Priming with Nondepolarizing Relaxants for Rapid Tracheal Intubation

Baumgerten, R. K.; Carter, C. E.; Reynolds, William J.; Brown, J. L.; DeVera, H. V.

doi:10.1097/00132586-198810000-00022

Cited by 5 publications

(6 citation statements)

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“…Another factor influencing the intubation conditions is the depth of anesthesia. This study was not placebocontrolled; Baumgarten et al (13) have already shown that, under comparable anesthetic conditions, intubation after a placebo is either very difficult or impossible.…”

Section: Discussionmentioning

confidence: 96%

Dose-Response Relation, Neuromuscular Blocking Action, Intubation Conditions, and Cardiovascular Effects of Org 9273, a New Neuromuscular Blocking Agent

Broek

Lambalk²,

Richardson³

et al. 1991

Anesthesia & Analgesia

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VAN DEN BROEK L, LAMBALK LM, RICHARDSON FJ, WIERDA JMKH. Dose-response relation, neuromuscular blocking action, intubation conditions, and cardiovascular effects of Org 9273, a new neuromuscular blocking agent. Anesth Analg 1991;72:811-6. The ED,, and the ED,,, the time-course of the neuromuscular block, the intubation conditions, and the cardiovascular effects of Org 9273, a new steroidal nondepolarizing neuromuscular blocking agent, have been evaluated in 41 anesthetized patients. From cumulative dose-response curves the ED,, and ED,, were calculated to be 175 and 300 pglkg, respectively. The time-course of neuromuscular blockade after 300-and 500-pglkg doses of Org 9273 appeared to be similar to that of equipotent doses of vecuronium. The neuromuscular block was characterized by a fast initial rate of block development. High-dose Org 9273(1 mglkg = 3 4 times the ED,,) had a clinical duration comparable to an intubating dose of pancuronium, but a considerably more rapid onset and recovery index. Three hundred micrograms per kilogram and 500 pglkg Org 9273 produced good to excellent intubation conditions 1 min after administration. Org 9273 in a dose of 0.5-2 times the ED,, produced no cardiovascular changes; however, 3 4 times the ED,, increased heart rate 20%-25% (P < 0.001), probably due to a vagolytic effect.Key Words: NEUROMUSCULAR RELAXANT, Org 9273.As a result of the search for a nondepolarizing neuromuscular blocking agent as an alternative to succinylcholine for intubation and short surgical procedures, some new neuromuscular blocking agents have recently become available for clinical trials. One of these agents is Org 9273, the 2-morpholino, 3-desacetyl analogue of vecuronium (Figure l), which has been shown to be stable in aqueous solution.Preliminary animal studies (1,2) show that Org 9273 is 3-5 times less potent than vecuronium but with a faster onset of action and a similar duration of action. Furthermore, Org 9273 in doses of 1-3 times the ED90 produces only minor changes in heart rate and blood pressure in experimental animals.We have performed a dose-finding study to investigate the dose-response relationship, the time-course of neuromuscular blocking action, the intubation conditions, and the hemodynamic stability of Org 9273 in anesthetized patients. MethodsThe study was approved by the local medical ethical committee. Forty-one ASA physical status I and I1 patients, aged 18-60 yr, scheduled for elective surgery, participated in this study after they had given written informed consent.After oral premedication with 7.5 mg midazolam approximately 60 min before the expected start of anesthesia, anesthesia was induced with 1-5 &kg fentanyl and 3-7 mg/kg thiopental. After tracheal intubation, anesthesia was maintained with halothane, 0.5% inspiratory concentration, in a 2:l mixture Of nitrous Oxide and Oxygen and increments of 50-100 pg fentanyl. End-tidal k o 2 was kept between 32 and 42 mm Hg. After 290% recovery from the Org 9273 vecuronium was to maintain muscle relaxation if necessary. Cent...

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Section: Discussionmentioning

confidence: 96%

Dose-Response Relation, Neuromuscular Blocking Action, Intubation Conditions, and Cardiovascular Effects of Org 9273, a New Neuromuscular Blocking Agent

Broek

Lambalk²,

Richardson³

et al. 1991

Anesthesia & Analgesia

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“…Most studies have found that time duration between priming dose and intubation dose is 4 min at least as good if not better than other interval tested. [5][6][7] The time to maximal blockade may be different in peripheral and respiratory muscles, probably because of differences in blood flow. Thus, the observation of intubating conditions constitutes a more clinically relevant endpoint than the measurement of adductor pollicis response.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%

“…Thus, the observation of intubating conditions constitutes a more clinically relevant endpoint than the measurement of adductor pollicis response. Larger doses are more effective in accelerating the onset of blockade, [5][6][7][8] but they may be associated with more adverse effects. Cisatracurium Besylate a stereoisomer of Atracurium is a nondepolarising Benzylisoquinolinium, intermediate acting, neuromuscular blocking agent with 4 times potency of Atracurium.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%

Effect of Two Different Priming Doses of Cisatracurium in Addition to its Bolus Dose- A Randomised Double-Blind Controlled Trial

Sinha¹,

Ghosh²,

Saha³

et al. 2019

jemds

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BACKGROUND Nondepolarizing muscle relaxants (NDMRs) used in current clinical practice have slower onset of action and are not suitable for rapid control of airway. In order to reduce interval between the administration of NDMRs to optimal intubating conditions, administering priming dose, a sub-paralysing dose of the NDMRs, few minutes before giving a large calculated dose is recommended for smooth tracheal intubation. Cisatracurium Besylate, an agent with 4 times potency of Atracurium, has a longer onset time. We wanted to compare two different priming doses of Cisatracurium with a bolus administration to arrive at an optimal priming dose of Cisatracurium. METHODS In this prospective randomised double-blind study, we evaluated the effect of two different priming regimens (10 and 15 microgram/Kg) from the total 100 mcg/Kg of Cisatracurium with regard to onset time of intubation as assessed by TOF (Train of Four) disappearance time compared to a bolus administration. 90 patients scheduled for various elective abdominal surgeries under general anaesthesia with endotracheal intubation, were enrolled and were divided into 2 study groups and 1 control group. Systolic and diastolic blood pressures, mean arterial pressure, heart rate, oxygen saturation and capnography were assessed before administration of study drug, before intubation, and subsequently, immediately after intubation and at 1, 3 and 10 minutes after intubation. Also, TOF disappearance time by acceleromyograph, intubation score by Viby Mogensen and adverse effects related to priming were assessed. RESULTS TOF disappearance time was shorter (148.07±12.63 second) in the group with priming dose of 15 mcg/Kg Cisatracurium than in the group with priming dose of 10 mcg/Kg (177.13±9.54). TOF disappearance time was longer (211.70±25.97) in the group where no priming drug but only the bolus dose was used for intubation. There were no statistically significant differences in intubation scores, haemodynamic parameters among all three groups in all time intervals. No adverse effects were found in any groups. CONCLUSIONS Priming dose of Cisatracurium reduces the onset time for intubation without affecting intubating conditions and haemodynamic parameters. Reduction in the onset time for intubation is more with higher priming doses (15%) than with lower priming dose (10%).

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“…Verschiedene Autoren zeigten oder widerlegten dies auch für Atracurium [1], Cisatracurium [13] und Mivacurium [14,18]. Der Zeitgewinn beträgt zwischen 20-60 s und ist bei der am langsamsten anschlagenden Substanz Cisatracurium am größten [21].…”

Section: Ergebnisseunclassified

Anwendung von Muskelrelaxanzien zur Routineeinleitung in Deutschland

Geldner¹,

Fuchs-Buder²,

Hofmockel

et al. 2003

Der Anaesthesist

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The aim of this study was to evaluate the use of muscle relaxants during induction of anesthesia in patients without risk of aspiration of stomach contents. Of the 2,996 questionnaires sent out, 2,054 (68.6%) could be analysed and the results show that succinylcholine is used regularly in 13.6% of anesthesia departments. The next most commonly used muscle relaxants are atracurium, vecuronium and mivacurium, followed by cis-atracrium, rocuronium and pancuronium. Alcuronium is the least frequently used muscle relaxant. During induction of an elective anesthesia procedure, a priming technique is used by 19% of anesthesiologists, 22% utilize precurarization, and a timing technique is performed in 7.1%. The use of muscle relaxants for on-going relaxation follows the same pattern as for induction of neuromuscular blockade and succinylcholine is used in 1.4% if further relaxation is needed. The desire for specific qualities of muscle relaxants is correlated with higher use of the specific substance: short onset time for rocuronium, good controllability with mivacurium, no side-effects with cisatracurium and economical aspects with alcuronium. Of the participants 76.6% voiced the desire for a non-depolarizing replacement for succinylcholine.Private practices use mivacurium more often than hospitals, level one hospitals use rocuronium and cisatracurium more often. This survey could not show a definite standard of use in terms of muscle relaxants for an elective case.Precurarization, priming and timing are used frequently in patients not at risk of aspiration. This should be reduced by on-going teaching.

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Priming with Nondepolarizing Relaxants for Rapid Tracheal Intubation

Cited by 5 publications

References 0 publications

Dose-Response Relation, Neuromuscular Blocking Action, Intubation Conditions, and Cardiovascular Effects of Org 9273, a New Neuromuscular Blocking Agent

Dose-Response Relation, Neuromuscular Blocking Action, Intubation Conditions, and Cardiovascular Effects of Org 9273, a New Neuromuscular Blocking Agent

Effect of Two Different Priming Doses of Cisatracurium in Addition to its Bolus Dose- A Randomised Double-Blind Controlled Trial

Anwendung von Muskelrelaxanzien zur Routineeinleitung in Deutschland

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