Time to peak effect of neostigmine at antagonism of atracurium- or vecuronium-induced neuromuscular block

Background In patients with Duchenne muscular dystrophy (DMD) the response to nondepolarizing muscle relaxants is scarcely documented and conflicting. The current study was conducted to determine the time to peak effect and the time for complete spontaneous recovery after a single dose of 0.6 mg/kg of rocuronium in patients with DMD. Methods Twenty-four patients (12 with DMD, 12 controls, aged 10-16 yr) were studied. All patients were anesthetized with propofol and fentanyl/remifentanil. Neuromuscular transmission was monitored by acceleromyography. After induction all patients received a single dose of 0.6 mg/kg of rocuronium. The complete time course of onset and spontaneous recovery were recorded Results Significant (P < 0.01) increase in the onset times to 95% neuromuscular block was observed in DMD patients (median, 203 s; range, 90-420 s) compared with controls (median, 90 s; range, 60-195 s). The time between rocuronium administration and recovery of first twitch of the train-of-four to 90% was significantly (P < 0.01) prolonged in DMD compared with controls (median, 132 min; range, 61-209 min versus 39 min; 22-55 min). The recovery index was also significantly prolonged in the DMD group compared with controls (median, 28 min, range, 15-70 min versus 8 min; 3-14 min). Conclusions The most striking and surprising result of this study is the delayed onset of blockade in DMD after a standard dose of rocuronium. This effect should be kept in mind in situations when a rapid airway protection is necessary in DMD patients. The documented very long recovery from rocuronium-induced block emphasizes the need for careful assessment of neuromuscular function in DMD patients.

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Time to peak effect of neostigmine at antagonism of atracurium- or vecuronium-induced neuromuscular block

Journal of Clinical Anesthesia ◽

10.1016/0952-8180(95)00088-7 ◽

1995 ◽

Vol 7 (8) ◽

pp. 635-639 ◽

Cited By ~ 17

Author(s):

Hans Kirkegaard-Nielsen ◽

Hans S. Helbo-Hansen ◽

Peter Lindholm ◽

Inge K. Severinsen ◽

Karsten Bülow

Keyword(s):

Neuromuscular Block ◽

Peak Effect ◽

Time To Peak

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Mivacurium Neuromuscular Block at the Adductor Muscles of the Larynx and Adductor Pollicis in Humans

Anesthesiology ◽

10.1097/00000542-199607000-00011 ◽

1996 ◽

Vol 85 (1) ◽

pp. 77-81 ◽

Cited By ~ 33

Author(s):

Benoit Plaud ◽

Bertrand Debaene ◽

Frank Lequeau ◽

Claude Meistelman ◽

Francois Donati

Keyword(s):

Neuromuscular Block ◽

Onset Time ◽

Pressure Change ◽

Peak Effect ◽

Adductor Pollicis ◽

Vocal Cords ◽

Laryngeal Muscles ◽

Time To Peak ◽

Adductor Muscles ◽

Train Of Four

Background Laryngeal muscles must be paralyzed for tracheal intubation. Time to peak effect (onset time) is shorter and intensity of blockade is less at laryngeal muscles compared with the adductor pollicis. The authors' aim in this study was to determine the neuromuscular effects of mivacurium at the laryngeal adductor muscles and the adductor pollicis. Methods In 22 adults, anesthesia was induced and maintained with propofol and alfentanil. The force of contraction of the adductor pollicis was recorded, and the laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords after train-of-four stimulation. Mivacurium (0.07 mg.kg-1 or 0.14 mg.kg-1) was given intravenously (10s). Results With 0.07 mg.kg-1 mivacurium, onset time was 151 +/- 40 s(mean +/- SD) at the larynx and 241 +/- 79 s at the adductor pollicis, respectively (P < 0.005). Maximum block was 78 +/- 18% and 95 +/- 8%, respectively (P < 0.002), and time to 90% recovery was 11.1 +/- 2.9 min and 23.3 +/- 7.6 min, respectively (P < 0.001). With 0.14 mg.kg-1 mivacurium, onset time also was more rapid at the vocal cords (137 +/- 20 s) than at the adductor pollicis (201 +/- 59 s, P < 0.01). Maximum block was 90 +/- 7% and 99 +/- 1% (P < 0.005), and time to 90% recovery was 16.4 +/- 4.9 min and 27.4 +/- 7.8 min, respectively (P < 0.01). Conclusions With mivacurium, onset and recovery are faster at the laryngeal muscles, but block is less intense than at the adductor pollicis. A dose greater than 0.14 mg.kg-1 mivacurium is necessary to ensure complete relaxation at the vocal cords.

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Faculty Opinions recommendation of Is time to peak effect of neuromuscular blocking agents dependent on dose? Testing the concept of buffered diffusion.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1120236.576398 ◽

2008 ◽

Author(s):

Harald Ihmsen

Keyword(s):

Peak Effect ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Time To Peak ◽

Blocking Agents

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Comparison of Plasma Compartment versus Two Methods for Effect Compartment–controlled Target-controlled Infusion for Propofol

Anesthesiology ◽

10.1097/00000542-200002000-00021 ◽

2000 ◽

Vol 92 (2) ◽

pp. 399-399 ◽

Cited By ~ 186

Author(s):

Michel M. R. F. Struys ◽

Tom De Smet ◽

Birgit Depoorter ◽

Linda F. M. Versichelen ◽

Eric P. Mortier ◽

...

Keyword(s):

Time Course ◽

Drug Effect ◽

Peak Effect ◽

Effect Compartment ◽

Loss Of Consciousness ◽

Group Iii ◽

Time To Peak ◽

Effect Site ◽

Effect Site Concentration ◽

Plasma Effect

Background Target-controlled infusion (TCI) systems can control the concentration in the plasma or at the site of drug effect. A TCI system that targets the effect site should be able to accurately predict the time course of drug effect. The authors tested this by comparing the performance of three control algorithms: plasmacontrol TCI versus two algorithms for effect-site control TCI. Methods One-hundred twenty healthy women patients received propofol via TCI for 12-min at a target concentration of 5.4 microg/ml. In all three groups, the plasma concentrations were computed using pharmacokinetics previously reported. In group I, the TCI device controlled the plasma concentration. In groups II and III, the TCI device controlled the effect-site concentration. In group II, the effect site was computed using a half-life for plasma effect-site equilibration (t1/2k(eo)) of 3.5 min. In group III, plasma effect-site equilibration rate constant (k(eo)) was computed to yield a time to peak effect of 1.6 min after bolus injection, yielding a t1/2keo of 34 s. the time course of propofol was measured using the bispectral index. Blood pressure, ventilation, and time of loss of consciousness were measured. Results The time course of propofol drug effect, as measured by the bispectral index, was best predicted in group III. Targeting the effect-site concentration shortened the time to loss of consciousness compared with the targeting plasma concentration without causing hypotension. The incidence of apnea was less in group III than in group II. Conclusion Effect compartment-controlled TCI can be safely applied in clinical practice. A biophase model combining the Marsh kinetics and a time to peak effect of 1.6 min accurately predicted the time course of propofol drug effect.

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Time to peak effect of aspirin-induced platelet inhibition and ex vivo effects of desmopressin: an observational study

Journal of Integrative Cardiology ◽

10.15761/jic.1000307 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Ulf Schött ◽

Sigurbjörg Sigurjonsdottir ◽

Owain Thomas ◽

Thomas Kander

Keyword(s):

Observational Study ◽

Ex Vivo ◽

Platelet Inhibition ◽

Peak Effect ◽

Time To Peak

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Pharmacokinetic-Pharmacodynamic Modeling of Propofol in Children

Anesthesiology ◽

10.1097/aln.0b013e3181e4f4ca ◽

2010 ◽

Vol 113 (2) ◽

pp. 343-352 ◽

Cited By ~ 63

Author(s):

Agnes Rigouzzo ◽

Frederique Servin ◽

Isabelle Constant

Keyword(s):

Peak Effect ◽

Concentration Effect ◽

Pharmacodynamic Modeling ◽

Maximal Effect ◽

Time To Peak ◽

Effect Site ◽

Mixed Effects Modeling ◽

Effect Site Concentration ◽

Relationship Of ◽

The Relationship

Background The aim of this study was to identify the best model to describe pharmacokinetics and pharmacodynamics in prepubertal children and therefore to calculate the corresponding pharmacodynamic parameters. In addition, and to confirm our method, a group of postpubertal subjects was also studied. Methods Sixteen children (9.5 yr, range 6-12) and 13 adults (22 yr, range 13-35) were included. Induction was performed by plasma target-controlled infusion of propofol (6 microg/ml) based on the Kataria model in children and on the Schnider model in adults. The relationship of bispectral index to predicted concentrations was studied during induction using the Kataria, pediatric Marsh, Schüttler, and Schnider models in children. Because the best performance was obtained, strangely enough, with the Schnider model, the two groups were pooled to investigate influence of puberty on pharmacodynamic parameters (kE0 [plasma effect-site equilibration rate constant] and Ce50 [effect-site concentration corresponding with 50% of the maximal effect]). The time-to-peak effect was calculated, and the kE0 was determined for the Kataria model (nonlinear mixed-effects modeling; pkpdtools). Results In children, the predicted concentration/effect relationship was best described using the Schnider model. When the whole population was considered, a significant improvement in this model was obtained using puberty as a covariate for kE0 and Ce50. The time to peak effect, Tpeak (median, 0.71 [range, 0.37-1.64] and 1.73 [1.4-2.68] min), and the Ce50 (3.71 [1.88-4.4] and 3.07 [2.95-5.21] microg/ml) were shorter and higher, respectively, in children than in adults. The kE0 linked to the Kataria model was 4.6 [1.4-11] min. Conclusions In children, the predicted concentration/effect relationships were best described using the Schnider model described for adults compared with classic pediatric models. The study suggests that the Schnider model might be useful for propofol target-control infusion in children.

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