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.

Estimation of the effect-site equilibration rate constant using the time-to-peak effect of muscle relaxants measured by train-of-four stimulation during general anesthesia induction / 대한마취과학회지

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.

Appraisal of anesthesia effect of CIS atracuriumbesilate and vecuronium in pediatric anesthesia in living related partial liver transplantation / 中华器官移植杂志

Objective To assess the anesthesia effect of CIS atracuriumbesilate and vecuronium in pediatric anesthesia in living related partial liver transplantation.Methods A total of 40 children undergoing living related partial liver transplantation were divided into CIS atracuriumbesilate compound anesthesia group (group C) and the vecuronium compound anesthesia group (group V) using the method of random number table.The anesthesia in group C and group V was induced and maintained with CIS atracurium and vecuronium respectively.Muscle relaxation was induced with 0.15 mg/kg C or 0.1 mg/kg V and maintained with 0.03 mg/kg C or 0.02 mg/kg V at T125％ recovery.Intubating conditions were assessed at 3 min after the initial dose.Time course of NMB was monitored using accelerography (TOF-Guard) of the adductor policis with train-of-four (TOF).The cerebral vascular hemodynamic indexes were observed at the time of entering room (T0),3 min before intubation (T1),3 min after intubation (T2),the beginning of the operation (T3),30 min after unhepatic phase (T4),30 min after reperfusion phase (T5) and extubation (T6),and the muscle relaxant effect time and intubation Coopers total score were recorded in the two groups.The operation time,total doses of muscle relaxant drugs in the two groups,anesthesia awakening period of each index,and adverse reactions were recorded.Parameters at recovery period and adverse reactions in the two groups were analyzed.Results There was no statistically significant difference between the two groups in the changes of hemodynamic indexes and intubation Cooper's score,operation time,and total doses of muscle relaxant drugs at different time points (P＞0.05).The muscle relaxant effect time and the recovery period were obviously shorter in the group A than those in the group V with the difference being statistically significant (P＞0.05).No adverse reactions were reported in the two groups.Conclusion The combination of CIS atracuriumbesilate and vecuronium in pediatric anesthesia in living related partial liver transplantation may obtain a satisfied anesthesia effect,maintaining stable hemodynamics,especially CIS atracuriumbesilate may take action faster and help muscle relaxation faster without accumulatior.

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%.

Effect of Vecuronium in different age group

Background: Muscle relaxants are adjuncts to good anesthesia. Neonates and infants are having less developed neuromuscular junction, larger distribution volume and poor hepatic and renal function. The aim of the present study was to define dose of Vecuronium in neonates and infants in comparison of other age groups, to observe cardiovascular effect of Vecuronium, to study adequacy of intubating condition and, Adequacy of intra-operative muscle relaxation, To observe completeness of recovery after reversal. Materials and methods: 100% patients belonging to physical status of A.S.A Group I and II for operative procedures from both routine and emergency surgeries were selected randomly for study to observe clinical Comparison of Vecuronium bromide in different age groups. Patients were divided into 4 groups each consists of 25 Patients: Group I - Patients of 0-1 year of Age, Group II - Patients of 1-5 year of Age, Group III - Patients of 6-15 year of Age, Group IV - Patients of 16-50 year of Age. Results: Mean pulse rate before induction in Group I patient was 143.92/min., it increased to 151.92 /min. after intubation and then maintained throughout the course of anesthesia between 143.68 to 146.28 / min. which was not significant. The mean arterial pressure in Group I patient was maintained between 74.32 mm of Hg, 77.24 mm of Hg in Group II from 84.21 of pre-induction value – small changes were there and MAP maintained between 79.9 to 89.3 mm of Hg. Pre-induction MAP in Group III was 87.95 mm of Hg, it maintained between 89.29 to 92.66 mm of Hg throughout and in Group IV pre-induction value of MAP was 94.62, where it was maintained between 91.78 – 98.5 mm of Hg. So, there was no any pulse rate or blood pressure changes reflecting cardiovascular stability of Vecuronium. Rajani B, Brahmbhatt H, Chaudhry H, Hiren Parmar H. Effect of Vecuronium in different age group. IAIM, 2016; 3(9): 210- 217. Page 211 Conclusion: Vecuronium is an excellent non-depolarizing muscle relaxant which is an intermediate duration of action in adult but of longer duration in neonates and infants (less than 1 year). It is having advantage of – Cardiostability, Lack of Ganglion blocking action, Lack of histamine release, Non cumulative property, Excellent conditions for intubation, Excellent muscle relaxation, Complete recovery without any complication

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.

Spectroscopy study on the interaction of γ-cyclodextrin and its two derivatives with rocuronium and vecuronium / 第二军医大学学报

Objective To study the interaction of γ-cyclodextrin (-CD) and its two derivatives with rocuronium and vecuronium. Methods The interactions of γ-CD and its two derivatives HS-7, Sugammadex with rocuronium and vecuronium were characterized by Isothermal Titration Calorimetry (ITC), and the thermodynamic constant and the binding constant was determined. The binding constant and inclusion ratio of γ-CD with rocuronium and vecuronium was observed by ultraviolet- visible spectrophotometry; the binding ability of three cyclodextrins with rocuronium and vecuronium was analyzed by nuclear magnetic resonance spectroscopy COSY and1HNMR. Results The results of ITC showed that HS-7, Sugammadex combined with rocuronium and vecuronium in a 1: 1 molar ratio, and γ-CDs combined with rocuronium in a 2: 1 molar ratio, with the binding constant of HS-7 and rocuronium being (3. 44 + 2. 18) X 107 L/mol, HS-7 and vecuronium being (5. 80 + 1. 83) X 106 L/mol, Sugammadex and rocuronium being (1. 04+0. 34) X 107 L/mol, Sugammadex and vecuronium being (2. 53 + 1. 07) X 106 L/mol, and γ-CD and rocuronium being (2. 84 + 3. 41) X 104 L/mol. The results of ultraviolet-visible spectrophotometry revealed that γ-CDs combined with rocuronium and vecuronium in a 2: 1 molar ratio, with the binding constant of y-CD and rocuronium being 6. 93 X 104 L/mol, and of γ-CD and vecuronium being 5. 17 X 104 L/mol. The results of nuclear magnetic resonance spectroscopy suggested that the binding ability of HS-7 with rocuronium and vecuronium was stronger than that of Sugammadex and γ -CD. Conclusion The binding ability of HS-7 with rocuronium and vecuronium is stronger than that of Sugammadex and γ -CD, and the three methods used in this study (ITC, ultraviolet-visible spectrophotometry and nuclear magnetic resonance spectroscopy) can characterize the inclusion complex from different perspectives.

Effects of magnesium sulfate on remifentanil requirements for achieving hemodynamic stability during laparoscopy assisted distal gastrectomy

BACKGROUND: Magnesium is known to reduce the requirement of analgesic agents by blocking calcium channels that exist at the neuronal and neuromuscular junctions. However, former studies have shown inconsistent results regarding this concept. Therefore, we investigated the effects of magnesium on remifentanil requirements for achieving hemodynamic stabilization in patients undergoing laparoscopic gastrectomy. METHODS: Laparoscopic gastrectomy patients (n = 30) were randomly divided into two groups. Group M received 50 mg/kg of magnesium sulfate for 15 minutes prior to the induction of anesthesia. Then, 20 mg/kg/h of magnesium was administered during the operation time. Group N was administered the same amount of saline. Anesthesia was maintained with intravenous propofol and remifentanil injection. Vecuronium (0.1 mg/kg) was administered before intubation, and an additional 0.02 mg/kg was administered if a T1 twitch response was observed during surgery. Anesthetic time was standardized to provide an appropriate comparison of all patients. During 100 minutes, total anesthetic requirements and anesthetic requirements at every 10 minutes were analyzed. Postoperative pain was controlled with a patient controlled analgesia device. RESULTS: The remifentanil and vecuronium requirements during 100 minutes were significantly lower in Group M. There was no significant difference in propofol requirements between the two groups. No significant difference was observed in mean arterial pressure and heart rate. Postoperative VAS, PONV, or shivering also did not show any difference between the two groups. CONCLUSIONS: Magnesium reduced remifentanil and vecuronium requirements but not propofol requirements. Magnesium seems to have antinociceptic properties and reduces remifentanil requirements.

Effectiveness of sugammadex in reversing prolonged neuromuscular block in a patient with acquired immune deficiency syndrome (AIDS) taking streptomycin: A case report

The duration of the effect of muscle relaxants is extended in patients with acquired immunodeficiency syndrome (AIDS); however, a specific mechanism for this effect has not yet been discovered. In addition, streptomycin is known to prolong the action of muscle relaxants by blocking activity at neuromuscular junctions. Here, we report the case of patient with AIDS taking streptomycin for pulmonary tuberculosis for which sugammadex was effective in reversing prolonged paralysis induced by rocuronium and vecuronium for video-assisted thoracoscopic surgery (VATS) lung wedge resection.

Effect of vecuronium at different doses for induction of anesthesia on monitoring of recurrent laryngeal nerve in patients undergoing thyroid operation / 中华麻醉学杂志

Objective To investigate the effect of vecuronium at different doses for induction of anesthesia on monitoring of recurrent laryngeal nerve in patients undergoing thyroid surgery.Methods One hundred and seventeen patients,ASA Ⅰ or Ⅱ,aged 20-64 yr,weighing 50-85 kg,scheduled for thyroid surgery,were randomly divided into three groups:group Ⅰ (n =39),group Ⅱ (n =40) and group Ⅲ(n =38).Anesthesia was induced with midazolam 2 mg,propofol 2 mg/kg,sulfentanil 0.5 μg/kg.Following BIS value at 40-50,vecuronium 0.05(ED95) or 0.10 mg/kg (2 × ED95)was intravenously injected in group Ⅰ or Ⅱ respectively,and the electromyographic (EMG) endotracheal tube was intubated under glidescope at 5 min after vecuronium administration.Group Ⅲ received sevoflurane inhalation and the EMG endotracheal tube was intubated following end-tidal sevoflurane concentration at 4％.Anesthesia was maintained with inhalation of sevoflurane in three groups.Cooper' s score and the success of attempt at endotracheal intubation were recorded.The recurrent laryngeal nerve-evoked EMG response was monitored to record the amplitude at 5 min intervals from 30 min to 70 min following surgery.Results The success rates of endotracheal intubation were 100％ in three groups,but the Cooper' s score of groups Ⅰ and Ⅱ was significantly higher than that of group Ⅲ (P ＜ 0.05),while there was no significant difference between groups Ⅰ and Ⅱ.In spite of the EMG amplitude being significantly decreased as compared with group Ⅲ,the EMG response was adequate for monitoring of recurrent laryngeal nerve in group Ⅰ.The EMG response was lost 30 min following surgery,and inadequate for neuromonitoring of recurrent laryngeal nerve 35-45 min following surgery in group Ⅱ.Conclusion Vecuronium 0.05 mg/kg (ED95)for induction of anesthesia may be helpful to provide satisfactory endotracheal intubation conditions,also not affect the monitoring of recurrent laryngeal nerve in patients undergoing thyroid surgery,which can be recommended as the optimal dosage.

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.

Antioxidant effect of muscle relaxants (vecuronium, rocuronium) on the rabbit abdominal aortic endothelial damage induced by reactive oxygen species / 대한마취과학회지

BACKGROUND: Muscle relaxants induce vascular smooth muscle relaxation by inducing synthesis of the prostaglandins that influence vasomotor tone. However, the effects of muscle relaxants on endothelial cells and tissues following injury by reactive oxygen species (ROS) are unclear. We tested the effects of the muscle relaxants vecuronium and rocuronium on impaired acetylcholine (ACh)-induced relaxation following induction of ROS in rabbit aorta in vitro. METHODS: Isolated rabbit abdominal aortic ring segments were pretreated with vecuronium or rocuronium at 10(-4), 3 x 10(-4), 10(-3) or 3 x 10(-3) M, with or without inhibitors of Cu/Zn superoxide dismutase (diethyldithiocarbamate; DETCA, 0.8 mM) or catalase (3-amino-1,2,4-triazole; 3AT, 50 mM). All groups of aortic rings were then exposed to ROS generated by electrolysis in the organ bath medium (Krebs-Henseleit solution). The effects of vecuronium and rocuronium on ROS-induced impairment of relaxation induced by ACh (10(-6) M) were assessed. RESULTS: Aortic rings treated with vecuronium or rocuronium at 10(-4), 3 x 10(-4), 10(-3) or 3 x 10(-3) M preserved the capacity for ACh-induced endothelial relaxation following ROS exposure in a dose-dependent manner. Pretreatment with DETCA partially inhibited the protective effects of vecuronium and rocuronium on ACh-induced relaxation (P < 0.001), but pretreatment with 3AT had no effect. CONCLUSIONS: Muscle relaxants protected the endothelium in isolated rabbit abdominal aorta from free-radical injury in a dose-dependent manner. These results suggest that vecuronium and rocuronium may act as superoxide anion scavengers.

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.

Analysis of postoperative residual paralysis and respiratory function of patients undergoing neurosurgical anesthesia / 中国医师进修杂志

ObjectiveTo investigate the incidence of postoperative residual paralysis and respiratory function of patients undergoing neurosurgical anesthesia.Methods Three hundred andtwenty-eight patients undergoing neurosurgical anesthesia (ASA Ⅰ - Ⅱ ) were divided into vecuronium group (135 cases) and rocuronium group (193 cases) by random digits table.Anesthesia was maintained with propofol in combination with sevoflurane and intermittented intravenous infusion boluses of muscle relaxatant.Extubation of the intratracheal tube in operation room was performed under clinical criteria.The neuromuscular function were detected by acceleromyography with supramaximal train-of- four(TOF) stimulation of the ulnar nerve,and pulmonary function were measured in postanesthesia care unit(PACU).The TOF ratio and pulmonary function were compared between two groups.ResultsThe incidence of postoperative residual paralysis was 31.9％(43/135) in vecuronium group,and 14.5％(28/193) in rocuronium group.Hypoxemia and hypercapnia occurred in vecuronium group with TOF ＜ 0.9 were higher than in those with TOF ≥0.9[7.0％(3/43) vs.4.3％(4/92) and 44.2％(19/43) vs.18.5％(17/92),P ＜ 0.01 ],while in rocuronium group with TOF ＜ 0.9 were higher than in those with TOF ≥ 0.9 [ 3.6％( 1/28 ) vs.1.2％ (2/165) and 39.3％( 11/28 )vs.17.0％ (28/165),P ＜ 0.01 ].ConclusionsThere is a high incidence of postoperative residual paralysis according to the clinical criteria of recovery of neuromuscular function of patients undergoing neurosurgical anesthesia,which would impair respiratory function.

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.

Comparision of two anesthesia combination regimens for renal transplantation / 中华内分泌外科杂志

Objective This research aimed to compare two regimens of anesthesia(vecuronium-fentanyl and cisatracurium-remifentanil)for kidney transplantation patients.Methods 108 patients were studied,45 patients(Group Ⅰ)received balanced anesthesia with vecuronium and fentanyl,to the others 63(Group Ⅱ),cisatracurium and remifentanyl was given.Comparison of the difference between the two groups was made on the extubation time,intraoperative hemodynamics,postoperative urine output,serum creatinine and anesthesia complications.Results Extubation time of the Group Ⅰ was significantly longer than that of Group Ⅱ(33.5min ±17.5min,P＜0.05),but there was no difference between two groups on intraoperative hemodynamics,postoperative urine output,serum creatinine and anesthesia complications.Conclusions Both of the two regimens can provide safe anesthesia for kidney transplantation.Patients received regimen of cisatracurium and remifentanil experienced shorter extubation time.This regimen may be a better anaesthesic regimen for renal transplantation.

Analysis of the rocuronium-vecuronium interaction on tetanic fade based on a generalized response surface model with varying relative potencies / 대한마취과학회지

BACKGROUND: Some studies have shown that rocuronium and vecuronium have additive, or synergistic effects on muscle relaxation based on the Loewe additivity. Therefore, we performed a fit of tetanic fade data to a generalized response surface model with varying relative potencies proposed by Kong and Lee (KLGRS) to evaluate the usefulness of KLGRS for capturing the interspersed drug interactions and to characterize the interaction between the two drugs. METHODS: Left phrenic nerve-hemidiaphragms (Male Sprague-Dawley rats, 150-250 g) were mounted in Krebs solution. Supramaximal electrical stimulation (0.2 ms, rectangular) of 50 Hz for 1.9 s to the phrenic nerve evoked tetanic contractions that were measured with a force transducer. Each preparation was exposed to one of 4 vecuronium concentrations (0.0, 1.5, 2.5, and 3.0 microM), or one of 4 rocuronium concentrations (0.0, 3.0, 4.5, and 5.5 microM). Subsequently the adequate amount of rocuronium was added to a vecuronium bath and that of vecuronium was added to a rocuronium until an 80-90% increase in tetanic fade was achieved. We then fitted the modified KLGRS models to the above data, after which we selected the best model, based on 5 methods for determining goodness of fit. Using this method, we obtained the response surface, as well as contour plots for the response surface (i.e. isoboles), the polynomial function and the interaction index. RESULTS: The model with the constant relative potency ratio and 8 parameters was found to best describe the results, and this model reflected well the characteristics of the raw data. In addition, the two drugs showed a synergistic interaction in almost every area and an antagonistic one in a very narrow area. CONCLUSIONS: KLGRS was found to be a useful method of analyzing data describing interspersed drug interactions. The interaction between rocuronium and vecuronium was found to be synergistic.

The effects of rocuronium and vecuronium on the increase in intraocular pressure associated with tracheal intubation

BACKGROUND: During ophthalmologic surgery, various intravenous anesthetic induction agents are used to prevent an intraocular pressure (IOP) increase. This study was designed to compare the effects of vecuronium and rocuronium on IOP in patients who were intubated. METHODS: Thirty-two patients undergoing elective strabismus surgery, aged 4 to 12 years, were randomized to receive rocuronium 0.6 mg/kg (Group 1, n = 16), or vecuronium 1.0 mg/kg (Group 2, n = 16).IOP, mean arterial pressure (MAP), and heart rate (HR) were measured at the following time points: prior to induction (B); after the administration of the induction agents; before intubation (T0); and at 1, 3 and 5 mins after intubation (T1, T3 and T5). RESULTS: The IOP after T0 in Group 1 was significantly lower than B (P < 0.05) in Group 2.The IOP at T1 in the Group 1 and 2 was not different from B, respectively.The IOP, MAP, and HR at T1 in the Groups 1 and 2 were significantly higher than at T0 (P < 0.05).No significant differences were observed between the groups in term of IOP. CONCLUSIONS: We concluded that vecuronium and rocuronium are both useful as muscle relaxants for use in general anesthesia in ophthalmologic surgery, because both agents caused similar decreases in intraocular pressure.

Effect of acute hypervolemic hemodilution on the onset and recovery of muscle relaxation induced by vecuronium / 中华麻醉学杂志

Objective To investigate the effect of acute hypervolemic hemodilution(AHHD)on the onset and recovery of muscle relaxation induced by vecuronium.Methods Thirty-two ASA Ⅰ orⅡpatients undergoing elective surgery under general anesthesia were randomly divided into 2 groups(n=16 each):control group and AHHD group.A loading dose of vecuronium 0.1 mg/kg Was given at 10 min after AHHD following tracheal intubatiom The muscular relaxation was maintained at Tl/Tc 5% to 15% by supplement with intravenous vecuroninm.Blood samples were taken at various times during AHHD for chemical analysis.The onset and recovery time of muscular relaxation were recorded.Results Compared with control group ,Hct,Hb and the concentration of TP and Alb were decreased,and the onset and recovery time of vecuronium were shortened in group AHHD(P＜0.05).Conclusion Acute hypervolemic hemodihtion can shorten the onset and recovery of muscle relaxation of vecuronium in patients under general anethesia.