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Anaesthesia Oct 1990
Topics: Aged; Aged, 80 and over; Female; Histamine Release; Humans; Hypotension; Infections; Intraoperative Complications; Vecuronium Bromide
PubMed: 1700641
DOI: 10.1111/j.1365-2044.1990.tb14594.x -
Anesthesiology May 2001
Topics: Bronchial Spasm; Humans; Neuromuscular Nondepolarizing Agents; Vecuronium Bromide
PubMed: 11388519
DOI: 10.1097/00000542-200105000-00006 -
British Journal of Anaesthesia Feb 2014Burn patients develop resistance to non-depolarizing neuromuscular blocking agents (NDNMBAs) and require a significantly large dose to produce a desired clinical...
BACKGROUND
Burn patients develop resistance to non-depolarizing neuromuscular blocking agents (NDNMBAs) and require a significantly large dose to produce a desired clinical response. Pathophysiological changes related to burn injury may alter pharmacokinetics (PK) and pharmacodynamics of NDNMBAs. The purpose of this study was to compare vecuronium PK in burns vs non-burns.
METHODS
Twenty adults, aged 23-58 yr, with 27-81% total body surface area (TBSA) burn, were studied at 4-57 post-burn days and compared with age- and sex-matched, non-burn controls. Vecuronium 0.12 mg kg(-1) was given i.v. as a single bolus within 10 s. Blood samples (n=20) were collected over 12 h at predetermined time points. NONMEM was used to describe plasma drug concentration-time profiles for burns and non-burns.
RESULTS
A three-compartment model best described vecuronium concentration-time profiles. Burn patients showed enhanced distributional clearance at the terminal phase (0.12 vs 0.095 litre min(-1), P<0.0001), which yielded shorter elimination half-life for vecuronium (5.5 vs 6.6 h, P<0.001). BURN was the single most significant covariate that explained the altered vecuronium disposition in burns.
CONCLUSIONS
The altered drug distribution between tissues may partially explain the known resistance to vecuronium in patients with major burns.
Topics: Adult; Burns; Female; Humans; Male; Middle Aged; Neuromuscular Blocking Agents; Vecuronium Bromide; Young Adult
PubMed: 24067332
DOI: 10.1093/bja/aet309 -
Anaesthesia Dec 1993A 19-year-old epileptic patient taking carbamazepine was anaesthetised for a sigmoid colectomy. Such patients are reported to show a resistance to the actions of...
A 19-year-old epileptic patient taking carbamazepine was anaesthetised for a sigmoid colectomy. Such patients are reported to show a resistance to the actions of competitive neuromuscular blocking drugs, and a conventional dose of vecuronium (0.1 mg.kg-1) produced relaxation for only 18 min. Subsequently she received vecuronium 6.7 mg.h-1 which kept the first twitch of the train-of-four response at 30% of the control value. Antagonism with neostigmine 1.25 mg produced a rapid and full recovery. The report illustrates the usefulness of monitoring neuromuscular transmission whenever there is an anticipation of an altered response.
Topics: Adult; Carbamazepine; Drug Resistance; Electroencephalography; Epilepsy; Female; Humans; Neostigmine; Vecuronium Bromide
PubMed: 7904430
DOI: 10.1111/j.1365-2044.1993.tb07529.x -
British Journal of Anaesthesia Sep 1986The plasma and bile concentrations, the biliary excretion and the neuromuscular blocking effect of vecuronium bromide were studied during surgery in 13 patients who had...
The plasma and bile concentrations, the biliary excretion and the neuromuscular blocking effect of vecuronium bromide were studied during surgery in 13 patients who had received 150 micrograms kg-1 i.v. The amount of vecuronium in liver biopsies taken after i.v injection was measured in a separate group of six patients. Vecuronium appeared early in the bile, in concentrations that were 30-50 times greater than those in the plasma. On the basis of the measured amount of vecuronium excreted in the bile, together with the accepted average daily bile flow, it was estimated that more than 40% of vecuronium was excreted in the bile in 24 h. Liver biopsies indicated that the liver may contain more than 50% of the i.v. dose 30 min after injection. The large distribution of vecuronium into the liver may account for the initial rapid decline in vecuronium plasma concentration and its relatively short duration of action. In this study, neuromuscular blockade was prolonged, possibly as a result of interference, by surgical manipulation, with the rapid hepatic uptake of vecuronium.
Topics: Adult; Aged; Bile; Cholelithiasis; Female; Humans; Liver; Male; Middle Aged; Muscle Contraction; Neuromuscular Blocking Agents; Time Factors; Vecuronium Bromide
PubMed: 2875725
DOI: 10.1093/bja/58.9.988 -
Journal of the Indian Medical... Jun 1991The drug vecuronium bromide, a short acting, non-depolarising agent with little side-effects, has brought much promise in the field of muscle relaxants. Fifth healthy...
The drug vecuronium bromide, a short acting, non-depolarising agent with little side-effects, has brought much promise in the field of muscle relaxants. Fifth healthy patients were induced with injection thiopentone sodium 4 mg/kg and vecuronium bromide, 0.1 mg/kg was given IV. The earliest time at which the largest percentage of patients could be intubated satisfactorily was noted. The intubating conditions were estimated by scoring method. The duration of clinical relaxation was decided from the time of IV injection of vecuronium bromide to the return of muscle power of the non-respiratory muscles requiring repeat dose of the drug. The ideal intubating condition was achieved at 120 seconds and the duration of clinical relaxation ranged from 11-15 minutes.
Topics: Adult; Humans; Injections, Intravenous; Intubation, Intratracheal; Premedication; Time Factors; Vecuronium Bromide
PubMed: 1684201
DOI: No ID Found -
Anaesthesia Nov 1990
Topics: Drug Overdose; Hemodynamics; Humans; Infant; Medication Errors; Vecuronium Bromide
PubMed: 1979208
DOI: 10.1111/j.1365-2044.1990.tb14667.x -
Journal of Neurosurgical Anesthesiology Apr 2008
Topics: Adult; Drug Incompatibility; Female; Humans; Infusions, Intravenous; Laminectomy; Methylprednisolone Hemisuccinate; Neuromuscular Nondepolarizing Agents; Neuroprotective Agents; Particulate Matter; Vecuronium Bromide
PubMed: 18362782
DOI: 10.1097/ANA.0b013e3181616c3a -
Canadian Journal of Anaesthesia =... Oct 1994
Topics: Administration, Oral; Adult; Cyclosporine; Drug Interactions; Drug Synergism; Humans; Male; Muscle Contraction; Neuromuscular Junction; Time Factors; Vecuronium Bromide
PubMed: 8001203
DOI: 10.1007/BF03010951 -
Clinical Pharmacokinetics 2002Rapacuronium is an aminosteroidal nondepolarising neuromuscular blocking agent (NMBA). Its neuromuscular blocking effects have a different time course to those of most... (Review)
Review
Rapacuronium is an aminosteroidal nondepolarising neuromuscular blocking agent (NMBA). Its neuromuscular blocking effects have a different time course to those of most currently available agents. It also has lower potency than many of the other NMBAs. In doses consistent with short to medium duration of action, rapacuronium has rapid and complete onset. In some doses it gives tracheal intubating conditions that compare favourably with those produced by suxamethonium (succinylcholine) during rapid sequence induction of anaesthesia. Tracheal intubating conditions improve as dose increases, but adverse effects (including potentially severe bronchospasm) become more prominent. Rapacuronium has an active metabolite that is at least as potent as the parent compound and is eliminated much less efficiently. Consequently, the time course of action of rapacuronium is prolonged after multiple doses or an infusion. Its potency is similar across age ranges and its time course after single doses is little altered in patients with hepatic or renal insufficiency. At least in part because of its active metabolite, rapacuronium is highly cumulative in renal failure. In keeping with its rapid onset and short to medium duration of action, rapacuronium has a more rapid clearance than most other NMBAs. Values for clearance are in the range 0.26-0.67 L/h/kg, with most studies giving a value of approximately 0.45 L/h/kg. There is some evidence that clearance declines marginally with advanced age, and it is also reduced in children. A typical value for steady-state volume of distribution is 0.3 L/kg. This is similar to that of many other NMBAs, but is small compared with many other drugs, as expected with a highly polar compound. Pharmacokinetic parameters do not appear to differ markedly in hepatic insufficiency, but clearance is reduced by approximately 30% in renal failure. Rapacuronium equilibrates very rapidly between the plasma and the site of effect. This is the principal explanation behind its unusually rapid onset. It also appears to have a similar potency at the larynx compared with the adductor pollicis; most other NMBAs are less effective at the larynx. Because it gives rapid onset in a dose consistent with brief duration of action, it was hoped that rapacuronium might be a suitable alternative to suxamethonium. It does not have the problems associated with suxamethonium, but its use is associated with bronchospasm, the incidence of which is dose-related. Rapacuronium has been withdrawn from sale because of this adverse effect, and its future availability is uncertain.
Topics: Age Factors; Anesthesia Recovery Period; Child; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Intubation, Intratracheal; Kidney Failure, Chronic; Liver Cirrhosis; Neuromuscular Nondepolarizing Agents; Vecuronium Bromide
PubMed: 12403643
DOI: 10.2165/00003088-200241130-00004