Do we need more muscle relaxants?

نویسندگان

  • R P Scott
  • J Norman
چکیده

In 1975 Savarese and Kitz [1] suggested that three new types of neuromuscular blocking drug were required. All should be non-depolarizing agents capable of antagonism and all should be free from cardiovascular side effects in therapeutic doses. The first type would replace suxamethonium, the second was to have a duration of action shorter than the competitive agents available at that time, and the third a longer action to replace pancu-ronium and tubocurarine. Since then two drugs, atracurium and vecuronium, have been introduced and have gained wide acceptance. It seems that we are about to be offered a further selection. Do we need the drugs on offer and do we still need further developments? Atracurium and vecuronium were developed and marketed as drugs of intermediate durations of action. They were tested thoroughly in animal preparations to ensure that the doses necessary to show vagolytic, sympathomimetic or ganglion blocking actions were well in excess of those needed to produce neuromuscular blockade. They exhibit remarkably similar durations of action in equipotent doses and these durations are less than those possessed by the competitive agents hitherto available. Atracurium achieves this by having the, so far unique, property of Hofmann degradation whereby it degrades spontaneously when warmed to body temperature and placed at physiological pH. The fact that one of the end products is laudanosine, which is a central nervous system excitant in high doses does not appear to be clinically important even with prolonged use in intensive care patients in renal failure [2]. The absence of significant prolongation of action in renal or liver disease is a significant advantage [3, 4]. One disadvantage may be the dose-related release of histamine seen on occasion, although this and the associated haemodynamic response may be attenuated simply by slowing the speed of injection [5, 6]. In contrast, the short duration of action of vecuronium appears to result from rapid uptake by the liver, with elimination mainly in the bile but also by the kidney [7]. Some prolongation of the action of vecuronium may be seen with renal failure, with obstructive jaundice and with cirrhosis, but the extent is usually much less than is seen with conventional doses of pan-curonium in healthy patients [8]. One additional problem is seen with both drugs. Neither shows vagolytic actions nor has sympathomimetic properties. Thus when they are used with opioids, with volatile agents such as halothane or when anaesthesia is insufficiently …

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عنوان ژورنال:
  • British journal of anaesthesia

دوره 61 5  شماره 

صفحات  -

تاریخ انتشار 1988