A Study of Biochemical Changes of Rocuronium Bromide and other Muscle Relaxants in Cardiac Surgery

Introduction: CAPD is one of the renal replacement therapieswhich is gaining popularity in the developing world especiallyIndia. This study was aimed to study the clinical profile andcomplication of Complications of Continuous AmbulatoryPeritoneal Dialysis (CAPD).Material and Methods: Patients on CAPD at our center wereevaluated for their clinical profile, complication and outcomeon follow-up.Results: A total of 100 patients were included in the study.There were 66%males and 34% females. Mean age of thepatients was 47.95± 6 years. Hypertension was seen as etiologyin 36%, Diabetes in 27%, chronic glomerulonephritis in 22%,Analgesic nephropathy in 4%, Obstructive nephropathy in 3%and in 4% cases no obvious cause for CKD could be found.Among the complications pain was seen in 11%, pericatheterleak in 5%, bleeding 7%, intestinal perforation in 2%, herniain 5%, total obstruction in 4%, exit site infection in 7%,tunnel infection in 2% and total 111 episodes of peritonitis.Technique survival at 1 year and 2 years was 97%and 94%respectively. Patient survival at one and two years was 90%and 78% respectivelyConclusion: CAPD presents a viable form of renalreplacement therapy. There has been sustained decrease incomplication rates and improvement in technique and patientsurvival with advancement in catheter implantation andcomplication management

A Study of Hemodynamic Effects of Rocuronium Bromide and other Muscle Relaxants in Cardiac Surgery

Introduction: Use of muscle relaxants in cardiac surgeryposes a challenge to anaesthesia due to narrow margin of safetyand limited cardiovascular function. Therefore aim of presentstudy is to find out the hemodynamic effects of Rocuroniumbromide and other muscle relaxant in cardiac surgery.Material and Methods: Present study was carried out on sixty(60) patients of different age groups from both sexes scheduledfor various cardiac surgical procedures at L.P.S. Institute ofCardiology, GSVM medical college Kanpur during the periodof August 1998 to August 1999. Patients were classified in 3equal groups. Muscle relaxants were given according to thegroup and hemodynamic parameters were recorded carefullyat the interval of two, five and ten minutes.Results: No statistically significant changes were observed insystolic blood pressure, diastolic blood pressure and centralvenous pressure at 2 minutes, 5 minutes and 10 minutes afterthe administration of all three drugs (P >0.05) comparedwith control values. Significant increase in heart rate wasobserved at 2 minutes and 5 minutes after the administrationof Pancuronium (P <0.05).Conclusion: On basis of present study’s result, it can besaid that Rocuronium bromide is safer in cardiac surgery ascompared to Vecuronium & Pancuronium.

The study of blood glucose level changes during general anesthesia in patients undergoing surgery

Background: Analgesia is meant to reduce the pain produced by surgery. To fulfil this requirement various drugs such as alcohol, opium, hashish and balladona have been used in the past by the Egyptians and Chinese for the control of pain during surgery when the anesthesia was not known. Glucose is a carbohydrate required for energy. During the process of metabolism of glucose the source storage come into play. Nervous influence, enzymatic action and hormonal involvement also have a significant role. Aim: The aim of the study was the study of blood glucose level changes during general anesthesia in patients under surgery. Materials and methods: The present study was done in the department of Anesthesiology during the year 2015-2016, 60 patients with age group of 25-65 years along with different sex distribution. Results: Regarding the anaesthesia group, there were 15 patients in the age group of 25-35 years and 36-45 years each.14 patients were in age group 46-55 years, while 16 patients in the age group of 56- G.V. Krishna Reddy, M. Madan Mohan Rao, G obulesu, R Salma Mahaboob. The study of blood glucose level changes during general anesthesia in patients undergoing surgery. IAIM, 2017; 4(1): 110-115. Page 111 65 years. Out of 60 patients 33 patients (55%) were male patients while remaining 27 patients (45%) were female patients. Conclusion: Present study showed that there is very highly significant rise in blood glucose level during the ether anesthesia while in case of relaxants there is only significant rise in blood glucose level.

Association between levobupivacaine and pancuronium. Interference in neuromuscular transmission and blockade in rats

ABSTRACT PURPOSE: To evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro. METHODS: Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I - levobupivacaine (5 µg.mL-1); Group II - pancuronium (2 µg.mL-1); Group III - pancuronium (2 µg.mL-1) + levobupivacaine (5µg.mL-1). The following parameters were evaluated: 1) amplitude of diaphragmatic response to indirect stimulation, before and 60 minutes after the addition of levobupivacaine and pancuronium alone, and after the addition of levobupivacaine combined with pancuronium; 2) membrane potentials (MP) and miniature endplate potentials (MEPP). RESULTS: Levobupivacaine alone did not alter the amplitude of muscle response and MP. In preparations previoulsy exposed to levobupivacaine, the block with pancuronium was significantly denser (90.2 ± 15.2%), showing a significant difference (p=0.031) in comparison to the block produced by pancuronium alone (48.9% ± 9.8%). There was a decrease in the frequency and amplitude of MEPPs. CONCLUSION: Levobupivacaine potentiated the neuromuscular blockade produced by pancuronium, confirming a presynaptic action by a decrease in miniature endplate potentials.

Triple drug intravenous regional anesthesia is safe and equally effective (025% lignocaine plus 1 g/kg fentanyl + 05 mg pancuronium) as compared to standard Bier’s block (05% lignocaine)

Intravenous regional anesthesia requires a tiny practice to obtain good results and proves economical. We evaluated the efficacy of fentanyl (1 µg/kg) and pancuronium (0.5 mg) in lower doses with 0.25% lignocaine (1.5 mg/kg) for intravenous regional anesthesia for upper limb surgeries for a period not exceeding one hour, additionally we also compared the above study with standard Bier's block i.e. intravenous regional anaesthesia with 0.5% lidocaine (0.5 mg/kg body weight). This study was conducted in a medical college government general hospital, in Andhra Pradesh over the period of 3 years during 2001 to 2004. Fifty patients belonging to ASA grade I and grade II undergoing upper limb surgery were selected. Patients were included if they were undergoing upper limb surgeries for a period not exceeding one hour. These patients were assigned in a randomized, double fashion to two groups: Group A received 0.6 ml/kg of 0.5 % lidocaine (3 mg/kg) and Group B received 0.6 ml/kg of 0.25 % lidocaine (1.5 mg/kg) plus fentanyl (1 µgm/kg) and pancuronium (0.5 mg). The patients were observed for two hours after the release of the tourniquet for any complications like bradycardia, hypotension, and convulsions etc. The present was compared with standard Bier's block, i.e., 0.5% Bakkireddy Srinivasulu Reddy, P. Narasimha Reddy. Triple drug intravenous regional anesthesia is safe and equally effective (0.25% lignocaine plus 1 µg/kg fentanyl + 0.5 mg pancuronium) as compared to standard Bier's block (0.5% lignocaine). IAIM, 2016; 3(6): 82-87. Page 83 lidocaine (3 mg/kg body weight). Data was presented as Mean±SD, actual numbers and percentages and analyzed using SPSS version 16. In this study, 50 patients undergoing various upper limbs, surgeries were given intravenous regional anesthesia which included 38 males and 12 females. The postoperative analgesia was slightly greater in Group B compared to Group A. The onset of sensory and a motor blockade were earlier in Group A patients when compared to Group B patients. Short delay observed with this new method in the onset of sensory and motor blockade should be noted and the start of surgical procedures delayed until 15-20 minutes after tourniquet inflation. There was no difference in the quality of analgesia and muscle relaxation between two groups. The triple combination of lidocaine, fentanyl and pancuronium can be considered as is safe and effective since the dose of lignocaine can be reduced to a non-toxic level with the same quality of anesthesia. However, the limiting factor in this new technique is a short delay in the onset of sensory and motor blockade compared to standard Bier's block.

Effect of ropivacaine combined with pancuronium on neuromuscular transmission and effectiveness of neostigmine and 4-aminopyridine for blockade reversal: experimental study / Efeito da associação ropivacaina-pancurônio na transmissão neuromuscular e eficácia da neostigmine e 4-aminopiridina na reversão do bloqueio: estudo experimental / Efecto de la asociación ropivacaína-pancuronio en la transmisión neuromuscular. Eficacia de la neostigmina y 4-aminopiridina en la reversión del bloqueo. Estudio experimental

BACKGROUND AND OBJECTIVES: The local anesthetic effects on neuromuscular junction and its influence on blockade produced by nondepolarizing neuromuscular blockers are still under-investigated; however, this interaction has been described in experimental studies and in humans. The aim of this study was to evaluate in vitro the interaction between ropivacaine and pancuronium, the influence on transmission and neuromuscular blockade, and the effectiveness of neostigmine and 4-aminopyridine to reverse the blockade. METHODS: Rats were divided into groups (n = 5) according to the study drug: ropivacaine (5 µg mL-1); pancuronium (2 µg mL-1); ropivacaine + pancuronium. Neostigmine and 4-aminopyridine were used at concentrations of 2 µg mL-1 and 20 µg mL-1, respectively. The effects of ropivacaine on membrane potential and miniature endplate potential, the amplitude of diaphragm responses before and 60 min after the addition of ropivacaine (degree of neuromuscular blockade with pancuronium and with the association of pancuronium-ropivacaine), and the effectiveness of neostigmine and 4-aminopyridine on neuromuscular block reversal were evaluated. RESULTS: Ropivacaine did not alter the amplitude of muscle response (the membrane potential), but decreased the frequency and amplitude of the miniature endplate potential. Pancuronium blockade was potentiated by ropivacaine, and partially and fully reversed by neostigmine and 4-aminopyridine, respectively. CONCLUSIONS: Ropivacaine increased the neuromuscular block produced by pancuronium. The complete antagonism with 4-aminopyridine suggests presynaptic action of ropivacaine. .

JUSTIFICATIVA E OBJETIVOS: Os efeitos dos anestésicos locais na junção neuromuscular e sua influência no bloqueio produzido por bloqueadores neuromusculares não-despolarizantes é ainda alvo de pouca investigação, no entanto esta interação tem sido descrita em trabalhos experimentais e em humanos. O objetivo deste estudo foi avaliar in vitro, a interação da ropivacaína com o pancurônio, a influência na transmissão e bloqueio neuromuscular e a efetividade da neostigmina e 4-aminopiridina na reversão do bloqueio. MÉTODO: Ratos foram distribuídos em grupos (n = 5) de acordo com o fármaco estudado: ropivacaína (5 µg mL-1); pancurônio (2 µg mL-1); ropivacaína + pancurônio. A neostigmina e a 4-aminopiridina foram usadas nas concentrações de 2 µg mL-1 e 20 µg.mL-1, respectivamente. Avaliou-se: 1) efeitos da ropivacaína sobre o potencial de membrana e potenciais de placa terminal em miniatura; 2) a amplitude das respostas do diafragma antes e 60 minutos após a adição da ropivacaína; o grau de bloqueio neuromuscular com o pancurônio e com a associação pancurônio - ropivacaína; 3) a efetividade da neostigmina e 4-aminopiridina na reversão do bloqueio neuromuscular. RESULTADOS: A ropivacaína não alterou a amplitude das respostas musculares, os potenciais de membrana, mas diminuiu a frequência e a amplitude dos potenciais de placa terminal em miniatura. O bloqueio produzido pelo pancurônio foi potencializado pela ropivacaína, e parcial e totalmente revertido pela neostigmina e 4-aminopiridina, respectivamente. CONCLUSÕES: A ropivacaína potencializou o bloqueio neuromuscular produzido pelo pancurônio. O antagonismo completo com a 4-aminopiridina sugere ação pré-sináptica da ropivacaína. .

JUSTIFICACIÓN Y OBJETIVOS: Los efectos de los anestésicos locales en la unión neuromuscular y su influencia en el bloqueo producido por bloqueantes neuromusculares no-despolarizantes todavía son poco investigados, sin embargo, esta interacción ha sido descrita en trabajos experimentales y en seres humanos. El objetivo de este estudio fue evaluar in vitro la interacción de la ropivacaína con el pancuronio, la influencia en la transmisión y bloqueo neuromuscular y la efectividad de la neostigmina y 4-aminopiridina en la reversión del bloqueo. MÉTODO: Unos ratones fueron distribuidos en grupos (n = 5) de acuerdo con el fármaco estudiado: ropivacaína (5 µg/ml-1); pancuronio (2 µg/ml-1); ropivacaína + pancuronio. La neostigmina y la 4-aminopiridina fueron usadas en concentraciones de 2 µg/ml-1 y 20 µg/ml-1, respectivamente. Evaluamos: 1) efectos de la ropivacaína sobre el potencial de membrana y potenciales de placa terminal en miniatura; 2) la amplitud de las respuestas del diafragma antes y 60 min después de la adición de la ropivacaína; el grado de bloqueo neuromuscular con el pancuronio y con la asociación pancuronio-ropivacaína; 3) la efectividad de la neostigmina y 4-aminopiridina en la reversión del bloqueo neuromuscular. RESULTADOS: La ropivacaína no alteró la amplitud de las respuestas musculares, los potenciales de membrana, pero disminuyó la frecuencia y la amplitud de los potenciales de placa terminal en miniatura. El bloqueo producido por el pancuronio fue potenciado por la ropivacaína, y parcial y totalmente revertido por la neostigmina y 4-aminopiridina, respectivamente. CONCLUSIONES: La ropivacaína potenció el bloqueo neuromuscular producido por el pancuronio. El antagonismo completo con la 4-aminopiridina muestra una acción presináptica de la ropivacaína. .

Comparision of potency of different types Neuro-Muscular Junction (NMJ) blockers on isolated rectus abdominis muscle of rana tigrina.

The most important use of neuromuscular blockers is as adjuvant to general anaesthesia where adequate muscle relaxation can be achieved at lighter plane. They also reduce reflex muscle contraction in the region undergoing surgery and assist maintenance of controlled ventilation during anaesthesia. They are particularly helpful in abdominal and thoracic surgery, intubations and endoscopies, orthopedic manipulation, etc. Thus, the risk of respiratory and cardiovascular depression is minimized, and post anesthetic recovery is shortened. The potency ratio of two commonly used neuromuscular agents depolarizing succinylcholine and non depolarizing pancuronium. Double pith a frog and fasten it to a frog board with ventral side up. The sternum was cut through just above the xiphisternum at its base and a pair of muscle attached to it were dissected out and transferred to a dish containing frog Ringer solution at room temperature. All the drug containing solutions were freshly prepared before the experiments Succinyl choline, Pancuronium (1,10,100mg/ml and 1mg/dl) respectively Acetyl choline (10,100mg/ml and 1mg/dl). Acetylcholine solution in various strength were prepared starting from 0.1% to 0.0001%.NMJ blocker Pancuronium was added to the biophase in addition to selected dose (128mg or 256mg) and the contraction of muscle till the 70-80% of inhibition is produced and the difference from sub maximal contractions. The median ED50 was interpolated from the figure taking 50%of inhibition from Height of contraction in mm. The ‘t’ test was performed to compare the ED50 value were interpolated from the regression line to find out the ED50 of the drug. The median doses (ED50) of both of them were calculated graphically and compared. The mean ED50 value of succinylcholine was found to be 1.59 ± 0.08μg (95% confidential limit was from 1.53 to 1.66μg). The ED50 of pancuronium was found to be 0.52 ± 0.10μg with 95% confidence limit being from 0.44 to 0.60μg. The ED50 value of the two drugs was very significantly different (P < 0.001). The potency ratio of pancuronium to succinylcholine was 0.32.

Chromatographic and spectrophotometric analysis of panchronium bromide.

The present investigation is centered on drug pancuronium bromide, which is a muscle relaxant basically used in clinical practice for an aesthetic purposes. Few rape cases have been reported where in this drug was used to incapacitate the rape victim. All this highlights the abuse potential of Pancuronium bromide in crime related to rape. Testing/analyzing Pancuronium bromide by making use of body material and other traces present in the surrounding of victim/crime scene will be of great importance for medico legal purpose and forensic view point. In the present study an attempt has been made to analysis Pancuronium bromide by chromatographic (TLC and HPLC) and UV-SPECTROPHOTOMETRY. In spite of the limitation the conclusions reached in the present study are of considerable forensic significance.

Anestesia peribulbar com ropivacaína como alternativa ao bloqueio neuromuscular para facectomia em cães / Peribulbar anesthesia with ropivacaine as an alternative to neuromuscular blocking agents for cataract surgery in dogs

Desenvolveu-se uma técnica de bloqueio peribulbar comparando-a à técnica de anestesia oftálmica com bloqueio neuromuscular parcial em cães submetidos à facectomia extracapsular. Doze cães, de diferentes raças, foram alocados em dois grupos (G1 e G2) e anestesiados com acepromazina (0,05mg/kg, IV) e propofol (5mg/kg, IV) e mantidos com isofluorano sob ventilação espontânea. Os cães do G1 receberam o bloqueio peribulbar com ropivacaína 0,75 por cento, e os do G2 o bloqueio neuromuscular parcial com brometo de pancurônio (0,01mg/kg, IV). Utilizaram-se, como parâmetros comparativos, escores de posicionamento do globo ocular, controle do reflexo oculocardíaco e pressão intraocular (mmHg). Foi possível propor uma técnica eficaz para cães baseando-se na técnica de bloqueio peribulbar posterior realizada no homem. Em ambos os grupos, o globo ocular permaneceu centralizado. Não ocorreram alterações eletrocardiográficas atribuídas ao reflexo oculocardíaco. Houve redução significativa da pressão intraocular em G1 após o bloqueio (10,7±0,6 e 14,7±0,6). Conclui-se que o bloqueio peribulbar proporcionou condições cirúrgicas apropriadas para a realização da facectomia, com a vantagem de promover bloqueio sensitivo do olho.

A peribulbar block technique was developed and its clinical efficacy was compared with neuromuscular blockade in dogs undergoing cataract surgery. Twelve dogs of different breeds were randomly and equally allocated in two groups. After given acepromazine (0.05mg/kg, IV), anesthesia was induced with propofol (5mg/kg, IV) and maintained with isoflurane in oxygen during spontaneous breathing. A peribulbar block with 0.75 percent ropivacaine was performed in G1 dogs while partial neuromuscular blockade with pancuronium (0.01mg/kg IV) was provided in G2 dogs. Globe position scores, oculocardiac reflex, and intra-ocular pressure (mmHg) were evaluated at pre-defined intervals during surgery. Peribulbar blocks were successful performed according to posterior peribulbar block described in humans. In both groups, the globe was centralized and globe position scores did not differ between groups. The intra-ocular pressure was significantly lower in G1 after the block (10.7±0.6 vs 14.7±0.6). There were no electrocardiographycal changes attributed to the oculocardiac reflex. In conclusion, satisfactory surgical conditions were provided by the peribulbar block. This technique can be used as an alternative to the use of neuromuscular blocking agents in dogs undergoing cataract surgery, with the advantage of providing analgesia of the eye.

Hemodynamic Effects of Vecuronium, Pancuronium and Rocuronium during O2-Midazolam-Fentanyl Anesthesia in Patients with Coronary Artery Disease or Valvular Heart Diseases / 대한마취과학회지

BACKGROUND: This study was designed to evaluate the hemodynamic effects of vecuronium, pancuronium and rocuronium in patients with coronary artery disease (CABG) or valvular heart disease (VHD). METHODS: With IRB approval, 121 patients (61 patients with CABG and 60 patients with VHD) were randomly divided into a vecuronium, pancuronium and rocuronium group, respectively. Midazolam and fentanyl were administered and then 3 times of ED95 of a muscle relaxant (vecuronium, 0.12 mg/kg; pancuronium, 0.12 mg/kg; or rocuronium, 0.9 mg/kg) was injected. Additional dose of fentanyl was given and the patient was intubated. Hemodynamic variables were measured before the induction of anesthesia, just prior and 1 min after the administration of the muscle relaxant, just before intubation, 5 and 10 min after intubation. RESULTS: The number of patients enrolled in the CABG-vecuronium, CABG-pancuronium, CABG- rocuronium, VHD-vecuronium, VHD-pancuronium, and VHD-rocuronium was 20, 20, 21, 19, 20, and 21 respectively. Each of 10, 4, 4, 5, 1, and 1, respectively, were treated for hypotension or bradycardia during the induction of anesthesia. The heart rate (HR) changed significantly only in the CABG- vecuronium group compared with the control value. All three muscle relaxants decreased mean systemic artery pressure (MAP) significantly in both CABG and VHD patients. The decrease in HR and MAP were significantly greater in CABG-vecuronium and VHD-vecuronium than in CABG-pancuronium and VHD-pancuronium, respectively. The decrease in HR was also greater in VHD-vecuronium than in VHD-rocuronium. Cardiac index (CI) decreased in CABG-vecuronium and all VHD patients. The decrease in CI was greater in CABG-vecuronium than in CABG-pancuronium but it was not significantly different among the three muscle relaxants in VHD patients. CONCLUSIONS: While pancuronium and rocuronium exerted minimal hemodynamic effects, vecuronium reduced HR and MAP more significantly than pancuronium in both CABG and VHD patients, and CI also decreased more significantly with vecuronium in CABG patients.

Comparative Study of Pharmacokinetics in the Onset and Offset of Mivacurium and Other Muscle Relaxants / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate mivacurium in the pharmacokinetics of onset and offset. METHODS: In 127 adult patients of ASA physical status I or II without any factors involving the neuromuscular function under general anesthesia, onset time (lag and manifest time) and clinical duration were measured after bolus or divided doses of ED95 x 2 of succinylcholine (SCC), rocuronium (ROC), atracurium (ATR), mivacurium (MIV), pancuronium (PAN) or vecuronium (VEC). Recovery time was defined as the recovery index and total duration measured after subsequent ED95 of MIV at 25% recovery of control twitch height from neuromuscular block induced by ED95 x 2 of ATR, MIV, PAN or VEC. Plasma cholinesterase (PChE) levels were measured following PAN or ATR. RESULTS: Onset time was faster with SCC and ROC, the low potency drugs, than with ATR, MIV, PAN or VEC, the high potent drugs. Manifest time was shorter in low potency drugs but longer in high potency drugs than lag time after bolus or divided doses of muscle relaxants given. Divided doses of various drugs induced a shortened onset time, but the patterns of relationship between lag and manifest time associated with drug potency did not alter. The recovery times with administered MIV were slowest after PAN pretreatment, and fastest after MIV pretreatment. PChE levels decreased significantly from 3 min to over 180 min after PAN administeration but not ATR. CONCLUSIONS: The onset time of MIV was not improved due to high drug potency as other nondepolarizing neuromuscular blockers. However, in spite of high potency, the recovery time of MIV was faster than other drugs. This results may be depend upon PChE activity rather than drug potency. Additionally, the prolonged recovery of MIV was not only under the influence of low PChE activity but also other some factors such as: the first relaxants administered before MIV dominated the neuromuscular block so that the duration of MIV given subsequently changed to resemble that of the first. The longer elimination half-life of the underlying relaxant prolonged the effects of subsequentshorter acting MIV. Structural similarities or dis-similarities between the interacting MIV and other drugs may have effects more potent in dis-similarity than in similarity.

Does Perioperative Monitoring of the Train-of-Four Response Influence the Frequency of Postoperative Residual Curarization in Propofol Anesthesia? / 대한마취과학회지

BACKGROUND: Sometimes hypoxemia occurs in the postoperative recovery room because of postoperative residual curarization (PORC). Some reports show that postoperative residual curarization is common. PORC occurs after the use of the long-acting muscle relaxants. It has been recommended to use intermediate-acting muscle relaxants and a TOF monitor to decrease PORC. The purpose of this study was to examine whether the use of the TOF monitor during propofol anesthesia affects the incidence of postoperative residual curarization. METHODS: 38 ASA I or II patients were divided randomly into two groups of 19 each. They received propofol-fentanyl-nitrous oxide for anesthesia. Pancuronium (80 100 microgram/kg) was used to facilitate tracheal intubation and additional doses were used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed, either with (control group:n = 19) or without (experimental group:n = 19) TOF monitoring. Fifteen minutes after the arrival at the recovery room, neuromuscular function was assessed clinically and by using TOF. RESULTS: There were no statistical differences in body weight, age, or duration of operation between the two groups. There was no statistical difference in the total dose of pancuronium and total dose of pancuronium relative to body weight and duration of operation. There were statistical differences in TOF ratio in the recovery room (0.73 vs. 0.86). The incidence of PORC was 47% in the control group and 5% in the experimental group. CONCLUSIONS: Though the monitoring of TOF did not effect the dose of muscle relaxant, it may have reduced the incidence of PORC. However, the PORC had no clinical significance because the mean TOF ratio in the two groups was over 0.7 and there were no clinical signs of residual muscle weakness.

Effects of Vecuronium and Pancuronium on the Tension of the Smooth Muscle in the Rat Trachea / 대한마취과학회지

BACKGROUND: Vecuronium and Pancuronium have been proven to be associated with nicotinic receptor of skeletal muscle. Generally, nondepolarizing muscle relaxant is associated with contraction of smooth tracheal muscle, but there have been few studies about effects of nondepolarizing muscle relaxant on the smooth tracheal muscle. METHODS: We studied the acetylcholine dose response curve of the tracheal smooth muscle contraction and effects of propranolol, L-NAME after pretreating with vecuronium and pancuronium. RESULTS: Vecuronium shifted the acetylcholine dose-response curve of the tracheal contraction to the left, and pancuronium shifted the curve to the right. Vecuronium and Pancuronium reduced the contraction of smooth tracheal muscle with the use carbachol. Propranolol and L-NAME had no effect on the contraction of smooth tracheal muscle after pretreating with vecuronium and pancuronium. CONCLUSION: We suggest that vecuronium has an anticholinergic effect, while pancuronium has some effect on the muscarinic receptor in addition to its anticholinergic effect.

The Effects of Vecuronium and Pancuronium on the Tension of the Isolated Rat Tracheal Smooth Muscle / 대한마취과학회지

BACKGROUND: Non-depolarizing muscle relaxants have their muscle relaxing effect by competing with acetylcholine (ACh) at the nicotinic receptor level. What are the effects of such muscle relaxants on the tracheal smooth muscle? This present study was set up to address the question as to how vecuronium and pancuronium influence the tracheal smooth muscle. METHODS: Sixty male Sprague-Dawley rat tracheal smooth muscles were isolated at optimal length for isometric force. The preparations were set up in an organ bath containing Tyrode's solution. And isometric force displacement transducer and physiograph were used to record the change in force. After the equilibration period the preparations were contracted with ACh 10(-5) M and carbachol 3x10(-7)M seperately. The preparations were washed with fresh tyrode's solution and allowed to return passively to resting tone. Then the cumulartive effect of ACh (from 3 10(-7) M through 10(-5) M) and carbachol (CCh, from 10(-8) M through 3 10(-6) M) were produced before and after pretreating the preparation with vecuronium (10(-5) M and 10(-6) M) and pancuronium (10(-5) M and 10(-6) M) respectively. Also, we studied the changes of contraction produced by neostigmine before and after pretreatment with vecuronium (10(-5) M and 3 10(-5) M) and pancuronium (3 10(-6) M and 3 10(-5) M). RESULTS: Vecuronium shifted the ACh dose-response curve of the tracheal contraction to the left (p0.05). CONCLUSIONS: Vecuronium inhibits the ACh hydrolyzing enzyme, especially acetylcholinesterase. Therefore it potentiates ACh contraction in the tracheal smooth muscle, but not the CCh contraction, while pancuronium has a different effect in comparison with vecuronium. That is, at a low concentration it reveals an antagonistic effect on the muscarinic M2 receptor and at a higher concentration it has an antagonistic effect on the muscarinic M3 receptor in the tracheal smooth muscle.

Effects of priming with pancuronium or rocuronium on intubation with rocuronium in children

Rocuronium is a non-depolarizing neuromuscular blocking agent which has a rapid onset and intermediate duration of action. The goal of this study was to compare the neuromuscular blocking actions of rocuronium with and without a priming dose of pancuronium or rocuronium in children. Thirty patients were randomly allocated into 3 groups. Ten patients received a single dose of 0.6 mg/kg rocuronium (Group I). The others received either 0.015 mg/kg pancuronium (Group II) or 0.06 mg/kg rocuronium (Group III) 3 minutes before an intubating dose of 0.54 mg/kg rocuronium was given. Neuromuscular blockade was measured via accelerographic response to single stimulations (1 Hz) of the ulnar nerve until maximal twitch depression was reached followed by train-of-four (TOF) stimuli (2 Hz) at 15 second intervals for the remainder of recovery. Groups were compared with regard to onset time, duration and recovery indices. The onset time and duration of block did not differ significantly between groups. However, the time to recovery in group II (24.5 +/- 9.9 min) was significantly prolonged compared to that in group I (12.7 +/- 3.1 min) or group III (12.7 +/- 3.9 min). We concluded that the use of rocuronium with a preceding dose of either pancuronium or rocuronium provided no advantage for intubation in children.

Influence of Various Muscle Relaxants on the Plasma Cholinesterase Activity / 대한마취과학회지

BACKGROUND: The reduction in the plasma cholinesterase (PChE) level results in slow to hydrolysis of succinylcholine (SCC) and mivacurium (MIV). The factors altering the level of the normal enzyme in human could be considered under the several conditions. We investigated in the present study whether the drugs induced decreases in normal PChE activity after administration of various muscle relaxants during anesthesia are evident and how these results should be influenced to the time course of neuromuscular blockade produced by SCC and MIV. METHODS: Young adult patients of ASA class I or II scheduled for elective surgery requiring muscle relaxation were premedicated and anesthesia was maintained with nitrous oxide in oxygen with increment of thiopentone or fentanyl as required. In the neuromuscular monitoring, surface electrodes were applied on the ulnar nerve at wrist. Supramaximal transcutaneous single twitch stimulation (1 Hz) during onset and 0.1 Hz during recovery of neuromuscular blockade induced by various muscle relaxants delivered by a peripheral nerve stimulator was applied. Twitch response of thumb adductor was measured mechanomyographically using 2 kg Load Cell Strain Gauge with thumb piece modification. Recordings were made on a Gould recorder. PChE levels were measured by the modified Garry method after induction of anesthesia and, at 3, 10, 20 and 30 min following administration of 2 x ED95 of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR). Neuromuscular recordings were measured with onset time defined as lag time and manifest time, and recovery time defined as clinical duration, recovery index and total duration. RESULTS: The levels of PChE were significantly reduced after administration of PAN and VEC (p<0.05). Onset times were significantly shorten but recovery time in the group given MIV pretreated by small dose of PAN was significantly prolonged (p<0.05). And there were a evidence to prolong recovery time in the group pretreated by small dose of VEC but not significant. CONCLUSIONS: It is concluded that aminosteroidal derivative neuromuscular blocking agents have presumably evidence induced decreases in PChE activity rather than benzylisoquinolinium derivative neuromuscular blocking agents.

The Evaluation of Postoperative Myalgia after Administration of Succinylcholine and the Effect of Pancuronium Pretreatment / 대한마취과학회지

BACKGROUND: Postoperative myalgia after administration of succinylcholine is a frequent complication after surgery. This study was designed to determine whether there was any association between postoperative myalgia and muscle relaxants. METHODS: Sixty patients were assigned to three groups of equal size. Group 1, the patients received succinylcholine, 1.0 mg/kg for tracheal intubation. Group 2, received pancuronium 0.01 mg/kg, 4 minutes before administration of succinylcholine 1.5 mg/kg. Group 3, received pancuronium 0.01 mg/kg, 4 minutes before administration of pancuronium 0.09 mg/kg. Blood samples for determination of serum potassium concentration were taken before the induction of anesthesia and 3 minutes after tracheal intubation. The incidence and severity of muscle fasciculation and myalgia were assessed in a double-blind manner. RESULTS: Serum potassium concentration was significantly increased in group 1. In group 2, incidence and severity of muscle fasciculation were significantly less than groups 1. Postoperative myalgia was significantly less in group 3 when compared with group 1 and 2. CONCLUSIONS: There was no significant correlation between succinylcholine induced fasciculation and postoperative myalgia. Pretreatment with pancuronium decreased the incidence of fasciculation and the changes of serum potassium concentration by succinylcholine, but has little effects on the succinylcholine induced postoperative myalgia.

Vecuronium or Pancuronium as a Priming Agent is Effective to Shorten the Onset of Mivacurium-Induced Neuromuscular Block for Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Mivacurium is a non-depolarizing neuromuscular blocking agent which has short duration of action. The goal of this study was to describe a technique which could shorten the onset time of mivacurium for rapid endotracheal intubation by using priming principle. METHODS: Thirty-one patients were randomly allocated into four groups. Patients in group I(n=8) received a single dose of 0.12 mg/kg mivacurium. Those in group II(n=10), III(n=6), and IV(n=7) received 0.015 mg/kg pancuronium, 0.012 mg/kg vecuronium, and 0.008 mg/kg mivacurium 4 minutes before the intubating dose of 0.12 mg/kg mivacurium was given respectively. Accelerographic response to train-of-four(TOF) stimulation of ulnar nerve at 15 seconds interval was used for neuromuscular monitoring. The onset time, the duration and recovery indices were compared between groups. RESULTS: The onset time in group II (2.9 0.49 min) and III (2.33 0.4 min) were significantly faster than that in group I (5.19 0.47 min). In the group II, the duration (26.3 1.9 min) and recovery index (12.35 2.45 min) were significantly prolonged than those in group I (9.12 1.21 and 4.75 0.52 min), respectively. CONCLUSION: The onset time is more rapid when pancuronium or vecuronium is used as priming agent than when mivacurium as single bolus injection or priming agent.

Effect of Pancuronium, Vecuronium and Atracurium to the Plasma Cholinesterase Activity / 대한마취과학회지

BACKGROUND: Succinylcholine is metabolized by plasma cholinesterase (PChE). When it was pretreated by small doses of nondepolarizing muscle relaxants in order to minimize the side effects, there are evidences to be associated with alteration in the duration of action. This study is investigated whether the responses would be related to the enzymatic activities. METHODS: In 21 adult patients, ASA class I or II, PChE levels were measured by the modified Garry method after induction of anesthesia (control value) and at 3, 10, 20 and 30 min following administration of pancuronium 0.1 mg/kg, vecuronium 0.1 mg/kg and atracurium 0.5 mg/kg. Data were expressed as mean (SEM). RESULTS: The levels of PChE were significantly lower (p<0.05) than the control values at 3, 10, 20 and 30 min after given pancuronium as 4764 (270), 4777 (261), 4796 (306) and 4740 (332) IU/L respectively and after given vecuronium as 5004 (341), 5051 (329), 4969 (340) and 4960 (340) IU/L respectively whereas enzyme levels after given atracurium were not significant differences to compare the control values as 5153 (336), 5136 (320) 5124 (312) and 5151 (275) respectively. CONCLUSIONS: The results of present study show that both pancuronium and vecuronium may possibly inhibit PChE activity but this was not affected by atracurium.

Cardiovascular Effects of Pancuronium, Vecuronium and Pipecuronium during High-Dose Fentanyl Anesthesia in Neonates, Infants and Children / 대한마취과학회지

BACKGROUND: High dose fentanyl for cardiac surgery in neonates, infants and children can cause severe bradycardia and chest wall rigidity that result in decreased cardiac output and oxygen desaturation due to fixed stroke volume in pediatric patients. To ameliorate the effects of fentanyl, it is common to administer neuromuscular blocking drugs with wanted cardiovascular side effects. This study was designed to compare the cardiovascular variables and oxygen saturation among different muscular relaxants in high dose fentanyl anesthesia. METHODS: Thirty pediatric cardiac patients were allocated randomly into three muscle relaxant groups treated with 0.2 mg/kg pancuronium (n=10), 0.2 mg/kg vecuronium (n=10) or 0.2 mg/kg pipecuronium (n=10) after receiving an initial bolus dose of 25 g/kg of fentanyl. Changes of heart rate (HR), mean arterial blood pressure (MAP), rate-pressure-product (RPP) and oxygen saturation (SpO2) were observed. The same cardiovascular variables were also observed 1 and 2 minutes after the second bolus dose of 25 g/kg fentanyl and compared to the results among muscle relaxants. RESULTS: HR, MAP and RPP decreased significantly (p<0.05) 1 and 2 minutes after injection of the 1st fentanyl, which returned to levels above the control value after administration of pancuronium, vecuronium or pipecuronium. Among muscle relaxants, pancuronium caused the most rapid and significantly high level compared to the control value in HR and MAP. Next was pipecuronium and then vecuronium. In clinical setting, SpO2 was decreased after the 1st fentanyl injection and increased after the injection of muscle relaxants, but not significant statistically. CONCLUSION: In view of hemodynamic changes, pancuronium is most efficient and rapid in returning the hemodynamic variables that was decreased after high dose fentanyl anesthesia in neonates, infants and children whose cardiac output was dependent on HR due to relatively fixed stroke volume.