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Abstract Introduction: The objective of this study was to investigate the effect of mivacurium in the application of fast-track anesthesia for transthoracic device closure of ventricular septal defects (VSDs) in children. Methods: The data of 108 children who underwent transthoracic device closure of VSDs from December 2018 to June 2020 were recorded and analyzed. All children were divided into group M (mivacurium group, n=55) and group C (cisatracurium group, n=53) according to the different muscle relaxant drug used. Results: No statistically significant differences in general preoperative data, intraoperative hemodynamic changes, or the incidence of adverse reactions were noted between the two groups (P>0.05). However, the intubation condition rating of children in group M was better than that in group C. The onset time, duration of clinical action and recovery index of the muscle relaxant, postoperative mechanical ventilation duration, and length of intensive care unit stay in group M were significantly lower than those in group C (P<0.05). Conclusion: It is safe and feasible to use mivacurium as a muscle relaxant in children undergoing fast-track cardiac anesthesia during transthoracic device closure of VSDs.
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Background:Cisatracurium is the stereoisomer of atracurium but has considerably higher neuromuscular blocking potency, better hemodynamic profile and no association with dose-dependent histamine release, as compared with the parent compound(1)(2,3). On the other hand, 2 ED95dose s of cis-atracurium (100? g/kg) do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium.There are limited studies which provide us the clarity of a better neuromuscular blocker in terms of intubation and maintainence amongst the two with the most optimum dose. Material And Methods:The study designed as randomised controlled trial, recruited 150 patients into three groups: Group A-atracurium 0.5 mg/kg(2×ED95), Group B and C-cis-atracurium 0.2 mg/kg (4×ED95) and 0.4 mg/kg (8×ED95)respectively and compared them on the basis of onset, duration of action, recovery time, haemodynamic effect and signs of histamine release clinically. Result:Patients in Group C had significantly shorter onset time of block when c ompared with group A & B. Mean duration of block after loading dose was significantly shorter in Group A than group B & C. Group B had a shorter duration of block than C. Recovery time of block in group A was significantly shorter than group B & C. Conclusion:Cis-atracurium in dose of 0.2 mg/kg seems to be better alternative to atracurium 0.5 mg/kg and cis-atracurium 0.4 mg/kg in providing faster onset, intermediate duration of action with fast recovery and it can be used for intubation as well as maintenance.
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The clinical data of patients with severe acute pancreatitis complicated with intraabdominal hypertension or abdominal compartment syndrome admitted to our Department of Critical Care Medicine from January 1, 2018 to October 1, 2021 were collected and analyzed.Patients were divided into a conventional treatment group and conventional treatment plus IV infusion of cisatracurium besilate group (muscle relaxation group). A prediction model of treatment propensity score was developed for paired screening, with 31 cases in each group.The conventional treatment group adopted conventional basic treatment methods such as gastrointestinal decompression, spasmolysis and analgesia, fluid therapy, inhibition of gastric acid, suppression of parenzyme, nutritional support, mechanical ventilation, and enemata.In muscle relaxation group, cisatracurium besilate was intravenously infused on the basis of routine treatment with the initial dose of 0.15 mg/kg given to facilitate endotracheal intubation, followed by continuous intravenous infusion at 1-3 μg·kg -1·min -1, and the dose was adjusted according to the patient′s basic vital signs and clinical effects.The primary outcome was survival rate.Secondary outcome measures were changes in intraabdominal pressure, oxygenation index, the number of defecation, volume of defecation, and urination volume before treatment and on 7, 14 and 20 days of treatment.and the recovery time of bowel sounds, length of mechanical ventilation, time of intensive care unit treatment, and total hospitalization costs.Compared with conventional treatment group, the survival rate was significantly increased, the intraabdominal pressure was decreased on 7, 14 and 20 days of therapy, the oxygenation index was increased, the number of defecation and volume of defecation were increased on 7 and 14 days of therapy, urinary volume was increased before treatment and on day 7 of therapy, the recovery time of intestinal sound was significantly shortened ( P<0.05), and no significant change was found in urinary volume on days 14 and 20 of therapy, length of ventilation, time of intensive care unit treatment, and total hospitalization costs in muscle relaxation group ( P>0.05). In conclusion, cisatracurium besilate can improve oxygenation, promote the recovery of intestinal function and improve the survival rate when used to assist the treatment in the patients with severe acute pancreatitis complicated with intraabdominal hypertension.
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Objective:To compare the efficacy of mivacurium versus cisatracurium in patients undergoing painless fiberoptic bronchoscopy.Methods:A total of 100 patients of both sexes, aged 18-64 yr, of American Society of Anesthesiology physical status I or Ⅱ, scheduled for elective fiberoptic bronchoscopy were divided into 2 groups ( n=50 each) using a random number table method: mivacurium group (M group) and cisatracurium group (C group). Mivacurium 0.15 mg/kg was injected intravenously in group M, and cisatracurium 0.1 mg/kg was injected intravenously in group C. The onset time of neuromuscular block (ThD95), the duration of neuromuscular block (TOFR25), recovery index (RI), recovery time of autonomous respiration, extubation time and time of discharge from postanesthesia care unit (PACU) were recorded.The occurrence of intraoperative and postoperative adverse reactions and complications were recorded.The mean arterial pressure (MAP), heart rate (HR) and SpO 2 at restlessness at 10 min after entering the operating room (T 1), at loss of consciousness (T 2), when laryngeal mask airway was inserted (T 3), at the end of surgery (T 4), when laryngel mask airway was removed (T 5), and when the patients left the operating room (T 6). Results:Compared with group C, TOFR25, RI, recovery time of autonomous respiration, extubation time and time of discharge from PACU were significantly shortened, the total incidence of adverse reactions was decreased ( P<0.05), and no significant change was found in ThD95 in group M ( P>0.05). There was no significant difference in MAP, HR and SpO 2 at each time point between the 2 groups ( P>0.05). Conclusion:Mivacurium provides better efficacy than cisatracurium when used for painless fiberoptic bronchoscopy.
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Abstract Introduction: The association between local anesthetics (LA) and neuromuscular blocking (NMB) drugs in clinical practice, and the possibility of interaction between these drugs has been investigated. LAs act on neuromuscular transmission in a dose-dependent manner and may potentiate the effects of NMB drugs. Objective: The aim of this study was to evaluate, in an experimental model, the effect of lidocaine and racemic bupivacaine on neuromuscular transmission and the influence on neuromuscular blockade produced by atracurium. Methods: Male Wistar rats, weighing from 250 to 300 g were used. The preparation was set up based on a technique proposed by Bülbring. Groups were formed (n = 5) according to the drug studied: lidocaine 20 µg.mL−1 (Group I); racemic bupivacaine 5 µg.mL−1 (Group II); atracurium 20 µg.mL−1 (Group III); atracurium 20 µg.mL−1 in a preparation previously exposed to lidocaine 20 µg.mL−1 and racemic bupivacaine 5 µg.mL−1, Groups IV and V, respectively. The following parameters were assessed: 1) Amplitude of hemi diaphragmatic response to indirect stimulation before and 60 minutes after addition of the drugs; 2) Membrane potentials (MP) and miniature endplate potentials (MEPPs). Results: Lidocaine and racemic bupivacaine alone did not alter the amplitude of muscle response. With previous use of lidocaine and racemic bupivacaine, the neuromuscular blockade (%) induced by atracurium was 86.66 ± 12.48 and 100, respectively, with a significant difference (p = 0.003), in comparison to the blockade produced by atracurium alone (55.7 ± 11.22). These drugs did not alter membrane potential. Lidocaine initially increased the frequency of MEPPs, followed by blockade. With the use of bupivacaine, the blockade was progressive. Conclusions: Lidocaine and racemic bupivacaine had a presynaptic effect expressed by alterations in MEPPs, which may explain the interaction and potentiation of NMB produced by atracurium.
Resumo Introdução: A associação de anestésicos locais (AL) com bloqueadores neuromusculares (BNM) na prática clínica e a possibilidade de interação entre esses fármacos têm sido investigadas. Objetivo: Avaliar, em modelo experimental, o efeito da lidocaína e da bupivacaína racêmica na transmissão neuromuscular e sua influência no bloqueio neuromuscular produzido pelo atracúrio. Método: Ratos machos da linhagem Wistar, peso entre 250 e 300 g. A preparação foi feita de acordo com a técnica proposta por Bulbring. Grupos (n = 5) de acordo com o fármaco em estudo: lidocaína 20 µg.mL-1 (Grupo I); bupivacaína racêmica 5 µg.mL-1 (Grupo II); atracúrio 20 µg.mL-1 (Grupo III); atracúrio 20 µg.mL-1 em preparação previamente exposta a lidocaína 20 µg.mL-1 e bupivacaína racêmica 5 µg.mL-1, Grupos IV e V, respectivamente. Foram avaliados: 1) A amplitude das respostas do hemidiafragma à estimulação indireta antes e 60 minutos após a adição dos fármacos; 2) Os potenciais de membrana (PM) e os potenciais de placa terminal em miniatura (PPTM). Resultados: Os AL, isoladamente, não alteraram a amplitude das respostas musculares. Com o uso prévio dos AL, o bloqueio neuromuscular (%) do atracúrio foi 86,66 ± 12,48 e 100, respectivamente, com diferença significante (p= 0,003) em relação ao produzido pelo atracúrio isoladamente (55,7 ± 11,22). Não alteraram o PM. A lidocaína inicialmente aumentou a frequência dos PPTM, seguido de bloqueio; com a bupivacaína, o bloqueio foi progressivo. Conclusão: A lidocaína e a bupivacaína racêmica apresentaram efeito pré-sináptico expresso por alterações nos PPTM, podem justificar a potencialização do bloqueio neuromuscular produzido pelo atracúrio.
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Animals , Male , Rats , Atracurium/pharmacology , Bupivacaine/pharmacology , Neuromuscular Blockade , Anesthetics, Local/pharmacology , Lidocaine/pharmacology , Neuromuscular Junction/drug effects , Neuromuscular Junction/physiology , Rats, Wistar , Drug InteractionsABSTRACT
Introduction: Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this would be thegreatest advantage in replacing atracurium for the facilitation of endotracheal intubation.Aim: The aim of the study was to compare the effectiveness of atracurium 0.5 (2 ED95) mg/kg IV versus two different dosesof cisatracurium, i.e., 0.1 (2 ED95) and 0.15 (3 ED95) mg/kg IV for intubation with regard to onset time for intubation, intubingconditions, duration of blockade, and hemodynamic parameters.Materials and Methods: In this study, 150 patients of the American Society of Anesthesiologists Grades 1 and 2 undergoingelective surgeries under general anesthesia were taken up and divided into three groups of 50 each by computer-generatedrandomization. GroupA received Inj. atracurium besylate 0.5 mg/kg IV, Group B received Inj. cisatracurium besylate 0.1 mg/kg IV,and Group C received Inj. cisatracurium besylate 0.15 mg/kg IV.Results: The three groups were compared regarding the onset of blockade, duration of blockade, condition of intubation,hemodynamic effects, and results analyzed.Conclusion: Cisatracurium 0.15 mg/kg provides excellent intubating conditions with rapid onset of action, with longer durationof action and no significant hemodynamic changes when compared with cisatracurium 0.1 mg/kg and atracurium 0.5 mg/kgand hence cisatracurium 0.15 mg/kg can be used as an ideal non-depolarizing muscle relaxant for intubation.
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The aim of this study was to investigate the acute effects of atracurium besylate on cellular damage in corneal endothelium of chickens. Twenty healthy chicken eyes were assigned to the following groups: Group 1 (G1), experimental group (n=10); and Group 2 (G2), control (n=10). Excised corneoscleral buttons were immediately placed on glass microscopy slides with endothelial region faced up. Corneal endothelium of eyes in G1 were covered with AB (0.2mL, 10mg/mL) for 3 min and then rinsed with balanced salt solution (BSS), while the corneal endothelium of eyes in G2 were covered with BBS for 3 min. Corneas from both groups were stained with alizarin red/trypan blue and visualized by light microscopy. Ten random photographs were taken from each cornea. The area of cellular damage was measured by software in all samples and cell loss of each group was averaged and compared. Endothelial area of denudation and Descemet's membrane exposure were higher in G1 than G2. In conclusion, atracurium besylate induced an acute damage on corneal endothelium of chickens.(AU)'
Objetivou-se avaliar os efeitos agudos do besilato de atracúrio sobre o endotélio corneano de galinhas. Vinte olhos saudáveis de galinhas foram aleatoriamente separados em dois grupos com 10 olhos cada, sendo G1 o grupo controle e G2 o grupo tratamento. Imediatamente após a excisão dos botões corneoesclerais estes foram colocados em lâminas de microscopia de vidro com o lado endotelial voltado para cima. No Grupo 1, o endotélio corneano foi recoberto com 0,2ml de besilato de atracúrio (10mg/ml) durante 3 minutos e depois lavado com solução salina balanceada. No Grupo 2, o endotélio corneano foi recoberto apenas com solução salina balanceada durante 3 min. As córneas de ambos os grupos foram coradas com vermelho de alizarina e azul de tripano e visualizadas com microscópio óptico. Foram obtidas dez fotografias aleatórias de cada amostra. As imagens foram analisadas e com auxílio de um software as áreas com ausência de células endoteliais calculadas. A perda celular endotelial foi significativamente maior no grupo tratamento comparativamente ao grupo controle. Com base nos resultados apresentados foi possível concluir que o besilato de atracúrio induziu dano agudo nas células do endotélio da córnea de galinhas.(AU)
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Animals , Atracurium/adverse effects , Endothelium, Corneal/pathology , Mydriasis/veterinary , Chickens , Corneal Endothelial Cell Loss/veterinaryABSTRACT
Objective To evaluate the pharmacodynamics of cisatracurium intravenously infused during liver transplantation.Methods Twenty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes,aged 18-60 yr,with body mass index of 20-30 kg/m2,scheduled for elective living donor liver transplantation,were enrolled in this study.Total intravenous anesthesia was used.The induction dose of cisatracurium for anesthesia was 0.15 mg/kg.When T1/T0 was restored to 10％,cisatracurium was injected intravenously at an initial rate of 1.5 μg · kg-1 · min-1.The infusion rate was adjusted according to the monitoring results of muscle relaxation,and T1/T0 was maintained at 10％.The total amount of cisatracurium infused and infusing time were recorded during dissection phase,anhepatic phase and neohepatic phase,and the consumption of cisatracurium per unit time was calculated.Before skin incision,at 5 and 30 min of anhepatic phase,at 5 and 30 min of neohepatic phase and at the end of operation,the body temperature and stroke volume variation were recorded,blood samples were collected from the radial artery for blood gas analysis and for measurement of blood K+,Mg2+ and Ca2+ concentrations,and blood samples were collected from the internal jugular vein for determination of serum creatinine (Cr),urea nitrogen (BUN) and β2 microspheres protein (β2-MG) concentrations.Results There was no significant difference in the amount of cisatracurium per unit time between dissection phase and anhepatic phase (P＞0.05).The amount of cisatracurium per unit time was significantly higher in neohepatic phase than in dissection phase and anhepatic phase (P＜0.05).Compared with baseline before skin incision,blood pH value was significantly decreased at 30 min of anhepatie phase and 5 min of neohepatic phase,serum Mg2+concentrations were decreased at 5 and 30 min of neohepatic phase and at the end of operation,the serum Cr,BUN and β2-MG concentrations were increased,the serum Ca2+ concentration was decreased at 5 min of anhepatic phase,and SVV was increased at 5 and 30 min of anhepatic phase (P＜ 0.05 or 0.01).Conclusion Muscle relaxation induced by cisatracurium infused intravenously in the anhepatic phase of liver transplantation is weakened.
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Objective To investigate the efficacy and prognosis of using midazolam combined with atracurium for treatment of a patient with super-refractory status epilepticus (SRSE) and coma. Methods A case of SRSE and coma admitted to the Department of Critical Care Medicine of Renmin Hospital of Wuhan University in May 2018 was enrolled. The symptoms, signs, laboratory examinations and treatment process were summarized, and combined with the literature review, the therapeutic course and prognosis were analyzed. Results A male patient, 24 years old, had convulsions after 4-day fever, blood routine, blood biochemistry, coagulation function and infection indexes were basically normal on admission. There was no obvious abnormality in cerebrospinal fluid examination; blood pathogenic microorganism examination suggested that viral infection possibly occur. Electroencephalogram (EEG) showed that the lesions involved the right frontal pole-frontal area-temporal area; cranial magnetic resonance imaging (MRI) suggested that sinusitis and meningeal and hippocampal infections might be present. Although several antiepileptic drugs had been used, the convulsions could not be controlled, after combined with the application of midazolam and atracurium, the convulsions were controlled, in the mean time, antiviral drug, glucocorticoid and immunoglobulin and therapies for prevention of complications were applied. Forty-three days later, the patient's consciousness was recovered and muscle strength was gradually improved. Conclusion The combination of midazolam and atracurium is effective for controlling epileptic activities and alleviating sequelae in patients with SRSE and coma.
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BACKGROUND: The concept of the effect-site concentration of anesthetic agents is important. The effect compartment model can be explained using the concepts of effect-site concentration and effect-site equilibration rate constant (k e0). This study confirms that the time-to-peak effect (tpe ) can be measured easily in clinical practice by applying a priming dose and train-of-four (TOF) during general anesthesia induction, and k e0 can be calculated from the tpe of the four muscle relaxants that are commonly used in general anesthesia. METHODS: Eighty patients who received general anesthesia were divided into the succinylcholine, rocuronium, atracurium, or vecuronium groups. Priming doses of muscle relaxants were administered. The effects of muscle relaxants were quantified by recording the twitch response of the adductor pollicis muscle after stimulating the ulnar nerve. The tpe was measured at the lowest TOF value. k e0 was calculated from the measured tpe . RESULTS: The k e0 values of the succinylcholine, rocuronium, atracurium, and vecuronium groups were 0.076 (0.030)/min, 0.228 (0.122)/min, 0.062 (0.011)/min, and 0.077 (0.019)/min, respectively. CONCLUSIONS: It is possible to estimate k e0 from the tpe of muscle relaxants using a priming dose and TOF during general anesthesia induction.
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Humans , Anesthesia, General , Anesthetics , Atracurium , Succinylcholine , Ulnar Nerve , Vecuronium BromideABSTRACT
Objective To evaluate the effect of neoadjuvant chemotherapy factor on neuromuscular block induced by cisatracurium in the patients undergoing radical gastrectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 48-79 yr,with body mass index of 20-27 kg/m2,scheduled for elective laparoscopic radical gastrectomy,were divided into 2 groups (n =30each) according to whether the patient received neoadjuvant chemotherapy before operation or not:nonchemotherapy group (group A) and neoadjuvent chemotherapy group (group B).Anesthesia was induced with cisatracurium 0.15 mg/kg (3×ED95) injected intravenously.When T1 recovered to 10％ of control height,Ⅳ infusion of cisatracurium was started with an initial dose of 1.5 μg · kg-1 · min 1,and the infusion rate was adjusted with the amplitude of 0.2 μg · kg 1 · min-1 to maintain T1 at 5％-10％ of control height.The onset time,nonresponse time,time for T1 to recover to 10％,recovery index and time for train of four ratio to recover to 90％ were recorded.The consumption of cisatracurium was continuously recorded event 30 min starting from Ⅳ infusion of cisatracurium for 3 times,90 min in total.The mean infusion rate within 90 min was calculated.Results Compared with group A,the onset time,recovery index and time for train of four ratio to recover to 90％ were significantly prolonged,the nonresponse time and time for T1 to recover to 10％ were shortened,and the consumption of cisatracurium and mean infusion rate were increased in group B (P＜0.05).Conclusion Neoadjuvant chemotherapy factor can weaken neuromuscular block induced by cisatracurium in the patients undergoing radical gastrectomy.
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Objective To evaluate the effect of deep and moderate neuromuscular blockade on surgical conditions during minor laparoscopic gynecologic surgery.Methods Sixty-five patients,with expected surgery time ＜ 3 h,aged 18-60 yr,with body mass index＜30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ orⅡ,scheduled for elective laparoscopic gynecological surgery,were allocated into deep neuromuscular blockade group (group D,n =33) and moderate neuromuscular blockade group (group M,n=32) using a random number table.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.Cisatracurium was continuously infused to maintain the degree of neuromuscular blockade in both groups to achieve the target degree post-tetanic count of 1 or 2 in group D and train-of-four (TOF) count of 1 or 2 in group M.Surgical conditions were assessed and scored after surgery.The recovery index,time for TOF ratio returning to 0.7 and 0.9,surgery time,mean intra-abdominal pressure,extubation time and TOF ratio at extubation were recorded.Results Compared with group M,the mean intra-abdominal pressure was significantly decreased,and the extubation time and time for TOF ratio returning to 0.7 and 0.9 were prolonged in group D (P＜0.05).There was no significant difference in the other parameters between the two groups (P＞0.05).Conclusion Moderate neuromuscular blockade can provide better surgical conditions for minor laparoscopic gynecological surgery with shorter recovery time.
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Objective To evaluate the efficacy of clemastine fumarate in antagonizing atracuriuminduced release of histamine in the patients undergoing surgery under general anesthesia.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 21-59 yr,with body mass index of 17-26 kg/m2,scheduled for elective modified radical mastectomy,were divided into 2 groups (n=40 each) using a random number table:control group (group C) and clemastine fumarat group (group CF).Clemastine fumarate 2 mg was injected intramuscularly at 20 min before induction of anesthesia.Anesthesia was induced with iv midazolam 0.1 mg/kg,etomidate 0.3 mg/kg,fentanyl 4-6 μg/kg and atracurium 0.8 mg/kg.The patients were mechanically ventilated after insertion of the larygeal mask airway.Anesthesia was maintained with inhalation of 2％ sevoflurane.Before administration of clemastine fumarate,at 20 min after administration,immediately before administration of atracurium,and at 2,5,10 and 20 min after administration of atracurium,arterial blood samples were taken for determination of plasma histamine concentrations,and the peak airway pressure and degree of cutaneous color were recorded.The development of histaminemia and adverse cardiovascular events was assessed.Steward recovery scores and Ramsay sedation scores were recorded at 10 min after removal of the laryngeal mask airway.Results The incidence of histaminemia was 60％ and 8％ in C and CF groups,respectively.Compared with group C,the plasma histamine concentrations,incidence of histaminemia,degree of cutaneous color,and incidence of hypotension and tachycardia were significantly decreased (P＜0.05),and no significant change was found in the peak airway pressure,Steward recovery scores and Ramsay sedation scores in group CF (P＞0.05).Conclusion For atracurium-induced release of histamine in the patients undergoing surgery under general anesthesia,clemastine fumarate 2 mg injected intramuscularly before operation can not only antagonize histamine at H1 level,but also reduce histamine release,and exerts no influence on recovery from anesthesia and produces good antihistamine efficacy.
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Objective To evaluate the effects of long?term glucocorticoid administration on cisatra?curium?induced neuromuscular blockade in the patients undergoing laparoscopic operation. Methods Six?ty?four patients of both sexes, aged 40-64 yr, with body mass index of 18-22 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic operation under general anesthesia, were assigned into 4 groups ( n=16 each) according to whether or not glucocorticoid was used for a long?term period: control ( non?hormone and non?laparoscopic operation ) group ( group C ) , hor?mone + laparoscopic operation group ( group HL ) , non?hormone + laparoscopic operation group ( group NHL) and hormone +non?laparoscopic operation group ( group HNL) . Midazolam 0.03 mg∕kg was injected intravenously, 8% sevoflurane was inhaled by mask, and the concentration of sevoflurane was decreased by 2% every 30 s until the concentration of 4% was reached. After loss of eyelash reflex, remifentanil 2μg∕kg was injected intravenously over 1 min, and 30 s later sevoflurane inhalation was stopped. The patients were tracheally intubated and mechanically ventilated. Anesthesia was maintained with propofol and remifentanil given by target?controlled infusion. Neuromuscular blockade was monitored with accelerograph TOF?watch SX. At 20 min of pneumoperitoneum in NHL and HL groups or 20 min after intubation in C and HNL groups, cisatracurium 0. 15 mg∕kg was injected intravenously. The onset time, maximal degree of N?M block, clinical duration and recovery index of cisatracurium were recorded. Results Compared with group C, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clini?cal duration was shortened, and the recovery index was decreased in HL and HNL groups ( P0.05) . Compared with group HNL, the clin?ical duration was significantly prolonged, the recovery index was increased (P0.05) , and the onset time was significantly shortened, the clinical duration was prolonged, and the recovery index was increased in group NHL ( P<0.05) . Com?pared with group NHL, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clinical duration was shortened, and the recovery index was decreased in group HL ( P<0.05) . Conclusion Long?term glucocorticoid administration can weaken cisatracurium?induced neuromus?cular blockade in the patients undergoing laparoscopic operation.
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Objective To analyze the effects of different age and gender on the efficacy and pharmacokinetics of the target controlled infusion of atracurium besylate on liver dysfunction.Methods 160 case of patients with liver dysfunction and undergoing elective general anesthesia operation were divided into four groups according to their age and gender, 40 cases in each group:group A (age≥65 years old, male), group B (age≥65 years old, female), group C (age<65 years old, male), group D (age<65 years old, female).The patients received one-time double dose ED95 atracurium besylate, pharmacodynamic indexes and pharmacokinetic parameters were compared.Results The four groups of patients with block onset time, block maintenance time, clinical duration of T25%, in vivo role time T95%, muscle relaxation recovery index were compared, the difference was not statistically significant.The preoperative and postoperative 24h, four groups of patients with liver function ( alanine aminotransferase, aspartate aminotransferase, albumin, bilirubin) and renal function ( creatinine, urea nitrogen) were compared, the difference was not statistically significant.There was no significant difference between the four groups in the plasma concentrations of the substance to be measured, the peak time, the area under the curve and the elimination half lives.Conclusion For the patients with liver dysfunction, the target controlled infusion of atracurium besylate in general anesthesia operation, gender and age were not considered.
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Drug-induced anaphylaxis has increased in frequency with the more widespread use of pharmaceutical agents. Neuromuscular blocking agents (NMBAs) are one of the most common causes of anaphylaxis during general anesthesia. However, the incidence of anaphylaxis due to atracurium is very rare (<1/10,000) according to UK Summary of Product Characteristics. NMBAs can induce two types of reactions: one is immune mediated - immunoglobulin E dependent and the second one is associated with non-specific stimulation of mast cells. Systemic manifestations of anaphylaxis can be in the form of hypotension, difficulty in breathing. Rarely, it can be associated with cutaneous manifestations such as urticaria, angioedema, and flushing. If it is not promptly diagnosed and treated, it can be fatal. In the present case, the patient was posted for submandibular gland surgery. She was well-stabilized after general anesthesia and within the seconds of giving injection atracurium; she had difficulty in breathing and marked decrease in blood pressure that was soon followed by periorbital swelling and swelling of lips. The patient was diagnosed with anaphylaxis with angioedema due to atracurium and was promptly managed in operation theater. She was kept under observation for 2 days. Anaphylaxis along with angioedema with atracurium is a very rare event, and hence it is being reported here.
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Objective To investigate the neuromuscular block effect of intravenous injection of cisatracurium in myasthenia gravis patients with different ages.Methods Fifteen geriatric patients defined as geriatric group(≥ 65 years old)with ASA Ⅰ-Ⅱ scheduled for video-assisted thoracoscopic (VATS)thymectomy with Ⅱ b MG and fifteen young-middle aged Ⅱ b MG patients defined as youngmiddle aged group (20-50 years) with paired sex,clinical symptoms,duration of symptoms,preoperative treatment regimen,anesthesia management and surgical time were included.Neuromuscular block was monitored with TOF Watch acceleration instrument.After induction of intravenous anesthesia,0.05mg/kg Cisatracurium was administrated intravenously,followed by increments of 0.015 mg/kg until T1/T0 was less than 5％ for each patient.A double-lumen bronchial tube was intubated when T1/T0 was less than5％.0.015 mg/kg cisatracurium was injected during the operation when T4/T1 was achieved to 25％.The dose of cisatracurium,the duration of blockade maintenance,duration of clinical action and neuromuscular block recovery index were obtained.Results There were no significant differences in tracheal doses of cisatracurium [(0.058 ± 0.013)mg/kg vs.(0.053±0.009)mg/kg]and the duration of blockade [(31.5±9.6)min vs.(40.0±19.8)min] between geriatric group and young-middle age group (P＞0.05).The duration of clinical action of cisatracurium [(21.6±6.7)min vs.(33.7±13.4)min]and the time to achieve a TOFr of 25％ were significantly shorter in geriatric MG group than those in young-middle aged MG group (P=0.045,0.037).The geriatric MG group were administrated more increments of ciastracurium than the young middle aged MG group during surgery (P=0.025).There was no significant difference in the time to achieve a TOFr of 70％ [(49.3±16.4)min vs.(57.4±34.7)min] and 90％ [(61.6± 19.2)min vs.(64.3±35.9)min] between geriatric MG group and young-middle aged MG group (P＞ 0.05).Conclusions The duration of clinical action of cisatracurium in geriatric MG patients was shorted than that in young-middle aged MG patients which was different with neuromuscular block effect in normal patients.It is suggested to do more studies to estimate the influence of age on cisatracurium and other muscle relaxants in MG patients.
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Ojective To compara the individual differences and clinical efficacy of cis-atracurium intermittent bolus injected according to fat-free mass and real body weight. Methods Forty patients (ASAI-II) who had no neuromuscular disease and underwent selective abdominal surgery under general anesthesia were randomly divided into group FFM (n=20) and group RBW(n=20) according to the different administration method. The responses of adductor pollicis to train-of-four (TOF) stimulation were monitored. Anesthesia was induced with propofol 2 mg/kg, fentanyl 3 ug/kg, cis-atracurium 129.6μg/kg (group FFM) or 100μg /kg (group RBW),and maintained with propofol and fentanyl given by target-controlled infusion. Intubation was attempted when T1 reached maximal inhibition. When the TOF stimulus T1 recovery to 5%, both group additional cis-atracurium 64.8 μg/kg (group FFM) or 50μg /kg (group RBW). The onset time, nonresponsive time, clinical duration, recovery index, pharmacological duration, cis-atracurium consumption, interval and frequency were recorded. Results No significant differences were found in general, interval, frequency,onset time, clinical duration, nonresponsive time,recovery index, pharmacological duration between the two groups (P > 0.05); There were significant differences in the cisatracurium consumption between two groups (P < 0.05); Compare with the group RBW, the differences of pharmacological duration and nonresponsive time between different individuals in group FFM were smaller (P < 0.05). Conclusion It can reduce the individual differences of muscle relaxant effect to apply cis-atracurium and cis-atracurium consumption according to fat-free mass.
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Objective To observe the effect of mivacurium,succinylcholine and atracurium in modified electric convulsive therapy (MECT).Methods Sixty ASA Ⅰ or Ⅱ patients with schizo-phrenia aged from 18 to 60 years old were randomly divided into 3 groups :mivacurium group (group A,n=20),succinylcholine group (group B,n=20),atracurium group (group C,n=20).The on-set time of muscle relaxation,the recovery time of spontaneous breathing after MECT,the awake time,as well as the changes of 5 min MAP,HR and SpO2 before and after MECT were observed re-spectively.Results The onset time of muscle relaxation and the recovery time of spontaneous breath-ing in group B were shorter than those in groups A and C (P <0.05).The onset time of muscle re-laxation and the recovery time of spontaneous breathing in group A were shorter than those in group C (P <0.05).Conclusion Mivacurium is a better alternative medicine in MECT in the situation of no succinylcholine or succnylcholine contraindication.
ABSTRACT
Objective To evaluate the effect of mild hypothermia on the recovery from cisatracurium blockade during the recovery from anesthesia in patients .Methods Thirty ASA physical status Ⅰ or Ⅱ patients , aged 18-64 yr , with body mass index 18-25 kg/m2 , scheduled for elective abdominal surgery under general anesthesia ,were enrolled in the study .The patients were divided into 2 groups according to the body temperature recorded when cisatracurium infusion was stopped at the end of surgery .The body temperature 36.0-36.9 ℃served as normothermia group (group N , n=14 ) and 34.0-35.9 ℃ served as mild hypothermia group (group H , n= 16 ) . The body temperature was measured by a thermocouple placed in the nasopharynx . Neuromuscular function was monitored by measuring the evoked mechanical response of the adductor pollicis muscle to supramaximal train-of-four (TOF) stimulation (frequency 2 Hz ,wave length 0.2 ms ,intensity 50 mA ,interval 15 s) of the ulnar nerve at the wrist using TOF-Watch SX? .Cisatracurium was intravenously infused at 1-3μg·kg-1 ·min-1 during surgery to maintain neuromuscular block with 1%