Neuromuscular Pharmacology

Lee, C.; Katz, Ronald L.

doi:10.1093/bja/52.2.173

Cited by 75 publications

(7 citation statements)

References 71 publications

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“…The intervals between PTCl and Tl for vecuronium, atracurium and pancuronium (table II) appeared somewhat shorter than those measured previously in adults (mean adult values 8.3, 9.0 and 33 min, respectively) [3,5,6]. This is consistent with earlier studies indicating that recovery from the effects of these blockers is more rapid in children [7][8][9], although the rates of recovery of our patients may have been enhanced by the frequent use of tetanic stimulation (every 2 min) [10].…”

Section: Discussionsupporting

confidence: 88%

Use of the Post-Tetanic Count to Monitor Recovery From Intense Neuromuscular Blockade in Children

Gwinnutt

Meakin

1988

British Journal of Anaesthesia

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The post-tetanic count was investigated as a method of monitoring intense neuromuscular blockade in children. One of five myoneural blockers (atracurium, vecuronium, pancuronium, tubocurarine or alcuronium) was given to groups of six children during nitrous oxide-oxygen-halothane anaesthesia. During recovery, the first post-tetanic response always preceded the first train-of-four response. The interval between the appearance of the first post-tetanic response and the first train-of-four response was typically 5-10 min for the intermediate-acting agents vecuronium and atracurium, and 20-30 min for the long-acting agents pancuronium, alcuronium and tubocurarine. A post-tetanic count of 6 with alcuronium and tubocurarine, or 7 with vecuronium, atracurium and pancuronium indicated that recovery of the first train-of-four response was imminent.

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Section: Discussionsupporting

confidence: 88%

Use of the Post-Tetanic Count to Monitor Recovery From Intense Neuromuscular Blockade in Children

Gwinnutt

Meakin

1988

British Journal of Anaesthesia

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“…In our patients, a slight fade of the TOF ratio was always seen during early recovery while the blockade was greater than 50%. Although often neglected, this is a common finding and not considered to be evidence of a phase II block 10 . This fade of the TOFR did not persist and during the latter phases of recovery, T 1 was about the same size as T 4 , until recovery was complete when enhancement of T 4 was often seen as was the case before drug administra-Anaesthesia and Intensive Care, Vol.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Suxamethonium

et al. 1997

Anaesth Intensive Care

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A study was undertaken to determine the time constants of elimination and effect compartment equilibration of suxamethonium and for the slope exponent of the Hill equation. Twelve patients were anaesthetized with thiopentone, fentanyl, and isoflurane in nitrous oxide and oxygen. After allowing conditions to become stable, they were administered three small doses of suxamethonium by rapid intravenous injection. The responses to supramaximal stimulation of the ulnar nerve were recorded by EMG in one and by accelerometry in eleven subjects. Because of failure to recover to control conditions, one subject was deleted from analysis. The recorded drug effect was used in a non-linear curve fitting technique to derive estimates of the pharmacokinetic and pharmacodynamic parameters. The plasma concentration of suxamethonium was adequately represented by a single compartment model. The mean half-life of elimination was 47s with a 95% confidence interval of 24 to 70 s; that of effect compartment equilibration, 211s with a 95% confidence range of 139 to 282s. The average slope exponent was 6.4 and its 95% confidence range was 4.6 to 8.2. The data from the first two doses were used to predict the time taken for the third dose to recover 50%. The predictions showed a mean bias of <1% (NS) and a mean error of 21%, with a confidence interval of 5 to 37%. In only two out of eleven subjects was the prediction error greater than 30%.

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“…Antibiotics such as aminoglycoside antibiotics and tetracycline, polymyxin B, and lincomycin may enhance the action of NMBDs or may have a neuromuscular blocking effect [ 63 ]. These antibiotics lead to a leftward shift in the dose–response curve and a rapid onset time of NMBDs [ 66 67 ].…”

Section: Factors That Affect Muscle Contractilitymentioning

confidence: 99%

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Kim

Sung

Yang

2017

Korean J Anesthesiol

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Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action. Factors that affect the onset time include the potency of the NMBDs, the rate of NMBDs reaching the effect site, the onset time by dose control, metabolism and elimination of NMBDs, buffered diffusion to the effect site, nicotinic acetylcholine receptor subunit affinity, drugs that affect acetylcholine (ACh) production and release at the neuromuscular junction, drugs that inhibit plasma cholinesterase, presynaptic receptors responsible for ACh release at the neuromuscular junction, anesthetics or drugs that affect muscle contractility, site and methods for monitoring neuromuscular function, individual variability, and coexisting disease. NMBDs with rapid onset without major adverse events are expected in the next few years, and the development of lower potency NMBDs will continue. Anesthesiologists should be aware of the use of NMBDs in the management of anesthesia. The choice of NMBD and determination of the appropriate dosage to modulate neuromuscular blockade characteristics such as onset time and duration of neuromuscular blockade should be considered along with factors that affect the effects of the NMBDs. In this review, we discuss the factors that affect the onset time of NMBDs.

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Neuromuscular Pharmacology

Abstract: This review stresses those areas of neuromuscular pharmacology where recent advances of clinical interest have been made. It is meant to be a general didactic review, rather than an exhaustive coverage of the literature.

Cited by 75 publications

References 71 publications

Use of the Post-Tetanic Count to Monitor Recovery From Intense Neuromuscular Blockade in Children

Use of the Post-Tetanic Count to Monitor Recovery From Intense Neuromuscular Blockade in Children

Pharmacokinetics and Pharmacodynamics of Suxamethonium

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

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