Canadian Journal of Anesthesia, Vol 33, 563-570, Copyright © 1986 by Canadian Anesthesiologists' Society

Potentiation of Atracurium by Pancuronium and D-Tubocurarine

¹ Department of Anaesthesia, University of Basel/Kantonsspital, Basel, Switzerland

Address correspondence to: Dr. Helmut R. Gerber, Department of Anaesthesia, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland.

In 60 adult patients undergoing general surgical procedures, the effect of pancuronium or d-tubocurarine "pretreatment" on the injection of a 0.1 mg·kg^-1 bolus of atracurium was measured in two separate studies. In study 1, the patients received either 0.5 mg (0.007 mg·kg^-1) or 1.0 mg (0.015 mg·kg^-1) pancuronium, or placebo (saline) three minutes before the injection of atracurium 0.1 mg·kg^-1. In study 2, the patients received 0.05 mg·kg^-1 or 0.1 mg·kg^-1 d-tubocurarine, or a placebo. The degree of neuromuscular blockade was assessed by evoked mechanogram (adductor pollicis muscle) using supramaximal train-of-four stimulation. Patients receiving pancuronium or d-tubocurarine pretreatment (equal to an ED₅-ED₁₅ dose) showed significantly greater inhibition of twitch (ED₇₀-ED₈₀) and train-of-four ratio compared with the placebo groups (ED₃₅-ED₄₀). Pretreatment with the larger dose of d-tubocurarine (0.1 mg·kg^-1) was associated with significant neuromuscular blockade. It is concluded that pancuronium and d-tubocurarine pretreatments potentiate the clinical action of 0.1 mg·kg^-1 atracurium in man by 35-100 per cent

Key Words: NEUROMUSCULAR RELAXANTS: atracurium, d-tubocurarine, pancuronium, pretreatment • NEUROMUSCULAR BLOCKADE: potentiation