Comparing the effects of vecuronium and cisatracurium on electrophysiologic monitoring during neurosurgery: a randomized controlled study

BACKGROUND: The differences between neuromuscular blocking (NMB) drugs on the efficacy of intraoperative motor-evoked potential (MEP) monitoring have not been established through clinical study. We compared the effects of vecuronium and cisatracurium on the efficacy of intraoperative MEP monitoring. METHODS: We enrolled 72 patients who had undergone neurosurgery with MEP monitoring. We randomly allocated the subjects into one of two groups, in whom we maintained continuous intravenous vecuronium (Group V) or cisatracurium (Group C) infusion during the surgeries; the target partial NMB for maintenance was T1/Tc 50% (T1, first twitch of TOF response; Tc, control response of T1 before NMB drug injection). We compared the means and coefficients of variation (CV, %) of all measured MEP amplitudes and the frequencies of NMB drug dose changes. RESULTS: The means and CVs of MEP amplitude and latency in all four limbs did not differ significantly between the groups, although we did change the continuous NMB drug doses in group V significantly less often than in group C. CONCLUSIONS: There were no significant differences between vecuronium and cisatracurium on the MEP variability and mean amplitudes. However, cisatracurium needed more frequent dose changes to maintain T1/Tc 50%.

Incidence and risk factors of postoperative residual curarization in patients with breast cancer: Prospective cohort study / 解放军医学杂志

Objective To determine the incidence and risk factors of postoperative residual curarization (PORC) in patients with breast cancer after total intravenous anesthesia (TIVA) with vecuronium. Methods Two hundred and fiftyseven female patients with breast cancer undergoing breast-cancer surgery were enrolled into the present study. Anesthesia was induced with target-controlled infusion of propofol (Cp 3-4µg/ml) and remifentanil (2-3 ng/ml). A bolus of vecuronium 0.1mg/ kg was administered intravenously over 5-10s as soon as the patient lost consciousness, and laryngeal mask was placed 3min later. Mechanical ventilation and TIVA were performed for maintaining anesthesia and keeping bispectral index (BIS) between 40 to 60 during the operation. According to the duration of operation, 0.02mg/kg of vecuronium was administrated intermittently. Extubation of the laryngeal tube was performed according to clinical criteria. Train-of-four ratios (TOFr) were immediately measured with Veryark-TOF (Guangzhou Weilifangzhou Technology Ltd, China) in the recovery room. The patients were divided into two groups (Group N and Group R) according to the value of TOFr at the time of extubation. N denoted the non-residual neuromuscular blockade group (TOF=0.7), and R denoted the residual neuromuscular blockade group (TOF0.05). In group R, age and hemoglobin level were lower (P0.05). More patients in Group R received neoadjuvant chemotherapy and multiple boluses of vecuronium administration, and the duration between last dose of vecuronium to extubation was also prolonged compared with Group N (P<0.05). Multivariate logistic regression analysis identified that age, neoadjuvant chemotherapy and multiple boluses of vecuronium administration were not associated with increased risk of PORC. Duration from last dose of vecuronium to extubation was associated with increased risk of PORC (OR=0.970, 95%CI 0.956-0.984, P<0.001). Conclusions PORC is commonly used in patients with breast cancer. Duration from last dose of vecuronium to extubation is associated with increased risk of PORC.

A study of vecuronium bromide on severe bronchial asthma acute attack with breathing machine in conventional sedati / 中国基层医药

Objective To explore the effects of vecuronium bromide within 24 hours in severe bronchial asthma with acute attack with breathing machine in conventional sedatio.Methods Prospective study,double-blind randomized standard control,where 46 cases of patients of severe bronchial asthma with acute attack transferred to ICU using breathing machine in this year were randomly divided into the vecuronium bromide group (muscle relaxant group) and conventional sedation group (normal group) according to medical record number; Two groups of sample compositions were compared by x test,using two independent samples of t test to compare the effects the treatment and prognosis.Results After mechanical ventilation for 15min and 1-3h in muscle relaxant group,patients' vital signs were statistically analyzed,including respiration; Blood gas analysis parameters were as follows:pH,PaO2,PaCO2,SpO2 of these were improved compared with those in the conventional group (P ＜ 0.05) with statistically significant differences;Compared with the conventional group,in the muscle relaxant group,the retention time in ICU (146.20 ± 17.92) hours,(214.15 ± 22.21) hours,the using time of breathing machine (125.93 ± 16.23) hours,(192.89 ± 22.60) hours,and the dosage of glucocorticoid (2.61 ± 0.17) mg · kg-1 · d-1,(3.55 ± 0.26) mg · kg-1 · d-1,anticholinergic agent(6.25 ±0.51) μg · kg-1 · d-1,(10.64 ±0.75) μg · kg-1 · d-1 and β2 adrenergic receptor agonist (0.06 ±0.01)mg · kg-1 · d-1,(0.15 ±0.04)mg · kg-1 · d-1 were all reduced (all P ＜0.05) with statistically significant differences;The patients were smoothly transferred out of ICU,without the adverse events of mechanical ventilation and cardiovascular diseases.Conclusion The use of vecuronium bromide made the patients with severe bronchial asthma in routine sedation use of breathing machine rapidly correct the clinical symptoms and improve the off-period prognosis.

Estudo de lidocaína a 0,5% e combinação de lidocaína a 0,25% com fentanil e vecurônio em anestesia regional intravenosa para cirurgias de membros superiores / Study of 0.5% lidocaine alone and combination of 0.25% lidocaine with fentanyl and vecuronium in intravenous regional anesthesia for upper limb surgeries / Estudio de la lidocaína al 0,5% y en combinación de lidocaína al 0,25% con fentanilo y vecuronio en anestesia regional intravenosa para cirugías de miembros superiores

JUSTIFICATIVA E OBJETIVOS: A anestesia regional intravenosa (ARIV) para cirurgias de membros superiores com a tradicional alta dose de lidocaína pode levar a efeitos colaterais potencialmente letais. A fim de evitar esses efeitos, muitas técnicas modificadas de ARIV foram experimentadas com o uso de uma dose baixa de lidocaína, relaxante muscular e opioide. MÉTODOS: O presente estudo foi feito com 60 pacientes não medicados previamente, com classificação ASA 1-2, para comparar as características sensoriais e motoras, os parâmetros cardiorrespiratórios e os efeitos colaterais durante o período intraoperatório e de deflação pós-torniquete entre os pacientes que receberam 40 mL de lidocaína a 0,5% (n = 30) e aqueles que receberam uma combinação de 40 mL de lidocaína a 0,25% com 0,05 mg de fentanil e 0,5 mg de vecurônio (n = 30) em ARIV para cirurgias ortopédicas de membros superiores. Os resultados foram analisados com o uso do teste t de Student pareado para identificar a significância estatística. RESULTADO: A diferença entre os dois grupos em relação ao tempo médio de início e completo bloqueio sensitivo e motor foi estatisticamente significante. Porém, houve completo bloqueio sensitivo e motor em ambos os grupos 15 minutos após a injeção da solução anestésica. CONCLUSÃO: Embora a pequena demora observada no início e na obtenção completa dos bloqueios sensitivo e motor possa, teoricamente, atrasar o início da cirurgia em 10-15 minutos, clinicamente esse tempo seria gasto na preparação do campo cirúrgico. Portanto, essa combinação pode ser usada com segurança e eficácia em anestesia regional intravenosa para cirurgias ortopédicas de membros superiores com menor possibilidade de toxicidade anestésica local.

BACKGROUND AND OBJECTIVE: Intravenous regional anesthesia (IVRA) for upper limb surgeries with traditional high dose of lidocaine can lead to life threatening side effects. In order to avoid these potential life threatening side effects, many modified techniques of IVRA have been attempted by using a low dose of lidocaine, muscle relaxant and opioid. METHOD: The present study is carried out in sixty unpremedicated ASA Class 1 and 2 patients to compare the sensory and motor characteristics, cardio-respiratory parameters and side-effects during intra-operative and post-tourniquet deflation period between the patients who received 40 mL of 0.5% lidocaine alone (n = 30) and those who received a combination of 40 mL of 0.25% lidocaine with 0.05 mg fentanyl and 0.5 mg vecuronium (n = 30) in IVRA for upper limb orthopedic surgeries. The results were analyzed for statistical significance using a paired student t test. RESULTS: The difference between the two groups regarding the mean time of onset and complete sensory and motor block was statistically significant. But 15 minutes after the injection of anesthetic solution, there was complete sensory and motor block in both groups. CONCLUSION: Although the short delay observed in the onset and attainment of complete sensory and motor block may theoretically delay the start of surgery for 10-15 minutes but clinically that time will be spent in the preparation of surgical field. So this combination can be used safely and effectively in intravenous regional anesthesia for upper limb orthopedic surgeries with reduced chance of local anesthetic toxicity.

JUSTIFICATIVA Y OBJETIVOS: La anestesia regional intravenosa (ARIV) para cirugías de miembros superiores con la tradicional dosis alta de lidocaína, puede conllevar a efectos colaterales que amenazan la vida. Para evitar esos efectos colaterales potencialmente amenazadores, muchas técnicas modificadas de ARIV fueron experimentadas con el uso de una dosis baja de lidocaína, relajante muscular y opioide. MATERIALES Y MÉTODOS: El presente estudio se hizo con 60 pacientes no medicados previamente, con clasificación ASA 1-2, para comparar las características sensoriales y motoras, los parámetros cardiorrespiratorios y los efectos colaterales durante el período intraoperatorio y de deflación pos torniquete, entre los pacientes que recibieron 40 mL de lidocaína al 0,5% sola (n = 30) y los que recibieron una combinación de 40 mL de lidocaína al 0,25% con 0,05 mg de fentanilo y 0,5 mg de vecuronio (n = 30) en ARIV para cirugías ortopédicas de miembros superiores. Los resultados se analizaron usando el teste t de Student pareado para identificar la significancia estadística. RESULTADO: La diferencia entre los dos grupos con relación al tiempo promedio de inicio y completo bloqueo sensitivo y motor, fue estadísticamente significativo. Sin embargo, hubo un completo bloqueo sensitivo y motor en ambos grupos 15 minutos después de la inyección de la solución anestésica. CONCLUSIONES: Aunque la pequeña demora observada al inicio y durante la obtención completa de los bloqueos sensitivo y motor, teóricamente pueda atrasar el inicio de la operación entre 10 y 15 minutos, clínicamente ese tiempo se gastaría en la preparación del campo quirúrgico. Por tanto, esa combinación puede ser usada con seguridad y eficacia en la anestesia regional intravenosa para las cirugías ortopédicas de miembros superiores con menor posibilidad de toxicidad anestésica local.

Comparison of pharmacodynamics of vecuronium administrated according to body surface area and body weight during general anesthesia / 中华麻醉学杂志

Objective To compare pharmacodynamics of vecuronium administered according to body surface area and body weight during general anesthesia.Methods Forty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 40-85 kg,undergoing general anesthesia,were randomly divided into 2 group ( n =20 each ).The patients received vecuronium 2× ED95 based on body weight (group W) or based on body surface area (group S).Anesthesia was induced with propofol 2 mg/kg,fentanyl 3 μg/kg and vecuronium 0.1 mg/kg ( group W) or 2.824 mg/m2 (group S).The patients was tracheal intubated and mechanically ventilated when the maximal depression of T1 was achieved.PET CO2 was maintained at 35-45 mm Hg and BIS value was maintained at 40-50.The intubation condition was evaluated using Cooper's score.The onset time,maximal depression of T1,duration of clinical action,recovery index,duration of pharmacological action and amount of vecuronium consumed were recorded.The coefficient of variation for all the indexes mentioned above was calculated.Results There was no significant difference in the coefficient of variation for intubation condition,onset time,duration of clinical action,recovery index,and duration of pharmacological action between the two groups ( P ＞ 0.05).Compared with group W,the coefficient of variation for the maximal depression of T1 and amount of vecuronium consumed were significantly decreased in group S ( P ＜ 0.05).Conclusion Vecuronium 2 × ED95 administered according to body surface area can reduce the individual variation in pharmacodynamics during general anesthesia.

Effects of acupuncture on neuromuscular block of vecuronium and analgesia under general anesthesia / 中华麻醉学杂志

ObjectiveTo investigate the effects of acupuncture on neuromuscular block of vecuronium and analgesia under general anesthesia.MethodsNinety ASA Ⅰ or Ⅱ patients,aged 29-80 yr,weighing 50-80kg,scheduled for laparoscopic chotecystectomy,were randomly divided into 3 groups (n =30 each):acupuncture at acupoints combined with general anesthesia group (group A),acupuncture at non-acupoints combined with general anesthesia group (group B) and general anesthesia group (group C).Bilateral Hegu (LI4),Neiguan (PC6),Zusanli (ST36),yanglingquan (GB34),and Quchi (LI11) acupoints were selected in group A.In group B,the points adopted were the midpoints between the meridians in which the acupoints were selected in group A and the adjacent meridians on the lateral side,at the level of selected meridian points correspondingly.Electric stimulation was started from 15-30 min before anesthesia induction and continued until the end of operation.Anesthesia was induced with iv injection of fentanyl,propofol and vecuronium and maintained with intermittent iv boluses of fentanyl and vecuronium.All the patients received patient-controlled intravenous analgesia after operation.The effect time,onset time,clinical duration and recovery index of vecuronium,consumption of anesthetics during operation,and consumption of fentanyl for postoperative analgesia and postoperative adverse reactions were recorded.Results Compared with group C,the elinical duration was significantly prolonged,the consumption of anesthetics during operation and consumption of fentanyl for postoperative analgesia were significantly reduced,and the incidence of nausea was significantly decreased ( P ＜ 0.05 ),while no significant changed was found in the effect time,onset time,and recovery index in group A ( P ＞ 0.05).Compared with group B,the amount of fentanyl consumed during and after operation was significantly reduced in group A ( P ＜ 0.05 ).ConclusionAcupuncture can prolong the clinical duration of vecuronium,and enhance the analgesic efficacy during and after operation under general anesthesia.

Accidental Intra-arterial Injection of Vecuronium: A case report / 대한마취과학회지

One of the complications of direct arterial pressure monitoring is drug injection through an arterial line mistaken for an intravenous line. We experienced a case of accidental intra-arterial vecuronium injection through an arterial line on the right radial artery. The incident was noticed just after the injection and the patient was treated by intra-arterial injection of heparin, papaverine, lidocaine and stellate ganglion block. No color change or edema of the right hand was observed until the end of operation. The patient was closely observed after operation and discharged without complication. We report a case of accidental intra-arterial vecuronium injection which was managed successfully.

EFFECTS OF CALCIUM ON THE TIME COURSE AND POTENCY OF RELAXANTS / 解放军医学杂志

To evaluate the effects of calcium on the time course and potency of depolarizing and non depolarizing relaxants, 12 ASA grade Ⅰ Ⅱ patients were randomly divided into two groups. After anesthesia, succinycholine was administered intravenous in a dose of 1mg/kg in group S and vecuronium was administered in a dose of 0 05mg/kg in group V, respectively. 5% calcium chloride 20ml dissolved in 100ml saline were intravenously injected at the same time. The concentration of blood calcium and neuromuscular function (TOF) were monitored. The results showed: (1) Both blood pressure and heart rate were increased in patients of two groups at 2 to 5min after calcium administration, and recovered to normal level 10min later. (2) The concentrations of blood total calcium and dissociated calcium were increased at 5min after calcium chloride administration and maintained to 10min. (3) The time of onset of effect of succinylcholine showed no changes, but the clinical action time and the recovery time were shortened after calcium administration. The recovery time of vecuronium was also obviously shortened by calcium chloride. It suggested that calcium can affect the time course and potency of both depolarizing and non depolarizing relaxants.

Effects of desflurane and isoflurane on the vecuronium-induced neuromuscular block in the elderly patients / 中华麻醉学杂志

Objective The study was designed to compare the effects of desflurane and isoflurane on the vecuronium-induced neuromuscular block in the elderly patients. Methods Thirty ASA class I - II elderly patients aged over 70 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups: desflurane group ( I , n = 10) ; isoflurane group ( II , n = 10) and 3 control group ( III , n = 10). Anesthesia was induced with midazolam 0.02-0.05 mg? kg-1 , propofol 0.5-2.0 mg ? kg-1 and fentanyl 2-5?g? kg-1 maintained with inhalation of 6% desflurane(1 MAC) +50% N2O in oxygen (group I ) or 1.15% isoflurane + 50% N2O in oxygen(group II ) or 50% N2O in oxygen (group III ) supplemented with intermittent iv boluses of propofol and fentanyl when necessary. Neuromuscular block was monitored using accelograph (TOF GUARD , Denmark) .A total dose of vecuronium 40 mg ?kg-1 was divided with 4 equal doses of 10?g ? kg-1 , which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak (T1 was no longer depressed in the height of 3 successive stimuli) .The cumulative dose-response curves of the 3 groups were established. The onset time and maximum depression of T1 of the initial dose and 3 incremental doses were recorded. After the last increment of 10 ?g?kg-1, the time for T1 to returned to 25% ,75% ,90% and TOF ratio(T4/T1) to 70% were recorded. The recovery index was also calculated.Results The demographic data were comparable between the 3 groups. The ED50 and ED95 were significantly lower in desflurane and isoflurane groups than those in control group(P 0.05 ) . The time for T1 to return to 25 % , 75 % and 90 % was significantly longer in desflurane and isoflurane group than that in the control group. The recovery from vecuronium-induced neuromuscular block was slower in desflurane group than that in isoflurane group( P

Effects of rocuronium and vecuronium alone or in combination on adult and fetal type muscle nicotinic acetylcholine receptors / 中华麻醉学杂志

Objective To investigate the effects of rocuronium and vecuronium on the adult-type (?-nAChR) and fetal-type (?-nAChR) muscle nicotinic acetylcholine receptors. Methods HEK293 cells were obtained from Institute of Cytology, Chinese Academy of Sciences.?- and ?-nAChRs were expressed heterologously in HEK293 cells using transfection technique. Whole cell patch clamp technique was used to determine the potencies of the two muscle relaxants alone or in combination in blocking the function of the two types of nAChRs. Results Both rocuronium and vecuronium could competitively inhibit the activation of ?- nAChR and ?-nAChR by Ach. The IC50 of rocuronium and vecuronium for ?-nAChR was 169.2 ? 12.5 and (8.3 ? 2.7) ?mol?L-1 and for ?-nAChR was 8.6 ? 2.7 and (55.0?10.4) ?mol?L-1 respectively. The IC50 of rocuronium in combination with vecuronium was (0.7 ? 0.3) ?mol ? L-1 for ?-nAChR and (36.3 ? 14.2) ?mol ? L-1 for ?-nAChR.Conclusion The two muscle relaxants have different blocking action on the two types of nAChRs. Rocuronium has stronger inhibitory effect on ?-nAChR than on ?-nAChR while vecuronium has stronger inhibitory effect on ?-nAChR than on ?-nAChR. The inhibitory effects of the two muscle relaxants in combination was synergistic on ?-nAChR and additive on ?-nAChR.

Actions of vecuronium and atracurium on adult and embryonic-type nicotinic acetylcholine receptor at skeletal muscle cell membrane / 中华麻醉学杂志

Objective To investigate and compare the actions of vecuronium and atracurium on adult and embryonic-type nicotinic acetylcholine receptors (?-and ?-nAChR) at skeletal muscle cell membrane. Methods The adult and embryonic nAChRs were heterologously expressed in HEK 293 cells. Peak currents induced by actions of vecuronium and atracurium at ?-and ?-nAChR were recorded in HEK 293 cells, using whole cell patch clamp technique. Results Vecuronium and atracurium competitively inhibited ?-and ?-nAChR in HEK 293 cells. The inhibitor concentrations for half-maximal response (IC50) for vecuronium and atracurium ate-nAChR were (8.3 ? 2.6) ?mol/L and (24.2 ? 10.5) ?mol/L respectively; The IC50 values for vecuronium and atracurium at e-nAChR were (55.0 44 28.4) ?mol/L and (183.2 ? 39.2) ?mol/L respectively.Conclusion According to IC50 values for both adult and embryonic type nAChR, vecuronium is more potent than atracurium on e-and 7-nAChR. Embryonic nAChR is less sensitive to vecuronium and atracurium than adult-type nAChR.

The influence of body temperature on the recovery from vecuronium-induced neuromus cular block / 中华麻醉学杂志

Objective To investigate the influence of body temperature on the recovery from vecuronium-induced neuromuscular block.Methods Sixty-eight ASA I - II patients (39 male, 29 female) aged 19-69 yr undergoing elective surgery under general anesthesia were randomly divided into 2 groups: group I in which patients' body temperature was maintained at 37 ℃ using warming blanket; group II in which no measures were taken to maintain the patients' body temperature. The patients were premedicated with phenobarbital 2 mg?kg-1 and atropine 0.01 mg? kg-1 intramuscularly. Anesthesia was induced with fentanyl 5 ?g? kg -1, propofol 2 mg? kg-1 and vecuronium 0. 1 mg?kg-1 . After tracheal intubation anesthesia was maintained with inhalation of 0.8%-2.5% isoflurane and propofol infusion at a rate of 2-4 mg ? kg-1? h-1 .Neuromuscular block was monitored using accelograph (Biometer, Denmark) .The changes in TOF and T1 were monitored. T1was maintained at 10% by vecuronium infusion during operation. At the end of operation a bolus of vecuronium 80?g ? kg-1 was given intravenously and T1 was completely depressed. The time for T1 to returned to 5% ,25% and 90% and the time required for T1 to return from 25 % to 75 % were recorded. The total amount of vecuronium given was recorded. Temperature probe was placed in the esophagus ( core temperature) . The room temperature was also recorded. Results The body temperature was lower, the total dose of vecuronium was smaller and the vecuronium-induced neuromuscular block lasted longer in group II as compared with group I . There was close correlation between body temperature and vecuronium-induced neuromuscular block. Conclusions Lower core body temperature could prolong the vecuronium-induced neuromuscular block.

Factors Influencing the Clinical Duratin of Vecuronium Bromide in Patients with Chronic Renal Failure / 대한마취과학회지

The clinical duration(the time from onset unitl 25% recovery of base line twitch amplitude) of vecuronium bromide(vecuronium) in patients with chronic renal failure showed great individual variations. The factors that influence the action of vecuronium were hypothermia, biliary and urinary excretion, electrolyte imbalance and acid base status, age, etc. The purpose of this study was to examine the relationship between influencing factors and clinical duration of vecuronium in patients without renal function. Thirty patients for renal transplantation were applied ulnar nerve stimuli of every 10 seconds single twitch using Myotest MK II . The adduction force of the resultant thumb twitch was measured by the acceleration of Mini-accelograph and recorded by Datascope 2200 I . After intravenous vecuronium 0.12mg/kg, the duration of action was measured during anesthesia with 1- 1.5% isoflurane and 50% nitrous oxide. The results were as follows : 1) There were only a significant relationship between clinical duration of vecuronum and diagnostic duration(the duration from diagnosis to operation). 2) I thought the clinical duration of male was longer thsn that of female was due to longer diagnostic duration of male. 3) I could not suspect the changes of clinical duration after small increased vecuronium in patients without kidney function, due to great individual variations. With the above results the author concluded that the clinical duration of vecuronium was followed by the diagnostic duration in patients without kidney function.

The Influence of Thiopental Sodium , Ketammine and Lidocaine on the twitch recovery after Vecuronium Bromide / 대한마취과학회지

Anesthetic drugs by themselves were without effect on neummuscular function, but when the margin of safety in transmission was reduced, because of the admimstration of a musde relaxant, then a synergistic effect on relaxation might be observed. The purpose of this study was to examine whether the twitch recovery after vecuronium bromide (vecuronium) was influenced by thiopental sodium (thiopental), ketamine and lidocaine. Eighty healthy adult patients were randomly allocated to four groups according to the drugs, control group, normal saline 5 ml, study group ; 2.5% thiopental 5 mg/kg, ketamine 2 mg/kg and 1% lidocaine 1 mg/kg. Neuromuscular bloek was induced by intravenous vecuronium 0.1 mg/kg and applied ulnar nerve stimuli of every 10 seconds single twitch using Myotest Mk II(R). The adduction force of the resultant thumb twitch was measured by the acceleration of a small piezo-electric ceramic wafer with electrodes of Mini-accelograph(8) and recorded by Datascope 2200I(8). When the twitch height was near 15 mm, the drug was injected and recorded the twitch height for 10 min. and checked mean arterial pressure and heart rate after injection. The results were as follows ; 1) There were no significant changes of mean arterial pressure after drug injection. 2) Heart rate was significantly increased in thiopental group (77.7+/-8.3 beats/min. 93.7+/-9.1 beats/min.) and lidocaine group (85.6+/-15.9 beats/min. - 88.4+/-16.4 beats/min.), but no change in control and ketamine group. 3) In the linear regression analysis between the twitch length and the time, control group was Y=16.0+/-1.0X, r2=0.33, thiopental group was Y=14.9+/-1.1X, r2%.39, ketamine gmup was Y=14.8+0.9X, r2=0.24 and lidocaine group was Y=15.1+0.8X, r2=0.30. Lidocaine group was only significantly decreased than control group. With the above results the authors concluded that the twitch recovery after vecuronium was significantly deaeased by lidocaine, but no cbanges by thiopental and ketamine. We should more find the drug interaction with vecuronium in the man.

Comparison of Response between the Ulnar , Facial , Peroneal and Tibial Nerve after Administration of Vecuronium / 대한마취과학회지

Since as neuromuscular blocking agents are usually used during general anesthesia, monitoring of muscle relaxation is integra1 part of the management of patients and the ulnar nerve is allowed commonly to evaluate of neuromuscu1ar blockade. But our study was designed to monitor neuromuscular blockade-induced Vecuronium blocakade in 40 ASA 1-2 adult pateints in various nerves other than ulnar nerve with the single twitch(T1) and post-tetanic count(PTC) methods. All patients were premedicated with glycopyrrolate 0.2 mg and hydroxizine 1 mg/kg Ihour before induction, and were inducted with thiopental sodium 5 mg/kg and maintained with nitrous oxide(50%) and enflurane(1-2%). The patients were randomly divided to 4 groups, the ulnar nerve group was monitored at the adductor pollicis muscle, the facial nerve group was monitored at the orbicularis oculi muscle, the peroneal nerve group was monitored at the extensor digitorum brevis muscle, and the tibial nerve group was monitored at the flexor hallucis brevis muscle. After administration of vecuronium bromide 0.1 mg/kg, the onset time, duration of action and recovery time were compared between 4 group by INNERVATOR(Fisher & Paykel Co). The results obtained were as follow; 1) At the onset time, the facial nerve group was significant shorter than the ulnar nerve group, but the tibial and peroneal nerve group was significant prolonged. 2) The action duration from disappearance of single twitch to first appearance of PTC was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve gruop. 3) The recovery time from disappearance of single twitch to first appearance of single twitch was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve group.

Comparison of Response between the Ulnar , Facial , Peroneal and Tibial Nerve after Administration of Vecuronium / 대한마취과학회지

Since as neuromuscular blocking agents are usually used during general anesthesia, monitoring of muscle relaxation is integra1 part of the management of patients and the ulnar nerve is allowed commonly to evaluate of neuromuscu1ar blockade. But our study was designed to monitor neuromuscular blockade-induced Vecuronium blocakade in 40 ASA 1-2 adult pateints in various nerves other than ulnar nerve with the single twitch(T1) and post-tetanic count(PTC) methods. All patients were premedicated with glycopyrrolate 0.2 mg and hydroxizine 1 mg/kg Ihour before induction, and were inducted with thiopental sodium 5 mg/kg and maintained with nitrous oxide(50%) and enflurane(1-2%). The patients were randomly divided to 4 groups, the ulnar nerve group was monitored at the adductor pollicis muscle, the facial nerve group was monitored at the orbicularis oculi muscle, the peroneal nerve group was monitored at the extensor digitorum brevis muscle, and the tibial nerve group was monitored at the flexor hallucis brevis muscle. After administration of vecuronium bromide 0.1 mg/kg, the onset time, duration of action and recovery time were compared between 4 group by INNERVATOR(Fisher & Paykel Co). The results obtained were as follow; 1) At the onset time, the facial nerve group was significant shorter than the ulnar nerve group, but the tibial and peroneal nerve group was significant prolonged. 2) The action duration from disappearance of single twitch to first appearance of PTC was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve gruop. 3) The recovery time from disappearance of single twitch to first appearance of single twitch was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve group.

Relationship between the Change of PTC and the Response of Endotracheal Intubation after Vecuronium Induction / 대한마취과학회지

The relationship between the post-tetanic count(PTC) and the response of tracheal intubation after vecuronium-induced neuromuscular blockade was studied in 99 cases who were ASA 1 or 2 adult patients. All patients were premedicated with glycopyrrolate 0.2mg and hydroxizine 1 mg/kg IM 1 hour before induetion, and were inducted with pentothal sodium Smg/kg and O2- N2O(50%) enflurane(2%). The patients were randomly divided to two groups according to dose of vecuronium applied after inducion ; 0.08 mg/kg(n=54) group and 0.12 mg/kg(n=45) group. Neuromuscular blockade was monitored by stimulation of the ulnar nerve at the wrist with single twitch using INNERVATOR(Fisher and Paykel Co.). Post tetanic count(PTC) was counted at different times, i.e., 0, 10, 20, 25, 30 and 35 seconds, 9 persons respectively at each time, after disappearance of single twitch. Tracheal intubation was performed immediately after counting of PTC. The response of tracheal intubation was appreciated based on vocal cord reflex, coughing or barking and patient movement. The time from administration of vecuronium to disappearance of single twitch was 167.8+/-23.4 seconds in 0.08mg/kg group and 163.7+/-51.1 seconds in 0.12mg/kg group and there was no statistical difference. After complete disappearance of single twitch, the PTC was zero at 35 seconds in 0.08 mg/kg group and at 25 seconds in 0. 12 mg/kg group. While the PTC was lowering, the lower intubation condition score should be expected, but the 0 of PTC did not coin-cided with the 0 of intubation condition score. However, the 0 of PTC did not always indicated that response to tracheal intubation could be disappear completely. Profound neuromuscular blockade did not reduce the hemodynamic responses to tracheal intubation.

The Effects of Vecuronium Bromide in Divided Dose on Endotracheal Intubation / 대한마취과학회지

Succinylcholine chloride is ordinarily the muscle relaxant of choice for rapid endotracheal intubation, but may produce myalgia, increase in intragastric pressure, increase in intraocular pressure, and it may be associated with malignant hyperthermia and hyperkalemia. Many investigators have tried to find an alternative drug for succinylcholine chloride. Foldes reported that the onset can be shortened by the administration of a subparalyzing dose of vecuronium bromide a nondepolarizing intermediate-acting muscle relaxant, prior to its intubating dose. This has been termed "the priming principle",. Mehta et al, Lennon et al and Schwarz reported similar results. These investigators studied to identify an optimal priming dose, priming interval (the time from the priming dose to the intubating dose) and intubating dose of vecuronium bromide, to perform a rapidsequence induction of anesthesia. We studied 50 healthy adult patients, and results are 1) Group IV (a priming dose of 0.02 mg/kg, a priming interval of 4 min and an intuating dose of 0. 1 mg/kg) had better intubating condition than the control group. 2) The groups with divided doses had significantly shorter onset time compared to the control group (0.1 mg/kg without prime dose). 3) Group II and IV (priming dose 0.02 mg/kg) had shorter onset time compared to group I and III (priming dose 0.01 mg/kg), but the difference was not significant. 4) Group III and IV (priming interval of 4 min) had shorter onset time compared to group I and II (priming interval of 2 min), but the difference was not significant. In conclusion, group IV (priming dose of 0.02 mg/kg and priming interval of 4 min) had the shortest onset time and provided the best intubating condition.