ABSTRACT
We have measured concentrations of atracurium and laudanosine in cerebrospinal fluid (CSF) and plasma in three intensive care patients receiving atracurium infusions of 22.5-106 h duration to maintain neuromuscular block. Two patients had suffered severe closed head injuries and the third patient had developed respiratory failure following the clipping of two intracranial aneurysms. The total dose of atracurium given was 14.3-136.6 mg kg-1; rate of infusion was 0.6-1.38 mg kg-1 h-1. Plasma concentrations of atracurium and laudanosine were 0.73-3.11 micrograms ml-1 and 0.48-8.65 micrograms ml-1, respectively; CSF concentration of laudanosine was 70-440 ng ml-1. No adverse effects attributable to these concentrations of laudanosine were observed.
Subject(s)
Atracurium/pharmacokinetics , Critical Care , Isoquinolines/metabolism , Opium/metabolism , Adult , Atracurium/administration & dosage , Atracurium/blood , Female , Humans , Isoquinolines/blood , Isoquinolines/cerebrospinal fluid , Male , Middle Aged , Opium/blood , Opium/cerebrospinal fluidABSTRACT
The concentration of laudanosine in cerebrospinal fluid (CSF) was measured in four patients undergoing brain electrode placement after the administration of atracurium. CSF: plasma laudanosine concentration ratios ranged from less than 1 to 14%, with a range of CSF laudanosine concentrations of less than 2-14 ng ml-1. One patient had no detectable laudanosine in CSF, but sampling in this patient was possible for only 30 min. There was no atracurium detectable in the CSF of any patient. We conclude that laudanosine crosses the blood-brain barrier and further study of its central nervous system effects in man is warranted.
