Variability of duration of action of neuromuscular-blocking drugs in elderly patients
Background: Steroid‐based, non‐depolarizing neuromuscular‐blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ‐dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a d...
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Published in | Acta anaesthesiologica Scandinavica Vol. 49; no. 3; pp. 312 - 315 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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Oxford, UK; Malden, USA
Blackwell Publishing Ltd/Inc
01.03.2005
Blackwell |
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Abstract | Background: Steroid‐based, non‐depolarizing neuromuscular‐blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ‐dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a duration of action not altered by ageing. The objective of the study was to determine if elderly patients had less variability in duration of action with 2 × ED95 of cisatracurium compared to equipotent doses of rocuronium or vecuronium.
Methods: Informed consent was obtained from 66 elderly patients with normal renal and liver function. Preoperative midazolam (1 mg) was given IV. The anaesthestic induction was with 5 mg kg−1 thiopental and 2 µg kg−1 fentanyl. The patients received 0.6 mg kg−1 rocuronium, 0.1 mg kg−1 vecuronium or 0.1 mg kg−1 cisatracurium. Anaesthetic maintenance was with sevoflurane in oxygen/nitrous oxide. Neuromuscular‐blocking duration of action was defined as the return of T1 twitch height to 25% of control. Variability was determined by subtracting the actual duration of action from the mean duration of action for each drug.
Results: The durations of action (range, min) were: cisatracurium, 37–81; vecuronium, 35–137; and rocuronium, 33–119. The median of the variability of duration was significantly less with cisatracurium (7 min) compared to vecuronium (18 min) and rocuronium (18 min) (P < 0.05).
Conclusion: When used with sevoflurane/N2O, there was a two‐fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium. |
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AbstractList | Background: Steroid‐based, non‐depolarizing neuromuscular‐blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ‐dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a duration of action not altered by ageing. The objective of the study was to determine if elderly patients had less variability in duration of action with 2 × ED95 of cisatracurium compared to equipotent doses of rocuronium or vecuronium.
Methods: Informed consent was obtained from 66 elderly patients with normal renal and liver function. Preoperative midazolam (1 mg) was given IV. The anaesthestic induction was with 5 mg kg−1 thiopental and 2 µg kg−1 fentanyl. The patients received 0.6 mg kg−1 rocuronium, 0.1 mg kg−1 vecuronium or 0.1 mg kg−1 cisatracurium. Anaesthetic maintenance was with sevoflurane in oxygen/nitrous oxide. Neuromuscular‐blocking duration of action was defined as the return of T1 twitch height to 25% of control. Variability was determined by subtracting the actual duration of action from the mean duration of action for each drug.
Results: The durations of action (range, min) were: cisatracurium, 37–81; vecuronium, 35–137; and rocuronium, 33–119. The median of the variability of duration was significantly less with cisatracurium (7 min) compared to vecuronium (18 min) and rocuronium (18 min) (P < 0.05).
Conclusion: When used with sevoflurane/N2O, there was a two‐fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium. Steroid-based, non-depolarizing neuromuscular-blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ-dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a duration of action not altered by ageing. The objective of the study was to determine if elderly patients had less variability in duration of action with 2 x ED95 of cisatracurium compared to equipotent doses of rocuronium or vecuronium. Informed consent was obtained from 66 elderly patients with normal renal and liver function. Preoperative midazolam (1 mg) was given IV. The anaesthestic induction was with 5 mg kg(-1) thiopental and 2 microg kg(-1) fentanyl. The patients received 0.6 mg kg(-1) rocuronium, 0.1 mg kg(-1) vecuronium or 0.1 mg kg(-1) cisatracurium. Anaesthetic maintenance was with sevoflurane in oxygen/nitrous oxide. Neuromuscular-blocking duration of action was defined as the return of T1 twitch height to 25% of control. Variability was determined by subtracting the actual duration of action from the mean duration of action for each drug. The durations of action (range, min) were: cisatracurium, 37-81; vecuronium, 35-137; and rocuronium, 33-119. The median of the variability of duration was significantly less with cisatracurium (7 min) compared to vecuronium (18 min) and rocuronium (18 min) (P < 0.05). When used with sevoflurane/N(2)O, there was a two-fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium. BACKGROUNDSteroid-based, non-depolarizing neuromuscular-blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ-dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a duration of action not altered by ageing. The objective of the study was to determine if elderly patients had less variability in duration of action with 2 x ED95 of cisatracurium compared to equipotent doses of rocuronium or vecuronium.METHODSInformed consent was obtained from 66 elderly patients with normal renal and liver function. Preoperative midazolam (1 mg) was given IV. The anaesthestic induction was with 5 mg kg(-1) thiopental and 2 microg kg(-1) fentanyl. The patients received 0.6 mg kg(-1) rocuronium, 0.1 mg kg(-1) vecuronium or 0.1 mg kg(-1) cisatracurium. Anaesthetic maintenance was with sevoflurane in oxygen/nitrous oxide. Neuromuscular-blocking duration of action was defined as the return of T1 twitch height to 25% of control. Variability was determined by subtracting the actual duration of action from the mean duration of action for each drug.RESULTSThe durations of action (range, min) were: cisatracurium, 37-81; vecuronium, 35-137; and rocuronium, 33-119. The median of the variability of duration was significantly less with cisatracurium (7 min) compared to vecuronium (18 min) and rocuronium (18 min) (P < 0.05).CONCLUSIONWhen used with sevoflurane/N(2)O, there was a two-fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium. Background: Steroid‐based, non‐depolarizing neuromuscular‐blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ‐dependent elimination and significantly longer durations of action in elderly compared to young patients. Cisatracurium is a benzylisoquinolinium NMB drug with a duration of action not altered by ageing. The objective of the study was to determine if elderly patients had less variability in duration of action with 2 × ED95 of cisatracurium compared to equipotent doses of rocuronium or vecuronium. Methods: Informed consent was obtained from 66 elderly patients with normal renal and liver function. Preoperative midazolam (1 mg) was given IV. The anaesthestic induction was with 5 mg kg −1 thiopental and 2 µg kg −1 fentanyl. The patients received 0.6 mg kg −1 rocuronium, 0.1 mg kg −1 vecuronium or 0.1 mg kg −1 cisatracurium. Anaesthetic maintenance was with sevoflurane in oxygen/nitrous oxide. Neuromuscular‐blocking duration of action was defined as the return of T1 twitch height to 25% of control. Variability was determined by subtracting the actual duration of action from the mean duration of action for each drug. Results: The durations of action (range, min) were: cisatracurium, 37–81; vecuronium, 35–137; and rocuronium, 33–119. The median of the variability of duration was significantly less with cisatracurium (7 min) compared to vecuronium (18 min) and rocuronium (18 min) ( P < 0.05). Conclusion: When used with sevoflurane/N 2 O, there was a two‐fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium. |
Author | Arain, S. R. Ficke, D. J. Kern, S. Ebert, T. J. |
Author_xml | – sequence: 1 givenname: S. R. surname: Arain fullname: Arain, S. R. organization: Department of Anaesthesiology, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, WI, and – sequence: 2 givenname: S. surname: Kern fullname: Kern, S. organization: University of Utah Medical Center, Salt Lake City, UT – sequence: 3 givenname: D. J. surname: Ficke fullname: Ficke, D. J. organization: Department of Anaesthesiology, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, WI, and – sequence: 4 givenname: T. J. surname: Ebert fullname: Ebert, T. J. email: tjebert@mcw.edu organization: Department of Anaesthesiology, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, WI, and |
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Keywords | Human cisatracurium Variability Anesthesia rocuronium recovery Elderly Neuromuscular blocking Age vecuronium Duration of action |
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Notes | ark:/67375/WNG-0MKM0TCJ-D istex:B7F94BB48E34519D81AD8344DA59F46B3EC67EEC ArticleID:AAS634 This study was performed at the VAMC, Milwaukee. Technical support for the TOF‐WatchSX and the statistical analyses were from Utah. Funding: supported in part by an Educational Grant from Abbott Laboratories, Inc. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23 |
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References_xml | – volume: 84 start-page: 300 year: 1996 end-page: 8 article-title: Pharmacokinetics of cisatracurium in patients receiving nitrous oxide/opioid/barbiturate anesthesia publication-title: Anesthesiology – volume: 84 start-page: 1083 year: 1996 end-page: 91 article-title: Pharmacokinetics and pharmacodynamics of cisatracurium in young and elderly adult patients publication-title: Anesthesiology – volume: 84 start-page: 362 year: 1996 end-page: 7 article-title: Residual block after mivacurium with or without edrophonium reversal in adults and children publication-title: Anesthesiology – volume: 20 start-page: 126 year: 2003 end-page: 40 article-title: Selecting neuromuscular‐blocking drugs for elderly patients publication-title: Drugs Aging – volume: 87 start-page: 1035 year: 1997 end-page: 43 article-title: Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: Simultaneous videomanometry and mechanomyography of awake human volunteers publication-title: Anesthesiology – volume: 46 start-page: 364 year: 2002 end-page: 71 article-title: Double‐blind comparison of the variability in spontaneous recovery of cisatracurium‐ and vecuronium‐induced meuromuscular block in adult and elderly patients publication-title: Acta Anaesthesiol Scand – volume: 14 start-page: 19 year: 1998 end-page: 27 article-title: New equipment for neuromuscular transmission monitoring: a comparison of the TOF‐Guard with the Myograph 2000 publication-title: J Clin Monit Comput – volume: 74 start-page: 23 year: 1994 end-page: 39 article-title: Organ physiology of aging publication-title: Surg Clin North Am – volume: 73 start-page: 39 year: 1991 end-page: 42 article-title: Distribution, elimination, and action of vecuronium in the elderly publication-title: Anesth Analg – volume: 84 start-page: 394 year: 2000 end-page: 5 article-title: Residual curarization in the recovery room after vecuronium publication-title: Br J Anaesth – volume: 76 start-page: 179 year: 1996 end-page: 85 article-title: Effect of age on MAC in humans: a meta‐analysis publication-title: Br J Anaesth – volume: 77 start-page: 1193 year: 1993 end-page: 7 article-title: Pharmacokinetics and pharmacodynamics of rocuronium (org 9426) in elderly surgical patients publication-title: Anesth Analg – volume: 41 start-page: 1095 year: 1997 end-page: 103 article-title: Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium publication-title: Acta Anaesthesiol Scand – volume: 40 start-page: 520 year: 1996 end-page: 3 article-title: Reduced hypoxic chemosensitivity in partially paralysed man. A new property of muscle relaxants? publication-title: Acta Anaesthesiol Sca+nd – volume: 56 start-page: 312 year: 2001 end-page: 8 article-title: Postoperative residual block after intermediate‐acting neuromuscular blocking drugs publication-title: Anaesthesia – volume: 78 start-page: 978 year: 1994 end-page: 82 article-title: An effectiveness study of a new piezoelectric sensor for train‐of‐four measurement publication-title: Anesth Analg – volume: 84 start-page: 520 year: 1996 end-page: 5 article-title: Pharmacodynamics and pharmacokinetics of cisatracurium in geriatric surgical pateints publication-title: Anesthesiology – volume: 32 start-page: 45 year: 1988 end-page: 8 article-title: Measurement of acceleration: a new method of monitoring neuromuscular function publication-title: Acta Anaesthesiol Scand – volume: 32 start-page: 79 year: 1988 end-page: 81 article-title: Residual curarisation: a comparative study of atracurium and pancuronium publication-title: Acta Anaesthesiol Scand – ident: e_1_2_5_11_2 doi: 10.1097/00000542-199602000-00007 – ident: e_1_2_5_8_2 doi: 10.1111/j.1399-6576.1996.tb04482.x – ident: e_1_2_5_4_2 doi: 10.1111/j.1399-6576.1997.tb04851.x – ident: e_1_2_5_12_2 doi: 10.1097/00000542-199603000-00005 – ident: e_1_2_5_5_2 doi: 10.1046/j.1365-2044.2001.01921.x – ident: e_1_2_5_19_2 doi: 10.1016/S0039-6109(16)46226-2 – ident: e_1_2_5_20_2 doi: 10.2165/00002512-200320020-00004 – ident: e_1_2_5_2_2 doi: 10.1097/00000542-199602000-00014 – ident: e_1_2_5_9_2 doi: 10.1213/00000539-199107000-00008 – ident: e_1_2_5_3_2 doi: 10.1111/j.1399-6576.1988.tb02692.x – ident: e_1_2_5_13_2 doi: 10.1097/00000542-199605000-00010 – ident: e_1_2_5_15_2 doi: 10.1111/j.1399-6576.1988.tb02686.x – ident: e_1_2_5_17_2 doi: 10.1213/00000539-199405000-00025 – ident: e_1_2_5_16_2 doi: 10.1023/B:JOCM.0000012481.06502.02 – ident: e_1_2_5_7_2 doi: 10.1097/00000542-199711000-00005 – ident: e_1_2_5_18_2 doi: 10.1093/bja/76.2.179 – ident: e_1_2_5_14_2 doi: 10.1034/j.1399-6576.2002.460406.x – ident: e_1_2_5_6_2 doi: 10.1093/oxfordjournals.bja.a013445 – ident: e_1_2_5_10_2 doi: 10.1213/00000539-199312000-00019 |
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Snippet | Background: Steroid‐based, non‐depolarizing neuromuscular‐blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ‐dependent elimination... Steroid-based, non-depolarizing neuromuscular-blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ-dependent elimination and... Background: Steroid‐based, non‐depolarizing neuromuscular‐blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ‐dependent elimination... BACKGROUNDSteroid-based, non-depolarizing neuromuscular-blocking (NMB) drugs (e.g. rocuronium, vecuronium) are characterized by organ-dependent elimination and... |
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SubjectTerms | Age Aged Aging - metabolism Analysis of Variance Androstanols - pharmacology Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Atracurium - analogs & derivatives Atracurium - pharmacology Biological and medical sciences cisatracurium Dose-Response Relationship, Drug Female Humans Male Medical sciences Neuromuscular Blocking Agents - pharmacology Neuromuscular Nondepolarizing Agents - pharmacology recovery rocuronium Time Factors variability vecuronium Vecuronium Bromide - pharmacology |
Title | Variability of duration of action of neuromuscular-blocking drugs in elderly patients |
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