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Anesth Analg 1983; 62:909-913
© 1983 International Anesthesia Research Society
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Succinylcholine–Vecuronium (Org NC 45) Sequence for Cesarean Section

Anis Baraka, MD, R. Noueihed, MD, H. Sinno, MD, N. Wakid, PhD, and S. Agoston, MD, PhD

Departments of Anesthesiology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon; and the Institute of Anesthesiology and Clinical Pharmacology, State University of Groningen, The Netherlands.

Abstract

Vecuronium (Org NC 45) was used in 27 parturients undergoing elective cesarean section under general anesthesia. One of the parturients had a twin pregnancy. Neuromuscular transmission was assessed clinically by stimulating the ulnar nerve and observing the contraction of the fingers. An initial bolus of 0.05 mg·kg–1 of vecuronium was injected after recovery from succinylcholine block. Complete neuromuscular block resulted in all cases and lasted for a mean duration of 19.3 ± 6.02 min. Muscular relaxation was maintained by incremental doses of 0.01 mg·kg–1 of vecuronium. Administration of vecuronium did not cause significant changes in blood pressure, pulse rate, or plasma cholinesterase activity. Also, there was no correlation between the plasma cholinesterase activity and the duration of neuromuscular block of vecuronium. The residual neuromuscular block could be antagonized at the end of the procedure by a mixture of 0.005 mg·kg–1 of glycopyrrolate and 0.025 mg·kg–1 of neostigmine. In all parturients, antagonism was adequate as evidenced by maintained tetanic response (50 Hz for 5 sec) and sustained head lift. Nine infants were delivered before the injection of vecuronium; 19 infants were delivered after its injection. There was no significant difference between the Apgar scores in the two groups, suggesting that vecuronium does not cross the placenta in concentrations that affect the newborn. Vecuronium may be advantageous in parturients undergoing cesarean section under general anesthesia because it maintains cardiovascular stability, is noncumulative, is readily antagonized by neostigmine, has no effect on the plasma cholinesterase activity, and has no deleterious effect on the newborn.

Key Words: NEUROMUSCULAR RELAXANTS: vecuronium • ANESTHESIA, Obstetric






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1983 by the International Anesthesia Research Society.