Dynamics of Atracurium Infusion

Ebert, Jürgen; Proctor, J. Harris

doi:10.1097/00000542-198409001-00292

Cited by 2 publications

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“…6 In people, the infusion rate required to induce 90 to 99% depression of T 1 varied with the anesthetic agent. When opioids were administered IV, a mean infusion rate of 8 .4 ± 0.3 J-Lg/kg/ min was required ,5 whereas when the inhalant agents isoflurane and enflurane were used , an infusion rate of 2.55 ± 0.48 J-Lg/kg/min maintained 90% twitch depression 3 This difference is attributable to enhancement of neuromuscular blockade by volatile anesthetic agents. Enhancement is greater in response to isoflurane and enflurane than to halothane, and is thought to be attributable to general eNS depression that causes decrease in muscular tone,13 decrease in sensitivity of post junctional membranes to depolarization,14 and especially with regard to isoflurane, increased skeletal muscle blood flow, which causes increased drug delivery to the neuromuscular junction.…”

Section: Discussionmentioning

confidence: 99%

Atracurium administration, as an infusion, to induce neuromuscular blockade in clinically normal and temporarily immune-suppressed cats

Ilkiw,

Forsyth,

Hill

et al. 1990

javma

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Summary Atracurium besylate, a nondepolarizing neuromuscular blocking agent, was administered by infusion to 10 cats that were anesthetized with isoflurane and oxygen to allow transplantation of a myocutaneous flap. Five of the cats were given cyclosporine (20 mg/kg of body weight, po, q 12 h in divided doses) for 2 days prior to anesthesia, and prednisolone (0.25 mg/kg, po) on the morning of surgery. The other 5 cats were not given either drug. Neuromuscular blockade was assessed, using the train-of-four stimulation, and throughout surgery, the infusion rate was adjusted to maintain the first-twitch response (T1) at 90 to 95% depression from baseline. At completion of surgery, atracurium was discontinued, and the infusion rate and the time for recovery (the time for the train-of-four ratio to increase from 50 to 75%) were recorded. Once the train-of-four ratio had been stable for 10 minutes, edrophonium (0.5 mg/kg), a cholinesterase inhibitor, was administered iv, and neuromuscular blockade was monitored for another 10 minutes. Mean (±sd) duration of the atracurium infusion was 302.1 ± 70.5 minutes for the control group and was 323.9 ± 61.7 minutes for the cats given cyclosporine and prednisolone. In the cats of the control group, the infusion rate required to induce 90 to 95% T1 depression from baseline was 3.7 ± 0.7 μg/kg/min. This rate was not significantly different from that of 2.8 ± 1.2 μg/kg/min in cats given cyclosporine and prednisolone. Significant difference in recovery time was not evident between the control group and the treated group (6.4 ± 4.5 minutes vs 6.2 ± 2.5 minutes). In this study, administration of atracurium by continuous infusion proved to be a suitable method of obtaining neuromuscular blockade for a prolonged period. Administration of cyclosporine and prednisolone did not affect the infusion rate of atracurium required to depress the first twitch by 90 to 95% and did not affect return of neuromuscular function.

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Section: Discussionmentioning

confidence: 99%