The Influence of Drugs Used in Therapeutics on the Action of Muscle Relaxants

Emery, E. R. J.

doi:10.1093/bja/35.9.565

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…atracurium can also interact with other drugs [23][24][25][26]. This study focused on the interaction between gentamicin and atracurium there are some studies discussed that effect of showed that there was no interaction between the group who took gentamicin and the control group who took only d-tubocurarine.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Gentamicin on the Action of Atracurium in Adult Patients

Abdeltawab¹,

Abdelrahim²,

Said³

et al. 2014

Med-Science

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Section: Discussionmentioning

confidence: 99%

The Effect of Gentamicin on the Action of Atracurium in Adult Patients

Abdeltawab¹,

Abdelrahim²,

Said³

et al. 2014

Med-Science

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“…The anaesthetist must concern himself not only with drugs which he himself administers, but also with drugs given by others. The antibiotics are of particular importance since most accumulate rapidly in the presence of renal failure, and streptomycin, neomycin, polymixin B, kanamycin and colistin potentiate non-depolarizing muscle relaxants and can themselves cause block (Emery, 1963;McQuillen, Cantor and O'Rourke, 1958;Pittinger, Eryasa and Adamson, 1970). It is significant that prolonged muscle paralysis induced by gallamine and tubocurarine in patients with renal disease has been associated with the simultaneous administration of streptomycin and kanamycin (Feldman and Levi, 1963;McQuillen, Cantor and O'Rourke, 1968;Lowenstein, Goldfine and Flacke, 1970).…”

Section: Discussionmentioning

confidence: 99%

“…Negligible amounts of phenylbutazone or dicoumarol appear unchanged in the urine; they are presumably secreted and then promptly reabsorbed. Basic drugs can also compete with each other for active secretion (Peters, 1960), and this might contribute to the potentiation of the muscle relaxant activity of tubocurarine and gallamine by mecamylamine, quinidine and antibiotics such as streptomycin, neomycin, kanamycin and colistin (Emery, 1963;McQuillen, Cantor and O'Rourke, 1968).…”

Section: Active Tubular Secretionmentioning

confidence: 99%

Mechanisms of Renal Excretion of Drugs (With Special Reference to Drugs Used by Anaesthetists)

Prescott¹

1972

British Journal of Anaesthesia

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Contrary to popular belief, the elimination of active drug by renal excretion is a relatively unimportant mechanism for the termination of drug action. Most drugs are weak electrolytes which are lipid-soluble in the un-ionized state, and as such they cannot be excreted by the kidney because they are extensively reabsorbed. These lipid-soluble drugs are invariably metabolized to more water-soluble derivatives which usually have little or no pharmacological activity and can readily be excreted in the urine. The duration of action is therefore determined largely by redistribution, metabolism, and in the case of the anaesthetic gases, by elimination through the lungs. On the other hand, some drugs have limited lipid solubility or are highly ionized in the physiological range of pH. They tend to be eliminated largely unchanged by renal excretion and their duration of action may be prolonged in the presence of impaired renal function. Familiar drugs which fall into this category include quaternary ammonium bases, ganglion blocking drugs, non-depolarizing muscle relaxants, many antibiotics, thiazide diuretics, methotrexate, digoxin and barbitone (table I). From a practical point of view it is obviously important to know whether the major route of elimination of a drug is through metabolism or renal excretion. TABLE I. Some drugs jor which renal excretion is normally an important route of elimination.

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“…22 (vii) The intensity and duration of response of the patient to D-tubocurarine is also dependent on its redistribution from the plasma into the body tissues. Kalow 86 described three overlapping phases to account for the redistribution and Fleischli and Cohen 26 used a simulated analog computer to calculate these changes.…”

mentioning

confidence: 99%

D-tubocurarine dosage based on lean body mass

Wulfsohn

1972

Canad. Anaesth. Soc. J.

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IS A GREAT VARIABILITY in the initial dosage of D-tubocurarine (DTC) recommended for relaxation during general anaesthesia. It varies from a low of .098 mg/Kg* 9 to a high of 1 mg/Kg* 1 . Foldes 29 and Kalow 87 recognized the fact that body build, amongst other factors, would influence the dosage requirement. Muscular patients would require more and fat patients less drug on a mg/Kg of total body weight basis. Long and Bachxnan 44 postulated that the lesser degree of paralysis and quicker recovery from D-tubocurarine in older children as compared to younger children, when given a dosage based on total body weight, probably was due to the difference in muscle mass. In infants muscle represents 20 per cent of body weight, whereas in older children it is 33 per cent.Body build is reflected in the lean body mass (LBM) and percentage fat. In this paper the use of lean body mass instead of total body weight as a predictor of dose is explored-METHOD Thirty-seven adult patients with normal cardio-vascular, respiratory and hepatic systems, and free of known neuromuscular disorders were measured for height (inches), weight (Kg) and girth (inches) using the umbilical level at expiration. The percentage fat and lean body mass was calculated from Weisberg's formula: Premedication consisted of atropine with pentobarbital or meperidine. Induction of anaesthesia was with thiopentone and anaesthesia maintained with nitrous oxide and one of three different anaesthetics, namely, halothane, methoxyflurane or meperidine. The umar nerve was supramaximally stimulated with a Block Aid Monitor (Burroughs Wellcome Co.), placing the subcutaneous needle electrodes near the wrist. Thumb movement was measured by a force displacement transducer (Grass FP 103) and recorded on a Grass Model 7 Polygraph. Endotracheal intubation was performed under relaxation with succinyldicholine which was given in doses of 1 mg/Kg LBM and the depression of twitch and tetanus were followed until full recovery.Artificial ventilation was maintained with an Airshield's Ventilator at an average of 600 ml tidal volume at a rate of 18/min.

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The Influence of Drugs Used in Therapeutics on the Action of Muscle Relaxants

Cited by 11 publications

References 20 publications

The Effect of Gentamicin on the Action of Atracurium in Adult Patients

The Effect of Gentamicin on the Action of Atracurium in Adult Patients

Mechanisms of Renal Excretion of Drugs (With Special Reference to Drugs Used by Anaesthetists)

D-tubocurarine dosage based on lean body mass

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