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Harald J Sparr - One of the best experts on this subject based on the ideXlab platform.
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Newer Neuromuscular Blocking Agents
Drugs, 2001Co-Authors: Harald J Sparr, Ton M. Beaufort, Thomas Fuchs-buderAbstract:Rapacuronium bromide (Rapacuronium; ORG-9487) is a nondepolarising muscle relaxant (NMBA) with a low potency [90% effective dose (ED_90) 1 mg/kg], which to some extent is responsible for its rapid onset of action. Because of the high plasma clearance (5.3 to 11.1 mg/kg/min) of Rapacuronium, its clinical duration of action following single bolus doses up to 2 mg/kg in adults is short (i.e.
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Choice of the muscle relaxant for rapid-sequence induction
European Journal of Anaesthesiology, 2001Co-Authors: Harald J SparrAbstract:Muscle relaxants are given as part of a rapid-sequence induction to facilitate tracheal intubation. Among all the muscle relaxants available, succinylcholine is the only one with a fast (approximately equal to 1 min) onset and a fast recovery. Therefore it is still the most frequently used muscle relaxant for rapid-sequence induction despite its well-known side-effects. The short duration of action of succinylcholine is, however, no substitute for aggressive airway management in the case of an unexpectedly difficult intubation in order to prevent life-threatening hypoxia. A preoperative assessment of the airway is mandatory in any patient and may indicate the need for using intubation techniques without a muscle relaxant. Rocuronium in large doses (i.e. > or = 1 mg kg-1) is an alternative to succinylcholine in a classical rapid-sequence setting under relatively light anaesthesia. With respect to rapid tracheal intubation, the timing and priming principles offer little advantage over the use of rocuronium in doses of 0.6 mg kg-1 in combination with an appropriate induction technique (i.e. including an opioid) or over the use of larger doses of rocuronium (> or = 1.0 mg kg-1) under relatively light anaesthesia, and may even be potentially harmful. In contrast to rocuronium, the use of Rapacuronium in a rapid-sequence setting has been associated with dose-dependent respiratory side-effects that limit its usefulness in doses higher than 1.5 mg kg-1 for this indication.
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Newer neuromuscular blocking agents: how do they compare with established agents?
Drugs, 2001Co-Authors: Harald J Sparr, Ton M. Beaufort, Thomas Fuchs-buderAbstract:Rapacuronium bromide (Rapacuronium; ORG-9487) is a nondepolarising muscle relaxant (NMBA) with a low potency [90% effective dose (ED90) 1 mg/kg], which to some extent is responsible for its rapid onset of action. Because of the high plasma clearance (5.3 to 11.1 mg/kg/min) of Rapacuronium, its clinical duration of action following single bolus doses up to 2 mg/kg in adults is short (i.e.
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Rapacuronium 2 0 or 2 5 mg kg 1 for rapid sequence induction comparison with succinylcholine 1 0 mg kg 1
BJA: British Journal of Anaesthesia, 2000Co-Authors: M Blobner, J. M. K. H. Wierda, R. K. Mirakhur, P.m.c. Wright, Klaus T. Olkkola, B. Debaene, Philippe Pendeville, J. Engbæk, Henk Rietbergen, Harald J SparrAbstract:The purpose of this nine-centre study in 602 patients was to show that the frequency of acceptable intubating conditions after Rapacuronium 2.0 or 2.5 mg kg−1 is not more than 10% lower than the frequency after succinylcholine 1.0 mg kg−1 during rapid-sequence induction of anaesthesia with fentanyl 1–2 μg kg−1 and thiopental 2–7 mg kg−1. Laryngoscopy and intubation were carried out 60 s after administration of muscle relaxant by an anaesthetist blinded to its identity. Intubating conditions were clinically acceptable (excellent or good) in 91.8% of patients given succinylcholine and in 84.1 and 87.6% of patients given Rapacuronium 2.0 and 2.5 mg kg−1 respectively. With respect to the percentage of clinically acceptable intubating conditions, the estimated difference (and the upper limit of the one-sided 97.5% confidence interval) between succinylcholine and Rapacuronium 2.0 mg kg−1 was 7.8 (14.4)% and between succinylcholine and Rapacuronium 2.5 mg kg−1 it was 4.0 (10.2)%. For both comparisons, the upper limit of the one-sided confidence interval exceeded the predefined 10% difference. Hence, it could not be demonstrated that the intubating conditions with either of the two doses of Rapacuronium were not inferior to those with succinylcholine 1.0 mg kg−1. The increase in heart rate was significantly greater during the first 5 min in the Rapacuronium groups, but the arterial pressure increased significantly only in the succinylcholine group (P
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Rapacuronium 2.0 or 2.5 mg kg–1 for rapid‐sequence induction: comparison with succinylcholine 1.0 mg kg–1
British Journal of Anaesthesia, 2000Co-Authors: Manfred Blobner, J. M. K. H. Wierda, R. K. Mirakhur, P.m.c. Wright, Klaus T. Olkkola, B. Debaene, Philippe Pendeville, J. Engbæk, Henk Rietbergen, Harald J SparrAbstract:The purpose of this nine-centre study in 602 patients was to show that the frequency of acceptable intubating conditions after Rapacuronium 2.0 or 2.5 mg kg−1 is not more than 10% lower than the frequency after succinylcholine 1.0 mg kg−1 during rapid-sequence induction of anaesthesia with fentanyl 1–2 μg kg−1 and thiopental 2–7 mg kg−1. Laryngoscopy and intubation were carried out 60 s after administration of muscle relaxant by an anaesthetist blinded to its identity. Intubating conditions were clinically acceptable (excellent or good) in 91.8% of patients given succinylcholine and in 84.1 and 87.6% of patients given Rapacuronium 2.0 and 2.5 mg kg−1 respectively. With respect to the percentage of clinically acceptable intubating conditions, the estimated difference (and the upper limit of the one-sided 97.5% confidence interval) between succinylcholine and Rapacuronium 2.0 mg kg−1 was 7.8 (14.4)% and between succinylcholine and Rapacuronium 2.5 mg kg−1 it was 4.0 (10.2)%. For both comparisons, the upper limit of the one-sided confidence interval exceeded the predefined 10% difference. Hence, it could not be demonstrated that the intubating conditions with either of the two doses of Rapacuronium were not inferior to those with succinylcholine 1.0 mg kg−1. The increase in heart rate was significantly greater during the first 5 min in the Rapacuronium groups, but the arterial pressure increased significantly only in the succinylcholine group (P
Dennis M. Fisher - One of the best experts on this subject based on the ideXlab platform.
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Phamacokinetics of Rapacuronium in Infants and Children with Intravenous and Intramuscular
2017Co-Authors: Lynne M. Reynolds, Andrew Infosino, Ronald Brown, Jim Hsu, Dennis M. FisherAbstract:I] Background. A nondepolarizing muscle relaxant with an onset and offset profile similar to succinylcholine is desirable for pediatric anesthesia. The onset and offset of Rapacuronium are rapid in children. In the current study, the authors determined its pharmacokinetic characteristics in children. In addition to administering Rapacuronium by the usual intravenous route, the authors also gave Rapacuronium intramuscularly to determine uptake characteristics and bioavailability. Methods: Forty unpremedicated patients aged 2 months to 3 yr were anesthetized with halothane, 0.82-1.0% end-tidal concentration. When anesthetic conditions were stable, Rapacuronium was injected either into a peripheral vein (2 mg/kg for infants, 3 mg/kg for children) or a deltoid muscle (2.8 mg/kg for infants, 4.8 mg/kg for children). Four venous plasma samples were obtained from each subject 2-240 min after Rapacuronium administration. A mixed-effects population pharmacokinetic analysis was applied to these values to determine bioavailability, absorption rate constant, and time to peak plasma concentration with intramuscular administration. Results: Plasma clearance was 4.77 ml . kg-' . min-l + 8.48 mVmin. Intramuscular bioavailability averaged 56%. Absorption from the intramuscular depot had two rate constants: 0.0491 min-' (72.4% of absorbed drug) and 0.0110 min-' (27.6% of the absorbed drug). Simulation indicated that plasma concentration peaks 4.0 and 5.0 min after intramuscular Rapacuronium in infants and children, respectively, and that, at 30 min, less than 25% of the administered dose remains to be absorbed from the intramuscular depot. Conclusions: In infants and children, Rapacuronium's clearance and steady state distribution volume are less than in adults. After intramuscular administration, bioavailability is 56%, and plasma Rapacuronium concentrations peak within 4 or 5 min. (Key words: Intramuscular injections; mixed-effects modeling; ORG9487.) RECENT trials in adults' and children' showed that the onset of intravenous Rapacuronium is rapid, approaching that of succinylcholine. In addition, recovery from a bolus dose of Rapacuronium is similar to that from mivacurium, currently the nondepolarizing muscle relaxant with the shortest duration of action.3 These characteristics suggest that Rapacuronium can be valuable for pediatric anesthesia. In the current study, we determined the pharmacokinetics of Rapacuronium in infants and children. In addition, because a recent pilot study from the University of California, San Francisco' suggested that
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Pharmacokinetics of Rapacuronium in infants and children with intravenous and intramuscular administration.
Anesthesiology, 2000Co-Authors: Lynne M. Reynolds, Andrew Infosino, Jim Hsu, Ronald T. Brown, Dennis M. FisherAbstract:BackgroundA nondepolarizing muscle relaxant with an onset and offset profile similar to succinylcholine is desirable for pediatric anesthesia. The onset and offset of Rapacuronium are rapid in children. In the current study, the authors determined its pharmacokinetic characteristics in children. In
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Intramuscular Rapacuronium in infants and children: dose-ranging and tracheal intubating conditions.
Anesthesiology, 1999Co-Authors: Lynne M. Reynolds, Andrew Infosino, Ronald T. Brown, James Hsu, Dennis M. FisherAbstract:BACKGROUND Rocuronium's rapid onset and intermediate duration of action with intravenous administration suggests that intramuscular administration might facilitate tracheal intubation without producing prolonged paralysis. Accordingly, in infants and children, the authors measured onset at the adductor pollicis and respiratory muscles to determine the optimal dose (phase I), then gave this optimal dose to determine the optimal time for tracheal intubation (phase II). METHODS The authors studied 45 unpremedicated patients aged 3 months to 5 yr. In phase I, 25 patients were anesthetized with nitrous oxide and halothane and breathed spontaneously; twitch tension and minute ventilation were measured. Rocuronium (800-2,400 micrograms/kg) was injected into the quadriceps or deltoid muscle; doses varied, using an "up-down" technique, the goal being to bracket the dose depressing twitch 75-90% within 5 min. In phase II, deltoid injections of the optimal dose from phase I (infants: 1,000 micrograms/kg; children: 1,800 micrograms/kg) were given to 20 patients anesthetized with 0.82-1.0% halothane. Tracheal intubation was attempted 1.5-3.0 min later; time to tracheal intubation was varied, using an "up-down" technique. RESULTS In phase I, 5 of 7 patients given quadriceps injections (1,200-2,200 micrograms/kg) had slow onset of twitch and ventilatory depression. With deltoid injections (800-2,400 micrograms/kg), all patients developed complete twitch depression; median time to 50% depression of minute ventilation was 3.2 min in infants and 2.8 min in children. In phase II, intubating conditions were consistently adequate or good-excellent at 2.5 min in infants and 3.0 min in children. Initial twitch recovery was at 57 +/- 13 min (mean +/- SD) in infants and 70 +/- 23 min in children. CONCLUSIONS Deltoid injections of rocuronium, 1,000 micrograms/kg in infants and 1,800 micrograms/kg in children, rapidly permit tracheal intubation in infants and children, despite a light plane of anesthesia. Duration of action of these large doses might limit clinical utility.
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Factors affecting the pharmacokinetic characteristics of Rapacuronium.
Anesthesiology, 1999Co-Authors: Dennis M. Fisher, George B. Bikhazi, David R. Bevan, Raymond Kahwaji, Robert J. Fragen, Martin S. Angst, Eugene Ornstein, Richard S. MatteoAbstract:Background Rapacuronium is a new nondepolarizing muscle relaxant with rapid onset and offset. As part of a study to determine its neuromuscular effects, the authors sampled plasma sparsely to determine the influence of age, gender, and other covariates on its pharmacokinetic characteristics. Methods Of 181 patients receiving a single bolus dose of 0.5-2.5 mg/kg Rapacuronium, 43 (aged 24-83 yr) had plasma sampled 3 or 4 times to determine plasma concentrations of Rapacuronium and its metabolite, ORG9488. Pharmacokinetic analysis was performed using a population approach (mixed-effects modeling) to determine the influence of demographic characteristics and preoperative laboratory values on the pharmacokinetic parameters. Results Rapacuronium's weight-normalized plasma clearance was 7.03 [middle dot] (1 - 0.0507 [middle dot] (HgB - 13)) ml [middle dot] kg-1 [middle dot] min-1, where HgB is the patient's preoperative value for hemoglobin (g/100 ml); however, Rapacuronium's blood clearance (11.4 +/− 1.4 ml [middle dot] kg-1 [middle dot] min-1, mean +/− SD) did not vary with hemoglobin. Rapacuronium's weight-normalized pharmacokinetic parameters were not influenced by age, gender, or other covariates examined. Plasma concentrations of ORG9488 were typically less than 14% those of Rapacuronium during the initial 30 min after Rapacuronium administration. Conclusions In this patient population, neither age nor gender influence elimination of Rapacuronium. This finding contrasts to an age-related decrease in plasma clearance observed in a study of 10 healthy volunteers and in a pooled analysis of the pharmacokinetic data from 206 adults in multiple clinical studies. Even if ORG9488 has a potency similar to that of Rapacuronium, its plasma concentrations after a single bolus dose of Rapacuronium are sufficiently small to contribute minimally to neuromuscular blockade.
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A Pharmacodynamic Explanation for the Rapid Onset/Offset of Rapacuronium Bromide
Anesthesiology, 1999Co-Authors: Peter Wright, Ronald T. Brown, Marie Lau, Dennis M. FisherAbstract:Background: Nondepolarizing muscle relaxants differ in their time course at the laryngeal adductors and the adductor pollicis, a result of differences in equilibration delays between plasma and effect sites, the sensitivity of each muscle to the relaxant, and the steepness of the concentration-effect relation at each muscle (the Hill factor). To determine whether similar differences exist for Rapacuronium, a muscle relaxant with rapid onset and offset, the authors determined its pharmacodynamic characteristics. Metbods: The twitch tensions of the adductor pollicis and the laryngeal adductors (via a tracheal tube cuff positioned at the vocal cords) were measured in 10 volunteers who were anesthetized with propofol. Rapacuronium, 1.5 mg/kg, was given and blood samples were collected. A semiparametric effect compartment pharmacodynamic model was fit to values for Rapacuronium plasma concentrations and twitch tension of the adductor pollicis and laryngeal adductors. Results: Equilibration between the Rapacuronium plasma concentration and both effect sites was rapid (typical values for the rate constant for equilibration between plasma and the effect site are 0.405 per min for the adductor pollicis and 0.630 per min for the laryngeal adductors) and was more rapid at the laryngeal adductors than at the adductor pollicis (ratio, 1.59 ± 0.16; mean ± SD). The steady state Rapacuronium plasma concentration that depressed twitch tension by 50% and the Hill factor were similar for the two muscles. Conclusions: The rapid onset and offset of Rapacuronium can be explained by the rapid equilibration between concentrations in plasma and at the effect site. Unlike the finding for other nondepolarizing muscle relaxants, the laryngeal muscles are not resistant to Rapacuronium.
Paul F. White - One of the best experts on this subject based on the ideXlab platform.
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Effect of maintenance bolus on the recovery profile of a short-acting nondepolarizing muscle relaxant
Journal of Clinical Anesthesia, 2002Co-Authors: Xiaoguang Chen, Paul F. White, Jun Tang, Tom Webb, Ronald H. Wender, Alexander Sloninsky, Robert Naruse, Robert Kariger, Eve NorelAbstract:Abstract Study objective To evaluate the effect of different maintenance boluses of a short-acting nondepolarizing neuromuscular blocking drug on its spontaneous recovery profile during anesthesia. Design Prospective, randomized, double-blind, dose-ranging study. Setting University-based medical center. Patients 69 ASA physical status I and II consenting adult outpatients undergoing general anesthesia with an anticipated duration of at least 2 hours. Interventions Patients were randomized to one of three study groups. Following induction of anesthesia with propofol and fentanyl, Rapacuronium 1.5 mg · kg –1 intravenously (IV), was administered to facilitate tracheal intubation. Anesthesia was maintained with desflurane 4% end-tidal in combination with nitrous oxide 67% in oxygen. When the first twitch (T 1 ) in the train-of-four (TOF) returned to 25% of its baseline value, a maintenance dose of Rapacuronium 0.25 mg · kg –1 IV (Group 1), 0.5 mg · kg –1 IV (Group 2), or 0.75 mg · kg –1 IV (Group 3) was administered. The time course of neuromuscular block was monitored at the wrist using standard electromyography. Measurements and main results The times for recovery of the T 1 to 25% of the baseline value following different maintenance doses of Rapacuronium were only 6.3 ± 2.2, 7.5 ± 2.3, and 9.6 ± 2.5 minutes, in Groups 1, 2 and 3, respectively. However, the times for the TOF ratio to return to 0.7 were 44 ± 15, 53 ± 20, and 66 ± 30 minutes in Groups 1, 2, and 3, respectively. Although recovery times were significantly longer after Rapacuronium 0.75 mg · kg –1 IV (Group 3), there were no significant differences in any of the recovery variables between Groups 1 and 2. Conclusions Spontaneous recovery of the T 1 to 25% of the baseline value occurred 6 to 10 minutes after a maintenance bolus dose of Rapacuronium 0.25 to 0.75 mg · kg –1 IV. However, recovery to a TOF >0.7 required 44 to 66 minutes during desflurane anesthesia.
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Rapacuronium: an alternative to succinylcholine for electroconvulsive therapy.
Anesthesia and Analgesia, 2001Co-Authors: Andrew G. Kadar, Barry Alan Kramer, Maury C. Barth, Paul F. WhiteAbstract:E lectroconvulsive therapy (ECT) is a brief procedure that is increasing in popularity in the United States, with over 100,000 procedures performed annually (1). Although serious complications after ECT are rare, fracture-dislocations have been described when ECT treatments are performed without muscle relaxants (2). Succinylcholine is commonly used to reduce the intense muscle contractions associated with the induced seizure activity (3). A survey in California found that 98% of the hospitals responding routinely used succinylcholine as the muscle relaxant (4). However, this short-acting muscle relaxant produces myalgias and is a potent triggering drug for malignant hyperthermia (MH). This Case Report describes the anesthetic management of a patient at risk for MH who underwent a series of ECT procedures with Rapacuronium, a recently Food and Drug Administration-approved nondepolarizing muscle relaxant.
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onset offset characteristics and intubating conditions of Rapacuronium a comparison with rocuronium
BJA: British Journal of Anaesthesia, 2000Co-Authors: T. J. Zhou, Paul F. White, J. W. Chiu, Girish P. Joshi, K. K. Dullye, L. L. Duffy, William K TongierAbstract:We compared onset and offset of action and tracheal intubating conditions after Rapacuronium and rocuronium in 60 patients in a randomized, assessor-blinded study. Following induction of anaesthesia with propofol 2.5 mg kg-1, either Rapacuronium 1.5 mg kg-1 (n = 30) or rocuronium 0.6 mg kg-1 (n = 30) was administered to facilitate tracheal intubation. Anaesthesia was maintained with either a propofol infusion (100 micrograms kg-1 min-1) or sevoflurane (1% end-tidal) with 66% nitrous oxide (N2O), n = 15 in each subgroup. Neuromuscular monitoring was performed using an electromyographic (EMG) device (Datex Relaxograph). The lag times (mean 42 (SD 11) s and 44 (16) s), maximum block (99 (2)% and 98 (3)%) and intubating conditions at 60 s (good-to-excellent in 86% and 84% of patients) were similar for Rapacuronium and rocuronium, respectively. The onset time of Rapacuronium was shorter than rocuronium (87 (20) vs 141 (65) s, P < 0.001), and the degree of block at 60 s was greater (69 (26) vs 50 (27)%, P < 0.05). Twenty-five per cent recovery was shorter with Rapacuronium than rocuronium during propofol (15.0 (3.2) vs 39.1 (14.2) min, P < 0.001) and sevoflurane (15.1 (4.2) vs 47.8 (19.0) min, P < 0.001) anaesthesia. We conclude that Rapacuronium 1.5 mg kg-1 had a more rapid onset, similar intubating conditions, and shorter recovery times than rocuronium 0.6 mg kg-1.
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Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol based anaesthesia
BJA: British Journal of Anaesthesia, 2000Co-Authors: Kevin W. Klein, Paul F. White, J. W. Chiu, Harry J. M. Lemmens, D. G. Whalley, David R. Drover, C. P. GreenbergAbstract:We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of Rapacuronium. Eighty ASA I–III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5–2.5 mg kg−1 and fentanyl 1–2 μg kg−1, followed by a bolus of Rapacuronium 1.5 mg kg−1. The patients were randomized to receive either desflurane (2–4% end-tidal, ET), sevoflurane (0.75–1.5% ET), isoflurane (0.4–0.8% ET), or a propofol infusion (75–150 μg kg−1 min−1) for maintenance of anaesthesia in combination with nitrous oxide (60–70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard® accelerometer) returned to 5%, an infusion of Rapacuronium was started at 3 mg kg−1 h−1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of Rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg−1 h−1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of Rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
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Spontaneous recovery profile of Rapacuronium during desflurane, sevoflurane, or propofol anesthesia for outpatient laparoscopy.
Anesthesia & Analgesia, 2000Co-Authors: Tian J. Zhou, Margarita Coloma, Paul F. White, Jun Tang, Tom Webb, John E. Forestner, Nancy B. Greilich, Larry L. DuffyAbstract:UNLABELLED We evaluated the spontaneous recovery characteristics of Rapacuronium during desflurane-, sevoflurane-, or propofol-based anesthesia in 51 consenting women undergoing laparoscopic tubal ligation procedures. After the induction of the anesthesia with standardized doses of propofol and fentanyl, 1.5 mg/kg IV Rapacuronium was administered to facilitate tracheal intubation. Patients were randomized to receive either 1 minimum alveolar anesthetic concentration of desflurane, 1 minimum alveolar concentration of sevoflurane, or 100 microg. kg(-1). min(-1) propofol infusion in combination with 66% nitrous oxide in oxygen for maintenance of anesthesia. Neuromuscular blockade was monitored at the wrist by using electromyography. The degree of maximum blockade and the times for first twitch recovery (T(1)) to 5%, 25%, 50%, 75%, and 90%, as well as the recovery index, were similar in all three anesthetic groups. However, recovery times for the train-of-four ratio to achieve 0.7 and 0.8 were significantly longer with desflurane (44.4 +/- 18.9 and 53.5 +/- 22.4 min) and sevoflurane (44.8 +/- 15.1 and 53.2 +/- 15.8 min) compared with propofol (31.8 +/- 5.3 and 36.5 +/- 6.5 min). Eight patients (16%) required a maintenance dose of 0.5 mg/kg Rapacuronium and reversal of Rapacuronium residual block occurred in three (6%) patients. We conclude that spontaneous recovery after an intubating dose of 1.5 mg/kg Rapacuronium was significantly prolonged by both desflurane and sevoflurane compared with propofol-based anesthesia. Routine monitoring of neuromuscular activity is recommended even when a single bolus dose of Rapacuronium is administered during ambulatory anesthesia. IMPLICATIONS When administered for laparoscopic surgery, the duration of action of an intubating dose of Rapacuronium was prolonged 40%-50% by desflurane and sevoflurane, respectively, (versus propofol). Monitoring recovery of neuromuscular blockade produced by Rapacuronium is particularly important when desflurane or sevoflurane is administered to ensure that an adequate recovery (train-of-four > or = 0.8) is achieved by the end of anesthesia.
C. P. Greenberg - One of the best experts on this subject based on the ideXlab platform.
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Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol based anaesthesia
BJA: British Journal of Anaesthesia, 2000Co-Authors: Kevin W. Klein, Paul F. White, J. W. Chiu, Harry J. M. Lemmens, D. G. Whalley, David R. Drover, C. P. GreenbergAbstract:We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of Rapacuronium. Eighty ASA I–III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5–2.5 mg kg−1 and fentanyl 1–2 μg kg−1, followed by a bolus of Rapacuronium 1.5 mg kg−1. The patients were randomized to receive either desflurane (2–4% end-tidal, ET), sevoflurane (0.75–1.5% ET), isoflurane (0.4–0.8% ET), or a propofol infusion (75–150 μg kg−1 min−1) for maintenance of anaesthesia in combination with nitrous oxide (60–70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard® accelerometer) returned to 5%, an infusion of Rapacuronium was started at 3 mg kg−1 h−1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of Rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg−1 h−1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of Rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
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Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol‐based anaesthesia
British Journal of Anaesthesia, 2000Co-Authors: Kevin W. Klein, Paul F. White, J. W. Chiu, Harry J. M. Lemmens, D. G. Whalley, David R. Drover, C. P. GreenbergAbstract:We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of Rapacuronium. Eighty ASA I–III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5–2.5 mg kg−1 and fentanyl 1–2 μg kg−1, followed by a bolus of Rapacuronium 1.5 mg kg−1. The patients were randomized to receive either desflurane (2–4% end-tidal, ET), sevoflurane (0.75–1.5% ET), isoflurane (0.4–0.8% ET), or a propofol infusion (75–150 μg kg−1 min−1) for maintenance of anaesthesia in combination with nitrous oxide (60–70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard® accelerometer) returned to 5%, an infusion of Rapacuronium was started at 3 mg kg−1 h−1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of Rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg−1 h−1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of Rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
J. W. Chiu - One of the best experts on this subject based on the ideXlab platform.
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onset offset characteristics and intubating conditions of Rapacuronium a comparison with rocuronium
BJA: British Journal of Anaesthesia, 2000Co-Authors: T. J. Zhou, Paul F. White, J. W. Chiu, Girish P. Joshi, K. K. Dullye, L. L. Duffy, William K TongierAbstract:We compared onset and offset of action and tracheal intubating conditions after Rapacuronium and rocuronium in 60 patients in a randomized, assessor-blinded study. Following induction of anaesthesia with propofol 2.5 mg kg-1, either Rapacuronium 1.5 mg kg-1 (n = 30) or rocuronium 0.6 mg kg-1 (n = 30) was administered to facilitate tracheal intubation. Anaesthesia was maintained with either a propofol infusion (100 micrograms kg-1 min-1) or sevoflurane (1% end-tidal) with 66% nitrous oxide (N2O), n = 15 in each subgroup. Neuromuscular monitoring was performed using an electromyographic (EMG) device (Datex Relaxograph). The lag times (mean 42 (SD 11) s and 44 (16) s), maximum block (99 (2)% and 98 (3)%) and intubating conditions at 60 s (good-to-excellent in 86% and 84% of patients) were similar for Rapacuronium and rocuronium, respectively. The onset time of Rapacuronium was shorter than rocuronium (87 (20) vs 141 (65) s, P < 0.001), and the degree of block at 60 s was greater (69 (26) vs 50 (27)%, P < 0.05). Twenty-five per cent recovery was shorter with Rapacuronium than rocuronium during propofol (15.0 (3.2) vs 39.1 (14.2) min, P < 0.001) and sevoflurane (15.1 (4.2) vs 47.8 (19.0) min, P < 0.001) anaesthesia. We conclude that Rapacuronium 1.5 mg kg-1 had a more rapid onset, similar intubating conditions, and shorter recovery times than rocuronium 0.6 mg kg-1.
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Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol based anaesthesia
BJA: British Journal of Anaesthesia, 2000Co-Authors: Kevin W. Klein, Paul F. White, J. W. Chiu, Harry J. M. Lemmens, D. G. Whalley, David R. Drover, C. P. GreenbergAbstract:We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of Rapacuronium. Eighty ASA I–III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5–2.5 mg kg−1 and fentanyl 1–2 μg kg−1, followed by a bolus of Rapacuronium 1.5 mg kg−1. The patients were randomized to receive either desflurane (2–4% end-tidal, ET), sevoflurane (0.75–1.5% ET), isoflurane (0.4–0.8% ET), or a propofol infusion (75–150 μg kg−1 min−1) for maintenance of anaesthesia in combination with nitrous oxide (60–70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard® accelerometer) returned to 5%, an infusion of Rapacuronium was started at 3 mg kg−1 h−1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of Rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg−1 h−1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of Rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
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Onset/offset characteristics and intubating conditions of Rapacuronium: a comparison with rocuronium
British Journal of Anaesthesia, 2000Co-Authors: T. J. Zhou, Paul F. White, J. W. Chiu, Girish P. Joshi, K. K. Dullye, L. L. Duffy, William K TongierAbstract:We compared onset and offset of action and tracheal intubating conditions after Rapacuronium and rocuronium in 60 patients in a randomized, assessor-blinded study. Following induction of anaesthesia with propofol 2.5 mg kg-1, either Rapacuronium 1.5 mg kg-1 (n = 30) or rocuronium 0.6 mg kg-1 (n = 30) was administered to facilitate tracheal intubation. Anaesthesia was maintained with either a propofol infusion (100 micrograms kg-1 min-1) or sevoflurane (1% end-tidal) with 66% nitrous oxide (N2O), n = 15 in each subgroup. Neuromuscular monitoring was performed using an electromyographic (EMG) device (Datex Relaxograph). The lag times (mean 42 (SD 11) s and 44 (16) s), maximum block (99 (2)% and 98 (3)%) and intubating conditions at 60 s (good-to-excellent in 86% and 84% of patients) were similar for Rapacuronium and rocuronium, respectively. The onset time of Rapacuronium was shorter than rocuronium (87 (20) vs 141 (65) s, P < 0.001), and the degree of block at 60 s was greater (69 (26) vs 50 (27)%, P < 0.05). Twenty-five per cent recovery was shorter with Rapacuronium than rocuronium during propofol (15.0 (3.2) vs 39.1 (14.2) min, P < 0.001) and sevoflurane (15.1 (4.2) vs 47.8 (19.0) min, P < 0.001) anaesthesia. We conclude that Rapacuronium 1.5 mg kg-1 had a more rapid onset, similar intubating conditions, and shorter recovery times than rocuronium 0.6 mg kg-1.
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Rapacuronium recovery characteristics and infusion requirements during inhalation versus propofol‐based anaesthesia
British Journal of Anaesthesia, 2000Co-Authors: Kevin W. Klein, Paul F. White, J. W. Chiu, Harry J. M. Lemmens, D. G. Whalley, David R. Drover, C. P. GreenbergAbstract:We examined the effect of four maintenance anaesthetics on the neuromuscular blocking activity and spontaneous recovery characteristics after a short-term infusion of Rapacuronium. Eighty ASA I–III adult patients undergoing elective surgery were studied at four centres. Anaesthesia was induced with propofol 1.5–2.5 mg kg−1 and fentanyl 1–2 μg kg−1, followed by a bolus of Rapacuronium 1.5 mg kg−1. The patients were randomized to receive either desflurane (2–4% end-tidal, ET), sevoflurane (0.75–1.5% ET), isoflurane (0.4–0.8% ET), or a propofol infusion (75–150 μg kg−1 min−1) for maintenance of anaesthesia in combination with nitrous oxide (60–70%) in oxygen. When the first twitch (T1) of a train-of-four stimulus (using the TOF Guard® accelerometer) returned to 5%, an infusion of Rapacuronium was started at 3 mg kg−1 h−1 and adjusted to maintain T1/T0 at 10%. The duration of infusion lasted between 45 and 60 min, and the average infusion rates of Rapacuronium were similar in all groups, ranging from 1.6 to 2.5 mg kg−1 h−1. There were no significant differences among the groups in the times for T1/T0 to return to 25%, 75% or 90%, or for T4/T1 to return to 70% and 80% upon discontinuation of the infusion. When potent inhalation anaesthetics are used in clinically relevant concentrations for maintenance of anaesthesia, the neuromuscular recovery profile of Rapacuronium administered as a variable-rate infusion for up to 1 h is similar to that found with a propofol-based anaesthetic technique.
