Doxacurium Chloride for Neuromuscular Blockade before Tracheal Intubation and Surgery during Nitrous Oxide-Oxygen-Narcotic-Enflurane Anesthesia

Lennon, Robert L.; Hosking, Michael P.; Houck, P. C.; Rose, Steven H.; Wedel, Denise J.; Gibson, Beth E.; Ascher, John; Rudd, G. David

doi:10.1213/00000539-198903000-00013

Cited by 14 publications

(3 citation statements)

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(0, 5, 10, 20 or 40 #g" kg -~) (moyenne 5: SEM, 45.0 + 3,9 vs 49,5 + 10,0% pour le T t et 25,2 + 3,8 vs 14,8 • 3,6%pour le rapport TOF TI: de 14,[3][4][5][6]8 et 25,7 • 2,5 • 1,7 et 25,3 • 2,

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Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children

et al. 1994

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“…

(0, 5, 10, 20 or 40 #g" kg -~) (moyenne 5: SEM, 45.0 + 3,9 vs 49,5 + 10,0% pour le T t et 25,2 + 3,8 vs 14,8 • 3,6%pour le rapport TOF TI: de 14,[3][4][5][6]8 et 25,7 • 2,5 • 1,7 et 25,3 • 2,

…”

unclassified

Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children

et al. 1994

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“…In their study, slightly larger doses of doxacurium (37.5 pg.kg-l) and fentanyl (2-3 pg.kg-') were used. Although larger doses of doxacurium facilitate more rapid tracheal intubation [9,121, the duration of neuromuscular blockade may be prolonged to an unacceptable extent.…”

Section: Discussionmentioning

confidence: 99%

The clinical pharmacology of doxacurium in young adults and in elderly patients

Martlew

Harper

1995

Anaesthesia

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Summary Key wordsNeuromuscular relaxants; doxacurium. Pharmacology. Age factors.Doxacurium is a new benzylisoquinolinium nondepolarising neuromuscular blocking agent. It is very potent (EDg5 23-33 pg.kg-l) with a duration of action similar to pancuronium [ 1-31. It has minimal cardiovascular side effects [2,4] although hypotension associated with an anaphylactoid response to doxacurium has been reported [5]. Approximately 30% of a dose of doxacurium is excreted unchanged in the urine [6] and the duration of action is prolonged in the presence of renal failure [7]. The physiological changes associated with ageing, i.e. a decrease in muscle mass, serum proteins, total body water and renal and hepatic blood flow, may affect drug disposition and elimination in the elderly. Doxacurium has been shown to have a similar potency in young and elderly patients with a slower onset in the elderly [6], but the effect of advancing age on the conditions for tracheal intubation has not been determined previously.Many workers have reported that doxacurium is antagonised relatively slowly [3, and this, together with a relatively slow rate of spontaneous recovery in patients aged over 70 years [lo], may make reversal more difficult in elderly age groups. The rate of antagonism of doxacurium in elderly patients, following a standard single dose of neostigmine, has not been previously compared with a younger group. This study was designed to compare the speed of onset of doxacurium, intubating conditions and the efficacy of neostigmine-induced antagonism in young and elderly patients during isoflurane anaesthesia. MethodsApproval for the study was granted by the Hospital Ethics Committee and written, informed consent was obtained from each patient. Thirty-eight patients were studied in two age groups: 18 to 55 years (young group) (n = 21) and over 65 years (elderly group) (n = 17). Patients were ASA 1 or 2 and underwent elective surgery of at least 1 h duration. Patients with neuromuscular disease, or receiving treatment withdrugs known to influence neuromuscular transmission, or who were more than 20% outside their ideal body weight were not studied. The majority of patients received oral premedication with temazepam 10-20 mg and droperidol 5 mg. General anaesthesia was induced with thiopentone 3-5 mg.kg-' (titrated to the loss of the eyelash reflex) and fentanyl 1-1.5 pg.kg-l, and maintained initially with 67% nitrous oxide in oxygen with increments of thiopentone as required. Ventilation was assisted manually if necessary. Skin electrodes were applied over the ulnar nerve at the wrist and supramaximal train-&-four stimuli (at 2 HZ every 20 s) were delivered by a portable electromyograph (Relaxograph, Datex). This also recorded the compound muscle action potential (CMAP) of the adductor pollicis using similar electrodes. After calibration and stabilisation of the control CMAP, a single intravenous bolus injection of doxacurium 30 pg.kg-' was administered over 5 s. Tracheal intubation was attempted after 4 min by the same investiga...

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“…Doxacurium, a potent benzylisoquinolinium nondepolarizing NMBA, has a long duration of action and is devoid of cardiovascular and histamine-releasing side effects at clinically effective doses Lennon et al 1989). Goudsouzian et al (1987) studied the dose response of doxacurium in nine children (4 to 8 years).…”

Section: Doxacuriummentioning

confidence: 99%

Evaluating the 10X Uncertainty Factor for Children and Elderly with Data-Derived Values for Neuromuscular Blocking Agents

Suh

Abdel‐Rahman

2002

Human and Ecological Risk Assessment: An International Journal

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Conventional risk assessment process utilizes a 10-fold uncertainty factor (UF) to extrapolate from the general human population to sensitive subgroups, such as children and elderly. The purpose of this investigation was to evaluate whether the magnitude of the 10X-UF can be reduced when pharmacokinetic and pharmacodynamic data are incorporated to characterize human sensitivity. An extensive literature search was conducted on seven neuromuscular blocking agents (mivacurium, atracurium, rocuronium, vecuronium, doxacurium, pancuronium, pipecuronium). Composite factors (kinetics × dynamics) were calculated using the highest dataderived kinetic and dynamic values. For the drugs examined, all of the composite factors for the sensitivity of children were lower than 5. In the elderly, all of the composite factors were lower than 10, and five of seven composite factors were less than 5. From this study, it was concluded that relevant compound-specific kinetic and dynamic data can reduce the uncertainties associated with sensitive subgroups.

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Doxacurium Chloride for Neuromuscular Blockade before Tracheal Intubation and Surgery during Nitrous Oxide-Oxygen-Narcotic-Enflurane Anesthesia

Cited by 14 publications

References 0 publications

Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children

Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children

The clinical pharmacology of doxacurium in young adults and in elderly patients

Evaluating the 10X Uncertainty Factor for Children and Elderly with Data-Derived Values for Neuromuscular Blocking Agents

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