Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000100002
Brazilian Journal of Anesthesiology
Scientific Article

Dose preparatória versus injeção única: estudo comparativo entre diferentes doses de cisatracúrio

Priming versus bolus: a comparative study with different cisatracurium doses

Angélica de Fátima de Assunção Braga; Glória Maria Braga Potério; Franklin Sarmento da Silva Braga; Eugesse Cremonesi; Francisco Pena Siqueira; Vanessa H Carvalho

http://dx.doi.org/10.1590/S0034-70942003000100002 Braz J Anesthesiol, vol.53, n1, p.9-16, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A técnica da dose preparatória é uma alternativa para encurtar o tempo de latência dos bloqueadores neuromusculares adespolarizantes. O objetivo deste estudo foi avaliar o tempo para instalação do bloqueio neuromuscular máximo, as condições de intubação traqueal e as alterações cardiocirculatórias ocasionadas por diferentes doses de cisatracúrio em injeção única e em doses fracionadas. MÉTODO: Foram estudados 80 pacientes, estado físico ASA I e II, distribuídos em dois grupos de acordo com a dose de cisatracúrio: Grupo I (0,1 mg.kg-1) e Grupo II (0,2 mg.kg-1). Formaram-se subgrupos de acordo com a técnica de curarização usada: Subgrupos P1 e P2 (dose preparatória) - 0,02 mg.kg-1ou 0,04 mg.kg-1 de cisatracúrio, respectivamente, seguido após um minuto de 0,08 mg.kg-1 ou 0,16 mg.kg-1 do mesmo bloqueador neuromuscular, respectivamente; Subgrupos U1 e U2 - injeção única de dose total de 0,1 mg.kg-1 ou 0,2 mg.kg-1 de cisatracúrio, respectivamente. A Indução anestésica foi feita com etomidato precedido de alfentanil. A função neuromuscular foi monitorizada empregando-se a SQE a cada 12 segundos. Foram avaliados: o tempo para instalação do bloqueio neuromuscular máximo; as alterações de pressão arterial média e de freqüência cardíaca, e as condições de intubação traqueal. RESULTADOS: Os tempos para instalação do bloqueio neuromuscular máximo foram: Grupo I (3,90 ± 0,60 min e 3,88 ± 0,74 min, nos subgrupos P1 e U1, respectivamente) e Grupo II (1,40 ± 0,40 min e 2 ± 0,30 min, nos subgrupos P2 e U2, respectivamente) sem diferença significativa. A comparação entre os subgrupos P1 e P2 e os subgrupos U1 e U2, mostrou diferença significativa. As condições de intubação traqueal foram aceitáveis em todos os pacientes sem alterações cardiocirculatórias. CONCLUSÕES: As doses empregadas de cisatracúrio não encurtou o tempo para a instalação do bloqueio neuromuscular máximo, em relação ao seu emprego em injeção única, porém proporcionaram condições aceitáveis de intubação traqueal, sem alterações cardiocirculatórias.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, BLOQUEADORES NEUROMUSCULARES

Abstract

BACKGROUND AND OBJECTIVES: The priming technique is an alternative to shorten nondepolarizing neuromuscular blockers onset time. This study aimed at evaluating maximum neuromuscular block onset, tracheal intubation conditions and cardiocirculatory changes determined by different cisatracurium single or fractional doses. METHODS: Participated in this study 80 patients physical status ASA I and II, who were distributed into two groups according to cisatracurium doses: Group I (0.1 mg.kg-1) and Group II (0.2 mg.kg-1). Subgroups were constituted according to the curarization technique employed: subgroups P1 and P2 (priming-dose) - 0.02 mg.kg-1 or 0.04 mg.kg-1cisatracurium, respectively, followed one minute later, by 0.08 mg.kg-1 or 0.16 mg.kg-1 of the same neuromuscular blocker, respectively; subgroups U1 and U2 - total bolus injection of 0.1 mg.kg-1 or 0.2 mg.kg-1 cisatracurium, respectively. Anesthesia was induced with etomidate, preceded by alfentanil. Train of Four (TOF) stimulation was applied at 12-second intervals to monitor neuromuscular function. Maximum neuromuscular blockade onset time, tracheal intubation conditions and changes in hemodynamic parameters (arterial mean blood pressure and heart rate) were evaluated. RESULTS: Mean times for maximum neuromuscular block onset were: Group I (3.90 ± 0.60 min and 3.88 ± 0.74 min, for subgroups P1 and U1, respectively) and Group II (1.40 ± 0.40 min and 2 ± 0.30 min, for subgroups P2 and U2, respectively) with no significant differences. Comparison between subgroups P1 and P2 and between subgroups U1 and U2, has shown statistically significant differences. Tracheal intubation conditions were acceptable in all patients and there were no cardiovascular changes. CONCLUSIONS: Fractional cisatracurium doses have not shortened maximum neuromuscular block onset as compared to bolus injections. They have however produced acceptable tracheal intubation conditions without cardiovascular changes.

Keywords

NEUROMUSCULAR BLOCKERS, NEUROMUSCULAR BLOCKERS

References

Donati F. Onset of action of relaxants. Can J Anaesth. 1988;35:S52-S58.

Foldes FF, Nagashima H, Kornak PH. Effect of priming. Anaesth Pharmacol Rev. 1993;1:49-56.

Koller ME, Husby P. High-dose vecuronium may be an alternative to suxamethonium for rapid-sequence intubation. Acta Anaesthesiol Scand. 1993;37:465-468.

Potério GMB, Braga AFA. Condições de intubação traqueal com pancurônio: O princípio do priming-dose. Rev Bras Anestesiol. 1989;39(^s11):CBA26.

Braga AFA, Potério GMB. Emprego do pancurônio e alcurônio em doses fracionadas na obtenção de relaxamento muscular para intubação traqueal. Rev Bras Anestesiol. 1993;43(^s17):CBA76.

Braga AA, Potério GB, Rousselet MS. Atracúrio e intubação traqueal: priming-dose X injeção única. Rev Bras Anestesiol. 1994;44(^s18):CBA115.

Mellinghoff H, Radbruch L, Diefenbach C. A comparison of cisatracurium and atracurium onset of neuromuscular block after bolus injection and recovery after subsequent infusion. Anesth Analg. 1996;83:1072-1075.

Bluestein LS, Stinson Jr LW, Lennon RL. Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesth. 1996;43:925-931.

Mallampati SR, Gatt SP, Gugino LD. A clinical sign to predict difficult tracheal intubation: a prospective study. Can J Anaesth. 1985;32:429-434.

Goldberg ME, Larijani GE, Azad SS. Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients. Anesth Analg. 1989;69:93-99.

Baumgarten RK, Carter CE, Reynolds WJ. Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation. Can J Anaesth. 1988;35:5-11.

Storella RJ, Jaffe J, Mehr E. In vitro investigation of the priming principle for rapid neuromuscular block. Br J Anaesth. 1989;62:478-482.

Foldes FF. Rapid tracheal intubation with non-depolarizing neuromuscular blocking drugs: the priming principle. Br J Anaesth. 1984;56:663.

Schwarz S, Ilias W, Lackner F. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology. 1985;62:388-391.

Redai I, Feldman SA. Priming studies with rocuronium and vecuronium. Eur J Anaesth. 1995;11:11-13.

Paton WDM, Waud DR. The margin of safety of neuromuscular transmission. J Physiol. 1967;191:59-90.

Waud BE, Waud DR. The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology. 1972;37:417-422.

Mehta MP, Choi WW, Gergis SD. Facilitation of rapid endotracheal intubations with divided doses of non-depolarizing neuromuscular blocking drugs. Anesthesiology. 1985;62:392-395.

Hofmockel R, Bernad G. Time-course of action and intubating conditions with rocuronium bromide under propofol-alfentanil anaesthesia. Eur J Anaesth. 1995;12:69-72.

Feldman SA. Rocuronium: onset times and intubating conditions. Eur J Anaesth. 1994;9:49-52.

Musich J, Walts LF. Pulmonary aspiration after a priming dose of vecuronium. Anesthesiology. 1986;64:517-519.

Van Aken H, Mertes N, Haess GM. Pretreatment technique for fast intubation with vecuronium: intubation conditions and unwanted effects. Acta Anaesthesiol Belg. 1986;37:199-204.

Engbaek J, Viby-Mogensen J. Pre-curarization: a hazard to the patient?. Acta Anaesthesiol Scand. 1984;28:61-62.

Mahajan RP, Laverty J. Lung function after vecuronium pre-treatment in young, healthy patients. Br J Anaesth. 1992;69:318-319.

Aziz L, Jahangir SM, Choudhury SNS. The effect of priming with vecuronium and rocuronium on young and elderly patients. Anesth Analg. 1997;85:663-666.

Mirakhur RK, Lavery GG, Gibson FM. Intubating conditions after vecuronium and atracurium given in divided doses (the priming technique). Acta Anaesthesiol Scand. 1986;30:347-350.

Glass PS, Wilson W, Mace JA. Is the priming principle both effective and safe?. Anesth Analg. 1989;68:127-134.

Miller RD. The priming principle. Anesthesiology. 1985;62:381-382.

Braga AFA, Potério GMB, Braga FSS. Rocurônio: dose preparatória versus injeção única. Rev Bras Anestesiol. 1999;49:379-384.

Harrop-Griffiths AW, Grounds RM, Moore M. Intubating conditions following pre-induction priming with alcuronium. Anaesthesia. 1986;41:282-286.

Deepika K, Kenaan CA, Bikhazi GB. Influence of the priming technique on pharmacodynamics and intubating conditions of cisatracurium. J Clin Anesth. 1999;11:572-575.

Stevens JB, Walker SC, Fontenot JP. The clinical neuromuscular pharmacology of cisatracurium versus vecuronium during outpatient anesthesia. Anesth Analg. 1997;85:1278-1283.

Hoffmann W, Schwarz U, Ruoff M. Effects of priming technique on onset profile of cisatracurium. Anaesth Reanim. 1999;24:130-133.

Puhringer FK, Scheller A, Kleinsasser A. The effect of different priming doses on the pharmacodynamics of cisatracurium. Anaesthesist. 2000;49:102-105.

Naguib M, Abdulatif M, Gyasi HD. Priming with atracurium: improving intubating conditions with additional doses of thiopental. Anesth Analg. 1986;65:1295-1299.

Muir AW, Anderson KA, Pow E. Interaction between rocuronium bromide and some drugs used during anaesthesia. Eur J Anaesth. 1994;11:93-98.

Muir AW, Houston J, Marshall RJ. A comparison of the neuromuscular blocking and autonomic effects of two new short-acting muscle-relaxants with those of succinylcholine in the anesthetized cat and pig. Anesthesiology. 1989;70:533-540.

Cason B, Baker DG, Hickey RF. Cardiovascular and neuromuscular effects of three steroidal neuromuscular blocking drugs in dogs (Org 9619, Org 9426, Org 9991). Anesth Analg. 1990;70:382-388.

Savarese JJ, Lien CA, Belmont MR. The clinical pharmacology of new benzylisoquinoline-diester compounds, with special consideration of cisatracurium and mivacurium. Anaesthesist. 1997;46:840-849.

Doenicke AW, Czeslick E, Moss J. Onset time, endotracheal intubating conditions, and plama histamina after cisatracurium and vecuronium administration. Anesth Analg. 1998;87:434-438.

Lepage JY, Malinovsky JM, Malinge M. Pharmacodynamic dose-response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2 opioid anesthesia. Anesth Analg. 1996;83:823-829.

Bryson HM, Faulds D. Cisatracurium besilate: A review of its pharmacology and clinical potential in anaesthetic practice. Drugs. 1997;53:848-866.

Reich DL, Mulier J, Viby-Mogensen J. Comparison of the cardiovascular effects of cisatracurium and vecuronium in patients with coronary artery disease. Can J Anaesth. 1998;45:794-797.

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