ORG 9487 Neuromuscular Block at the Adductor Pollicis and the Laryngeal Adductor Muscles in Humans 

1997 ◽  
Vol 86 (6) ◽  
pp. 1300-1305 ◽  
Author(s):  
Bertrand Debaene ◽  
Thomas Lieutaud ◽  
Valerie Billard ◽  
Claude Meistelman
Keyword(s):  
Neuromuscular Block ◽  
Onset Time ◽  
Rapid Onset ◽  
Adductor Pollicis ◽  
Vocal Cords ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Adductor Pollicis Muscle ◽  
Org 9487 ◽  
Adductor Muscles

Background ORG 9487 is a new steroidal nondepolarizing muscle relaxant with a rapid onset of action. This study was designed to determine the neuromuscular blocking profile of ORG 9487 at the adductor muscles of the larynx and the adductor pollicis. Methods In 30 adults, anesthesia was induced with propofol (2-5 mg/kg) and fentanyl (2-3 microg/kg). After train-of-four stimulation, the block of the laryngeal adductor muscles was evaluated by measuring the pressure changes in the cuff of the tracheal tube placed between the vocal cords, and the force of the contraction of the adductor pollicis was measured with a force transducer. Patients were randomly allocated to receive ORG 9487 at intravenous bolus doses of 0.75, 1.5 or 2 mg/kg (n = 10 in each group). Results Time to peak effect was significantly shorter at the vocal cords than at the adductor pollicis muscle (P < 0.001). Onset time at the vocal cords was 62 +/- 16 s, 62 +/- 13 s, and 52 +/- 14 s (mean +/- SD) after doses of 0.75, 1.5, and 2 mg/kg, respectively (not significant). Onset time at the adductor pollicis muscle was 126 +/- 33 s, 96 +/- 20 s, and 82 +/- 21 s after 0.75, 1.5, and 2 mg/kg doses, respectively (P < 0.001). Maximum block was significantly less intense at the vocal cords than at the adductor pollicis muscle (69 +/- 15% vs. 94 +/- 4% after 0.75 mg/kg; 86 +/- 7% vs. 97 +/- 4% after 1.5 mg/kg; and 91 +/- 5% vs. 99 +/- 1% after 2 mg/kg). After 1.5 mg/kg duration to 25%, recovery was 3.7 +/- 2.2 min versus 10.2 +/- 2.5 min at the vocal cords and the adductor pollicis muscle, respectively, and 75% recovery occurred at 9.7 +/- 3.7 min at the vocal cords and at 18.3 +/- 5.2 min at the adductor pollicis muscle. Conclusions ORG 9487 has a rapid onset of action at the laryngeal adductor and the adductor pollicis muscles. Onset and duration of action are faster at the vocal cords than at the adductor pollicis muscle. However, the maximum block obtained at the laryngeal muscles was less than at the adductor pollicis, regardless of the dose of ORG 9487.

Mivacurium Neuromuscular Block at the Adductor Muscles of the Larynx and Adductor Pollicis in Humans

1996 ◽  
Vol 85 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Benoit Plaud ◽  
Bertrand Debaene ◽  
Frank Lequeau ◽  
Claude Meistelman ◽  
Francois Donati
Keyword(s):  
Neuromuscular Block ◽  
Onset Time ◽  
Pressure Change ◽  
Peak Effect ◽  
Adductor Pollicis ◽  
Vocal Cords ◽  
Laryngeal Muscles ◽  
Time To Peak ◽  
Adductor Muscles ◽  
Train Of Four

Background Laryngeal muscles must be paralyzed for tracheal intubation. Time to peak effect (onset time) is shorter and intensity of blockade is less at laryngeal muscles compared with the adductor pollicis. The authors' aim in this study was to determine the neuromuscular effects of mivacurium at the laryngeal adductor muscles and the adductor pollicis. Methods In 22 adults, anesthesia was induced and maintained with propofol and alfentanil. The force of contraction of the adductor pollicis was recorded, and the laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords after train-of-four stimulation. Mivacurium (0.07 mg.kg-1 or 0.14 mg.kg-1) was given intravenously (10s). Results With 0.07 mg.kg-1 mivacurium, onset time was 151 +/- 40 s(mean +/- SD) at the larynx and 241 +/- 79 s at the adductor pollicis, respectively (P < 0.005). Maximum block was 78 +/- 18% and 95 +/- 8%, respectively (P < 0.002), and time to 90% recovery was 11.1 +/- 2.9 min and 23.3 +/- 7.6 min, respectively (P < 0.001). With 0.14 mg.kg-1 mivacurium, onset time also was more rapid at the vocal cords (137 +/- 20 s) than at the adductor pollicis (201 +/- 59 s, P < 0.01). Maximum block was 90 +/- 7% and 99 +/- 1% (P < 0.005), and time to 90% recovery was 16.4 +/- 4.9 min and 27.4 +/- 7.8 min, respectively (P < 0.01). Conclusions With mivacurium, onset and recovery are faster at the laryngeal muscles, but block is less intense than at the adductor pollicis. A dose greater than 0.14 mg.kg-1 mivacurium is necessary to ensure complete relaxation at the vocal cords.

Effects of an Intubating Dose of Succinylcholine and Rocuronium on the Larynx and Diaphragm 

1999 ◽  
Vol 90 (4) ◽  
pp. 951-955 ◽  
Author(s):  
Gilles Dhonneur ◽  
Krassen Kirov ◽  
Velislav Slavov ◽  
Philippe Duvaldestin
Keyword(s):  
Elective Surgery ◽  
Onset Time ◽  
Neuromuscular Blocking ◽  
Blocking Effect ◽  
Muscle Relaxants ◽  
Adductor Pollicis ◽  
Maximum Effect ◽  
Adductor Pollicis Muscle ◽  
Adductor Muscles ◽  
Before And After

Background Paralysis of the vocal cords is one objective of using relaxants to facilitate tracheal intubation. This study compares the neuromuscular blocking effect of succinylcholine and rocuronium on the larynx, the diaphragm, and the adductor pollicis muscle. Methods Electromyographic response was used to compare the neuromuscular blocking effect of succinylcholine and rocuronium on the laryngeal adductor muscles, the diaphragm, and the adductor pollicis muscle. Sixteen patients undergoing elective surgery were anesthetized with propofol and fentanyl, and their tracheas were intubated without neuromuscular blocking agents. The recurrent laryngeal and phrenic nerves were stimulated at the neck. The electromyographic response was recorded from electrodes placed on the endotracheal tube and intercostally before and after administration of 1 mg/kg succinylcholine or 0.6 mg/kg rocuronium. Results The maximum effect was greater at the adductor pollicis (100 and 99%) than at the larynx (96 and 97%) and the diaphragm (94 and 96%) after administration of succinylcholine and rocuronium, respectively (P < or = 0.05). Onset time was not different between the larynx (58+/-10 s), the diaphragm (57+/-8 s), and the adductor pollicis (54+/-13 s), after succinylcholine (all mean +/- SD). After rocuronium, onset time was 124+/-39 s at the larynx, 130+/-44 s at the diaphragm, and 115+/-21 s at the adductor pollicis. After succinylcholine administration, time to 90% recovery was 8.3+/-3.2, 7.2+/-3.5, and 9.1+/-3.0 min at the larynx, the diaphragm, and the adductor pollicis, respectively. Time to 90% recovery after rocuronium administration was 34.9+/-7.6, 30.4+/-4.2, and 49.1+/-11.4 min at the larynx, the diaphragm, and the adductor pollicis, respectively. Conclusion Neuromuscular blocking effect of muscle relaxants on the larynx can be measured noninvasively by electromyography. Although the larynx appears to be resistant to muscle relaxants, we could not demonstrate that its onset time differed from that of peripheral muscles.

ORG 9487 Neuromuscular Block at the Adductor Pollicis and the Laryngeal Adductor Muscles in Humans

1998 ◽  
Vol 42 (4) ◽  
pp. 225
Author(s):  
BERTRAND DEBAENE ◽  
THOMAS LIEUTAUD ◽  
VALERIE BILIARD ◽  
CLAUDE MEISTELMAN
Keyword(s):  
Neuromuscular Block ◽  
Adductor Pollicis ◽  
Org 9487 ◽  
Adductor Muscles

scholarly journals Clinical Evaluation of Etidocaine in Continuous Caudal Analgesia for Pelvic Floor Repair and Post-Operative Pain Relief

1976 ◽  
Vol 4 (3) ◽  
pp. 239-244 ◽  
Author(s):  
L. T. Seow ◽  
H. H. Chiu ◽  
C. Y. Tye
Keyword(s):  
Pelvic Floor ◽  
Muscle Relaxation ◽  
Rapid Onset ◽  
Onset Of Action ◽  
Double Blind ◽  
Duration Of Action ◽  
Pelvic Floor Repair ◽  
Post Operative Pain ◽  
Caudal Anaesthesia ◽  
Caudal Analgesia

A randomized double-blind trial compared 1·0% etidocaine and 1·5% lignocaine (both with 1/200,000 adrenaline), for caudal anaesthesia for pelvic floor repair. Etidocaine was highly effective for the surgical procedure, with rapid onset of action, adequate muscle relaxation and longer duration of action. Its use for post-operative analgesia may be hindered by the concomitant immobilization of the legs. The problem of tachyphylaxis with etidocaine needs further investigation.

The Influence of Mild Hypothermia on the Pharmacokinetics and Time Course of Action of Neostigmine in Anesthetized Volunteers

2002 ◽  
Vol 97 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Tom Heier ◽  
David Clough ◽  
Peter M. C. Wright ◽  
Manohar L. Sharma ◽  
Daniel I. Sessler ◽  
...  
Keyword(s):  
Time Course ◽  
Mechanical Response ◽  
Mild Hypothermia ◽  
Neuromuscular Block ◽  
Onset Time ◽  
Volume Of Distribution ◽  
Maximum Effect ◽  
Surface Cooling ◽  
Duration Of Action ◽  
Course Of Action

Background The pharmacokinetics, maximum effect, and time course of action of neostigmine were studied in seven human volunteers. Methods Each volunteer was studied twice, during both normothermia and hypothermia. Anesthesia was induced with 30 microg/kg alfentanil and 3 mg/kg propofol, and was maintained with 60-70% nitrous oxide and 0.7-0.9% isoflurane. The mechanical response of the adductor pollicis to train-of-four stimulation of the ulnar nerve was recorded, and central body temperature maintained stable at either less than 34.5 degrees C or greater than 36.5 degrees C by surface cooling or warming. Before neostigmine administration, a stable 5% twitch height was obtained by an infusion of vecuronium, and the infusion rate remained unchanged thereafter. Neostigmine, 70 microg/kg, was then infused over 2 min, and blood samples for estimation of neostigmine concentrations were collected at intervals for 240 min. Results With hypothermia, the central volume of distribution of neostigmine decreased by 38%, and onset time of maximum effect increased (4.6 vs. 5.6 min). Hypothermia did not change the clearance (696 ml/min), maximum effect, or duration of action of neostigmine. Conclusions The efficacy of neostigmine as an antagonist of vecuronium-induced neuromuscular block is not altered by mild hypothermia.

scholarly journals Neuromuscular block in patients 80 years and older: a prospective, controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Denis Schmartz ◽  
Raouf Sghaier ◽  
Paul Bernard ◽  
Jean François Fils ◽  
Thomas Fuchs-Buder
Keyword(s):  
Time Course ◽  
Neuromuscular Block ◽  
Demographic Data ◽  
Onset Time ◽  
Rapid Onset ◽  
Controlled Study ◽  
Younger Adults ◽  
Number Of Patients ◽  
Long Acting ◽  
Prospective Controlled Study

Abstract Background An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults. Methods Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined. Results Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P < 0.001 and the clinical duration was 52 [48–69.5] min and 36 [34–41] min, respectively, P < 0.001. Duration to 90% recovery of baseline was 77.5 [71–88.5] min and duration to 100% recovery of baseline was 91.2 [82.2–98] min in patients ≥ 80 years and the corresponding values in the patients 20–50 years old were 53.5 [49–55.5] min and 59.5 [56.5–70.25] min, respectively, P < 0.001. Conclusion Compared to younger adults rocuronium shifted in patients ≥ 80 years from a rapid onset, intermediate acting compound to a slower onset, long-acting compound. Trial registration ClinicalTrials.gov identifier: NCT03551652 (29/05/2018).

Sedation at the end of life

2015 ◽  
Author(s):  
Eric L. Krakauer
Keyword(s):  
Informed Consent ◽  
Neuropsychiatric Symptoms ◽  
Terminally Ill ◽  
Rapid Onset ◽  
Palliative Sedation ◽  
Anaesthetic Induction ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Agitated Delirium ◽  
Induction Agents

Palliative sedation is a well-accepted therapy that should be considered in the rare situations when a terminally ill patient whose overriding goal is comfort experiences severe suffering that is refractory to all available standard palliative interventions. Typically, such suffering is caused by physical or neuropsychiatric symptoms such as pain, dyspnoea, vomiting, seizures, agitated delirium, anxiety, or depression. The level of sedation should be proportional to an individual patient’s suffering and should be just deep enough to provide the desired relief. In some cases, sedation to unconsciousness is necessary. The intention of palliative sedation should be only to relieve suffering, never to hasten death. Informed consent must be obtained, and clinicians should demonstrate their intentions by documenting the regimen used and the patient’s response. Ideal medications have a rapid onset of action and a short duration of action that facilitate titration to the desired effect. The best agents are barbiturates such as pentobarbital and anaesthetic induction agents such as propofol.

Comparison of the Intubation Conditions Provided by Rapacuronium (ORG 9487) or Succinylcholine in Humans during Anesthesia with Fentanyl and Propofol 

1999 ◽  
Vol 91 (5) ◽  
pp. 1311-1311 ◽  
Author(s):  
Neal W. Fleming ◽  
Frances Chung ◽  
Peter S. A. Glass ◽  
John B. Kitts ◽  
Hans Kirkegaard-Nielsen ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Short Duration ◽  
Rapid Onset ◽  
Neuromuscular Function ◽  
Neuromuscular Blocking ◽  
Blocking Drug ◽  
Duration Of Action ◽  
Prospective Randomized Clinical Trial ◽  
Org 9487 ◽  
Train Of Four

Background Currently, the only approved muscle relaxant with a rapid onset and short duration of action is succinylcholine, a drug with some undesirable effects. Rapacuronium is an investigational nondepolarizing relaxant that also has a rapid onset and short duration and consequently should be compared with succinylcholine in its ability to facilitate rapid tracheal intubation. Methods This prospective, randomized clinical trial involved 336 patients. Anesthesia was induced with fentanyl and propofol and either 1.5 mg/kg rapacuronium or 1.0 mg/kg succinylcholine. The goal was to accomplish tracheal intubation by 60 s after administration of the neuromuscular blocking drug. Endotracheal intubation was performed, and conditions were graded by a blinded investigator. Recovery of neuromuscular function was assessed by electromyography. Results Intubation conditions were evaluated in 236 patients. Intubation by 60 s after drug administration occurred in 100% of patients with rapacuronium and in 98% with succinylcholine. Intubation conditions were excellent or good in 87% of patients with rapacuronium and in 95% with succinylcholine (P &lt; 0.05). The time (median and range) to the first recovery of the train-of-four response was 8.0 (2.8-20.0) min with rapacuronium and 5.7 (1.8-17.7) min with succinylcholine (P &lt; 0.05). The overall incidence of adverse effects was similar with both drugs. Conclusions A 1.5-mg/kg dose of rapacuronium effectively facilitates rapid tracheal intubation. It can be considered a valid alternative to 1.0 mg/kg succinylcholine for this purpose.

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