Calderón HC, Guzmán NR, Olivares MH, Espíritu MS, Gutiérrez GA, Montañez RH, Pérez-García EA

Idioma: Español
Referencias bibliográficas: 42
Paginas: 132-137
Archivo PDF: 148.69 Kb.

RESUMEN

El tiempo que transcurre desde la inducción hasta la intubación traqueal es determinado por el establecimiento del bloqueo neuromuscular y en parte por la velocidad con la que la droga alcanza la unión neuromuscular. La interacción de la combinación del rocuronio y mivacurio es el resultado de una acción sinérgica. La efedrina puede incrementar estas variables. Material y métodos: Se estudiaron 20 pacientes adultos con estado físico ASA I/II. Se registró la respuesta del aductor del pulgar a la estimulación del nervio cubital. Sin premedicación. La anestesia fue inducida con fentanil 2 µg/kg, seguido con propofol 2 mg/kg. Los pacientes fueron asignados al azar para recibir efedrina 70 µg/kg (grupo II) o solución salina (grupo I) antes del propofol. Después, se administran rocuronio 300 µg/kg y mivacurio 80 µg/kg. Resultados: No hubo diferencias demográficas entre los grupos. Las condiciones de intubación fueron calificadas de buenas a excelentes, sin diferencias significativas. El tiempo de acción fue más corto en el grupo II, estadísticamente significativo. La administración de efedrina no se asoció a cambios significativos en la frecuencia cardiaca o tensión arterial. Ningún paciente presentó arritmias durante el periodo de estudio. Conclusiones: La efedrina reduce el tiempo de acción del rocuronio/mivacurio sin efectos adversos significativos.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Donati F. Onset of action of relaxants. Can J Anaesth 1988; 35: 552-558.

2. Cohn JN. Comparative cardiovascular effects of tyramine, ephedrine, and norepinephrine in man. Cir 1965; 16: 174-182.

3. Wepierre J, Cohen Y, Valette G. Action vasculaire de l’ephédrine dans les territoires musculaires et mésenterique. Arch Int Pharmacodyn 1970; 185: 34–46.

4. Santiveri X, Mansilla R, Pardina B, Navarro J, Álvarez JC, Castillo J. La efedrina acorta el inicio de acción del rocuronio pero no del atracurio. Rev Esp Anestesiol Reanim 2003; 50: 176-181.

5. Savarese JJ, Ali HH Basta SJ, Embree PB, Scott RPF, Sunder N, Weakly JN, Wastila WB, El-Sayad HA. The clinical neuromuscular pharmacology of mivacurium chloride administered to patients during oxygen-sufentanil anesthesia for coronary artery bypass grafting or valve replacement. Anesth Analg 1994; 78: 318-326.

6. Stoops CM, Curtis CA, Kovach DA et al. Hemodynamic effects of mivacurium chloride administered to patients during oxygen-sufentanil anesthesia for coronary artery bypass grafting or valve replacement. Anesth Analg 1989; 68: 333-338.

7. Levy JH, Davis GK, Duggan J, Szalm F. Determination of the hemodynamics and histamine release of rocuronium (ORG 9426) when administered in increased doses under N2O/O2 sufentanil anesthesia. Anesth Analg 1994; 78: 318-321.

8. Savarese JJ, Ali HH, Basta SJ, Scott RP, Embree PB, Wastila WB et al. The cardiovascular effects of mivacurium chloride (BW B1090U) in patients receiving nitrous oxide-opiate-barbiturate anesthesia. Anesthesiology 1989; 70: 386-394.

9. Naguib MB. Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination. Anesthesiology 1994; 81: 388-395.

10. Naguib M. Different priming techniques, including mivacurium, accelerate the onset of rocuronium. Can J Anaesth 1994; 41: 902-907.

11. Stevens JB, Shepherd JM, Vories PA et al. Rapid sequence induction of anesthesia with a combination of rocuronium and mivacurium. Anesthesiology 1995; 83: 912-919.

12. Waud BE, Waud DR. Quantitative examination of the interaction of competitive neuromuscular blocking agents on the indirectly elicited twitch. Anesthesiology 1984; 61: 420-427.

13. Naguib M, Abdulatif M. Isobolographic and dose-response analysis of the interaction between pipecuronium and vecuronium in surgical patients. Br J Anaesth 1993; 71; 556-560.

14. Lebowitz PW, Ramsey FM, Savarese JJ, Ali HH. Potentiation of neuromuscular blockade in man produced by combinations of pancuronium and metocurine or pancuronium and d-tubocuranine. Anesth Analg 1980; 59: 604-609.

15. Waud BE, Waud DR. Interaction among agents that block endplate depolarization competitively. Anesthesiology 1985; 63: 4-15.

16. Zaritsky AL, Chernow B. Catecholamines, sympathomimetics. In: Ziegler MG, Lake CR (eds): Frontiers of clinical neuroscience. Baltimore: Williams & Wilkins; 1984; vol 2 (Norepinephrine). p. 481.

17. Ramanathan S, Grant G, Turndorf H. Cardiac preload changes with ephedrine therapy for hypotension in obstetrical patients. Anesth Analg 1986; 65: 125-130.

18. Stanton-Hicks M, Hock A, Stuhmeier K, Arndt JO. Venoconstrictor agents mobilize blood from different sources and increase intrathoracic filling during epidural anesthesia in supine humans. Anesthesiology 1987; 66: 317-323.

19. Ramanathan S, Grant GJ. Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section. Acta Anaesthesiol Scand 1988; 32: 1-9.

20. Zaimis E. Vasopressor drugs and catecholamines. Anesthesiology 1968; 29: 732-737.

21. Smith NT, Corbascio AN. The use and misuse of pressor agents. Anesthesiology 1970; 8: 58-62.

22. Smith CE, Donati F, Bevan DR. Differencial effects of pancuronium on masseter and adductor pollicis muscles in humans. Anesthesiology 1989; 71: 57-61.

23. Donati F, Plaud B, Meistelman C. Vecuronium neuromuscular blockade at the adductor muscle of the larynx and the adductor pollicis. Anesthesiology 1991; 74: 833-837.

24. Pansard JL, Chauvin M, Lebreault C et al. Effect of an intubating dose of succinylcholine and atracurium on the diaphragm and adductor pollicis muscle in humans. Anesthesiology 1987; 67: 326-330.

25. Bartowski RR. Incomplete reversal of pancuronium neuromuscular blockade by neostigmine, pyridostigmine and edrophonium. Anesth Analg 1987; 66: 594-598.

26. Beemer GH, Bjorksten AR, Dawson PJ et al. Determinants of the reversal time of competitive neuromuscular block by anticholinesterases. Br J Anesth 1991; 66: 469-474.

27. Waud BE, Waud DR. The relation between tetanic fade and receptor occlusion in the presence of competitive neuromuscular block. Anesthesiology 1971; 35: 456-461.

28. Mogorian T, Flannery KB Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology 1993; 79: 913-918.

29. Lee C. Succinylcholine update. Curr Opin Anaesthesiol 1993; 6: 709-714.

30. Hunter JM. Rocuronium: The newest aminosteroid neuromuscular blocking drug. Br J Anaesth 1996; 76: 481-483.

31. Foldes FF. Rapid tracheal intubation with nondepolarizing neuromuscular blocking drugs: The priming principle. Br J Anaesth 1984; 56: 663-669.

32. Schwartz S, llias W, Lackner F et al. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology 1985; 62: 388-391.

33. Mehta MP, Choy W, Gergis SD et al. Facilitation of rapid sequence endotracheal intubations with divided doses of nondepolarizing neuromuscular blocking drugs. Anesthesiology 1985; 62: 392-395.

34. Rorvik K, Husby P, Gramstad L et al. Comparison of large dose of vecuronium with pancuronium for prolonged neuromuscular blockade. Br J Anaesth 1988; 61: 180-185.

35. Ginsberg B, Glass PS, Quill T et al. Onset and duration of neuromuscular blockade following high-dose vecuronium administration. Anesthesiology 1989; 71: 201-205.

36. Harrison GA, Junius F. Effects of circulation time on the neuromuscular action of suxamethonium. Anesth Intensive Care 1972; 1: 33-40.

37. Goat VA, Yeung ML, Blakeney C, Feldman SA. The effect of blood flow upon the activity of gallamine triethiodide. Br J Anaesth 1976; 48: 69-73.

38. Kopman AF. Onset of action of neuromuscular blockade: contributing factors. Curr Opin Anaesthesiol 1992; 5: 561-567.

39. Gill RS, Scott RPF. Etomidate shortens the onset time of neuromuscular block. Br J Anaesth 1992; 69: 444-446.

40. Gamlin F, Vucevic M, Winslow L, Berridge J. The Haemodynamic effects of propofol in combination with ephedrine. Anaesthesia 1996; 51: 488-491.

41. Pollard BJ, Jones RM. Interactions between tubocuranine, pancuronium and alcuronium demonstrated in the rat phrenic nerve hemidiaphragm preparation. Br J Anaesth 1983; 55: 1127-1130.

42. El-Beheiry H, Kim J, Milne B, Seegobin R. Prophylaxis against the systemic hypotension induced by propofol during rapid sequence intubation. Can J Anaesth 1995; 42: 875-878.