RESUMO
Objective To establish a method for the determination of cisatracurium besylate in human plasma by UPLC-MS/MS which could be used in the monitoring of drug residual in plasma of elderly patients after operation. Methods The samples were precipitated with 0.1% formic acid-acetonitrile solution and separated by an SHISEIDO ADME column(3.0 mm×100 mm, 2.7 μm) for isocratic elution with the mobile phase of water containing 0.1% formic acid with 2 mmol/L ammonium acetate and acetonitrile (30:70, V/V). MS condition was optimized in the positive ion detection mode by multiple reaction monitoring (MRM), along with the Agilent jet stream electrospray source interface (AJS-ESI). The precursors to the product ion transitions were m/z 464.3→358.2 for cisatracurium besylate and m/z 557.4→356.3 for vecuronium bromide (the internal standard, IS). Plasma samples of elderly patients undergoing spinal surgery were collected after anesthesia induction, at the end of surgery, 0.5 h and 1 h after surgery, and from the blood bags while autologous blood transfusion, and stored in cryopreservation tubes with 2% formic acid solution. Then the contents of cisatracurium besylate were determined. The effects of autogenous blood transfusion on plasma concentration of cisatracurium besylate in elderly patients after surgery evaluated. Results The calibration curve was linear in the range of 20-5 000 ng/ml for cisatracurium besylate in human plasma, r=0.999 7. The intra-day and inter-day precision and accuracy were good (RSD<10%, RE<±10%). The matrix effect of different concentrations was 71.88%~80.64%. The recovery of different concentrations was 83.62%~88.87%. The recovery of vecuronium bromide (IS) was 125.91%, which conformed with the requirement of methodological validation. There was a certain degree of residual cisatracurium besylate in the plasma of elderly patients, so the extubation time should be strictly controlled and the stay time of patients in the anesthesia recovery room should be appropriately extended. Conclusion The method is sensitive, accurate, and efficient, which could be used for the determination of cisatracurium besylate in human plasma of elderly patients after operation.
RESUMO
Objective To study the pharmacodynamics features of cisatracurium besylate in differ-ent age patients. Methods One hundred and eighty patients were randomized to group Ⅰ (50-60 years old),group Ⅱ (61-70 years old)and group Ⅲ (above 70 years old).Each group was subdivided according to the dose of cisatracurium besylate, 0.10 mg/kg (2ED95)or 0.15 mg/kg (3ED95) into group Ⅰ2, Ⅰ3, Ⅱ2, Ⅱ3,Ⅲ2, Ⅲ3(n = 30).ECG, SpO2, PETCO2, HR and neuromuscular blockade were monitored. Intubation conditions were assessed when T1 was zero after cisatracurium besylate administer ration using a 4-part scale.The onset time, TOF no reaction time, duration time, recovery lime and hemodynamic response time were recorded. Re-sults The onset times of group Ⅰ3, Ⅱ3 and Ⅲ3 were significantly shorter than those of group Ⅰ2, Ⅱ2 and Ⅲ2 (P < 0.05).The percentages of patients with excellent intubation condition in group Ⅰ3, Ⅱ3 and Ⅲ3 were 93%, 90%, and 80%, which were markedly higher than those in group Ⅰ2, Ⅱ2 and Ⅲ2 (67%, 60%, 60%). TOF no reaction time and duration time were longer in group Ⅰ3, Ⅱ3 and Ⅲ3 than those in group Ⅰ2, Ⅱ2 and Ⅲ2. There was no significant difference in muscle chalasis among the six groups. Conclusions Cisatracuri-um besylate 0.15 mg/kg produces quicker onset time and acceptable intubation conditions in the different age patients than 0.10 mg/kg. Recovery time is independent on the dosage and age. Aging has no influence on the phannacodynamics of single injection of cisatracurium besylate.