BLOQUEADORES DESPOLARIZANTES Mecanismo de acción: › FASE I ( Despolarizante): Unión al receptor nicotinico de Ach. Despolarización de la. BLOQUEADORES NEUROMUSCULARES • Esses Bloqueadores são análogos estruturais da Ach e atuam como antagonistas(tipo não despolarizante) ou. ensayos usaron suxametonio, y 18 ensayos usaron ABNM no despolarizantes. Efecto de la evitación de los agentes bloqueadores neuromusculares en.
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I ; Carlos Neutzling Lehn, M. V ; Marcelo Kirsch, M. V ; Gustavo Cimerman, M. One of the most important neuromuscular blockers property is short onset, allowing bloqjeadores 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 bloqueadorex elective surgeries under general anesthesia.
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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: T test for independent samples was used for statistical analysis and Shapiro Wilks was used to test normality. 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. Fueron divididos en dos grupos: Grupo 1 donde fue utilizada el priming con 0,01 mg.
Fast onset allowing early tracheal intubation is one of the most important neuromuscular blocker properties A low nondepolarizing blocker dose before its full dose is recommended to obtain ideal tracheal intubation conditions in a shorter period of time 1,4,5. Pipecuronium bromide is a long-lasting aminosteroid neuromuscular blocker, with negligible cardiovascular effects until DE 95 0.
This study aimed at evaluating the effects of low pipecuronium priming dose 0. After the Ethics Committee, Hospital de Ensino Padre Anchieta, Hospital de Ensino Faculdade de Medicina ABC, participated in this randomized double-blind study 33 adult patients of both genders, aged 20 to 65 years, physical status ASA I and II, to be submitted to elective surgeries under general anesthesia with tracheal intubation and lasting more than 60 minutes.
Exclusion criteria were patients with kidney or renal failure, body mass index above 30, neuromuscular disease, family history of malignant hyperthermia or under drugs interfering with neuromuscular transmission.
After preanesthetic evaluation the day before surgery, patients were premedicated with oral midazolam 15 mg neuuromusculares hour before surgery. Neuromuscular transmission was monitored by acceleromyography TOF-Guard every 15 seconds to evaluate adductor pollicis muscle response with stimulating electrodes on wrist ulnar nerve. TOF-Guard was installed after anesthetic induction and ulnar nerve stimulation was only started when patients were asleep.
Patients received intravenous neuromuscular blocker and were divided in two groups of 16 patients: Group 1 – pipecuronium with priming: Group 2 – pipecuronium without priming: Excel 97 and Statistic v. Data were analyzed by descriptive statistics and represented in central trend measurements and error, mean and standard deviation and percentage count, as shown in table I. Table I show means, percentage distributions and differences between groups in demographics, physical status and onset.
Parametric variables were defined as those with continuous neyromusculares scale and distributed within the normality curve, confirmed by Shapiro Wilk test. Groups were similar in age, body mass, physical status and gender, indicating homogeneity and parity among studied subjects characteristics Table I. Pipecuronium neuroomusculares is a long-lasting nondepolarizing neuromuscular blocker. As with other neuromuscular blockers, its phamarcokinetics and pharmacodynamics are influenced by age, obesity, kidney and liver failure, drugs and neuromuscular diseases 4,5,9.
Volatile inhalational anesthetics associated to pipecuronium usually prolong its duration. Parenteral antibiotics, such as neomycin, streptomycin and gentamycin, in high doses, exacerbate neuromuscular block In myasthenia gravis patients, low nondepolarizing neuromuscular blocker doses may have exaggerated effects, being indicated short-lasting agents for those patients and counterindicated pipecuronium Priming action mechanism may be explained by the wide safety margin in neuromuscular transmission.
Our study has evaluated pipecuronium onset by two different techniques: The study has shown that the priming technique was statistically acceptable in shortening onset, as compared to the other technique.
Similar observations were reported by other authors using different neuromuscular blockers, such as vecuronium 8pancuronium 9 and atracurium Some authors 11 have studied the priming effect of pipecuronium as compared to bolus injection of the same drug and have observed results similar to ours. Onset time after bolus pipecuronium injection 0. With priming, onset was seconds, slightly higher that those reported in the literature 11, Our conclusion was that, similar to other nondepolarizing neuromuscular blockers, pipecuronium also has its onset shortened if priming dose is administered three minutes before total dose.
So, it could be observed that priming was effective in shortening pipecuronium onset in our patients. We acknowledge Isabel de Camargo Neves Sacco for the excellent statistical analysis of this study.
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Foldes FF – Rapid tracheal intubation with non-depolarizing neuromuscular blocking drugs: Br J Anaesth, ; Rathmell JP, Brooker RF, Prielipp RC et al – Hemodynamic and pharmacodynamic comparison of doxacurium and pipecuronium with pancuronium during induction of cardiac anesthesia: Acta Chir Hung, ; Can J Anaesth, ; Agoston S, Richardson FJ – Pipecuronium bromide Arduan – a new long action non-depolarizing neuromuscular blocking drug.
Acta Anaesthesiol Scand, ; Can Anaesth Soc J, ; Eur J Anaesthesiol, ; Paula de Camargo Neves Neuromusculqres Address: Submitted for publication November 18, Accepted for publication April 13, All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. RESULTS Data were analyzed by descriptive statistics and represented in central trend measurements and error, mean and standard deviation and percentage count, as shown in table I.
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