Pharmacokinetics and cardiovascular dynamics of pipecuronium bromide during coronary artery surgery

Wierda, J. M. K. H.; Karliczek, G.; Vandenbrom, Ron H.G.; Pinto, Igal; Kersten-Kleef, Ursula W.; Meijer, Dirk K. F.; Ágoston, S.

doi:10.1007/bf03005467

Cited by 36 publications

(9 citation statements)

References 17 publications

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“…22 (2) 1992 curonium. Renal elimination of this compound affects 37 to 41% of the administered dose (a proportion similar to that of pancuronium), biliary excretion is negligible (2%) and only small amounts (4 to 10%) of the 3-desacetyl (3-0H) metabolite could be recovered from the urine in 24h (Wierda et al 1990a(Wierda et al , 1991b. There are considerable alterations (a prolonged duration of action) in the time course of pipecuronium effects in patients with renal failure and little or no change in pharmacokinetic and time course parameters in patients with hepatobiliary tract disease.…”

Section: Pipecuroniummentioning

confidence: 97%

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Clinical Pharmacokinetics of Neuromuscular Blocking Drugs

Ágoston

Vandenbrom

Wierda

1992

Clinical Pharmacokinetics

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Neuromuscular blocking agents provide muscle relaxation for a great variety of surgical procedures with light planes of general anaesthesia. Besides having a significant impact in the development of anaesthesia and surgery, these agents continue to play an important role as pharmacological tools in the elucidation of the physiological and pharmacological regulation of neuromuscular transmission and the morphofunctional organisation of the neuromuscular junction. In the daily practice of anaesthesia, muscle relaxants are considered to be safe drugs with predictable, straightforward pharmacological actions. However, the use of relaxants constitutes a deliberate encroachment on respiration, one of the most important physiological mechanisms. The pharmacokinetic behaviour of this class of agents is little influenced by age or anaesthetic agents; however, hepatic or renal disease may profoundly alter their excretion pattern, resulting in prolonged duration of neuromuscular blockade. Biotransformation plays an important role in the total elimination of recently introduced compounds. Consequently, knowledge of the disposition pharmacokinetics, excretion and biotransformation of this class of drugs is indispensable for their rational choice for various surgical procedures. In this review, the known pharmacokinetics of standard compounds (introduced before 1980) are briefly summarised and new information generated by the development of vecuronium, rocuronium, pipecuronium (steroidal agents) and atracurium, mivacurium, doxacurium (benzylisoquinolinium esters) is discussed in more detail.

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Section: Pipecuroniummentioning

confidence: 97%

“…37 to 41% of a pipecu. ronium dose is excreted unchanged in the urine, 2% in the bile and 4 to 10% is metabolised (Wierda et al 1990a(Wierda et al , 1991. Doxacurium is a his-quater.…”

Section: Alracuriummentioning

confidence: 99%

Clinical Pharmacokinetics of Neuromuscular Blocking Drugs

Ágoston

Vandenbrom

Wierda

1992

Clinical Pharmacokinetics

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“…These were seen in patients maintained with halothane-nitrous oxide anaesthesia (Scott & Norman 1989). Pipecuronium may similarly be associated with bradycardia (Dubois et al 1991), as well as decreased cardiac output, even in the absence of bradycardia (Wierda et al 1990a).…”

Section: Bradyarrhythrniasmentioning

confidence: 95%

Adverse Effects of Nondepolarising Neuromuscular Blocking Agents

Abel

1994

Drug Safety

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Nondepolarising muscle relaxants block neuromuscular transmission, acting as antagonists of the nicotinic receptors at the neuromuscular junction. Their undesired effects are frequently caused by interaction with acetylcholine receptors outside this junction, and autonomic cardiovascular effects may result. Other adverse effects include anaphylactic or anaphylactoid reactions, and histamine release. Various disease states may present specific considerations in the use of nondepolarising muscle relaxants. Although many complications of these drugs (such as prolonged block or resistance) are easily treated, others may necessitate immediate intervention and vigorous therapy. Careful selection of an appropriate relaxant for a particular patient will usually prevent the occurrence of complications.

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“…Haemodynamic adverse effects including slight reductions in blood pressure and slight bradycardia are of negligible clinical relevance (Tassonyi et al 1988, Wierdo et al 1990). 40 to 60% of pipecuronium is eliminated renally, which is far below the rate for pancuronium (Caldwell et al 1989).…”

Section: Pipecuroniummentioning

confidence: 99%

The Safe Use of Anaesthetics and Muscle Relaxants in Older Surgical Patients

1993

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Age greater than or equal to 75 years is not a special risk for adverse outcomes after general anaesthesia on its own but an indicator of risk. Biological or physiological age expressed by preoperative health status is much more important than chronological age. The type of anaesthesia seems to play no, or only a minor role. It is, however, most important to reduce the dosage considerably. As a rule of thumb, the dosage should be reduced by 10 to 15% for every decade over the age of 40. In addition, patients must be monitored extensively intra- and postoperatively, ideally in an intensive care setting. The controversy concerning regional versus general anaesthesia should be studied further. Regional anaesthesia techniques like high spinal or epidural anaesthesia that are haemodynamically effective do not reduce morbidity and mortality postoperatively but have the risk of profound hypertension. Peripheral blockades and spinal or epidural anaesthesia without additional sedation may, however, be associated with a reduced incidence of complications. The reduced reserves of geriatric patients demand for experienced anaesthetists and surgeons as well as intense intra- and postoperative monitoring. To secure a short recovery period, we recommend administration of short-acting drugs like propofol, midazolam, alfentanil, vecuronium, atracurium or isoflurane in appropriately reduced dosages.

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Pharmacokinetics and cardiovascular dynamics of pipecuronium bromide during coronary artery surgery

Cited by 36 publications

References 17 publications

Clinical Pharmacokinetics of Neuromuscular Blocking Drugs

Clinical Pharmacokinetics of Neuromuscular Blocking Drugs

Adverse Effects of Nondepolarising Neuromuscular Blocking Agents

The Safe Use of Anaesthetics and Muscle Relaxants in Older Surgical Patients

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