Simulations of Recovery Times Following Nondepolarizing Neuromuscular Blockade Produced by Steady-state Infusions. Vecuronium, Pancuronium and Rocuronium.

DOI 1 Citations 5 References
  • YAJIMA Choku
    Department of Anesthesiology, Tokyo University School of Medicine
  • TSUDAKA Shozou
    Department of Anesthesiology, Tokyo University School of Medicine
  • NAGATA Osamu
    Department of Anesthesiology, Tokyo University School of Medicine
  • TAGAMI Megumi
    Department of Anesthesiology, Tokyo University School of Medicine
  • HANAOKA Kazuo
    Department of Anesthesiology, Tokyo University School of Medicine

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Other Title
  • 筋弛緩作用が一定になるよう持続静注した後に，筋弛緩薬投与を中止した時の作用回復のシミュレーション　　パンクロニウム，ベクロニウム，ロクロニウムの比較
  • Vecuronium, Pancuronium and Rocuronium
  • パンクロニウム,ベクロニウム,ロクロニウムの比較

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Abstract

Concerning the three nondepolarizing neuromuscular blocking drugs pancuronium, vecuronium and rocuronium, we calculated the time required for recovery from some muscle relaxation rates (e. g. 99%) to another rate (e. g. 50%) after maintaining a constant relaxation rate (e. g. 99%) by changing the administration rate using PID (proportional plus integral plus derivative) control and the combined pharmacokinetic-pharmacodynamic model, and we also calculated the contextsensitive half-times of these three drugs. For this analysis, we used known pharmacokinetic parameters3), 4) and the pharmacodynamic parameters which were calculated from our own date of the three nondepolarizing muscle relaxants under general anesthesia using an inhalation anesthetic (<1MAC). The neuromuscular effects of these three drugs were mechanically monitored by measuring the twitch tension of the adductor pollicis muscle with stimulation of the ulnar nerve at the wrist.<br>The context-sensitive half-time curve of rocuronium was shorter than that of vecuronium but the 99-50% recovery time curve of rocuronium was longer than that of vecuronium. Both of 99-50% recovery time curves of the three neuromuscular blocking drugs were cumulatively increasing at 360 minutes of continuous administration. The 90-50% and the 90-75% recovery time curves reached plateaus in vecuronium and rocuronium beyond 120 minutes of administration, but in pancuronium both of these time curves were rising untill 240 minutes. If "kss(E)" is the administration rate of a neuromuscular blocking agent in the steady state which maintains "E"% relaxation rate, then we obtained kss (99)/kss(90)=1.5 and kss(90)/kss (75)=1.2 in both pancuronium and vecuronium, and kss (99)/kss(90)=2.0 and kss(90)/kss (75)=1.4 in rocuronium. Consequently, rocuronium requires a greater change of infusion rate to profound relaxation rate from 75% or 90% to 99% than pancuronium or vecuronium.<br>The context-sensitive half-time of these three nondepolarizing neuromuscular blocking drugs were much different from their duration times due to their nonlinearities of pharmacodynamics.

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