Neuromuscular and cardiovascular effects of pipecuronium

Francis F. Foldes, Hideo Nagashima, Hung D. Nguyen, Deryck Duncalf, Paul L. Goldiner

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Pipecuronium bromide (Arduan) is a bisquaternary, steroid-type neuromuscular blocking agent in clinical use in Eastern Europe. Before its introduction into clinical practice in the USA, in the first phase of this study the neuromuscular potency of pipecuronium was determined under "balanced" and enflurane anaesthesia by the cumulative log dose-response method in 30 patients each. In the second phase the intubation and onset times, clinical duration of the first and repeated doses, spontaneous recovery index, reversibility of its residual neuromuscular effect by an anticholinesterase and its effect on heart rate and blood pressure was compared with the same variables observed in patients, anaesthetized with identical techniques but who had received vecuronium or pancuronium. The neuromuscular potency of pipécuronium was greater under enflurane [ED95 = 23.6 ± 1.1 μg · kg-1 (mean ± SEM)] than under balanced (ED95 = 35.1 ± 17 μg · kg-1) anaesthesia. Pipecuronium was more potent than vecuronium under both balanced (ED95 = 45.8 μg · kg-1) and enflurane anaesthesia (ED95 = 27 A μg · kg-1). Following the administration of 2 × ED95 doses there were no clinically significant differences in the intubation or onset times of pipecuronium, vecuronium and pancuronium. Under balanced anaesthesia the clinical duration of 2 × ED95 dose of pipécuronium (110.5 ± 0.3 min) or pancuronium (115.8 ± 8.1 min) were similar and about three times longer than that of vecuronium (36.3 ± 2.1 min). The recovery indices of pipécuronium (44.5 ± 8.2 min) and pancuronium (41.3 ± 4.2 min) were also similar and about three times longer than that of vecuronium (14.3 ± 1.4 min). Residual neuromuscular block of the three muscle relaxants could be equally well reversed by anticholinesterases at the end of anaesthesia. The 2 × ED95 doses of pipécuronium or vecuronium had no significant effect on heart rate or blood pressure. Pancuronium increased heart rate by about 20 per cent. Pipecuronium is preferable to pancuronium for the production of muscular relaxation for relatively long operations, when it is desirable to avoid acceleration of heart rate.

Original languageEnglish (US)
Pages (from-to)549-555
Number of pages7
JournalCanadian Journal of Anaesthesia
Volume37
Issue number5
DOIs
StatePublished - Jul 1990

Fingerprint

Pipecuronium
Neuromuscular Agents
Pancuronium
Vecuronium Bromide
Enflurane
Heart Rate
Balanced Anesthesia
Anesthesia
Cholinesterase Inhibitors
Intubation
Delayed Emergence from Anesthesia
Blood Pressure
Neuromuscular Blocking Agents
Eastern Europe
Steroids
Muscles

Keywords

  • complications: cardiovascular
  • neuromuscular relaxants: pancuronium, pipecuronium, vecuronium

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Foldes, F. F., Nagashima, H., Nguyen, H. D., Duncalf, D., & Goldiner, P. L. (1990). Neuromuscular and cardiovascular effects of pipecuronium. Canadian Journal of Anaesthesia, 37(5), 549-555. https://doi.org/10.1007/BF03006324

Neuromuscular and cardiovascular effects of pipecuronium. / Foldes, Francis F.; Nagashima, Hideo; Nguyen, Hung D.; Duncalf, Deryck; Goldiner, Paul L.

In: Canadian Journal of Anaesthesia, Vol. 37, No. 5, 07.1990, p. 549-555.

Research output: Contribution to journalArticle

Foldes, FF, Nagashima, H, Nguyen, HD, Duncalf, D & Goldiner, PL 1990, 'Neuromuscular and cardiovascular effects of pipecuronium', Canadian Journal of Anaesthesia, vol. 37, no. 5, pp. 549-555. https://doi.org/10.1007/BF03006324
Foldes FF, Nagashima H, Nguyen HD, Duncalf D, Goldiner PL. Neuromuscular and cardiovascular effects of pipecuronium. Canadian Journal of Anaesthesia. 1990 Jul;37(5):549-555. https://doi.org/10.1007/BF03006324
Foldes, Francis F. ; Nagashima, Hideo ; Nguyen, Hung D. ; Duncalf, Deryck ; Goldiner, Paul L. / Neuromuscular and cardiovascular effects of pipecuronium. In: Canadian Journal of Anaesthesia. 1990 ; Vol. 37, No. 5. pp. 549-555.
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