A pharmacokinetic-dynamic explanation of the rapid onset–offset of rapacuronium

Proost, Johannes H.; Wright, P. M. C.

doi:10.1097/00003643-200100003-00016

Cited by 3 publications

(3 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While these few seconds do not make much difference in the usual clinical practice, they can be helpful when rapid intubation is important. In fact, this rapid onset approaches that of succinylcholine [1], a finding reported by others in this supplement [5][6][7].…”

Section: Rapid Onsetsupporting

confidence: 72%

Rapacuronium: first experience in clinical practice

Bartkowski¹,

Witkowski²

2001

Eur J Anaesthesiol

View full text Add to dashboard Cite

Rapacuronium is a new non-depolarizing relaxant with a fast onset and rapid recovery. It was approved for the market in the United States in August 1999. The reasons for its acceptance in practice and the niche it fills are the subject of this review. Rapacuronium has been accepted wherever rapid onset and short duration of action are advantageous. It has received the greatest acceptance in brief outpatient procedures that require tracheal intubation. The average time of recovery to a train-of-four ratio of 80% is about 25 min after a usual intubating dose of 1.5 mg kg À1 , when block is reversed. Its rapid onset has led some to use it in rapid-sequence induction, but the exact place in this scenario is still being defined. Its spontaneous recovery is rapid enough that many practitioners do not reverse the block if the procedure is long enough. Data suggest that this is reasonable after 60 min and may even be earlier, even 30 min, if verified by monitoring. The main adverse effects of rapacuronium are bronchospasm, hypotension and tachycardia. Of these, only bronchospasm has had significant clinical impact. These effects are dose related and the recommended dose of 1.5 mg kg À1 may keep problems to a minimum. Because rapacuronium is a new drug with unique properties its use gradually increased in its first year. Because of the problems associated with succinylcholine, rapacuronium may have advantages for brief outpatient procedures and in cases where rapid termination of block is desired, provided its adverse effects can be minimized.

show abstract

Section: Rapid Onsetsupporting

confidence: 72%

Rapacuronium: first experience in clinical practice

Bartkowski¹,

Witkowski²

2001

Eur J Anaesthesiol

View full text Add to dashboard Cite

show abstract

“…The onset of block at the laryngeal muscles was reported to be faster than at the adductor pollicis muscle, although the degree of maximum block was less [8]. The reasons for rapid onset of action of rapacuronium are discussed fully elsewhere in this issue of the journal [13].…”

Section: Basic Pharmacologymentioning

confidence: 99%

Rapacuronium: clinical pharmacology

Mirakhur

McCourt

2001

Eur J Anaesthesiol

View full text Add to dashboard Cite

Summary The need for a rapid‐acting non‐depolarizing neuromuscular blocking agent with a short duration of action resulted in the synthesis of rapacuronium. The onset of maximum block with rapacuronium occurs in 60–90 s with doses of 1.5–2.5 mg kg−1 with a duration of clinical relaxation of 15–30 min. Rapacuronium provides clinically acceptable intubating conditions in 60 s in a majority of patients with these doses, although the conditions are somewhat inferior to those obtained with succinylcholine in lightly anaesthetized patients, such as those undergoing a rapid‐sequence induction. The main drawbacks of rapacuronium are the occurrence of dose‐related pulmonary side‐effects (increased airway pressure and/or overt bronchospasm) and hypotension and tachycardia. The cause of pulmonary side‐effects is not certain but these have been serious enough to make its worldwide introduction doubtful.

show abstract

“…Rapacuronium, a new non‐depolarizing relaxant with a short to intermediate duration has been developed for short‐lasting interventions and was therefore regarded as a potential agent for inducing paralysis for day care procedures [14]. Its time course of action with a rapid onset and a fast recovery may be due to its fast equilibration with the effect compartment due to on one hand, a high equilibration rate constant and on the other hand, a high initial clearance from the plasma [15]. While the onset of action of rapacuronium may be close to that of succinylcholine, intubating conditions and the offset characteristics do not seem to match those of succinylcholine.…”

mentioning

confidence: 99%