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  • 1
    Electronic Resource
    Electronic Resource
    Beeinflussung der Pharmakodynamik von Rocuronium durch Cimetidin (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 900-902 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Pharmakodynamik: Rocuronium ; Medikamentöse Wechselwirkung: Cimetidin ; Key words Pharmacodynamics: rocuronium ; Drug interactions: rocuronium ; cimetidine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Cimetidine is a commonly used H2-receptor antagonist that has been recommended for the prevention of acid aspiration syndrome and has been shown to potentiate vecuronium-induced neuromuscular block. The present study was designed to investigate the influence of a single IV dose of cimetidine on the neuromuscular effects of rocuronium, an analogue of vecuronium with a short onset time. Methods. Twenty adults aged 18–65 years were included in the study with their informed consent and approval of the Ethics Committee. Following oxazepam premedication, 10 patients were randomly allocated to receive cimetidine 400 mg IV 30 min before anaesthesia. After fentanyl and thiopentone induction, single-twitch stimulation of the ulnar nerve was performed every 10 s. Following stabilisation of control responses, patients received rocuronium 0.6 mg/kg for intubation. Anaesthesia was maintained with enflurane ≤0.8 vol.% (end-tidal) and 65% nitrous oxide. Onset time and recovery times to 25% and 75% of the twitch control values were recorded. Results. Onset and recovery times did not differ between groups. Conclusions. The results of the present study demonstrate that cimetidine does not increase the duration of rocuronium neuromuscular blockade. Inhibition of the cytochrome P450 system or a direct effect at the neuromuscular junction have been suggested as the mechanisms of drug interaction associated with cimetidine. Impairment of hepatic microsomal drug metabolism results in a prolonged duration of action of vecuronium, which appears to be eliminated primarily via the liver. Data on the elimination pathway of rocuronium in humans are not available. The fact that cimetidine does not alter the recovery from rocuronium-induced neuromuscular block confirms a previous suggestion that rocuronium may not be eliminated principally by the liver. A direct effect of cimetidine on the neuromuscular junction could not be confirmed by this study. Therefore, cimetidine can be given as premedication without a risk of prolonged rocuronium block.
    Notes: Zusammenfassung Nach Gabe von Cimetidin kann die Wirkungszeit nichtdepolarisierender Muskelrelaxanzien verlängert sein. Wir untersuchten diesen Zusammenhang für Rocuronium nach einer Einzeldosis von 400 mg Cimetidin intravenös im Vergleich mit einer Kontrollgruppe. Die Antwort des M. adductor pollicis nach Stimulation des N. ulnaris wurde elektromyographisch registriert. Die Anschlags- und Erholungszeiten sind in beiden Gruppen vergleichbar. Der fehlende Einfluß von Cimetidin auf die neuromuskuläre Blockade von Rocuronium könnte darauf hindeuten, daß die Elimination von Rocuronium nicht nur in der Leber stattfindet. Eine mögliche direkte Beeinflussung der neuromuskulären Endplatte durch Cimetidin, wie sie für Vecuronium postuliert worden ist, trifft nach unseren Ergebnissen nicht für Rocuronium zu. Die Anwendung von Cimetidin in der Prämedikation verlängert nicht die Dauer der neuromuskulären Blockade durch Rocuronium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050323
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  • 2
    Electronic Resource
    Electronic Resource
    Plasmakonzentrationen von Bupivacain bei kontinuierlicher Periduralanästhesie im Kindesalter (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 202-208 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Anästhesie ; peridurale ; Kinder ; Schmerztherapie ; postoperative ; Bupivacain ; Lokalanästhetikaintoxikation ; Key words Anaesthesia ; epidural ; Child ; Pain therapy ; postoperative ; Bupivacaine ; Anaesthetics ; local adverse effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Epidural anaesthesia is extremely useful in providing postoperative analgesia for children after surgery of the lower body. Although results on early pharmacokinetics in children have previously been reported, no data are available on the long-term effects of epidural anaesthesia. The aim of this investigation was the assessment of plasma bupivacaine levels in children with continuous epidural anaesthesia in the postoperative period. A catheter with an outer diameter of 0.63 mm was inserted through a 19G Tuohy cannula into the epidural space. A maximum dose of 0.4 mg/kg/h bupivacaine was administered for continuous epidural infusion. Careful monitoring was performed to detect early signs of local anaesthetic intoxication. Two milliliters of blood were obtained in each patient per day and nepholometric serum measurement were performed to determine α1-acid glycoprotein and albumin levels. Bupivacaine plasma concentrations were assessed according to the method described by Sattler et al. [25]. Ten children were included in the investigation. The measured albumin and α1-acid glycoprotein concentrations were within the range described by other investigators. At the onset of pain therapy maximum levels of 0.5 µg/ml where recorded after a loading dose of bupivacaine and levels of up to 2.2 µg/ml were achieved following continuous infusion. There were no neurologic complications or signs of lokal anesthetic intoxication. In conclusion our results show that a dose of up to 0.4 mg/kg/h bupivacaine during continuous epidural infusion is not associated with toxic complications. Careful monitoring of the children by experienced staff is mandatory.
    Notes: Zusammenfassung Zur postoperativen Schmerztherapie bei Kindern mit Operationen an der unteren Körperhälfte bietet sich eine Periduralanästhesie an. Bisher wurde die initiale Pharmakokinetik bei Kindern untersucht, nicht hingegen der langfristige Verlauf. Ziel dieser Untersuchung war die Erhebung von Daten zum zeitlichen Verlauf des Plasma-Bupivacainspiegels, der sauren α1-Glycoprotein- und Albuminkonzentrationen bei Kindern mit kontinuierlicher Periduralanästhesie in der postoperativen Phase. Methodik:Über eine 19G Tuohy-Kanüle legten wir einen Katheter mit 0,63 mm Außendurchmesser in den Periduralraum ein. Während der kontinuierlichen periduralen Bupivacaininfusion durfte eine Dosis von 0,4 mg/kgKG/h Bupivacain nicht überschritten werden. Frühzeichen einer Lokalanästhetikaintoxikation wurden gezielt erfragt. Täglich wurden 2 ml Blut abgenommen, in dessen Serum das saure α1-Glycoprotein und das Albumin nepholometrisch gemessen wurde. Die Lokalanästhetikabestimmung erfolgte dann nach der Methode von Sattler et al. [25]. Ergebnisse: In die Untersuchung wurden zehn Kinder aufgenommen. Die Bestimmung der Bindungsproteine Albumin und sα1-GP ergab für beide Proteine Konzentrationen im vorbeschriebenen Rahmen. Nach der Bolusinjektion von Bupivacain zu Beginn der Schmerztherapie wurden maximale Blutspiegel von 0,5 µg/ml und infolge der anschließenden kontinuierlichen Infusion Blutspiegel bis 2,2 µg/ml erreicht. Wir beobachteten keine neurologischen Störungen oder Anzeichen einer Lokalanästhetikaintoxikation. Schlußfolgerung: Aus der Literaturübersicht und unseren eigenen Erfahrungen geht hervor, daß bei kontinuierlicher periduraler Infusion bis zu einer Bupivacaindosierung von 0,4 mg/kgKG/h nicht mit toxischen Komplikationen gerechnet werden muß. Eine adäquate Überwachung der Kinder durch geschultes Personal muß jedoch sichergestellt sein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050548
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  • 3
    Electronic Resource
    Electronic Resource
    Die Wirkung des Alters auf Anschlagszeit und Erholung nach Atracurium, Rocuronium und Vecuronium (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 903-906 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Pharmakodynamik: Atracurium ; Rocuronium ; Vecuronium ; Relaxation: Anschlagszeit ; Erholung ; Altersfaktoren ; Key words Pharmacodynamics: atracurium ; rocuronium ; vecuronium ; Neuromuscular block: onset ; recovery ; Age factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Elderly patients may show an age-related decline in physiologic functions, which may be responsible for the prolonged duration of some neuromuscular blocking agents. Previous studies have yielded conflicting results as to the effects of these drugs in the elderly. Methods. After obtaining informed consent and approval of the Ethics Committee, we compared onset and recovery times of single IV doses of atracurium, rocuronium, and vecuronium given to 108 patients divided into three groups according to age (18–50, 51–64, ≥65 years). Following oxazepam premedication and fentanyl and thiopentone induction, patients were randomly allocated to receive atracurium, rocuronium or vecuronium (0.5, 0.6, or 0.1 mg/kg, respectively) in ≤0.8 vol.% enflurane (end-tidal)-nitrous oxide anaesthesia. Muscular relaxation was assessed by electromyographic (EMG) recording of the adductor pollicis muscle after supramaximal single-twitch stimulation of the ulnar nerve every 10 s. Onset time and recovery to 25%, 75% and 90% of twitch control values (DUR25, 75, 90) were recorded. Creatinine clearance predicted from serum creatinine (Ccr) was correlated with recovery from neuromuscular block. Results. Onset time was not different among groups or relaxants. The results showed a prolonged duration of action for atracurium (DUR75, DUR90), rocuronium (DUR25, DUR75), and vecuronium (DUR25) in the elderly. A number of patients did not reach DUR75 or DUR90. There was a significant relationship between age and failure to return to control values during recovery from neuromuscular block, especially after atracurium and rocuronium. Ccr showed a negative correlation with age for all relaxants, but a negative significant correlation between Ccr and recovery was found only for rocuronium. Conclusions. This study suggests that onset time for atracurium, rocuronium and vecuronium is not age-dependent. Recovery was prolonged in the elderly for all three relaxants. This effect appears to be secondary to changes in body composition and function accompanying the aging process. Neither atracurium nor vecuronium depends significantly on the kidney for elimination, but the negative correlation between Ccr and rocuronium suggests an appreciable role for the kidney in the elimination of this relaxant. The long recovery times observed in this study could also be related to enflurane anaesthesia. We suggest that failure of EMG responses to return to baseline values during recovery from neuromuscular block may be related to age, especially for atracurium and rocuronium.
    Notes: Zusammenfassung Bei alten Patienten kann die Wirkung von Muskelrelaxanzien verändert sein. Wir untersuchten diesen Zusammenhang an 108 Patienten dreier Altersgruppen, die randomisiert klinisch übliche Intubationsdosen von Atracurium, Rocuronium und Vecuronium erhielten. Anschlagszeit und Erholung von der neuromuskulären Blockade wurden mit dem evozierten EMG des M. adductor pollicis nach Stimulation des N. ulnaris (Einzelreizung, 0,1 Hz) ermittelt. Die Anschlagszeiten sind in allen drei Altersgruppen vergleichbar, die Erholungszeiten bei den alten Patienten nach allen drei Relaxanzien verlängert. Die verlängerte Erholungszeit für Rocuronium korreliert mit erhöhten Werten der berechneten Kreatinin-Clearance, was für eine im Vergleich mit Atracurium und Vecuronium vermehrte renale Elimination spricht. Die nicht vollständige Erholung von der neuromuskulären Blockade bei einigen Patienten, auch nach längerer Zeit, korreliert mit dem Alter. Eine Erklärung hierfür kann nicht gegeben werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050324
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  • 4
    Electronic Resource
    Electronic Resource
    Die Wechselwirkung von Rocuronium und Rauchen Der Einfluß des Rauchens auf die neuromuskuläre Übertragung nach Rocuronium (1997)
    Springer
    Der Anaesthesist 46 (1997), S. 493-495 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Pharmakodynamik ; Muskelrelaxanzien ; Rocuronium ; Medikamentöse Wechselwirkung ; Rauchen ; Nikotin ; Key words Pharmacodynamics ; Neuromuscular blocking agents ; Rocuronium ; Drug interactions ; Smoking ; Nicotine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Recent studies have shown different results concerning the effects of smoking on neuromuscular blocking agents. Some reports indicate that smokers need higher doses of vecuronium, but are more sensitive to atracurium. The aim of this study was to evaluate the effects of smoking on onset and recovery time after a single 0.6 mg/kg intubating dose of rocuronium an analog of vecuronium. Methods: Following institutional approval and informed consent, 20 smokers (〉10 cigarettes/day) and 20 nonsmokers were included in the study. Following oxazepam premedication and induction with fentanyl and thiopental, single-twitch stimulation of the ulnar nerve was performed every 10 s. Following stabilisation of control responses, patients received rocuronium 0.6 mg/kg for intubation. Anaesthesia was maintained with enflurane ≤0.8 vol.% (end-tidal) and 65% nitrous oxide in oxygen. Onset time and recovery to 25% and 75% of the twitch control values were recorded. Results: Onset and recovery times were not different between smokers and nonsmokers. Conclusions: The results of the present study suggest that chronic nicotine exposure does not change onset time or duration of rocuronium neuromuscular blockade. A previous study found a greater need for vecuronium in smokers and discussed stimulation of the neuromuscular junction and enhanced biotransformation due to the enzyme-inducing properties of nicotine. The differences in our results could be partly due to a longer period of refraining from smoking in our patients, leading to very low nicotine blood concentrations without the proposed receptor-stimulating effect. Another cause for different behaviour of the two analogs could be different elimination pathways. Recent investigations suggest that rocuronium may not be eliminated principally by the liver. Therefore, enhanced nicotine-induced biotransformation, as suggested for vecuronium, would not occur with rocuronium.
    Notes: Zusammenfassung Nach bisherigen Untersuchungen beeinflußt das Rauchen die Pharmakodynamik von Muskelrelaxanzien in unterschiedlicher Weise. Einerseits wurden bei Rauchern höhere Dosen von Vecuronium benötigt, andererseits reagierten Raucher sensibler auf Atracurium. Methoden: Wir untersuchten diesen Zusammenhang für eine Einzeldosis von Rocuronium 0,6 mg/kg an jeweils 20 Rauchern und 20 Nichtrauchern. Die Antwort des M. adductor pollicis nach Stimulation des N. ulnaris wurde elektromyographisch registriert. Ergebnis: Nikotin beeinflußte die klinische Wirkung von Rocuronium nicht, die Anschlags- und Erholungszeiten waren in beiden Gruppen vergleichbar. Diskussion: Der fehlende Einfluß des Nikotins auf die neuromuskuläre Blockade von Rocuronium könnte auf die lange Nikotinkarenz von 8–10 h zurückgeführt werden ebenso wie auf die Tatsache, daß die Metabolisierung von Rocuronium nach neuesten Erkenntnissen nicht der seines Analogons Vecuronium entspricht. Eine durch Nikotin verursachte hepatische Enzyminduktion mit rascherer Metabolisierung, wie dies für Vecuronium diskutiert worden ist, würde daher nicht in dem entsprechenden Umfang für das Rocuronium zu erwarten sein. Aus unseren Ergebnissen schließen wir, daß nach einer Karenzzeit von 8–10 h keine Beeinflussung der Pharmakodynamik von Rocuronium bei Rauchern stattfindet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050429
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  • 5
    Electronic Resource
    Electronic Resource
    Prolonged anaesthesia with isoflurane and halothane (1988)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 43 (1988), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Hepatic function was assessed pre-operatively and on the first and sixth postoperative days in 40 healthy patients who underwent prolonged maxillofacial surgery with isoflurane or halothane anaesthesia. No major changes were observed in hepatic enzymes or bilirubin. One-stage prothrombin time and Factor VII concentrations decreased on the first postoperative day and this change-was more pronounced in the halothane group. The results support the use of isoflurane rather than halothane for prolonged anaesthesia in respect of the synthesising function of the liver.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1988.tb05536.x
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  • 6
    Electronic Resource
    Electronic Resource
    New tools (1989)
    Springer
    Surgical endoscopy and other interventional techniques 3 (1989), S. 117-118 
    Details
    ISSN: 1432-2218
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00590915
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  • 7
    Electronic Resource
    Electronic Resource
    Verschluß einer Gaumenspalte bei einer Patientin mit Ebstein-Anomalie unter Hochfrequenzoszillationsbeatmung (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 212-216 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hochfrequenzoszillationsbeatmung ; Hämodynamik ; Ebstein-Anomalie ; Gaumenspalte ; Key words High-frequency oscillatory ventilation ; Cardiopulmonary interactions ; Ebstein’s anomaly ; Cleft palate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background: We report on the unsuccessful attempt to put a young patient with Ebstein’s anomaly on conventional ventilation for maxillofacial surgery. Reduced pulmonary bloodflow and cardiac output were followed by arterial hypotension and reduction of oxygen saturation. Spontaneous breathing without positive pressure ventilation normalized of the hemodynamic situation. Operation: Two years later, using a high-frequency oscillatory ventilator (SensorMedics 3100A), with relatively constant intrathoracic pressures and avoidance of high inspiratory pressures, the patient was adequately ventilated and oxygenated during the operation.
    Notes: Zusammenfassung Hintergrund: Es wird über den zunächst nicht erfolgreichen Versuch der konventionellen Beatmung während eines kieferchirurgischen Eingriffs bei einer Patientin mit Ebstein-Anomalie berichtet. Verminderter pulmonaler Blutfluß und entsprechend verminderter linksventrikulärer Auswurf führten zu einer arteriellen Hypotonie mit Sauerstoffsättigungsabfall. Unter Spontanatmung normalisierte sich der kritische Zustand rasch. Operation: Der Einsatz eines Hochfrequenzoszillationsbeatmungsgeräts (SensorMedics 3100A) mit gleichbleibendem mittlerem Atemwegsdruck und Vermeiden inspiratorischer Spitzendrücke ermöglichte 2 Jahre später eine adäquate Ventilation und Oxygenierung der Patientin, so daß die Operation durchgeführt werden konnte.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050264
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