Vor- und Nachteile der Anwendung neuerer Muskelrelaxanzien zur Narkoseeinleitung

  • C. Diefenbach
  • W. Buzello
Conference paper
Part of the Klinische Anästhesiologie und Intensivtherapie book series (KAI, volume 44)

Zusammenfassung

Beim Umgang mit Analgetika und Hypnotika sind wir gewohnt, durch fraktionierte Gabe ein möglichst günstiges Verhältnis von Wirkung und Nebenwirkung zu erzielen. Besonders während der Narkoseeinleitung spielt die Titration dieser Medikamente eine wichtige Rolle. Von den Muskelrelaxanzien hingegen wird nach dem Einschlafen des Patienten ein möglichst rascher Wirkeintritt erwartet, um die Zeit der Maskenbeatmung abzukürzen bzw. frühzeitig die Intubation zu ermöglichen. Dies läßt sich nur durch eine Einzelinjektion des Muskelrelaxans in hoher Dosierung erreichen, ohne den Bedarf des einzelnen Patienten auszuloten. Daher ist das Risiko unerwünschter Wirkungen, wie Histaminfreisetzung und Wechselwirkungen mit Rezeptoren des autonomen Nervensystems, während der Einleitungsphase am größten.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Ali HH, Savarese JJ, Embree PB, Basta SJ, Stout RG, Bottros LH, Weakly JN (1988) Clinical pharmacology of mivacurium chloride infusion: comparison with vecuronium and atracurium. Br J Anaesth 61: 541–546PubMedCrossRefGoogle Scholar
  2. 2.
    Baraka A (1977) Irreversible curarisation. Anaesth Intens Care 5: 244–246Google Scholar
  3. 3.
    Basta SJ, Savarese JJ, Ali HH, Embree PB, Schwartz AF, Rudd GD, Wastila WB (1988) Clinical pharmacology of doxacurium chloride. Anesthesiology 69: 478–486PubMedCrossRefGoogle Scholar
  4. 4.
    Caldwell JE, Canfell PC, Castagnoli KP, Lynam DP, Fahey MR, Fisher DM, Miller RD (1987) The influence of renal failure on the pharmacokinetics and duration of action of pipecuronium bromide. Anesthesiology 67: A612CrossRefGoogle Scholar
  5. 5.
    Caldwell JE, Castagnoli KP, Canfell PC, Fahey MR, Lynam DP, Fisher DM, Miller RD (1988) Pipecuronium and Pancuronium: comparison of pharmacokinetics and duration of action. Br J Anaesth 61: 693–697PubMedCrossRefGoogle Scholar
  6. 6.
    Cook DR, Freeman JA, Lai AA, Robertson KA, Kang Y, Stiller RL, Aggarwal S, Abou-Donia MM, Welch RM (1991) Pharmacokinetics and pharmacodynamics of Doxacurium in normal patients and in those with hepatic or renal failure. Anesth Analg 72: 145–150PubMedCrossRefGoogle Scholar
  7. 7.
    Foldes FF, Nagashima H, Nguyen HD,Weiss R, Goldiner PL (1986) The human cumulative dose-response of pipecuronium bromide under balanced anesthesia. Anesthesiology 65: A116Google Scholar
  8. 8.
    Foldes FF, Nagashima H, Ngyen HD, Schiller WS, Mason MM, Ohta Y (1991) The neuromuscular effects of ORG 9426 in patients receiving balanced anesthesia. Anesthesiology 75: 191–196PubMedCrossRefGoogle Scholar
  9. 9.
    From RP, Pearson KS, Choi WW, Abou-Donia M, Sokoll MD (1990) Neuromuscular and cardiovascular effects of mivacurium (BWB1090U) during nitrous oxide-fentanyl- thiopentone and nitrous oxide-halothane anaesthesia. Br J Anaesth 64: 193–198PubMedCrossRefGoogle Scholar
  10. 10.
    Goldhill DR, Whitehead JP, Emmot RS, Griffith AP, Bracey BJ, Flynn JP (1991) Neuromuscular and clinical effects of mivacurium chloride in healthy adults patients during nitrous oxide-enflurane anaesthesia. Br J Anaesth 67: 289–295PubMedCrossRefGoogle Scholar
  11. 11.
    Khuenl-Brady K, Castagnoli KP, Canfell C, Caldwell JE, Agoston S, Miller RD (1990) The neuromuscular blocking effects and pharmacokinetics of ORG 9426 and ORG 9616 in the cat. Anesthesiology 72: 669–674PubMedCrossRefGoogle Scholar
  12. 12.
    Metha MP, Sokol MD, Gergis SD (1988) Accelerated onset of non-depolarizing neuro¬muscular blocking drugs: pancuronium, atracurium and vecuronium. A comparison with succinylcholine. Eur J Anaesth 5: 15–21Google Scholar
  13. 13.
    Muir AW, Houston J, Green KL, Marshall RJ, Bowman WC, Marshall IG (1989) Effects of a new neuromuscular blocking agent (Org 9426) in anaesthetized cats and pigs and in isolated nerve-muscle preparations. Br J Anaesth 63: 400–410PubMedCrossRefGoogle Scholar
  14. 14.
    Murray DJ, Metha MP, Choi WW, Forbes RB, Sokoll MP, Gergis SD, Rudd GD, Abou-Donia MM (1988) The neuromuscular blocking and cardiovascular effects of doxacurium chloride in patients receiving nitrous oxide narcotic anesthesia. Anesthesiology 69: 472–477PubMedCrossRefGoogle Scholar
  15. 15.
    Savage D, Sleigh T, Carlyle I (1980) The emerge of ORGNC45,l-[(23,3a,5a,16p,173) -3,17-bis(acetyloxy)-2- (1 -piperidiny l)-androstan- 16-yl] -1 -methy lpiperidinium bromide, from the pancuronium series. Br J Anaesth 52: 3S–9SGoogle Scholar
  16. 16.
    Savarese JJ, Wastila WB, El-Sayad HA, Ali HH, Basta SJ, Embree PB, Weakly JN, Rudd GD (1988) Some aspects of the basic and clinical pharmacology of mivacurium (BW W1090U) and doxacurium (BW A938U): a preliminary report. In: Jones RM, Payne JP (eds) Recent developments in muscle relaxation: Atracurium in perspective. Soc Med Serv Int Congr and Symp Ser 131, London, pp 55–60Google Scholar
  17. 17.
    Savarese JJ, Ali HH, Basta SJ et al. (1988) The clinical neuromuscular pharmacology of mivacurium chloride (BWB1090U) Anesthesiology 68: 723–732Google Scholar
  18. 18.
    Scott RPF, Savarese JJ, Basta SJ, Sunder N, Ali HH, Gargarian M, Gionfriddo M, Batson AG (1985) Atracurium: clinical strategies for preventing histamine release and attenuating the haemodynamic response. Br J Anaesth 57: 550–553PubMedCrossRefGoogle Scholar
  19. 19.
    Shanks CA, Fragen RJ, Pemberton D, Katz JA, Risner ME (1989) Mivacurium-induced neuromuscular blockade following single bolus doses and with continous infusion during either balanced of enflurane anesthesia. Anesthesiology 71: 362–366PubMedCrossRefGoogle Scholar
  20. 20.
    Stanley JC, Carson IW, Gibson FM, McMurray TJ, Elliott P, Lyons SM, Mirakhur RK (1991) Comparison of the haemodynamic effects of pipecuronium and pancuronium during fentanyl anaesthesia. Acta Anaesthesiol Scand 35: 262–266PubMedCrossRefGoogle Scholar
  21. 21.
    Stenlake JB, Waigh RD, Urwin J, Dewar GH, Coker GG (1983) Atracurium: conception and inception. Br J Anaesth 55: 3S–10SPubMedCrossRefGoogle Scholar
  22. 22.
    Szenohradsky J, Segredo V. Caldwell JE, Sharma M, Gruenke LD, Miller RD (1991) Pharmacokinetics, onset and duration of action of Org 9426 in humans: normal vs absent renal function. Anesth Analg 72: S290Google Scholar
  23. 23.
    Tassonyi E, Neidhart P, Pittet JF, Morel DR, Gemperle M (1988) Cardiovascular effects of pipecuronium and pancuronium in patients undergoing coronary artery bypass grafting. Anesthesiology 69: 793–796PubMedCrossRefGoogle Scholar
  24. 24.
    Tuba Z (1980) Synthesis of 2p,16(3-bis-(4-dimethyl-r-piperazino)- 3a,17p-diaceto- xy-5a-androstane dibromide and related compounds. Arzneimittelforsch/Drug Res 30: 342–346Google Scholar
  25. 25.
    Tullock WC, Diana P, Cook DR, Wilks DH, Brandon BW, Stiller RL, Beach CA (1990) Neuromuscular and cardiovascular effects of high-dose vecuronium. Anesth Analg 70: 86–90PubMedCrossRefGoogle Scholar
  26. 26.
    Wierda JMKH, Richardson FJ, Agoston S (1989) Dose-response relation and time course of action of pipecuronium bromide in humans anesthetized with nitrous oxide and isoflurane, halothane, or droperidol and fentanyl. Anesth Analg 68: 208 - 213PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • C. Diefenbach
  • W. Buzello

There are no affiliations available

Personalised recommendations