Potency and maintenance requirement of atracurium and vecuronium given alone or together

Acta Anaesthesiol Scand. 1995 Feb;39(2):220-3. doi: 10.1111/j.1399-6576.1995.tb04047.x.

Abstract

A synergism exists between some competitive muscle relaxants. However, maintenance requirement of a combination of muscle relaxants has been evaluated only in paediatric patients. We studied 45 elective adult surgical patients (ASA I-II) during propofol-alfentanyl-N2O-O2-anaesthesia. The first 30 patients were randomized to receive either atracurium or vecuronium to create individual dose-response curves for these muscle relaxants. ED95-values for atracurium and vecuronium were 260 +/- 9 and 59 +/- 3 micrograms.kg-1, respectively (mean +/- s.e. mean). Requirements of atracurium and vecuronium to maintain an 85-95% neuromuscular blockade were 301 and 83 micrograms kg-1 h-1, respectively. An additional 15 patients received a combination of atracurium and vecuronium (cAV) in an equipotent dose ratio. An ED95 of a cAV was 94 +/- 7 micrograms.kg-1 of atracurium together with 21 +/- 2 micrograms.kg-1 of vecuronium, or 72 +/- 6% of one ED95 dose of a parent agent. Potentiation was significant (P = 0.0001). A maintenance requirement of a cAV was 120 micrograms kg-1 h-1 of atracurium together with 27 micrograms kg-1 h-1 of vecuronium. Thus, a significant potentiation was maintained also during the course of anaesthesia. A cAV had an effect like one intermediate-acting agent. If a cAV is used instead of using atracurium or vecuronium alone, the maximal reduction of drug consumption would be approximately 30%.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Anesthesia, Inhalation
  • Anesthesia, Intravenous
  • Atracurium / administration & dosage
  • Atracurium / pharmacology*
  • Dose-Response Relationship, Drug
  • Drug Combinations
  • Drug Synergism
  • Elective Surgical Procedures
  • Electromyography / drug effects
  • Evoked Potentials / drug effects
  • Evoked Potentials / physiology
  • Humans
  • Linear Models
  • Middle Aged
  • Neuromuscular Junction / drug effects
  • Synaptic Transmission / drug effects
  • Ulnar Nerve / drug effects
  • Ulnar Nerve / physiology
  • Vecuronium Bromide / administration & dosage
  • Vecuronium Bromide / pharmacology*

Substances

  • Drug Combinations
  • Atracurium
  • Vecuronium Bromide