D-Tubocurarine Chloride

Abstract

Two years ago we (Gray and Halton, 1946) expressed the opinion that d-tubocurarine chloride was the curare preparation of choice and were surprised that anmsthesiologists of the United States had preferred a comparatively crude substance. It is gratifying to find that the pure alkaloid is now used almost exclusively in this country and tends to replace intocostrin in the New World. It is unfortunate, however, that the States continue to assay their preparations against an arbitrary standard rather than compute the dosage in mg. of the pure alkaloid. It is even more regrettable and to be deprecated that one firm has introduced a preparation of tubocurarine of different strength to that usual in this country. Such deviations from accepted local custom can only cause confusion and may be dangerous.The history, pharmacology and story of the clinical use of d-tubocurarine chloride have been amply discussed during the last years. This paper, therefore, will be a critical appraisal of the status of this substance in the light of three years' experience of its use in anesthesia. I circulated a questionnaire to all the anmsthetists in the Liverpool district who were using d-tubocurarine chloride for their major abdominal and thoracic surgery. From the replies it would appear that in Liverpool alone close on 8,500 cases had been anesthetized with the aid of this substance up to the end of 1947. Much information accrued from this survey, and, most important, it was evident not one of these other anmsthetists had had a single death which they attributed in any way to d-tubocurarine chloride. Nor had they seen any evidence of an unexpected side-effect.From my own observations on the human, electrocardiogram and from animal experimentation (Gray and Gregory, 1948) it seems quite certain that there is no significant effect produced by d-tubocurarine chloride on the heart. In animals large amounts injected quickly may produce a sudden fall in blood-pressure. In human subjects, although Harroun and her colleagues (1947) have described a slight fall in blood-pressure, I have never been able to observe this and in two cases it did not follow the very rapid injection of doses of the order of 45 mg. Nor did Smith (1947), in the experiment in which he received 500 units of intocostrin, exhibit any alteration in the blood-pressure.There has not been any evidence of kidney or liver dysfunction following the use of tubocurarine nor, in my experience, has there been any hyperglycemia. I have used this substance in diabetic patients without any disturbance of their carbohydrate balance.

Postoperative residual block after intermediate‐acting neuromuscular blocking drugs

“…Although the possibility of patients being transferred to the postoperative recovery ward with residual paralysis was remarked upon by Gray as far back as 1948 [1], it is only within the last 20 years or so that the matter has received considerable attention. A 42% incidence of residual block, defined as a train‐of‐four ratio (TOFR) of <0.7, following the use of long‐acting neuromuscular blocking drugs, was reported by Viby‐Mogenson et al .…”

Paraneoplastic Syndromes in Patients with Laryngeal and Hypopharyngeal Cancers

“…75 Paraneoplastic syndromes usually occur before the malignancy is diagnosed, and the best described are those associated with specific antibodies. 76 Eaton-Lambert myasthénie syndrome was reported in abstract form by Lambert et al 77 in 1956 and again in more detail by Eaton and Lambert in 1957, 78 though the same condition had been reported by Gray and Halton 79 in 1948. It is usually seen in association with lung cancer, but may also be associated with laryngeal cancer.…”

Paraneoplastic Syndromes Associated with Laryngeal Cancer

“…The complete syndrome was further delineated by Eaton and Lambert [57,80]. The same disease had previously been described by Gray and Halton [81]. It is usually associated with small cell lung cancer [82], but also with larynx cancer [83][84][85][86].…”