PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Neuromuscular Blockade”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed1995

[Diltiazem potentiates the neuromuscular blockade by vecuronium in humans].

We investigated interaction of diltiazem with vecuronium using constant infusion technique in 24 ASA class I or II elective surgical patients with no preoperative administration of Ca antagonists. Neuromuscular blockade was evaluated with accelerometry, which measured single twitch height of adductor pollicis muscle. After tracheal intubation under isoflurane anesthesia, patients received either no diltiazem (control group, n = 8)m, 5 mg (bolus) + 2 mcg.kg-1.min-1 constant infusion (2 mcg group, n = 8) or 5 mg (bolus) + 4 mcg.kg-1.min-1 constant infusion (4 mcg group, n = 8). When single twitch height returned to 10% of control value, infusion of vecuronium was started and the infusion rate was adjusted to maintain twitch height at 10% of the control value. After 30 minutes of stable twitch height, the vecuronium infusion rate and plasma diltiazem concentrations were measured. Diltiazem infusion of 4 mcg.kg-1.min-1 decreased the vecuronium infusion rate by 45% compared with 2 other groups. Plasma diltiazem concentrations in patients receiving 4 mcg.kg-1.min-1 were significantly higher than those receiving 2 mcg.kg-1.min-1. In conclusion diltiazem 4 mcg.kg-1.min-1 potentiates the neuromuscular blockade of vecuronium and it relates with the plasma diltiazem concentration.

Adult↗
PubMed1991

The effect of the depth of neuromuscular blockade on the haemodynamic response to tracheal intubation.

The effect of two different doses of vecuronium on the heart rate and mean arterial pressure response to tracheal intubation was compared in 32 adult ASA class I patients. It was found that the higher dose of vecuronium (2.5 X ED95) produced greater depression of the evoked electromyogram (P less than 0.01), and provided better intubating conditions (P less than 0.01) than the lower dose of vecuronium (1 X ED95). However, the heart rate and the mean arterial pressure response to tracheal intubation was similar with both doses. The results indicate that, within the range of neuromuscular blockade commonly used to facilitate tracheal intubation, the depth of neuromuscular blockade per se does not affect the haemodynamic response to intubation.

Adult↗
PubMed2006

The effects of volatile anesthetics on intraoperative monitoring of myogenic motor-evoked potentials to transcranial electrical stimulation and on partial neuromuscular blockade during propofol/fentanyl/nitrous oxide anesthesia in humans.

The aim of the present study was to compare the influence of volatile anesthetics on transcranial motor-evoked potentials (tcMEP) in humans anesthetized with propofol/fentanyl/nitrous oxide and on partial neuromuscular blockade (NMB). The authors studied 35 ASA I and II patients who were undergoing elective craniotomy and brain tumor resection. The patients were randomized to one of three groups to receive halothane (HAL), isoflurane (ISO), or sevoflurane (SEV). Anesthetic depth was initially adjusted using the bispectral index to 40+/-5, and NMB was adjusted to 40%-50% of one twitch of train of four (T1) after recovery from intubation. MEPs with train of five square-wave pulses were elicited using screw electrodes placed in the skull over C3-C4. After craniotomy, the inhalational agent was introduced at 0.5 MAC and then 1.0 MAC (20 minutes each), and the effects on MEPs, NMB, and hemodynamic variables were studied. A decrease in BIS and systolic blood pressure was observed with all agents. Both SEV and ISO at 1.0 MAC significantly decreased train-of-four ratio from 38.4+/-18.1 at control to 19.0+/-9.7 and from 35.3+/-12.4 to 26.1+/-13.7, respectively (P<0.001), but not HAL at 1.0 MAC. The amplitudes of tcMEPs were significantly reduced by all agents at 1.0 MAC, with the effect being less in HAL at 0.5 MAC. We have shown that HAL had a lesser suppressive effect on MEPs than either ISO or SEV at 0.5 MAC, which was partially due to a lesser degree of NMB.

Adult↗
PubMed2000

The effects of nimodipine on vecuronium-induced neuromuscular blockade.

Nimodipine, a calcium channel blocking drug, is used in the treatment of cerebral arterial spasm after subarachnoid haemorrhage due to bleeding from an intracranial aneurysm. The purpose of this study was to evaluate the effects of nimodipine on neuromuscular blockade after vecuronium had been given to facilitate tracheal intubation and maintenance of muscle paralysis in patients undergoing clipping of intracranial aneurysm. Twenty patients were divided into two groups: a control group (n = 10) who received no calcium channel blocking drug, and a nimodipine group (n = 10) consisting of patients treated with nimodipine at clinically used doses of 0.03 mg kg(-1) h(-1) pre- and perioperatively. Anaesthesia was induced with atropine 10 microg kg(-1), dehydrobenzperidol 5 mg, fentanyl 5 microg kg(-1), thiopental 5 mg kg(-1) and maintained with a mixture of N2O and isoflurane (0.5-1% inspired concentration) in O2, and additional doses of fentanyl 2.5 microg kg(-1). Neuromuscular responses were monitored by acceleromyograpy. The first twitch of the train-of-four response (T1) was considered as twitch height. After a stabilization period, an intubating dose of vecuronium 0.1 mg kg(-1) was administered. The onset of action, the time of first appearance of T1 and clinical duration of action were recorded. Then, maintenance doses of vecuronium 0.03 mg kg(-1) were administered twice more when T1 had recovered to 25% of control twitch height. The study ended when the recordings of the 3rd 25% T1 recovery had been obtained. There were no statistical differences in the onset time (120+/-44 s in the control group, 141+/-33 s in the nimodipine group), in the first appearance time of T1 (28+/-6 min in the control group, 30+/-8 min in the nimodipine group), and in the times for 25% recovery in T1 (41+/-11, 32+/-2, 40+/-13 min in the control group, respectively, and 44+/-16, 36+/-15, 38+/-15 min in nimodipine group, respectively) between the groups studied. The time between the injection of the intubating dose of vecuronium and the third recovery of T1-25% of control was not significantly different between the control group (113+/-34 min) and the nimodipine group (117+/-42 min). This study indicates that nimodipine does not have any significant effect on the time course of action of vecuronium including the onset time and its clinical duration of action after the initial and the two maintenance doses in these patients.

Adjuvants, Anesthesia↗
PubMed2000

[Time course of neuromuscular blockade after rocuronium. A comparison between women and men].

BACKGROUND: We studied 40 patients (20 female and 20 male) undergoing elective surgery under general anaesthesia to evaluate the effect of gender on the pharmacodynamics of rocuronium. METHODS: Using electromyography (EMG) we determined the maximal neuromuscular block and time course of action of 0.45 mg/kg rocuronium (1.5 x ED95). RESULTS: Age and body mass index were comparable between females and males (38 (+/- 8) vs. 37 (+/- 10) years and 24.2 (+/- 2.9) vs. 25.2 (+/- 1.7) kg/m2. However, significant differences in weight and height were found between females and males (65.7 +/- 9.3 kg vs. 77.5 +/- 5.5 kg; p < 0.01 and 178 +/- 6.8 cm vs. 164 +/- 6.7 cm; p < 0.01). Onset time was shorter in females (168 +/- 65 s vs. 211 +/- 56 s; p < 0.05). Maximal neuromuscular blockade after 0.45 mg/kg rocuronium was 94 (+/- 3) % in females and 89 (+/- 6) % in males; p < 0.01. Clinical duration was increased in females (23 +/- 5 min vs. 17 +/- 5 min; p < 0.05), while the recovery index was comparable between both groups (9 +/- 4 min in females and 9 +/- 3 min in males; n.s.). CONCLUSION: Compared to men neuromuscular blockade after 0.45 mg/kg rocuronium was more pronounced in women. The onset time was shortened and the clinical duration increased in female patients.

Adult↗
PubMed2002

[Neuromuscular blockade with cisatracurium in infants andchildren. Its course under sevoflurane anesthesia].

OBJECTIVE: To compare the onset, duration and maximum effect of 0.1 mg/kg cisatracurium during balanced anesthesia with sevoflurane and remifentanil between infants and children. METHODS: We measured the time course of the neuromuscular blockade in 15 infants and 15 children by electromyography. Anesthesia was induced with propofol/remifentanil and maintained with sevoflurane (constant 2% endtidal) and remifentanil according to the patients individual requirements. After injection of 0.1 mg/kg cisatracurium we measured the following parameters: onset time: time between the beginning of injection of cisatracurium and maximum T1 depression, clinical duration: time between injection of the drug and recovery of T1 to 25%, recovery index: time between recovery of T1 from 25% to 75%. TOFR 0.9: time between injection of cisatracurium and recovery of the train-of-four ratio to 90%. In addition, we determined the maximum neuromuscular blockade Tmax after 0.1 mg/kg cistracurium. RESULTS: Both groups differed significantly with regard to onset time and clinical duration. In the infants, the onset time was shorter (74 s vs. 198 s) and the clinical duration longer (55 min vs. 41 min) compared to the older children. The TOFR 0.9 was 73 min (range 56-86 min) in the group of the infants and 59 min (range 43-72 min) in the group of the older children (p < 0.001). Tmax was 100% (range 97-100%) in the infants and 98% (range 92-100%) in the children (p < 0.01). However, the recovery index was comparable in both groups (21 vs. 16 min). CONCLUSIONS: Infants are substantially more sensitive to cisatracurium than children, which can be demonstrated in a significantly shorter onset time, a prolonged clinical duration and a delayed neuromuscular recovery. As there exist large interindividual differences, we recommend the use of neuromuscular monitoring in the routine practice of pediatric anesthesia.

Aging↗
PubMed1990

[Neuromuscular blockade following high-dose vecuronium administration].

To determine the onset time, duration of action and recovery time of high-dose vecuronium, 70 patients were assigned to receive either 100, 150, 200 or 300 micrograms.kg-1 of vecuronium for muscle relaxation during elective surgery. Neuromuscular blockade was continuously quantitated by recording the EMG response to stimulation of the ulnar nerve. The onset time from the time of vecuronium administration to maximum blockade decreased from 4.6 +/- 1.1 to 2.4 +/- 0.5 min when the vecuronium doses increased from 100 to 300 micrograms.kg-1. Significant differences were observed in the onset time between the 100 micrograms.kg-1 dose and the other dose groups. Endotracheal intubating conditions were excellent in all patients except 3 in the 100 micrograms.kg-1 dose group. The duration of action from the time of injection to 25% recovery increased from 32 +/- 9 to 138 +/- 48 min in a dose dependent manner. The duration of action after increment doses of 40 or 50 micrograms.kg-1 up to 25% recovery of T1 did not vary significantly within the same dose group. With an initial dose of 150 micrograms.kg-1 and subsequent increment doses of 50 micrograms.kg-1 or less, the duration of action remained constant. The recovery time from 25 to 75% recovery was within 11 minutes when antagonists were administered. High-dose vecuronium may, therefore, be a useful alternative to SCC, when a rapid onset is required and to pancuronium, when a rapid recovery from neuromuscular blockade is requested.

Adult↗
PubMed1975

The interaction of tubocurarine and suxamethonium at different stages of recovery from tubocurarine-induced neuromuscular blockade in anaesthetized man.

The interaction of tubocurarine and suxamethonium in man was studied by the use of tetanic and single twitch contractions of the adductor pollicis muscles. Suxamethonium 0.2 mg/kg was administered at the times when the recovery of the tetanic contraction from neuromuscular blockade produced by tubocurarine 0.2 mg/kg had reached 20% and 50% of the control. At the 20% recovery point, suxamethonium improved both the tetanic and single twitch contractions; at the 50% recovery point, the single twitch response was markedly enhanced but the tetanic contraction was depressed. The findings suggest that the interaction of tubocurarine and suxamethonium is both antagonistic and synergistic. The tetanic contraction is more sensitive to the synergistic action compared with the single twitch contraction. When the interaction of these two agents is being evaluated it is important to consider the doses of the agents, the stage of curarization where the interaction took place and the method of assessing the neuromuscular blockade.

Adult↗
PubMed1992

A sciatic nerve blockade method to differentiate drug-induced local anesthesia from neuromuscular blockade in mice.

This report introduces a simple and easy technique for animal handling and drug administration into the sciatic nerve area for determining local anesthesia and neuromuscular blocking activity in mice. The drugs were injected into the popliteal space of the right hindlimb (i.e., the sciatic nerve area). The loss of motor activity of the right hindlimb was taken as a sign of producing local anesthesia. A positive local anesthetic activity was recorded when a mouse was only able to walk using three limbs on an inverted wire mesh screen and the injected limb was hanging in the air. This method is superior to the commonly used techniques of applying drugs to the rabbit's cornea, the guinea pig's back skin, or the root of the mouse tail to determine the reduced reflex responses and to assess the local anesthetic activity. The present method has evaluated a number of drugs (cocaine, lidocaine, procaine, propranolol, quinidine, quinacrine, verapamil, and diltiazem), which are known to produce local anesthesia. The sciatic nerve blockade technique is also capable of determining neuromuscular blocking activity of drugs, in which the end point of activity taken is different from that for local anesthetic drugs. The method reported here has been validated by reference neuromuscular blocking agents (d-tubocurarine, decamethonium, and succinylcholine). A positive neuromuscular blockade was recorded when a mouse was unable to stay on the inverted wire mesh screen. The information provides not only the local anesthetic or neuromuscular blocking potency of drugs but also duration of action of drugs.

Anesthetics, Local↗
PubMed1986

Antagonism of atracurium-induced neuromuscular blockade by neostigmine or edrophonium.

Antagonism of atracurium-induced neuromuscular blockade by neostigmine or edrophonium has been studied using the tetanic (50 Hz) and train-of-four (2 Hz) or single twitch responses of the adductor pollicis muscle in 22 anaesthetized patients. A further nine patients not given an anticholinesterase acted as a control group. In two groups (six patients for each anticholinesterase) in whom antagonism was attempted at 95-98% blockade of the tetanic response, recovery of the tetanic response after two or three doses of edrophonium 0.75 mg kg-1 i.v. was not statistically different from that in the control group; recovery after two doses of neostigmine 2.5 mg i.v. was significantly faster (P less than 0.001). Recovery of the single twitch response after antagonism with edrophonium, although longer than that with neostigmine (P less than 0.01), was significantly shorter than in the control group (P less than 0.05). When edrophonium is given at the commencement of recovery, the initial rapid antagonism of tetanic block is not sustained, whereas antagonism by neostigmine is more persistent and the recovery phase is significantly shortened. In a further two groups of patients (n = 5) given atracurium 0.3 mg kg-1 i.v., antagonism was not attempted until the peak height of the tetanic contraction had reached approximately 50% of the control value.(ABSTRACT TRUNCATED AT 250 WORDS)

Atracurium↗
PubMed1988

Differential effects of calcium channel blocking agents on pancuronium- and suxamethonium-induced neuromuscular blockade.

The effects were studied of several calcium channel blocking agents on muscle twitch, and possible interactions between these drugs and pancuronium and suxamethonium, using a rat phrenic-hemidiaphragm preparation. Nicardipine, verapamil and diltiazem each caused a concentration-related depression of muscle response. Nicardipine had the most, and diltiazem the least, potent effect. Verapamil and diltiazem 5 and 10 mumol litre-1 caused a concentration-dependent enhancement of suxamethonium-induced neuromuscular blockade, but increased the effect of pancuronium only at 10 mumol litre-1. Nicardipine 10 mumol litre-1 significantly enhanced pancuronium-induced neuromuscular blockade, but not that produced by suxamethonium.

Animals↗
PubMed1991

Changes in plasma potassium and neuromuscular blockade following suxamethonium in patients pre-treated with terbutaline.

Plasma potassium, heart rate, systolic and diastolic blood pressure were measured in adult surgical patients pre-treated with either terbutaline 1.25 mg (n = 10) or normal saline (n = 10) prior to and during general anaesthesia which included suxamethonium 1 mg kg-1. Neuromuscular blockade was then measured using a train-of-four technique. Plasma potassium was significantly lower before and during general anaesthesia in those patients who had received terbutaline but the rise following suxamethonium (measured at 1, 3, 5, 7, 10, 12, 15, 30 and 180 min after suxamethonium) was similar in both groups. Heart rate increased significantly in the treatment group both over time and compared to the control group. Onset time to maximum neuromuscular blockade and duration of blockade was shorter in the terbutaline-treated group.

Adult↗
PubMed1994

Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children.

Recovery after doxacurium and pancuronium neuromuscular blockade and their acceleration by neostigmine have not been compared in children. Therefore, 60 paediatric surgical patients aged 2-10 yr (ASA 1-2) were studied. They were randomized to receive doxacurium 30 micrograms.kg-1 or pancuronium 70 micrograms.kg-1 iv during propofol, fentanyl, isoflurane and nitrous oxide anaesthesia. Electromyographic (EMG) responses of the adductor pollicis to train-of-four (TOF) stimulation of the ulnar nerve were recorded every ten seconds using a Datex NMT monitor. Six patients in each relaxant group received neostigmine (0, 5, 10, 20 or 40 micrograms.kg-1) with atropine by random allocation when first twitch height (T1) had recovered to 25% of control. Spontaneous recovery after ten minutes was similar following doxacurium (mean +/- SEM values of 45.0 +/- 3.9 vs 49.5 +/- 10.0% for T1 and 25.2 +/- 3.8 vs 14.8 +/- 3.6% for TOF ratios). Dose-responses to neostigmine were calculated from the log dose vs logit of T1 or TOF ratio after ten minutes. Neostigmine-assisted recovery was not different in the two groups, with ED70 and ED90 doses for T1 of 14.3 +/- 1.8 and 25.7 +/- 2.7 micrograms.kg-1 for doxacurium and 12.5 +/- 1.7 and 25.3 +/- 2.3 micrograms.kg-1 for pancuronium. Time to recovery of TOF ratio to 70% after neostigmine 40 micrograms.kg-1 was 2.3 +/- 1.0 and 4.2 +/- 1.7 min (P = NS) following pancuronium and doxacurium, respectively. Adjusted recovery due to neostigmine alone (spontaneous recovery subtracted from the total) required two to three times higher doses of neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗
PubMed1991

[A case report of monitoring neuromuscular blockade during anesthesia in a patient with facioscapulohumeral muscle dystrophy].

Facioscapulohumeral muscle dystrophy (FSHMD) is characterized by slowly progressive wasting of facial, pectoral and shoulder-girdle muscles that begins in adolescence. A 31 year-old man with FSHMD had dystrophic changes in the deltoid, anterior serratus and pectoralis major muscles but not in the distal muscle of his arms and legs. He underwent an operation for thoraco-scapula fixation under enflurane-nitrous oxide anesthesia with vecuronium 6 mg. At the end of the surgical procedure, the train-of-four (TOF) responses of a thumb and a toe, as measured by using an acceleration transducer, were recorded simultaneously. TOF stimulation in an arm demonstrated an apparent fade phenomenon (TOF; 0.54), while a TOF test in the leg showed complete recovery of the TOF ratio (TOF; 1.0). The patient revealed no clinical signs of residual neuromuscular blockade. It was clear that there was a difference in the degree of neuromuscular block between the arm and the leg in a FSHMD patient. Use of the peripheral nerve stimulator only in the arm may be an unreliable guide to assess neuromuscular block in FSHMD patients. Therefore, two sites should be chosen for monitoring neuromuscular blockade in a FSHMD patient.

Adult↗
PubMed2001

A review of neuromuscular blockade in the critically ill patient.

The continuous administration of neuromuscular blocking agents is thought to be associated with a number of adverse effects and complications, including post-paralytic syndrome (characterized by persistent paralysis), muscle weakness, and the inability to wean from the ventilator despite discontinuation of the therapy. Consequently, clinical objectives emphasize administering only the dose necessary to optimize the effect of the drug and for the shortest possible time. This article provides an overview of the administration of neuromuscular blocking agents, from the perspective of a critical care pharmacist and critical care nurses. The complexities associated with pharmacological paralysis in critically ill patients warrants the comprehensive approach to care that multidisciplinary team members can provide.

Critical Care↗
PubMed1986

Effects of calcium channel blockers on neuromuscular blockade induced by aminoglycoside antibiotics.

The effects of several calcium channel blockers (nifedipine, verapamil and diltiazem) on rat phrenic-hemidiaphragm preparations were studied. The calcium channel blockers were used either alone or associated with two aminoglycoside antibiotics, neomycin and streptomycin. All drugs investigated produced a concentration-dependent decrease in indirectly elicited diaphragmatic contractions. The order of potency was: verapamil greater than neomycin congruent to nifedipine greater than diltiazem greater than streptomycin. Moreover, neomycin-induced neuromuscular blockade was significantly increased by nifedipine (1 and 10 microM), verapamil (1 and 10 microM) and diltiazem (10 microM), whereas the streptomycin-induced neuromuscular blockade was increased only by nifedipine (1 and 10 microM) and verapamil (10 microM).

Aminoglycosides↗
PubMed1996

Acceleromyography improves detection of residual neuromuscular blockade in children.

PURPOSE: To determine whether detection of residual blockade is improved by using the accelerograph. A secondary objective was to compare acceleromyographic measurements with those obtained by electromyography. METHODS: In a prospective, randomized, double-blind investigation, 22 anaesthetized children were studied during recovery from neuromuscular blockade following 0.1 mg.kg-1 vecuronium i.v.. Assessments of depth of block began 10 min after injection and were repeated at one minute intervals using electromyography (Datex, Relaxograph) in one hand, and acceleromyography (Biometer, Tofguard) in the other, to measure response of the adductor pollicis to train-of-four (TOF) stimulation of the ulnar nerve. Monitoring was stopped when no fade was visible and TOF ratio > or = 0.7. The electromyographic (EMG) and acceleromyographic (AMG) data were compared with corresponding observations of the number of twitches and TOF fade in the visible responses of the thumb, made by the attending anaesthetist. The method of Bland and Altman was used to compare differences between AMG and EMG data. RESULTS: During recovery from neuromuscular blockade, fade was no longer visible clinically 38.6 +/- 10.4 min (mean +/- SD) after the administration of vecuronium. This corresponded to TOF ratios of 0.04 +/- 0.23 by AMG and 0.34 +/- 0.21 by EMG. Usually, two twitches were visible before AMG detected the first twitch. The time to TOF ratio > or = 0.7 by AMG and EMG was similar at 49.1 +/- 10.5 and 50.9 +/- 9.0 min, respectively. The bias between AMG and EMG was one minute, with limits of agreement from -10 to nine min. CONCLUSION: AMG is superior to visual assessment in detecting residual neuromuscular block and provides similar estimates of recovering block as the more cumbersome EMG.

Anesthesia Recovery Period↗