Pipecuronium versus high dose vecuronium. II. A comparison of speed of onset and cumulation during propofol anaesthesia.

Department of Anaesthesia, St Mary's Hospital, London.
Anaesthesia (Impact Factor: 3.85). 03/1992; 47(2):107-9.
Source: PubMed

ABSTRACT The onset time and tendency to cumulation of pipecuronium and high-dose vecuronium were compared during nitrous oxide anaesthesia supplemented with a propofol infusion. Pipecuronium 0.06 had a similar duration of action to vecuronium 0.2 (49 vs 43). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p less than 0.01). Neither pipecuronium nor vecuronium showed marked cumulation.

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    ABSTRACT: Four neuromuscular blocking drugs, doxacurium, mivacurium, pipecuronium, and rocuronium have been or are about to be introduced into clinical practice. The purpose of this MiniReview is to describe their pharmacology, to consider their place in clinical anaesthetic practice, and to examine whether the needs of the clinician have been met. Two of the agents (doxacurium, mivacurium) are benzylisoquinolines resembling atracurium and two (pipecuronium, rocuronium) are aminosteroids related to pancuronium and vecuronium. Two (doxacurium, pipecuronium) are long-acting compounds, similar in duration of action to pancuronium, although the need for such a profile is questionable. Rocuronium has an intermediate duration of action and produces its maximum effect within two minutes which is much more rapid than any other non-depolarizing relaxant and this is probably a result of its poor potency. However, the onset of paralysis is not as quick as after succinylcholine. Mivacurium is unique because it is metabolized by plasma cholinesterase which produces a rapid recovery although slower than succinylcholine. All of the new drugs are devoid of serious cardiovascular or other side effects. The anaesthetist is now presented with an armamentarium of safe, nondepolarizing muscle relaxants with varying durations of action. However, the rapid onset and recovery associated with succinylcholine are unique and important in the urgent control of a patient's airway and respiration. The indications for succinylcholine will not disappear and the search for a non-polarizing replacement will continue.
    Pharmacology &amp Toxicology 02/1994; 74(1):3-9.
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    ABSTRACT: In a little over 10 years, six new muscle relaxants have been introduced into clinical practice. The first two, the intermediate-duration vecuronium and atracurium were outstanding drugs and clearly an advance over the long-acting drugs which had been available previously. The next two, the long-acting doxacurium and pipecuronium were relics of an earlier era, and have made little clinical impact. Mivacurium created a new class, the short-acting nondepolarizer, and caused succinylcholine to be reclassified as an ultrashort-acting drug. However, mivacurium has neither the rapid onset nor the ultrashort duration of succinylcholine and is to some extent still trying to establish a significant clinical role. Rocuronium is the first non-depolarizer to have an onset approaching that of succinylcholine, and has spurred the development of drugs of low potency. It is likely that we will see the introduction of at least two more drugs, ORG 9487 and 51W89 by the end of this decade, but the goal of a nondepolarizing relaxant which is a complete replacement for succinylcholine still seems some distance in the future.
    Baillière's Clinical Anaesthesiology. 03/1995; 9(1).