Onset and Duration of Rocuronium-induced Meeting Abstracts in Patients with Duchenne Muscular Dystrophy

2005 ◽  
Vol 102 (5) ◽  
pp. 915-919 ◽  
Author(s):  
Stefanie Wick ◽  
Tino Muenster ◽  
Joachim Schmidt ◽  
Juergen Forst ◽  
Hubert J. Schmitt
Keyword(s):  
Single Dose ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Time Course ◽  
Spontaneous Recovery ◽  
Standard Dose ◽  
Neuromuscular Block ◽  
Peak Effect ◽  
Surprising Result ◽  
Time To Peak

Background In patients with Duchenne muscular dystrophy (DMD) the response to nondepolarizing muscle relaxants is scarcely documented and conflicting. The current study was conducted to determine the time to peak effect and the time for complete spontaneous recovery after a single dose of 0.6 mg/kg of rocuronium in patients with DMD. Methods Twenty-four patients (12 with DMD, 12 controls, aged 10-16 yr) were studied. All patients were anesthetized with propofol and fentanyl/remifentanil. Neuromuscular transmission was monitored by acceleromyography. After induction all patients received a single dose of 0.6 mg/kg of rocuronium. The complete time course of onset and spontaneous recovery were recorded Results Significant (P < 0.01) increase in the onset times to 95% neuromuscular block was observed in DMD patients (median, 203 s; range, 90-420 s) compared with controls (median, 90 s; range, 60-195 s). The time between rocuronium administration and recovery of first twitch of the train-of-four to 90% was significantly (P < 0.01) prolonged in DMD compared with controls (median, 132 min; range, 61-209 min versus 39 min; 22-55 min). The recovery index was also significantly prolonged in the DMD group compared with controls (median, 28 min, range, 15-70 min versus 8 min; 3-14 min). Conclusions The most striking and surprising result of this study is the delayed onset of blockade in DMD after a standard dose of rocuronium. This effect should be kept in mind in situations when a rapid airway protection is necessary in DMD patients. The documented very long recovery from rocuronium-induced block emphasizes the need for careful assessment of neuromuscular function in DMD patients.

Reversal of rocuronium-induced profound neuromuscular block by sugammadex in Duchenne muscular dystrophy

2009 ◽  
Vol 19 (12) ◽  
pp. 1226-1228 ◽  
Author(s):  
HANS D. de BOER ◽  
JAN van ESMOND ◽  
LEO H.J.D. BOOIJ ◽  
JACQUES J. DRIESSEN
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Neuromuscular Block

Time to peak effect of neostigmine at antagonism of atracurium- or vecuronium-induced neuromuscular block

1995 ◽  
Vol 7 (8) ◽  
pp. 726
Author(s):  
Hans Kirkegaard-Nielsen ◽  
Hans S. Helbo-Hansen ◽  
Peter Lindholm ◽  
Inge K. Severinsen ◽  
Karsten Bülow
Keyword(s):  
Neuromuscular Block ◽  
Peak Effect ◽  
Time To Peak

Comparison of Plasma Compartment versus  Two Methods for Effect Compartment–controlled Target-controlled Infusion for Propofol

2000 ◽  
Vol 92 (2) ◽  
pp. 399-399 ◽  
Author(s):  
Michel M. R. F. Struys ◽  
Tom De Smet ◽  
Birgit Depoorter ◽  
Linda F. M. Versichelen ◽  
Eric P. Mortier ◽  
...  
Keyword(s):  
Time Course ◽  
Drug Effect ◽  
Peak Effect ◽  
Effect Compartment ◽  
Loss Of Consciousness ◽  
Group Iii ◽  
Time To Peak ◽  
Effect Site ◽  
Effect Site Concentration ◽  
Plasma Effect

Background Target-controlled infusion (TCI) systems can control the concentration in the plasma or at the site of drug effect. A TCI system that targets the effect site should be able to accurately predict the time course of drug effect. The authors tested this by comparing the performance of three control algorithms: plasmacontrol TCI versus two algorithms for effect-site control TCI. Methods One-hundred twenty healthy women patients received propofol via TCI for 12-min at a target concentration of 5.4 microg/ml. In all three groups, the plasma concentrations were computed using pharmacokinetics previously reported. In group I, the TCI device controlled the plasma concentration. In groups II and III, the TCI device controlled the effect-site concentration. In group II, the effect site was computed using a half-life for plasma effect-site equilibration (t1/2k(eo)) of 3.5 min. In group III, plasma effect-site equilibration rate constant (k(eo)) was computed to yield a time to peak effect of 1.6 min after bolus injection, yielding a t1/2keo of 34 s. the time course of propofol was measured using the bispectral index. Blood pressure, ventilation, and time of loss of consciousness were measured. Results The time course of propofol drug effect, as measured by the bispectral index, was best predicted in group III. Targeting the effect-site concentration shortened the time to loss of consciousness compared with the targeting plasma concentration without causing hypotension. The incidence of apnea was less in group III than in group II. Conclusion Effect compartment-controlled TCI can be safely applied in clinical practice. A biophase model combining the Marsh kinetics and a time to peak effect of 1.6 min accurately predicted the time course of propofol drug effect.

scholarly journals Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy †

2005 ◽  
Vol 95 (6) ◽  
pp. 769-772 ◽  
Author(s):  
J. Schmidt ◽  
T. Muenster ◽  
S. Wick ◽  
J. Forst ◽  
H.J. Schmitt
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Neuromuscular Block

Glutathione depletion during experimental damage to rat skeletal muscle and its relevance to Duchenne muscular dystrophy

1991 ◽  
Vol 80 (6) ◽  
pp. 559-564 ◽  
Author(s):  
M. J. Jackson ◽  
M. H. Brooke ◽  
K. Kaiser ◽  
R. H. T. Edwards
Keyword(s):  
Skeletal Muscle ◽  
Creatine Kinase ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Time Course ◽  
Contractile Activity ◽  
Calcium Ionophore ◽  
Glutathione Depletion ◽  
Ionophore A23187 ◽  
Enzyme Release

1. The release of glutathione has been studied in comparison with the release of creatine kinase from isolated rat soleus muscles subjected to certain forms of experimental damage. 2. Excessive electrically stimulated contractile activity or treatment of muscles with the mitochondrial inhibitor, 2,4-dinitrophenol, induced a substantial release of both creatine kinase and glutathione and a reduction in the total glutathione content of the muscle. The time course of this release and depletion indicates that the efflux of the two molecules is not directly related and that a reduction in muscle glutathione content does not occur before cytosolic enzyme release. 3. 2,4-Dinitrophenol-stimulated release of creatine kinase was significantly reduced by the omission of external calcium from the incubation media, but glutathione release and depletion was relatively unaffected by this. Deliberate elevation of the muscle intracellular calcium content with the calcium ionophore, A23187, induced a substantial loss of creatine kinase, but had no significant effect on the release of glutathione. 4. Muscle biopsies from patients with Duchenne muscular dystrophy were found to have an elevated content of glutathione and an equivalent protein-thiol content compared with control subjects. 5. We conclude that, although release of glutathione from skeletal muscle occurs after excessive contractile activity or inhibition of mitochondrial metabolism, this is not a key step in the damaging processes leading to cytosolic enzyme release, neither is it relevant to the ongoing damage to skeletal muscle which occurs in patients with Duchenne muscular dystrophy.

scholarly journals Assessment of Left Ventricular Dyssynchrony by Speckle Tracking Echocardiography in Children with Duchenne Muscular Dystrophy

2021 ◽  
Author(s):  
Nicolas Lanot ◽  
Marie Vincenti ◽  
Hamouda Abassi ◽  
Charlene Bredy ◽  
Audrey Agullo ◽  
...  
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Controlled Study ◽  
Left Ventricular Dyssynchrony ◽  
Clinical Trial Registration ◽  
Time To Peak

Abstract Purpose-Prognosis of Duchenne muscular dystrophy (DMD) is related to cardiac dysfunction. Two dimensional-speckle tracking echocardiography (2D-STE) has recently emerged as a non-invasive functional biomarker for early detection of DMD-related cardiomyopathy. This study aimed to determine, in DMD children, the existence of a left ventricle (LV) dyssynchrony using 2D-STE analysis.Methods-This prospective controlled study enrolled 25 boys with DMD (mean age 11.0±3.5 years) with normal LV ejection fraction and 50 age-matched controls. Three measures were performed to assess LV mechanical dyssynchrony: the opposing-wall delays (longitudinal and radial analyses), the modified Yu index, and the time-to-peak delays of each segment. Feasibility and reproducibility of 2D-STE dyssynchrony were evaluated. Results-All three mechanical dyssynchrony criteria were significantly higher in the DMD group than in healthy subjects: (1) opposing-wall delays in basal inferoseptal to basal anterolateral segments (61.4±45.3 msec vs. 18.3±50.4 msec, P<0.001, respectively) and in mid inferoseptal to mid anterolateral segments (58.6±35.3 msec vs. 42.4±36.4 msec, P<0.05, respectively), (2) modified Yu index (33.3±10.1 msec vs. 28.5±8.1 msec, P<0.05, respectively), and (3) most of time-to-peak values, especially in basal and mid anterolateral segments. Feasibility was excellent and reliability was moderate to excellent, with ICC values ranging from 0.49 to 0.97.Conclusion-Detection of LV mechanical dyssynchrony using 2D-STE analysis is an easily and reproducible method in pediatrics. The existence of an early LV mechanical dyssynchrony visualized using 2D-STE analysis in children with DMD before the onset of cardiomyopathy represents a perspective for future pediatric drug trials in the DMD-related cardiomyopathy prevention. Clinical Trial Registration-Clinicaltrials.gov NCT02418338. Post-hoc study, registered on April 16, 2015.

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