Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000100006
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos hemodinâmicos do atracúrio e do cisatracúrio e o uso de difenidramina e cimetidina

Hemodynamic effects of atracurium and cisatracurium and the use of diphenhydramine and cimetidine

Claudia Maria Nogueira Correa; Gisele Zapata Sudo; Roberto Takashi Sudo

http://dx.doi.org/10.1590/S0034-70942010000100006 Braz J Anesthesiol, vol.60, n1, p.52-63, 2010
PDF Português
PDF English
Downloads: 0
Views: 1735

Resumo

JUSTIFICATIVA E OBJETIVOS: Haja visto que atracúrio pode causar hipotensão arterial no homem, investigaram-se os efeitos hemodinâmicos promovidos pelo atracúrio e pelo cisatracúrio e a proteção hemodinâmica conferida pela difenidramina e cimetidina em ratos. MÉTODO: 1) Ratos Wistar anestesiados com pentobarbital sódico e preparados de acordo com Brown e col. para avaliar doses de atracúrio e cisatracúrio para redução de T4/T1 da sequência de quatro estímulos maior ou igual a 95%. 2) Avaliação das alterações hemodinâmicas de atracúrio e cisatracúrio por injeção venosa, medindo-se a pressão arterial sistêmica da artéria carótida e eletrocardiograma de ratos. 3) Observação de proteção hemodinâmica pelo tratamento prévio com difenidramina (2 mg.kg-1) e/ou cimetidina (4 mg.kg-1) por injeção venosa. Análise estatística: teste t de Student, ANOVA. RESULTADOS: O atracúrio e o cisatracúrio não modificaram a pressão arterial média (PAM) nas doses de 1 mg.kg-1 e 0,25 mg.kg-1, respectivamente. Doses de 4 mg.kg-1 promoveram diminuição da PAM de 62,8 ± 4,5% do controle para o atracúrio, e de 82,5 ± 2,3% do controle para o cisatracúrio. Com difenidramina e cimetidina, a pressão sistólica diminuiu 95,4 ± 2,5% do controle. Com cimetidina, pressão diastólica diminuiu 82,7 ± 8,4% do controle. O efeito conjunto sobre as pressões sistólica e diastólica refletiu-se nos valores observados da PAM. CONCLUSÕES: A difenidramina e a cimetidina, isoladamente, não impediram a diminuição da pressão arterial média induzida pelo atracúrio. No entanto, associação destes dois fármacos foi eficaz na prevenção dos efeitos hemodinâmicos induzidos pelo atracúrio. O cisatracúrio nas doses do experimento não promoveu diminuição da pressão arterial que justificasse as medidas preventivas aplicadas nos grupos onde se utilizou o atracúrio.

Palavras-chave

ANIMAIS, BLOQUEADORES NEUROMUSCULARES: Não despolarizante, BLOQUEADORES NEUROMUSCULARES: Não despolarizante, DROGAS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Since atracurium can cause hypotension in humans, the hemodynamic effects of atracurium and cisatracurium as well as the hemodynamic protection of diphenhydramine and cimetidine were investigated in rats. METHODS: 1) Wistar rats were anesthetized with sodium pentobarbital and prepared according to Brown et al. to evaluate different doses of atracurium and cisatracurium in the reduction of T4/T1 equal or greater than 95%. 2) Assessment of the hemodynamic changes caused by the intravenous administration of atracurium and cisatracurium by monitoring the blood pressure in the carotid artery and the electrocardiogram of rats. 3) Observation of the hemodynamic protection of prior treatment with the intravenous administration of diphenhydramine (2 mg.kg-1) and/or cimetidine (4 mg.kg-1). Statistical analysis: Student t test and ANOVA. RESULTS: Doses of 1 mg.kg-1 and 0.25 mg.kg-1 of atracurium and cisatracurium respectively did not change the mean arterial pressure (MAP). Doses of 4 mg.kg-1 of atracurium and cisatracurium decreased MAP to 62.8 ± 4.5% and 82.5 ± 2.3% respectively when compared to control levels. When the rats were pre-treated with diphenhydramine and cimetidine, diastolic pressure was reduced to 95.4% ± 2.5%. With cimetidine, diastolic pressure was reduced to 82.7 ± 8.4% when compared to the control group. The effects on systolic and diastolic blood pressure were reflected in the levels of MAP. CONCLUSIONS: The isolated administration of diphenhydramine and cimetidine did not prevent the reduction in mean arterial pressure induced by atracurium. However, the association of both drugs was able to prevent the hemodynamic effects of atracurium. The doses of cisatracurium used in this study did not cause a reduction in blood pressure significant enough to justify the use of the preventive measures used in the atracurium groups.

Keywords

ANIMALS, DRUGS, DRUGS, NEUROMUSCULAR BLOCKERS, Non-depolarizing

References

Mertes PM, Laxenaire MC. Allergy and anaphylaxis in anaesthesia. Minerva Anestesiol. 2004;70:285-291.

Heier T, Guttormsen AB. Anaphylatic reactions during induction of anaesthesia using rocuronium for muscle relaxation: a report including 3 cases. Acta Anaesthesiol Scand. 2000;44:775-781.

Toh KW, Deacoch SJ, Fawcett WJ. Severe anaphylactic reaction to cisatracurium. Anesth Analg. 1999;88:462-464.

Basta SJ, Savarese JJ, Ali HH. Histamine-releasing potencies of atracurium, dimethyl tubocurarine and tubocurarine. Br J Anaesth. 1983;55:105s-106s.

Lien CA, Belmont MR, Abalos A. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid barbiturate anesthesia. Anesthesiology. 1995;82:1131-1138.

Wastila WB, Maehr RB, Turner GL. Comparative pharmacology of cisatracurium (51W89), atracurium, and five isomers in cats. Anesthesiology. 1996;85:169-177.

Hosking MP, Lennon RL, Gronert GA. Combined H1 and H2 blockade attenuates the cardiovascular effects of high dose atracurium in rabbits. Life Sci. 1989;44:347-353.

Hosking MP, Lennon RL, Gronert GA. Combined H1 and H2 receptor blockade attenuates the cardiovascular effects of high dose atracurium for rapid sequence endotracheal intubation. Anesth Analg. 1988;67:1089-1092.

Brown GL, Dale HH, Feldberg W. Reactions of the normal mammalian muscle to acetylcholine and to eserine. J Physiol (London). 1936;87:394-424.

Ali HH, Savarese JJ. Monitoring of neuromuscular function. Anesthesiology. 1976;45:216-249.

Ali HH, Savarese JJ, Lebowitz PW. Twitch, tetanus and trainof- four as indices of recovery from nondepolarizing neuromuscular blockade. Anesthesiology. 1981;54:294-297.

Waud BE, Waud DR. The relation between the response to "train-offour" stimulation and receptor occlusion during competitive neuromuscular block. Anesthesiology. 1972;37:413-416.

Belmont MR, Maehr RB, Wastila WB. Pharmacodynamics and pharmacokinetics of benzylisoquinolinium (curare-like) neuromuscular blocking drugs. Anesthesiol Clin North America. 1993;11:251-281.

Stellato C, de Paulis A, Cirillo R. Heterogeneity of human mast cells and basophils in response to muscle relaxants. Anesthesiology. 1991;74:1078-1086.

Moss J, Rosow CE. Histamine release by narcotics and muscle relaxants in humans. Anesthesiology. 1983;59:330-339.

Moss J, Rosow CE, Savarese JJ. Role of histamine in the hypotensive action of d-tubocurarine in humans. Anesthesiology. 1981;55:19-25.

Marone G, Stellato C, Mastronardi P. Mechanisms of activation of human mast cells and basophils by general anesthetic drugs. Ann Fr Anesth Reanim. 1993;12:116-125.

Inada E, Philbin DM, Machaj V. Histamine antagonists and dtubocurarine induced hypotension in cardiac surgical patients. Clin Pharmacol Ther. 1986;40:575-580.

Jooste E, Zhang Y, Emala CW. Neuromuscular blocking agents differential bronchoconstrictive potential in Guinea pig airways. Anesthesiology. 2007;106:763-772.

Toda N, Konishi M, Miyazaki M. Involvement of endogenous prostaglandin I2 in the vascular action of histamine in dogs. J Pharmacol Exp Ther. 1982;223:257-262.

Tayo F. Role of the endothelium and smooth muscle tone in the dilator response of the rabbit coeliac artery to histamine. J Pharm Pharmacol. 1991;43:396-400.

Elbradie S. Neuromuscular efficacy and histamine-release hemodynamic changes produced by rocuronium versus atracurium: a comparative study. J Egypt Natl Canc Inst. 2004;16:107-113.

Orzechowski RF, Currie DS, Valancius CA. Comparative anticholinergic activities of 10 histamine H1 receptor antagonists in two functional models. Eur J Pharmacol. 2005;506:257-264.

5dd2f0330e8825a655c63494 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