-
British Journal of Anaesthesia Sep 1988Train-of-four stimulation was applied to the ulnar and phrenic nerves in 18 adult patients anaesthetized with nitrous oxide and halothane in oxygen. The response of the... (Comparative Study)
Comparative Study
Train-of-four stimulation was applied to the ulnar and phrenic nerves in 18 adult patients anaesthetized with nitrous oxide and halothane in oxygen. The response of the adductor pollicis and the diaphragm were measured. Incremental doses of atracurium and vecuronium were given, with an infusion to replace drug lost by elimination or distribution. The mean (SEM) doses of atracurium associated with 50% and 90% depression of response to the first stimulation in the train-of-four (ED50 and ED90) were 90 (9) and 133 (10) micrograms kg-1 at the adductor pollicis, and 130 (9) and 245 (17) micrograms kg-1 at the diaphragm, respectively. The mean (SEM) ED50 and ED90 of vecuronium were 25 (2) and 38 (4) micrograms kg-1 at the adductor pollicis and 34 (3) and 58 (5) micrograms kg-1 at the diaphragm, respectively. The mean (SEM) ED50 ratios were 1.56 (0.16) for atracurium and 1.47 (0.16) for vecuronium. ED90 ratios were 1.93 (0.29) and 1.55 (0.17) for atracurium and vecuronium, respectively. It is concluded that both atracurium and vecuronium exhibit a similar degree of sparing of the diaphragm.
Topics: Adult; Atracurium; Diaphragm; Dose-Response Relationship, Drug; Female; Hand; Humans; Male; Middle Aged; Muscle Contraction; Muscles; Phrenic Nerve; Ulnar Nerve; Vecuronium Bromide
PubMed: 2902872
DOI: 10.1093/bja/61.3.286 -
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 -
British Journal of Anaesthesia Aug 1987The distribution and kinetics of 14C-vecuronium were studied in rats and mice. 14C-Vecuronium accumulated rapidly in the liver. Both unchanged and metabolized vecuronium...
The distribution and kinetics of 14C-vecuronium were studied in rats and mice. 14C-Vecuronium accumulated rapidly in the liver. Both unchanged and metabolized vecuronium were excreted with the bile into the intestines and stomach. Reabsorption in the gut was probably responsible for an enterohepatic increase in radioactivity in the liver after one hour. Excretion through the kidneys increased continuously from low values after the initial peak. Binding in compartments with acid mucopolysaccharides such as cartilage, connective tissue etc., was less important. Blood-brain barrier and placenta were permeable only to a small degree.
Topics: Animals; Autoradiography; Carbon Radioisotopes; Female; Male; Mice; Organ Specificity; Pregnancy; Rats; Tissue Distribution; Vecuronium Bromide; Whole-Body Counting
PubMed: 2888475
DOI: 10.1093/bja/59.8.1044 -
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 -
Anesthesiology Nov 2004Neonates and infants often require extended periods of mechanical ventilation facilitated by sedation and neuromuscular blockade. (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
Neonates and infants often require extended periods of mechanical ventilation facilitated by sedation and neuromuscular blockade.
METHODS
Twenty-three patients aged younger than 2 yr were randomly assigned to receive either cisatracurium or vecuronium infusions postoperatively in a double-blinded fashion after undergoing congenital heart surgery. The infusion was titrated to maintain one twitch of a train-of-four. The times to full spontaneous recovery of train-of-four without fade, extubation, intensive care unit discharge, and hospital discharge were documented after drug discontinuation. Sparse sampling after termination of the infusion and a one-compartment model were used for pharmacokinetic analysis. The Mann-Whitney U test and Student t test were used to compare data between groups.
RESULTS
There were no significant differences between groups with respect to demographic data or duration of postoperative neuromuscular blockade infusion. The median recovery time for train-of-four for cisatracurium (30 min) was less than that for vecuronium (180 min) (P < 0.05). Three patients in the vecuronium group had prolonged train-of-four recovery: Two had long elimination half-lives for vecuronium, and one had a high concentration of 3-OH vecuronium. There were no differences in extubation times, intensive care unit stays, or hospital stays between groups.
CONCLUSIONS
Our results parallel data from adults demonstrating a markedly shorter recovery of neuromuscular transmission after cisatracurium compared with vecuronium. Decreased clearance of vecuronium and the accumulation of 3-OH vecuronium may contribute to prolonged spontaneous recovery times. Cisatracurium is associated with faster spontaneous recovery of neuromuscular function compared with vecuronium but not with any differences in intermediate outcome measures in neonates and infants.
Topics: Atracurium; Biotransformation; Cardiac Surgical Procedures; Chromatography, High Pressure Liquid; Double-Blind Method; Half-Life; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Intensive Care Units; Length of Stay; Monitoring, Intraoperative; Neuromuscular Nondepolarizing Agents; Synaptic Transmission; Vecuronium Bromide
PubMed: 15505447
DOI: 10.1097/00000542-200411000-00011 -
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 -
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 Jan 2000The authors evaluated the influence of temperature on the pharmacokinetics and pharmacodynamics of vecuronium because mild core hypothermia doubles its duration of... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
The authors evaluated the influence of temperature on the pharmacokinetics and pharmacodynamics of vecuronium because mild core hypothermia doubles its duration of action.
METHODS
Anesthesia was induced with alfentanil and propofol and maintained with nitrous oxide and isoflurane in 12 healthy volunteers. Train-of-four stimuli were applied to the ulnar nerve, and the mechanical response of the adductor pollicis was measured. Volunteers were actively cooled or warmed until their distal esophageal temperatures were in one of four ranges: < 35.0 degrees C, 35.0-35.9 degrees C, 36.0-36.9 degrees C, and > or = 37.0 degrees C. With temperature stabilized, vecuronium was infused at 5 microg x kg(-1) x min(-1) until the first response of each train-of-four had decreased by 70%. Arterial blood (for vecuronium analysis) was sampled at intervals until the first response recovered to at least 90% of its prevecuronium level. Vecuronium, 20 microg x kg(-1) x min(-1), was then infused for 10 min, and arterial blood was sampled at intervals for up to 7 h. Population-based nonlinear mixed-effects modeling was used to examine the effect of physical characteristics and core temperature on vecuronium pharmacokinetics and pharmacodynamics.
RESULTS
Decreasing core temperature over 38.0-34.0 degrees C decreases the plasma clearance of vecuronium (11.3% per degrees C), decreases the rate constant for drug equilibration between plasma and effect site (0.023 min(-1) per degrees C), and increases the slope of the concentration-response relationship (0.43 per degrees C).
CONCLUSIONS
Our results show that reduced clearance and rate of effect site equilibration explain the increased duration of action of vecuronium with reducing core temperature. Tissue sensitivity to vecuronium is not influenced by core temperature.
Topics: Adult; Alfentanil; Anesthesia, Inhalation; Anesthetics, Intravenous; Body Temperature; Female; Humans; Hypothermia; Male; Metabolic Clearance Rate; Models, Biological; Neuromuscular Nondepolarizing Agents; Propofol; Sex Factors; Vecuronium Bromide
PubMed: 10638903
DOI: 10.1097/00000542-200001000-00018 -
British Journal of Anaesthesia Jun 1998To determine the differences between men and women in the dose-response curve and the time-course of effect of vecuronium, we studied 60 adult patients (30 male and 30...
To determine the differences between men and women in the dose-response curve and the time-course of effect of vecuronium, we studied 60 adult patients (30 male and 30 female), ASA I, age 18-51 yr, undergoing elective plastic surgery. Anaesthesia was maintained with nitrous oxide 60% in oxygen; thiopentone and incremental doses of fentanyl were given as required. Neuromuscular function was assessed mechanomyographically using the train-of-four (TOF) stimulation at the wrist every 12 s. The percentage depression of T1 was used as the study variable. The dose-response relationship of vecuronium was determined by a cumulative dose-response technique. The dose-response curve in men was shifted in a parallel fashion to the right, indicating a decrease in the sensitivity to vecuronium-induced neuromuscular block, compared with women. The ED50, ED90 and ED95 of vecuronium were 23.9 (4.7), 45.4 (11.2) and 55.7 (14.3) micrograms kg-1 in men and 18.4 (3.7), 33.5 (7.8) and 39.8 (9.6) micrograms kg-1 in women respectively. There were statistically significant differences in these values between the two groups (P < 0.01 in each instance). After a total dose of vecuronium 80 micrograms kg-1, neuromuscular block was significantly longer in women than in men. The duration of peak effect, clinical duration, and the total duration were 18.7 (7.1), 26.6 (8.8) and 50.6 (16.0) min respectively in men and 26.0 (7.2), 37.1 (11.2) and 65.9 (20.7) min in women. They differed significantly between men and women (P < 0.005 in each case).
Topics: Adolescent; Adult; Anesthesia, General; Dose-Response Relationship, Drug; Electric Stimulation; Female; Humans; Male; Middle Aged; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Sex Factors; Time Factors; Vecuronium Bromide
PubMed: 9771296
DOI: 10.1093/bja/80.6.720 -
Anaesthesia Jan 1998The combination of vecuronium and atracurium was studied in 60 children of ASA physical status 1 or 2. In part I, the dose-response relationships were determined in 30... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The combination of vecuronium and atracurium was studied in 60 children of ASA physical status 1 or 2. In part I, the dose-response relationships were determined in 30 children who were randomly assigned to receive a single bolus of 0.02, 0.025 or 0.03 mg kg-1 of vecuronium or 0.075, 0.01 or 0.0125 mg.kg-1 of atracurium. The evoked electromyogram of the adductor pollicis brevis muscle to train-of-four stimulation was monitored. The speed of onset of the neuromuscular blockade was determined by a 95% depression of the train-of-four whereas the recovery index was established at 75% recovery of T1. In part II, 30 children were randomly assigned to receive 2 x ED95 of vecuronium, 2 x ED95 of atracurium, or a combination of 1 x ED95 of vecuronium + 1 x ED95 of atracurium. This study showed that the ED50 and ED95 for vecuronium were 0.021 mg.kg-1 and 0.037 mg.kg-1 and for atracurium 0.11 mg.kg-1 and 0.30 mg.kg-1, respectively. The slopes of the dose-response relationships were significantly different (p < 0.001). With vecuronium alone, the speed of onset of neuromuscular blockade was significantly slower (p < 0.001) and the duration of action less (p < 0.001) than that with atracurium alone or with the combination. There were no differences between atracurium and the combination of both medications. The recovery index was similar for all groups. We conclude that the dose-response relationships of vecuronium and atracurium in children undergoing halothane anaesthesia are not parallel and the neuromuscular effects of vecuronium and atracurium are neither additive nor synergistic. While vecuronium has a shorter duration of action than atracurium, this feature is not apparent when it is combined with atracurium in equipotent doses. Recovery is rapid and not prolonged when these two drugs are combined.
Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Atracurium; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Interactions; Electromyography; Halothane; Humans; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Time Factors; Vecuronium Bromide
PubMed: 9505740
DOI: 10.1111/j.1365-2044.1998.00259.x