The Experts below are selected from a list of 3354 Experts worldwide ranked by ideXlab platform
U. Klein - One of the best experts on this subject based on the ideXlab platform.
-
Comparison of Cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscle.
European journal of anaesthesiology, 2000Co-Authors: L. De Rossi, H. Fritz, U. KleinAbstract:Adequate relaxation of the masseter muscle is important during endotracheal intubation and for the patency of a patient's airway during recovery from anaesthesia. We evaluated onset and recovery from Cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscles. Thirty patients were randomly allocated to receive either 0.1 or 0.15 mg kg -1 Cisatracurium. The evoked response was measured at both muscles using acceleromyography. Onset time was significantly shorter at the masseter muscle than at the adductor pollicis (0.1 mg kg -1 Cisatracurium: 155 ± 52 vs. 229 ± 44 s; 0.15 mg kg -1 Cisatracurium: 105 ± 24 vs. 174 ± 35 s). Following 0.1 mg kg -1 Cisatracurium, recovery to a TOF-ratio of 0.7 was faster at the masseter compared to the adductor pollicis (P < 0.05). In the 0.15 mg kg -1 Cisatracurium group recovery of T 1 to 75% of control and to a TOF-ratio of 0.7 occurred sooner at the masseter (P < 0.05). We conclude that onset and recovery from Cisatracurium neuromuscular block occurs more rapidly at the masseter than at the adductor pollicis. It appears unlikely that residual paralysis is present at the masseter once neuromuscular function at the adductor pollicis has completely recovered.
-
Cisatracurium am M. orbicularis oculi Vergleich der neuromuskulären Wirkung von Cisatracurium und Atracurium am M. orbicularis oculi und M. adductor pollicis
Der Anaesthesist, 1999Co-Authors: L. De Rossi, H. Fritz, L. Kröber, U. KleinAbstract:Fragestellung: Muskelrelaxanzien zeigen ein unterschiedliches pharmakodynamisches Wirkungsprofil an verschiedenen Muskelgruppen. Am M. adductor pollicis hat Cisatracurium, bis auf eine längere Anschlagzeit, ein vergleichbares pharmakodynamisches Profil wie Atracurium. Untersuchungen an anderen Muskelgruppen wurden für Cisatracurium bisher nicht durchgeführt. In der vorliegenden klinischen Studie sollte daher die neuromuskuläre Wirkung von Cisatracurium am M. orbicularis oculi (OO) – dessen neuromuskuläre Reaktion annähernd derjenigen des Diaphragmas und der Larynxmuskulatur entspricht – und am M. adductor pollicis (AP) im Vergleich mit Atracurium untersucht werden. Methodik: Untersucht wurden 45 Patienten (ASA I–II), die sich einer elektiven Wirbelsäulenoperation unterziehen mußten. Nach Narkoseeinleitung erfolgte die Intubation ohne vorherige Injektion eines Muskelrelaxans. An beiden Muskeln wurde die evozierte Muskelantwort mittels Akzeleromyographie gemessen. Die Patienten erhielten randomisiert 0,1 mg/kg (2× ED_95), 0,15 mg/kg (3× ED_95) Cisatracurium oder 0,5 mg/kg Atracurium (2× ED_95). Die Anschlag- und Erholungszeiten wurden entsprechend den Empfehlungen der Copenhagen Consensus Conference definiert. Ergebnisse: Nach 0,15 mg/kg Cisatracurium und 0,5 mg/kg Atracurium waren die Anschlagzeiten am OO kürzer als am AP ( p
-
Cisatracurium am M. orbicularis oculi Vergleich der neuromuskulären Wirkung von Cisatracurium und Atracurium am M. orbicularis oculi und M. adductor pollicis
Der Anaesthesist, 1999Co-Authors: L. De Rossi, H. Fritz, L. Kröber, U. KleinAbstract:Objectives: Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle Cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of Cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of Cisatracurium and atracurium in the orbicularis oculi muscle (OO) – which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles – and the adductor pollicis muscle (AP). Methods: Forty-five patients (ASA I–II), scheduled for elective spinal surgery were anaesthetized with propofol and fentanyl. Endotracheal intubation was performed without using a muscle relaxant. Neuromuscular transmission was monitored using acceleromyography in both muscles. Patients received 0.1 mg/kg (2× ED_95) or 0.15 mg/kg (3× ED_95) Cisatracurium, or 0.5 mg/kg atracurium (2× ED_95) at random. Onset and recovery times were measured according to the recommendation of the Copenhagen Consensus Conference. Results: Onset time was significantly shorter in the OO than in the AP following 0.15 mg/kg Cisatracurium and 0.5 mg/kg atracurium ( P
F K Puhringer - One of the best experts on this subject based on the ideXlab platform.
-
incidence and duration of residual paralysis at the end of surgery after multiple administrations of Cisatracurium and rocuronium
Anaesthesia, 2007Co-Authors: Dirk M Maybauer, F K Puhringer, R Hofmockel, Hendrik Wulf, Götz Geldner, Leopold H J Eberhart, Christian Arndt, Manfred Blobner, Matthias EikermannAbstract:Summary In a randomised, controlled, double-blind, multicentre trial in 338 patients, we assessed the incidence of residual paralysis following administration of Cisatracurium or rocuronium. The incidence at the end of surgery was significantly lower in patients treated with rocuronium (62 of 142 patients, 44%) than in those given Cisatracurium (99 of 175 patients, 57%) (p < 0.05). In contrast, with rocuronium the mean (SD) time between skin closure and extubation was 28 (28) min vs 18 (19) min for Cisatracurium, and the duration 0.9 (time from administration of last top-up dose to recovery of the train-of-four ratio to 0.9) was significantly longer and more variable for rocuronium than for Cisatracurium. Thus, after repeated administration, the duration and variability of duration of action are greater with rocuronium compared with Cisatracurium. These pharmacodynamic differences do not necessarily translate into a higher incidence of residual paralysis, because clinicians compensate for the longer duration of action and variability of rocuronium by terminating administration of the neuromuscular blocking earlier.
-
the influence of atracurium Cisatracurium and mivacurium on the proliferation of two human cell lines in vitro
Anesthesia & Analgesia, 2001Co-Authors: Anton Amann, Vladimir Nigrovic, Josef Rieder, Martina Fleischer, Peter Niedermuller, Georg F Hoffmann, Albert Amberger, Christian Marth, F K PuhringerAbstract:We tested the influence of atracurium and Cisatracurium (final concentrations: 0, 0.96, 3.2, 9.6, 32, and 96 μM) on proliferation of human cells (hepatoma HepG2 cells and human umbilical vein endothelial cells) in vitro. In additional experiments, glutathione, N-acetylcysteine, or carboxyl esterase was added before the addition of either relaxant. The number of cells counted after 72 h of incubation was expressed as a percentage of the mean cell number in wells incubated without additives. Atracurium and Cisatracurium progressively decreased cell proliferation in a concentration-dependent pattern. With human umbilical vein endothelial cells, atracurium or Cisatracurium (3.2 μM) decreased the cell count to 67.7 % (sd, 14.8%) and 50% (sd, 8.6%), respectively. Cell proliferation was not inhibited by mivacurium. The results were similar to those with HepG2 cells. Glutathione, N-acetylcysteine, and carboxyl esterase partially reversed the effects of atracurium and Cisatracurium. When incubated in a buffer with glutathione, atracurium decreased the number of glutathione-sulfhydryl groups. The findings that atracurium and Cisatracurium inhibit proliferation of human cell lines in vitro, but that mivacurium does not, and that this effect is alleviated by glutathione and N-acetylcysteine, as well as by the carboxyl esterase, indicate that the inhibition may be caused by the reactive acrylate metabolites.
-
Die Wirkung unterschiedlicher Primingdosierungen auf die Pharmakodynamik von Cisatracurium
Der Anaesthesist, 2000Co-Authors: F K Puhringer, A. Scheller, A. Kleinsasser, A. Löckinger, P. Keller, C. Raedler, C. KellerAbstract:Fragestellung: Kann durch das Primingprinzip (Prinzip der geteilten Dosierungen) die Anschlagzeit von 100 µg/kg Cisatracurium bei Verwendung zweier unterschiedlicher Dosierungsregime im Vergleich zur Bolusgabe reduziert werden? Methodik: 51 Patienten wurden randomisiert und erhielten entweder 100 µg/kg Cistracurium als Bolus oder 10 µg/kg Cisatracurium als Primingdosis und nach 4 min 90 µg/kg Cisatracurium oder 15 µg/kg als Primingdosis und nach 4 min 85 µg/kg Cisatracurium. Das neuromuskuläre Monitoring wurde mittels Mechanomyographie (Groningen II Monitor) durchgeführt; die Anästhesie wurde mit Propofol, Fentanyl eingeleitet und mit kontinuierlicher Propofolinfusion sowie Lachgas/Sauerstoff aufrechterhalten. Ergebnisse: Die Primingkombination, Primingdosis 15 µg/kg und nach 4 min 85 µg/kg Cisatracurium ergab eine signifikante Verkürzung ( p
-
The effect of different priming doses on the pharmacodynamics of Cisatracurium
Der Anaesthesist, 2000Co-Authors: F K Puhringer, A. Scheller, A. Kleinsasser, A. Löckinger, C. Raedler, P. Keller, C. KellerAbstract:OBJECTIVE The aim of the study was to evaluate the effect of two different priming regimen on the onset time of 100 micrograms/kg Cisatracurium, when compared to bolus administration. METHODS 51 patients were randomly assigned and received either a bolus of 100 micrograms/kg Cisatracurium, or a priming dose of 10 micrograms/kg Cisatracurium followed after 4 min by 90 micrograms/kg Cisatracurium, or a priming dose of 15 micrograms/kg Cisatracurium followed after 4 min by 85 micrograms/kg Cisatracurium. The neuromuscular monitoring was performed using a mechanomyograph (Groningen II Monitor). Anaesthesia was induced with propofol and fentanyl and maintained by continuous infusion of propofol. RESULTS The priming combination of 15 micrograms/kg Cisatracurium followed after 4 min by 85 micrograms/kg Cisatracurium produced a statistically significant reduction in the onset time (95% block) (180 +/- 60 s) and time to complete block (210 +/- 48 s), when compared to the bolus group (240 +/- 60 s and 288 +/- 66 s) (p < 0.05). CONCLUSION Our data indicate that the "priming principle" is an appropriate technique to shorten the onset time of Cisatracurium. To achieve a maximum effect the priming combination of 15 micrograms/kg Cisatracurium followed after 4 min by 85 micrograms/kg Cisatracurium is recommended.
John J. Savarese - One of the best experts on this subject based on the ideXlab platform.
-
Pharmacokinetics of Cisatracurium in Patients Receiving Nitrous Oxide/Opioid/Barbiturate Anesthesia
Anesthesiology, 1996Co-Authors: Cynthia A. Lien, David F. Kisor, Virginia D. Schmith, Matthew R. Belmont, Amy Abalos, John J. SavareseAbstract:Background Cisatracurium, one of the ten isomers in atracurium, is a nondepolarizing muscle relaxant with an intermediate duration of action. It is more potent and less likely to release histamine than atracurium. As one of the isomers composing atracurium, it presumably undergoes Hofmann elimination. This study was conducted to describe the pharmacokinetics of Cisatracurium and its metabolites and to determine the dose proportionality of Cisatracurium after administration of 2 or 4 times the ED95. Methods Twenty ASA physical status 1 or 2 patients undergoing elective surgery under nitrous oxide/opioid/barbiturate anesthesia were studied. Patients received a single rapid intravenous bolus dose of 0.1 or 0.2 mg *symbol* kg sup -1 (2 or 4 times the ED95, respectively) Cisatracurium. All patients were allowed to recover spontaneously to a train-of-four ratio greater or equal to 0.70 after Cisatracurium-induced neuromuscular block. Plasma was extracted, acidified, and stored frozen before analysis for Cisatracurium, laudanosine, the monoquaternary acid, and the monoquaternary alcohol metabolite. Results The clearances (5.28+/-1.23 vs. 4.66+/- 0.67 ml *symbol* min sup -1 *symbol* kg sup -1) and terminal elimination half-lives (22.4+/-2.7 vs. 25.5+/-4.1 min) were not statistically different between patients receiving 0.1 mg *symbol* kg sup -1 and 0.2 mg *symbol* kg sup -1, respectively. Maximum concentration values for laudanosine averaged 38+/-21 and 103+/-34 ng *symbol* ml sup -1 for patients receiving the 0.1 and 0.2 mg *symbol* kg sup -1 doses, respectively. Maximum concentration values for monoquaternary alcohol averaged 101+/-27 and 253+/-51 ng *symbol* ml sup -1, respectively. Monoquaternary acid was not quantified in any plasma sample. Conclusions Cisatracurium undergoes Hofmann elimination to form laudanosine. The pharmacokinetics of Cisatracurium are independent of dose after single intravenous doses of 0.1 and 0.2 mg *symbol* kg sup -1.
-
pharmacokinetics of Cisatracurium in patients receiving nitrous oxide opioid barbiturate anesthesia
Anesthesiology, 1996Co-Authors: Cynthia A. Lien, David F. Kisor, Virginia D. Schmith, Matthew R. Belmont, Amy Abalos, John J. SavareseAbstract:Background Cisatracurium, one of the ten isomers in atracurium, is a nondepolarizing muscle relaxant with an intermediate duration of action. It is more potent and less likely to release histamine than atracurium. As one of the isomers composing atracurium, it presumably undergoes Hofmann elimination. This study was conducted to describe the pharmacokinetics of Cisatracurium and its metabolites and to determine the dose proportionality of Cisatracurium after administration of 2 or 4 times the ED95. Methods Twenty ASA physical status 1 or 2 patients undergoing elective surgery under nitrous oxide/opioid/barbiturate anesthesia were studied. Patients received a single rapid intravenous bolus dose of 0.1 or 0.2 mg *symbol* kg sup -1 (2 or 4 times the ED95, respectively) Cisatracurium. All patients were allowed to recover spontaneously to a train-of-four ratio greater or equal to 0.70 after Cisatracurium-induced neuromuscular block. Plasma was extracted, acidified, and stored frozen before analysis for Cisatracurium, laudanosine, the monoquaternary acid, and the monoquaternary alcohol metabolite. Results The clearances (5.28+/-1.23 vs. 4.66+/- 0.67 ml *symbol* min sup -1 *symbol* kg sup -1) and terminal elimination half-lives (22.4+/-2.7 vs. 25.5+/-4.1 min) were not statistically different between patients receiving 0.1 mg *symbol* kg sup -1 and 0.2 mg *symbol* kg sup -1, respectively. Maximum concentration values for laudanosine averaged 38+/-21 and 103+/-34 ng *symbol* ml sup -1 for patients receiving the 0.1 and 0.2 mg *symbol* kg sup -1 doses, respectively. Maximum concentration values for monoquaternary alcohol averaged 101+/-27 and 253+/-51 ng *symbol* ml sup -1, respectively. Monoquaternary acid was not quantified in any plasma sample. Conclusions Cisatracurium undergoes Hofmann elimination to form laudanosine. The pharmacokinetics of Cisatracurium are independent of dose after single intravenous doses of 0.1 and 0.2 mg *symbol* kg sup -1.
L. De Rossi - One of the best experts on this subject based on the ideXlab platform.
-
Comparison of Cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscle.
European journal of anaesthesiology, 2000Co-Authors: L. De Rossi, H. Fritz, U. KleinAbstract:Adequate relaxation of the masseter muscle is important during endotracheal intubation and for the patency of a patient's airway during recovery from anaesthesia. We evaluated onset and recovery from Cisatracurium-induced neuromuscular block at the masseter and adductor pollicis muscles. Thirty patients were randomly allocated to receive either 0.1 or 0.15 mg kg -1 Cisatracurium. The evoked response was measured at both muscles using acceleromyography. Onset time was significantly shorter at the masseter muscle than at the adductor pollicis (0.1 mg kg -1 Cisatracurium: 155 ± 52 vs. 229 ± 44 s; 0.15 mg kg -1 Cisatracurium: 105 ± 24 vs. 174 ± 35 s). Following 0.1 mg kg -1 Cisatracurium, recovery to a TOF-ratio of 0.7 was faster at the masseter compared to the adductor pollicis (P < 0.05). In the 0.15 mg kg -1 Cisatracurium group recovery of T 1 to 75% of control and to a TOF-ratio of 0.7 occurred sooner at the masseter (P < 0.05). We conclude that onset and recovery from Cisatracurium neuromuscular block occurs more rapidly at the masseter than at the adductor pollicis. It appears unlikely that residual paralysis is present at the masseter once neuromuscular function at the adductor pollicis has completely recovered.
-
Cisatracurium am M. orbicularis oculi Vergleich der neuromuskulären Wirkung von Cisatracurium und Atracurium am M. orbicularis oculi und M. adductor pollicis
Der Anaesthesist, 1999Co-Authors: L. De Rossi, H. Fritz, L. Kröber, U. KleinAbstract:Fragestellung: Muskelrelaxanzien zeigen ein unterschiedliches pharmakodynamisches Wirkungsprofil an verschiedenen Muskelgruppen. Am M. adductor pollicis hat Cisatracurium, bis auf eine längere Anschlagzeit, ein vergleichbares pharmakodynamisches Profil wie Atracurium. Untersuchungen an anderen Muskelgruppen wurden für Cisatracurium bisher nicht durchgeführt. In der vorliegenden klinischen Studie sollte daher die neuromuskuläre Wirkung von Cisatracurium am M. orbicularis oculi (OO) – dessen neuromuskuläre Reaktion annähernd derjenigen des Diaphragmas und der Larynxmuskulatur entspricht – und am M. adductor pollicis (AP) im Vergleich mit Atracurium untersucht werden. Methodik: Untersucht wurden 45 Patienten (ASA I–II), die sich einer elektiven Wirbelsäulenoperation unterziehen mußten. Nach Narkoseeinleitung erfolgte die Intubation ohne vorherige Injektion eines Muskelrelaxans. An beiden Muskeln wurde die evozierte Muskelantwort mittels Akzeleromyographie gemessen. Die Patienten erhielten randomisiert 0,1 mg/kg (2× ED_95), 0,15 mg/kg (3× ED_95) Cisatracurium oder 0,5 mg/kg Atracurium (2× ED_95). Die Anschlag- und Erholungszeiten wurden entsprechend den Empfehlungen der Copenhagen Consensus Conference definiert. Ergebnisse: Nach 0,15 mg/kg Cisatracurium und 0,5 mg/kg Atracurium waren die Anschlagzeiten am OO kürzer als am AP ( p
-
Cisatracurium am M. orbicularis oculi Vergleich der neuromuskulären Wirkung von Cisatracurium und Atracurium am M. orbicularis oculi und M. adductor pollicis
Der Anaesthesist, 1999Co-Authors: L. De Rossi, H. Fritz, L. Kröber, U. KleinAbstract:Objectives: Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle Cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of Cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of Cisatracurium and atracurium in the orbicularis oculi muscle (OO) – which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles – and the adductor pollicis muscle (AP). Methods: Forty-five patients (ASA I–II), scheduled for elective spinal surgery were anaesthetized with propofol and fentanyl. Endotracheal intubation was performed without using a muscle relaxant. Neuromuscular transmission was monitored using acceleromyography in both muscles. Patients received 0.1 mg/kg (2× ED_95) or 0.15 mg/kg (3× ED_95) Cisatracurium, or 0.5 mg/kg atracurium (2× ED_95) at random. Onset and recovery times were measured according to the recommendation of the Copenhagen Consensus Conference. Results: Onset time was significantly shorter in the OO than in the AP following 0.15 mg/kg Cisatracurium and 0.5 mg/kg atracurium ( P
Cynthia A. Lien - One of the best experts on this subject based on the ideXlab platform.
-
Pharmacokinetics of Cisatracurium in Patients Receiving Nitrous Oxide/Opioid/Barbiturate Anesthesia
Anesthesiology, 1996Co-Authors: Cynthia A. Lien, David F. Kisor, Virginia D. Schmith, Matthew R. Belmont, Amy Abalos, John J. SavareseAbstract:Background Cisatracurium, one of the ten isomers in atracurium, is a nondepolarizing muscle relaxant with an intermediate duration of action. It is more potent and less likely to release histamine than atracurium. As one of the isomers composing atracurium, it presumably undergoes Hofmann elimination. This study was conducted to describe the pharmacokinetics of Cisatracurium and its metabolites and to determine the dose proportionality of Cisatracurium after administration of 2 or 4 times the ED95. Methods Twenty ASA physical status 1 or 2 patients undergoing elective surgery under nitrous oxide/opioid/barbiturate anesthesia were studied. Patients received a single rapid intravenous bolus dose of 0.1 or 0.2 mg *symbol* kg sup -1 (2 or 4 times the ED95, respectively) Cisatracurium. All patients were allowed to recover spontaneously to a train-of-four ratio greater or equal to 0.70 after Cisatracurium-induced neuromuscular block. Plasma was extracted, acidified, and stored frozen before analysis for Cisatracurium, laudanosine, the monoquaternary acid, and the monoquaternary alcohol metabolite. Results The clearances (5.28+/-1.23 vs. 4.66+/- 0.67 ml *symbol* min sup -1 *symbol* kg sup -1) and terminal elimination half-lives (22.4+/-2.7 vs. 25.5+/-4.1 min) were not statistically different between patients receiving 0.1 mg *symbol* kg sup -1 and 0.2 mg *symbol* kg sup -1, respectively. Maximum concentration values for laudanosine averaged 38+/-21 and 103+/-34 ng *symbol* ml sup -1 for patients receiving the 0.1 and 0.2 mg *symbol* kg sup -1 doses, respectively. Maximum concentration values for monoquaternary alcohol averaged 101+/-27 and 253+/-51 ng *symbol* ml sup -1, respectively. Monoquaternary acid was not quantified in any plasma sample. Conclusions Cisatracurium undergoes Hofmann elimination to form laudanosine. The pharmacokinetics of Cisatracurium are independent of dose after single intravenous doses of 0.1 and 0.2 mg *symbol* kg sup -1.
-
pharmacokinetics of Cisatracurium in patients receiving nitrous oxide opioid barbiturate anesthesia
Anesthesiology, 1996Co-Authors: Cynthia A. Lien, David F. Kisor, Virginia D. Schmith, Matthew R. Belmont, Amy Abalos, John J. SavareseAbstract:Background Cisatracurium, one of the ten isomers in atracurium, is a nondepolarizing muscle relaxant with an intermediate duration of action. It is more potent and less likely to release histamine than atracurium. As one of the isomers composing atracurium, it presumably undergoes Hofmann elimination. This study was conducted to describe the pharmacokinetics of Cisatracurium and its metabolites and to determine the dose proportionality of Cisatracurium after administration of 2 or 4 times the ED95. Methods Twenty ASA physical status 1 or 2 patients undergoing elective surgery under nitrous oxide/opioid/barbiturate anesthesia were studied. Patients received a single rapid intravenous bolus dose of 0.1 or 0.2 mg *symbol* kg sup -1 (2 or 4 times the ED95, respectively) Cisatracurium. All patients were allowed to recover spontaneously to a train-of-four ratio greater or equal to 0.70 after Cisatracurium-induced neuromuscular block. Plasma was extracted, acidified, and stored frozen before analysis for Cisatracurium, laudanosine, the monoquaternary acid, and the monoquaternary alcohol metabolite. Results The clearances (5.28+/-1.23 vs. 4.66+/- 0.67 ml *symbol* min sup -1 *symbol* kg sup -1) and terminal elimination half-lives (22.4+/-2.7 vs. 25.5+/-4.1 min) were not statistically different between patients receiving 0.1 mg *symbol* kg sup -1 and 0.2 mg *symbol* kg sup -1, respectively. Maximum concentration values for laudanosine averaged 38+/-21 and 103+/-34 ng *symbol* ml sup -1 for patients receiving the 0.1 and 0.2 mg *symbol* kg sup -1 doses, respectively. Maximum concentration values for monoquaternary alcohol averaged 101+/-27 and 253+/-51 ng *symbol* ml sup -1, respectively. Monoquaternary acid was not quantified in any plasma sample. Conclusions Cisatracurium undergoes Hofmann elimination to form laudanosine. The pharmacokinetics of Cisatracurium are independent of dose after single intravenous doses of 0.1 and 0.2 mg *symbol* kg sup -1.
-
Importance of the organ-independent elimination of Cisatracurium.
Anesthesia and analgesia, 1996Co-Authors: D. F. Kisor, Virginia D. Schmith, Eugene Ornstein, Cynthia A. Lien, W A Wargin, D R CookAbstract:Cisatracurium, one of 10 isomers of atracurium, undergoes pH and temperature-dependent Hofmann elimination in plasma and tissues. The clearance of Cisatracurium due to Hofmann elimination and organ elimination was estimated by applying a nontraditional two-compartment pharmacokinetic model with elimination occurring from both compartments to plasma Cisatracurium concentration-time data from 31 healthy adult surgical patients with normal renal and hepatic function. The elimination rate constant from the central compartment, intercompartmental rate constants, and the volume of the central compartment were obtained from the model fit. The elimination rate constant from the peripheral compartment could not be independently estimated in vivo and was therefore fixed to the rate of degradation of Cisatracurium in human plasma (pH 7.4 and 37 degrees C) and held constant in the model. Total body clearance, Hofmann clearance, organ clearance, and the volume of distribution at steady-state were derived from the model parameter estimates. Renal clearance was calculated from Cisatracurium urinary excretion data from 12 of the 31 patients. Clearance values (mean +/- SD) were 5.20 +/- 0.86, 4.00 +/- 1.04, 1.20 +/- 0.71, and 0.85 +/- 0.32 mL.min-1.kg-1 for total body clearance, Hofmann clearance, organ clearance, and renal clearance, respectively. Hofmann clearance accounted for 77% of total body clearance. Organ clearance was 23% of total body clearance. Renal clearance, a component of organ clearance, was 16% of total body clearance. The organ-independent nature of the elimination of Cisatracurium was characterized by a relationship between steady-state volume of distribution and total body clearance. The half-life is an independent variable and is not dependent on the total body clearance nor the steady-state volume of distribution. Hofmann elimination is the predominant pathway for Cisatracurium elimination in humans.