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Dose-Response Relation and Time Course of Action of Pipecuronium Bromide in Humans Anesthetized with Nitrous Oxide and Isoflurane, Halothane, or Droperidol and Fentanyl

Research Group of the Institutes for Experimental Anesthesiology and Clinical Pharmacology, University of Groningen, The Netherlands.

Abstract

The dose-response relation of pipecuronium bromide, the time course of its neuromuscular blocking effects, and the reversibility of the residual block by neostigmine and edrophonium have been investigated in patients undergoing various types of anesthesia. The estimated doses of pipecuronium required for 95% depression of the twitch height were 44.6, 46.9, and 48.7 figkg^–1 during anesthesia with nitrous oxide (65%) and isoflurane (group 1), halothane (group 2), or droperidol/fentanyl (group 3), respectively.

The potentiating effects of the volatile anesthetics were reflected by the significant prolongation of the duration of both initial (50.0 ± 4.3, 36.0 ± 3.3, and 29.0 ± 2.0 minutes) and maintenance doses (56.0 ± 2.5, 49.5 ± 3.3, and 41.2 ± 1.6 minutes) of pipecuronium during anesthesia with nitrous oxide and isoflurane, halothane, or droperidol! fentanyl, respectively. Both edrophonium chloride (0.5 mg-kg^–1) and neostigmine methylsulphate (40 Hgkg^–1) promptly reversed the residual block induced by pipecuronium. No side effects attributable to pipecuronium were seen in this study.

Key Words: ANESTHETICS, INTRAVENOUS—fentanyl, droperidol • ANESTHETICS, VOLATILE—halothane, isoflurane • NEUROMUSCULAR RELAXANTS, PIPECURONIUM

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