The title compound, C(21)H(33)BrO(3), an inter-mediate in the synthesis of the neuromuscular blocking agent rocuronium bromide, contains two independent mol-ecules in the asymmetric unit, which have almost identical geometries: in both mol-ecules, the steroidal rings A, B and C have slightly flattened chair conformations and ring D assumes a half-chair conformation. In the crystal, O-H⋯O hydrog...

EVIDENCE DEFINITIONS  Class I: Prospective randomized controlled trial.  Class II: Prospective clinical study or retrospective analysis of reliable data. Includes observational, cohort, prevalence, or case control studies.  Class III: Retrospective study. Includes database or registry reviews, large series of case reports, expert opinion.  Technology assessment: A technology study which doe...

The pharmacodynamics and pharmacokinetics of the two most recent aminosteroid neuromuscular blocking drugs to become available, rapacuronium bromide (Org 9487) and rocuronium bromide are reviewed. Two new classes of drug with neuromuscular blocking properties, the bis-tetrahydroisoquinolinium chlorofumarates and the tropinyl diester derivatives are introduced. Comparisons between these drugs an...

GANGLIONIC blockade was first used to produce controlled hypotension during surgery by Scurr (1951). This technique has since become generally accepted in anaesthetic practice. Ganglion blocking drugs now available include the methonium compounds and the short acting agents trimetaphan and homatropinium (Trophenium). There is no doubt that these drugs act selectively on the sympathetic ganglia,...

The onset characteristics of pancuronium, tubocurarine and a mixture of these two neuromuscular blocking drugs were studied during the induction of neuromuscular blockade, using a train-of-four pattern of stimulation. Four characteristics of onset were defined: train-of-four fade = a reduction in the height of the fourth twitch greater than a reduction in the height of the first twitch; latent ...

In an open sequential pharmacodynamic study in 40 patients, the rate of onset of neuromuscular blockade using tubocurarine or vecuronium was measured. Comparison was made between groups of 10 patients who received thiopentone followed by either blocker and a "reverse" sequence where the blocker was injected before thiopentone. There was a small difference between groups, amounting to a few seco...

GANGLIONIC blockade was first used to produce controlled hypotension during surgery by Scurr (1951). This technique has since become generally accepted in anaesthetic practice. Ganglion blocking drugs now available include the methonium compounds and the short acting agents trimetaphan and homatropinium (Trophenium). There is no doubt that these drugs act selectively on the sympathetic ganglia,...

The literature (2012-4) describing experimental pig surgery was reviewed to estimate the extent to which neuromuscular block (NMB) is used, to examine methods for ensuring unconsciousness, and to identify the rationale for use of NMB and establish the anaesthetist's training. In the first stage of a two-stage review, NMB use was estimated using Web of Knowledge to identify articles describing N...

The effects on neuromuscular blockade by d-tubocurarine and succinylcholine of inhibition of prostaglandin biosynthesis by indomethacin and of intra-arterial administration of prostoglandins E2 and F2 alpha, before and after inhibition of prostoglandin biosynthesis, were evaluated in the cat sciatic-tibialis preparation. Non-specific inhibition of prostaglandin biosynthesis by indomethacin 3 mg...

Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. The clinical indications for ECT as an effective therapeutic modality have been considerably expanded since its introduction. Anaesthesia and neuromuscular blocking agents (NMBAs) are required to ensure pat...