European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of rocuronium and vecuronium: the pharmacodynamic, cardiovascular and intra-ocular effects.
The aim of this study was to compare, in 30 patients, the pharmacodynamics of equipotent intubating doses of rocuronium and vecuronium and to compare their effects on heart rate, arterial pressure and intra-ocular pressure under steady state propofol anaesthesia. Baseline readings of heart rate and arterial pressure, using a Dinamap, and intra-ocular pressure, using a Tonopen, were made after induction of anaesthesia. The effects of the administration of the relaxants on these parameters were measured, recorded and compared. ⋯ Rocuronium caused a rise in mean arterial pressure (10-15%) and a slight rise in heart rate (5-10%). Both vecuronium and rocuronium caused similar falls in intra-ocular pressure. With its rapid onset time and lack of intra-ocular pressure effects, rocuronium is perhaps the relaxant of choice in patients with penetrating eye injuries requiring emergency endotracheal anaesthesia where a longer-acting relaxant is not contraindicated.
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Eur J Anaesthesiol Suppl · Jan 1994
Randomized Controlled Trial Clinical TrialEvaluation of the onset and intubation conditions of rocuronium bromide.
Rocuronium 0.6, 0.75, or 0.9 mg kg-1, was given after supramaximal train-of-four stimulation of the ulnar nerve, measuring the compound action potential of the hypothenar muscles, Intubation conditions, onset time, recovery to 25% and recovery index of the three doses of rocuronium bromide were determined in 60 ASA I or II consenting patients, who were receiving propofol, alfentanil and N2O/O2 for ophthalmic surgery. Intubation conditions were randomly assessed either 45 s or 60 s after injection. In general, intubation conditions were excellent or good; in only three patients were poor conditions obtained, always at 45 s. ⋯ No difference could be shown between the three dose groups. The onset time was longer (P < 0.01) in the 0.6 mg kg-1 group, compared to that in the 0.9 mg kg-1 group. The recovery to 25% and spontaneous recovery index were shorter in the 0.6 mg kg-1 group (P < 0.01).
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A computer simulation has been developed based on pharmacodynamic-pharmacokinetic modelling of the effect of neostigmine on rocuronium-induced neuromuscular blockade. The results of a previous study involving 60 patients were used as a test of the model. ⋯ The optimum dose of neostigmine depends on the degree of block at the time of administration: for a more intense block the optimum dose is 80 micrograms kg-1 and for a less intense block is about 30 micrograms kg-1. The pharmacokinetic behaviour rather than the potency of the relaxant determines its reversibility.
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Eur J Anaesthesiol Suppl · Jan 1994
Pharmacokinetics and pharmacodynamics of rocuronium bromide in adult patients.
In seven patients (M/F: 4:3) rocuronium 0.6 mg kg-1 was given after the induction of anaesthesia with propofol, and during maintenance with N2O/O2, halothane 0.5% and alfentanil 60-90 micrograms kg-1 h-1. Intubation conditions were scored at 60 s and lag time, onset time, maximal block achieved, recovery to 25% of T1, and Recovery Index, were measured using a Relaxograph. ⋯ Mean clearance was 5.2 ml kg-1 min-1, the terminal half-life was 69 min and distribution volume at steady state was 0.22 litre kg-1. Cumulative urinary excretion was around 18% within 24 h.
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Eur J Anaesthesiol Suppl · Jan 1994
Pharmacodynamics and pharmacokinetics of rocuronium following continuous infusion in patients during intravenous anaesthesia.
After an initial bolus dose (0.6 mg kg-1), 10 patients received a continuous infusion of rocuronium, initially at 0.5 mg kg-1h-1, and then adjusted to maintain 90% twitch depression. Blood samples were analysed for 420 min after switching off the infusion. The dose required to maintain the block was 595 +/- 146 micrograms kg-1h-1, 7-9 times that reported for vecuronium under similar conditions. The pharmacokinetic parameters (volume of distribution at steady state, 309 +/- 80 ml kg-1, plasma clearance 4.5 +/- 1.96 ml kg-1 min-1, and elimination half-life 107 +/- 37 min) were similar to those previously reported after a large single bolus.