ABSTRACT
We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of rapacuronium. Eighty ASA I-III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5-2.5 mg kg-1 and fentanyl 1-2 micrograms kg-1, followed by a bolus of rapacuronium 1.5 mg kg-1. The patients were randomized to receive either desflurane (2-4% end-tidal, ET), sevoflurane (0.75-1.5% ET), isoflurane (0.4-0.8% ET), or a propofol infusion (75-150 micrograms kg-1 min-1) for maintenance of anaesthesia in combination with nitrous oxide (60-70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard accelerometer) returned to 5%, an infusion of rapacuronium was started at 3 mg kg-1 h-1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg-1 h-1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
Subject(s)
Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Neuromuscular Nondepolarizing Agents/administration & dosage , Propofol/administration & dosage , Vecuronium Bromide/analogs & derivatives , Adolescent , Adult , Aged , Anesthesia Recovery Period , Desflurane , Drug Synergism , Electromyography , Female , Humans , Infusions, Intravenous , Isoflurane/administration & dosage , Isoflurane/analogs & derivatives , Male , Methyl Ethers/administration & dosage , Middle Aged , Sevoflurane , Time Factors , Vecuronium Bromide/administration & dosageSubject(s)
Ambulatory Surgical Procedures/economics , Anesthesia, Conduction/economics , Analgesia/methods , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods , Anesthesia, Epidural , Anesthesia, Local , Anesthesia, Spinal , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Anesthetics, Local/economics , Cost-Benefit Analysis , Drug Costs , Humans , Models, Economic , Nerve BlockSubject(s)
Cholinesterase Inhibitors/pharmacology , Cholinesterases/blood , Cholinesterases/genetics , Succinylcholine/pharmacology , Adult , Benzoylcholine/metabolism , Cholinesterases/metabolism , Dibucaine/pharmacology , Female , Fluorides/pharmacology , Genetic Variation , Heterozygote , Humans , Phenotype , Time FactorsABSTRACT
Incubation of thyroparathyroid gland from 8-day-old rats with estradiol (10(-7) and 10(-9) M) and progesterone (10(-9) and 3 X 10(-10) M) resulted in stimulation of CT secretion. The effect of the gonadal steroids on CT secretion occurred at near physiological concentrations and persisted for at least 73 h. The studies demonstrate that exposure to gonadal steroids results in direct and prolonged stimulation of CT secretion. Therefore the decrease in bone resorption observed after the administration of gonadal steroids in vivo may at least in part be mediated via stimulation of CT secretion.
