Influence of a continuous prednisolone medication on the time course of neuromuscular block of atracurium in patients with chronic inflammatory bowel disease

Soltész, Stefan; Mencke, Thomas; Mey, C. De; Röhrig, S.; Diefenbach, C.; Molter, G.

doi:10.1093/bja/aen084

Cited by 20 publications

(22 citation statements)

References 24 publications

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“…Therefore, a prospective and randomized clinical study addressing this topic was published by our research team recently. In our investigation, we observed a shorter duration of an atracurium‐induced block of roughly 20% in patients receiving a long‐term prednisolone medication 6 …”

supporting

confidence: 47%

Attenuation of a rocuronium‐induced neuromuscular block in patients receiving prednisolone

Soltész

Mencke

Stunz

et al. 2009

Acta Anaesthesiol Scand

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supporting

confidence: 47%

Attenuation of a rocuronium‐induced neuromuscular block in patients receiving prednisolone

Soltész

Mencke

Stunz

et al. 2009

Acta Anaesthesiol Scand

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“…Soltész et al (2008Soltész et al ( , 2009 found a shorter duration of atracurium (ATR)-induced neuromuscular block in patients receiving long-term prednisolone medication and later confirmed that this was also valid for rocuronium (ROC). Parr et al (1991) observed that patients on long-term betamethasone treatment required 75% more vecuronium (VEC).…”

Section: Introductionmentioning

confidence: 85%

Different magnitude of resistance to non-depolarizing muscle relaxants in dexamethasone-treated rat diaphragm associated with altered acetylcholine receptor expression

Chen¹,

Yang²,

Huang³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the influence of chronic dexamethasone (Dex) administration on rat diaphragm sensitivity to non-depolarizing muscle relaxants (NDMRs) and muscular nicotinic acetylcholine receptor (nAChR) expression, which may help direct future administration of NDMRs. Adult male SpragueDawley rats were randomized to receive a daily intraperitoneal injection of Dex (600 μg/kg body mass) or an equivalent volume of saline (N = 20 in each group) for 14 days. We evaluated isometric twitch tensions of nerve-hemidiaphragm preparations elicited by indirect supramaximal stimulation at 0.1 Hz. Real-time quantitative PCR was performed to determine the mRNA expression of two nAChR subunits (ε-subunit and γ-subunit) in the diaphragm. Dex administration markedly (P < 0.01) increased the 50% twitch depression (IC 50 ) of the three NDMRs. The IC 50 ratio, which standardized the magnitudes of the resistance, was the Differential Dex-induced resistance to muscle relaxants largest for atracurium, with the second largest for vecuronium and the smallest for rocuronium (P < 0.01). The ε-and γ-subunit mRNAs were both upregulated with an increased γ/ε ratio in rats exposed to Dex. The results indicated that chronic Dex administration induces hyposensitivity to NDMRs, the degree of which depends on the kind of neuromuscular blocker, and is associated with increased nAChR expression.

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“…While glucocorticoids produce no changes on skeletal muscle twitches triggered by low frequency nerve stimulation, these drugs significantly enhance post-tetanic potentiation and attenuate neuromuscular block produced by antinicotinic muscle relaxants [53][54][55]. All these properties are mediated by non-genomic pre-synaptic actions of glucocorticoids [56,57] and may contribute to improve neuromuscular transmission deficits in myasthenic patients besides their empirical use as immunosuppressive agents.…”

Section: Discussionmentioning

confidence: 99%

Tetanic Facilitation of Neuromuscular Transmission by Adenosine A<sub>2A</sub> and Muscarinic M<sub>1</sub> Receptors is Dependent on the Uptake of Choline via High-Affinity Transporters

Castellão-Santana¹,

Abiko²,

Ambiel³

et al. 2018

Pharmacology

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Background/Aims: In this study, we evaluated the functional impact of facilitatory presynaptic adenosine A_2A and muscarinic M₁ receptors in the recovery of neuromuscular tetanic depression caused by the blockage of high-affinity choline transporter (HChT) by hemicholinium-3 (HC-3), a condition that mimics a myasthenia-like condition. Methods: Rat diaphragm preparations were indirectly stimulated via the phrenic nerve trunk with 50-Hz frequency trains, each consisting of 500–750 supramaximal intensity pulses. The tension at the beginning (A) and at the end (B) of the tetanus was recorded and the ratio (R) B/A calculated. Results: Activation of A_2A and M₁ receptors with CGS21680 (CGS; 2 nmol/L) and McN-A-343c (McN; 3 μmol/L) increased R values. Similar facilitatory effects were obtained with forskolin (FSK; 3 μmol/L) and phorbol 12-myristate 13-acetate (PMA; 10 μmol/L), which activate adenylate cyclase and protein kinase C respectively. HC-3 (4 μmol/L) decreased transmitter exocytosis measured by real-time videomicroscopy with the FM4-64 fluorescent dye and prevented the facilitation of neuromuscular transmission caused by CGS, McN, and FSK, with a minor effect on PMA. The acetylcholinesterase inhibitor, neostigmine (NEO; 0.5 μmol/L), also decreased transmitter exocytosis. The paradoxical neuromuscular tetanic fade caused by NEO (0.5 μmol/L) was also prevented by HC-3 (4 μmol/L) and might result from the rundown of the positive feedback mechanism operated by neuronal nicotinic receptors (blocked by hexamethonium, 120 μmol/L). Conclusion: Data suggest that the recovery of tetanic neuromuscular facilitation by adenosine A_2A and M₁ receptors is highly dependent on HChT activity and may be weakened in myasthenic patients when HChT is inoperative.

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Influence of a continuous prednisolone medication on the time course of neuromuscular block of atracurium in patients with chronic inflammatory bowel disease

Abstract: Long-term medication with prednisolone resulted in a shorter duration of an atracurium-induced neuromuscular block in patients with Crohn's disease or ulcerative colitis. The presence of the inflammatory bowel disease did not influence the time course of the neuromuscular block.

Cited by 20 publications

References 24 publications

Attenuation of a rocuronium‐induced neuromuscular block in patients receiving prednisolone

Attenuation of a rocuronium‐induced neuromuscular block in patients receiving prednisolone

Different magnitude of resistance to non-depolarizing muscle relaxants in dexamethasone-treated rat diaphragm associated with altered acetylcholine receptor expression

Tetanic Facilitation of Neuromuscular Transmission by Adenosine A<sub>2A</sub> and Muscarinic M<sub>1</sub> Receptors is Dependent on the Uptake of Choline via High-Affinity Transporters

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