British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of rapacuronium using edrophonium or neostigmine: pharmacodynamics and pharmacokinetics.
We have studied the pharmacodynamics and pharmacokinetics of rapacuronium (Org 9487) in 70 healthy patients. Neuromuscular transmission was monitored using TOF stimulation of the ulnar nerve and mechanomyography of the adductor pollicis muscle. Half of the patients were given a single dose of rapacuronium 1.5 mg kg-1 and the remainder rapacuronium 1.5 mg kg-1 with three incremental doses of 0.5 mg kg-1, each given when T1/T0 had recovered to 25%. ⋯ A three-compartment pharmacokinetic model was justified. Typical values for clearance and initial volume of distribution (V1) were 4.4 ml kg-1 min-1 and 94.8 ml kg-1, respectively. In females, clearance was decreased by 38.5% compared with males and V1 was decreased by 25% in patients aged more than 65 yr.
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Comment Letter Comparative Study
Effect of rocuronium compared with succinylcholine on IOP.
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Sedation is an important component of patient comfort in the intensive care unit (ICU), especially in those undergoing mechanical ventilation. Sedation that is too light or too deep can have important consequences, and therefore assessment of the degree of sedation should be an important part of patient management. Although there are many methods available to assess the degree of sedation, none is ideal. ⋯ There were no significant differences in mean or highest levels between patients in the two phases (mean 2.89 (SD 0.11) vs 2.67 (0.13), P = 0.22; highest 3.16 (0.11) vs 3.10 (0.14), P = 0.78). However, the lowest level was significantly greater in patients in the second phase than in those in the first phase (2.61 (0.11) vs 2.16 (0.13); P = 0.011), indicating that the number of patients with excessive sedation was significantly reduced with the introduction of this scale. Thus the use of this scale can have a real clinical impact for patients undergoing mechanical ventilation, principally by avoiding excessive sedation.