The Use of a Homatropinium Derivative to Produce Controlled Hypotension

Robertson, J. David; Gillies, John; Spencer, Kamilah

doi:10.1093/bja/29.8.342

Cited by 14 publications

(4 citation statements)

References 12 publications

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“…Phenactropinium (Trophenium). This is capable of producing paralysis and respiratory arrest in animals (Robertson et al, 1957). This block like hexamethonium is antidepolarizing in type, and can be produced with doses comparable to those used clinically.…”

Section: Motor Endplatementioning

confidence: 98%

The Influence of Drugs Used in Therapeutics on the Action of Muscle Relaxants

Emery

1963

British Journal of Anaesthesia

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When one considers the many types of chemical compound used in modern therapeutics, it is not surprising that some of these modify the action of muscle relaxants. In general such substances may interfere with neuromuscular transmission, or may influence relaxants by actions at other sites. Some such side effects are well known. Others, based on animal experiments on many different species and under varying conditions, are more difficult to assess precisely. Nevertheless, it would be unwise for the anaesthetist to ignore the possible risks they suggest. Although it is difficult to classify drugs accurately according to their pharmacological action at the neuromuscular junction, they may be grouped under the following headings. It must, however, be remembered that one drug may have several effects. (1) Drugs influencing the release or metabolism of acetylcholine. (2) Drugs altering the sensitivity of the motor endplate. (3) Drugs affecting the metabolism and excretion of muscle relaxants. DRUGS INFLUENCING THE RELEASE OR METABOLISM OF ACETYLCHOLINE Magnesium. Magnesium ions block the release of acetylcholine at the neuromuscular junction. They may also stabilize the endplate, making it resistant to the effects of acetylcholine. These actions, together with the accelerating action of magnesium ions on the action of the true cholinesterases (del Castillo and Engbaek, 1954), potentiate the actions of the antidepolarizing relaxants which in turn will also potentiate the action of magnesium. However, high enough concentrations of this ion are unlikely to be encountered except perhaps in the magnesium treatment of eclampsia. The neuromuscular block produced by magnesium is reversed by calcium ions.

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Section: Motor Endplatementioning

confidence: 98%

The Influence of Drugs Used in Therapeutics on the Action of Muscle Relaxants

Emery

1963

British Journal of Anaesthesia

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“…It is of more than passing interest that the next edition of the book in which this statement was published did not include a chapter on the clinical aspects of deliberate hypotension. Although other ganglionic blocking agents have been introduced into clinical practice, such as trimetaphan (Magill, Scurr and Wyman, 1953), pentolinium (Enderby, 1954) and phenactropinium (Robertson, Gillies and Spencer, 1957) only the former has changed clinical practice, being sufficiently short-acting to be given by infusion and thus permitting a new dimension in controllability which has been surpassed only by sodium nitroprusside.…”

Section: Research Into Neuro-humoral Blockersmentioning

confidence: 99%

The History of Controlled Hypotension

Leigh¹

1975

British Journal of Anaesthesia

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As the physiology of deliberate hypotension has been unravelled, and as each new pharmacological agent has become available which either depresses or blocks peripheral vascular tone, depresses myocardial performance, or interferes with the conducting tissues within the myocardium, its possible incorporation into the armamentarium of the anaesthetist who offers induced hypotension has been considered. The result has been a sequence of variations in technique of characteristically recognizable vintage. No matter how the condition of induced hypotension is produced, there is usually vasodilatation, and the characteristic disturbance in physiology is of a loss of postural reactivity in the cardiovascular system. Important lessons have been learned concerning the management of shock states. Though it is difficult to evaluate the morbidity of deliberate induced hypotension, and terms such as "physiological trespass" have been used by its antagonists, it would appear that a well-considered and skilfully managed controlled hypotension is no more of a physiological trespass than anaesthesia, nor indeed than the trespass of the surgeon's knife itself.

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“…This special feature of tropane alkaloids had prompted earlier studies correlating steric structure and pharmacologi-cal action (4,5). New parasympatholytic and ganglion-blocking tropane derivatives have emerged from these studies with therapeutic utility in cardiovascular, gastrointestinal and bronchospastic disorders (6)(7)(8)(9)(10). Neuromuscular blocking bis-quaternary ammonium derivatives of tropane and tropine have also been synthesized and explored.…”

mentioning

confidence: 99%