SCULAR BLOCK INDUCED BY ROCURONIO AND VECURONIO

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Acta Medica Mediterranea, 2009, 25: 105
ANTAGONIZATION ACTION OF THE NEOSTIGMINE IN THE INVERSION OF THE NEUROMUSCULAR BLOCK INDUCED BY ROCURONIO AND VECURONIO
MARIA GRAZIA BAGLIERI - FLAVIO VINCENZO EVANDRO RUSSO - AGOSTINO MESSINA - RITA AZZOLINA
University of Catania - Department of Medical Biology Chemistry and Molecular Biology - Reanimation and Anaesthesia Section
(Head: Prof.ssa Rita Azzolina)
[Azione antagonizzante della neostigmina nell’inversione del blocco neuromuscolare indotto da rocuronio e vecuronio]
SUMMARY
RIASSUNTO
The scope of our study is one that puts and confronts the
antagonism of the neostigmine in association to the atropine
sulphate, in the neuromuscular block induced by the rocuronio
and vecuronio.
We have studied 8 patients, sub divided in 2 groups: the
patients whether the first or second group,have been given
rocuronio or vecuronio in different doses and with antagonists
neostigmine and atropine sulphate.
It has been proven that the median amount of time necessary to antagonize the muscular relaxation, induced by rocuronio, is modestly less than that of the vecuronio and therefore it
can be concluded that these myorelants can be used in alternative ways for practical anaesthesiology.
Lo scopo del nostro studio è quello di mettere a confronto l’azione antagonizzante della neostigmina, in associazione
all’atropina solfato, nel blocco neuromuscolare indotto da
rocuronio e da vecuronio.
Abbiamo valutato 8 pazienti, suddivisi in 2 gruppi: ai
pazienti, sia del primo che del secondo gruppo, è stato somministrato rocuronio o vecuronio a dosi differenti e come antagonista l’associazione neostigmina e atropina solfato.
È stato evidenziato che la mediana (minuti) del tempo
necessario per antagonizzare il rilassamento muscolare, indotto
da rocuronio, è modestamente inferiore a quella del vecuronio e
pertanto si può concludere che questi miorilassanti si possono
utizzare in modo alternativo nella pratica anestesiologica.
Key words: neuromuscular block, rocuronio, vecuronio, antagonism action, neostigmine
Introduction
The rocuronio and vecuronio, blocking neuromuscular non depolarized, and during intermediate
action, determine a muscular paralysis, interacting
with the nicotinic receptors of the motor plate, act inhibiting the connection of the Ach and same receptor.
Treated by molecules of great dimension,
otherwise polar and inactive by oral means, therefore are administered by intravenous injection, so
they don’t surpass the hematoencephalic barrier,
don’t have effects on the SNC and conciousness
remains integrated; so in the patients treated with
the above cures, have also been administered inhaled anaesthetic, intravenous injection or sedatives to
avoid the unpleasant sensation of being curarized.
The muscular relaxation is determined by
improving surgical conditions and the ease of endotracheal tubes and mechanical ventilation.
The rocuronio and the vecuronio become eliminated across the bilary via or the metabolism
hepatic; it’s important to adjust the administered
doses, taking account that some pharmaceuticals
Parole chiave: blocco neuromuscolare, rocuronio, vecuronio,
azione antagonizzante, neostigmina
(inhaled and local anaesthetics, aminoglutetimide
antibiotics, beta blockers, diuretics and corticosteroids) and particular conditions of patients (wilks’
syndrome, hepatic or renal insufficiency metabolic
acidosis, old age) can increase the entity and the
duration of paralysis or unfavourable results.
The neostigmine and the anticolinesterasic
most commonly used to antagonize the neuromuscular block, determined by a non depolarizant like
rocuronio or vecuronio, allowing in brief time the
refreshing of muscular activity and the refreshing of
spontaneous respiration; the effect lasted for 20-30
minutes from intravenous injection and it can therefore be necessary for a second dose.
The administration of atropine sulphate, previous and contemporary to the neostigmine avoids
bradycardia, sialorrhoea and other muscarinic
effects induced by the neostigmine.
Clinical cases
We have studied eight adult patients for this
study with an age between 20 and 50 years.
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The people selected must have had a surgical
operation relating to superior abdominal surgery.
We divided the patients into two groups, each
one four people, two males and two females.
The first group of two patients were administered with a dose of rocuronio 0,6 mg/kg e.v. and
the other two with a dose of vecuronio at 0,1mg/kg
e.v., to allow the intubation, both followed by constant infusion maintaining doses of 12mcg bromuro
rocuronio/kg or 2mcg bromuro vecuronio/kg by
body weight when necessary.
After the last dose of rocuronio or vecuronio
when 1-2 PTC (post tetanic counts) after neuromuscular stimulation (deep block) patients have been
treated with neostigmine 70mcg/kg by bodyweight
and atropine sulphate 0,01 mg/kg by intravenous
injection.
In the second group we have administered
standard intubation doses of rocuronio to two
patients and vecuronio to the other two, both followed by constant infusion maintaining doses of
8mcg bromuro rocuronio/kg or 0,8mcg bromuro
vecuronio/kg by bodyweight.
After the last dose of rocuronio or vecuronio
when the second contraction appeared (T2) in a
TOF stimulation( moderate block) we have administered the patients 50mcg/kg by bodyweight of neostigmine and 0,01mg/kg of atropine sulphate.
As a consequence, advantages derived by the
administration of rocuronio relating to vecuronio,
are nearly irrelevant and these lissive steroids can
be alternatively used in the anestesiological practice
above all if you consider the same are similar under
pharmacokinetic profile for what regards timed
action (20-35 min), the via of elimination (liver 7590% and kidneys) and cardiovascular stability.
Results
References
In the first group the median (minutes) of
necessary time to antagonize the muscular relaxation until a rapport of TOF equal to 0,9 has been of
49 minutes for rocuronio and of 49,9 minutes for
vecuronio.
In the second group the median of necessary
time to antagonize the muscular relaxation until a
rapport of TOF equal to 0,9 has been of 17,6 minutes for rocuronio and 18,9 minutes for vecuronio.
1)
Debate
From the obtained results related to the above
study the median necessary to antagonize muscular
relaxation, induced by rocuronio until a rapport of
TOF equal to 0,9 has been demonstrated to be modestly inferior than relative to the vecuronio: 49,0
minutes and 17,6 minutes for rocuronio, respectively
in deep block and in a moderate one, against 49,9
minutes and 18,9 minutes for vecuronio, even using
the same antagonizing therapeutic scheme.
Conclusions
It’s well known that the neostigmine is actually the most efficient in antagonizing the effects of
the superior parts of the non depolarizant neuromuscular blocking.
Recently the the european commission approved a new drug the “sugammadex” that acts in a
completely innovative way, incapsule the myorelaxant molecule, rocuronio or vecuronio, is inactive
allowing to antagonize the muscular relaxation in 23 minutes, whether moderate or deep.
The use of the above mentioned drug, in
respect to the actual antagonists available, neostigmine associated with atropine solfate, could improve the conditions of safety in operating theatres in
the case of frequent administration of rocuronio or
vecuronio, favouring a quicker recovery of the
patients functions.
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2)
De Boer HD, Driessen JJ, Van Egmond J, Booij LHDJ.
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Anesth, February 1, 2008; 55(2): 124-125
3)
Eikermann M, Zaremba S, Malhotra A, Jordan AS,
Rosow C, Chamberlin L. Neostigmine but not sugammadex impairs upper airway dilator muscle activity
and breathing. Br. J. Anaesth., September 1, 2008;
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Hunter JM, Atherton DP. Clinical pharmacokinetics of
the newer neuromuscular blocking drugs. Clin
Pharmacokinet 1999; 36: 169
5)
Kopman AF, Yee PS, Neuman GG. Relationship of the
train of four fade ratio to clinical signs and symptoms
of residual paralysis in awake volunteers. Anesthesiology 86: 765-771. 1997
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