Abstract
Different priming sequences of equipotent doses of rocuronium and mivacurium on the onset of maximum neuromuscular block and intubating conditions were compared with those obtained after succinylcholine. During thiopentone-fentanylnitrous oxide anaesthesia, 70 patients were randomly assigned into seven groups. Group I received mivacurium 0.15 mg · kg−1 as a single bolus dose. Group II received a priming dose of mivacurium 0.015 mg · kg−1 followed three minutes later by mivacurium 0.135 mg · kg−1. Group III received rocuronium 0.6 mg · kg−1 as a single bolus dose, and Group IV received an initial dose of rocuronium 0.06 mg · kg−1 followed by rocuronium 0.54 mg · kg−1. Group V received a priming dose of mivacurium 0.015 mg · kg−1 followed by rocuronium 0.54 mg · kg−1. Group VI received an initial dose of rocuronium 0.06 mg · kg−1 followed by mivacurium 0.135 mg · kg−1. Group VII received succinykholine 1.0 mg · kg−1. Groups I, III, and VII received a placebo injection before the administration of the neuromuscular blocking drug. Additional thiopentone 2 mg · kg−1 iv was given 30 sec before intubation. Onset times (mean (95% confidence interval)) after priming a rocuronium block with either rocuronium (73 (57–90) sec) or mivacurium (58 (47–69) sec) were similar to those after succinykholine (54 (40–68) sec), and were shorter (P < 0.01) than that observed in other groups. Intubating conditions were not different between the groups. The duration of neuromuscular block was shortest with succinykholine. It is concluded that priming a rocuronium block with either mivacurium or rocuronium resulted in a neuromuscular block comparable to that of succinykholine in both the onset of action and intubating conditions.
Résumé
Cette étude compare l’influence de différentes séquences d’amorçage avec des doses d’égale puissance de rocuronium et de mivacurium sur le début du bloc neuromusculaire complet et les conditions d’intubation avec celles de la succinykholine. Pendant une anesthésie au thiopentone-fentanyl-protoxyde d’azote, 70 patients sont assignés au hasard entre sept groupes. Le groupe I reçoit un seul bolus de mivacurium 0,15 mg · kg−1. Le groupe II reçoit une dose d’amorce de mivacurium 0,015 mg · kg−1 suivie trois minutes plus tard de mivacurium 0,135 mg · kg−1. Le groupe III reçoit un seul bolus de rocuronium 0,6 mg · kg−1. Le groupe IV reçoit une dose initiale de 0,06 mg · kg−1 de rocuronium suivie de rocuronium 0,54 mg · kg−1. Le groupe V reçoit une dose initiale de mivacurium 0,015 mg · kg−1 suivie de rocuronium 0,54 mg · kg−1. Le groupe VI reçoit une dose initiale de rocuronium 0,06 mg · kg−1 suivie par mivacurium 0,135 mg · kg−1. Le groupe VII reçoit succinykholine 1,0 mg · kg−1. Les groupes I, III et VII reçoivent un placébo en injection avant le myorelaxant. Un supplément de thiopentone 2 mg · kg−1 iv est administré 30 sec avant l’intubation. Le début d’action (moyenne (intervalle de confiance 95%)) après l’amorçage du bloc au rocuronium (73 (57–90) sec) ou au mivacurium (58 (47–69) sec) est identique à celui qui suit la succinykholine (54 (40–68) sec) et est plus court (P < 0,01) que celui qui est observé dans les autres groupes. Les conditions d’intubation ne diffèrent pas entre les groupes. Le bloc neuromusculaire k plus court est obtenu avec la succinykholine. En conclusion, l’amorçage du bloc neuromusculaire avec soit k mivacurium soit le rocuronium produit un bloc comparabk à celui de la succinykholine tant pour le début d’action que pour ks conditions d’intubation.
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References
Rørvik K, Husby P, Gramstad L, Vamnes JS, Bitsch-Larsen L, Koller M-E. Comparison of large dose of vecuronium with pancuronium for prolonged neuromuscular blockade. Br J Anaesth 1988; 61: 180–5.
Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology 1993; 79: 913–8.
Gibbs NM, Rung GW, Braunegg PW, Martin DE. The onset and duration of neuromuscular blockade using combinations of atracurium and vecuronium. Anaesth Intensive Care 1991; 19: 96–100.
Doherty WG, Breen PJ, Donati F, Bevan DR. Accelerated onset of pancuronium with divided doses. Can Anaesth Soc J 1985; 32: 1–4.
Naguib M, Gyasi HK, Abdulatif M, Absood GH. Rapid tracheal intubation with atracurium — a comparison of priming intervals. Can Anaesth Soc J 1986; 33: 150–6.
Taboada JA, Rupp SM, Miller RD. Refining the priming principle for vecuronium during rapid-sequence induction of anaesthesia. Anesthesiology 1986; 64: 243–7.
Naguib M. Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination. Anesthesiology (in press).
Baumgarten RK, Carter CE, Reynolds WJ, Brown JL, De Vera HV. Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation. Can J Anaesth 1988; 35: 5–11.
Meistelman C, Plaud B, Donati F. Neuromuscular effects of succinylcholine on the vocal cords and adductor pollicis muscles. Anesth Analg 1991; 73: 278–82.
Naguib M, Abdulatif M, Gyasi HD, Absood GH. Priming with atracurium: improving intubating conditions with additional doses of thiopental. Anesth Analg 1986; 65: 1295–9.
Savarese JJ, Ali HH, Basta SJ, et al. The clinical neuro-muscular pharmacology of mivacurium chloride (BW B1090U). A short-acting, nondepolarizing ester neuromuscular blocking drug. Anesthesiology 1988; 68: 723–32.
Bartkowski RR, Witkowski TA, Azad S, Lessin J, Man A. Rocuronium onset of action: a comparison with atracurium and vecuronium. Anesth Analg 1993; 77: 574–8.
Naguib M, Abdulatif M, Absood GH. The optimal priming dose for atracurium. Can Anaesth Soc J 1986; 33: 453–7.
Peterman R, Axelrod E, Brown M. Rapid sequence induction with mivacurium. Anesthesiology 1993; 79: A937.
Smith CE, Donati F, Bevan DR. Dose-response curves for succinylcholine: single versus cumulative techniques. Anesthesiology 1988; 69: 338–42.
Cooper R, Mirakhur RK, Elliott P, McCarthy GJ. Estimation of the potency of ORG 9426 using two different modes of nerve stimulation. Can J Anaesth 1992; 39: 139–42.
Caldwell JE, Kitts JB, Heier T, Fahey MR, Lynam DP, Miller RD. The dose-response relationship of mivacurium chloride in humans during nitrous oxide-fentanyl or nitrous oxide-enflurane anesthesia. Anesthesiology 1989; 70: 31–5.
Cooper R, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of ORG 9426 (rocuronium) and suxamethonium. Br J Anaesth 1992; 69: 269–73.
Foldes FF, Nagashima H, Kornak PH. Effect of priming. Anaesthetic Pharmacology Review 1993; 1: 49–56.
Foldes FF, Nagashima H, Nguyen HD, Schiller WS, Mason MM, Ohta Y. The neuromuscular effects of ORG9426 in patients receiving balanced anesthesia. Anesthesiology 1991; 75: 191–6.
Molbegott L, Baker T. Speed and ease of endotracheal intubation after mivacurium doses of various multiples of ED95 with and without priming compared to SCH. Anesthesiology 1993; 79: A933.
Donati F, Meistelman C, Plaud B. Vecuronium neuro-muscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology 1991; 74: 833–7.
Meistelman C, Plaud B, Donati F. Rocuronium (ORG 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth 1992; 39: 665–9.
Vandenbrom RHG, Houwertjes MC, Agoston S. A method for studying the pharmacodynamic profile of neuromuscular blocking agents on vocal cord movements in anaesthetized cats. Br J Pharmacol 1991; 102: 861–4.
Donati F, Meistelman C. A kinetic-dynamic model to explain the relationship between high potency and slow onset time for neuromuscular blocking drugs. J Pharmacokinet Biopharm 1991; 19: 537–52.
Glavinovic MI, Law Min JC, Kapural L, Donati F, Bevan DR. Speed of action of various muscle relaxants at the neuromuscular junction binding vs buffering hypothesis. J Pharmacol Exp Ther 1993; 265: 1181–6.
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Naguib, M. Different priming techniques, including mivacurium, accelerate the onset of rocuronium. Can J Anaesth 41, 902–907 (1994). https://doi.org/10.1007/BF03010932
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DOI: https://doi.org/10.1007/BF03010932