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ANESTHETIC PHARMACOLOGY

Duration of Action of Vecuronium After an Intubating Dose of Rapacuronium, Vecuronium, or Succinylcholine

Tong J. Gan, MB, FRCA, FFARCS (I)^*, Raman Madan, MB, FRCA, FFARCS (I)^*, Ratan Alexander, MB, FRCA^*, Rajiv Jhaveri, MB, FRCA^*, Habib El-Moalem, PhD^*, Kevin Weatherwax, BS, CCRC^*, and Peter S. A. Glass, MB, FFA (SA)

*Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and University Medical Center at Stony Brook, Department of Anesthesiology Health Sciences Center, Stony Brook, New York

Address correspondence and reprint requests to T. J. Gan, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to gan00001{at}mc.duke.edu

Rapacuronium (RAP) is a new, rapid-onset, short-duration, nondepolarizing neuromuscular blocker. If RAP is used to facilitate endotracheal intubation, what will the duration of a subsequent maintenance dose of vecuronium (VEC) be? We investigated the duration of action of a maintenance dose of VEC after intubation with RAP, VEC, or succinylcholine (SUC). Adult surgical patients under general anesthesia were randomly allocated to receive a tracheal intubating dose of RAP 1.5 mg/kg, VEC 0.1 mg/kg, or SUC 1 mg/kg. The anesthetic was induced with propofol and maintained with propofol, nitrous oxide, and oxygen. Neuromuscular function was monitored with electromyography. Recovery of the intubating dose of neuromuscular blocker was allowed to occur spontaneously until the first twitch of the train-of-four (T1) reached 50% of baseline, and then VEC 0.025 mg/kg (0.5 x 95% effective dose [ED₉₅]) was administered. The onset, duration, and recovery to T1 = 25% and 50% were recorded. The durations of action (recovery of T1 25%) after intubating doses of RAP, VEC, and SUC were 13.7 ± 5.3, 43.2 ± 13.2, and 9.2 ± 3.7 min (mean ± SD), respectively (P < 0.0001). The times to maximum depression of T1 after a maintenance dose of VEC (0.5 x ED₉₅) were 5.4 ± 2.9, 5.1 ± 2.5, and 5.3 ± 2.8 min (mean ± SD) for the RAP, VEC, and SUC groups, respectively. Recoveries to T1 25% after VEC for the RAP, VEC, and SUC groups were 18.9 ± 11.5, 21.5 ± 8.03, and 12.8 ± 8.4 min, and at T1 50% they were 21.5 ± 9.1, 30.8 ± 9.5, and 15.5 ± 9.7 min (mean ± SD), respectively (P < 0.001, RAP and VEC versus SUC). The duration of action of a maintenance dose of VEC was similar after an intubating dose of RAP or VEC but was shortened when preceded by an intubating dose of SUC.

Implications: The duration of action of a maintenance dose of vecuronium was longer after an endotracheal intubating dose of rapacuronium compared with succinylcholine.

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