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Se Pu = Chinese Journal of... Jul 2021Vecuronium, rocuronium, and pancuronium are widely used as non-depolarizing muscle relaxants. There have been occasional cases of allergic reactions and even death when...
Vecuronium, rocuronium, and pancuronium are widely used as non-depolarizing muscle relaxants. There have been occasional cases of allergic reactions and even death when using such muscle relaxants. Rapid determination of the concentration of these muscle relaxants in blood can provide valuable information for early clinical diagnosis. As quaternary ammonium compounds, these muscle relaxants are highly polar. Hence, they cannot be retained effectively on reversed-phase chromatographic columns with conventional mobile phases. These quaternary ammonium muscle relaxants are mainly separated by ion-pair chromatography. Using an ion-pairing reagent can help improve the retention capabilities of quaternary ammonium muscle relaxants. Nevertheless, the sensitivity of MS detection is significantly decreased because of ionic inhibition caused by the ion-pairing reagent in the mobile phase. Furthermore, ion-pairing reagents can pollute the MS system. A method based on high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was established for the simultaneous determination of the three quaternary ammonium muscle relaxants in blood. The blood samples were diluted and subjected to high-speed centrifugation. The supernatant was purified on a Bond Elut AL-N solid phase extraction column and then filtered through a 0.45 μm microporous membrane. The quaternary ammonium muscle relaxants were separated on a ZIC-cHILIC analytical column (50 mm×2.1 mm, 3.0 μm) with gradient elution. Acetonitrile and 0.1% formic acid aqueous solution were used as mobile phases. The separated compounds were analyzed by tandem MS with an electrospray ionization (ESI) source in positive and multiple reaction monitoring (MRM) modes. The matrix effects of vecuronium, rocuronium, and pancuronium in blood were 88.1% to 95.4%. The calibration curves for vecuronium, rocuronium, and pancuronium showed good linear relationships in each range, and all correlation coefficients () were > 0.996. The limits of detection of vecuronium, rocuronium, and pancuronium were 0.2-0.8 ng/mL, with the corresponding limits of quantification being 0.5-2.0 ng/mL. The recoveries of vecuronium, rocuronium, and pancuronium were 92.8% to 110.6%, with relative standard deviations (RSDs) of 3.2%-9.4%. This method is sensitive, accurate, and easy to operate, and it can be used to rapidly determine vecuronium, rocuronium, and pancuronium in blood.
Topics: Ammonium Compounds; Chromatography, High Pressure Liquid; Humans; Neuromuscular Agents; Pancuronium; Rocuronium; Solid Phase Extraction; Tandem Mass Spectrometry; Vecuronium Bromide
PubMed: 34227366
DOI: 10.3724/SP.J.1123.2020.09020 -
Neurology India Mar 2000A prospective, randomised, single blind study was conducted to evaluate and compare the intracranial pressure (ICP) and cardiovascular effects of pipecuronium (PPC) and... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
A prospective, randomised, single blind study was conducted to evaluate and compare the intracranial pressure (ICP) and cardiovascular effects of pipecuronium (PPC) and pancuronium (PNC) in 20 patients undergoing supratentorial surgery. Patients were randomly divided into two groups. Patients in Group I (n = 10) received pancuronium (0.1 mg kg(-1)) and in Group II (n = 10) pipecuronium (0.07 mg kg(-1)) for intubation. Intracranial pressure (ICP), heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP, MAP), central venous pressure (CVP), nasopharyngeal temperature and arterial blood gases (ABG) were monitored at the following time periods: before induction (0 minutes); 3 minutes after thiopentone and muscle relaxant; immediately after intubation; and 4, 6, 8, 10, 20 and 30 minutes following intubation. The rise in intracranial pressure at intubation was significantly greater in group I (21.10+/-3.97 torr, 122.59%) when compared to group II patients (1.80+/-0.70 torr, 10.04%) (p<0.0 1). Cardiovascular parameters also showed a significantly greater degree of rise in group I when compared to group II patients. Heart rate increased by 29+/-6.32 beats min(-1) (33.52%) and systolic arterial pressure by 11.60+/-7.37 torr (9.47%) in group I. These parameters did not change significantly in group II. No significant alterations were observed in the other measured parameters in either of the two groups.
Topics: Adolescent; Adult; Female; Hemodynamics; Humans; Intracranial Pressure; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pancuronium; Pipecuronium; Prospective Studies; Single-Blind Method; Supratentorial Neoplasms
PubMed: 10751812
DOI: No ID Found -
British Journal of Anaesthesia Oct 1984In vitro studies using the rat phrenic nerve-hemidiaphragm preparation were performed to investigate the effects of diazepam and three of its metabolites on indirectly...
In vitro studies using the rat phrenic nerve-hemidiaphragm preparation were performed to investigate the effects of diazepam and three of its metabolites on indirectly evoked twitch tension. Diazepam, desmethyldiazepam and temazepam alone caused an increase in twitch tension in lower concentrations, followed by complete depression in higher concentrations. Oxazepam did not cause an initial increase in twitch tension, but showed an immediate and dose-dependent depression. Cumulative concentration-response curves for pancuronium and suxamethonium in the presence of different concentrations of diazepam or oxazepam showed that small concentrations of diazepam, which did not change twitch tension alone, caused antagonism of the action of pancuronium, but not of suxamethonium. With oxazepam no such antagonism was observed. In liminal and supraliminal concentrations, both diazepam and oxazepam potentiated the action of pancuronium and suxamethonium. Possible implications for in vivo interactions are discussed.
Topics: Animals; Diazepam; Dose-Response Relationship, Drug; Drug Interactions; In Vitro Techniques; Muscle Contraction; Neuromuscular Junction; Nordazepam; Oxazepam; Pancuronium; Rats; Rats, Inbred Strains; Succinylcholine; Temazepam
PubMed: 6433949
DOI: 10.1093/bja/56.10.1131 -
Anesthesiology Aug 1983This study was designed to compare the effects of three neuromuscular blocking agents, in a clinically relevant dose range, on the regional distribution of blood flow... (Comparative Study)
Comparative Study
This study was designed to compare the effects of three neuromuscular blocking agents, in a clinically relevant dose range, on the regional distribution of blood flow measured with 15-microns radioactive microspheres in anesthetized, optimally ventilated cats. d-Tubocurarine (400, 800, and 1,600 micrograms X kg-1) caused hypotension and a decrease in ascending aortic blood flow. Pancuronium (20, 40, and 80 micrograms X kg-1) only caused a moderate tachycardia, while vecuronium (40, 80, and 160 micrograms X kg-1) was devoid of any systemic hemodynamic effect. Neither pancuronium nor vecuronium caused major changes in regional blood flows. On the other hand, d-tubocurarine increased blood flow to the stomach but decreased that to the kidneys, liver, skin, spleen, intestine, and adrenal glands. These effects of d-tubocurarine show a striking resemblance to those elicited by the infusion of histamine. Blood flow to the nerve-stimulated tibialis anterior muscle, which was about six times that of the unstimulated muscle, was decreased significantly by all three neuromuscular blockers. In conclusion, the results clearly show that, while d-tubocurarine produces major cardiovascular disturbances, pancuronium and, in particular, vecuronium do not cause serious changes in systemic and regional hemodynamics in doses that are two to four times the ED90 for neuromuscular blocking action.
Topics: Animals; Blood Gas Analysis; Cats; Female; Hemodynamics; Male; Muscles; Neuromuscular Nondepolarizing Agents; Pancuronium; Regional Blood Flow; Tubocurarine; Vascular Resistance; Vecuronium Bromide
PubMed: 6135374
DOI: 10.1097/00000542-198308000-00006 -
Anesthesiology Jun 1983To determine the effects of cardiopulmonary bypass (CPB) and hypothermia on the neuromuscular blockade produced by pancuronium, this relaxant was infused intravenously...
To determine the effects of cardiopulmonary bypass (CPB) and hypothermia on the neuromuscular blockade produced by pancuronium, this relaxant was infused intravenously into 10 anesthetized patients to produce and maintain 90% depression of the twitch tension of the adductor pollicis muscle following supramaximal ulnar nerve stimulation. Infusion rates, plasma concentration of pancuronium, and adductor pollicis temperature were measured every 15 min. During the normothermic period preceding the start of CPB, the pancuronium requirement, the pancuronium plasma concentration, and muscle temperature were mean (mean +/- SEM): 238 +/- 12 micrograms . m-2 . 15 min-1, 0.31 +/- 0.01 microgram/ml, and 33.9 +/- 0.1 degrees C, respectively. At the beginning of CPB, the pancuronium infusion rate increased to 362 +/- 32 micrograms . m-2 . 15 min-1 (P less than 0.001) despite a decrease in the muscle temperature to 29.2 +/- 0.9 degrees C (P less than 0.001) and in pancuronium plasma concentration to 0.22 +/- 0.02 microgram/ml. During sustained muscle hypothermia to 28.3 +/- 0.4 degrees C the pancuronium plasma concentration remained constant at 0.22 +/- 0.01 micrograms/ml (P less than 0.001) while the requirement decreased to 94 +/- 15 micrograms . m-2 . 15 min-1 (P less than 0.001). After the muscle temperature was returned to 34 +/- 0.6 degrees C, the plasma pancuronium concentration and requirements increased to 0.35 +/- 0.05 microgram/ml and 392 +/- 32 micrograms . m-2 . 15 min-1 (P less than 0.001), respectively. After CPB, these values were 0.39 +/- 0.04 microgram/ml and 239 +/- 25 microgram . m-2 . 15 min-1. These results demonstrate that pancuronium requirements are increased at the beginning of CPB because of circulatory volume changes and again during rewarming of the patient once muscle temperature reaches about 34 degrees C.
Topics: Adult; Body Temperature; Cardiopulmonary Bypass; Creatinine; Humans; Hypothermia, Induced; Middle Aged; Muscle Contraction; Muscles; Pancuronium
PubMed: 6859580
DOI: 10.1097/00000542-198306000-00004 -
British Journal of Anaesthesia Aug 1987Dose-response relations for atracurium, vecuronium and pancuronium were determined in patients in end-stage renal failure for the initial neuromuscular blockade (using... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Dose-response relations for atracurium, vecuronium and pancuronium were determined in patients in end-stage renal failure for the initial neuromuscular blockade (using three cumulative doses) and for the maintenance of stable 90% response (during continuous infusion). All measurements were during renal transplant surgery, and the interaction of azathioprine on neuromuscular blockade was estimated. Mean ED95 doses were (microgram kg-1): atracurium 375.6, vecuronium 67.2, pancuronium 86.6; the initial blockade required significantly larger doses than in normal patients (37%, 20% and 45%, respectively, using ED50 values). Mean infusion rates for 90% sustained blockade in renal failure were (microgram kg-1 h-1): atracurium 409.4, vecuronium 78.3, pancuronium 14.2. The atracurium dose was not influenced by renal function, whereas vecuronium and pancuronium requirements were significantly reduced by 23.2% and 61.5%, respectively, compared with normal patients (previous study). Azathioprine was injected at the rate of 1 mg kg-1 min-1 for 3 min at stable 90% neuromuscular blockade with constant-rate infusion of the neuromuscular blocking drug. This produced a relatively small and transient antagonism of blockade--probably of negligible clinical significance.
Topics: Adolescent; Adult; Atracurium; Azathioprine; Dose-Response Relationship, Drug; Drug Interactions; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Neuromuscular Junction; Pancuronium; Vecuronium Bromide
PubMed: 2888477
DOI: 10.1093/bja/59.8.995 -
The Journal of Emergency Medicine 1996Neuromuscular blocking agents (NMBAs) are utilized frequently in the emergency department (ED). We begin with a brief history of neuromuscular blockade, then review the... (Review)
Review
Neuromuscular blocking agents (NMBAs) are utilized frequently in the emergency department (ED). We begin with a brief history of neuromuscular blockade, then review the indications and guidelines for its use in the emergency department setting. The relevant agents will be discussed focusing on dosage, side effects, and adverse reactions. Special attention will be paid to succinylcholine, the drug most commonly employed in the ED setting, followed by a summary of the nondepolarizing agents currently available, in particular the four shorter-acting agents that are most appropriate for administration in the ED.
Topics: Androstanols; Atracurium; Drug Utilization; Emergency Service, Hospital; Humans; Isoquinolines; Mivacurium; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pancuronium; Rocuronium; Succinylcholine; Vecuronium Bromide
PubMed: 8740751
DOI: 10.1016/0736-4679(95)02105-1 -
British Journal of Anaesthesia Aug 1982Speed of onset, maximum block, duration of action and 10-25% recovery time for atracurium, Org NC 45 and pancuronium were determined using equipotent doses: 330... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Speed of onset, maximum block, duration of action and 10-25% recovery time for atracurium, Org NC 45 and pancuronium were determined using equipotent doses: 330 micrograms kg-1, 66 micrograms kg-1 and 75 micrograms kg-1 respectively. Vein-to-muscle and artery-to-muscle onset times were measured by use of simultaneous recordings. Mean speeds of onset to 95% twitch depression were: atracurium 2.7 min, Org NC 45 2.8 min and pancuronium 3.6 min. The median value of maximum neuromuscular block exceeded 98.5% for all drugs and the mean durations of action to 25% recovery of control twitch height were: atracurium 27.6 min, Org NC 45 21.9 min and pancuronium 45.1 min. The differences were statistically significant. The recovery period from 10% to 25% twitch response was considerably longer for pancuronium than for the other drugs, which did not differ significantly from each other. We were unable to validate the artery-to-muscle technique in the determination of onset time.
Topics: Adult; Arteries; Atracurium; Drug Evaluation; Female; Humans; Isoquinolines; Middle Aged; Muscle Contraction; Muscles; Neuromuscular Blocking Agents; Pancuronium; Time Factors; Vecuronium Bromide; Veins
PubMed: 6125161
DOI: 10.1093/bja/54.8.827 -
British Medical Journal (Clinical... Mar 1986
Topics: Humans; Hyaline Membrane Disease; Infant, Newborn; Pancuronium; Respiration, Artificial
PubMed: 3081171
DOI: 10.1136/bmj.292.6520.575 -
Anesthesiology Oct 1983
Topics: Anesthesia; Child; Child, Preschool; Edrophonium; Humans; Infant; Infant, Newborn; Muscle Contraction; Neostigmine; Pancuronium; Synaptic Transmission
PubMed: 6311057
DOI: 10.1097/00000542-198310000-00008