British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical comparison of atracurium and vecuronium (Org NC 45).
The potency, histamine releasing ability, cardiovascular effects, and pharmacodynamics of vecuronium and atracurium were investigated in 64 healthy patients following administration i.v. Cumulative dose-response curves showed vecuronium to be 4.4 times as potent as atracurium. Using the calculated ED90 of each drug (43 micrograms kg-1 for vecuronium and 188 micrograms kg-1 for atracurium), vecuronium had a significantly more rapid onset time and shorter duration of action than atracurium. ⋯ There was no clinical evidence of histamine release during the study. No clinically significant changes in arterial pressure or heart rate were seen after the injection of either drug, although vecuronium caused a statistically significant decrease in heart rate (approximately 5%) at 5 and 10 min after administration. Both drugs would appear to have certain advantages over existing non-depolarizing neuromuscular blocking drugs.
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Org NC 45, a new non-depolarizing neuromuscular blocking drug, was evaluated in 200 adult patients. The drug was administered in doses of 0.1, 0.15 or 0.2 mg kg-1. ⋯ The duration of clinical relaxation following repeated administration of 2-3 mg was remarkably constant (between 17 and 20 min) thus showing lack of cumulation. The antagonism of residual block was prompt and easy following administration of neostigmine, and the drug lacked any significant cardiovascular effects as seen by routine monitoring.
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Comparative Study Clinical Trial Controlled Clinical Trial
Muscular relaxation with atracurium, vecuronium and duador under balanced anaesthesia.
The neuromuscular effects of three new nondepolarizing neuromuscular blocking drugs, atracurium, vecuronium and Duador, were investigated in surgical patients under balanced anaesthesia. (The numbers of patients in each study are given in the tables.) There were no significant differences in the neuromuscular effects of the three agents. None showed any cumulation after repeated administration of maintenance doses. Muscular relaxation for upper abdominal surgery was adequate as long as the isometric twitch tension (P) was no more than 25% of control. ⋯ The initial dose of Duador caused a 16.7% increase in heart rate. The findings indicate that the three new muscle relaxants merit further clinical trial. In our opinion, until the results of such studies become available, atracurium should not be used in patients with a history of allergic diathesis and Duador in those in whom increased heart rate may be harmful.
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Conditions for endotracheal intubation provided by different dose regimens of atracurium 0.4 mg kg-1 and 0.5 mg kg-1 were studied and compared with each other and with suxamethonium 1.0 mg kg-1. Intubation was attempted at 2.5, 2 min and 1.5 min following a bolus dose of atracurium, and 1 min following suxamethonium. ⋯ Atracurium, when administered 5 min following recovery from a suxamethonium-induced block, had a significantly faster onset of neuromuscular blockade (P less than 0.01) than the onset observed following atracurium alone. Administration of atracurium 0.42 mg kg-1 3 min after an initial dose of 0.08 mg kg-1 of the drug produced a significantly more rapid onset of block when compared with a bolus dose of 0.5 mg kg-1 (P less than 0.02).