European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Jan 1994
Time course of action and recovery of rocuronium bromide in children during halothane anaesthesia--a preliminary report.
In this preliminary study, two groups of 15 patients, aged 1-4 years and 5-10 years respectively, received one of four doses of rocuronium (0.12, 0.17, 0.22 or 0.27 mg kg-1) and when block was maximal a supplementary dose to bring them all to a total of 0.5 mg kg-1. In half the patients, the block was reversed with atropine and neostigmine at a T1 recovery of 25%. The remainder were allowed to recover spontaneously. ⋯ Mean spontaneous recovery time from T1 25% to a train-of-four ratio of 0.7 was about 11 min. Neostigmine doubled the rate of recovery. There was a moderate increase in heart rate in the younger age range.
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Eur J Anaesthesiol Suppl · Jan 1994
Dose-response relationship and time course of action of rocuronium bromide in perspective.
The available evidence indicates that rocuronium is one of the least potent non-depolarizing muscle relaxants, having a clinical duration, recovery index and reversal time similar to those of atracurium and vecuronium. The onset time, however, is significantly shorter than that of currently used non-depolarizing muscle relaxants. ⋯ There is no difference in potency of rocuronium between adult and elderly patients, but it is not clear yet whether the potency differs between adults and neonates, infants or children. The onset time, duration of action, and recovery index are prolonged in elderly patients and the onset time, duration of action, and recovery index are longer in infants than in children.
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Eur J Anaesthesiol Suppl · Jan 1994
Safety aspects of non-depolarizing neuromuscular blocking agents with special reference to rocuronium bromide.
The safety of neuromuscular relaxants can be assessed according to their cardiovascular and autonomic effects, their liability to release histamine, their tendency to cause anaphylactic/anaphylactoid reactions, their effect on cholinesterase, on intra-ocular and intracranial pressure, their tendency to cumulation and their reversibility. Any adverse effects of metabolites are also potential problems. Against these standards, rocuronium may have some mild vagolytic activity. Apart from that, its safety profile is indistinguishable from that of vecuronium.
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Eur J Anaesthesiol Suppl · Jan 1994
Interaction between rocuronium bromide and some drugs used during anaesthesia.
In cats anaesthetized with i.p. chloralose and pentobarbitone, neuromuscular blockade produced by various doses of rocuronium was measured and dose response curves constructed in the presence of halothane, enflurane, nitrous oxide, propofol, alfentanil, thiopentone, ketamine, diazepam, chlorpromazine, morphine or streptomycin. In general, when a shift in the dose response curve was produced, it was a parallel shift to the left, indicating potentiation. Both halothane and enflurane produced a left shift and a small increase in the time from maximum block to 90% recovery. ⋯ Streptomycin had a potentiating effect in four cats but not in two others. Diazepam displaced the dose-response curve to the right in four cats. Prior treatment with suxamethonium had no effect.
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Many factors influence the minimum time required to achieve an easy and successful tracheal intubation after a non-depolarizing relaxant. The ideal study design has never been achieved in practice: an overall picture of the efficacy of rocuronium depends on careful interpretation of studies with different methodologies, which have usually compared the new drug with vecuronium or suxamethonium, currently the best alternatives. ⋯ Although some studies have produced evidence that rocuronium can produce smooth easy intubation conditions in 60 s, 90 s would appear to be closer to the time when excellent conditions can be guaranteed. Whether this is an acceptable alternative to the 45 s or so needed after suxamethonium is a matter of clinical judgement which only testing in practice will answer.