Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000400002
Brazilian Journal of Anesthesiology
Scientific Article

Efeito do priming na redução da latência do pipecurônio, novo bloqueador neuromuscular não-despolarizante

Effect of priming in shortening onset of pipecuronium, a new nondepolarizing neuromuscular blocker

José Carlos Canga; Carlos Neutzling Lehn; Deoclécio Tonelli; Paula de Camargo Neves Sacco; Danielle Beltrão; Marcelo Kirsch; Fernando César Serralheiro; Gustavo Cimerman

http://dx.doi.org/10.1590/S0034-70942005000400002 Braz J Anesthesiol, vol.55, n4, p.381-386, 2005
PDF Português
PDF English
Downloads: 0
Views: 1041

Resumo

JUSTIFICATIVA E OBJETIVOS: Uma das mais importantes propriedades dos bloqueadores neuromusculares é o rápido início de ação, possibilitando intubação traqueal precoce. A administração de pequena dose de bloqueador não-despolarizante antes da dose plena é sabidamente redutora da latência da maioria dos bloqueadores neuromusculares utilizados. O brometo de pipecurônio é um agente aminoesteróide de longa duração com grande estabilidade cardiovascular, porém, com início de ação tardio. O objetivo desse estudo foi avaliar o efeito do priming do pipecurônio em pacientes adultos submetidos a cirurgias eletivas sob anestesia geral. MÉTODO: Foram estudados 33 pacientes adultos de ambos os sexos, com idade entre 20 e 65 anos, estado físico ASA I ou II, submetidos a cirurgias eletivas sob anestesia geral. Foram excluídos do estudo pacientes com insuficiência renal ou hepática, neuromiopatia, uso concomitante de drogas que influenciem a sua farmacocinética ou pacientes com histórico familiar de hipertermia maligna. Foram divididos em dois grupos: Grupo 1 onde foi utilizado o priming com 0,01 mg.kg-1 e três minutos depois completada a dose de 0,08 mg.kg-1 e o Grupo 2, sem dose priming (Grupo Controle). O relaxamento neuromuscular foi controlado pela aceleromiografia (Aparelho TOF-Guard) e no momento em que T1 < 10% era realizada a laringoscopia. A análise estatística foi feita pelos testes T para amostras independentes e a normalidade pelo Shapiro Wilks. RESULTADOS: Os grupos foram homogêneos e observou-se que o tempo para T1 < 10% no Grupo 1 foi de 161,4 ± 13,7 segundos e no Grupo 2 foi 217,8 ± 23,4 segundos, com p < 0,001, havendo diferença estatística significativa entre os grupos. CONCLUSÕES: Os resultados do estudo mostraram diferença estatística significativa entre os grupos com e sem priming, indicando que o pipecurônio também tem latência reduzida, assim como os demais bloqueadores neuromusculares conhecidos.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, BLOQUEADORES NEUROMUSCULARES

Abstract

BACKGROUND AND OBJECTIVES: One of the most important neuromuscular blockers property is short onset, allowing early tracheal intubation. Low nondepolarizing blocker dose before the full dose is known to decrease the onset of most neuromuscular blockers. Pipecuronium bromide is a long-lasting aminosteroid with major cardiovascular stability, however, with late onset. This study aimed at evaluating pipecuronium priming effect in adult patients submitted to elective surgeries under general anesthesia. METHODS: Participated in this study 33 adult patients of both genders, aged 20 to 65 years, physical status ASA I or II, to be submitted to elective surgeries under general anesthesia. Exclusion criteria were patients with kidney or liver failure, neuromuscular diseases, in concurrent use of drugs influencing pipecuronium pharmacokinetics, and patients with family history of malignant hyperthermia. Patients were divided in 2 groups: Group 1 = priming with 0.01 mg.kg-1 and 3 minutes later the remaining 0.07 mg.kg-1 (total 0.08 mg.kg-1); Group 2 = no priming dose (group control). Neuromuscular relaxation was controlled by acceleromyography (TOF-Guard device) and laryngoscopy was accomplished when T1 < 10%. T test for independent samples was used for statistical analysis and Shapiro Wilks was used to test normality. RESULTS: Groups were homogeneous. Time for T1 < 10% was 161.4 ± 13.7 seconds for Group 1 and 217.8 ± 23.4 seconds for Group 2, with p < 0.001 and statistically significant differences between groups. CONCLUSIONS: Our results have shown statistically significant differences between groups with and without priming, indicating that pipecuronium also has its onset decreased, similarly to other known neuromuscular blockers.

Keywords

NEUROMUSCULAR BLOCKERS, NEUROMUSCULAR BLOCKERS

References

Foldes FF. Rapid tracheal intubation with non-depolarizing neuromuscular blocking drugs: the priming principle. Br J Anaesth. 1984;56:663.

Rathmell JP, Brooker RF, Prielipp RC. Hemodynamic and pharmacodynamic comparison of doxacurium and pipecuronium with pancuronium during induction of cardiac anesthesia: does the benefit justify the cost?. Anesth Analg. 1993;76:513-519.

Boros M, Szenohradszky J, Kertesz A. Clinical experiences with pipecuronium bromide. Acta Chir Hung. 1983;24:207-214.

Larijani GE, Bartkowski RR, Azad SS. Clinical pharmacology of pipecuronium bromide. Anesth Analg. 1989;68:734-739.

Schwarz S, Ilias W, Lackner F. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology. 1985;62:388-391.

Wierda JM, Karliczek GF, Pinto I. Pharmacokinetics and cardiovascular dynamics of pipecuronium bromide during coronary artery surgery. Can J Anaesth. 1990;37:183-191.

Agoston S, Richardson FJ. Pipecuronium bromide (Arduan): a new long action non-depolarizing neuromuscular blocking drug. Clin Anaesthesiol. 1985;3:361-369.

Mirakhur RK, Lavery GG, Gibson FM. Intubating conditions after vecuronium and atracurium given in divided doses: the priming technique. Acta Anaesthesiol Scand. 1986;30:347-350.

Donati F, Lahoud J, Walsh CM. Onset of pancuronium and d-tubocurarine blockade with priming. Can Anaesth Soc J. 1986;30:347-350.

Naguib M, Abdulatif M, Gyasi HK. Priming whith atracurium: improving intubating conditions with additional thiopental. Anesth Analg. 1986;65:1295-1299.

Puhringer FK, Mitterschiffthaler G, Khuenl-Brady KS. The onset of pipecuronium following application of the priming principle. Eur J Anaesthesiol. 1996;13:478-482.

Swen J, Rashkovsky OM, Ket J. Interactions between nondepolarizing neuromuscular blocking agents and inhalational anesthetics. Anesth Analg. 1989;69:752-755.

Paton WD, Waud DR. The margin of safety of neuromuscular transmission. J Physiol. 1967;191:59-90.

Atherton DP, Hunter JM. Clinical pharmacokinetics of the newer neuromuscular blocking drugs. Clin Pharmacokinet. 1999;36:169-189.

Meretoja OA, Erkola O. Pipecuronium revisited: dose-response and maintenance requirement in infants, children, and adults. J Clin Anesth. 1997;9:125-129.

5dd6e4fb0e8825e83f13f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections