-
European Review For Medical and... Apr 2017To observe the influences of atracurium besylate and vecuronium bromide on muscle relaxant effects and electromyography of patients with tracheal intubation under... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To observe the influences of atracurium besylate and vecuronium bromide on muscle relaxant effects and electromyography of patients with tracheal intubation under general anesthesia in thyroid surgery.
PATIENTS AND METHODS
120 patients treated with thyroid surgery were randomly divided into group A and group V. Patients in group A were administered with cisatracurium besylate combined with propofol and fentanyl for induction of tracheal intubation under general anesthesia. Patients in group V were administered with 0.10 mg/kg vecuronium bromide combined with propofol and fentanyl for induction of tracheal intubation under general anesthesia. Then, the amplitude in electromyography was observed 30-70 min after I.V. muscle relaxant medicine to record the time for patients to reach 0% TW convulsion in abductor pollicis muscle and to observe the muscle relaxant effects.
RESULTS
There was no statistical difference in the time to reach 0% TW in two groups (p>0.05). After 30 min of injection of muscle relaxants, EMG positive rate and TW value in group A were significantly higher than those in group V (p<0.05). After 50-70 min of injection of muscle relaxants, EMG positive rate of patients in two groups was up to 100%, and EMG amplitude in group A was significantly higher than that in group V (p<0.05). The time of taking muscle relaxant effects in group A was significantly faster than that in group V (p<0.05), while the recovery time of autonomous respiration and the time of autonomous body activity in group A were slightly lower than those in group V (p>0.05). There was no statistical difference in the time of eye-opening of both groups (p>0.05). MAP and HR of patients in both groups showed no statistical difference before and after injection (p>0.05).
CONCLUSIONS
Average EMG amplitude and the positive rate of effective EMG amplitude of cisatracurium besylate are all higher than those of vecuronium bromide. With faster effects and shorter action time, cisatracurium besylate is more suitable in thyroid surgery IONM (intraoperative neurophysiological monitoring).
Topics: Adult; Anesthesia, General; Atracurium; Electromyography; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Blocking Agents; Vecuronium Bromide
PubMed: 28485777
DOI: No ID Found -
BMC Cardiovascular Disorders Dec 2022Cardiac arrest (CA) is caused by a nonshockable rhythm with a low success rate of return of spontaneous circulation (ROSC) and a poor prognosis. This study intended to...
OBJECTIVE
Cardiac arrest (CA) is caused by a nonshockable rhythm with a low success rate of return of spontaneous circulation (ROSC) and a poor prognosis. This study intended to establish a nonshockable rhythm CA model caused by asphyxia.
MATERIALS AND METHODS
Healthy adult male Wistar rats were injected with vecuronium bromide to induce CA. After the CA duration reached the target time point, cardiopulmonary resuscitation was performed. The survival status and neurological and cardiac function were evaluated after ROSC. Brain histopathology, including hematoxylin staining, Nissl staining and Terminal dUTP nick-end labeling (TUNEL) staining, was performed to evaluate the surviving cells and apoptotic cells. Apoptosis-related proteins after ROSC for 72 h were analyzed by western blot.
RESULTS
CA was successfully induced in all animals. The time for the three groups of animals to PEA was 320 ± 22 s in the CA-8 group, 322 ± 28 s in the CA-12 group and 320 ± 18 s in the CA-15 group. The time to asystole was 436 ± 54 s in the CA-8 group, 438 ± 62 s in the CA-12 group and 433 ± 56 s in the CA-15 group. The NDS of rats in the CA group was significantly decreased after ROSC for 24 h. The NDS in the CA-15 group was 5-16 points, while it was 58-67 points and 15-43 points in the CA-8 and CA-12 groups, respectively. The cardiac function of animals in the CA group was impaired after ROSC, and the ejection fraction, fractional shortening, stroke volume and cardiac output, were all significantly decreased. Brain histopathology showed that the number of surviving neurons was decreased, and the number of apoptotic cells was increased in CA group, the longer the CA duration, the more apoptotic cells increased. The expression of the proapoptotic protein Bax and the apoptotic executive protein caspase3 in the hippocampus of CA rats was significantly increased, while the expression of the antiapoptotic protein Bcl-2 was significantly reduced.
CONCLUSIONS
The use of vecuronium can successfully induce CA caused by nonshockable rhythm in rats, which will help to further study the pathophysiological changes after CA by nonshockable rhythm.
Topics: Rats; Male; Animals; Asphyxia; Rats, Wistar; Heart Arrest; Cardiopulmonary Resuscitation; Brain
PubMed: 36581829
DOI: 10.1186/s12872-022-02996-w -
Medicinski Glasnik : Official... Feb 2020Aim To compare the quality of the conditions for endotracheal intubation and muscle relaxation between rocuronium bromide and vecuronium bromide using the ''timing... (Randomized Controlled Trial)
Randomized Controlled Trial
Aim To compare the quality of the conditions for endotracheal intubation and muscle relaxation between rocuronium bromide and vecuronium bromide using the ''timing principle'' method for induction in anaesthesia. The "timing principle" includes the administration of muscle relaxants before the hypnotic agent during induction in anaesthesia. Method Sixty patients who had undergone elective surgery were randomly allocated into two equal groups using muscle relaxants: rocuronium (group R) and vecuronium (group V). The intubation conditions were assessed using Cooper's scoring system, based on jaw relaxation, vocal cords position and response to intubation. The quality of muscle relaxation was evaluated by recording the time of clinical weakness, a count of ''train of four'' (TOF) twitches at intubation, the time of loss TOF response and duration of direct laryngoscopy. Results The intubation conditions were excellent in 100% of patients in the group R versus excellent in 80% and good in 20% of patients in the group V (p<0.05). The time of clinical weakness was statistically significantly shorter in the group R than in the group V (p<0.000). The time of loss of TOF response was statistically significantly shorter in the group R (p<0.000). The absence of TOF twitches (the level of muscle relaxation of 100%) at intubation recorded in 25 (83.3%) patients in the group R versus five (16.7%) patients in the group V (p<0.000). Duration of direct laryngoscopy did not significantly differ between the groups. Conclusion Rocuronium bromide provides better intubation conditions and greater quality of muscle relaxation than vecuronium bromide using ''timing principle'' technique.
Topics: Androstanols; Humans; Intubation, Intratracheal; Muscle Relaxation; Neuromuscular Nondepolarizing Agents; Rocuronium; Time Factors; Vecuronium Bromide
PubMed: 31402637
DOI: 10.17392/1045-20 -
Drugs & Aging Oct 2022Residual neuromuscular paralysis, the presence of clinically significant weakness after administration of pharmacologic neuromuscular blockade reversal, is associated...
Residual neuromuscular paralysis, the presence of clinically significant weakness after administration of pharmacologic neuromuscular blockade reversal, is associated with postoperative pulmonary complications and is more common in older patients. In contemporary anesthesia practice, reversal of neuromuscular blockade is accomplished with neostigmine or sugammadex. Neostigmine, an acetylcholinesterase inhibitor, increases the concentration of acetylcholine at the neuromuscular junction, providing competitive antagonism of neuromuscular blocking drug and facilitating muscle contraction. Sugammadex, a modified gamma-cyclodextrin, antagonizes neuromuscular blockade by encapsulating rocuronium and vecuronium in a one-to-one ratio for renal clearance, a pharmacokinetic property that led to the recommendation that sugammadex not be administered to those with end-stage renal disease. While data are limited, reports suggest sugammadex is efficacious and well tolerated in individuals with reduced renal function. Sugammadex provides a more rapid and complete reversal of neuromuscular blockade than neostigmine. There is also accumulating evidence that sugammadex may provide a protective effect against the development of postoperative pulmonary complications, nausea, and vomiting, and that it may have beneficial effects on the rate of bowel and bladder recovery after surgery. Accordingly, sugammadex administration is beneficial for most older patients undergoing surgery.
Topics: Acetylcholine; Acetylcholinesterase; Aged; Cholinesterase Inhibitors; Humans; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Postoperative Complications; Rocuronium; Sugammadex; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 35934764
DOI: 10.1007/s40266-022-00969-4 -
European Journal of Anaesthesiology Oct 2020Drug errors during neuraxial anaesthesia or analgesia are not well known. (Review)
Review
BACKGROUND
Drug errors during neuraxial anaesthesia or analgesia are not well known.
OBJECTIVES
To review the clinical consequences associated with incorrect administration of neuromuscular blocking drugs (NMBDs) during spinal or epidural anaesthesia, and to investigate human factors and strategies available to help prevent such errors.
DESIGN
A review of reports of neuraxial administration of NMBDs in humans.
DATA SOURCES
Published reports of errors involving NMBDs. We searched the period between 1965 and 2019.
ELIGIBILITY CRITERIA
Error reports in any language. Nonneuraxial drug errors were excluded.
RESULTS
We identified 20 reports involving seven different NMBDs inadvertently administered via the epidural or intrathecal routes. All patients developed systemic neuromuscular junction blockade. Fourteen errors occurred while patients were awake. The onset of action was delayed following epidural rocuronium and suxamethonium. The duration of action was prolonged following epidural administration of vecuronium, pancuronium, cisatracrium and suxamethonium. Five patients required emergency airway interventions. Intrethecal gallamine caused convulsions and muscle spasms migrating up the body. Syringe swap was the primary cause for the majority of errors and perceptual errors were the most common. Implementation of recommendations could have prevented the errors.
CONCLUSION
Following the epidural injection of NMBDs the effects are delayed and prolonged. There was no serious morbidity reported following neuraxial administration of the NMBDs used in current practice. Perceptual errors resulting in incorrect syringe choice were the commonest cause. Four measures can be introduced to reduce such errors.
Topics: Humans; Neuromuscular Blockade; Pharmaceutical Preparations; Rocuronium; Succinylcholine; Vecuronium Bromide
PubMed: 32371827
DOI: 10.1097/EJA.0000000000001232 -
Drug Design, Development and Therapy 2021High intra-abdominal pressure induced by artificial pneumoperitoneum can obviously impair respiratory and circulatory functions and has a negative effect on the... (Review)
Review
High intra-abdominal pressure induced by artificial pneumoperitoneum can obviously impair respiratory and circulatory functions and has a negative effect on the prognosis of patients undergoing conventional and robot-assisted laparoscopic surgery. The application of deep neuromuscular blockade during the operation is reported to lower the intra-abdominal pressure and improve patients' outcome. However, concern lies in the risks of postoperative residual muscular paralysis with the use of deep neuromuscular blockade. Sugammadex, a specific antagonist for aminosteroids muscle relaxants, can effectively and rapidly reverse rocuronium and vecuronium induced neuromuscular blockade of different depths. Thus, sugammadex allows the ability to safeguard the application of deep neuromuscular blockade in laparoscopic operations and helps to alleviate the adverse complications associated with pneumoperitoneum. Here, we review the application of deep neuromuscular blockade in different laparoscopic surgeries and discuss the benefits and possible risks of sugammadex administration in the reversal of deep neuromuscular blockade in these operations.
Topics: Humans; Laparoscopy; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Robotic Surgical Procedures; Rocuronium; Sugammadex; Vecuronium Bromide
PubMed: 34548781
DOI: 10.2147/DDDT.S328682 -
American Journal of Health-system... Jan 2023There is a lack of information on the compatibility of remimazolam with opioid analgesics, muscle relaxants, and other sedatives. This study aimed to evaluate the...
PURPOSE
There is a lack of information on the compatibility of remimazolam with opioid analgesics, muscle relaxants, and other sedatives. This study aimed to evaluate the physical compatibility of remimazolam with these drug classes.
METHODS
Remimazolam was combined with 1 or 2 target drugs (remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam). Ten physical compatibility tests were conducted, including four 3-drug compatibility tests. Remimazolam was dissolved in 0.9% sodium chloride injection to a final concentration of 5 mg/mL. Other medications were diluted in 0.9% sodium chloride injection to obtain clinically relevant concentrations. Compatibility tests were conducted with 3 test solutions, wherein remimazolam and the target drugs were compounded at equal volume ratios (1:1 or 1:1:1). Visual appearance was assessed and testing of Tyndall effect, turbidity, and pH was performed immediately after mixing and then again 1 hour and 4 hours after mixing. Appearance and turbidity were evaluated by comparison with the control solution of each target drug diluted with 0.9% sodium chloride injection to the same concentration as the test solution.
RESULTS
All drugs tested were determined to be compatible with remimazolam. The drug combination with the highest change of turbidity was remimazolam and vecuronium (a mean increase of 0.16 NTU relative to the remimazolam control solution), 4 hours after mixing. The combination with the highest pH was remimazolam, fentanyl, and vecuronium (mean [SD], 3.76 [0.01]), 4 hours after mixing. The combination of remimazolam and fentanyl showed a larger change in pH at 4 hours after mixing (a mean increase of 2.6%) than immediately after mixing.
CONCLUSION
Remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam are physically compatible with remimazolam during simulated Y-site administration.
Topics: Humans; Analgesics, Opioid; Drug Incompatibility; Remifentanil; Sodium Chloride; Anti-Bacterial Agents; Infusions, Intravenous; Hypnotics and Sedatives; Midazolam; Vecuronium Bromide; Rocuronium; Dexmedetomidine; Fentanyl; Muscles
PubMed: 36094564
DOI: 10.1093/ajhp/zxac262 -
European Journal of Pharmaceutical... Jan 2020Neuromuscular blockers (NMBs) selectively block neuromuscular transmission at the N2-nicotinic receptor on motor neurons to paralyze skeletal muscles, and are mainly... (Randomized Controlled Trial)
Randomized Controlled Trial
Neuromuscular blockers (NMBs) selectively block neuromuscular transmission at the N2-nicotinic receptor on motor neurons to paralyze skeletal muscles, and are mainly used to facilitate tracheal intubation and surgical procedures. Rapid reversal is necessary in clinical practice to avoid profound block and reduce recovery time. Adamgammadex sodium is a modified γ-cyclodextrin derivative consisting of a lipophilic core and a hydrophilic outer end that forms an inactive tight inclusion complex with free molecules of rocuronium and vecuronium. In preclinical study, adamgammadex produced a concentration-dependent reversion effect of neuromuscular blockade induced by rocuronium in beagle dogs. Furthermore, adamgammadex had a less potential side effects than sugammadex and other clinical used neuromuscular block antagonists. In this study, the objective was to assess the safety, tolerability, and pharmacokinetics of single intravenous injection of adamgammadex in healthy volunteers. Approved by the China Food and Drug Administration, 52 healthy volunteers (half male and half female) were enrolled in this single-center, randomized, double-blind placebo-controlled study. No serious adverse effects were happened in this study. The overall frequency of adverse effects in adamgammadex was similar for that in placebo, and there was no specific adverse effect in adamgammadex. All of the volunteers bearing the adverse effects were recovered to normal without any treatment or intervention. In pharmacokinetic study, the value of half-time, T, and clearance were not changed significantly, and the C and AUC increased with a similar ratio of the escalating doses. For dose proportionality analysis of adamgammadex, the estimate of slope was close to 1, and it was not significantly different from 1 after doses (AUC, 0.9965 [90%CI, 0.9468, 1.046]; C, 0.9462 [90%CI, 0.8800, 1.012]). Therefore, adamgammadex exposure in plasma increased in a dose- proportional manner. The urinary route is a significant excretory pathway for adamgammadex, and it is mostly completed at 8 h. All the results in this study showed that adamgammadex may be a novel safe neuromuscular blockade reversal agent .
Topics: Adult; Double-Blind Method; Female; Healthy Volunteers; Humans; Male; Neuromuscular Blockade; Rocuronium; Vecuronium Bromide; Young Adult; gamma-Cyclodextrins
PubMed: 31678425
DOI: 10.1016/j.ejps.2019.105134 -
International Journal of General... 2023The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2%...
The Effects of Prophylactic Intravenous Lignocaine vs Vecuronium on Succinylcholine-Induced Fasciculation and Postoperative Myalgia in Patients Undergoing Elective Surgery at Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2022: Prospective Cohort Study.
BACKGROUND
The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery.
METHODS
A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample -test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant.
RESULTS
This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride.
CONCLUSION
Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation.
PubMed: 37388716
DOI: 10.2147/IJGM.S415854 -
Medicine Nov 2022Sevoflurane and desflurane are commonly used inhalation anesthetics in clinical practice. This study compared the synergistic effects of sevoflurane and desflurane on... (Randomized Controlled Trial)
Randomized Controlled Trial
Sevoflurane and desflurane are commonly used inhalation anesthetics in clinical practice. This study compared the synergistic effects of sevoflurane and desflurane on the muscarinic agent vecuronium in laparoscopic colon cancer surgery. The aim of this study was to compare sevoflurane and desflurane in a synergistic effect on the muscle relaxant vecuronium in laparoscopic colon cancer surgery. Sixty patients undergoing elective laparoscopic radical resection of colon cancer were randomly divided into sevoflurane (n = 30) and desflurane (n = 30) groups. After anesthesia and successful tracheal intubation, patients in both groups were maintained with combined remifentanil. Muscle relaxant effects were monitored in both groups using a muscle relaxant monitor (train of stimuli-Watch), the onset time, T1 and T2 recovery time, and muscle relaxant dosage of vecuronium were observed. Hemodynamic changes were observed in both groups, and the dosage of vasoactive drugs was recorded. The quality of recovery of the patients was evaluated using the Mini-Mental State Examination (MMSE) and the discharge from the Aldrete score criteria. There was no significant difference in the onset time of vecuronium between the two groups (P > .05). The desflurane group's T1 and T2 recovery times were later than that of the sevoflurane group. The dosage of vecuronium was statistically significantly less than that in the sevoflurane group (P < .05); the extubation time in the desflurane group was statistically significantly longer than that in the sevoflurane group (P < .05). There were no significant differences in preoperative and intraoperative mean arterial pressure, heart rate, ephedrine and atropine dosage, MMSE score, and Aldrete score between the 2 groups (P > .05). Compared with sevoflurane, desflurane has a stronger synergistic effect on the muscle relaxant of vecuronium without increasing the incidence of cardiovascular adverse reactions and affecting patient recovery.
Topics: Humans; Sevoflurane; Desflurane; Vecuronium Bromide; Isoflurane; Methyl Ethers; Anesthesia Recovery Period; Laparoscopy; Colonic Neoplasms; Muscles
PubMed: 36397349
DOI: 10.1097/MD.0000000000031569