Does Perioperative Monitoring of the Train-of-Four Response Influence the Frequency of Postoperative Residual Curarization in Propofol Anesthesia? / 대한마취과학회지

BACKGROUND: Sometimes hypoxemia occurs in the postoperative recovery room because of postoperative residual curarization (PORC). Some reports show that postoperative residual curarization is common. PORC occurs after the use of the long-acting muscle relaxants. It has been recommended to use intermediate-acting muscle relaxants and a TOF monitor to decrease PORC. The purpose of this study was to examine whether the use of the TOF monitor during propofol anesthesia affects the incidence of postoperative residual curarization. METHODS: 38 ASA I or II patients were divided randomly into two groups of 19 each. They received propofol-fentanyl-nitrous oxide for anesthesia. Pancuronium (80 100 microgram/kg) was used to facilitate tracheal intubation and additional doses were used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed, either with (control group:n = 19) or without (experimental group:n = 19) TOF monitoring. Fifteen minutes after the arrival at the recovery room, neuromuscular function was assessed clinically and by using TOF. RESULTS: There were no statistical differences in body weight, age, or duration of operation between the two groups. There was no statistical difference in the total dose of pancuronium and total dose of pancuronium relative to body weight and duration of operation. There were statistical differences in TOF ratio in the recovery room (0.73 vs. 0.86). The incidence of PORC was 47% in the control group and 5% in the experimental group. CONCLUSIONS: Though the monitoring of TOF did not effect the dose of muscle relaxant, it may have reduced the incidence of PORC. However, the PORC had no clinical significance because the mean TOF ratio in the two groups was over 0.7 and there were no clinical signs of residual muscle weakness.

The Effects of Vecuronium and Pancuronium on the Tension of the Isolated Rat Tracheal Smooth Muscle / 대한마취과학회지

BACKGROUND: Non-depolarizing muscle relaxants have their muscle relaxing effect by competing with acetylcholine (ACh) at the nicotinic receptor level. What are the effects of such muscle relaxants on the tracheal smooth muscle? This present study was set up to address the question as to how vecuronium and pancuronium influence the tracheal smooth muscle. METHODS: Sixty male Sprague-Dawley rat tracheal smooth muscles were isolated at optimal length for isometric force. The preparations were set up in an organ bath containing Tyrode's solution. And isometric force displacement transducer and physiograph were used to record the change in force. After the equilibration period the preparations were contracted with ACh 10(-5) M and carbachol 3x10(-7)M seperately. The preparations were washed with fresh tyrode's solution and allowed to return passively to resting tone. Then the cumulartive effect of ACh (from 3 10(-7) M through 10(-5) M) and carbachol (CCh, from 10(-8) M through 3 10(-6) M) were produced before and after pretreating the preparation with vecuronium (10(-5) M and 10(-6) M) and pancuronium (10(-5) M and 10(-6) M) respectively. Also, we studied the changes of contraction produced by neostigmine before and after pretreatment with vecuronium (10(-5) M and 3 10(-5) M) and pancuronium (3 10(-6) M and 3 10(-5) M). RESULTS: Vecuronium shifted the ACh dose-response curve of the tracheal contraction to the left (p0.05). CONCLUSIONS: Vecuronium inhibits the ACh hydrolyzing enzyme, especially acetylcholinesterase. Therefore it potentiates ACh contraction in the tracheal smooth muscle, but not the CCh contraction, while pancuronium has a different effect in comparison with vecuronium. That is, at a low concentration it reveals an antagonistic effect on the muscarinic M2 receptor and at a higher concentration it has an antagonistic effect on the muscarinic M3 receptor in the tracheal smooth muscle.

Effects of Vecuronium and Pancuronium on the Tension of the Smooth Muscle in the Rat Trachea / 대한마취과학회지

BACKGROUND: Vecuronium and Pancuronium have been proven to be associated with nicotinic receptor of skeletal muscle. Generally, nondepolarizing muscle relaxant is associated with contraction of smooth tracheal muscle, but there have been few studies about effects of nondepolarizing muscle relaxant on the smooth tracheal muscle. METHODS: We studied the acetylcholine dose response curve of the tracheal smooth muscle contraction and effects of propranolol, L-NAME after pretreating with vecuronium and pancuronium. RESULTS: Vecuronium shifted the acetylcholine dose-response curve of the tracheal contraction to the left, and pancuronium shifted the curve to the right. Vecuronium and Pancuronium reduced the contraction of smooth tracheal muscle with the use carbachol. Propranolol and L-NAME had no effect on the contraction of smooth tracheal muscle after pretreating with vecuronium and pancuronium. CONCLUSION: We suggest that vecuronium has an anticholinergic effect, while pancuronium has some effect on the muscarinic receptor in addition to its anticholinergic effect.

Cardiovascular Effects of Pancuronium, Vecuronium and Pipecuronium during High-Dose Fentanyl Anesthesia in Neonates, Infants and Children / 대한마취과학회지

BACKGROUND: High dose fentanyl for cardiac surgery in neonates, infants and children can cause severe bradycardia and chest wall rigidity that result in decreased cardiac output and oxygen desaturation due to fixed stroke volume in pediatric patients. To ameliorate the effects of fentanyl, it is common to administer neuromuscular blocking drugs with wanted cardiovascular side effects. This study was designed to compare the cardiovascular variables and oxygen saturation among different muscular relaxants in high dose fentanyl anesthesia. METHODS: Thirty pediatric cardiac patients were allocated randomly into three muscle relaxant groups treated with 0.2 mg/kg pancuronium (n=10), 0.2 mg/kg vecuronium (n=10) or 0.2 mg/kg pipecuronium (n=10) after receiving an initial bolus dose of 25 g/kg of fentanyl. Changes of heart rate (HR), mean arterial blood pressure (MAP), rate-pressure-product (RPP) and oxygen saturation (SpO2) were observed. The same cardiovascular variables were also observed 1 and 2 minutes after the second bolus dose of 25 g/kg fentanyl and compared to the results among muscle relaxants. RESULTS: HR, MAP and RPP decreased significantly (p<0.05) 1 and 2 minutes after injection of the 1st fentanyl, which returned to levels above the control value after administration of pancuronium, vecuronium or pipecuronium. Among muscle relaxants, pancuronium caused the most rapid and significantly high level compared to the control value in HR and MAP. Next was pipecuronium and then vecuronium. In clinical setting, SpO2 was decreased after the 1st fentanyl injection and increased after the injection of muscle relaxants, but not significant statistically. CONCLUSION: In view of hemodynamic changes, pancuronium is most efficient and rapid in returning the hemodynamic variables that was decreased after high dose fentanyl anesthesia in neonates, infants and children whose cardiac output was dependent on HR due to relatively fixed stroke volume.

Effect of Administration of Vecuronium or Rocuronium on Recovery from Pancuronium and Vice Versa in Isolated Forearm / 대한마취과학회지

BACKGROUND: It is important to consider the sequential administration of long- and short-acting non-depolarizing muscle relaxants. The purpose of this study is to evaluate the interaction between non-depolarizing muscle relaxants under isolated forearm test. METHODS: Ethics committee approval for all the volunteers (n=12) experiments was obtained. Pancuronium, 0.3 mg in 20 mL saline, was injected into one forearm; and vecuronium, 0.3 mg in 20 mL saline, was injected simultaneously into the other forearm in 6 volunteers. Three minutes later both tourniquets were released. Following spontaneous recovery in each forearm to 50% of the control twitch, the tourniquet was reinflated and the dose of drug of the same dilution used in the contralateral forearm was then injected (i. e., vecuronium following pancuronium in one forearm and pancuronium following vecuronium in the other forearm). Tourniquet was again released after 3 minutes and spontaneous recovery was allowed to occur. Interactions between pancuronium (0.3 mg) and rocuronium (2.0 mg) in 6 volunteers were also evaluated in a same method. RESULTS: Prior administration of pancuronium significantly prolonged the recovery rate from subsequent rocuronium (23.9 vs. 32.1 min, p<0.05), and rocuronium significantly shortened the recovery rate of pancuronium (32.4 vs. 25.9 min, p<0.05). There was simple additive interaction between pancuronium and vecuronium. CONCLUSION: The possible mechanism of these phenomena may be due to interaction of drug with acetylcholine receptors in the neuromuscular junction rather than due to residual plasma drug concentration.