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Pharmacy World and Science

, Volume 19, Issue 1, pp 45–52 | Cite as

Part 4: Use of relaxants in paediatric and elderly patients, in obstetrics, and in the intensive care unit

  • L.H.D.J. Booij
Article

Abstract

The pharmacodynamic and pharmacokinetic characteristics of the non-depolarizing muscle relaxants are dependent on age. Thus differences are found between paediatric patients, adults, and elderly patients. Muscle relaxants cross the placenta and thus may cause problems in the fetus. Many of the potential adverse effects of relaxant administration are seen more pronounced in intensive care patients. Prolonged effects and problems in weaning patients from the ventilator are observed when muscle relaxants are used in such patients. Critical illness neuropathy is a syndrome different from relaxant induced neuromyopathy, but may be enhanced by relaxant administration.

Adverse effects Critical illness neuromyopathy Elderly Intensive care unit Muscle relaxants Obstetrics Paediatrics 

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References

  1. 1.
    Van der Spek AFL, Reynolds PI, Fang WB, Ashton Miller JA, Stohler CS, Schork MA. Changes in resistance to mouth opening induced by depolarizing and non-depolarizing neuromuscular relaxants. Br J Anaesth 1990;64:21–7.Google Scholar
  2. 2.
    Plumley MH, Bevan JC, Saddler JM, Donati F, Bevan DR. Dose-related effects of succinylcholine on the adductor pol-licis and masseter muscles in children. Can J Anaesth 1990;37:15–20.Google Scholar
  3. 3.
    Saddler JM. Jaw stiffness - an ill understood condition. Br J Anaesth 1991;67:515–16.Google Scholar
  4. 4.
    Hackl W, Mauritz W, Schemper M, Winkler M, Sporn P, Steinbereithner K. Prediction of malignant hyperthermia susceptibility: statistical evaluation of clinical signs. Br J Anaesth 1990;64:425–9.Google Scholar
  5. 5.
    Allen G, Rosenberg H. Malignant hyperthermia susceptibility in adult patients with masseter muscle rigidity. Can J Anaesth 1990;37:31–5.Google Scholar
  6. 6.
    Matteo RS, Libermann IG, Salanitre E, McDaniel DD, Diaz J. Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults. Anesth Analg 1984;63:799–804.Google Scholar
  7. 7.
    Fisher DM, O'Keefe C, Stanski, DR, Cronnelly R, Miller RD, Gregory GA. Pharmacokinetics and pharmacodynamics of d-tubocurarine in infants, children, and adults. Anesthesiology 1982;57:203–8.Google Scholar
  8. 8.
    Brandom BW, Stiller RL, Cook DR, Woelfel SK, Chakravorti S, Lai A. Pharmacokinetics of atracurium in anaesthetized infants and children. Br J Anaesth 1986;58:1210–13.Google Scholar
  9. 9.
    Fisher DM, Canfell PC, Spellman MJ, Miller RD. Pharmacokinetics and pharmacodynamics of atracurium in infants and children. Anesthesiology 1990;73:33–7.Google Scholar
  10. 10.
    Kitts JB, Fisher DM, Canfell PC, Spellman, MJ, Caldwel JE, Heier T, Fahey MR, Miller RD. Pharmacokinetics and phar-macodynamics of atracurium in the elderly. Anesthesiology 1990;72:272–5.Google Scholar
  11. 11.
    Goudsouzian NG, Alifimoff JK, Liu LMP, Foster VJ, McNulty BF, Savarese JJ. Neuromuscular and cardiovascular effects of doxacurium in children anaesthetized with halothane. Br J Anaesth 1989;62:263–8.Google Scholar
  12. 12.
    Sarner JB, Brandom BW, Cook DR, Dong ML, Horn MC, Woelfel SK, Davis PJ, Rudd GD, Foster WJ, McNulty BF. Clinical pharmacology of doxacurium chloride (BW 938U) in children. Anesth Analg 1988;67: 303–6.Google Scholar
  13. 13.
    Goudsouzian NG, Alifimoff JK, Ebery C, Smeets R, Griswold J, Miller V, McNulty BF, Savarese JJ. Cardiovascular effects of mivacurium in children. Anesthesiology 1989;70:237–42.Google Scholar
  14. 14.
    Meistelman C, Agoston S, Kersten UW, Saint-Maurice C, Bencini AF, Loose JP. Pharmacokinetics and pharmacody-namics of vecuronium and pancuronium in anaesthetized children. Anesth Analg 1986;65:1319–23.Google Scholar
  15. 15.
    Pittet JF, Taasonyi E, Morel DR, Gemperle G, Rouge JC. Neuromuscular effect of pipecuronium bromide in infants and children during nitrous oxide-alfentanil anesthesia. Anesthesiology 1990;72:432–5.Google Scholar
  16. 16.
    Vuksanaj D, Fisher DM. Pharmacokinetics of rocuronium in children aged 4-11 years. Anesthesiology 1995;82:1104–10.Google Scholar
  17. 17.
    Lien CA, Matteo RS, Ornstein E, Schwartz AE, Diaz J. Distribution, elimination, and action of vecuronium in the elderly. Anesth Analg 1991;73:39–42.Google Scholar
  18. 18.
    Rupp SM, Castagnoli K, Fisher DM, Miller RD. Pancuronium and vecuronium pharmacokinetics and pharmacodynamics in younger and elderly adults. Anesthesiology 1983;59:A270.Google Scholar
  19. 19.
    Walker J, Shanks CA, Triggs EJ. Clinical pharmacokinetics of alcuronium chloride in man. Eur J Clin Pharmacol 1980;17:449–57.Google Scholar
  20. 20.
    Stephens ID, Ho PC, Holloway AW, Bonne DW, Triggs EJ. Pharmacokinetics of alcuronium in elderly patients undergo-ing total hip replacements or aortic reconstructive surgery. Br J Anaesth 1984;56:465–71.Google Scholar
  21. 21.
    Cronnelly R, Fisher SM, Miller RD, Gencarelli P, Nguyen-Gruenke L, Castagnolie N, Jr. Pharmacokinetics and pharma-codynamics of vecuronium (Org NC45) and pancuronium in anaesthetized humans. Anesthesiology 1983;58:405–8.Google Scholar
  22. 22.
    D'Hollander AA, Massaux F, Nevelsteen M, Agoston S. Age-dependent dose-response relationship of Org-NC45 in anaesthetized patients. Br J Anaesth 1982;54:653–6.Google Scholar
  23. 23.
    Matteo RS, Backus WW, McDaniel DD, Brotherton WP, Abraham R, Diaz J. Pharmacokinetics and pharmacodynam-ics of d-tubocurarine and metocurine in the elderly. Anesth Analg 1985;64:22–8.Google Scholar
  24. 24.
    Kent AP, Hunter JM. The pharmacodynamics of alcuronium in the elderly. Anesthesia 1991;46:271–4.Google Scholar
  25. 25.
    McLeod K, Hull CJ, Watson MJ. Effect of ageing on the phar-macokinetics of pancuronium. Br J Anaesth 1979;51:435–8.Google Scholar
  26. 26.
    Dresdner DL, Basta SJ, Ali HH, Schwartz AF, Embree PB, Wargin WA, Lai AA, Brady KA, Savarese JJ. Pharmacokinetics and pharmacodynamics of doxacurium in young and elderly patients during isoflurane anesthesia. Anesth Analg 1990;498–502.Google Scholar
  27. 27.
    Ornstein E, Matteo RS, Schwartz AE, Jamdar SC, Diaz J. Pharmacokinetics and pharmacodynamics of pipecuronium bromide (Arduan) in elderly surgical patients. Anesth Analg 1992;74:841–4.Google Scholar
  28. 28.
    Matteo RS, Ornstein E, Schwartz AE, Ostapkovich N, Stone JG. Pharmacokinetics and pharmacodynamics of rocuroni-um (Org 9426) in elderly surgical patients. Anesth Analg 1993;77:1193-.Google Scholar
  29. 29.
    D'Hollander AA, Luyckx C, Barvais L, de Ville A. Clinical eval-uation of atracurium besylate requirement for a stable mus-cle relaxation during surgery: lack of age-related effects. Anesthesiology 1983;59:237–40.Google Scholar
  30. 30.
    Slavov V, Khalil M, Merle JC, Agostini MM, Ruggier R, Duvaldestin P. Comparison of duration of neuromuscular blocking effect of atracurium and vecuronium in young and elderly patients. Br J Anaesth 1995;74:709–11.Google Scholar
  31. 31.
    Kent AP, Parker CJR, Hunter JM. Pharmacokinetics of atracurium and laudanosine in the elderly. Br J Anaesth 1989;63:661–6.Google Scholar
  32. 32.
    Bell PF, Mirakhur RK, Clarke RSJ. Dose-response studies of atracurium, vecuronium and pancuronium in the elderly. Anaesthesia 1989;44:925–7.Google Scholar
  33. 33.
    Koscielniak-Nielsen ZJ, Law-Min JC, Donati F, Bevan DR, Clement P, Wise R. Dose-response relations of doxacurium and its reversal with neostigmine in young adults and healthy elderly patients. Anesth Analg 1992;74:845–50.Google Scholar
  34. 34.
    Parker CJP, Hunter JM, Snowdon SL. Effect of age, gender and anaesthetic technique on the pharmacodynamics of atracurium. Br J Anaesth 1993;70:38–42.Google Scholar
  35. 35.
    Duvaldestin P, Saada J, Berger JL, D'Hollander A, Desmonts JM. Pharmacokinetics, pharmacodynamics and dose-response relationships of pancuronium in control and elder-ly subjects. Anesthesiology 1982;56:36–40.Google Scholar
  36. 36.
    Bevan DR, Fiset P, Balendram P, Law-Min JC, Ratcliffe A, Donati F. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth 1993;40:127–32. 50.Google Scholar
  37. 37.
    Young WL, Matteo RS, Ornstein E. Duration of action of neo-stigmine and pyridostigmine in the elderly. Anesth Analg 1988;67:775–8.Google Scholar
  38. 38.
    Matteo RS, Young WL, Ornstein E, Schwartz AE, Silverberg PA, Diaz J. Pharmacokinetics and pharmacodynamics of edrophonium in elderly surgical patients. Anesth Analg 1990;71:334–9.Google Scholar
  39. 39.
    Morris RB, Cronelly R, Miller RD, Stanski DR, Fahey MR. Pharmacokinetics of edrophonium and neostigmine when antagonizing d-tubocurarine neuromuscular blockade in man. Anesthesiology 1981;54:399–402.Google Scholar
  40. 40.
    Duvaldestin P, Demetriou M, Henzel D, Desmonts JM. The placental transfer of pancuronium and its pharmacokinetics during caesarian section. Acta Anaesthesiol Scand 1978;22: 327–33.Google Scholar
  41. 41.
    Dailey PA, Fisher DM, Schnider SM, Baysinger CL, Shinohara Y, Miller RD, Aboud TK, Kim KC. Pharmacokinetics, placental transfer, and neonatal effects of vecuronium and pancuroni-um administered during Caesarean section. Anesthesiology 1984;60:569–74.Google Scholar
  42. 42.
    Flynn PJ, Frank M, Hughes R. Use of atracurium in caesarean section. Br J Anaesth 1984;56:599–605.Google Scholar
  43. 43.
    Abouleish E, Wingard Jr, S, De La Vega S, Uy N. Pancuro-nium in Caesarean section and its placental transfer. Br J Anaesth 1980;52:531–6.Google Scholar
  44. 44.
    Ho PC, Stephens ID, Triggs EJ. Caesarean section and pla-cental transfer of alcuronium. Anaesth Intens Care 1981;9: 113–18.Google Scholar
  45. 45.
    Leighton BL, Chuk TG, Gross JB, Apfelbaum JL, Schantz BB, Gutsche BB, Rosenberg H. Succinylcholine pharmacody-namics in peripartum patients. Anesthesiology 1986;64: 202–5.Google Scholar
  46. 46.
    West R. Curare in man. Proc. R. Soc. Med. 1932;25:1107–16.Google Scholar
  47. 47.
    Merriman HM. The techniques used to sedate ventilated patients. Int Care Med 1981;7:217–24.Google Scholar
  48. 48.
    Bion JF, Ledingham IMA. Sedation in intensive care: a postal survey. Int.Care Med. 1987;13:215–16.Google Scholar
  49. 49.
    Murray MJ, Strickland RA, Weiler C. The use of neuromuscu-lar blocking drugs in the intensive care unit: a US perspec-tive. Int Care Med 1993;19:S40–S44.Google Scholar
  50. 50.
    Williatts SM. Paralysis for ventilated patients? Yes or No? Intens Crit Care Digest 1985;4:9–10.Google Scholar
  51. 51.
    Parker MM, Schubert W, Shelhamer JH, Parrillo JE. Perceptions of a critically ill patient experiencing therapeutic paralysis in an ICU. Crit Care Med 1984;12:69–71.Google Scholar
  52. 52.
    Booij LHDJ. The influence of renal and hepatic function on the pharmacodynamics and pharmacokinetics of nondepo-larizing muscle relaxants. Pharm Weekblad Scie ed 1987;9: 56–60.Google Scholar
  53. 53.
    Booij LHDJ. Muscle relaxants and medical status of the patient. Curr. Opinion in Anaesthesiol. 1989;2:488–92.Google Scholar
  54. 54.
    Argov Z, Mastaglia FL. Disorders of neuromuscular transmis-sion caused by drugs. New Engl J Med 1979;301:409–13.Google Scholar
  55. 55.
    Martyn JAJ, Hogue CW. Competitive antagonism of acetyl-choline receptor increases receptor number and tolerance to tubocurarine. Br J Anaesth 1990;65:578.Google Scholar
  56. 56.
    Dodson BA, Kelly BJ, Braswell LM, Cohen NH. Changes in acetylcholine receptor number in muscle from critically ill patients receiving muscle relaxants: an investigation of the molecular mechanism of prolonged paralysis. Crit Care Med 1995;23:815–21.Google Scholar
  57. 57.
    Hogue CW, Jr, Ward JM, Itani MS, Martyn JAJ. Tolerance and upregulation of acetylcholine receptors follow chronic infu-sion of d-tubocurarine. J Appl Physiol 1992;72:1326–31.Google Scholar
  58. 58.
    Gronert GA. Disuse atrophy with resistance to pancuronium. Anesthesiology 1981;55:547–9.Google Scholar
  59. 59.
    Coursin DB, Klasek G, Goelzer S. Increased requirements for continuously infused vecuronium in critically ill patients. Anest Analg 1989;69:518–21.Google Scholar
  60. 60.
    Kushimo OT, Darowski MJ, Morris P, Hollis S, Meakin G. Dose requirements of atracurium in paediatric intensive care patients. Br J Anaesth 1991;67:781–3.Google Scholar
  61. 61.
    Yate PM, Flynn PJ, Arnold RW et al. Clinical experience and plasma laudanosine concentrations during infusion of atra-curium in the intensive care unit. Br J Anaesth 1987;59:211–17.Google Scholar
  62. 62.
    Callanan DL. Development of resistance to pancuronium in adult respiratory distress syndrome. Anesth Analg 1985;64:1126–8.Google Scholar
  63. 63.
    Sethna DH, Starr NJ, Estafanous FG. Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with aortic valve disease. Can J Anaesth 1987;34:582–8.Google Scholar
  64. 64.
    Murray MJ, Coursin DB, Scuderi PE, Kamath G, Prough DS, Howard DM, Abou-Donia MA. Double-blind, randomized, multicenter study of doxacurium vs. pancuronium in inten-sive care unit patients who require neuromuscular-blocking agents. Crit Care Med 1995;23:450–8.Google Scholar
  65. 65.
    Stellato C, dePaulis A, Cirillo R, Mastronardi P, Mazzarella B, Marone G. Heterogeneity of human mast cells and basophils in response to muscle relaxants. Anesthesiology 1991;74:1078–86.Google Scholar
  66. 66.
    North FC, Kettelkamp N, Hirshman CA. Comparison of cuta-neous and in vitro histamine release by muscle relaxants. Anesthesiology 1987;66:543–6.Google Scholar
  67. 67.
    Robertson EN, Fragen RJ, Booij LHDJ, Crul JF. Intradermal histamine release by 3 muscle relaxants. Acta Anaesthesiol Scand 1983;27:203–5.Google Scholar
  68. 68.
    Vetterman J, Beck KC, Lindahl SHE, Brichant JF, Rehder K. Actions of enflurane, isoflurane, vecuronium, atracurium and pancuronium on pulmonary resistance in dogs. Anes-thesiology 1988;69:688–95.Google Scholar
  69. 69.
    Crago RR, Bryan AC, Laws AK, Winestock AE. Respiratory flow resistance after curare and pancuronium measured by forced oscillations. Can Anaesth Soc J 1972;19:607–14.Google Scholar
  70. 70.
    Mehr EH, Hirshman CA, Lindeman KS. Mechanism of action of atracurium on airways. Anesthesiology 1992;76:448–54.Google Scholar
  71. 71.
    Gerbershagen HU, Bergmann HA. The effect of d-tubocura-rine on respiratory resistance in anesthetized man. Anesthesiology 1967;28-981-4.Google Scholar
  72. 72.
    Simpson DA, Wright DJ, Hammond JE. Influence of tubocu-rarine, pancuronium and atracurium on bronchomotor tone. Br J Anaesth 1985;57:753–7.Google Scholar
  73. 73.
    Eriksson LI, Sato M, Severinghaus JW. Effect of a vecuroni-um-induced partial neuromuscular block on hypoxic ventila-tory response. Anesthesiology 1993;78:693–9.Google Scholar
  74. 74.
    Park GR, Gray PA. Infusions of analgesics, sedatives and muscle relaxants in patients who require intensive care. Anaesthesia 1989;4:879–80.Google Scholar
  75. 75.
    Segredo V, Caldwell JE, Matthay MA, Sharma ML, Gruenke LD, Miller RD. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med 1992;327:524–8.Google Scholar
  76. 76.
    Segredo V, Malthay MA, Sharma ML, Greunke LD, Caldwell JE, Miller RD. Prolonged neuromuscular blockade after long term administration of vecuronium in two critically ill patients. Anesthesiology 1990;72:566–70.Google Scholar
  77. 77.
    Castagnoli KP, Caldwell JE, Canfell PC, Lynam DP, Arden JR, Miller RD. Does the independent measurement of 3-desace-tylvecuronium influence the pharmacokinetics of vecuroni-um? Anesthesiology 1988;69:A479.Google Scholar
  78. 78.
    Vandenbrom RHG, Wierda JMKH. Pancuronium bromide in the intensive care unit: a case of overdose. Anesthesiology 1988;69:996–1001Google Scholar
  79. 79.
    Meyer KC, Prielipp RC, Grossman JE, Coursin DB. Prolonged weakness after infusion of atracurium in two intensive care unit patients. Anesth Analg 1994;78:772–4.Google Scholar
  80. 80.
    Mesry S, Baradaran J. Accidental intrathecal injection of gal- lamine triethiodide. Anaesthesia 1974;29:301–4.Google Scholar
  81. 81.
    Peduto VA, Gungii P, Di Martino MR, Napoleone M. Accidental subarachnoid injection of pancuronium. Anesth Analg 1989;69:516–17.Google Scholar
  82. 82.
    Matteo RS, Pua EK, Khambotta KJ, Spector S. Cerebrospinal fluid levels of d-tubocurarine in man. Anesthesiology 1977;46:396–400.Google Scholar
  83. 83.
    Frankville DD, Drummond JC. Hyperkalemia after succinyl-choline administration in a patient with closed head injury without paresis. Anesthesiology 1987;67:264–6.Google Scholar
  84. 84.
    Gooch JL, Suchtya MR, Balbierz JM, Petajan JH, Clemmer TP. Prolonged paralysis after treatment with neuromuscular junction blocking agents. Crit Care Med 1991;19:1125–31.Google Scholar
  85. 85.
    Heckmatt JZ, Pitt MC, Kirkham F. Peripheral neuropathy and neuromuscular blockade presenting as prolonged respiratory paralysis following critical illness. Neuropediatrics 1993;24:123–5.Google Scholar
  86. 86.
    Kupfer Y, Namba T, Kaldawi E, Tessler S. Prolonged weakness after long-term infusion of vecuronium bromide. Ann Int Med 1992;117:484–6.Google Scholar
  87. 87.
    Zochodne DW, B olton CF, Wells GA, Gilbert JJ, Hahn AF, Browm JD, Sibbald WA. Critical illness polyneuropathy - a complication of sepsis and multiorgan failure. Brain 1987;110:819–42.Google Scholar
  88. 88.
    Witt NJ, Zochodne DW, Bolton CF, Grans'Maison F, Wells G, Young GB, Sibbald WJ. Peripheral nerve function in sepsis and multiple organ failure. Chest 1991;99:176–84.Google Scholar
  89. 89.
    Bolton CF, Young GB, Zochodne DW. The neurological com-placations of sepsis. Ann Neurol 1993;33:94–100.Google Scholar
  90. 90.
    Helliwell TR, Coakley JH, Wagenmakers AJM, Griffiths RD, Campbell IT, Green CJ, McClelland P, Bone JM. Necrotizing myopathy in critically-ill patients. J Pathol 1991;164:307–14.Google Scholar
  91. 91.
    Zochodne DW, Ramsay DA, Saly V, Shelley S, Moffatt S. Acute necrotizing myopathy of intensive care: electrophys-iological studies. Muscle & Nerve 1994;17:285–92.Google Scholar
  92. 92.
    Giostra E, Magistris MR, Pizzolato G, Cox J, Chevrolet J-C. Neuromuscular disorders in intensive care unit patients treated with pancuronium bromide. Occurrence in a cluster group of seven patients and two sporadic cases, with elec-trophysiologic and histologic examination. Chest 1994;106:210–20. 51.Google Scholar
  93. 93.
    Danon MJ, Carpenter S. Myopathy with filament (myosin) loss following prolonged paralysis with vecuronium during steroid treatment. Muscle & Nerve 1991;14:1131–9.Google Scholar
  94. 94.
    Al-Lozi MT, Pestronk A, Yee WC, Flaris N, Cooper J. Rapidly evolving myopathy with myosin-deficient muscle fibers. Ann Neurol 1994;35:273–9.Google Scholar
  95. 95.
    Matsubara S, Okada T, Yoshida M. Mitochondrial changes in acute myopathy after treatment of respiratory failure with mechanical ventilation (acute relaxant-steroid myopathy). Acta Neuropathol 1994;88:475–8.Google Scholar
  96. 96.
    Brun-Buisson C, Gherardi R. Hydrocortisone and pancuroni-um bromide: acute myopathy during status asthmaticus. Crit Care Med 1988;731-2. (letter to the editor)Google Scholar
  97. 97.
    Lacomis D, Smith TW, Chad DA. Acute myopathy and neu-ropathy in status asthmaticus: case report and literature review. Muscle & Nerve 1993;16:84–90.Google Scholar
  98. 98.
    Gorson KC, Ropper AH. Acute respiratory failure neuropa-thy: a variant of critical illness polyneuropathy. Crit Care Med 1993;21:267–71.Google Scholar
  99. 99.
    Barohn RJ, Jackson CE, Rogers SJ, Ridings LW, McVey AL. Prolonged paralysis due to nondepolarising neuromuscular blocking agents and corticosteroids. Muscle & Nerve 1994;17:647–54.Google Scholar
  100. 100.
    Op de Coul AAW, Lambregts PCLA, Koeman J, van Puyenbroek MJE, Ter Laak JH, Gabreels-Festen AAWM. Neuromuscular complications in patients given pavulon (pancuronium bromide) during artificial ventilation. Clin Neurol Neurosurg 1985;87:17–22.Google Scholar
  101. 101.
    Griffin D, Fairman N, Coursin DB, Rawsthorne L, Grossman JE. Acute myopathy during treatment of status asthmaticus with corticosteroids and steroidal relaxants. Chest 1992; 102:510–14.Google Scholar
  102. 102.
    Manthous CA, Chatila W. Prolonged weakness after the withdrawal of atracurium. Am J Crit Care Med 1994;150: 1441–3.Google Scholar
  103. 103.
    Khaleeli A, Edwards W, Gohill K, McPhail G, Rennie M, Round J. Corticosteroid myopathy: a clinical and pathologi-cal study. Clin Endocrinol 1983;18:155–66.Google Scholar
  104. 104.
    Gwinnutt CL, Eddleston JM, Edwards D, Pollard BJ. Concentrations of atracurium and laudanosine in cerebro-spinal fluid and plasma in three intensive care patients. Br J Anaesth 1990;65:829–32.Google Scholar
  105. 105.
    Parker CJR, Jones JE, Hunter JM. Disposition of infusions of atracurium and its metabolite, laudanosine, in patients with renal and respiratory failure in an ITU. Br J Anaesth 1988;61:531–40.Google Scholar
  106. 106.
    Nigrovic V, Klaunig JE, Smith SL, Schulz NE, Wajskol A. Comparative toxicity of atracurium and metocurine in isolat-ed rat hepatocytes. Anesth Analg 1986;65:1107–11.Google Scholar
  107. 107.
    Partridge BL, Abrams JH, Bazemore C, et al. Prolonged neu-romuscular blockade after long-term infusion of vecuronium bromide in the intensive care unit. Crit Care Med 1990;18:1177–9.Google Scholar
  108. 108.
    Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 1975;43:89–99.Google Scholar
  109. 109.
    Epstein HM, Jarzensky D, Zuckerman L, Vagher P. Plasma cholinesterase activity in bank blood. Anesth Analg 1980;59:211–14.Google Scholar
  110. 110.
    Badetti C, Manelli JC. Curare and burns. Ann Fr Anesth Reanim 1994;13:705–12.Google Scholar
  111. 111.
    John DA, Tobey RE, Homer LD, Rice CL. Onset of succinyl-choline-induced hyperkalemia following denervation. Anesthesiology 1976;45:294–9.Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • L.H.D.J. Booij
    • 1
  1. 1.Department of AnaesthesiologyCatholic University NijmegenNijmegenThe Netherlands

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