Clinical variability of vecuronium. Experience at an institution in Colombia

  • Luis Reyes Anesthesiologist - Intensivist, Fundación Universitaria de Ciencias de la Salud, Head of the Graduate Program of Anesthesiology and Resuscitation, Bogotá, Colombia
  • Luis Muñoz Anesthesiologist - Intensivist, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
  • David Orozco Cardiovascular Anesthesiologist, Fundación Clínica Shaio, Bogotá, Colombia
  • Carlos Arias Resident 111 year of Anesthesiology and Resuscitation, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
  • Victor Vergel Anesthesiologist, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
  • Albert Valencia Anesthesiologist - Intensivist, Sanitas International Organization, Clínica Colombia, Bogotá, Colombia
Keywords: Neuromuscular blocking agents, Anesthesiology, Intratracheal intubation, Colombia

Abstract

Objective: To establish the variability of vecuronium (lag-time, latency duration, clinical duration and complete recovery), original molecule, in a group of patients who received the agent prior to surgery under general anesthesia with endotracheal intubation.

Materials and methods: Observational, prospective study including 20 adult patients - ASA I or II classification - selected on the basis of suitability, who received general anesthesia and vecuronium as neuromuscular relaxant. Remifentanyl and propofol were the induction agents. The neuromuscular activity was quantified using a TOF-WATCH SX® stimulator, establishing lag-time, duration of latency, clinical duration and complete recovery. The data were analyzed using STATA 10.

Results:The data on lag-time to complete recovery are given as medians: lag-time: 32.5 seconds; latency time: 240 seconds; clinical length 25: 43.5 min; clinical length 50: 57.5 min; clinical length 75: 58.5 min; clinical length 100: 55 min; complete recovery: 87 min; need for reversion: 55%; adverse effects: none.

Conclusions: The results obtained suggest a broad variability between the time of administration of vecuronium, its clinical effect and duration of action, all of which were above the levels recorded in the literature. This suggests that the agent is long-acting and highly unpredictable. We recommend neuromuscular function monitoring as an indispensable routine and preferably quantitative.

References

1. Miller R. Pharmacology of muscle relaxants and their antagonist. En: Miller R, editor. Miller’s Anesthesia. 6.a ed. Filadelfia, Pensilvania: Elsevier; 2011.

2. Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599,548 anesthesias in ten institutions 1948-1952, inclusive. Ann Surg. 1954;140:2-35.

3. Bencini A, Newton DE. Rate of onset of good intubating conditions, respiratory depression and hand muscle paralysis after vecuronium. Br J Anaesth. 1984;56:959-65.

4. Fisher DM, Fahey MR, Cronnelly R, Miller RD. Potency determination for vecuronium (ORG NC45): comparison of cumulative and single-dose techniques. Anesthesiology. 1982;57:309-10.

5. Segredo V, Caldwell JE, Matthay MA, Sharma ML, Gruenke LD, Miller RD. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med. 1992;327:524-8.

6. Viby-Mogensen J. Why, how and when to monitor neuromuscular function. Minerva Anestesiol. 1999;65:239-44.

7. Viby-Mogensen J. Neuromuscular monitoring. Curr Opin Anaesthesiol. 2001;14:655-9.

8. Viby-Mogensen J, Claudius C, Eriksson LI. Neuromuscular monitoring and postoperative residual curarization. Br J Anaesth. 2007;99:297, author reply, 299.

9. Viby-Mogensen J, Claudius C. Evidence-based management of neuromuscular block. Anesth Analg. 2010;111:1-2.

10. Fahey MR, Morris RB, Miller RD, Nguyen TL, Upton RA. Pharmacokinetics of Org NC45 (Norcuron) in patients with and without renal failure. Br J Anaesth. 1981;53:1049-53.

11. Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology. 1991;74:833-7.

12. Fahey MR, Morris RB, Miller RD, Sohn YJ, Cronnelly R, Gencarelli P. Clinical pharmacology of ORG NC45 (NorcuronTM): a new nondepolarizing muscle relaxant. Anesthesiology. 1981;55:6-11.

13. Krieg N, Mazur L, Booij LH, Crul JF. Intubation conditions and reversibility of a new non-depolarizing neuromuscular blocking agent, Org-NC45. Acta Anaesthesiol Scand. 1980;24:423-5.

14. Miller RD, Rupp SM, Fisher DM, Cronnelly R, Fahey MR, Sohn YJ. Clinical pharmacology of vecuronium and atracurium. Anesthesiology. 1984;61:444-53.

15. Lebrault C, Berger JL, D’Hollander AA, Gomeni R, Henzel D, Duvaldestin P. Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC 45) in patients with cirrhosis. Anesthesiology. 1985;62:601-5.

16. Savage DS, Sleigh T, Carlyle I. The emergence of ORG NC 45, 1-[2 beta, 3 alpha, 5 alpha, 16 beta, 17 beta)-3, 17-bis(acetyloxy)-2-(1-piperidinyl)-androstan-16-yl]-1- methylpiperidinium bromide, from the pancuronium series. Br J Anaesth. 1980;52 Suppl 1:3S-9S.

17. Smith I, Saad RS. Comparison of intubating conditions after rocuronium or vecuronium when the timing of intubation is judged by clinical criteria. Br J Anaesth. 1998;80: 235-7.

18. Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the diaphragm, orbicularis oculi and adductor pollicis muscles. Can J Anaesth. 1990;37 4 Pt 2:S13.

19. Claudius C, Viby-Mogensen J. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence. Anesthesiology. 2008;108:1117-40.

20. Claudius C, Skovgaard LT, Viby-Mogensen J. Is the performance of acceleromyography improved with preload and normalization? A comparison with mechanomyography. Anesthesiology. 2009;110:1261-70.

21. Mortensen CR, Berg H, el-Mahdy A, Viby-Mogensen J. Perioperative monitoring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium. Acta Anaesthesiol Scand. 1995;39:797-801.

22. Cronnelly R, Fisher DM, Miller RD, Gencarelli P, Nguyen-Gruenke L, Castagnoli N. Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC45) and pancuronium in anesthetized humans. Anesthesiology. 1983;58:405-8.

23. Rivera Díaz RC, Rivera Díaz JS. Bloqueantes neuromusculares: en pro del uso adecuado. Rev Col Anest. 2011;39:352-7.

24. Datapharm Communications Ltd. The electronic Medicines Compendium. Merck Sharp and Dohme Limited [internet] [consultado Nov 2011]. Disponible en http://www.medicines.org.uk/emc/medicine/1398/SPC
How to Cite
1.
Reyes L, Muñoz L, Orozco D, Arias C, Vergel V, Valencia A. Clinical variability of vecuronium. Experience at an institution in Colombia. Colomb. J. Anesthesiol. [Internet]. 2012Oct.1 [cited 2021Jun.24];40(4):251–255. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/725

Downloads

Download data is not yet available.
Published
2012-10-01
How to Cite
1.
Reyes L, Muñoz L, Orozco D, Arias C, Vergel V, Valencia A. Clinical variability of vecuronium. Experience at an institution in Colombia. Colomb. J. Anesthesiol. [Internet]. 2012Oct.1 [cited 2021Jun.24];40(4):251–255. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/725
Section
Original

More on this topic