Abstract
The synergistic effect of pancuronium bromide (PCB) and d-tubocurarine (DTC) on the onset time of neuromuscular blockade was tested in 108 ASA physical status I and II adults anaesthetized with thiopentone, nitrous oxide and halothane. Either saline or a small (priming) dose (DTC, 0.04mg·kg-1 or PCB, 0.007 mg·kg-1) was administered 3 min before a paralyzing dose of either DTC or PCB. The total dose of relaxant was equivalent to DTC, O.4mg·kg-1, or PCB, 0.07mg·kg-1. Neuromuscular activity was measured using train-of-four stimulation applied every 12 s. Time to 50 per cent first twitch blockade was 63 ± 4.6 s (mean ± SEM) with DTC and 88 ± 5.2 s with PCB (p < 0.002). Times to 90 per cent blockade were not different between the two drugs (161 ±20 s and 141 ±21 s respectively). Priming a DTC blockade with either DTC or PCB or priming a PCB blockade with PCB produced an acceleration of less than 10 s at all levels of blockade. Compared with PCB alone, priming PCB blockade with DTC reduced the time to 50 per cent blockade to 71 ±4.5 s (p< 0.02) and to 90 per cent blockade to 111 ±8 s(p< 0.05). Priming did not affect the duration of action significantly, except in the case of PCB priming of DTC, where duration was increased from 39 ± 4.4 to 57 ±4 min (p < 0.02). It is concluded that priming with a synergistic relaxant might increase speed of onset without prolonging the duration of neuromuscular blockade. However, the effect of DTC priming of PCB onset is too small to be clinically significant.
Résumé
L’effet synergistique du bromure de pancuronium (PCB) et de la d-tubocurarine (DTC) sur le début d’action du bloc neuromusculaire a été évalué chez 108 adultes classe ASA 1 et II anesthésiés avec du thiopentone, protoxyde d’azote et halothane. Soit du salin ou une petite dose d’amorce (priming) (de DTC 0.04 mg·kg-1 ou PCB 0.007 mg·kg-1) a été administré trois minutes avant la dose paralysante soit de DTC ou PCB. La dose totale de relaxant musculaire etait l’équivalente à la DTC 0.4 mg·kg-1 ou PCB 0.07 mg·kg-1. L’activité neuromusculaire était mesurée par une stimulation utilisant l’ondéede-quatre (train-of-four) appliquée chaque 12 secondes. Le temps pour une dépression à 50 pour cent du premier twitch était de 63 ± 4.6 s (moyenne ± SEM) avec la DTC et88± 5.2 s avec le PCB (p<0.002). Les temps pour un blocage à 90 pour cent n’étaient pas différents entre les deux groupes (161 ±20 s et 141 ±21 s respectivement). Pour un blocage neuromusculaire à la DTC, amorcé avec soit la DTC ou le PCB et pour un blocage au PCB amorcé avec du PCB a produit une accélération de moins de dix secondes à tous les niveaux de blocage. Comparativement au PCB seul, l’amorçage du bloc au PCB avec la DTC a réduit le temps de blocage à 50 pour cent de bloc à 71 ±4.5 s (p<0.02) et à 90 pour cent de bloc a 111 ± 8 s (p< 0.05). L’amorçage n’a pas affecté la durée d’action significativement excepté dans le cas d’amorçage au PCB pour un blocage à la DTC où la durée a augmenté de 39 ±4.4 à 57 ±4 min (p < 0.02). On conclut que l’amorcage avec un relaxant musculaire synergistique peut accélérer le début d’action sans prolonger la durée du blocage neuromusculaire. Cependant, l’effet de l’amorgage à la DTC sur le début d’action d’un blocage au PCB est minime pour être cliniquement significatif.
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Donati, F., Lahoud, J., Walsh, C.M. et al. Onset of pancuronium and d-tubocurarine blockade with priming. Can Anaesth Soc J 33, 571–577 (1986). https://doi.org/10.1007/BF03014262
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DOI: https://doi.org/10.1007/BF03014262