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Masui. the Japanese Journal of... Dec 2007We report a case of accidental epidural injection of vecuronium during cholecystectomy in a 55-year-old man (63 kg, 158 cm). Following 3 ml of lidocaine 1% as an...
We report a case of accidental epidural injection of vecuronium during cholecystectomy in a 55-year-old man (63 kg, 158 cm). Following 3 ml of lidocaine 1% as an epidural test dose, inadvertent epidural (T7-8) injection of vecuronium 4.25 mg instead of ropivacaine occurred. After immediate removal of the syringe containing vecuronium, 10 ml of ropivacaine 0.375% was injected epidurally. Intubation was performed under propofol infusion using a target-controlled infusion system with intravenous vecuronium 10 mg. There was a 3 min interval between inadvertent epidural and intravenous injection of vecuronium. Anesthesia was maintained with propofol infusion (2.6-3.0 microg x ml(-1)) titrated to maintain bispectral index between 35-55 and buprenorphine 0.16 mg with 40% oxygen in air. T1 response in the train-of-four (TOF) appeared 87 min after epidural vecuronium injection. Ten minutes later, additional vecuronium 0.5mg was required due to bucking. Seven minutes after that, T1 in the TOF reappeared and the operation was finished. Twenty-three minutes after the additional vecuronium, 4 responses in the TOF were obtained. Following reversal with atropine 1.0 mg and neostigmine 2.0 mg, the patient was able to sustain head lift and handgrip, and to protrude the tongue fully awake. The patient was extubated 124 min after epidural vecuronium injection. There was no memory of back pain during epidural vecuronium injection. There was no postoperative respiratory insufficiency or neurological disorder. We suspect the duration of action of epidural vecuronium is approximately twice that of intravenous injection and becomes prolonged with higher doses and advanced age.
Topics: Amides; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Intravenous; Cholecystectomy; Humans; Injections, Epidural; Intraoperative Care; Male; Medication Errors; Middle Aged; Ropivacaine; Treatment Outcome; Vecuronium Bromide
PubMed: 18078103
DOI: No ID Found -
Paediatric Anaesthesia 2001
Review
Topics: Androstanols; Atracurium; Child; Dose-Response Relationship, Drug; Humans; Infant; Isoquinolines; Mivacurium; Muscles; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Rocuronium; Vecuronium Bromide
PubMed: 11696115
DOI: 10.1046/j.1460-9592.2001.00661.x -
Anaesthesia and Intensive Care Nov 1987
Topics: Adult; Anesthesia, General; Atracurium; Bradycardia; Female; Heart Arrest; Humans; Vecuronium Bromide
PubMed: 2892432
DOI: No ID Found -
British Journal of Anaesthesia Sep 1986The pharmacokinetics and pharmacodynamics of vecuronium were studied in nine surgical patients with cholestasis, and in 14 patients without hepatic or renal disease....
The pharmacokinetics and pharmacodynamics of vecuronium were studied in nine surgical patients with cholestasis, and in 14 patients without hepatic or renal disease. After the administration of vecuronium 0.2 mg kg-1 the plasma concentration of vecuronium and the degree of neuromuscular blockade were measured. The plasma clearance of vecuronium was decreased significantly (P less than 0.01) from 4.30 +/- 1.56 ml min-1 kg-1 (mean +/- SD) in normal patients to 2.36 +/- 0.80 ml min-1 kg-1 in patients with cholestasis. The elimination half-life was of 58 +/- 22 min in normal patients and was prolonged to 98 +/- 57 min (P less than 0.05) in patients with cholestasis. The total apparent volume of distribution was unchanged in patients with cholestasis. A prolonged neuromuscular blockade induced by vecuronium was observed in patients with cholestasis: the duration of effect from injection to 75% recovery of the twitch height was prolonged from 74 +/- 19 min in normal patients to 111 +/- 13 min in patients with cholestasis. The plasma concentration corresponding to 50% recovery from paralysis did not differ significantly between the two groups. Vecuronium has a prolonged effect in patients with cholestasis which is caused by a delay in its elimination.
Topics: Adult; Aged; Cholestasis; Female; Half-Life; Humans; Kinetics; Male; Middle Aged; Muscle Contraction; Neuromuscular Blocking Agents; Time Factors; Vecuronium Bromide
PubMed: 2875724
DOI: 10.1093/bja/58.9.983 -
Anesthesiology Jul 1990Eleven myasthenia gravis and seven control patients were studied during N2O/O2-fentanyl anesthesia to determine the ED50, ED95, and maintenance requirement of vecuronium...
Eleven myasthenia gravis and seven control patients were studied during N2O/O2-fentanyl anesthesia to determine the ED50, ED95, and maintenance requirement of vecuronium using both mechanomyography and electromyography. The ED95 of vecuronium was 17 (range 8-34) micrograms/kg in patients with myasthenia gravis, and this was significantly related to patient's acetylcholine receptor antibody titer (r = -0.75, P less than 0.01). The average ED95 value was 250% greater in control than in myasthenic patients (P less than 0.01). The hourly requirement of vecuronium to maintain an 80-90% neuromuscular blockade was 38 +/- 10 micrograms/kg in myasthenic and 120 +/- 27 micrograms/kg in control patients (P less than 0.001). When these requirements were related to individual ED95 doses, they were comparable indicating similar time durations of effect of vecuronium following an equipotent dose in myasthenic and in control patients.
Topics: Adult; Anesthesia, Inhalation; Dose-Response Relationship, Drug; Electromyography; Female; Fentanyl; Humans; Male; Middle Aged; Myasthenia Gravis; Neuromuscular Junction; Vecuronium Bromide
PubMed: 1972873
DOI: 10.1097/00000542-199007000-00005 -
British Journal of Anaesthesia Oct 1987Priming with vecuronium was evaluated in three groups of patients. Group 1 (n = 10) received tubocurarine 0.05 mg kg-1, group 2 (n = 19) received physiological saline... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Priming with vecuronium was evaluated in three groups of patients. Group 1 (n = 10) received tubocurarine 0.05 mg kg-1, group 2 (n = 19) received physiological saline and group 3 (n = 21) received vecuronium 0.012 mg kg-1. After 4 min maximum inspiratory pressure was measured. Anaesthesia was induced with thiopentone 6-8 mg kg-1 and controlled ventilation with nitrous oxide and oxygen via a face mask instituted. The ulnar nerve was stimulated at the wrist. At 5 min group 1 patients received suxamethonium 1.5 mg kg-1, group 2 received vecuronium 0.072 mg kg-1, and group 3 received vecuronium 0.060 mg kg-1. Intubation was accomplished at 6.5 min in all patients in group 1, 89% in group 2 and 90% in group 3. Patients in group 1 had no twitch response to stimulation at the time of intubation. Mean T4:T1 ratios at 6.5 min were 0.82 in group 2 and 0.61 in group 3 (P less than 0.05). Intubating conditions were excellent in all group 1 patients, and in 53% and 67% of groups 2 and 3, respectively. Two patients in group 3 did not tolerate the priming dose and many had subjective complaints. Four group 3 patients could not sustain head lift and five showed decreased inspiratory pressure. Priming did not improve intubating conditions when compared with a single bolus technique and was not well tolerated.
Topics: Adult; Drug Evaluation; Humans; Intubation, Intratracheal; Succinylcholine; Time Factors; Tubocurarine; Vecuronium Bromide
PubMed: 2890364
DOI: 10.1093/bja/59.10.1236 -
Canadian Journal of Anaesthesia =... Feb 1992This 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... (Comparative Study)
Comparative Study
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 micrograms.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.
Topics: Adult; Anesthesia Recovery Period; Anesthesia, Intravenous; Anesthesia, Obstetrical; Cesarean Section; Electromyography; Female; Humans; Intubation, Intratracheal; Ketamine; Monitoring, Intraoperative; Neuromuscular Junction; Pregnancy; Synaptic Transmission; Time Factors; Vecuronium Bromide
PubMed: 1347489
DOI: 10.1007/BF03008643 -
Canadian Journal of Anaesthesia =... Jul 2012
Topics: Anesthesia, General; Animals; Dose-Response Relationship, Drug; Female; Models, Animal; Neuromuscular Nondepolarizing Agents; Sheep; Species Specificity; Vecuronium Bromide
PubMed: 22476920
DOI: 10.1007/s12630-012-9707-7 -
Anesthesia and Analgesia Oct 1992We 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... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
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) micrograms/kg, respectively, and in the control group (n = 24), 20 (17-24) and 39 (34-37) micrograms/kg, respectively. The onset of action of an 80-micrograms/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.
Topics: Adult; Anesthesia, Intravenous; Dose-Response Relationship, Drug; Drug Interactions; Humans; Middle Aged; Propofol; Surgical Procedures, Operative; Vecuronium Bromide
PubMed: 1356319
DOI: 10.1213/00000539-199210000-00012 -
Legal Medicine (Tokyo, Japan) May 2006A simultaneous determination method of quaternary amino steroidal muscle relaxants, pancuronium (PAN), vecuronium (VEC), and 17-monodesacetyl pancuronium (17-OH-PAN),...
A simultaneous determination method of quaternary amino steroidal muscle relaxants, pancuronium (PAN), vecuronium (VEC), and 17-monodesacetyl pancuronium (17-OH-PAN), 3,17-bisdesacetyl pancuronium (3,17-OH-PAN), 3-monodesacetyl vecuronium (3-OH-VEC), 3,17-bisdesacetyl vecuronium (3,17-OH-VEC) in human serum was developed using liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). The weak cation exchange cartridge was useful for the extraction of these compounds. Under optimized LC-ESI-MS conditions, these compounds were almost fully separated within 6.5 min. Linear responses over the concentration range 0.25-50.0 ng/mL were demonstrated for each compound. The developed method successfully detected VEC, 3-OH-VEC and 3,17-OH-VEC in serum intravenously administered with VEC. The level of 3-OH-VEC was higher than other compounds. This suggested that 3-OH-VEC was useful as a forensic probe in VEC administration.
Topics: Chromatography, Liquid; Female; Forensic Medicine; Humans; Neuromuscular Nondepolarizing Agents; Pancuronium; Spectrometry, Mass, Electrospray Ionization; Vecuronium Bromide
PubMed: 16621652
DOI: 10.1016/j.legalmed.2006.02.001