AGOSTON, S AF PUHRINGER, F ADLER, R MITTERSCHIFFTHALER, G KOLLER, J MAIR, P KHUNLBRADY, KS AGOSTON, S TI DOSE-RESPONSE RELATIONSHIP AND TIME COURSE OF THE ACTION OF ALCURONIUM SO ANAESTHESIST LA German DT Article C1 UNIV INNSBRUCK,ANAESTHESIE & ALLGEMEINE INTENS MED KLIN,ANICHSTR 35,A-6020 INNSBRUCK,AUSTRIA. STATE UNIV GRONINGEN,EXPTL ANAESTHESIOL & CLIN PHARMACOL RES GRP,9700 AB GRONINGEN,NETHERLANDS. NR 19 TC 4 Z9 4 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD OCT PY 1990 VL 39 IS 10 BP 508 EP 512 PG 5 WC Anesthesiology SC Anesthesiology GA EF643 UT WOS:A1990EF64300011 ER PT J AU SARNER, JB BRANDOM, BW DONG, ML PICKLE, D COOK, DR WEINBERGER, MJ AF SARNER, JB BRANDOM, BW DONG, ML PICKLE, D COOK, DR WEINBERGER, MJ TI CLINICAL-PHARMACOLOGY OF PIPECURONIUM IN INFANTS AND CHILDREN DURING HALOTHANE ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article C1 UNIV PITTSBURGH,SCH MED,DEPT ANESTHESIOL,PITTSBURGH,PA 15261. ORGANON INC,W ORANGE,NJ. RP SARNER, JB (reprint author), CHILDRENS HOSP PITTSBURGH,DEPT ANESTHESIOL,3705 5TH AVE & DESOTO ST,PITTSBURGH,PA 15213, USA. NR 13 TC 10 Z9 11 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD OCT PY 1990 VL 71 IS 4 BP 362 EP 366 PG 5 WC Anesthesiology SC Anesthesiology GA EA575 UT WOS:A1990EA57500007 ER PT J AU OLKKOLA, KT SCHWILDEN, H AF OLKKOLA, KT SCHWILDEN, H TI QUANTITATION OF THE INTERACTION BETWEEN ATRACURIUM AND SUCCINYLCHOLINE USING CLOSED-LOOP FEEDBACK-CONTROL OF INFUSION OF ATRACURIUM SO ANESTHESIOLOGY LA English DT Article C1 UNIV BONN,INST ANASTHESIOL,W-5300 BONN,GERMANY. NR 17 TC 17 Z9 17 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD OCT PY 1990 VL 73 IS 4 BP 614 EP 618 DI 10.1097/00000542-199010000-00005 PG 5 WC Anesthesiology SC Anesthesiology GA EB623 UT WOS:A1990EB62300005 ER PT J AU EMMOTT, RS BRACEY, BJ GOLDHILL, DR YATE, PM FLYNN, PJ AF EMMOTT, RS BRACEY, BJ GOLDHILL, DR YATE, PM FLYNN, PJ TI CARDIOVASCULAR EFFECTS OF DOXACURIUM, PANCURONIUM AND VECURONIUM IN ANESTHETIZED PATIENTS PRESENTING FOR CORONARY-ARTERY BYPASS-SURGERY SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article RP EMMOTT, RS (reprint author), UNIV LONDON LONDON HOSP,COLL MED,ANAESTHET UNIT,LONDON E1 1BB,ENGLAND. NR 18 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 OCT PY 1990 VL 65 IS 4 BP 480 EP 486 DI 10.1093/bja/65.4.480 PG 7 WC Anesthesiology SC Anesthesiology GA ED105 UT WOS:A1990ED10500007 ER PT J AU ERIKSSON, LI LENNMARKEN, C STAUN, P VIBYMOGENSEN, J AF ERIKSSON, LI LENNMARKEN, C STAUN, P VIBYMOGENSEN, J TI USE OF POSTTETANIC COUNT IN ASSESSMENT OF A REPETITIVE VECURONIUM-INDUCED NEUROMUSCULAR BLOCK SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article C1 UNIV COPENHAGEN,RIKSHOSP,DEPT ANAESTHESIA,DK-2100 COPENHAGEN,DENMARK. RP ERIKSSON, LI (reprint author), LINKOPING UNIV HOSP,DEPT ANAESTHESIOL,S-58185 LINKOPING,SWEDEN. NR 6 TC 10 Z9 10 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 OCT PY 1990 VL 65 IS 4 BP 487 EP 493 DI 10.1093/bja/65.4.487 PG 7 WC Anesthesiology SC Anesthesiology GA ED105 UT WOS:A1990ED10500008 ER PT J AU MERETOJA, OA GEBERT, R AF MERETOJA, OA GEBERT, R TI POSTOPERATIVE NEUROMUSCULAR BLOCK FOLLOWING ATRACURIUM OR ALCURONIUM IN CHILDREN SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 ROYAL CHILDRENS HOSP,PARKVILLE,VIC 3052,AUSTRALIA. RP MERETOJA, OA (reprint author), UNIV HELSINKI,CHILDRENS HOSP,DEPT ANAESTHESIOL,SF-00290 HELSINKI 29,FINLAND. NR 15 TC 13 Z9 14 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD OCT PY 1990 VL 37 IS 7 BP 743 EP 746 PG 4 WC Anesthesiology SC Anesthesiology GA EB327 UT WOS:A1990EB32700006 ER PT J AU PARTRIDGE, BL ABRAMS, JH BAZEMORE, C RUBIN, R AF PARTRIDGE, BL ABRAMS, JH BAZEMORE, C RUBIN, R TI PROLONGED NEUROMUSCULAR BLOCKADE AFTER LONG-TERM INFUSION OF VECURONIUM BROMIDE IN THE INTENSIVE-CARE UNIT SO CRITICAL CARE MEDICINE LA English DT Article C1 UNIV MINNESOTA,DEPT SURG,MINNEAPOLIS,MN 55455. BALBOA NAVAL HOSP,SAN DIEGO,CA. WOODLAND MEM HOSP,SACRAMENTO,CA. RP PARTRIDGE, BL (reprint author), UNIV CALIF SAN DIEGO,DEPT ANAESTHESIOL,SAN DIEGO,CA 92103, USA. NR 21 TC 77 Z9 81 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD OCT PY 1990 VL 18 IS 10 BP 1177 EP 1179 DI 10.1097/00003246-199010000-00025 PG 3 WC Critical Care Medicine SC General & Internal Medicine GA EB816 UT WOS:A1990EB81600026 ER PT J AU FIACCHINO, F ARIANO, C GEMMA, M CERRATO, D AF FIACCHINO, F ARIANO, C GEMMA, M CERRATO, D TI ABNORMAL RESPONSES TO SUCCINYLCHOLINE AND PANCURONIUM IN A PATIENT WITH HEMIPARESIS SO ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES LA English DT Article RP FIACCHINO, F (reprint author), IST NAZL NEUROL C BESTA,DIV ANESTESIA & RIANIMAZ,VIA CELORIA 11,I-20133 MILAN,ITALY. NR 0 TC 3 Z9 3 PU MASSON DIVISIONE PERIODICI PI MILAN PA VIA STATUTO 2/4, 20121 MILAN, ITALY SN 0392-0461 J9 ITAL J NEUROL SCI JI Ital. J. Neurol. Sci. PD OCT PY 1990 VL 11 IS 5 BP 497 EP 499 DI 10.1007/BF02336571 PG 3 WC Clinical Neurology; Neurosciences SC Neurosciences & Neurology GA EK124 UT WOS:A1990EK12400010 ER PT J AU HAYNES, SR MORTON, NS AF HAYNES, SR MORTON, NS TI PROLONGED NEUROMUSCULAR BLOCKADE WITH VECURONIUM IN A NEONATE WITH RENAL-FAILURE SO ANAESTHESIA LA English DT Article C1 ROYAL HOSP SICK CHILDREN,DEPT ANAESTHESIA,GLASGOW G3 8SJ,SCOTLAND. NR 9 TC 5 Z9 5 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD SEP PY 1990 VL 45 IS 9 BP 743 EP 745 DI 10.1111/j.1365-2044.1990.tb14444.x PG 3 WC Anesthesiology SC Anesthesiology GA DW537 UT WOS:A1990DW53700009 ER PT J AU SUFIT, RL KREUL, JF BELLAY, YM HELMER, P BRUNSON, DB WILL, J AF SUFIT, RL KREUL, JF BELLAY, YM HELMER, P BRUNSON, DB WILL, J TI DOXACURIUM AND MIVACURIUM DO NOT TRIGGER MALIGNANT HYPERTHERMIA IN SUSCEPTIBLE SWINE SO ANESTHESIA AND ANALGESIA LA English DT Article C1 UNIV WISCONSIN,DEPT ANESTHESIOL,600 HIGHLAND AVE,MADISON,WI 53792. UNIV WISCONSIN,SCH AGR & LIFE SCI,DEPT POLYMER CHEM,MADISON,WI 53792. UNIV WISCONSIN,SCH VET MED,DEPT MED & SURG,MADISON,WI 53792. NR 9 TC 5 Z9 5 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD SEP PY 1990 VL 71 IS 3 BP 285 EP 287 PG 3 WC Anesthesiology SC Anesthesiology GA DV429 UT WOS:A1990DV42900012 ER PT J AU MAGORIAN, TT LYNAM, DP CALDWELL, JE MILLER, RD AF MAGORIAN, TT LYNAM, DP CALDWELL, JE MILLER, RD TI CAN EARLY ADMINISTRATION OF NEOSTIGMINE, IN SINGLE OR REPEATED DOSES, ALTER THE COURSE OF NEUROMUSCULAR RECOVERY FROM A VECURONIUM-INDUCED NEUROMUSCULAR BLOCKADE SO ANESTHESIOLOGY LA English DT Article C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,SAN FRANCISCO,CA 94143. NR 20 TC 41 Z9 42 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD SEP PY 1990 VL 73 IS 3 BP 410 EP 414 DI 10.1097/00000542-199009000-00008 PG 5 WC Anesthesiology SC Anesthesiology GA DX668 UT WOS:A1990DX66800008 ER PT J AU KAMBAM, JR JANSON, VE DAY, P SASTRY, BVR AF KAMBAM, JR JANSON, VE DAY, P SASTRY, BVR TI PANCURONIUM, VECURONIUM, AND D-TUBOCURARINE INHIBIT AND SUCCINYLCHOLINE STIMULATES CHOLINE-ACETYLTRANSFERASE ACTIVITY SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 VANDERBILT UNIV,MED CTR,DEPT ANESTHESIOL,NASHVILLE,TN 37232. VANDERBILT UNIV,MED CTR,DEPT PHARMACOL,NASHVILLE,TN 37232. NR 23 TC 0 Z9 0 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD SEP PY 1990 VL 37 IS 6 BP 690 EP 694 PG 5 WC Anesthesiology SC Anesthesiology GA DX763 UT WOS:A1990DX76300020 ER PT J AU NIELSEN, HK MAY, O JENSEN, AG LYBECKER, H AF NIELSEN, HK MAY, O JENSEN, AG LYBECKER, H TI RECOVERY FROM PROFOUND ATRACURIUM BLOCK EVALUATED BY THE POSTTETANIC COUNT AND TIME FROM LAST ATRACURIUM ADMINISTRATION SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article RP NIELSEN, HK (reprint author), ESBJERG CENT HOSP,DEPT ANAESTHESIOL,ESBJERG,DENMARK. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD SEP PY 1990 VL 7 IS 5 BP 389 EP 394 PG 6 WC Anesthesiology SC Anesthesiology GA DY165 UT WOS:A1990DY16500005 ER PT J AU MURRAY, DJ SOKOLL, MD CHOI, WW MEHTA, MP FORBES, RB GERGIS, SD AF MURRAY, DJ SOKOLL, MD CHOI, WW MEHTA, MP FORBES, RB GERGIS, SD TI THE NEUROMUSCULAR BLOCKING EFFECT OF DOXACURIUM CHLORIDE DURING ISOFLURANE ANESTHESIA SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article RP MURRAY, DJ (reprint author), UNIV IOWA,COLL MED,DEPT ANESTHESIA,IOWA CITY,IA 52242, USA. NR 0 TC 3 Z9 3 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD SEP PY 1990 VL 7 IS 5 BP 395 EP 402 PG 8 WC Anesthesiology SC Anesthesiology GA DY165 UT WOS:A1990DY16500006 ER PT J AU MERRIFIELD, PA KIELY, R KONIGSBERG, IR AF MERRIFIELD, PA KIELY, R KONIGSBERG, IR TI NORMAL EXPRESSION OF MYOSIN FAST ALKALI LIGHT CHAIN-3 IN THE HINDLIMB MUSCLE OF CHICK-EMBRYOS PARALYZED WITH CURARE SO EXPERIMENTAL NEUROLOGY LA English DT Article C1 UNIV VIRGINIA,DEPT BIOL,CHARLOTTESVILLE,VA 22901. NR 55 TC 3 Z9 3 PU ACADEMIC PRESS INC JNL-COMP SUBSCRIPTIONS PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 SN 0014-4886 J9 EXP NEUROL JI Exp. Neurol. PD SEP PY 1990 VL 109 IS 3 BP 342 EP 348 DI 10.1016/S0014-4886(05)80025-1 PG 7 WC Neurosciences SC Neurosciences & Neurology GA EA645 UT WOS:A1990EA64500011 ER PT J AU DENAI, M LINKENS, DA ASBURY, AJ MACLEOD, AD GRAY, WM AF DENAI, M LINKENS, DA ASBURY, AJ MACLEOD, AD GRAY, WM TI SELF-TUNING PID CONTROL OF ATRACURIUM-INDUCED MUSCLE-RELAXATION IN SURGICAL PATIENTS SO IEE PROCEEDINGS-D CONTROL THEORY AND APPLICATIONS LA English DT Article C1 UNIV GLASGOW,DEPT ANAESTHESIA,GLASGOW G12 8QQ,SCOTLAND. RP DENAI, M (reprint author), UNIV SHEFFIELD,DEPT CONTROL ENGN,MAPPIN ST,SHEFFIELD S1 3JD,S YORKSHIRE,ENGLAND. NR 30 TC 12 Z9 12 PU IEE-INST ELEC ENG PI HERTFORD PA MICHAEL FARADAY HOUSE SIX HILLS WAY STEVENAGE, HERTFORD, ENGLAND SG1 2AY SN 0143-7054 J9 IEE PROC-D PD SEP PY 1990 VL 137 IS 5 BP 261 EP 272 PG 12 WC Engineering, Electrical & Electronic; Instruments & Instrumentation SC Engineering; Instruments & Instrumentation GA DY742 UT WOS:A1990DY74200001 ER PT J AU KOSITSYN, VF KONYAEV, AE KOZHUKHOVSKAYA, SA AF KOSITSYN, VF KONYAEV, AE KOZHUKHOVSKAYA, SA TI ENERGY-LEVELS OF AMERICIUM AND CURIUM MESOATOMS SO SOVIET RADIOCHEMISTRY LA English DT Article AB Energy levels of americium and curium mesoatoms are calculated using wave functions. Relativistic corrections are calculated using first order perturbation theory. NR 7 TC 0 Z9 0 PU PLENUM PUBL CORP PI NEW YORK PA CONSULTANTS BUREAU 233 SPRING ST, NEW YORK, NY 10013 SN 0038-576X J9 SOV RADIOCHEM+ PD SEP-OCT PY 1990 VL 32 IS 5 BP 427 EP 431 PG 5 WC Chemistry, Analytical SC Chemistry GA GF798 UT WOS:A1990GF79800003 ER PT J AU VARIN, F DUCHARME, J BESNER, JG THEORET, Y AF VARIN, F DUCHARME, J BESNER, JG THEORET, Y TI DETERMINATION OF ATRACURIUM AND LAUDANOSINE IN HUMAN PLASMA BY HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHY SO JOURNAL OF CHROMATOGRAPHY-BIOMEDICAL APPLICATIONS LA English DT Article C1 UNIV MONTREAL,DEPT PHARMACOL,MONTREAL H3C 3J7,QUEBEC,CANADA. RP VARIN, F (reprint author), UNIV MONTREAL,FAC PHARM,CP 6128,SUCC A,MONTREAL H3C 3J7,QUEBEC,CANADA. NR 12 TC 17 Z9 17 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0378-4347 J9 J CHROMATOGR-BIOMED JI J. Chromatogr.-Biomed. Appl. PD AUG 3 PY 1990 VL 529 IS 2 BP 319 EP 327 DI 10.1016/S0378-4347(00)83838-4 PG 9 WC Chemistry, Analytical SC Chemistry GA DV619 UT WOS:A1990DV61900006 ER PT J AU STIRT, JA CHIU, GJ AF STIRT, JA CHIU, GJ TI INTRAOCULAR-PRESSURE DURING RAPID SEQUENCE INDUCTION - USE OF MODERATE-DOSE SUFENTANIL OR FENTANYL AND VECURONIUM OR ATRACURIUM SO ANAESTHESIA AND INTENSIVE CARE LA English DT Article RP STIRT, JA (reprint author), UNIV VIRGINIA,HLTH SCI CTR,DEPT ANESTHESIOL,BOX 223,CHARLOTTESVILLE,VA 22908, USA. NR 36 TC 2 Z9 2 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 1990 VL 18 IS 3 BP 390 EP 394 PG 5 WC Anesthesiology; Critical Care Medicine SC Anesthesiology; General & Internal Medicine GA DT826 UT WOS:A1990DT82600017 ER PT J AU GUNNICKER, M FREUND, U HIRCHE, H POHLEN, G SCHERER, R HESS, W AF GUNNICKER, M FREUND, U HIRCHE, H POHLEN, G SCHERER, R HESS, W TI HEMODYNAMIC AND MYOCARDIAL ENERGY-BALANCE IN HEART-SURGERY PATIENTS DURING ANESTHESIA WITH HIGH-DOSE FENTANYL AND PANCURONIUM OR MODIFIED BALANCED ANESTHESIA WITH PANCURONIUM SO ANAESTHESIST LA German DT Article C1 UNIV ESSEN GESAMTHSCH KLINIKUM,INST MED INFORMAT & BIOMECH,W-4300 ESSEN 1,GERMANY. ALLGEMEINES KRANKENHAUS ST GEORG,ANAESTHESIE ABT 1,HAMBURG,GERMANY. RP GUNNICKER, M (reprint author), UNIV ESSEN GESAMTHSCH KLINIKUM,INST ANAESTHESIOL,HUFELANDSTR 55,W-4300 ESSEN 1,GERMANY. NR 22 TC 3 Z9 3 PU SPRINGER VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 SN 0003-2417 J9 ANAESTHESIST JI Anaesthesist PD AUG PY 1990 VL 39 IS 8 BP 406 EP 411 PG 6 WC Anesthesiology SC Anesthesiology GA DW078 UT WOS:A1990DW07800003 ER PT J AU HAWKINS, JL JOHNSON, TD KUBICEK, MA SKJONSBY, BS MORROW, DH JOYCE, TH AF HAWKINS, JL JOHNSON, TD KUBICEK, MA SKJONSBY, BS MORROW, DH JOYCE, TH TI VECURONIUM FOR RAPID-SEQUENCE INTUBATION FOR CESAREAN-SECTION SO ANESTHESIA AND ANALGESIA LA English DT Article RP HAWKINS, JL (reprint author), BAYLOR UNIV,DEPT ANESTHESIOL,435D,HOUSTON,TX 77030, USA. NR 20 TC 13 Z9 13 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 1990 VL 71 IS 2 BP 185 EP 190 PG 6 WC Anesthesiology SC Anesthesiology GA DQ760 UT WOS:A1990DQ76000012 ER PT J AU HUANG, KC HEISE, A SHRADER, AK TSUEDA, K AF HUANG, KC HEISE, A SHRADER, AK TSUEDA, K TI VANCOMYCIN ENHANCES THE NEUROMUSCULAR BLOCKADE OF VECURONIUM SO ANESTHESIA AND ANALGESIA LA English DT Article C1 UNIV LOUISVILLE,DEPT ANESTHESIOL,LOUISVILLE,KY 40292. RP HUANG, KC (reprint author), VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA,DEPT ANESTHESIOL,RICHMOND,VA 23298, USA. NR 26 TC 8 Z9 8 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD AUG PY 1990 VL 71 IS 2 BP 194 EP 196 PG 3 WC Anesthesiology SC Anesthesiology GA DQ760 UT WOS:A1990DQ76000014 ER PT J AU BESSER, R VOGT, T GUTMANN, L AF BESSER, R VOGT, T GUTMANN, L TI PANCURONIUM IMPROVES THE NEUROMUSCULAR-TRANSMISSION DEFECT OF HUMAN ORGANOPHOSPHATE INTOXICATION SO NEUROLOGY LA English DT Article C1 W VIRGINIA UNIV,MED CTR,SCH MED,DEPT NEUROL,MORGANTOWN,WV 26506. RP BESSER, R (reprint author), UNIV MAINZ,DEPT NEUROL,LANGENBECKSTR 1,W-6500 MAINZ,GERMANY. NR 15 TC 13 Z9 13 PU LITTLE BROWN CO PI BOSTON PA 34 BEACON STREET, BOSTON, MA 02108-1493 SN 0028-3878 J9 NEUROLOGY JI Neurology PD AUG PY 1990 VL 40 IS 8 BP 1275 EP 1277 PG 3 WC Clinical Neurology SC Neurosciences & Neurology GA DT488 UT WOS:A1990DT48800025 ER PT J AU GUNNICKER, M POHLEN, G HESS, W AF GUNNICKER, M POHLEN, G HESS, W TI THE INFLUENCE OF PANCURONIUM AND VECURONIUM COMBINED WITH BALANCED ANESTHESIA ON HEMODYNAMICS AND MYOCARDIAL OXYGEN BALANCE SO ACTA ANAESTHESIOLOGICA SCANDINAVICA LA English DT Article C1 ALLGEMEIN KRANKENHAUS ST GEORG,DEPT ANAESTHESIA 1,HAMBURG,GERMANY. RP GUNNICKER, M (reprint author), UNIV ESSEN GESAMTHSCH KLINIKUM,DEPT ANAESTHESIOL,HUFELANDSTR 55,W-4300 ESSEN 1,GERMANY. NR 31 TC 2 Z9 2 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 1990 VL 34 IS 5 BP 327 EP 334 PG 8 WC Anesthesiology SC Anesthesiology GA DP119 UT WOS:A1990DP11900001 ER PT J AU BRANDOM, BW SARNER, JB WOELFEL, SK DONG, ML HORN, MC BORLAND, LM COOK, DR FOSTER, VJ MCNULTY, BF WEAKLY, JN AF BRANDOM, BW SARNER, JB WOELFEL, SK DONG, ML HORN, MC BORLAND, LM COOK, DR FOSTER, VJ MCNULTY, BF WEAKLY, JN TI MIVACURIUM INFUSION REQUIREMENTS IN PEDIATRIC SURGICAL PATIENTS DURING NITROUS-OXIDE HALOTHANE AND DURING NITROUS-OXIDE NARCOTIC ANESTHESIA SO ANESTHESIA AND ANALGESIA LA English DT Article C1 BURROUGHS WELLCOME CO,DEPT CLIN NEUROSCI,RES TRIANGLE PK,NC 27709. UNIV PITTSBURGH,DEPT ANESTHESIOL,PITTSBURGH,PA 15260. RP BRANDOM, BW (reprint author), CHILDRENS HOSP PITTSBURGH,DEPT ANESTHESIOL,1 CHILDRENS PL,3705 5TH AVE & DESOTO ST,PITTSBURGH,PA 15213, USA. NR 20 TC 35 Z9 36 PU WILLIAMS & WILKINS PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 SN 0003-2999 J9 ANESTH ANALG JI Anesth. Analg. PD JUL PY 1990 VL 71 IS 1 BP 16 EP 22 PG 7 WC Anesthesiology SC Anesthesiology GA DK763 UT WOS:A1990DK76300003 ER PT J AU NILSSON, E MERETOJA, OA AF NILSSON, E MERETOJA, OA TI VECURONIUM DOSE - RESPONSE AND MAINTENANCE REQUIREMENTS IN PATIENTS WITH MYASTHENIA-GRAVIS SO ANESTHESIOLOGY LA English DT Article C1 UNIV HELSINKI,CENT HOSP,DEPT ANAESTHESIA,SF-00100 HELSINKI 10,FINLAND. NR 24 TC 34 Z9 35 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1990 VL 73 IS 1 BP 28 EP 32 DI 10.1097/00000542-199007000-00005 PG 5 WC Anesthesiology SC Anesthesiology GA DK885 UT WOS:A1990DK88500005 ER PT J AU FISHER, DM CANFELL, PC SPELLMAN, MJ MILLER, RD AF FISHER, DM CANFELL, PC SPELLMAN, MJ MILLER, RD TI PHARMACOKINETICS AND PHARMACODYNAMICS OF ATRACURIUM IN INFANTS AND CHILDREN SO ANESTHESIOLOGY LA English DT Article C1 UNIV CALIF SAN FRANCISCO,PEDIAT,SAN FRANCISCO,CA 94143. UNIV CALIF SAN FRANCISCO,PHARMACOL,SAN FRANCISCO,CA 94143. RP FISHER, DM (reprint author), UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,S-436,SAN FRANCISCO,CA 94143, USA. NR 24 TC 54 Z9 54 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD JUL PY 1990 VL 73 IS 1 BP 33 EP 37 DI 10.1097/00000542-199007000-00006 PG 5 WC Anesthesiology SC Anesthesiology GA DK885 UT WOS:A1990DK88500006 ER PT J AU FOLDES, FF NAGASHIMA, H NGUYEN, HD DUNCALF, D GOLDINER, PL AF FOLDES, FF NAGASHIMA, H NGUYEN, HD DUNCALF, D GOLDINER, PL TI NEUROMUSCULAR AND CARDIOVASCULAR EFFECTS OF PIPECURONIUM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article RP FOLDES, FF (reprint author), MONTEFIORE MED CTR,ALBERT EINSTEIN COLL MED,DEPT ANESTHESIOL,111 E 210TH ST,BRONX,NY 10467, USA. NR 10 TC 23 Z9 24 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD JUL PY 1990 VL 37 IS 5 BP 549 EP 555 PG 7 WC Anesthesiology SC Anesthesiology GA DM553 UT WOS:A1990DM55300012 ER PT J AU VARIN, F DUCHARME, J THEORET, Y BESNER, JG BEVAN, DR DONATI, F AF VARIN, F DUCHARME, J THEORET, Y BESNER, JG BEVAN, DR DONATI, F TI INFLUENCE OF EXTREME OBESITY ON THE BODY DISPOSITION AND NEUROMUSCULAR BLOCKING EFFECT OF ATRACURIUM SO CLINICAL PHARMACOLOGY & THERAPEUTICS LA English DT Article C1 UNIV MONTREAL,DEPT PHARMACOL,MONTREAL H3C 3J7,QUEBEC,CANADA. MCGILL UNIV,FAC MED,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. RP VARIN, F (reprint author), UNIV MONTREAL,FAC PHARM,CP 6128,SUCCURSALE A,MONTREAL H3C 3J7,QUEBEC,CANADA. NR 31 TC 33 Z9 35 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0009-9236 J9 CLIN PHARMACOL THER JI Clin. Pharmacol. Ther. PD JUL PY 1990 VL 48 IS 1 BP 18 EP 25 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA DR010 UT WOS:A1990DR01000003 ER PT J AU HOLGYE, Z AF HOLGYE, Z TI DETERMINATION OF PLUTONIUM, AMERICIUM AND CURIUM IN AIRBORNE EFFLUENTS OF NUCLEAR-POWER-PLANTS SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY-ARTICLES LA English DT Article RP HOLGYE, Z (reprint author), CTR RADIAT HYG,INST HYG & EPIDEMIOL,CS-10042 PRAGUE,CZECHOSLOVAKIA. NR 13 TC 6 Z9 6 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0236-5731 J9 J RADIOAN NUCL CH AR JI J. Radioanal. Nucl. Chem.-Artic. PD JUL PY 1990 VL 141 IS 1 BP 101 EP 106 DI 10.1007/BF02060189 PG 6 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA DW638 UT WOS:A1990DW63800011 ER PT J AU MURRAY, GM DELCUL, GD BEGUN, GM HAIRE, RG YOUNG, JP PETERSON, JR AF MURRAY, GM DELCUL, GD BEGUN, GM HAIRE, RG YOUNG, JP PETERSON, JR TI ANTI-STOKES LUMINESCENCE OF CURIUM-248(III) BROMIDE SO CHEMICAL PHYSICS LETTERS LA English DT Article C1 UNIV TENNESSEE,DEPT CHEM,KNOXVILLE,TN 37996. OAK RIDGE NATL LAB,DIV CHEM,TRANSURANIUM RES LAB,OAK RIDGE,TN 37831. RI Murray, George/A-6625-2011 NR 11 TC 12 Z9 12 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0009-2614 J9 CHEM PHYS LETT JI Chem. Phys. Lett. PD MAY 11 PY 1990 VL 168 IS 5 BP 473 EP 476 DI 10.1016/0009-2614(90)85146-4 PG 4 WC Chemistry, Physical; Physics, Atomic, Molecular & Chemical SC Chemistry; Physics GA DE492 UT WOS:A1990DE49200012 ER PT J AU TOMA, P LUCIGRAI, G DODERO, P LITUANIA, M AF TOMA, P LUCIGRAI, G DODERO, P LITUANIA, M TI PRENATAL DETECTION OF AN ABDOMINAL-MASS BY MR IMAGING PERFORMED WHILE THE FETUS IS IMMOBILIZED WITH PANCURONIUM-BROMIDE SO AMERICAN JOURNAL OF ROENTGENOLOGY LA English DT Article C1 GIANNINA GASLINI CHILDRENS HOSP,DEPT SURG,I-16100 GENOA,ITALY. GIANNINA GASLINI CHILDRENS HOSP,DEPT OBSTET & GYNECOL,I-16100 GENOA,ITALY. RP TOMA, P (reprint author), GIANNINA GASLINI CHILDRENS HOSP,DEPT RADIOL,LARGO G GASLINI 5,I-16100 GENOA,ITALY. NR 7 TC 12 Z9 12 PU AMER ROENTGEN RAY SOC PI RESTON PA 1891 PRESTON WHITE DR SUBSCRIPTION FULFILLMENT, RESTON, VA 22091 SN 0361-803X J9 AM J ROENTGENOL JI Am. J. Roentgenol. PD MAY PY 1990 VL 154 IS 5 BP 1049 EP 1050 PG 2 WC Radiology, Nuclear Medicine & Medical Imaging SC Radiology, Nuclear Medicine & Medical Imaging GA CY905 UT WOS:A1990CY90500021 ER PT J AU ENGBOEK, J OSTERGAARD, D SKOVGAARD, LT VIBYMOGENSEN, J AF ENGBOEK, J OSTERGAARD, D SKOVGAARD, LT VIBYMOGENSEN, J TI REVERSAL OF INTENSE NEUROMUSCULAR BLOCKADE FOLLOWING INFUSION OF ATRACURIUM SO ANESTHESIOLOGY LA English DT Article C1 UNIV COPENHAGEN,DEPT ANESTHESIA,DK-1168 COPENHAGEN,DENMARK. RIGSHOSP,HERLEV HOSP,DEPT ANESTHESIA,DK-2100 COPENHAGEN,DENMARK. NR 15 TC 28 Z9 28 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAY PY 1990 VL 72 IS 5 BP 803 EP 806 DI 10.1097/00000542-199005000-00005 PG 4 WC Anesthesiology SC Anesthesiology GA DC981 UT WOS:A1990DC98100005 ER PT J AU BOULANGER, A HARDY, JF LEPAGE, Y AF BOULANGER, A HARDY, JF LEPAGE, Y TI RAPID INDUCTION SEQUENCE WITH VECURONIUM - SHOULD WE INTUBATE AFTER 60 OR 90 SECONDS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 UNIV MONTREAL,DEPT ANAESTHESIA,MONTREAL H3C 3J7,QUEBEC,CANADA. UNIV MONTREAL,DEPT MATH & STAT,MONTREAL H3C 3J7,QUEBEC,CANADA. NR 21 TC 5 Z9 5 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 1990 VL 37 IS 3 BP 296 EP 300 PG 5 WC Anesthesiology SC Anesthesiology GA CX463 UT WOS:A1990CX46300004 ER PT J AU EISENKRAFT, JB BOOK, WJ AF EISENKRAFT, JB BOOK, WJ TI SENSITIVITY TO VECURONIUM IN MYASTHENIA-GRAVIS - A DOSE-RESPONSE STUDY SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 CUNY MT SINAI SCH MED,DEPT ANESTHESIOL,NEW YORK,NY 10029. CUNY MT SINAI SCH MED,DEPT SURG,NEW YORK,NY 10029. NR 17 TC 29 Z9 29 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 1990 VL 37 IS 3 BP 301 EP 306 PG 6 WC Anesthesiology SC Anesthesiology GA CX463 UT WOS:A1990CX46300005 ER PT J AU SHARPE, MD LAM, AM NICHOLAS, JF CHUNG, DC MERCHANT, R ALYAFI, W BEAUCHAMP, R AF SHARPE, MD LAM, AM NICHOLAS, JF CHUNG, DC MERCHANT, R ALYAFI, W BEAUCHAMP, R TI CORRELATION BETWEEN INTEGRATED EVOKED EMG AND RESPIRATORY-FUNCTION FOLLOWING ATRACURIUM ADMINISTRATION IN UNANESTHETIZED HUMANS SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 UNIV WASHINGTON,DEPT ANESTHESIOL,SEATTLE,WA 98195. UNIV WESTERN ONTARIO,ST JOSEPHS HOSP,DEPT ANAESTHESIA,LONDON N6A 3K7,ONTARIO,CANADA. NR 34 TC 16 Z9 16 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD APR PY 1990 VL 37 IS 3 BP 307 EP 312 PG 6 WC Anesthesiology SC Anesthesiology GA CX463 UT WOS:A1990CX46300006 ER PT J AU KIMURA, T AF KIMURA, T TI SIMULTANEOUS DETERMINATION OF NEPTUNIUM, PLUTONIUM, AMERICIUM AND CURIUM USING COPRECIPITATION WITH BISMUTH PHOSPHATE SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY-ARTICLES LA English DT Article RP KIMURA, T (reprint author), JAPAN ATOM ENERGY RES INST,DEPT CHEM,TOKAI,IBARAKI 31911,JAPAN. NR 15 TC 9 Z9 9 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0236-5731 J9 J RADIOAN NUCL CH AR JI J. Radioanal. Nucl. Chem.-Artic. PD APR PY 1990 VL 139 IS 2 BP 297 EP 305 DI 10.1007/BF02061815 PG 9 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA DC404 UT WOS:A1990DC40400012 ER PT J AU KIMURA, T AF KIMURA, T TI SEQUENTIAL SEPARATION OF NEPTUNIUM, PLUTONIUM, AMERICIUM AND CURIUM USING COPRECIPITATION WITH BISMUTH PHOSPHATE SO JOURNAL OF RADIOANALYTICAL AND NUCLEAR CHEMISTRY-ARTICLES LA English DT Article RP KIMURA, T (reprint author), JAPAN ATOM ENERGY RES INST,DEPT CHEM,TOKAI,IBARAKI 31911,JAPAN. NR 9 TC 1 Z9 1 PU AKADEMIAI KIADO PI BUDAPEST PA PO BOX 245, H-1519 BUDAPEST, HUNGARY SN 0236-5731 J9 J RADIOAN NUCL CH AR JI J. Radioanal. Nucl. Chem.-Artic. PD APR PY 1990 VL 139 IS 2 BP 307 EP 314 DI 10.1007/BF02061816 PG 8 WC Chemistry, Analytical; Chemistry, Inorganic & Nuclear; Nuclear Science & Technology SC Chemistry; Nuclear Science & Technology GA DC404 UT WOS:A1990DC40400013 ER PT J AU LIU, GK BEITZ, JV AF LIU, GK BEITZ, JV TI EXCITED-STATE DYNAMICS AND ENERGY-TRANSFER OF CURIUM-+4 IN CERIUM TETRAFLUORIDE SO PHYSICAL REVIEW B LA English DT Article RP LIU, GK (reprint author), ARGONNE NATL LAB,ARGONNE,IL 60439, USA. NR 53 TC 18 Z9 18 PU AMERICAN PHYSICAL SOC PI COLLEGE PK PA ONE PHYSICS ELLIPSE, COLLEGE PK, MD 20740-3844 USA SN 0163-1829 J9 PHYS REV B JI Phys. Rev. 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PD MAR PY 1990 VL 70 IS 3 BP 248 EP 252 PG 5 WC Anesthesiology SC Anesthesiology GA CR660 UT WOS:A1990CR66000003 ER PT J AU PITTET, JF TASSONYI, E MOREL, DR GEMPERLE, G ROUGE, JC AF PITTET, JF TASSONYI, E MOREL, DR GEMPERLE, G ROUGE, JC TI NEUROMUSCULAR EFFECT OF PIPECURONIUM BROMIDE IN INFANTS AND CHILDREN DURING NITROUS-OXIDE ALFENTANIL ANESTHESIA SO ANESTHESIOLOGY LA English DT Article C1 UNIV GENEVA,HOP CANTONAL,DEPT ANESTHESIA,CH-1211 GENEVA 4,SWITZERLAND. NR 25 TC 9 Z9 9 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1990 VL 72 IS 3 BP 432 EP 435 DI 10.1097/00000542-199003000-00006 PG 4 WC Anesthesiology SC Anesthesiology GA CR166 UT WOS:A1990CR16600006 ER PT J AU SEGREDO, V MATTHAY, MA SHARMA, ML GRUENKE, LD CALDWELL, JE MILLER, RD AF SEGREDO, V MATTHAY, MA SHARMA, ML GRUENKE, LD CALDWELL, JE MILLER, RD TI PROLONGED NEUROMUSCULAR BLOCKADE AFTER LONG-TERM ADMINISTRATION OF VECURONIUM IN 2 CRITICALLY ILL PATIENTS SO ANESTHESIOLOGY LA English DT Article C1 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,BOX 0648,SAN FRANCISCO,CA 94143. NR 20 TC 95 Z9 98 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD MAR PY 1990 VL 72 IS 3 BP 566 EP 570 DI 10.1097/00000542-199003000-00030 PG 5 WC Anesthesiology SC Anesthesiology GA CR166 UT WOS:A1990CR16600030 ER PT J AU HARRISON, MJ AF HARRISON, MJ TI PREDICTION OF INFUSION RATES - VALIDATION OF A COMPUTER-SIMULATION USING VECURONIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article RP HARRISON, MJ (reprint author), AUCKLAND HOSP,PK RD,AUCKLAND 3,NEW ZEALAND. NR 9 TC 8 Z9 9 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 1990 VL 64 IS 3 BP 287 EP 293 DI 10.1093/bja/64.3.287 PG 7 WC Anesthesiology SC Anesthesiology GA CT334 UT WOS:A1990CT33400006 ER PT J AU DERRINGTON, MC HINDOCHA, N AF DERRINGTON, MC HINDOCHA, N TI COMPARISON OF NEUROMUSCULAR BLOCK IN THE DIAPHRAGM AND HAND AFTER ADMINISTRATION OF TUBOCURARINE, PANCURONIUM AND ALCURONIUM SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article RP DERRINGTON, MC (reprint author), UNIV LEICESTER,LEICESTER ROYAL INFIRM,DEPT ANAESTHESIA,LEICESTER LE1 5WW,ENGLAND. NR 10 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 MAR PY 1990 VL 64 IS 3 BP 294 EP 299 DI 10.1093/bja/64.3.294 PG 6 WC Anesthesiology SC Anesthesiology GA CT334 UT WOS:A1990CT33400007 ER PT J AU GILL, SS BEVAN, DR DONATI, F AF GILL, SS BEVAN, DR DONATI, F TI EDROPHONIUM ANTAGONISM OF ATRACURIUM DURING ENFLURANE ANESTHESIA SO BRITISH JOURNAL OF ANAESTHESIA LA English DT Article C1 MCGILL UNIV,ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,687 PINE AVE W,RM F301,MONTREAL H3A 1A1,QUEBEC,CANADA. NR 16 TC 16 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 MAR PY 1990 VL 64 IS 3 BP 300 EP 305 DI 10.1093/bja/64.3.300 PG 6 WC Anesthesiology SC Anesthesiology GA CT334 UT WOS:A1990CT33400008 ER PT J AU WIERDA, JMKH KARLICZEK, GF VANDENBROM, RHG PINTO, I KERSTENKLEEF, UW MEIJER, DKF AGOSTON, S AF WIERDA, JMKH KARLICZEK, GF VANDENBROM, RHG PINTO, I KERSTENKLEEF, UW MEIJER, DKF AGOSTON, S TI PHARMACOKINETICS AND CARDIOVASCULAR DYNAMICS OF PIPECURONIUM BROMIDE DURING CORONARY-ARTERY SURGERY SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 STATE UNIV GRONINGEN,EXPTL ANAESTHESIOL & CLIN PHARMACOL RES GRP,9700 AB GRONINGEN,NETHERLANDS. STATE UNIV GRONINGEN,SUBFAC PHARM,DEPT PHARMACOL & PHARMACOTHERAPEUT,9700 AB GRONINGEN,NETHERLANDS. RP WIERDA, JMKH (reprint author), STATE UNIV GRONINGEN HOSP,DEPT ANAESTHESIA,POB 30001,9700 RB GRONINGEN,NETHERLANDS. NR 30 TC 22 Z9 23 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 1990 VL 37 IS 2 BP 183 EP 191 PG 9 WC Anesthesiology SC Anesthesiology GA CQ379 UT WOS:A1990CQ37900007 ER PT J AU DUPUIS, JY MARTIN, R TETRAULT, JP AF DUPUIS, JY MARTIN, R TETRAULT, JP TI CLINICAL, ELECTRICAL AND MECHANICAL CORRELATIONS DURING RECOVERY FROM NEUROMUSCULAR BLOCKADE WITH VECURONIUM SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article RP DUPUIS, JY (reprint author), CHU SHERBROOKE,DEPT ANAESTHESIA,3001 12TH AVE N,SHERBROOKE J1H 5N4,QUEBEC,CANADA. NR 15 TC 32 Z9 32 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 1990 VL 37 IS 2 BP 192 EP 196 PG 5 WC Anesthesiology SC Anesthesiology GA CQ379 UT WOS:A1990CQ37900008 ER PT J AU SZALADOS, JE DONATI, F BEVAN, DR AF SZALADOS, JE DONATI, F BEVAN, DR TI EDROPHONIUM PRIMING FOR ANTAGONISM OF ATRACURIUM NEUROMUSCULAR BLOCKADE SO CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE LA English DT Article C1 MCGILL UNIV,DEPT ANAESTHESIA,MONTREAL H3A 2T5,QUEBEC,CANADA. ROYAL VICTORIA HOSP,DEPT ANAESTHESIA,MONTREAL H3A 1A1,QUEBEC,CANADA. NR 13 TC 2 Z9 2 PU CANADIAN ANAESTHETISTS SOC INC PI TORONTO PA 1 EGLINTON AVE EAST, SUITE 208, TORONTO ON M4P 3A1, CANADA SN 0832-610X J9 CAN J ANAESTH JI Can. J. Anaesth.-J. Can. Anesth. PD MAR PY 1990 VL 37 IS 2 BP 197 EP 201 PG 5 WC Anesthesiology SC Anesthesiology GA CQ379 UT WOS:A1990CQ37900009 ER PT J AU NIGROVIC, V SEGAL, F KLAUNIG, JE FRY, K AF NIGROVIC, V SEGAL, F KLAUNIG, JE FRY, K TI THE SITE AND MECHANISM OF THE CYTOTOXIC EFFECT OF ATRACURIUM INVITRO SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article RP NIGROVIC, V (reprint author), MED COLL OHIO,DEPT ANESTHESIOL,POB 10008,TOLEDO,OH 43699, USA. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD MAR PY 1990 VL 7 IS 2 BP 123 EP 131 PG 9 WC Anesthesiology SC Anesthesiology GA CT272 UT WOS:A1990CT27200005 ER PT J AU EADSFORTH, P HICKMOTT, KC POLLARD, BJ KAY, B AF EADSFORTH, P HICKMOTT, KC POLLARD, BJ KAY, B TI THE USE OF ATRACURIUM AND VECURONIUM TO EXTEND AN EXISTING ALCURONIUM NEUROMUSCULAR BLOCKADE SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY LA English DT Article C1 UNIV MANCHESTER,DEPT ANAESTHESIA,MANCHESTER M13 9PL,LANCS,ENGLAND. NR 0 TC 0 Z9 0 PU BLACKWELL SCIENCE LTD PI OXFORD PA OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0EL SN 0265-0215 J9 EUR J ANAESTH JI Eur. J. Anaesth. PD MAR PY 1990 VL 7 IS 2 BP 153 EP 157 PG 5 WC Anesthesiology SC Anesthesiology GA CT272 UT WOS:A1990CT27200009 ER PT J AU DEANGELIS, R LOEBS, P MAEHR, R SAVARESE, J WELCH, R AF DEANGELIS, R LOEBS, P MAEHR, R SAVARESE, J WELCH, R TI HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHIC ANALYSIS OF DOXACURIUM, A NEW LONG-ACTING NEUROMUSCULAR BLOCKER SO JOURNAL OF CHROMATOGRAPHY-BIOMEDICAL APPLICATIONS LA English DT Article C1 CORNELL UNIV,MED CTR,NEW YORK HOSP,SCH MED,DEPT ANESTHESIOL,NEW YORK,NY 10021. RP DEANGELIS, R (reprint author), BURROUGHS WELLCOME CO,DEPT MED BIOCHEM,DURHAM,NC 27713, USA. NR 18 TC 14 Z9 14 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0378-4347 J9 J CHROMATOGR-BIOMED JI J. Chromatogr.-Biomed. Appl. PD FEB 23 PY 1990 VL 525 IS 2 BP 389 EP 400 DI 10.1016/S0378-4347(00)83415-5 PG 12 WC Chemistry, Analytical SC Chemistry GA CT705 UT WOS:A1990CT70500014 ER PT J AU BELLIS, DJ DAY, S BARNES, PK AF BELLIS, DJ DAY, S BARNES, PK TI THE CHRONOTROPIC EFFECT OF ACETYLCHOLINE IN THE PRESENCE OF VECURONIUM AND ATRACURIUM - A STUDY IN THE ISOLATED PERFUSED RABBIT HEART SO ANAESTHESIA LA English DT Article RP BELLIS, DJ (reprint author), WESTMINSTER MED SCH & HOSP,MAGILL DEPT ANAESTHET,LONDON SW1P 2AP,ENGLAND. NR 10 TC 2 Z9 2 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0003-2409 J9 ANAESTHESIA JI Anaesthesia PD FEB PY 1990 VL 45 IS 2 BP 118 EP 119 DI 10.1111/j.1365-2044.1990.tb14274.x PG 2 WC Anesthesiology SC Anesthesiology GA CM467 UT WOS:A1990CM46700005 ER EF