Subject(s)
Androstane-3,17-diol/therapeutic use , Androstanols/therapeutic use , Anesthesia, Obstetrical/methods , Cesarean Section , Muscle Relaxants, Central/therapeutic use , Pancuronium/therapeutic use , Piperazines/therapeutic use , Acid-Base Equilibrium/drug effects , Androstane-3,17-diol/adverse effects , Androstane-3,17-diol/analogs & derivatives , Apgar Score , Drug Evaluation , Female , Humans , Infant, Newborn , Muscle Relaxants, Central/adverse effects , Pancuronium/adverse effects , Pipecuronium , Piperazines/adverse effects , PregnancyABSTRACT
In 40 cases anesthetized with chloralose and urethane, pancuronium was infused i.v. at a constant rate to produce and maintain 90% depression twitch tension of the anterior tibialis muscle following supramaximal stimulation of the peroneal nerve. Neither respiratory alkalosis nor metabolic acidosis influenced the infusion rate required to produce 90% depression of twitch tension or antagonism of this depression yb neotigmine. Respiratory acidosis (pH 7.15; PaCO2 10 kPa) did not alter the required infusion rate but did prevent complete antagonism by neostigmine. Metabolic alkalosis (pH 7.65; PaCO2 4.8 kPa) reduced both the required infusion rate and prevented complete restoration of twitch tension by neostigmine. The duration of neostigmine antagonism was shortened by metabolic alkalosis. We conclude that respiratory acidosis and metabolic alkalosis prevent antagonism of pancuronium by neostigmine.
Subject(s)
Acid-Base Equilibrium , Neostigmine/pharmacology , Neuromuscular Junction/drug effects , Pancuronium/antagonists & inhibitors , Animals , Cats , Time FactorsABSTRACT
This randomized double-blind study compared the hemodynamic and metabolic effects of pancuronium and vecuronium during treatment of shivering after cardiac surgery with hypothermic cardiopulmonary bypass. Thirty sedated and pain-free patients who shivered after cardiac surgery were treated with pancuronium (n = 15) or vecuronium (n = 15) 0.08 mg/kg. Baseline values of heart rate (HR), mean arterial pressure, arterial and venous blood gases, total body oxygen consumption indexed to body surface area (VO2-I), and pressure work index (PWI, an estimate of myocardial oxygen consumption) were measured on arrival in the intensive care unit, at onset of shivering, and repeatedly for 2 h after treatment. Continuous ST segment analysis of leads II and V5 were used for detection of myocardial ischemia. Treatment of shivering with pancuronium decreased VO2-I by 32% (P = 0.0001). This was accompanied by a 14% increase in HR (P = 0.001) and a 10% increase in PWI (P = 0.03). Vecuronium decreased VO2-I by 36% (P = 0.003) with a 4% decrease in HR (P = 0.04) and a 6% decrease in PWI (P = 0.06). Myocardial ischemia (n = 3) and ventricular arrhythmias (n = 3) occurred in five patients treated with pancuronium. Only one patient treated with vecuronium had ventricular arrhythmia (P = 0.08). Seven patients treated with pancuronium and eight treated with vecuronium were taking beta-adrenergic blockers preoperatively which was associated with lower HR (96 +/- 16 vs 109 +/- 15 bpm; P = 0.025) and lower PWI (8.8 +/- 1.2 vs 10.7 +/- 1.92 mL.min-1 x 100 g-1; P = 0.003) at onset of shivering. However, beta-adrenergic blockers did not attenuate the relative HR increase induced by pancuronium. No relationship was found between hypercapnia and tachycardia or hypertension. These results suggest that, when compared to pancuronium for treatment of postoperative shivering, vecuronium may be advantageous because it does not increase myocardial work. The disproportionate relationship between VO2-I and PWI after treatment with muscle relaxants indicates that increased VO2-I does not contribute significantly to the hemodynamic disturbances associated with shivering. These disturbances are more likely the results of increased adrenergic activity related to pain and recovery from anesthesia. Shivering and its associated hemodynamic disturbances appear to be concomitant but independent signs of awakening.
Subject(s)
Cardiac Surgical Procedures , Pancuronium/therapeutic use , Shivering/drug effects , Vecuronium Bromide/therapeutic use , Acid-Base Equilibrium/drug effects , Adult , Aged , Double-Blind Method , Female , Hemodynamics/drug effects , Humans , Male , Middle Aged , Oxygen Consumption/drug effectsABSTRACT
Vecuronium and atracurium provide addition flexibility to the clinician using neuromuscular blocking drugs. The shorter duration of action, lack of significant cardiovascular effects, and the lack of dependence on the kidney for elimination provide clinical advantages over, or alternatives to, currently available nondepolarizing neuromuscular blocking drugs.
Subject(s)
Isoquinolines/pharmacology , Neuromuscular Blocking Agents/pharmacology , Pancuronium/analogs & derivatives , Acid-Base Equilibrium , Adolescent , Adult , Age Factors , Aged , Anesthesia , Anesthesia, Obstetrical , Atracurium , Cardiopulmonary Bypass , Cardiovascular System/drug effects , Cesarean Section , Chemical Phenomena , Chemistry , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , Infant , Infant, Newborn , Isoquinolines/antagonists & inhibitors , Isoquinolines/metabolism , Kinetics , Liver Diseases/metabolism , Middle Aged , Neostigmine/pharmacology , Pancuronium/antagonists & inhibitors , Pancuronium/metabolism , Pancuronium/pharmacology , Pregnancy , Succinylcholine/pharmacology , Time Factors , Vecuronium BromideSubject(s)
Acid-Base Equilibrium , Hypothermia/metabolism , Respiration, Artificial , Vascular Surgical Procedures , Aged , Anesthesia, General , Aorta, Abdominal/surgery , Blood , Blood Transfusion , Blood Vessel Prosthesis , Carbon Dioxide/blood , Cardiac Output , Humans , Hydrogen-Ion Concentration , Hypotension/prevention & control , Iliac Artery/surgery , Middle Aged , Nitrous Oxide , Oxygen , Pancuronium , Thrombosis/surgerySubject(s)
Acidosis , Decamethonium Compounds/pharmacology , Muscle Contraction/drug effects , Pancuronium/pharmacology , Succinylcholine/pharmacology , Acid-Base Equilibrium/drug effects , Acidosis/chemically induced , Animals , Ascorbic Acid/pharmacology , Blood , Blood Pressure/drug effects , Carbon Dioxide/blood , Cats , Depression, Chemical , Diaphragm/drug effects , Hydrochloric Acid/pharmacology , Hydrogen-Ion Concentration , In Vitro Techniques , Partial Pressure , Phrenic Nerve , Rats , Tibia , Trimethadione/analogs & derivativesSubject(s)
Antidotes/therapeutic use , First Aid , Poisoning/therapy , Acid-Base Equilibrium , Acids/poisoning , Alcoholic Intoxication/drug therapy , Cardiac Glycosides/therapeutic use , Central Nervous System/drug effects , Chelating Agents/therapeutic use , Cyanides/poisoning , Detergents/poisoning , Emetics/therapeutic use , Gas Poisoning , Gastric Lavage , Humans , Hypnotics and Sedatives/poisoning , Insecticides/poisoning , Iron/poisoning , Lead Poisoning , Mercury Poisoning/drug therapy , Metals/poisoning , Methemoglobin/biosynthesis , Opium/poisoning , Poisoning/diagnosis , Renal Dialysis , Respiration, Artificial , Thallium/poisoningSubject(s)
Anesthesia, Intravenous , Anesthetics , Pregnanes , Acid-Base Equilibrium/drug effects , Adolescent , Adult , Aged , Anesthetics/administration & dosage , Anesthetics/pharmacology , Blood Pressure/drug effects , Cardiac Output/drug effects , Child , Female , Heart Rate/drug effects , Humans , Ketones/administration & dosage , Ketones/pharmacology , Male , Middle Aged , Movement/drug effects , Opium , Oxygen/blood , Partial Pressure , Preanesthetic Medication , Pregnanes/administration & dosage , Pregnanes/pharmacology , Respiration/drug effectsSubject(s)
Anesthetics/pharmacology , Cyclohexanes/pharmacology , Hemodynamics/drug effects , Ketamine , Metabolism/drug effects , Acid-Base Equilibrium/drug effects , Anesthesia, Intravenous , Animals , Blood Glucose , Blood Pressure/drug effects , Dogs , Epinephrine/blood , Fatty Acids/blood , Heart Rate/drug effects , Norepinephrine/blood , Oxygen Consumption/drug effects , Pancuronium/pharmacologySubject(s)
Azo Compounds/pharmacology , Neuromuscular Nondepolarizing Agents/pharmacology , Pyridinium Compounds/pharmacology , Acid-Base Equilibrium/drug effects , Atropine/pharmacology , Azo Compounds/antagonists & inhibitors , Blood Pressure/drug effects , Carbon Dioxide/blood , Heart Rate/drug effects , Humans , Imidazoles/antagonists & inhibitors , Imidazoles/pharmacology , Intraocular Pressure/drug effects , Intubation, Intratracheal , Muscle Contraction/drug effects , Neostigmine/pharmacology , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Oxygen/blood , Pancuronium/pharmacology , Partial Pressure , Pyridinium Compounds/antagonists & inhibitors , Time FactorsABSTRACT
Les Acides sont des médicaments homéopathiques importants. Il ne peut en être qu´ainsi puisque la balance acido-basique est un élément essentiel de notre homéostasie. Le pH normal du sanf est de 7,4. au-dessus, il y a alcalose, au-dessous acidose. Sa régulation est un phénomène complexe où le couple bicarbonate intervient parmi d´autres facteurs.(AU)