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Veterinary Anaesthesia and Analgesia Sep 2012To compare the duration of action of vecuronium in diabetic dogs with a control group. (Clinical Trial)
Clinical Trial
OBJECTIVE
To compare the duration of action of vecuronium in diabetic dogs with a control group.
STUDY DESIGN
Prospective clinical study.
ANIMALS
Forty client-owned diabetic (n = 20) and non-diabetic dogs.
METHODS
Dogs were considered free from other concurrent disease based on clinical examination and laboratory data. After pre-anaesthetic medication with acepromazine and methadone, anaesthesia was induced with intravenous (IV) propofol and maintained with isoflurane-nitrous oxide in oxygen. Neuromuscular blockade (NMB) was achieved with vecuronium, 0.1 mg kg(-1) IV and its effects recorded by palpation (pelvic limb digital extension) and electromyography (m. tibialis cranialis) of responses (twitches; T) to repeated train-of-four (TOF) nerve stimulation. Time to onset of NMB was the period between vecuronium injection and loss of fourth twitch (T4) in the TOF pattern recorded by EMG and palpation. Duration of NMB was defined as the time from drug administration to return of T1 by palpation (T1(tactile) ) and EMG (T1(EMG) ). Times to return of T2-4 were also recorded. Time from induction of anaesthesia to vecuronium injection was recorded. Heart rate, non-invasive mean arterial pressure, body temperature, end-tidal isoflurane and end-tidal CO(2) concentrations were recorded at onset of NMB and when T1(EMG) returned. Loss and return of palpable and EMG responses for diabetic and non-diabetic dogs were compared using t-tests and Mann Whitney U-tests.
RESULTS
There were significant (p < 0.05) differences between diabetic and non-diabetic dogs for the return of all four palpable and EMG responses. Times (mean ± SD) for return of T1(tactile) were 13.2 ± 3.5 and 16.9 ± 4.2 minutes in diabetic and non-diabetic dogs respectively. There were no differences between diabetic and non-diabetic dogs in the time to onset of vecuronium with EMG or tactile monitoring.
CONCLUSIONS AND CLINICAL RELEVANCE
The duration of action of vecuronium was shorter in diabetic dogs as indicated by both tactile and EMG monitoring.
Topics: Animals; Diabetes Mellitus; Dog Diseases; Dogs; Female; Male; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Vecuronium Bromide
PubMed: 22642320
DOI: 10.1111/j.1467-2995.2012.00714.x -
British Journal of Anaesthesia Mar 2000We have investigated residual block after anaesthesia which included the use of the neuromuscular blocking agent vecuronium but no anticholinesterase, in 568 consecutive...
We have investigated residual block after anaesthesia which included the use of the neuromuscular blocking agent vecuronium but no anticholinesterase, in 568 consecutive patients on admission to the recovery room. The ulnar nerve was stimulated submaximally using TOF stimulation (30 mA). Postoperative residual curarization was defined as a TOF ratio < 0.7. Of the 568 patients, 239 (42%) had a TOF < 0.7 in the recovery room. These patients had received a larger cumulative dose of vecuronium than patients who had full recovery (mean 7.7 (SD 3.6) mg vs 6.2 (2.7) mg; P < 0.05) and a shorter time had elapsed since the last vecuronium dose (117 (70) min vs 131 (80) min; P < 0.05). Of 435 patients whose trachea was extubated, 145 (33%) exhibited inadequate recovery from neuromuscular block. Six of these had one or no response to TOF stimulation and were reintubated. In the remaining 139 patients, neuromuscular block was successfully antagonized. Only 20 patients (3.5%) remembered TOF stimulation when questioned 2 h later in the recovery room, and discomfort associated with it was assessed using a visual analogue scale before discharge. We conclude that it is necessary to antagonize residual block produced by vecuronium.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia Recovery Period; Anesthesia, General; Electric Stimulation; Female; Humans; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Prospective Studies; Vecuronium Bromide
PubMed: 10793602
DOI: 10.1093/oxfordjournals.bja.a013445 -
Anesthesiology Jul 1987To evaluate the effect of aging on the distribution, metabolism, and neuromuscular junction sensitivity to pancuronium and vecuronium, the authors determined the...
To evaluate the effect of aging on the distribution, metabolism, and neuromuscular junction sensitivity to pancuronium and vecuronium, the authors determined the pharmacokinetics and pharmacodynamics of these drugs in 12 healthy elderly subjects (70-84 yr) and 12 young adults (30-57 yr) during halothane-nitrous oxide anesthesia. Plasma concentrations of the muscle relaxants were determined using a selective ion-monitoring mass spectrometric technique specific for the parent compound. For vecuronium, plasma clearance (3.7 +/- 1.0 and 5.2 +/- 0.8 ml X kg-1 X min-1, respectively), and volume of distribution at steady-state (179 +/- 31 and 244 +/- 38 ml X kg-1, respectively) were lower in the elderly than in young adults; values for distribution half-lives, elimination half-life, and sensitivity of the neuromuscular junction were similar for the two groups. For pancuronium, there were no statistically significant differences between groups for these pharmacokinetic or pharmacodynamic parameters. However, there was a trend toward reduced clearance (20%) and prolonged elimination half-life (16%) in the elderly as compared to the younger patients. The authors conclude that healthy elective surgical patients between the ages of 70 and 84 yr of age do not differ markedly from younger adults in their pharmacokinetic/pharmacodynamic response to vecuronium and pancuronium.
Topics: Adult; Aged; Aged, 80 and over; Aging; Half-Life; Humans; Middle Aged; Muscles; Neuromuscular Junction; Osmolar Concentration; Pancuronium; Vecuronium Bromide
PubMed: 2886080
DOI: 10.1097/00000542-198707000-00008 -
Canadian Journal of Anaesthesia =... Mar 2016
Topics: Androstanols; Female; Humans; Male; Neuromuscular Blockade; Neuromuscular Monitoring; Vecuronium Bromide
PubMed: 26668081
DOI: 10.1007/s12630-015-0535-4 -
Anaesthesia Sep 1991
Topics: Accidents, Occupational; Eye; Humans; Male; Paralysis; Vecuronium Bromide
PubMed: 1681759
DOI: 10.1111/j.1365-2044.1991.tb09807.x -
Acta Anaesthesiologica Scandinavica Nov 1988Our knowledge of the possible cumulative properties of vecuronium is limited. Previous studies have shown a tendency towards an increased duration of effect, a slightly...
Our knowledge of the possible cumulative properties of vecuronium is limited. Previous studies have shown a tendency towards an increased duration of effect, a slightly prolonged recovery time, as well as an increased variation in duration of effect. We have studied 15 patients scheduled for middle-ear surgery. During i.v. N2O-O2 anaesthesia the twitch response of the adductor pollicis muscle was recorded after supramaximal stimulation of the ulnar nerve at the wrist. Prior to tracheal intubation a bolus dose of vecuronium was given (0.08 mg/kg body weight). During surgery supplementary doses of 0.02 mg/kg body weight were given at a train-of-four (TOF) ratio of 0.25. The duration of effect (DUR-IT-25) and recovery time from a TOF ratio of 0.10 to 0.25 (Recovery-IT-10-25) were recorded. When comparing 10 iteration doses, the mean DUR-IT-25 in the 15 patients studied showed only minor variations (n.s.). Each patient had a near constant interval between the iteration doses; however, a noteworthy variation between individuals was found. Recovery-IT-10-25 was 250 +/- 80 (mean +/- s.d.) 240 +/- 80 and 260 +/- 80 s comparing the second, sixth and tenth iteration doses, respectively. In conclusion, the duration of effect varied considerably between patients. Each patient showed, however, a near constant iteration interval and a recovery time with only small variations. This indicates that cumulation is unlikely to exist following repetitive administration of vecuronium of 0.02 mg/kg body weight.
Topics: Adolescent; Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Female; Humans; Male; Middle Aged; Surgical Procedures, Operative; Time Factors; Vecuronium Bromide
PubMed: 2905565
DOI: 10.1111/j.1399-6576.1988.tb02798.x -
British Journal of Anaesthesia May 1992
Topics: Dexamethasone; Drug Resistance; Humans; Muscles; Receptors, Cholinergic; Vecuronium Bromide
PubMed: 1353681
DOI: 10.1093/bja/68.5.540 -
Anaesthesia Apr 1988
Topics: Humans; Injections, Intravenous; Pain; Vecuronium Bromide
PubMed: 2897807
DOI: 10.1111/j.1365-2044.1988.tb08999.x -
Masui. the Japanese Journal of... Oct 2013It is known that blood concentration of rocuronium increases after administration of sugammadex, but this is not clear in the case of vecuronium. We report a pediatric...
It is known that blood concentration of rocuronium increases after administration of sugammadex, but this is not clear in the case of vecuronium. We report a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. A 19-month-old girl weighing 7.8 kg had a history of aortic valvuloplasty at 4 months of age due to truncus arteriosus. She presented again to our hospital due to aortic regurgitation. She underwent aortic valvuloplasty and then aortic valve replacement. The postoperative course was complicated with severe heart failure and acute kidney injury requiring peritoneal dialysis. For that reason she required long-term sedation including administration of a large amount of muscle relaxant due to severe low cardiac output syndrome after aortic valvuloplasty. A total of 615 mg (79 mg x kg(-1)) of vecuronium was administered over a period of 24 days. On weaning from mechanical ventilation, 125 mg (16 mg x kg(-1)) of sugammadex was given. Vecuronium concentration measured by high-performance liquid chromatography (HPLC) was 5.03 ng x ml(-1) before sugammadex administration and increase to 13.98 ng x ml(-1) after that. However, blood concentration of metabolic products of vecuronium did not exceed the lower limits of measurement in each sample. She was successfully weaned from mechanical ventilation without recurarizarion. Serum concentration of vecuronium increased after administration of sugammadex because extravascular vecuronium was redistributed to intravascular space according to the concentration gradient induced by binding and clathration of vecuronium. The measured values of vecuronium after sugammadex administration on HPLC represented the total amount of free vecuronium and vecuronium combined with sugammadex. Recurarization might occur after sugammadex reversal in patients after long-term administration of vecuronium, especially if relatively smaller doses of sugammadex were given. We experienced a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. There is a risk of recurarization after sugammadex reversal in patients after long-term administration of vecuronium.
Topics: Aortic Valve; Female; Humans; Infant; Neuromuscular Nondepolarizing Agents; Postoperative Period; Sugammadex; Truncus Arteriosus; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 24228462
DOI: No ID Found -
European Journal of Anaesthesiology Apr 20113-Desacetyl-vecuronium is an active metabolite of the neuromuscular blocking agent (NMBA) vecuronium, which might lead to residual paralysis after prolonged...
BACKGROUND AND OBJECTIVE
3-Desacetyl-vecuronium is an active metabolite of the neuromuscular blocking agent (NMBA) vecuronium, which might lead to residual paralysis after prolonged administration of vecuronium in critically ill patients with renal failure. This study investigated the ability of sugammadex to reverse 3-desacetyl-vecuronium-induced neuromuscular block (NMB) in the anaesthetised rhesus monkey.
METHODS
Experiments were performed in anaesthetised female rhesus monkeys. After bolus intravenous injection of vecuronium (n = 8) or 3-desacetyl-vecuronium (n = 8) 10 μg kg(-1) (ED90), a continuous infusion of the same NMBA was started to maintain the first twitch of the train-of-four (TOF) at 10% of baseline value. The infusion was stopped and NMB recovered spontaneously. The procedure was repeated, but immediately after stopping the infusion, an intravenous bolus dose of sugammadex 0.5 or 1.0 mg kg(-1) was given. For each NMBA, four placebo experiments were performed, in which the second recovery from NMB was also spontaneous. For all experiments, time to recovery of the TOF ratio to 90% was retrieved.
RESULTS
After administration of sugammadex for reversal of 3-desacetyl-vecuronium-induced NMB, recovery was significantly faster than spontaneous recovery. Mean time to recovery of TOF to 90% was 3.2 min (sugammadex 0.5 mg kg(-1)) and 2.6 min (1.0 mg kg(-1)), compared to spontaneous recovery (17.6 min). For vecuronium-induced NMB, mean time to recovery of TOF to 90% was 17.1 min (0.5 mg kg(-1)) and 4.6 min (1.0 mg kg(-1)), compared to spontaneous recovery (23.4 min).
CONCLUSION
Sugammadex rapidly and effectively reversed 3-desacetyl-vecuronium-induced NMB in the rhesus monkey, at a lower dose than that needed to reverse vecuronium-induced NMB.
Topics: Action Potentials; Animals; Electric Stimulation; Female; Infusions, Intravenous; Injections, Intravenous; Macaca mulatta; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Recovery of Function; Sugammadex; Time Factors; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 21157358
DOI: 10.1097/EJA.0b013e328340894f