Facilitation of rapid-sequence intuhation with large-dose vecuronium with or without priming

Krishnaprasad Deepika, George B. Bikhazi, Hassan M J Mikati, Michael Namba, Francis F. Foldes

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Study Objectives: To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mglkg. Design: Randomized, unblinded study. Setting: Operating rooms and postanesthetic recovery unit of a university-affiliated general hospital. Patients: Thirty female ASA physical status I and II patients scheduled for intraperitoneal surgery divided into two groups of 15 each. Interventions: Anesthesia was induced and maintained with sufentanil, droperidol, thiopental sodium, and nitrous oxide in oxygen. Patients in Group 1 were given vecuronium 0.015 mglkg 4 minutes before induction and vecuronium 0.285 mglkg 1 minute after induction. Patients in Group 2 received a single 0.3 mglkg dose of vecuronium 1 minute after thiopental sodium. The ulnar nerve was stimulated every 10 seconds with train-of-four supramaximal impulses of 0.2 millisecond duration at 2 Hz. The compound electromyogram (EMG) of the adductor pollicis was continuously recorded. The trachea was intubated when the amplitude of the EMG decreased to 15% to 25% of control. At the end of surgery, residual neuromuscular block was reversed with edrophonium 0.75 mg/kg. Measurements and Main Results: All patients in Group 1 could be intubated in 80 seconds or less, and the longest onset time was 120 seconds. In Group 2, the longest intubation time was 140 seconds, and the longest onset time was 200 seconds. Clinical durations in both groups were unpredictable, ranging from 47 to 185 minutes in Group 1 and from 63 to 160 minutes in Group 2. Ten of the 30 patients required an additional 0.5 mglkg of edrophonium for antagonism of the residual neuromuscular block. There were no significant changes in heart rate or blood pressure attributable to vecuronium. Conclusions: Seventy-five percent to 85 % neuromuscular block of the adductor pollicis, required for atraumatic tracheal intubation, developed in 80 seconds or less when vecuronium 0.3 mglkg was administered in divided doses and in 140 seconds or less when it was injected as a single bolus dose. Clinical duration of vecuronium 0.3 mgl kg is long and unpredictable, and reversal of residual neuromuscular block may require larger doses of anticholinesterases. It is recommended that an intubatiog dose of vecuronium 0.3 mg/kg be used only in patients undergoing long surgical procedures that require prolonged postanesthetic mechanical ventilation.

Original languageEnglish
Pages (from-to)106-110
Number of pages5
JournalJournal of Clinical Anesthesia
Volume4
Issue number2
DOIs
StatePublished - Jan 1 1992

Fingerprint

Vecuronium Bromide
Delayed Emergence from Anesthesia
Intubation
Edrophonium
Thiopental
Electromyography
Sufentanil
Droperidol
Neuromuscular Blockade
Ulnar Nerve
Cholinesterase Inhibitors
Nitrous Oxide
Operating Rooms
Trachea
Artificial Respiration
General Hospitals
Anesthesia
Heart Rate
Oxygen
Blood Pressure

Keywords

  • priming
  • Vecuronium, large-dose

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Facilitation of rapid-sequence intuhation with large-dose vecuronium with or without priming. / Deepika, Krishnaprasad; Bikhazi, George B.; Mikati, Hassan M J; Namba, Michael; Foldes, Francis F.

In: Journal of Clinical Anesthesia, Vol. 4, No. 2, 01.01.1992, p. 106-110.

Research output: Contribution to journalArticle

Deepika, Krishnaprasad ; Bikhazi, George B. ; Mikati, Hassan M J ; Namba, Michael ; Foldes, Francis F. / Facilitation of rapid-sequence intuhation with large-dose vecuronium with or without priming. In: Journal of Clinical Anesthesia. 1992 ; Vol. 4, No. 2. pp. 106-110.
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abstract = "Study Objectives: To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mglkg. Design: Randomized, unblinded study. Setting: Operating rooms and postanesthetic recovery unit of a university-affiliated general hospital. Patients: Thirty female ASA physical status I and II patients scheduled for intraperitoneal surgery divided into two groups of 15 each. Interventions: Anesthesia was induced and maintained with sufentanil, droperidol, thiopental sodium, and nitrous oxide in oxygen. Patients in Group 1 were given vecuronium 0.015 mglkg 4 minutes before induction and vecuronium 0.285 mglkg 1 minute after induction. Patients in Group 2 received a single 0.3 mglkg dose of vecuronium 1 minute after thiopental sodium. The ulnar nerve was stimulated every 10 seconds with train-of-four supramaximal impulses of 0.2 millisecond duration at 2 Hz. The compound electromyogram (EMG) of the adductor pollicis was continuously recorded. The trachea was intubated when the amplitude of the EMG decreased to 15{\%} to 25{\%} of control. At the end of surgery, residual neuromuscular block was reversed with edrophonium 0.75 mg/kg. Measurements and Main Results: All patients in Group 1 could be intubated in 80 seconds or less, and the longest onset time was 120 seconds. In Group 2, the longest intubation time was 140 seconds, and the longest onset time was 200 seconds. Clinical durations in both groups were unpredictable, ranging from 47 to 185 minutes in Group 1 and from 63 to 160 minutes in Group 2. Ten of the 30 patients required an additional 0.5 mglkg of edrophonium for antagonism of the residual neuromuscular block. There were no significant changes in heart rate or blood pressure attributable to vecuronium. Conclusions: Seventy-five percent to 85 {\%} neuromuscular block of the adductor pollicis, required for atraumatic tracheal intubation, developed in 80 seconds or less when vecuronium 0.3 mglkg was administered in divided doses and in 140 seconds or less when it was injected as a single bolus dose. Clinical duration of vecuronium 0.3 mgl kg is long and unpredictable, and reversal of residual neuromuscular block may require larger doses of anticholinesterases. It is recommended that an intubatiog dose of vecuronium 0.3 mg/kg be used only in patients undergoing long surgical procedures that require prolonged postanesthetic mechanical ventilation.",
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