115 research outputs found
Influence Of Stimulus Frequency On Blockade Induced By Pancuronium And Rocuronium: Study On Rats Phrenic Nerve-diaphragm Preparation.
To evaluate the influence of two stimulation frequencies on the installation of neuromuscular blockade produced by pancuronium and rocuronium on the rat diaphragm. Diaphragms were submitted to an indirect frequency stimulation of 0.1 and 1 Hz (Groups I and II, respectively). Subgroups were formed (n=5) according to the neuromuscular blocker employed (pancuronium-2 microg/ml and rocuronium-4 microg/ml). The twitch height depression was evaluated at 5, 15 and 30 minutes after adding the neuromuscular blocker. The decrease in twitch height was greater (p<0.01) with a frequency of 1 Hz at all time periods studied both in preparations that are blocked with pancuronium and in those that are blocked with rocuronium. The frequency of stimulation interferes significantly with the installation of neuromuscular blockade produced by pancuronium and rocuronium, since the reduction in amplitude of the rat diaphragm response was greater for 1 Hz frequencies, at all periods studied.22446-5
Drug-delivery systems for racemic bupivacaine (S50-R50) and bupivacaine enantiomeric mixture (S75-R25): cyclodextrins complexation effects on sciatic nerve blockade in mice
BACKGROUND AND OBJECTIVES: Bupivacaine-induced side effects have led to the search for new local anesthetics (LA) with similar potency and lower toxicity, such as bupivacaine enantiomeric mixture (S75-R25). Drug-delivery systems for LA in carriers, such as cyclodextrins (CD), have been developed to improve anesthetic potency and therapeutic index of those drugs. This study aimed at preparing, characterizing and evaluating the anesthetic efficacy of inclusion complexes of bupivacaine enantiomeric mixture (S75-R25) and racemic bupivacaine (S50-R50) with hydroxypropylb- cyclodextrin (HPb-CD) comparing them to clinically available preparations. METHODS: Inclusion complexes were obtained by mixing appropriate volumes of HPb-CD and S50-R50 or S75-R25 to final 1:1 or 1:2 molar ratios and were characterized by phase solubility experiments. Affinity constants (K) were determined between HPb-CD and each LA. Motor and sensory blocks induced by plain or complexed LA formulations were evaluated in mice by sciatic nerve block. Three LA concentrations were used during the experiment: 0.125, 0.25 and 0.5%. RESULTS: Solubility experiments results were indicative of S50-R50:HPb-CD and S75-R25:HPb-CD complexation, with similar affinity constant (K) values: 14.7 M-1 and 14,3 M-1, respectively. In vivo experiments have shown that complexation has enhanced differential nerve blockade induced by LA: i) motor blockade duration induced by S75-R25 was similar, to the induced by but less intense S50-R50 ( p < 0.001). S50-R50HPb-CD and S75-R25HPb-CD complexes have decreased onset (p < 0.01 and p < 0.05, respectively), without changing motor block intensity (Emax) as compared to plain drugs; ii) sensory block evaluation has revealed higher analgesic intensity with S50-R50HPb-CD (2-fold, p < 0.001) and S75-R25HPb-CD (1.5-1.8-fold, p < 0.01 and p < 0.001, respectively) with both molar ratios (1:1 and 1:2, LA:CD), in addition to prolonging analgesic effect as compared to S50-R50 and S75-R25. CONCLUSIONS: More pronounced analgesic effects obtained by complexation with HPb-CD have shown that both formulations, S50-R50HPb-CD and S75-R25HPb-CD, are very useful for postoperative pain relief, requiring lower LA concentrations. Nevertheless, it is worth noticing that S75-R25 - being less toxic than racemic bupivacaine - is an interesting alternative for the development of more effective and safe drug-delivery systems as compared to racemic bupivacaine (S50-R50).JUSTIFICATIVA E OBJETIVOS: Os efeitos adversos associados ao uso de bupivacaína levaram à procura por novos anestésicos locais (AL) com perfil de bloqueio semelhante e menos tóxicos, surgindo novas preparações como a mistura enantiomérica de bupivacaína (S75-R25). Os sistemas de liberação controlada, contendo AL em carreadores como ciclodextrinas (CD), têm como objetivo melhorar a eficácia anestésica e o índice terapêutico dessas drogas. Este estudo visou a preparação, a caracterização e a avaliação da eficácia anestésica dos complexos de inclusão da mistura enantiomérica da bupivacaína (S75-R25) e da bupivacaína racêmica (S50-R50) com hidroxipropilb-ciclodextrina (HPb-CD) comparando-os com as preparações atualmente utilizadas na clínica. MÉTODO: Os complexos de inclusão foram preparados misturando-se quantidades apropriadas de HPb-CD e S50-R50 ou S75-R25 nas razões molares (1:1 e 1:2) e caracterizados por estudos de solubilidade de fases. Determinaram-se as constantes de afinidade (K) de cada AL pela HPb-CD. Os bloqueios motor e sensorial induzidos pelas drogas livres e complexadas foram avaliados, em camundongos, através do bloqueio do nervo ciático. Para a realização dos experimentos, utilizaram-se três concentrações de AL: 0,125%; 0,25% e 0,5%. RESULTADOS: Os estudos de solubilidade indicaram a formação de complexos de inclusão de S50-R50 e S75-R25 com HPb-CD, com valores de constante de afinidade (K) similares para os dois anestésicos: 14,7 M-1 (S50-R50:HP-bCD) e 14,3 M-1 (S75-R25:HP-bCD). Os testes em animais mostraram que a complexação potencializou o bloqueio nervoso diferencial induzido pelos AL: i) a duração do bloqueio motor induzido por S75-R25 foi similar à do S50-R50, mas menos intenso (p < 0,001). Já os complexos, S50-R50HPb-CD e S75-R25HPb-CD reduziram a latência (p < 0,01 e p < 0,05, respectivamente) sem modificar a intensidade do bloqueio motor (Emáx), em relação às drogas livres; ii) a avaliação do bloqueio sensorial mostrou aumento na intensidade da analgesia com os sistemas S50-R50HPb-CD (2 vezes, p < 0,001) e S75-R25HPb-CD (1,5-1,8 vezes; p < 0,01 e p < 0,001, respectivamente), nas duas proporções molares (1:1 e 1:2, AL:CD), além do prolongamento da duração do efeito analgésico, quando comparados às formulações S50-R50 e S75-R25. CONCLUSÕES: Os efeitos analgésicos mais pronunciados, obtidos após a complexação com HPb-CD, mostram que ambas as formulações, S50-R50HPb-CD e S75-R25HPb-CD, são de grande interesse para o alívio da dor no período pós-operatório, com a vantagem de serem administradas em menores concentrações. Entretanto, há que se ressaltar que a mistura enantiomérica de bupivacaína (S75-R25), por ser menos tóxica, representa uma alternativa no desenvolvimento de formulações de liberação controlada mais seguras e eficazes do que com a bupivacaína racêmica (S50-R50).JUSTIFICATIVA Y OBJETIVOS: Los efectos adversos asociados al uso de bupivacaína llevaron a la búsqueda por nuevos anestésicos locales (AL) con perfil de bloqueo semejante y menos tóxicos, surgiendo nuevas preparaciones como la mezcla enantiomérica de bupivacaína (S75-R25). Los sistemas de liberación controlada, conteniendo AL en carreadores como ciclodextrinas (CD), tienen como objetivo mejorar la eficacia anestésica y el índice terapéutico de esas drogas. Este estudio visó la preparación, caracterización y evaluación de la eficacia anestésica de los complejos de inclusión de la mezcla enantiomérica de la bupivacaína (S75-R25) y de la bupivacaína racémica (S50-R50) con hidroxipropilb-ciclodextrina (HPb-CD) comparándolos con las preparaciones actualmente utilizadas en la clínica. MÉTODO: Los complejos de inclusión fueron preparados mezclándose cantidades apropiadas de HPb-CD y S50-R50 ó S75-R25 en las razones molares (1:1 y 1:2) y caracterizados por estudios de solubilidad de fases. Se determinaron las constantes de afinidad (K) de cada AL por la HPb-CD. Los bloqueos motor y sensorial inducidos por las drogas libres y complejadas fueron evaluados en ratones, a través del bloqueo del nervio ciático. Para la realización de los experimentos, se utilizaron tres concentraciones de AL: 0,125; 0,25 y 0,5%. RESULTADOS: Los estudios de solubilidad indicaron la formación de complejos de inclusión de S50-R50 y S75-R25 con HPb-CD, con valores de constante de afinidad (K) análogos para los dos anestésicos: 14,7 M-1 (S50-R50: HP-bCD) y 14,3 M-1 (S75-R25: HP-bCD). Las pruebas en animales mostraron que la complejidad potenció el bloqueo nervioso diferencial inducido por los AL: i) la duración del bloqueo motor inducido por S75-R25 fue análogo al del S50-R50, pero menos intenso (p < 0,001). Ya los complejos, S50-R50HPb-CD y S75-R25 HPb-CD redujeron la latencia (p < 0,01 y p < 0,05, respectivamente) sin modificar la intensidad del bloqueo motor (Emáx), con relación a las drogas libres; ii) la evaluación del bloqueo sensorial mostró un aumento en la intensidad de la analgesia con los sistemas S50-R50 HPb-CD (2 veces, p < 0,001) y S75-R25 HPb-CD (1,5-1,8 veces; p < 0,01 y p < 0,001, respectivamente), en las dos proporciones molares (1:1 y 1:2, AL:CD), además del prolongamiento de la duración del efecto analgésico, cuando comparados a las formulaciones S50-R50 y S75-R25. CONCLUSIONES: Los efectos analgésicos más pronunciados logrados después de la complexación con HPb-CD muestran que ambas formulaciones, S50-R50 HPb-CD y S75-R25 HPb-CD, son de grande interés para el alivio del dolor en el período postoperatorio, con la ventaja de ser administradas en menores concentraciones. Mientras, hay que resaltar que la mezcla enantiomérica de bupivacaína (S75-R25), por ser una droga menos tóxica, representa una alternativa en el desarrollo de formulaciones de liberación controlada más seguras y eficaces de que con la bupivacaína racémica (S50-R50).31632
Association between levobupivacaine and pancuronium. Interference in neuromuscular transmission and blockade in rats
To evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro. METHODS: Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I - levobupivacaine (5 mu g.mL-(1)); Group II - pancuronium (2 mu g.mL(-1)); Group III - pancuronium (2 mu g.mL(-1)) + levobupivacaine (5 mu g.mL(-1)). The following parameters were evaluated: 1) amplitude of diaphragmatic response to indirect stimulation, before and 60 minutes after the addition of levobupivacaine and pancuronium alone, and after the addition of levobupivacaine combined with pancuronium; 2) membrane potentials (MP) and miniature endplate potentials (MEPP). RESULTS: Levobupivacaine alone did not alter the amplitude of muscle response and MP. In preparations previoulsy exposed to levobupivacaine, the block with pancuronium was significantly denser (90.2 +/- 15.2%), showing a significant difference (p=0.031) in comparison to the block produced by pancuronium alone (48.9% +/- 9.8%). There was a decrease in the frequency and amplitude of MEPPs. CONCLUSION: Levobupivacaine potentiated the neuromuscular blockade produced by pancuronium, confirming a presynaptic action by a decrease in miniature endplate potentials.To evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro. METHODS: Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I - l317486489SEM INFORMAÇÃOSEM INFORMAÇÃOTo evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro. METHODS: Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I -
Influência do fenobarbital no bloqueio neuromuscular produzido pelo rocurônio em ratos
PURPOSE: To evaluate in vitro and in vivo neuromuscular blockade produced by rocuronium in rats treated with Phenobarbital and to determine cytochrome P450 and cytochrome b5 concentrations in hepatic microsomes. METHODS: Thirty rats were included in the study and distributed into 6 groups of 5 animals each. Rats were treated for seven days with phenobarbital (20 mg/kg) and the following parameters were evaluated: 1) the amplitude of muscle response in the preparation of rats exposed to phenobarbital; 2) rocuronium effect on rat preparation exposed or not to phenobarbital; 3) concentrations of cytochrome P450 and cytochrome b5 in hepatic microsomes isolated from rats exposed or not to phenobarbital. The concentration and dose of rocuronium used in vitro and in vivo experiments were 4 µg/mL and 0,6 mg/kg, respectively. RESULTS: Phenobarbital in vitro and in vivo did not alter the amplitude of muscle response. The neuromuscular blockade in vitro produced by rocuronium was significantly different (p=0.019) between exposed (20%) and not exposed (60%) rats; the blockade in vivo was significantly greater (p=0.0081) in treated rats (93.4%). The enzymatic concentrations were significantly greater in rats exposed to phenobarbital. CONCLUSIONS: Phenobarbital alone did not compromise neuromuscular transmission. It produced enzymatic induction, and neuromuscular blockade in vivo produced by rocuronium was potentiated by phenobarbital.OBJETIVO: Avaliar in vitro e in vivo o bloqueio neuromuscular produzido pelo rocurônio em ratos tratados com fenobarbital e determinar as concentrações de citocromo P450 e b5 em microssomos hepáticos. MÉTODOS: Trinta ratos foram incluídos no estudo e distribuídos em seis grupos de cinco animais cada. Ratos foram tratados por sete dias com fenobarbital (20 mg/kg) e avaliou-se: 1) amplitude das respostas musculares em preparação de ratos expostos ao fenobarbital; 2) o efeito do rocurônio em preparações de ratos expostos ou não ao fenobarbital; 3) as concentrações de citocromo P450 e b5 em microssomos isolados de fígados dos ratos expostos ou não ao fenobarbital. A concentração e dose de rocurônio utilizadas nos experimentos in vitro e in vivo foram respectivamente de 4 µg/mL e 0,6 mg/kg. RESULTADOS: In vitro e in vivo, o fenobarbital não alterou a amplitude das respostas musculares. In vitro, o bloqueio produzido pelo rocurônio foi significativamente diferente (p=0.019) entre expostos (20%) e não expostos (60%); in vivo o bloqueio foi significativamente maior (p=0.0081) nos ratos tratados (93,4%). As concentrações enzimáticas foram significativamente maiores nos ratos expostos ao fenobarbital. CONCLUSÕES: O fenobarbital isoladamente não comprometeu a transmissão neuromuscular. Ocasionou indução enzimática, e in vivo o bloqueio com o rocurônio foi potencializado pelo fenobarbital.34334
Evidence of presynaptic and postsynaptic action of local anesthetics in rats
PURPOSE: To assess the probable actions of ropivacaine, 50% enantiomeric excess bupivacaine mixture (S75-R25) and levobupivacaine on neuromuscular transmission in vitro. METHODS: Thirty rats were distributed into groups (n=5) according to the drug used: ropivacaine, bupivacaine (S75-R25) and levobupivacaine. The concentration used for the three local anesthetics (LA) was 5 µg.mL.-1The following parameters were evaluated: 1) LA effects on membrane potential (MP) and miniature end plate potential (MEPP). A chick biventer cervicis preparation was also used to evaluate LA effects on the contracture response to acetylcholine. RESULTS: LA did not alter MP values and decreased the frequency and amplitude of MEPP. In a chick biventer cervicis preparation, bupivacaine (S75-R25) and levobupivacaine decreased the contracture response to acetylcholine with statistical significance, in comparison to ropivacaine. CONCLUSIONS: In the concentrations used, levobupivacaine and bupivacaine (S75-R25) exhibited presynaptic and postsynaptic actions evidenced by alterations in miniature end plate potentials and contracture response to acetylcholine. Ropivacaine only had a presynaptic action.77477
Epidural Block for Cesarean Section. A Comparative Study between 0.5% Racemic Bupivacaine (S50-R50) and 0.5% Enantiomeric Excess Bupivacaine (S75-R25) Associated with Sufentanil
SummaryBackground and objectivesEpidural 0.5% racemic bupivacaine associated with opioids is a technique used in cesarean sections; however, its toxicity has been questioned. 50% Enantiomeric excess bupivacaine has lower cardio- and neurotoxicity. The efficacy of epidural 0.5% racemic bupivacaine and 0.5% enantiomeric excess bupivacaine associated with sufentanil in parturients undergoing cesarean sections was evaluated.MethodsFifty gravida at term, undergoing elective cesarean section under epidural block, were divided in two groups according to the local anesthetic used: Group I – 0.5% racemic bupivacaine with vasoconstrictor; and Group II – 0.5% enantiomeric excess bupivacaine (S75-R25) with vasoconstrictor. In both groups, the local anesthetic (100 mg) was associated with sufentanil (20 μg), and a total of 24 mL of the solution was used. The following parameters were evaluated: latency of the sensitive blockade; maximal level of the sensitive blockade; degree for motor blockade; time of motor blockade regression; duration of analgesia; maternal side effects; and neonatal repercussions.ResultsLatency, maximal level of sensitive blockade, degree of motor blockade, and duration of analgesia were similar in both groups; the mean time for regression of the motor blockade was significantly smaller in Group II. The incidence of side effects was similar in both groups. Maternal cardiocirculatory changes and neonatal repercussions were not observed.ConclusionsEpidural racemic bupivacaine and 50% enantiomeric excess bupivacaine provided adequate anesthesia for cesarean sections. 50% Enantiomeric excess bupivacaine is a promising alternative for this procedure, since it has faster regression of the motor blockade, which is desirable in obstetric patients
Influência da freqüência de estímulos no bloqueio neuromuscular produzido pelo pancurônio e rocurônio: estudo em preparação nervo frênico-diafragma de ratos
PURPOSE: To evaluate the influence of two stimulation frequencies on the installation of neuromuscular blockade produced by pancuronium and rocuronium on the rat diaphragm. METHODS: Diaphragms were submitted to an indirect frequency stimulation of 0.1 and 1Hz (Groups I and II, respectively). Subgroups were formed (n=5) according to the neuromuscular blocker employed (pancuronium-2µg/ml and rocuronium-4µg/ml). The twitch height depression was evaluated at 5, 15 and 30 minutes after adding the neuromuscular blocker. RESULTS: The decrease in twitch height was greater (p<0.01) with a frequency of 1Hz at all time periods studied both in preparations that are blocked with pancuronium and in those that are blocked with rocuronium. CONCLUSION: The frequency of stimulation interferes significantly with the installation of neuromuscular blockade produced by pancuronium and rocuronium, since the reduction in amplitude of the rat diaphragm response was greater for 1Hz frequencies, at all periods studied.OBJETIVO: Avaliar a influência de duas freqüências de estimulação na instalação do bloqueio neuromuscular induzido por pancurônio e rocurônio em diafragma de ratos. MÉTODOS: Os diafragmas foram submetidos a uma freqüência de estimulação indireta de 0.1 e 1Hz (Grupos I e II, respectivamente). Os animais foram divididos em subgrupos (n=5) de acordo com o bloqueador neuromuscular a ser utilizado (pancurônio-2µg/mL e rocurônio-4µg/mL). A amplitude das respostas musculares foi avaliada 5, 15 e 30 minutos após a adição do bloqueador neuromuscular à preparação. RESULTS: A redução na intensidade da contração foi maior (p<0.01) com a freqüência de 1Hz em todos os tempos avaliados para as preparações contendo pancurônio e rocurônio CONCLUSION: A freqüência de estímulo interfere significativamente na instalação do bloquio neuromuscular produzido por pancurônio e rocurônio, uma vez que a redução na amplitude da resposta do diafragma foi maior para a freqüência de 1Hz em todos os períodos estudados.44645
Insulinoma e gestação: anestesia e manejo perioperatório
ResumoO insulinoma é um tumor neuroendócrino funcional de células beta das ilhotas de Langerhans pancreáticas, geralmente solitários, benignos, curáveis com cirurgia (enucleação). Raramente ocorre durante a gravidez e se manifesta clinicamente por hipoglicemia, principalmente no primeiro trimestre da gravidez. Durante a gestação as condutas terapêuticas conservadoras (medicamentosas) e o tratamento cirúrgico constituem desafios tendo em vista a impossibilidade de estudos sobre teratogenicidade de fármacos, assim como as repercussões materno‐fetais durante intervenções cirúrgicas, como a hipoglicemia e alterações decorrentes do estresse.Relato de casoPaciente com 33 anos, 86 Kg, 1,62m, IMC 32,7kg/m2, primigesta, 15 semanas de idade gestacional, estado físico III da ASA, investigada por rebaixamento do nível de consciência. Aos exames laboratoriais constataram‐se: hipoglicemia (45mg/dL) associada à hiperinsulinemia (24 nUI/ml) e hemoglobina glicosilada (4,1%); demais exames laboratoriais e exame físico normais. A ressonância magnética mostrou nódulo de 1,1cm em cauda de pâncreas com hipótese de insulinoma. Devido ao difícil controle glicêmico com infusão em bolus e contínua de glicose, foi feita laparotomia para enucleação do tumor sob anestesia venosa total associada a bloqueio peridural. Monitoração, acesso venoso central e periférico, cateterização de artéria radial, diurese, glicosimetria a cada 15 minutos. No intraoperatório, observou‐se hipoglicemia acentuada nos momentos de manipulação e imediatamente antes da enucleação do tumor, controlada com infusão contínua de solução cristaloide balanceada glicosada a 10% (100 a 230ml/h). A evolução no pós‐operatório seguiu sem intercorrências, com resolução dos quadros de hipoglicemia e retirada total da infusão venosa de glicose.AbstractInsulinoma is a functional neuroendocrine tumor derived from beta cells of the pancreatic islets of Langerhans, usually solitary, benign, and curable with surgery (enucleation). It rarely occurs during pregnancy and is clinically manifested by hypoglycemia, particularly in the first trimester of pregnancy. During pregnancy, both conservative therapeutic measures (medication) and surgical treatment are challenging regarding the impossibility of studies on drug teratogenicity as well as the maternal‐fetal repercussions during surgery, such as hypoglycemia and changes due to stress.Case reportA 33‐year primiparous woman, 86kg, 1.62m, BMI 32.7kg/m2, at 15 weeks’ gestation, physical status ASA III, investigated for a reduced level of consciousness. Laboratory tests showed: hypoglycemia (45mg/dL) associated with hyperinsulinemia (24 nUI/mL), glycosylated hemoglobin (4.1%); other laboratory findings and physical examination were normal. Magnetic resonance imaging showed a 1.1cm nodule in the pancreatic tail with suspected insulinoma. Due to the difficult glycemic control with bolus and continuous infusion of glucose, laparotomy was performed for tumor enucleation under total intravenous anesthesia combined with epidural block. Monitoring, central and peripheral venous access, radial artery catheterization, diuresis, and glucosimetry were recorded every 15minutes. Intraoperatively, there was severe hypoglycemia while handling the tumor and shortly before its enucleation, which was controlled through continuous infusion of 10% glucose balanced crystalloid solution (100‐230mL/h). The patient's postoperative evolution was uneventful, with resolution of hypoglycemia and total withdrawal of glucose intravenous infusion
Neuromuscular and cardiovascular effects of pipecuronium: a comparative study between different dose
BACKGROUND AND OBJECTIVES: Pipecuronium is a non-depolarizing neuromuscular blocker with similar properties to pancuronium, but without cardiovascular effects. Neuromuscular effects, conditions of tracheal intubation, and hemodynamic repercussions of two different doses of pipecuronium were evaluated. METHOD: Patients were divided into two groups according to the dose of pipecuronium: Group I (0.04 mg.kg-1) and Group II (0.05 mg.kg-1). Intramuscular midazolam (0.1 mg.kg-1) was administered 30 minutes before the surgery. Propofol (2.5 mg.kg-1), preceded by fentanyl (5 µg.kg-1) and pipecuronium (0.04 and 0.05 mg.kg-1 for Groups I and II, respectively), was administered for anesthetic induction. Patients were ventilated with 100% oxygen via a face mask until a 75% reduction in the amplitude of the response to an isolated stimulus (1 Hz) is achieved, at which time laryngoscopy and intubation were carried out. Anesthetic maintenance was achieved with isoflurane (0.5 to 1%) with a mixture of 50% O2 and N2O. Mechanical ventilation was used to maintain P ET CO2 between 32 and 36 mmHg. The pharmacodynamics of pipecuronium was evaluated by acceleromyography. RESULTS: Mean times and standard deviation for the onset of action, clinical duration (T1(25%)), and recovery index (T1(25-75%)) were: Group I (122.10 ± 4.18 sec, 49.63 ± 9.54 min, and 48.21 ± 6.72 min), and Group II (95.78 ± 8.91 sec, 64.84 ± 13.13 min, and 48.52 ± 4.95 min). Onset of action, clinical duration, and conditions of tracheal intubation were significantly different for both groups. CONCLUSIONS: Pipecuronium at a dose of 0.05 mg.kg-1 can be used in prolonged procedures in which cardiovascular changes should be avoided.JUSTIFICATIVA E OBJETIVOS: O pipecurônio é um bloqueador neuromuscular não-despolarizante, com propriedades similares as do pancurônio, mas desprovido de efeitos cardiovasculares. Foram avaliados os efeitos neuromusculares, as condições de intubação traqueal e as repercussões hemodinâmicas de duas diferentes doses de pipecurônio. MÉTODO: Pacientes foram distribuídos em dois grupos de acordo com a dose de pipecurônio: Grupo I (0,04 mg.kg-1) e Grupo II (0,05 mg.kg-1). A medicação pré-anestésica consistiu em midazolam (0,1 mg.kg-1) por via muscular, 30 minutos antes da operação. A indução anestésica foi obtida com propofol (2,5 mg.kg-1) precedido de fentanil (5 µg.kg-1) e pipecurônio nas doses de 0,04 e 0,05 mg.kg-1 para os Grupos I e II, respectivamente. Os pacientes foram ventilados com O2 a 100% sob máscara até a redução de 75% da amplitude da resposta a estímulo isolado (1 Hz), quando foram realizadas a laringoscopia e intubação traqueal. O isoflurano (0,5 a 1%) em mistura de O2 e N(2)0 a 50% para a manutenção da anestesia, foi introduzido logo após a intubação traqueal. Os pacientes foram ventilados mecanicamente para manter P ET CO2 entre 32 e 36 mmHg. A farmacodinâmica do pipecurônio foi avaliada por aceleromiografia. RESULTADOS: Os tempos médios e desvios-padrão para o início de ação, duração clínica (T1(25%)) e índice de recuperação (T1(25-75%)) foram: Grupo I (122,10 ± 4,18 s, 49,63 ± 9,54 min e 48,21 ± 6,72 min) e Grupo II (95,78 ± 8,91 s, 64,84 ± 13,13 min e 48,52 ± 4,95 min). O início de ação, a duração clínica e as condições de intubação traqueal foram significativamente diferentes entre os grupos. CONCLUSÕES: O pipecurônio na dose 0,05 mg.kg-1 pode ser usado em procedimentos de longa duração, nos quais é desejável evitar alterações cardiocirculatórias.JUSTIFICATIVA Y OBJETIVOS: El pipecuronio es un bloqueador neuromuscular no despolarizador, con propiedades similares a las del pancuronio, pero desprovisto de efectos cardiovasculares. Se evaluaron los efectos neuromusculares, condiciones de intubación traqueal y las repercusiones hemodinámicas de de los diferentes dosis de pipecuronio. MÉTODO: Los pacientes fueron distribuidos en de los grupos de acuerdo a la dosis de pipecuronio: Grupo I (0,04 mg.kg-1) y Grupo II (0,05 mg.kg-1). La medicación preanestésica consistió en midazolam (0,1 mg.kg-1) por vía muscular, 30 minutos antes de la operación. La inducción anestésica se obtuvo con propofol (2,5 mg.kg-1) precedido del fentanil (5 µg.kg-1) y del pipecuronio en las dosis de 0,04 y 0,05 mg.kg-1 para los Grupos I y II, respectivamente. Los pacientes se ventilaron con O2 a 100% bajo máscara hasta la reducción de un 75% de la amplitud de la respuesta al estímulo aislado (1 Hz), cuando fueron realizadas la laringoscopía y la intubación traqueal. El isoflurano (0,5 a 1%) en mezcla de O2 y N(2)0 a un 50% para el mantenimiento de la anestesia, fue introducido a continuación de la intubación traqueal. Los pacientes fueron ventilados mecánicamente para mantener el P ET CO2 entre 32 y 36 mmHg. La farmacodinámica del pipecuronio se evaluó por aceleromiografía. RESULTADOS: Los tiempos promedios y desviaciones estándar para el inicio de acción, duración clínica (T1(25%)) e índice de recuperación (T1(25-75%)) fueron los siguientes: Grupo I (122,10 ± 4,18 seg, 49,63 ± 9,54 min y 48,21 ± 6,72 min) y Grupo II (95,78 ± 8,91 seg, 64,84 ± 13,13 min y 48,52 ± 4,95 min). El inicio de acción, la duración clínica y las condiciones de intubación traqueal fueron significativamente diferentes entre los grupos. CONCLUSIONES: El pipecuronio, en la dosis 0,05 mg.kg-1 puede ser usado en procedimientos de larga duración donde se desee evitar alteraciones cardiocirculatorias.58259
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