Summary
The dosage of D-tubocurarine recommended varies greatly with different authors. The body build, reflected in the lean body mass (LBM), influences the dose. The dose which produces a 90-95 per cent depression of neuromuscular blockade is better correlated to the lean body mass than the body weight Age and body somatotype influence this dosage.
Less D-tubocurarine is required when halothane is the anaesthetic, than when methoxyflurane or meperidine are used.
The average recovery time to 50 per cent muscle power when 0.38 mg/Kg LBM is given with methoxyflurane is 38.8 minutes and this was best related to percentage fat.
Résumé
La dose de d-Tubocurarine nécessaire pour produire une dépression de 90-95 pour cent du blocage neuromusculaire se calcule mieux d’après la masse maigre du corps que d’après le poids corporel. Cette dose peut varier selon l’agent anesthésique employé concomittamment; avec l’halothane, la dose est 0.24 mg/kg de masse maigre; avec le meperidine, 0.34 mg/kg de masse maigre et, avec le méthoxyflurane, 0.38 mg/kg. Le retour de 50 pour cent de la force musculaire est deux fois plus rapide chez le sujet gras que chez le sujet maigre.
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Aladjemoff, L., Ducstein, S., &Shafrir, E. The binding of d-tubocurarine chloride to plasma proteins. J. Fharm. and Exp. Therap.123: 1, 43 (1958).
Abtusio, J.F., Marbury, B.E., &Crews, M.A. A quantitative study of d-tubocurarine, flaxedil and dimethylommonium compounds in anesthetized man. Ann. N.Y. Acad. Sci.54: 512 (1951).
Artusio, J., Van Poznak, A., Hunt, R., Tiers, F., &Alexander, M. A clinical evaluation of methoxyflurane in man. Anesthsiol.21: 5, 512 (1960).
Baraka, A. The influence of carbon dioxide on the neuromuscular block caused by tubercurarine chloride in the human subject. Brit, J. Anaesth.36: 272 (1964).
Baraka, A. Effect of halothane on tubocurarine and suxamethonium block in man. Brit. J. Anaesth.40: 602 (1968).
Brdenbaugh, P., &Churchill-Davidson, H.C. Response to tubocurarine chloride and its reversal by neostigmine methylsulfate in man. J.A.M.A.203: 8, 541 (1968).
Bush, G. &Baraka, A. Factors affecting the termination of curarisation in the human subject. Brit. J. Anaesth.36: 356 (1964).
Campbell, M., Hvolboll, A., &Brechner, V. Penthrane: A clinical evaluation in 50 cases. Anesth. and Analg.41:2, 134 (1962).
Cavaltto, C.J. Transactions of the International Symposium on Curare and Curare-like substances. Amsterdam, Elsevier Publishing Co., p. 288 (1959),
Chagas, C. Fate of curare, in: Curare and curare-like agents. Ed. A. de Reuck, little, Brown & Co., Boston (1962).
Cheek, D.B., Human Growth. Lea and Febiger, Philadelphia (1968).
Cohen, E., Paulson, W., &Elert, B. Studies of d-tubocurarine with measurements of concentration in human blood, Anesthesio L.18: 2, 301 (1957).
Cohen, E., Corbascio, A., &Fleischli, G. The distribution and fate of d-tubocurarine. J. Pharm. & Exp. Therap.147: 120 (1965).
Cohen, E., Brewer, H., &Smith, D. The metabolism and elimination of d-tubocurarine-H3. Anesthesiol.28: 2, 309 (1967).
Churchill-Davidson, H., Way, W., &de Jong, R. The muscle relaxants and renal excretion. Anesthesiol28: 3, 540 (1967).
Dal Santo, G. Kinetics of distribution of radio-active labeled muscle relaxants. Investigations with C14-dimethyl-d-tubo-curarine. Anesthesiol25:6, 788 (1964).
de Jong, R.H. Controlled relaxation. I. Quantitation of electromyogram with abdominal relaxation. J. Amer. Med. Ass.197: 6, 393 (1966a).
de Jong, R.H. Controlled relaxation, II, Clinical management of muscle relaxant administration. J. Amer. Med. Ass.198: 11, 1163 (1966b).
Dundee, J.W. Relationship of dosage of d-tubocurarine and landolissin to body weight, sex and age. Brit. J. Anes.26: 173 (1954).
Durbans, S.F. Prolonged apnoea. Lancet,2: 539 (1952).
Egebr, E.I. A mathematical model of uptake and distribution of anesthetic agents; Ed. Papper, E.M. & Kitz, R.J. McGraw-Hill Book Co., N.Y. (1963).
Emery, E.R.J. The influence of drugs in therapeutics on the action of muscle relaxants. Brit. J. Anaesth.35: 565 (1963).
Epstein, R. &Jackson, S. The effect of depth of anesthesia on the neuromuscular nefractory period of anesthised man. Anesthesial.32: 6, 494 (1970).
Everett, G.M. Pharmacological studies of d-tubocurarine and other curare fractions. J. Pharm. & Exp. Therap.92: 236 (1948).
Feldman, S.A. Effect of changes in electrolytes, hydration and pH upon the reactions to muscle relaxants. Brit. J. Anaesth.35; 546 (1963).
Fleischli, G. &Cohen, E. An analog computer simulation for the distribution of d-tubocurarine. Anesthesiol27; 1, 64 (1966),
Foldes, F.F. Fate of muscle relaxants in man. Acta Anes. Scand.1: 63 (1957a).
Foldes, F.F. Muscle relaxants in anesthesiology. Chas. C. Thomas, Springfield, Illinois (1957).
Foldes, F.F. Factors which alter the effects of muscle relaxants. Anesthesiol20: 4, 464 (1959).
Gerbershagen, H. &Bergman, N. Effect of d-tubocurarine on respiratory resistance in anesthetised man. Anesthesiol28: 6, 981 (1967).
Goldstein, A. Interaction of drugs and plasma proteins. Pharmacol. Rev. I: 102 (1949).
Gray, T. C. &Halton, J. A milestone in anesthesia (d-tubocurarine chloride). proc. Roy. Soc. Med.39: 400 (1946).
Cray, T.C. Use of d-tubocurarine chloride in anesthesia. Ann. Roy. Coll. Surg. Engl. 1–191 (1947).
Jarman, R. Methoxyflurane (Pentrane): A clinical investigation. Anesthesia18: 3, 265 (1963).
Kalow, W. Urinary excretion of d-tubocurarine in man. J. Pharm. & Exp. Therap.109: 74 (1953).
Kalow, W. The distribution, destruction and elimination of muscle relaxants. Anesthesiol20: 4, 505 (1959).
Kalow, W., Relaxants in: Uptake and distribution of anesthetic agents. Ed. Pauper, E.M. and Kitz, R.J. McGraw-Hill Co., New York, N.Y. (1963).
Katz, B. &Wolf, C. Neuromuscular and electromyographic studies in man. Effects of hyperventilation, carbon dioxide inhalation and d-tubocurarine. Anesthesiol. 25: 6 781 (1964).
Katz, R. &Gissen, A. Neuromuscular and electromyographic effects of halothane and its interaction with d-tubocurarine in man. Anesthesiol28: 3, 564 (1967).
Katz, R. Neuromuscular effects of d-tubocurarine edrophonium and neostigmine in man. Anesthesiol28: 2, 327 (1967).
Katz, R., Norman, J., Seed, R., &Conrad, L. A comparison of the effect of suxamethonium and tubocurarine in patients in London and New York. Brit. J. Anaesth.41: 1041 (1969).
Kovanev, V. &Khemelevsky, Y. Evaluation of muscular relaxation in controlled respiration. Brit. J. Anaesth. 36: 279 (1964).
Levy, G. Relationship between rate of elimination of tubocurarine and rate of decline of its pharmacological activity. Brit. J. Anaesth.36: 694 (1964).
Long, G. &Bachman, L. Neuromuscular blockade by d-tubocurarine in children. Anesthesiol.28: 4, 723 (1967).
Makfowz, M. The fate of tubocurarine in the body. Brit. J. Pharmacol.4: 295 (1949).
Marsh, D.F. The distribution metabolism and excretion of d-tubocurarine chloride and related compounds in man and other animals. J. Pharm. & Exp. Therap.105: 299 (1952).
Ngai, S.H. &Hanks, E.C. Effect of methoxyflurane on electromyogram neuromuscular transmission and spinal reflex. Anesthesiol.23: 1, 158 (1962).
Payne, J.P. The influence of changes in blood pH on the neuromascular blocking properties of d-tubocurarine and dimethyl d-tubocurarine in the cat. Acta. Anes. Scand.4; 83 (1960).
Pelikan, E., Unna, K., Mcfarlane, D., Cozort, R., Sadove, S., &Nelson, J. Evaluation of curarising drugs in man. J. Pharm. & Exp. Therap.99: 215 (1950).
Pelikan, E.W., Tether, J.E., &Unna, K.R. Sensitivity of myesthenia gravis patients to tubocurarine and decamethonium. Neurology3: 284 (1953).
PITTINGER, C.B., Morris, L.E., &CULLEN, S.C. D-tubocurarine chloride concentrations in human plasma after intravenous injection during anesthesia. J. Lab. Clin. Med.35: 397 (1951).
Poulsen, H. &Hougs, W. The effect of some curarsing drugs in unanesthetized man, I. Acta Anes. Scand.1: 15–39 (1957).
Price, H.L. Circulation; general considerations, in: uptake and distribution of anesthetic agents, ed. Papper, E.M. and Kitz, R. J. McGraw-Hill Book Co., New York, N.Y. (1963).
Ryan, A.R. Tubocurarine administration based upon its disappearance and accumulation curves in anesthetised man. Brit. J. Anaesth.36: 287 (1964).
Stead, A. &Andrews, W.H. The role of the canine liver in the detoxication of d-tubocurarine chloride gallamine triethiodide and laudexium. Brit J. Anaesth.29: 151 (1957).
Thomason, R., Licht, G., &Holaday, D. Methoxyflurane anesthesia: A clinical appraisal Anesth. & Analg,41: 2, 225 (1962).
Thornton, J., Whelpton, D., &Brown, B. The effect of general anesthetic agents on nerve conduction velocities. Brit. J. Anaesth.40; 583 (1968).
Utting, J. pH as a factor influencing plasma concentrations of d-tubocurarine. Brit. J. Anaesth.35: 706 (1963).
Walts, L. &Dillon, J.B. Durations of action of d-tubocurarine and gallamine. Anesthesiol.29: 3, 499 (1968).
Weisberg, H.F. Water, electrolytes and acid-base balance. 2nd ed. Baltimore: Williams and Wilkins (1962).
Wise, R.P. Muscle disorders and the relaxants. Brit. J. Anaesth.35: 558 (1963).
Wylie, W.D. &Churchill-Davidson, H.C. A practice of anesthesia. Yearbook Medical Publishers, Chicago (1966).
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Supported by NIH Grant #1 SO1 FR 05654-01.
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Wulfsohn, N.L. D-tubocurarine dosage based on lean body mass. Canad. Anaesth. Soc. J. 19, 251–262 (1972). https://doi.org/10.1007/BF03028291
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DOI: https://doi.org/10.1007/BF03028291