Effect of Rate of Injection on the Neuromuscular Block Produced by Vecuronium

Feldman, Saúl; Soni, Neil; Kraayenbrink, Maryke A.

doi:10.1213/00000539-198911000-00014

Cited by 2 publications

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“…Finally, suxamethonium was given slowly (over 20 s) to decrease the chances of failing to inflate the tourniquet at 20 % block. A slow rate of injection of the blocker is known to increase onset time [17]. All of these factors contributed to increase the onset time.…”

Section: Discussionmentioning

confidence: 99%

Onset of neuromuscular block after tourniquet inflation: comparison of suxamethonium with vecuronium

Audibert

Donati

1995

British Journal of Anaesthesia

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To determine the influence of circulatory factors on onset of neuromuscular block, we have measured twitch height in an arm with a tourniquet inflated during onset and compared this with data from a control arm in 20 patients under fentanyl-thiopentone-nitrous oxide-isoflurane anaesthesia. Patients were allocated randomly to receive either vecuronium 0.1 mg kg-1 (n = 10) or suxamethonium 1 mg kg-1 (n = 10). The EMG response of the first dorsal interosseous to single twitch stimulation of the ulnar nerve every 10 s was recorded in both arms. When neuromuscular block was 20% (i.e. twitch height was 80% of control), the tourniquet was inflated to a pressure of 250 mm Hg. It was deflated 5 min later. In the vecuronium group, the rate of onset did not differ in both arms and mean maximum block was 95 (SD 4)% in the tourniquet arm, which was not different from 99 (2)% in the perfused arm. In the suxamethonium group, the presence of a tourniquet decreased the rate of onset by 66%. Maximum block was only 74 (20)% in the tourniquet arm compared with 97 (5)% in the perfused arm (P < 0.05). The difference in maximum neuromuscular block between arms was 4 (3)% in the vecuronium group and 22 (17)% in the suxamethonium group (P < 0.01). We conclude that during onset, neuromuscular block continued to increase in spite of interruption of blood flow, and this increase was greater with vecuronium than with suxamethonium.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

Onset of neuromuscular block after tourniquet inflation: comparison of suxamethonium with vecuronium

Audibert

Donati

1995

British Journal of Anaesthesia

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“…This noncirculatory effect has a time course of a few minutes and appears to be quantitatively important for the relatively late onset of action of neuromuscular relaxants such as pancuronium. Feldman and colleagues [7] showed that the onset of neuromuscular block after the administration of the same dose of nondepolarizing relaxant was much slower after infusion than after bolus injection, although the degree of maximum block was similar in both groups. Theoretically, it is possible that in patients with cardiac regurgitation the neuromuscular relaxant might recirculate in the heart and be carried to the peripheral circulation so that the concentration gradient between the receptor area and plasma would be less than that in subjects without cardiac valve disease.…”

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Effect of severe cardiac valve regurgitation on the onset of the neuromuscular blocking action of pancuronium

et al. 1998

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Monitoring the onset of neuromuscular block produced by nondepolarizing relaxants provides useful and important information on muscle relaxation and the timing of endotracheal intubation. Goat and her colleagues [1] initially reported that the onset and intensity of paralysis produced by gallamine were directly related to muscle blood flow. We also reported that the onset of neuromuscular blockade in the adductor pollicis muscles occurred more rapidly in patients given vecuronium via the pulmonary artery than in patients given the drug via a peripheral vein on the hand [2]. Furthermore, the onset time of a neuromuscular relaxant is governed by noncirculatory factors, such as the concentration gradient between plasma and receptor sites, the potency, and the administered dose [3,4]. It has also been reported that the onset of action of pancuronium is slower in children with congenital heart disease (CHD) than in children without CHD [5]. We examined the influence of severe cardiac valve disease on the time of onset of action of pancuronioum in adult patients.With approval from our institution's human research committee and the informed consent of the patients, 47 patients scheduled for elective cardiac surgery (coronary artery bypass graft, n = 22; valve replacement, n = 25) aged 17-78 years (mean, 55) and weighing 40-75 kg (mean, 58) were included. The severity of mitral or aortic regurgitation in 25 patients with cardiac Address correspondence to: H. Iwasaki Received for publication on May 30, 1997; accepted on September 27, 1997 valve disease was qualitatively assessed by cardiac catheterization before surgery and was graded on a scale of 1 to IV in severity. Patients with moderately severe (grade III) and severe (grade IV) regurgitation were included in this study. All patients received midazolam 2.5 mg and either atropine 0.5 mg or scopolamine 0.4mg i.m. lh before induction of anesthesia. Anesthesia was induced with midazolam 2.0-3.0 mg i.v. and maintained with fentanyl 10-25~g.kg -~ and 50%-60% nitrous oxide in oxygen administered by face mask. Before insertion of an endotracheal tube, ventilation was controlled manually to keep PETCO2 within the range of 35 to 40mmHg.At least 5rain after the induction of anesthesia, pancuronium 0.1mg.kg -~ was randomly administered through an indwelling cannula on the dorsum of the hand and was flushed by a fast-running infusion. Neuromuscular block was evaluated every 12s by the force-of-thumb adduction produced in response to supramaximal stimulation of the ulnar nerve with repetitive train-of-four using surface electrodes at the wrist (Myograph 2000, Biometer, Denmark).Immediately after the administration of pancuronium, the cardiac output was measured with a pulmonary artery catheter inserted preoperatively, using 10ml of iced 5% dextrose in all patients. The average of three measurements was taken as the cardiac index. Tracheal intubation was not performed until the relaxation, judged by twitch responses, was 95% or greater.The degree of neuromuscular block was measured...

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Effect of Rate of Injection on the Neuromuscular Block Produced by Vecuronium

Cited by 2 publications

References 0 publications

Onset of neuromuscular block after tourniquet inflation: comparison of suxamethonium with vecuronium

Onset of neuromuscular block after tourniquet inflation: comparison of suxamethonium with vecuronium

Effect of severe cardiac valve regurgitation on the onset of the neuromuscular blocking action of pancuronium

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