Double-blind comparison of two doses of rocuronium and succinylcholine for rapid-sequence intubation.

STUDY OBJECTIVE: To compare the pharmacodynamics of two commonly recommended doses of rocuronium bromide (0.7 mg/kg and 0.9 mg/kg) and succinylcholine (1.5 mg/kg) when used for rapid-sequence intubation. DESIGN: Prospective, double-blind, randomized study. SETTING: Operating rooms at a university hospital. PATIENTS: 45 ASA physical status I and II adult patients scheduled for elective surgeries under general anesthesia. INTERVENTIONS: Nonpremedicated patients were anesthetized with fentanyl 2 mcg/kg followed by thiopental sodium 4 to 5 mg/kg and muscle relaxant using rapid-sequence technique. Group 1 (n = 15) received rocuronium bromide 0.7 mg/kg. Group 2 (n = 16) received rocuronium bromide 0.9 mg/kg, and Group 3 (n = 14) received succinylcholine 1.5 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxant. MEASUREMENTS AND MAIN RESULTS: The case of intubation was scored using a scale of 1 to 4. Blood pressure and heart rate were measured beginning one minute before induction of anesthesia up to 5 minutes after intubation. Intubation scores were similar in groups 2 and 3 and were noted as good or excellent in all patients. Group 1 displayed a significantly lower intubation score than the other two groups; 60% were rated as poor. No significant differences in hemodynamic data were seen among the three groups. CONCLUSIONS: Rocuronium bromide at a dose of 0.9 mg/kg provides intubating conditions similar to succinylcholine 1.5 mg/kg at 1 minute. Intubating conditions at 1 minute following a 0.7 mg/kg dose of rocuronium are not as good as those following a 0.9 mg/kg dose of rocuronium or a 1.5 mg/kg dose of succinylcholine.

Increased collagen synthesis and increased content of type VI collagen in myocardium of tight skin mice.

OBJECTIVE: The tight skin mouse (TSK) is a mutant strain characterised by excessive collagen accumulation in skin and some internal organs such as the heart. The aims of this study were (1) to examine in vitro collagen synthesis in TSK myocardium; (2) to determine myocardial content of type VI collagen in the same model; and (3) to examine the expression of one of the genes for type VI collagen in cultured TSK myocardial fibroblasts. METHODS: Individual hearts from 8 month old heterozygous male TSK and normal sex and age matched mice were incubated with 14C proline. Total 14C protein and 14C collagen synthesis by myocardial tissues were determined with collagenase digestion and SDS gel electrophoresis. For determination of type VI collagen, hearts from 10 month old male TSK and normal mice were subjected to guanidine extraction followed by pepsin digestion, salt fractionation, and western blotting. Expression of the alpha 2(VI) collagen gene was determined in myocardial fibroblasts cultured from TSK and normal mice, employing northern and dot blot hybridizations with a murine specific cDNA. RESULTS: TSK hearts had up to twofold greater protein and collagen biosynthesis and 2.5-fold greater type VI collagen content (400 micrograms v 156 micrograms). Fibroblasts cultured from TSK mice hearts displayed up to threefold higher steady state concentrations of alpha 2(VI) collagen mRNA than normal myocardial fibroblasts. CONCLUSIONS: Hearts from TSK mice showed increased protein and collagen biosynthesis and increased myocardial content of type VI collagen compared with hearts from age matched normal mice. Also, fibroblast cultures from TSK mice myocardium showed increased expression of the alpha 2(VI) collagen gene, indicating that increased transcription of type VI collagen genes may be responsible for the accumulation of this collagen in myocardium from TSK mice.

Growth properties and biochemical characterization of collagens synthesized by adult rat heart fibroblasts in culture.

Collagen is the most important component of the extracellular matrix of the myocardium; it supports the myocytes and maintains the architecture of the heart. Collagen also participates in the myocardial response to various forms of pressure overload. Increased tissue collagen content occurs as a result of spontaneous or experimental overload-induced myocardial hypertrophy. In order to determine the mechanisms responsible for the increased collagen deposition in experimental cardiac hypertrophy, we established monolayer cultures of fibroblasts isolated from normal adult rat myocardium and studied their growth and biosynthetic characteristics. These cells have a doubling time of about 20h and synthesize and secrete several collagenous and non-collagenous proteins. We found that type I collagen was the major collagenous product of these cells representing 80% of total newly synthesized collagen. Most of the newly synthesized collagen was secreted into the culture medium as intact and partially cleaved procollagens. About 20% of the total collagen synthesized was type III collagen which was also secreted into the medium as a procollagen. A small proportion of type V collagen (less than 5%) was also synthesized by these cultures. Fibronectin which was identified by its mobility in SDS gel electrophoresis was quantified by immunoprecipitation with specific antisera and was the most abundant non-collagenous protein synthesized by these cells. Northern blot hybridization analysis demonstrated that these cells expressed transcripts for alpha 1 chains of types I and III collagen and for fibronectin.