Pancuronium Pharmacokinetics in Patients With Liver Cirrhosis

Duvaldestin, P.; Ágoston, S.; Henzel, D.; Kersten, U.; Desmonts, J. M.

doi:10.1093/bja/50.11.1131

Cited by 95 publications

(25 citation statements)

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“…We also had success using pancuronium, a common, readily available nondepolarizing paralytic agent. The benefits of pancuronium are its rapid onset of action, longer duration of action, extended shelf life, and low cost (5,8). Pancuronium showed no significant cardiac effects as long as exposure was limited to 30 min or less.…”

Section: Discussionmentioning

confidence: 99%

“…Pancuronium bromide is an aminosteroidal competitive neuromuscular blocker that requires renal excretion and is partially metabolized by the liver. In humans, pancuronium bromide causes a dose-dependent increase in heart rate accompanied by increases in cardiac output and blood pressure due to sympathomimetic properties (5,8). Doses of the paralytic medications were chosen to achieve rapid onset of paralysis while minimizing the duration of effect.…”

Section: Methodsmentioning

confidence: 99%

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Characterization of embryonic cardiac pacemaker and atrioventricular conduction physiology in Xenopus laevis using noninvasive imaging

Bartlett¹,

Scholz²,

Lamb³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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Congenital heart defects often include altered conduction as well as morphological changes. Model organisms, like the frog Xenopus laevis, offer practical advantages for the study of congenital heart disease. X. laevis embryos are easily obtained free living, and the developing heart is readily visualized. Functional and morphological evidence for a conduction system is available for adult frog hearts, but information on the normal properties of embryonic heart contraction is lacking, especially in intact animals. With the use of fine glass microelectrodes, we were able to obtain cardiac recordings and make standard electrophysiological measurements in 1-wk-old embryos ( stage 46). In addition, a system using digital analysis of video images was adapted for measurement of the standard cardiac intervals and compared with invasive measurements. Video images were obtained of the heart in live, pharmacologically paralyzed, stage 46 X. laevis embryos. Normal values for the timing of the cardiac cycle were established. Intervals determined by video analysis ( n = 53), including the atrial and ventricular cycle lengths (473 ± 10 ms and 464 ± 19 ms, respectively) and the atrioventricular interval (169 ± 5 ms) were not statistically different from those determined by intrathoracic cardiac recordings. We also present the data obtained from embryos treated with standard medications that affect the human conduction system. We conclude that the physiology of embryonic X. laevis cardiac conduction can be noninvasively studied by using digital video imaging. Additionally, we show the response of X. laevis embryonic hearts to chronotropic agents is similar but not identical to the response of the human heart.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Characterization of embryonic cardiac pacemaker and atrioventricular conduction physiology in Xenopus laevis using noninvasive imaging

Bartlett¹,

Scholz²,

Lamb³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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“…Therefore, we do not believe that pancuronium failed to produce muscle relaxation because of the presence of myotonic contracture. Specific pathologic states cause increased resistance to nondepolarizing muscle relaxants, e.g., upper motor neuron lesion [10], disuse atrophy [11], severe thermal injuries [12], and liver cirrhosis [13]. However, our patient was not in any of these pathologic states.…”

Section: Discussionmentioning

confidence: 85%

Unexpected resistance to pancuronium in a patient with myotonic dystrophy (myotonia dystrophica)

Akata

Sasaki

Saito

et al. 2000

Journal of Anesthesia

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baldness, and cataract formation. In addition, he appeared to have cardiac dysrhythmias associated with myotonia dystrophica, and he was diagnosed 7 years previously with Adam-Stokes' syndrome. However, without any cardiac medication, first-degree atrioventricular block (PQ interval, 0.28 s) was the only abnormality found in the resting electrocardiogram, and the echocardiogram was normal. Pulmonary function tests, chest X-rays, and arterial blood gas analysis were all within normal limits (NL). The patient's serum concentrations of electrolytes were all normal. However, the preoperative screening tests on the endocrine system revealed the presence of mild adrenocortical insufficiency due to pituitary dysfunction: urine 17-hydroxycorticosteroids, 0.85 to 2.465 (NL ϭ 3.6-9.0) mg·day Ϫ1 ; 17-ketosteroids, 1.68 to 4.35 (NL ϭ 3.0-13.0) mg·day Ϫ1 ; serum cortisol 6.2 (NL ϭ 5.5-17.0) µg·dl Ϫ1 ; serum ACTH 13 (NL ϭ 30-60) pg·ml Ϫ1 ; ACTH test, within NL. Thyroid function was, however, normal. The preoperative laboratory tests also indicated the presence of hyperlipidemia (triglycerides, 241-384 mg·dl Ϫ1 ; cholesterol, 255-286 mg·dl Ϫ1 ). Other laboratory data, including those on both hepatic and renal function, were normal. The patient had not previously undergone surgery with general anesthesia.The patient was premedicated with intramuscular hydroxyzine hydrochloride (50 mg) and atropine sulfate (0.5 mg) 45 min prior to the induction of anesthesia. Because of the adrenocortical insufficiency, 100 mg of hydrocortisone was intravenously administered immediately before induction of anesthesia. The patient was then mildly sedated with intravenous diazepam (5 mg) and fentanyl (150 µg), and the trachea was successfully intubated without using a neuromuscular blocking agent while the patient was sedated and awake. After endotracheal intubation, the lungs were easily ventilated, and anesthesia was subsequently maintained with 67% N 2 O/1-3% enflurane in oxygen and supplemented by further intravenous administration of fentanyl (total

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“…Les deux conséquences cliniques sont donc la nécessité éventuelle d'augmenter la dose initiale pour obtenir un relâchement musculaire satisfaisant, et un risque de prolongation de la durée de son action. On observe un phénomène de résis-tance à la curarisation et un allongement important de la durée des effets thérapeutiques [40]. Vécuronium.…”

Section: Les Curaresunclassified

Adaptation des thérapeutiques médicamenteuses en cas d’insuffisance hépatocellulaire

et al. 2007

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Pancuronium Pharmacokinetics in Patients With Liver Cirrhosis

Cited by 95 publications

References 0 publications

Characterization of embryonic cardiac pacemaker and atrioventricular conduction physiology in Xenopus laevis using noninvasive imaging

Characterization of embryonic cardiac pacemaker and atrioventricular conduction physiology in Xenopus laevis using noninvasive imaging

Unexpected resistance to pancuronium in a patient with myotonic dystrophy (myotonia dystrophica)

Adaptation des thérapeutiques médicamenteuses en cas d’insuffisance hépatocellulaire

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