European journal of anaesthesiology. Supplement
-
Eur J Anaesthesiol Suppl · Sep 1995
ReviewThe pharmacokinetics of rocuronium bromide in hepatic cirrhosis.
The pharmacokinetics of aminosteroid neuromuscular blocking drugs have been shown to be altered in patients with hepatic cirrhosis. A reduced clearance and prolonged elimination half-life of pancuronium and vecuronium have been demonstrated. ⋯ Nevertheless, rocuronium, even in cirrhotic patients, has the fastest onset of action of any non-depolarizing neuromuscular blocking agent. Further pharmacokinetic studies are necessary of this drug in hepatic cirrhosis.
-
Eur J Anaesthesiol Suppl · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialDose-response and time-course of action of rocuronium bromide.
Rocuronium is a new aminosteroidal muscle relaxant, the main feature of which is a low potency compared to other aminosteroidal muscle relaxants. The ED95 is approximately 0.3 mg kg-1, although the estimated potency may vary slightly with different modes of stimulation and under different anaesthetic techniques. ⋯ The estimated potency is similar in adults and the elderly, although the ED95 may be slightly higher in children. Rocuronium is affected in the same way as vecuronium by the use of volatile anaesthetic agents.
-
Eur J Anaesthesiol Suppl · Sep 1995
Comparative Study Clinical TrialCross-reactivity of rocuronium with other neuromuscular blocking agents.
The cross-reactivity of rocuronium with other neuromuscular blocking agents (NMBAs) was studied in 31 patients known to be allergic to a muscle relaxant. Tests for diagnosing cross-reactivity were skin tests (prick tests and intradermal tests: IDTs), detection by RAST assay of IgEs against the quaternary ammonium group (QAS-RIA: quaternary ammonium sepharose radio-immuno-assay), QAS-RIA inhibition test to detect IgE specificity, and leucocyte histamine release test (LHRT). Skin tests were performed with rocuronium, suxamethonium, gallamine, vecuronium, pancuronium, atracurium. ⋯ In one of the five patients allergic to all the NMBAs available, rocuronium was the only one which did not cross-react. In those 10 patients, rocuronium may be safely used for subsequent anaesthesia. In terms of allergy, rocuronium appeared to be very close to the other steroidal NMBAs.
-
Eur J Anaesthesiol Suppl · Sep 1995
Clinical Trial Controlled Clinical TrialThe influence of hypothermia (surface cooling) on the time-course of action and on the pharmacokinetics of rocuronium in humans.
Hypothermia prolongs the time-course of action of non-depolarizing neuromuscular blocking agents. The mechanism, however, is unknown. We studied the influence of hypothermia (by surface cooling, nasopharyngeal temperature < or = 31 degrees C) on the time-course of action and on the pharmacokinetics of rocuronium in humans. ⋯ Hypothermia (30.4 +/- 0.8 degrees C (mean +/- SD)) increased the duration of action, temperature dependently, and delayed the recovery. Hypothermia reduced the plasma clearance significantly (2.17 +/- 0.62 vs. 4.26 +/- 0.50 mL kg-1 min-1, P = 0.004), did not change the volume of distribution (224 +/- 64 vs. 232 +/- 60 mL kg-1 min-1, P = 1.0), and prolonged the mean residence time (108 +/- 39 vs. 56 +/- 19 mL kg-1 min-1, P = 0.01). We conclude that hypothermia prolongs the duration of action of rocuronium and delays spontaneous recovery and that altered pharmacokinetics, such as a decreased clearance, play an important role in this.
-
Eur J Anaesthesiol Suppl · Sep 1995
Clinical Trial Controlled Clinical TrialRocuronium bromide in the ICU: dose finding and pharmacokinetics.
Thirty patients requiring elective ventilation in the ICU received either intermittent boluses (25 patients) or a continuous infusion (five patients) of rocuronium. Degree of block was monitored by train-of-four stimuli and maintained at one twitch either observed or palpated. ⋯ Control of ventilation was better with the continuous infusion of rocuronium, but these patients also had a more intense block receiving 9.9 +/- 1.3 micrograms kg-1 min-1 as compared to 6.4 +/- 2.3 micrograms kg-1 min-1 in the bolus group. Elimination half-time, volume of distribution at steady-state, and mean residence time were significantly greater than in surgical patients receiving comparable infusions, but plasma clearance was similar.