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Canadian Journal of Anesthesia, Vol 33, 571-577, Copyright © 1986 by Canadian Anesthesiologists' Society

Onset of Pancuronium and D-Tubocurarine Blockade with Priming

F. DONATI PHD MD FRCPC1, J. LAHOUD MD1, C. M. WALSH MB FFARSCI1, P. A. LAVELLE MB FFARSCI1, and D. R. BEVAN MB MRCP FFARCS1

1 Departments of Anaesthesia, Royal Victoria Hospital & McGill University, Montrel, Quebec, Canada

Address correspondence to: Dr. F. Donati, Department of Anaesthesia, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1.

The synergistic effect of pancuronium bromide (PCB) and d-tubocurarine (DTC) on the onset time of neuromuscular blockade was tested in 108 ASA physical status I and II adults anaesthetized with thiopentone, nitrous oxide and halothane. Either saline or a small (priming) dose (DTC, 0.04 mg·kg-1, or PCB, 0.007 mg·kg-1) was administered 3 min before a paralyzing dose of either DTC or PCB. The total dose of relaxant was equivalent to DTC, 0.4 mg·kg-1, or PCB, 0.07 mg·kg-1. Neuromuscular activity was measured using train-of-four stimulation applied every 12 s. Time to 50 per cent first twitch blockade was 63 ± 4.6 s (mean ± SEM) with DTC and 88 ± 5.2 s with PCB (p < 0.002). Times to 90 per cent blockade were not different between the two drugs (161 ±20 s and 141 ±21 s respectively). Priming a DTC blockade with either DTC or PCB or priming a PCB blockade with PCB produced an acceleration of less than 10 s at all levels of blockade. Compared with PCB alone, priming PCB blockade with DTC reduced the time to 50 per cent blockade to 71±4.5 s (p < 0.02) and to 90 per cent blockade to 111 ± 8 s (p<0.05). Priming did not affect the duration of action significantly, except in the case of PCB priming of DTC, where duration was increased from 39 ± 4.4 to 57 ± 4 min (p < 0.02). It is concluded that priming with a synergistic relaxant might increase speed of onset without prolonging the duration of neuromuscular blockade. However, the effect of DTC priming of PCB onset is too small to be clinically significant.

Key Words: NEUROMUSCULAR RELAXANTS: pancuronium, tubocurarine • DRUG INTERACTION: pancuronium, tubocurarine • PHARMACODYNAMICS: priming principle






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Copyright © 1986 by the Canadian Anesthesiologists' Society.