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ANESTHETIC PHARMACOLOGY

The Dose Effect of Ephedrine on the Onset Time of Vecuronium

Department of Anesthesiology, Hanyang University Hospital, Seoul, Korea

Address correspondence and reprint requests to Kyo Sang Kim, MD, PhD, Department of Anesthesiology, Hanyang University Hospital, #17 Haengdang dong, Sungdong gu, Seoul 133-792, Korea. Address e-mail to kimks{at}hanyang.ac.kr

A small dose of ephedrine decreases the onset time of rocuronium and cisatracurium; however, ephedrine might be associated with adverse hemodynamic effects. The appropriate dose of ephedrine has not been determined. We, therefore, studied 120 patients anesthetized with fentanyl 2 µg/kg and propofol 2–2.5 mg/kg who were randomly divided to receive either ephedrine (30, 70, or 110 µg/kg) or saline. During propofol anesthesia, the neuromuscular block was monitored by mechanomyography by using submaximal current of train-of-four stimulation every 10 s. To determine cardiac output, a transcutaneous Doppler probe was placed externally at the suprasternal notch. Tracheal intubation was performed by a blinded investigator at 2 min after vecuronium. Neuromuscular block, intubating conditions, and hemodynamic effects were measured during the induction of anesthesia. Both ephedrine 70 and 110 µg/kg improved intubating conditions at 2 min after vecuronium; however, 110 µg/kg was associated with adverse hemodynamic effects. We conclude that ephedrine 70 µg/kg given before the induction of anesthesia improved intubating conditions at 2 min after vecuronium, probably by increased cardiac output without significant adverse hemodynamic effects.

IMPLICATIONS:Ephedrine 70 µg/kg given before the induction of anesthesia improved tracheal intubating conditions at 2 min after vecuronium by increased cardiac output without significant adverse hemodynamic effects.

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