Abstract
In 60 adult patients undergoing general surgical procedures, the effect of pancuronium or d-tubocurarine “pretreatment” on the injection of a 0.1 mg·kg-1 bolus of atracurium was measured in two separate studies. In study 1, the patients received either 0.5 mg (·0.007 mg·kg-1) or 1.0mg (·0.015 mg·kg-1 ) pancuronium, or placebo (saline) three minutes before the injection of atracurium O.l mg#x 00B7;kg-1 .ln study 2, the patients received 0.05 mg·kg-1 or 0.1 mg·kg-1 d-tubocurarine, oraplacebo. The degree of neuromuscular blockade was assessed by evoked mechanogram (adductor pollicis muscle) using supramaximal train-of-four stimulation. Patients receiving pancuronium or d-tubocurarine pretreatment (equal to an ED5–ED5 dose) showed significantly greater inhibition of twitch (ED70–ED80) and train-of-four ratio compared with the placebo groups (ED35–ED40). Pretreatment with the larger dose of d-tubocurarine (0.1 mg·kg-1) was associated with significant neuromuscular blockade. It is concluded that pancuronium and d-tubocurarine pretreatments potentiate the clinical action of 0.1 mg·kg-1 atracurium in man by 35-100 per cent.
Résumé
Chez 60 patients adultes devant subir une procédure chirurgicale, l’effet de “prétraitement” au pancuronium ou à la d-tubocurarine avant un bolus d’atracurium de 0.1 mg·kg-1 a été mesuré dans deux études séparées. Dans la première étude, les patients ont reçu soit 0.5 mg (approximativement 0.007mg·kg-1) ou 1.0 mg (approximativement 0.015 mg·kg-1) de pancuronium ou du placebo (sérum physiologique isotonique) trois minutes avant l’injection d’atracurium 0.1 mg·kg-1 Dans la deuxième étude, les patients ont reçu 0.05 mg·kg-1 ou 0.1 mg·kg-1 de d’ tubocurarine ou un placebo. Le degre de blocage neuromusculaire a été évalué par le mécanogramme évoqué (muscle adducteur du pouce) utlisant une stimulation supramaximale de l’ondée-de-quatre (train-of-four). Les patients ayant reçu du pancuronium ou de la a’tubocurarine comme prétraitement (une dose égale à ED5–ED15) ont démontré une inhibition significativement plus grande du twitch (ED70–ED80) ainsi que du rapport de l’ondée-de-quatre (train-of-four) comparativement au groupe placebo (ED35–ED40). Un prétraitement avec des doses plus grandes de d-tubocurarine (0.1 mg·kg-1) était associé avec un blocage neuromusculaire significatif. On conclut que le prétraitement avec du pancuronium ou de la d’tubocurarine potentialise l’action de 0.1 mg·kg-1 d’atracurium chez l’homme d’environ 35–100 pour cent.
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Gerber, H.R., Romppainen, J. & Schwinn, W. Potentiation of atracurium by pancuronium and d-tubocurarine. Can Anaesth Soc J 33, 563–570 (1986). https://doi.org/10.1007/BF03014261
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DOI: https://doi.org/10.1007/BF03014261