BACKGROUND: It has long been held that antiepileptics reduce the duration of action, and increase the requirement for, neuromuscular blocking agents. However, levetiracetam, a relatively novel antiepileptic agent, possesses different pharmacokinetic properties to other, conventional antiepileptics, such that its effect on neuromuscular blocking agents might also differ. The purpose of this retrospective study is to investigate the effect of levetiracetam on the clinical duration of rocuronium. METHODS: In this study, the duration of neuromuscular blockade induced by rocuronium was compared between control and levetiracetam-receiving groups. The data were retrieved from one of our previous studies. RESULTS: The control and levetiracetam groups comprised 16 and 13 patients, respectively, all of whom underwent cerebrovascular surgery. Subjects received supplementary rocuronium (0.15 mg/kg) whenever the train-of-four count reached 2 during surgery. The interval between supplementary rocuronium (0.15 mg/kg) injections was significantly longer in the levetiracetam vs. control group (50 and 39 minutes, respectively; P = 0.036). CONCLUSIONS: The present results challenge the convention that antiepileptics decrease the duration of action of neuromuscular blockers, thereby alerting clinicians to the possibility of prolonged neuromuscular blockade in patients taking levetiracetam. Anesthetic management should encompass careful neuromuscular monitoring in such patients.
Anticonvulsants ; Humans ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Neuromuscular Nondepolarizing Agents ; Retrospective Studies

BACKGROUND: The train of four (TOF) stimulation is valuable to study pharmacodynamics associated with the interaction between muscle relaxants and receptors in the neuromuscular junction. TOF fade expresses presynaptic effect diminished output of transmitters. The aim of this study was to examine differences in presynaptic effects of different relaxants by measuring the TOF ratio during the onset and offset of block. METHODS: Eighty four healthy adult patients of ASA grades I or II were included in the study. The muscle relaxants studied were vecuronium (0.08 mg/kg), atracurium (0.5 mg/kg), mivacurium (0.15 mg/kg), rocuronium (0.6 mg/kg) and succinylcholine (1.0 mg/kg, 0.1 mg/kg, 0.2 mg/kg, 0.4 mg/kg). The TOF ratios were measured at approximate height of first response in the TOF (T1) of 75, 50 and 25% during onset and offset. Especially its ratios were measured at first depress of T1 during onset and its corresponding T1 during offset following administration of subclinical doses of succinylcholine. RESULTS: In the non-depolarizing muscle relaxants, TOF fade is more evident during offset than onset (p<0.05). The extent of fade varies between muscle relaxants. The greatest TOF fade has been shown in rocuronium during onset. In the succinylcholine, the TOF fade is apparent during onset and related to doses given (p<0.05). However the significant TOF fade is not seen during offset. CONCLUSIONS: All muscle relaxants, including both depolarizing and nondepolarizing agent, have predominantly postsynaptic and presynaptic effects. Furthermore, the fact that moderate TOF fade after subclinical doses of succinylcholine occurred obviously during onset of block is possibly indicating a greater presynaptic receptor blocking action.
Adult ; Atracurium ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Neuromuscular Junction ; Neuromuscular Nondepolarizing Agents ; Receptors, Presynaptic ; Succinylcholine ; Vecuronium Bromide

No abstract available.
Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents

No abstract available.
Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents*

No abstract available.
Anaphylaxis* ; Androstanols ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents*

In this study, we tested the hypothesis that volatile anesthetic enhancement of muscle relaxation is the result of combined drug effects on the nicotinic acetylcholine receptors. The poly A m RNA from muscle by isolation were microinjected into Xenopus oocytes for receptor expression. Concentration-effect curves for the inhibition of Ach-induced currents were established for vecuronium, rocuranium, and isoflurane. Subsequently, inhibitory effects of NDMRs were studied in the presence of the isoflurane at a concentration equivalent to half the concentration producing a 50% inhibition alone. All tested drugs produced rapid and readily reversible concentration-dependent inhibition. The 50% inhibitory concentration values were 889 micromol/L (95% CI: 711-1214 micromol). 33.4 micromol (95% CI: 27.1-41.7 nmol) and 9.2 nmol (95% CI: 7.9-12.3 nmol) for isoflurane. rocuranium and vecuronium, respectively. Coapplication of isoflurane significantly enhanced the inhibitory effects of rocuranium and vecuronium, and it was especially so at low concentration of NMDRs. Isoflurane increases the potency of NDMRs, possibly by enhancing antagonist affinity at the receptor site.
Androstanols ; pharmacology ; Anesthetics, Inhalation ; pharmacology ; Animals ; Drug Synergism ; Female ; Isoflurane ; pharmacology ; Neuromuscular Blocking Agents ; pharmacology ; Neuromuscular Junction ; drug effects ; Neuromuscular Nondepolarizing Agents ; pharmacology ; Oocytes ; Receptors, Nicotinic ; drug effects ; Vecuronium Bromide ; pharmacology ; Xenopus laevis

In this study, we tested the hypothesis that volatile anesthetic enhancement of muscle relaxation is the result of combined drug effects on the nicotinic acetylcholine receptors. The poly A m RNA from muscle by isolation were microinjected into Xenopus oocytes for receptor expression. Concentration-effect curves for the inhibition of Ach-induced currents were established for vecuronium, rocuranium, and isoflurane. Subsequently, inhibitory effects of NDMRs were studied in the presence of the isoflurane at a concentration equivalent to half the concentration producing a 50% inhibition alone. All tested drugs produced rapid and readily reversible concentration-dependent inhibition. The 50% inhibitory concentration values were 889 micromol/L (95% CI: 711-1214 micromol). 33.4 micromol (95% CI: 27.1-41.7 nmol) and 9.2 nmol (95% CI: 7.9-12.3 nmol) for isoflurane. rocuranium and vecuronium, respectively. Coapplication of isoflurane significantly enhanced the inhibitory effects of rocuranium and vecuronium, and it was especially so at low concentration of NMDRs. Isoflurane increases the potency of NDMRs, possibly by enhancing antagonist affinity at the receptor site.
Androstanols/*pharmacology ; Anesthetics, Inhalation/pharmacology ; Drug Synergism ; Isoflurane/*pharmacology ; Neuromuscular Blocking Agents/*pharmacology ; Neuromuscular Junction/drug effects ; Neuromuscular Nondepolarizing Agents/*pharmacology ; Oocytes ; Receptors, Nicotinic/*drug effects ; Vecuronium Bromide/pharmacology ; Xenopus laevis

BACKGROUND: Previous studies reported the lack of interaction between propofol and neuromuscular blockers. The current study was designed to compare the influence of propofol to that of enflurane on the vecuronium. METHODS: Forty , either sex, adult patients, scheduled for elective surgery, were randomly assigned to two groups. Patients received either propofol (Group I n=20) or thiopental (Group II n=20) as an induction agent and anesthesia were maintained with either propofol-N2O-O2(Group I) or enflurane- N2O-O2(Group II). Before induction, initial twitch was obtained as a control with supramaximal stimulus. Neuromuscular contraction was monitored continuously and recorded on a relaxograph. Onset time (T0), clinical duration (T25), and recovery index (RI) were measured. RESULTS: Onset time and clinical duration of vecuronium were not significantly different between two groups. Mean recovery index was 18.5 min and 38.6 min in group Iand II, respectively. CONCLUSION: These results indicated that propofol, different from enflurane, did not have influence on the recovery index of vecuronium.
Adult ; Anesthesia ; Anesthetics ; Enflurane* ; Humans ; Neuromuscular Agents* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Propofol* ; Thiopental ; Vecuronium Bromide*

Administration of a subparalytic dose of a nondepolarizing muscle relaxant prior to intubating dose hastens the onset time of neuromuscular blockade. This study was designed to investigate the influence of a priming dose of vecuronium (0.015 mg/kg) and d-tubocurarine (0.05 mg/kg) on intubating dose of vecuronium (0.085 mg/kg). The authors measured TOF ratio using neuromuscular monitoring. This monitoring was carried out by stimulation of ulnar nerve at a frequency of 2Hz every 20 seconds using Datex relaxograph to measure the compound evoked electrographic response of hypothenar muscle. The patients were randomly divided into two groups as priming dose ; vecuronium and dtubocurarine (DTC) group respectively. Mixture of two different nondepolarizing muscle relaxant may produce synergism, although the reason for this synergism is unknown. It may be the results of the action of the drugs at different sites. In our study, we found the results as follows ;1) The rapid onset was occured with d-tubocurarine(0.05 mg/kg) as priming drug than vecuronium (0.015 mg/kg) 2) The duration was longer when d-tubocurarine was used (P<0.05) The authors conclude that the onset is more rapid and the duration is longer when other species of nondepolarizing muscle relaxant is used than same agent is used as priming drug.
Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Tubocurarine* ; Ulnar Nerve ; Vecuronium Bromide*

BACKGROUND: A pneumatic tourniquet is commonly used in orthopedic surgery. However, neuromuscular blocking agent can be sequestered in the isolated limb and be reabsorbed into the systemic circulation after tourniquet release, potentially delaying extubation. To investigate the change in the train-of-four (TOF) ratio after tourniquet release and correlate the TOF ratio change with the extubation time. METHODS: Forty patients undergoing unilateral total knee arthroplasty were enrolled. Before and after the pneumatic tourniquet release, 10 measurements of the TOF ratio were averaged and compared. Additionally, we investigated the correlation between the percentage change in the TOF ratio before and after tourniquet release and the extubation time. RESULTS: Among the 40 patient subjects, 30 showed a TOF ratio before tourniquet release and 10 showed only a TOF count. Of the 30 patients with a TOF ratio, 21 showed a TOF ratio increase after tourniquet release and 9 showed a TOF decrease; both increase and decrease were statistically significant (P < 0.001 and P = 0.008, respectively). The extubation time showed a weak negative correlation with the percentage change in the TOF ratio after tourniquet release (P = 0.004). CONCLUSIONS: In orthopedic surgery using a pneumatic tourniquet, neuromuscular function monitoring may be required to monitor the change in the effect of neuromuscular blocking agent before and after tourniquet release, which may help to improve anesthesia safety.
Anesthesia ; Arthroplasty* ; Extremities ; Humans ; Knee* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Orthopedics ; Tourniquets*