10.1093/bja/43.10.953

Sensitivity to gallamine and pancuronium with special reference to serum proteins

Abstract

In 1(X) females undergoing lower abdominal surgery, the requirement of pancuronium (mg/m2 body surface) showed no notable correlation with any serum protein fraction. In a comparable series of 100 female patients the requirement of gallamine (mg/m2 body surface) displayed a positive correlation with the serum albumin level both with diazepam as induction agent (r=0.34) and with thiopentone as the induction agent (r=0.25). The doses of both relaxants were 7-8 per cent lower and displayed a lower inter-individual variation with diazepam compared with thiopentone. It is suggested that charge-dissipating ethyl quaternization present in the gallamine molecule is responsible for the correlation of this relaxant with the serum albumin level. It has been shown that sensitivity to tubocurarine and alcuronium is related to the serum levels of gamma globulin and albumin respectively in females undergoing lower abdominal surgery (Stovner, Theodorsen and Bjelke, 1971). This may explain the resistance to tubocurarine met with in patients with liver disease and other conditions of altered albumin/globulin ratios. The low alcuronium requirement in ovarian cancer patients may likewise be explained by the low serum albumin levels in such patients. Such correlations between relaxants and serum proteins might also have other consequences. If the serum proteins act as "silent receptors " for the relaxants, then they might reduce the relaxant potency of these drugs. Such a "silent store " of relaxants in the blood might be displaced by other drugs, for instance by injection of anaes-thetic agents. For the synthesis of new relaxants it is of importance to know what molecular groups are responsible for this special relationship to serum proteins. It was considered that by investigating relaxants with different chemical structures indications might be obtained of the role played by the various molecular groups in this respect. The present paper reports the correlation between the serum protein fractions and th

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oai:CiteSeerX.psu:10.1.1.913.4499Last time updated on 11/1/2017

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