Comparative study of atracurium, vecuronium (Org NC 45) and pancuronium.
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Biomedical subjects
Publications and source records attributed to B Minsaas.
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Speed of onset, maximum block, duration of action and 10-25% recovery time for atracurium, Org NC 45 and pancuronium were determined using equipotent doses: 330 micrograms kg-1, 66 micrograms kg-1 and 75 micrograms kg-1 respectively. Vein-to-muscle and artery-to-muscle onset times were measured by use of simultaneous recordings. Mean speeds of onset to 95% twitch depression were: atracurium 2.7 min, Org NC 45 2.8 min and pancuronium 3.6 min. The median value of maximum neuromuscular block exceeded 98.5% for all drugs and the mean durations of action to 25% recovery of control twitch height were: atracurium 27.6 min, Org NC 45 21.9 min and pancuronium 45.1 min. The differences were statistically significant. The recovery period from 10% to 25% twitch response was considerably longer for pancuronium than for the other drugs, which did not differ significantly from each other. We were unable to validate the artery-to-muscle technique in the determination of onset time.
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Cremophor is a nonionic, surface-acting agent, previously shown to bind to proteins and biological membranes. The compound is used as a solvent for certain anaesthetics. The effects of this surfactant on the onset times for alcuronium and pancuronium were investigated. Both artery-to-muscle (A-M) and vein-to-muscle (V-M) onset times were determined after cremophor- and non-cremophor-containing induction agents. Circulatory effects of the surfactant were investigated by measuring the blood velocity of the brachial artery using pulsed Doppler ultrasound. A significant reduction in both A-M and V-M onset time was found for pancuronium after cremophor-containing anaesthetics. However, no difference was found for the onset times for alcuronium in the two induction groups. In contrast to alcuronium, there was no significant difference between A-M and V-M onset times for pancuronium. Arterial blood velocity was found to be practically the same after cremophor and non-cremophor induction agents. The possible of a stronger affinity of pancuronium than alcuronium to intravascular binding sites is suggested. Cremophor might, due to its protein and membrane effects, interfere with pancuronium association to these sites.
Artery-to-muscle (A-M) onset time for five neuromuscular blocking agents was studied in 50 female patients under light endotracheal anaesthesia. Circulation to the right arm was occluded by a tourniquet and released 1 min after the injection i.v. into the left arm of a myoneural blocking drug. Muscle twitches were recorded in the right hand after stimulation of the ulnar nerve (1 Hz). After releasing the tourniquet the response to single twitches continued without decrease in height (latent onset time). The onset of gradual decreases in twitch height was noted, and the time until 90% depression of twitch height was measured (manifest onset time). The mean latent onset times were: pancuronium 31.9 s, tubocuraine 21 s, alcuronium 17.2 s, fazadinium 8.6 s and suxamethonium 4.8 s. Mean A-M latent onset time was significantly different for each drug (P less than 0.005). Manifest A-M onset times were related to A-M latent onset time except for tubocurarine which exhibited a slower decline in twitch height. A-M latent onset time correlated well with the values for intravenous onset times reported in the literature.
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