Relationship Between Cardiac Output and Onset of Succinylcholine Chloride Action in Electroconvulsive Therapy Patients

Matsumoto, Naoki; Tomioka, Akihiro; Satô, Tomonobu; Kawasaki, Masakazu; Kikuchi, Yuji; Saito, Shigeru

doi:10.1097/yct.0b013e3181926ac0

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…Although there was a tendency towards a longer interval between commencement of administration of neuromuscular blocking agents and T1 zero in the rocuronium group in this study, the difference between the two groups was not significant. The possible cause of this difference, as we previously showed [16], is that the onset of action of muscle relaxants is greatly affected by cardiac output before injection. Another possibility is that Sluga et al [15] selected 1.5 mg/kg propofol with 2 lg/kg fentanyl for anesthetic induction.…”

Section: Discussionmentioning

confidence: 82%

Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy

et al. 2011

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Section: Discussionmentioning

confidence: 82%

Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy

et al. 2011

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“…First, we previously showed that the onset and duration of muscle relaxants were greatly influenced by cardiac output before injection [13]. Hence, the onset and duration of muscle relaxation in each of our patients may have been affected by their individual cardiac outputs.…”

Section: Discussionmentioning

confidence: 92%

“…This could partly explain why almost twice the time was needed for the recovery of T1 to 10 and 90% in this patient. Another possibility is that the onset and duration of muscle relaxants are greatly influenced by cardiac output before injection [13] be responsible for these differences observed in case 1.…”

Section: Discussionmentioning

confidence: 99%

Use of rocuronium–sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy

et al. 2011

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We compared the recovery time from neuromuscular blockade induced by rocuronium combined with sugammadex versus succinylcholine during electroconvulsive therapy (ECT). Anesthesia was induced using propofol, followed by succinylcholine (1 mg/kg) or rocuronium (0.6 mg/kg). Immediately after the seizure stopped, 16 mg/kg sugammadex was infused. Neuromuscular monitoring was performed and continued until recovery of the train-of-four ratio to 0.9. We compared the recovery time of T1 to 10 and 90% between groups. Patients were also assessed for clinical signs, such as time to first spontaneous breath from the administration of muscle relaxant and eye opening to verbal commands. Although recovery time of T1 to 10 and 90% in the rocuronium-sugammadex group was shorter than in the succinylcholine group, the difference was not statistically significant. Further, the seizure duration with succinylcholine (33 ± 8 s) was shorter than that with rocuronium-sugammadex (39 ± 4 s). In conclusion, this study demonstrates the potential benefit of use of rocuronium-sugammadex as an alternative to succinylcholine for muscle relaxation during ECT.

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“…Previously, we reported that the onset and effect duration of succinylcholine chloride (Sch), which is metabolized by the same metabolic enzyme, plasma pseudocholinesterase, as landiolol, is related to CI before administration among patients receiving electroconvulsive therapy. 36) In that report, we found that higher CI shortened the onset of Sch and prolonged the effect duration of Sch. In order to examine the effects of circulating time on landiolol concentration, we calculated the estimated circulating blood volume (ECBV) by formula 1 for men and formula 2 (for women) 37) : …”

Section: Discussionmentioning

confidence: 77%

Influence of Hemodynamic Variations on the Pharmacokinetics of Landiolol in Patients Undergoing Cardiovascular Surgery

Matsumoto

Aomori

Kanamoto

et al. 2012

Biological & Pharmaceutical Bulletin

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Although landiolol is useful in the emergency management of atrial fibrillation, atrial flutter, and tachycardia, as well as in perioperative arrhythmia control, the influence of hemodynamic changes on the pharmacokinetics of landiolol is unknown. We investigated the influence of hemodynamic variation and the following hepatocirculatory changes after systemic heparinization on the pharmacokinetics of landiolol in patients undergoing cardiovascular surgery under cardiopulmonary bypass. Cardiac output and cardiac index (CI) were continuously monitored in 19 patients using an arterial pressure-based cardiac output monitor. The middle and right hepatic venous blood flow indexes (mHVBFI and rHVBFI) were measured by transesophageal echocardiography, and hemodynamic data were collected at points (T1-T3) as follows: T1, before administration of heparin and after sternotomy; T2, just before systemic heparinization (300 U/kg); T3, 10 min after T2. The plasma concentration of landiolol was measured by HPLC at the same point. After administration of heparin, mean arterial blood pressure, CI, mHVBFI, and rHVBFI were significantly decreased (<0.05). Heart rate was not significantly changed. After systemic heparinization, the landiolol concentration was significantly decreased from 0.407 0.251 µg·mL 1 to 0.232 0.207 µg·mL 1 (<0.01). There was no significant difference between T1 and T2 ( 0.88). In conclusion, the plasma concentration of landiolol was decreased by diminished CI due to systemic heparinization, but not affected by the change of hepatic blood flow.Key words landiolol; cardiac index; hepatic venous blood flow; heparin; HPLC; pseudocholinesterase β 1 -Blockers have been reported to decrease perioperative morbidity and mortality in patients with cardiovascular disease undergoing surgery, [1][2][3][4] and are recommended to be started as early as possible before the operation and maintained during and after surgery.5) β 1 -Blockers have been reported to be effective regulators of heart rate (HR) and sinus rhythm in postoperative atrial fibrillation and flutter, 6) which play an important role in the increased incidence of postoperative complications and the duration of hospitalization among patients requiring cardiac surgery. [7][8][9] Landiolol is an ultra-short-acting β 1 -selective adrenergic receptor-blocking agent. It is rapidly hydrolyzed to an inactive form by both carboxylesterase in the liver and pseudocholinesterase in the plasma, 10) resulting in an estimated half-life of about 4 min, which is significantly shorter than the elimination half-lives of conventional β 1 -blockers.11) In addition, landiolol hydrochloride has a much higher cardioselectivity (β 1 /β 2 =255) than currently available β 1 -blockers such as esmolol hydrochloride (β 1 /β 2 =33).10) Because of its characteristics, landiolol hydrochloride has been used in the emergency management of atrial fibrillation, atrial flutter, and tachycardia, as well as in perioperative arrhythmia control. Landiolol has been reported to attenuate tachycardia wi...

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Relationship Between Cardiac Output and Onset of Succinylcholine Chloride Action in Electroconvulsive Therapy Patients

Abstract: The onset of muscle relaxation varies among patients receiving ECT and is related to CI before Sch administration. In patients for whom fasciculation is difficult to determine, the effects of a muscle relaxant should be objectively confirmed before electrical stimulation of the brain.

Cited by 7 publications

References 12 publications

Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy

Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy

Use of rocuronium–sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy

Influence of Hemodynamic Variations on the Pharmacokinetics of Landiolol in Patients Undergoing Cardiovascular Surgery

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