Artículos de revistas
Priming Versus Bolus. A Comparative Study With Different Cisatracurium Doses [dose Preparatória Versus Injeção Unica. Estudo Comparativo Entre Diferentes Doses De Cisatracúrio]
Registro en:
Revista Brasileira De Anestesiologia. , v. 53, n. 1, p. 9 - 16, 2003.
347094
2-s2.0-0037232395
Autor
De Assuncao Braga A.D.F.
Braga Poterio G.M.
Da Silva Braga F.S.
Cremonesi E.
Siqueira F.P.
Carvalho V.H.
Institución
Resumen
Background and Objectives - The priming technique is an alternative to shorten nondepolarizing neuromuscular blockers onset time. This study aimed at evaluating maximum neuromuscular block onset, tracheal intubation conditions and cardiocirculatory changes determined by different cisatracurium single or fractional doses. Methods - Participated in this study 80 patients physical status ASA I and II, who were distributed into two groups according to cisatracurium doses: Group I (0.1 mg.kg-1) and Group II (0.2 mg.kg-1). Subgroups were constituted according to the curarization technique employed: subgroups P1 and P2 (priming-dose) - 0.02 mg.kg-1 or 0.04 mg.kg-1 cisatracurium, respectively, followed one minute later, by 0.08 mg.kg-1 or 0.16 mg.kg-1 of the same neuromuscular blocker, respectively; subgroups U1 and U2 - total bolus injection of 0.1 mg.kg-1 or 0.2 mg.kg-1 cisatracurium, respectively. Anesthesia was induced with etomidate, preceded by alfentanil. Train of Four (TOF) stimulation was applied at 12-second intervals to monitor neuromuscular function. Maximum neuromuscular blockade onset time, tracheal intubation conditions and changes in hemodynamic parameters (arterial mean blood pressure and heart rate) were evaluated. Results - Mean times for maximum neuromuscular block onset were: Group / (3.90 ± 0.60 min and 3.88 ± 0.74 min, for subgroups P1 and U1, respectively) and Group II (1.40 ± 0.40 min and 2 ± 0.30 min, for subgroups P2 and U2, respectively) with no significant differences. Comparison between subgroups P1 and P2 and between subgroups U1 and U2, has shown statistically significant differences. Tracheal intubation conditions were acceptable in all patients and there were no cardiovascular changes. Conclusions - Fractional cisatracurium doses have not shortened maximum neuromuscular block onset as compared to bolus injections. They have however produced acceptable tracheal intubation conditions without cardiovascular changes. 53 1 9 16 Donati, F., Onset of action of relaxants (1988) Can J Anaesth, 35, pp. S52-S58 Foldes, F.F., Nagashima, H., Kornak, P.H., Effect of priming (1993) Anaesth Pharmacol Rev, 1, pp. 49-56 Koller, M.E., Husby, P., High-dose vecuronium may be an alternative to suxamethonium for rapid-sequence intubation (1993) Acta Anaesthesiol Scand, 37, pp. 465-468 Potério, G.M.B., Braga, A.F.A., Condições de intubação traqueal com pancurônio. O princípio do priming-dose (1989) Rev Bras Anestesiol, 39 (SUPPL. 11), pp. CBA26 Braga, A.F.A., Potério, G.M.B., Emprego do pancurônio e alcurônio em doses fracionadas na obtenção de relaxamento muscular para intubação traqueal (1993) Rev Bras Anestesiol, 43 (SUPPL. 17), pp. CBA76 Braga, A.A., Potério, G.B., Rousselet, M.S., Atracúrio e intubação traqueal: Priming-dose X injeção única (1994) Rev Bras Anestesiol, 44 (SUPPL. 18), pp. CBA115 Mellinghoff, H., Radbruch, L., Diefenbach, C., A comparison of cisatracurium and atracurium onset of neuromuscular block after bolus injection and recovery after subsequent infusion (1996) Anesth Analg, 83, pp. 1072-1075 Bluestein, L.S., Stinson L.W., Jr., Lennon, R.L., Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation (1996) Can J Anaesth, 43, pp. 925-931 Mallampati, S.R., Gatt, S.P., Gugino, L.D., A clinical sign to predict difficult tracheal intubation: A prospective study (1985) Can J Anaesth, 32, pp. 429-434 Goldberg, M.E., Larijani, G.E., Azad, S.S., Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients (1989) Anesth Analg, 69, pp. 93-99 Baumgarten, R.K., Carter, C.E., Reynolds, W.J., Priming with nondepolarizing relaxants for rapid tracheal intubation: A double-blind evaluation (1988) Can J Anaesth, 35, pp. 5-11 Storella, R.J., Jaffe, J., Mehr, E., In vitro investigation of the priming principle for rapid neuromuscular block (1989) Br J Anaesth, 62, pp. 478-482 Foldes, F.F., Rapid tracheal intubation with non-depolarizing neuromuscular blocking drugs: The priming principle (1984) Br J Anaesth, 56, p. 663 Schwarz, S., Ilias, W., Lackner, F., Rapid tracheal intubation with vecuronium: The priming principle (1985) Anesthesiology, 62, pp. 388-391 Redai, I., Feldman, S.A., Priming studies with rocuronium and vecuronium (1995) Eur J Anaesth, 11, pp. 11-13 Paton, W.D.M., Waud, D.R., The margin of safety of neuromuscular transmission (1967) J Physiol, 191, pp. 59-90 Waud, B.E., Waud, D.R., The margin of safety of neuromuscular transmission in the muscle of the diaphragm (1972) Anesthesiology, 37, pp. 417-422 Mehta, M.P., Choi, W.W., Gergis, S.D., Facilitation of rapid endotracheal intubations with divided doses of non-depolarizing neuromuscular blocking drugs (1985) Anesthesiology, 62, pp. 392-395 Hofmockel, R., Bernad, G., Time-course of action and intubating conditions with rocuronium bromide under propofol-alfentanil anaesthesia (1995) Eur J Anaesth, 12, pp. 69-72 Feldman, S.A., Rocuronium: Onset times and intubating conditions (1994) Eur J Anaesth, 9, pp. 49-52 Musich, J., Walts, L.F., Pulmonary aspiration after a priming dose of vecuronium (1986) Anesthesiology, 64, pp. 517-519 Van Aken, H., Mertes, N., Haess, G.M., Pretreatment technique for fast intubation with vecuronium: Intubation conditions and unwanted effects (1986) Acta Anaesthesiol Belg, 37, pp. 199-204 Engbaek, J., Viby-Mogensen, J., Pre-curarization: A hazard to the patient? (1984) Acta Anaesthesiol Scand, 28, pp. 61-62 Mahajan, R.P., Laverty, J., Lung function after vecuronium pre-treatment in young, healthy patients (1992) Br J Anaesth, 69, pp. 318-319 Aziz, L., Jahangir, S.M., Choudhury, S.N.S., The effect of priming with vecuronium and rocuronium on young and elderly patients (1997) Anesth Analg, 85, pp. 663-666 Mirakhur, R.K., Lavery, G.G., Gibson, F.M., Intubating conditions after vecuronium and atracurium given in divided doses (the priming technique) (1986) Acta Anaesthesiol Scand, 30, pp. 347-350 Glass, P.S., Wilson, W., Mace, J.A., Is the priming principle both effective and safe? (1989) Anesth Analg, 68, pp. 127-134 Miller, R.D., The priming principle (1985) Anesthesiology, 62, pp. 381-382 Braga, A.F.A., Potério, G.M.B., Braga, F.S.S., Rocurônio: Dose preparatória versus injeção única (1999) Rev Bras Anestesiol, 49, pp. 379-384 Harrop-Griffiths, A.W., Grounds, R.M., Moore, M., Intubating conditions following pre-induction priming with alcuronium (1986) Anaesthesia, 41, pp. 282-286 Deepika, K., Kenaan, C.A., Bikhazi, G.B., Influence of the priming technique on pharmacodynamics and intubating conditions of cisatracurium (1999) J Clin Anesth, 11, pp. 572-575 Stevens, J.B., Walker, S.C., Fontenot, J.P., The clinical neuromuscular pharmacology of cisatracurium versus vecuronium during outpatient anesthesia (1997) Anesth Analg, 85, pp. 1278-1283 Hoffmann, W., Schwarz, U., Ruoff, M., Effects of priming technique on onset profile of cisatracurium (1999) Anaesth Reanim, 24, pp. 130-133 Puhringer, F.K., Scheller, A., Kleinsasser, A., The effect of different priming doses on the pharmacodynamics of cisatracurium (2000) Anaesthesist, 49, pp. 102-105 Naguib, M., Abdulatif, M., Gyasi, H.D., Priming with atracurium: Improving intubating conditions with additional doses of thiopental (1986) Anesth Analg, 65, pp. 1295-1299 Muir, A.W., Anderson, K.A., Pow, E., Interaction between rocuronium bromide and some drugs used during anaesthesia (1994) Eur J Anaesth, 11, pp. 93-98 Muir, A.W., Houston, J., Marshall, R.J., A comparison of the neuromuscular blocking and autonomic effects of two new short-acting muscle-relaxants with those of succinylcholine in the anesthetized cat and pig (1989) Anesthesiology, 70, pp. 533-540 Cason, B., Baker, D.G., Hickey, R.F., Cardiovascular and neuromuscular effects of three steroidal neuromuscular blocking drugs in dogs (Org 9619, Org 9426, Org 9991) (1990) Anesth Analg, 70, pp. 382-388 Savarese, J.J., Lien, C.A., Belmont, M.R., The clinical pharmacology of new benzylisoquinoline-diester compounds, with special consideration of cisatracurium and mivacurium (1997) Anaesthesist, 46, pp. 840-849 Doenicke, A.W., Czeslick, E., Moss, J., Onset time, endotracheal intubating conditions, and plama histamina after cisatracurium and vecuronium administration (1998) Anesth Analg, 87, pp. 434-438 Lepage, J.Y., Malinovsky, J.M., Malinge, M., Pharmacodynamic dose-response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2 opioid anesthesia (1996) Anesth Analg, 83, pp. 823-829 Bryson, H.M., Faulds, D., Cisatracurium besilate. A review of its pharmacology and clinical potential in anaesthetic practice (1997) Drugs, 53, pp. 848-866 Reich, D.L., Mulier, J., Viby-Mogensen, J., Comparison of the cardiovascular effects of cisatracurium and vecuronium in patients with coronary artery disease (1998) Can J Anaesth, 45, pp. 794-797