pancuronium and Liver-Diseases

Vecuronium and atracurium provide addition flexibility to the clinician using neuromuscular blocking drugs. The shorter duration of action, lack of significant cardiovascular effects, and the lack of dependence on the kidney for elimination provide clinical advantages over, or alternatives to, currently available nondepolarizing neuromuscular blocking drugs.

Topics: Acid-Base Equilibrium; Adolescent; Adult; Age Factors; Aged; Anesthesia; Anesthesia, Obstetrical; Atracurium; Cardiopulmonary Bypass; Cardiovascular System; Cesarean Section; Chemical Phenomena; Chemistry; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Infant, Newborn; Isoquinolines; Kinetics; Liver Diseases; Middle Aged; Neostigmine; Neuromuscular Blocking Agents; Pancuronium; Pregnancy; Succinylcholine; Time Factors; Vecuronium Bromide

Topics: Adult; Aged; Alcuronium; Child; Drug Interactions; Drug Utilization; Female; Gallamine Triethiodide; Humans; Infant, Newborn; Kidney Diseases; Liver Diseases; Maternal-Fetal Exchange; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Neuromuscular Diseases; Neuromuscular Junction; Pancuronium; Pregnancy; Pyridinium Compounds; Succinylcholine; Synaptic Transmission; Tubocurarine

Topics: Acidosis; Aminopyridines; Electric Stimulation; Humans; Hypothermia; Kidney Diseases; Liver Diseases; Neostigmine; Neuromuscular Blocking Agents; Neuromuscular Junction; Pancuronium; Peripheral Nerves; Respiration; Sensory Receptor Cells; Synaptic Transmission; Water-Electrolyte Balance

Topics: Anesthesia, Inhalation; Anesthesia, Obstetrical; Asthma; Female; Glaucoma; Histamine Release; Humans; Liver Diseases; Maternal-Fetal Exchange; Muscle Relaxants, Central; Pancuronium; Pregnancy; Shock, Hemorrhagic; Urologic Diseases

Topics: Androstanes; Anesthetics; Animals; Atropine; Blood Pressure; Cardiovascular System; Drug Synergism; Electrocardiography; Female; Heart Rate; Humans; Intubation, Gastrointestinal; Kinetics; Liver Diseases; Neostigmine; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pancuronium; Pregnancy; Surgical Procedures, Operative; Time Factors

In 32 patients with chronic liver disease, undergoing major abdominal surgery, anaesthesia was induced with either Althesin (alphaxalone and alphadolone acetate) or thiopentone, and maintained with nitrous oxide, oxygen and increments of either pethidine or fentanyl. The patients were ventilated artificially to maintain PaCO, values in the normal range. Pancuronium bromide was used as the muscle relaxant. Liver function tests at 24 hr and 5 day after surgery showed only minor changes compared with findings before operation. There was no significant difference between the Althesin and thiopentone groups. In two patients with severe obstructive jaundice there was difficulty in reversing the effects of pancuronium, but "pancuronium resistance" was observed in all patients. It is concluded that the anaesthetic sequence described, with either Althesin or thiopentone induction, is satisfactory with respect to changes in liver function in patients with chronic liver disease undergoing major surgery.

Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Anesthesia, General; Chronic Disease; Humans; Liver Diseases; Liver Function Tests; Middle Aged; Nitrous Oxide; Pancuronium; Pregnanediones; Serum Albumin; Thiopental

We examine two cases of prolonged neuromuscular blockade (NMB) after cardiac surgery. To the best of our knowledge, these are the first reported cases of complete paralysis lasting more than ten hours after surgery.. We attribute the extended durations of NMB (more than ten hours) to high doses of NMB drugs in combination with magnesium sulphate and moderate renal failure. Advanced age, hepatic disease, aminoglycoside exposure, hypocalcemia, and possible interaction between rocuronium and pancuronium may have played minor roles.. We should avoid administering large doses of NMB agents, even in the context of planned postoperative ventilation. If NMB is not monitored intraoperatively in patients who are at risk of prolonged NMB, then train-of-four response should be measured in the intensive care unit. Adequate sedation should be provided until proper recovery of neuromuscular function is documented.

Topics: Acute Kidney Injury; Aged; Aminoglycosides; Androstanols; Anesthesia Recovery Period; Aorta; Aortic Valve; Cardiac Surgical Procedures; Coronary Artery Bypass; Drug Interactions; Female; Heart Valve Prosthesis Implantation; Humans; Hypocalcemia; Liver Diseases; Magnesium Sulfate; Mitral Valve; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pancuronium; Paralysis; Rocuronium

Topics: Animals; Atracurium; Child; Child, Preschool; Dogs; Humans; Isoquinolines; Kidney Diseases; Kinetics; Liver Diseases; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

Topics: Animals; Atracurium; Isoquinolines; Kidney Diseases; Liver Diseases; Male; Neuromuscular Blocking Agents; Pancuronium; Portacaval Shunt, Surgical; Rats; Rats, Inbred Strains; Renal Circulation; Tubocurarine; Vecuronium Bromide

The effects of atracurium (initial dose 0.5 mg kg-1; incremental doses 0.2 mg kg-1) and vecuronium (initial dose 0.1 mg kg-1; incremental doses 0.04 mg kg-1) are described in patients with portal hypertension and some degree of liver dysfunction, and the findings compared with those from normal patients. With these doses there was no evidence of gross resistance to the two neuromuscular blockers in the patients with liver problems, although the duration of action of the initial dose was somewhat shorter, and the same may have been true of incremental doses. The method of elimination would suggest that atracurium may be the better drug in patients with severe liver dysfunction, but the use of small doses of vecuronium is not contraindicated in this type of patient.

Topics: Adult; Aged; Atracurium; Esophageal and Gastric Varices; Female; Humans; Hypertension, Portal; Intubation, Intratracheal; Isoquinolines; Liver Diseases; Liver Function Tests; Male; Middle Aged; Neostigmine; Neuromuscular Blocking Agents; Pancuronium; Sclerosing Solutions; Time Factors; Vecuronium Bromide

Glucocorticoids are used in physiological and pharmacological amounts in the management of a variety of clinical conditions. Concomitant utilisation of other drugs or the presence of some diseases may affect the physiological action of the steroid in the tissues. Phenytoin, phenobarbitone, ephedrine and rifampicin accelerate the metabolism of glucocorticoids thereby decreasing their biological activity. A similar phenomenon occurs in patients with hyperthyroidism. In contrast, glucocorticoid action is enhanced in hypothyroid patients and in those with hepatic damage as the result of a defect in the clearance of the hormone from blood. In turn, glucocorticoids antagonise the effects of cholinesterase inhibitors and ganglion blocking agents. The above mentioned effects should be kept in mind whenever glucocorticoids are utilised in the diagnosis and management of endocrine or non-endocrine conditions.

Topics: Anticonvulsants; Cholinesterase Inhibitors; Contraceptives, Oral; Cushing Syndrome; Dexamethasone; Diuretics; Drug Interactions; Ephedrine; Ganglionic Blockers; Glucocorticoids; Humans; Hypnotics and Sedatives; Insulin; Kinetics; Liver Diseases; Pancuronium; Rifampin; Salicylates; Thyroid Diseases

Topics: Female; Humans; Kidney Failure, Chronic; Liver Diseases; Middle Aged; Pancreatic Cyst; Pancuronium; Postoperative Complications; Renal Dialysis