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HUANG Y, TANG H, SONG Y, CHEN B, ZHONG H. [Simultaneous determination of three quaternary ammonium muscle relaxants in blood by high performance liquid chromatography-tandem mass spectrometry]. Se Pu 2021; 39:695-701. [PMID: 34227366 PMCID: PMC9404065 DOI: 10.3724/sp.j.1123.2020.09020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Vecuronium, rocuronium, and pancuronium are widely used as non-depolarizing muscle relaxants. There have been occasional cases of allergic reactions and even death when using such muscle relaxants. Rapid determination of the concentration of these muscle relaxants in blood can provide valuable information for early clinical diagnosis. As quaternary ammonium compounds, these muscle relaxants are highly polar. Hence, they cannot be retained effectively on reversed-phase chromatographic columns with conventional mobile phases. These quaternary ammonium muscle relaxants are mainly separated by ion-pair chromatography. Using an ion-pairing reagent can help improve the retention capabilities of quaternary ammonium muscle relaxants. Nevertheless, the sensitivity of MS detection is significantly decreased because of ionic inhibition caused by the ion-pairing reagent in the mobile phase. Furthermore, ion-pairing reagents can pollute the MS system. A method based on high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was established for the simultaneous determination of the three quaternary ammonium muscle relaxants in blood. The blood samples were diluted and subjected to high-speed centrifugation. The supernatant was purified on a Bond Elut AL-N solid phase extraction column and then filtered through a 0.45 μm microporous membrane. The quaternary ammonium muscle relaxants were separated on a ZIC-cHILIC analytical column (50 mm×2.1 mm, 3.0 μm) with gradient elution. Acetonitrile and 0.1% formic acid aqueous solution were used as mobile phases. The separated compounds were analyzed by tandem MS with an electrospray ionization (ESI) source in positive and multiple reaction monitoring (MRM) modes. The matrix effects of vecuronium, rocuronium, and pancuronium in blood were 88.1% to 95.4%. The calibration curves for vecuronium, rocuronium, and pancuronium showed good linear relationships in each range, and all correlation coefficients (R2) were > 0.996. The limits of detection of vecuronium, rocuronium, and pancuronium were 0.2-0.8 ng/mL, with the corresponding limits of quantification being 0.5-2.0 ng/mL. The recoveries of vecuronium, rocuronium, and pancuronium were 92.8% to 110.6%, with relative standard deviations (RSDs) of 3.2%-9.4%. This method is sensitive, accurate, and easy to operate, and it can be used to rapidly determine vecuronium, rocuronium, and pancuronium in blood.
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Affiliation(s)
- Yongpeng HUANG
- 国民核生化灾害防护国家重点实验室, 北京 102205
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Hui TANG
- 国民核生化灾害防护国家重点实验室, 北京 102205
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Yunyang SONG
- 国民核生化灾害防护国家重点实验室, 北京 102205
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Bo CHEN
- 国民核生化灾害防护国家重点实验室, 北京 102205
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Hui ZHONG
- 国民核生化灾害防护国家重点实验室, 北京 102205
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
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Abd Elrahman MK, El Houssini OM, Fahem DK, Zaazaa HE. Stability indicating liquid chromatography method for the analysis of Vecuronium bromide: study of the degradation profile. Heliyon 2020; 6:e03530. [PMID: 32195388 PMCID: PMC7076553 DOI: 10.1016/j.heliyon.2020.e03530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/29/2019] [Accepted: 01/28/2020] [Indexed: 11/25/2022] Open
Abstract
Neuromuscular blocker agent namely; Vecuronium bromide (VEC) was quantified through developing a simple reversed phase liquid chromatographic (RP-LC) method, in drug substance and in drug product. The proposed method could quantify VEC in the presence of its degradation products produced from exposing VEC to different stress conditions as recommended by the International Conference on harmonization (ICH) guidelines. Acidic (2M HCl), basic (2MNaOH) hydrolysis, oxidation (3% H2O2), photolysis (UV light at 254nm), and thermal (135 °C) degradation were estimated by exposing the drug substances to different stress conditions. The separation of the drug from its degradation products was successfully conducted on Tracer Extrasil CN (150 × 4.6mm; 5μm) column using O-phosphoric acid (pH6; 0.05M)-acetonitrile (50:50v/v) as mobile phase. The detection and quantification was done with UV detection at210nm.The validation data were found to be acceptable over a concentration range10-120 μg/ml. The limit of quantification (LOQ) and detection (LOD) were 8.10 and 2.67 μg/ml, respectively. The proposed method met all criteria for validation in accordance with the International Conference on harmonization (ICH) guidelines. The presented work monitored the degradation profile for VEC under various stress conditions and provided a simple LC method for its routine analysis. The structures of the forced degradation products had been described in details using the MS data and the possible degradation pathways were outlined. Besides, the results obtained from the developed method compared statistically with that of the official method indicting high accuracy and precision.
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Affiliation(s)
- Mohamed K Abd Elrahman
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562, Egypt
| | - Ola M El Houssini
- National Organization for Drug Control and Research (NODCAR), 51 Wezaret El-Zeraa St, Agouza P.O. Box 12553, Giza, 35521, Egypt
| | - Diana K Fahem
- National Organization for Drug Control and Research (NODCAR), 51 Wezaret El-Zeraa St, Agouza P.O. Box 12553, Giza, 35521, Egypt
| | - Hala E Zaazaa
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562, Egypt
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Fahem DK, El Houssini OM, Abd El-Rahman MK, Zaazaa HE. A point of care screen printed potentiometric sensor for therapeutic monitoring of vecuronium. Microchem J 2019. [DOI: 10.1016/j.microc.2019.03.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Chung S, Hwang BY, Naveen MH, Shim YB. Detection of Rocuronium in Whole Blood Using a Lipid-bonded Conducting Polymer and Porous Carbon Composite Electrode. ELECTROANAL 2018. [DOI: 10.1002/elan.201800102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Saeromi Chung
- Department of Chemistry, Institute of BioPhysio Sensor Technology (IBST); Pusan National University; Busan 46241 Republic of Korea
| | - Boo-Young Hwang
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute; Pusan National University Hospital; Busan 49241 Republic of Korea
| | - M. H. Naveen
- Department of Chemistry, Institute of BioPhysio Sensor Technology (IBST); Pusan National University; Busan 46241 Republic of Korea
| | - Yoon-Bo Shim
- Department of Chemistry, Institute of BioPhysio Sensor Technology (IBST); Pusan National University; Busan 46241 Republic of Korea
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Cho HE, Park MJ, Kim SC, Hong RS, Moon DC, Ahn SY. Analysis of Rocuronium in Human Whole Blood and Tissues Using Liquid Chromatography-Tandem Mass Spectrometry. J Chromatogr Sci 2013; 51:297-301. [DOI: 10.1093/chromsci/bms252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Vecuronium Pharmacokinetic-Pharmacodynamic Modelling With and Without a Receptor Concentration in the Effect Compartment in Anaesthetised Patients. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03257402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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García PL, Gomes FP, Santoro MIRM, Kedor-Hackmann ÉRM, Quero JLV, Montón AN, Montoya GC, Cabrera MA. Determination of Vecuronium Bromide in Pharmaceuticals: Development, Validation and Comparative Study of HPLC and CZE Analytical Methods. Chromatographia 2011. [DOI: 10.1007/s10337-011-1945-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lestari MLAD, Indrayanto G. Rocuronium bromide. PROFILES OF DRUG SUBSTANCES, EXCIPIENTS, AND RELATED METHODOLOGY 2010; 35:285-308. [PMID: 22469224 DOI: 10.1016/s1871-5125(10)35006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Błażewicz A, Fijałek Z, Samsel K. Determination of pipecuronium bromide and its impurities in pharmaceutical preparation by high-performance liquid chromatography with coulometric electrode array detection. J Chromatogr A 2008; 1201:191-5. [DOI: 10.1016/j.chroma.2008.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 04/25/2008] [Accepted: 05/05/2008] [Indexed: 11/26/2022]
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Błażewicz A, Fijałek Z, Warowna-Grześkiewicz M, Boruta M. Simultaneous determination of rocuronium and its eight impurities in pharmaceutical preparation using high-performance liquid chromatography with amperometric detection. J Chromatogr A 2007; 1149:66-72. [DOI: 10.1016/j.chroma.2006.12.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 12/05/2006] [Accepted: 12/11/2006] [Indexed: 11/29/2022]
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Woloszczuk-Gebicka B, Wyska E, Grabowski T, Swierczewska A, Sawicka R. Pharmacokinetic-pharmacodynamic relationship of rocuronium under stable nitrous oxide-fentanyl or nitrous oxide-sevoflurane anesthesia in children. Paediatr Anaesth 2006; 16:761-8. [PMID: 16879519 DOI: 10.1111/j.1460-9592.2005.01840.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to compare pharmacokinetics and pharmacokinetic-pharmacodynamic (PK-PD) relationship of rocuronium in children anesthetized with nitrous oxide (N2O) and fentanyl or with N2O and sevoflurane. METHODS Twenty-four children (3-11 years old, ASA PS I or II) were randomized to receive N2O/O2-fentanyl or N2O/O2-sevoflurane (one MAC) anesthesia. Neuromuscular transmission was monitored electromyographically. Initial bolus dose of rocuronium, 0.6 mg x kg(-1) was followed by continuous infusion, targeting at steady-state 95% T1 depression. Neuromuscular transmission was allowed to recover spontaneously. Plasma samples were collected at the moment of discontinuation of infusion, and 10, 20, 30, 50, 60 and 75 min afterwards. Concentrations of rocuronium were measured using high-performance liquid chromatography with electrochemical detection (HPLC-EC). Rocuronium PK was described by a two-compartment model and PD parameters were estimated using effect compartment and sigmoidal E(max) models. RESULTS No differences in rocuronium PK parameters were observed between study groups. Clearance was 3.91 +/- 2.07 and 3.62 +/- 0.80 ml x min(-1) x kg(-1) in sevoflurane and fentanyl groups, respectively (P < 0.65). Effect compartment concentrations corresponding to 50% inhibition of T1 (EC50) were 1.41 +/- 0.45 and 2.32 +/- 1.00 microg x ml(-1) (P < 0.02), and rate constants for equilibration between plasma and effect compartment (k(e0)) values were 0.10 +/- 0.04 and 0.24 +/- 0.14 min(-1) (P < 0.009) in sevoflurane and fentanyl groups, respectively. CONCLUSIONS Disposition of rocuronium was similar under stable N2O-fentanyl and N2O-sevoflurane anesthesia. Sevoflurane reduced rocuronium requirements as well as decreased EC50 relevant to inhibition of T1 and rocuronium transfer to effect compartment. Therefore, the potentiating effect of sevoflurane seems to be mainly of PD origin, probably due to an increased sensitivity of the neuromuscular junction.
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Usui K, Hishinuma T, Yamaguchi H, Saga T, Wagatsuma T, Hoshi K, Tachiiri N, Miura K, Goto J. Simultaneous determination of pancuronium, vecuronium and their related compounds using LC–ESI-MS. Leg Med (Tokyo) 2006; 8:166-71. [PMID: 16621652 DOI: 10.1016/j.legalmed.2006.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Revised: 02/23/2006] [Accepted: 02/23/2006] [Indexed: 11/30/2022]
Abstract
A simultaneous determination method of quaternary amino steroidal muscle relaxants, pancuronium (PAN), vecuronium (VEC), and 17-monodesacetyl pancuronium (17-OH-PAN), 3,17-bisdesacetyl pancuronium (3,17-OH-PAN), 3-monodesacetyl vecuronium (3-OH-VEC), 3,17-bisdesacetyl vecuronium (3,17-OH-VEC) in human serum was developed using liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). The weak cation exchange cartridge was useful for the extraction of these compounds. Under optimized LC-ESI-MS conditions, these compounds were almost fully separated within 6.5 min. Linear responses over the concentration range 0.25-50.0 ng/mL were demonstrated for each compound. The developed method successfully detected VEC, 3-OH-VEC and 3,17-OH-VEC in serum intravenously administered with VEC. The level of 3-OH-VEC was higher than other compounds. This suggested that 3-OH-VEC was useful as a forensic probe in VEC administration.
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Affiliation(s)
- Kiyotaka Usui
- Division of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
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Ezzine S, Varin F. Interstitial muscle concentrations of rocuronium under steady-state conditions in anaesthetized dogs: actual versus predicted values. Br J Anaesth 2005; 94:49-56. [PMID: 15542539 DOI: 10.1093/bja/aei005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The objective of this study was to compare rocuronium effect (C(e)) and peripheral (C(2)) compartment concentrations predicted by pharmacokinetic-pharmacodynamic (PK-PD) modelling with those measured in plasma (C(p)) and in the interstitial fluid of muscle tissue (C(ISF,u)) by microdialysis in anaesthetized dogs. METHODS After approval by the Animal Care Committee, eight adult male dogs with a body weight ranging from 7 to 18 kg were anaesthetized with pentobarbital. Each dog received a 2-min rocuronium infusion of 0.15 mg kg(-1) min(-1) followed by a 118-min infusion of 60 microg kg(-1) min(-1) via the right jugular vein. Arteriovenous gradient across the hindlimb was measured at 40, 60, 100 and 120 min. Three microdialysis samples were collected at 40-min intervals. Once the infusion stopped, arterial samples were collected every 2 min for the first 10 min and every 20 min for the next 120 min. Neuromuscular function was monitored using train-of-four stimulation until full recovery. Dogs were then killed and a biopsy of muscle tissue was performed (C(m)). RESULTS At steady state, the mean C(ISF,u) value was 1353 ng ml(-1). After correction for the unbound fraction in plasma, the mean C(e,corr) and C(2,corr) were 1681 and 1481 ng ml(-1), respectively. At the terminal sampling point, C(m) was 10-fold higher than C(p). CONCLUSION Unbound concentration of rocuronium measured in the muscle interstitial fluid under steady-state conditions confirms that parametric PK-PD modelling gives reliable estimates of effect site concentrations. Rocuronium accumulates in muscle tissue, probably by non-specific protein binding in the interstitial space.
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Affiliation(s)
- S Ezzine
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
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Dragne A, Varin F, Plaud B, Donati F. Rocuronium pharmacokinetic-pharmacodynamic relationship under stable propofol or isoflurane anesthesia. Can J Anaesth 2002; 49:353-60. [PMID: 11927473 DOI: 10.1007/bf03017322] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the pharmacokinetics, pharmacodynamics and the concentration-effect relationship of rocuronium in patients under stable propofol or isoflurane anesthesia. METHODS Ten patients were randomized to receive fentanyl, propofol and nitrous oxide (60%) or fentanyl, thiopental, isoflurane (1.2% end-tidal concentration) and nitrous oxide (60%). To obtain good intubation conditions and maintain adequate muscle relaxation during surgery, patients received two bolus doses of rocuronium: 0.5 mg x kg(-1) (1.7 x ED95) at induction followed one hour later by 0.3 mg x kg(-1) (1 x ED95). Arterial blood samples were obtained over six hours after the second bolus dose. Plasma concentrations of rocuronium were measured using high pressure liquid chromatography. Muscle twitch tension was monitored by mechanomyography for the two doses. Pharmacokinetic and pharmacodynamic parameters were determined. RESULTS No differences in rocuronium pharmacokinetic parameters were observed between both groups. After the second bolus, clinical duration was 20 +/- 6 min in the propofol group vs 39 +/- 8 min in the isoflurane group (P <0.05). The effect compartment concentration corresponding to 50% block, EC50, was higher under propofol anesthesia: 1008 vs 592 microg x L(-1) (P <0.05). CONCLUSION Rocuronium body disposition is similar under stable propofol or isoflurane anesthesia. In contrast to isoflurane, propofol does not prolong the neuromuscular block. Therefore, the potentiating effect of isoflurane is of pharmacodynamic origin only, as explained by an increased sensitivity at the neuromuscular junction. In contrast with isoflurane anesthesia where the dose of rocuronium has to be decreased under stable conditions, no dose adjustment is required under propofol anesthesia.
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Affiliation(s)
- Alexandrina Dragne
- De la Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
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Fine GF, Brandom BW, Yellon RF. Unmasked Residual Neuromuscular Block After Administration of Vecuronium for Days. Anesth Analg 2001. [DOI: 10.1213/00000539-200108000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fine GF, Brandom BW, Yellon RF. Unmasked residual neuromuscular block after administration of vecuronium for days. Anesth Analg 2001; 93:345-7 , 3rd contents page. [PMID: 11473857 DOI: 10.1097/00000539-200108000-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPLICATIONS Significant neuromuscular block may be present in patients who have received vecuronium for days.
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Affiliation(s)
- G F Fine
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA.
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Soriano SG, Sullivan LJ, Venkatakrishnan K, Greenblatt DJ, Martyn JA. Pharmacokinetics and pharmacodynamics of vecuronium in children receiving phenytoin or carbamazepine for chronic anticonvulsant therapy. Br J Anaesth 2001; 86:223-9. [PMID: 11573664 DOI: 10.1093/bja/86.2.223] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The pharmacokinetics and time course of action of vecuronium in normal children and children receiving anticonvulsant drugs for prolonged periods were characterized. A bolus dose of vecuronium 0.15 mg kg(-1) was administered i.v. to 10 non-epileptic children and to 10 children on phenytoin and 10 children on carbamazepine, who were matched for age and weight. Plasma concentrations of vecuronium, 3-OH desacetylvecuronium (the primary metabolite of vecuronium) and alpha1-acid glycoprotein (AAG) were determined. Pharmacokinetic variables were derived from plasma samples collected before and after administration of vecuronium. Neuromuscular transmission was monitored by evoked compound electromyography. Recovery of the first twitch of the train-of-four (T1/T0) and the recovery index (RI), the time for 25-75% recovery of T1/T0, were determined. The elimination half-life of vecuronium was significantly reduced in both anticonvulsant groups compared with control [control 48.2 (SD 40.3), phenytoin 23.5 (13.1), carbamazepine 18.4 (16.6) min, P<0.05]. Vecuronium clearance was increased in both anticonvulsant groups [control 9.0 (3.6), phenytoin 15.1 (8.9), carbamazepine 18.8 (13.1) ml kg(-1) min(-1), 0.05<P<0.1]. Children on chronic anticonvulsant therapy had a significantly shorter RI than control [control 21.8 (11), phenytoin 12.5 (8.3), carbamazepine 10.6 (5.9) min, P<0.05]. Concentrations of vecuronium at different degrees of recovery of T1, volumes of distribution and AAG concentrations were not different between groups. Our data confirm anticonvulsant-induced resistance to vecuronium in children and support a pharmacokinetic component contributing to the resistance.
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Affiliation(s)
- S G Soriano
- Department of Anesthesia, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Withington D, Menard G, Harris J, Kulkarni P, Donati F, Varin F. Vecuronium pharmacokinetics and pharmacodynamics during hypothermic cardiopulmonary bypass in infants and children. Can J Anaesth 2000; 47:1188-95. [PMID: 11132740 DOI: 10.1007/bf03019867] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the effect of moderate and deep hypothermic cardiopulmonary bypass (CPB) on the pharmacokinetic and pharmacodynamic behaviour of vecuronium in infants and children. METHODS We studied 12 patients undergoing surgery for congenital heart disease under narcotic-nitrous oxide anesthesia. Neuromuscular blockade was maintained constant (TI 4-10% by Datex electromyograph) by adjusting a vecuronium infusion. Plasma vecuronium concentrations (Cpss) were analysed by HPLC to describe a pseudosteady-state during each of the pre-CPB, CPB and post-CPB phases. Paired arterial blood samples were taken 20 min apart after at least 20 min of constant infusion. RESULTS Nine cases were analysed, mean age 20 mo, mean weight 9 kg. Three patients had deep and six moderate hypothermia. In the pre-CPB phase Cpss fell into two groups (mean +/- SD: 330 +/- 42 ng x ml(-1); 127 +/- 27 ng x ml(-1); P < 0.001); similarly the clearances showed a bimodal distribution (mean +/- SD: 5.08 +/- 0.94; 11.51 +/- 0.2 ml x min(-1) x kg(-1) P < 0.001), although in different patients. During CPB this bimodal distribution disappeared. Vecuronium infusion rate (VIR) decreased by 84% and 92% from pre-CPB to CPB phase in deep and moderate hypothermia groups respectively (P < 0.05), paralleled by decreases in Cpss of 36% (P > 0.05) and 52% (P < 0.05). CONCLUSION Changes in vecuronium requirements and plasma concentrations during CPB demonstrate that vecuronium pharmacokinetics and pharmacodynamics are both affected by hypothermic CPB in infants. The finding of bimodal distributions for plasma vecuronium and vecuronium clearance highlights the need for individual monitoring of neuromuscular blockade in this age group.
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Affiliation(s)
- D Withington
- Department of Anaesthesia, McGill University, Montreal Children's Hospital, Quebec, Canada.
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Gutteck-Amsler U, Rentsch KM. Quantification of the Aminosteroidal Non-Depolarizing Neuromuscular Blocking Agents Rocuronium and Vecuronium in Plasma with Liquid Chromatography-Tandem Mass Spectroscopy. Clin Chem 2000. [DOI: 10.1093/clinchem/46.9.1413] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Katharina M Rentsch
- Institute of Clinical Chemistry, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland
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Gao H, Roy S, Donati F, Varin F. Determination of succinylcholine in human plasma by high-performance liquid chromatography with electrochemical detection. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 1998; 718:129-34. [PMID: 9832369 DOI: 10.1016/s0378-4347(98)00350-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An alternative HPLC method for the quantification of the depolarizing neuromuscular blocking agent succinylcholine in human plasma is described. Drug spiked plasma and patient plasma samples were extracted using a C1 solid-phase cartridge. Succinylcholine was separated on a Cyano column and quantitated using electrochemical detection at a potential of 450 mV and 750 mV. Mobile phase consisted of a mixture of phosphoric acid-acetonitrile-methanol (45:35:25) adjusted to an apparent pH of 5. Standard curves for the quantitation were linear in the range of 250-8000 ng/ml. Between-day and within-day relative standard deviations were 5.1% and 1.7%, respectively. Mean drug recovery and accuracy was 68% and 104%, respectively.
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Affiliation(s)
- H Gao
- Faculté de Pharmacie, Université de Montréal, Quebec, Canada
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Rudis MI, Sikora CA, Angus E, Peterson E, Popovich J, Hyzy R, Zarowitz BJ. A prospective, randomized, controlled evaluation of peripheral nerve stimulation versus standard clinical dosing of neuromuscular blocking agents in critically ill patients. Crit Care Med 1997; 25:575-83. [PMID: 9142020 DOI: 10.1097/00003246-199704000-00005] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine if vecuronium doses individualized by peripheral nerve stimulation are lower than those doses chosen by standard clinical techniques; and to determine whether patients monitored by peripheral nerve stimulation exhibit shorter recovery times and less prolonged neuromuscular blockade after discontinuation of vecuronium than control patients. DESIGN A prospective, randomized, controlled, single-blind trial. SETTING Two ten-bed medical intensive care units of a 937-bed tertiary care, not-for-profit, teaching hospital and health system. PATIENTS Mechanically ventilated patients requiring continuous neuromuscular blockade as part of their therapy. INTERVENTIONS After obtaining written, informed consent and baseline neurologic examinations, patients were randomized to treatment, where dosing was individualized by peripheral nerve stimulation or standard clinical assessment. Doses in the peripheral nerve stimulation group were adjusted to 90% blockade (Train-of-Four of 1/4). The standard clinical dosing group received doses individualized to clinical response by the medical team (blinded to Train-of-Four). Differences between groups were evaluated by Wilcoxon matched-pairs signed rank test. MEASUREMENTS AND MAIN RESULTS A total of 77 patients (35 standard clinical patients vs. 42 peripheral nerve stimulation patients) were enrolled in the study. Despite no difference in initial doses and time to reach 90% blockade or clinical response between groups, the peripheral nerve stimulation group used less drug than the standard clinical group (0.040 +/- 0.028 vs. 0.070 +/- 0.030 mg/kg/hr, respectively, p = .001). The total cumulative amount of vecuronium for the episode of paralysis was greater in the control group (285.8 +/- 246.6 vs. 137.1 +/- 106.4 mg, p = .001). The peripheral nerve stimulation group recovered neuromuscular function (relative risk of 1.85, with 95% confidence interval [CI] of 1.02-3.35, p = .039) and spontaneous ventilation (relative risk of 1.86, 95% CI 1.00-3.45, p = .047) faster than the control group. In patients, adjusting for renal dysfunction, the likelihood of a faster recovery in the peripheral nerve stimulation group increased for neuromuscular function (relative risk of 1.89, 95% CI of 1.07-3.32, p = .018) and spontaneous ventilation (relative risk of 2.27, 95% CI of 1.23-4.21, p = .019). Patients with combined renal and liver failure similarly demonstrated a faster recovery in the peripheral nerve stimulation group. The recovery was affected to a lesser extent by adjusting for concurrent aminoglycoside and corticosteroid administration. CONCLUSIONS Use of peripheral nerve stimulation for monitoring the degree of blockade and adjusting drug doses in continuously paralyzed critically ill medical patients results in lower doses of vecuronium to maintain a desired depth of paralysis, and allows a faster recovery of neuromuscular function and spontaneous ventilation.
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Affiliation(s)
- M I Rudis
- Department of Pharmacy Services, Henry Ford Health System, Detroit, MI 48025, USA
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Cameron M, Donati F, Varin F. In Vitro Plasma Protein Binding of Neuromuscular Blocking Agents in Different Subpopulations of Patients. Anesth Analg 1995. [DOI: 10.1213/00000539-199511000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cameron M, Donati F, Varin F. In vitro plasma protein binding of neuromuscular blocking agents in different subpopulations of patients. Anesth Analg 1995; 81:1019-25. [PMID: 7486041 DOI: 10.1097/00000539-199511000-00022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In vitro protein binding of several neuromuscular blocking agents (NMBAs) was measured by ultrafiltration in plasma from patients susceptible to demonstrate changes in their protein constituents. First, the relationship between the free fraction of atracurium and plasma lipoproteins levels in young volunteers (22-32 yr old, n = 6) and hyperlipidemic patients (44-68 yr old, n = 13) was studied, and second, the free fraction of atracurium, mivacurium, doxacurium, and vecuronium was determined in plasma of healthy young (27-47 yr old, n = 10), elderly (72-89 yr old, n = 11) and obese (21-57 yr old, n = 9, 200%-360% ideal body weight) patients scheduled for elective surgery. In hyperlipidemic patients, atracurium free fraction was significantly less than in young volunteers (40% +/- 5% vs 50% +/- 5%, mean +/- SD), and decreased as total cholesterol, low-density lipoprotein cholesterol and triglycerides increased (P < 0.05). In young individuals, NMBA free fraction was 25% +/- 5% for vecuronium, 58% +/- 8% for doxacurium, 52% +/- 6% for atracurium, and 72% +/- 3%, 70% +/- 3%, 70% +/- 4% for mivacurium trans-trans, cis-trans, and cis-cis isomers, respectively. Higher triglyceride concentrations in obese patients and lower high-density-lipoprotein cholesterol concentrations in both obese and elderly patients were observed when compared with young subjects. However, there was no significant difference in protein binding of NMBAs among these three groups. We conclude that, in otherwise healthy patients, age and weight are not likely to alter the free fraction of NMBAs.
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Affiliation(s)
- M Cameron
- Faculté de Pharmacie, Université de Montréal, Québec, Canada
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Kleef UW, Proost JH, Roggeveld J, Wierda JM. Determination of rocuronium and its putative metabolites in body fluids and tissue homogenates. JOURNAL OF CHROMATOGRAPHY 1993; 621:65-76. [PMID: 8308088 DOI: 10.1016/0378-4347(93)80077-h] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A sensitive and selective HPLC method was developed for the quantification of the neuromuscular blocking agent rocuronium and its putative metabolites (the 17-desacetyl derivative and the N-desallyl derivative of rocuronium) in plasma, urine, bile, tissue homogenates and stoma fluid. Samples were prepared by extraction of the biological matrix with dichloromethane, after mixing with a KI-glycine buffer. After evaporation of the organic solvent the samples were chromatographed on a reversed-phase HPLC column, using an aqueous buffer-dioxane (84:16, v/v) as the mobile phase. The aqueous buffer consisting of 0.1 M sodium dihydrogen phosphate, 0.11 mM 9,10-dimethoxyanthracene-2-sulphonate (DAS), 0.11 mM 1-heptane-sulfonic acid, was adjusted to pH 3 with orthophosphoric acid. After separation, the eluent was extracted with dichloroethane, and the organic phase was led to a fluorimetric detector, operating at 385 nm (excitation) and 452 nm (emission). The method was validated for the assay in plasma, urine, bile, tissue homogenates and stoma fluid, by determination of the repeatability, reproducibility, accuracy, lower limit of quantification, lower limit of detection, extraction recovery, effect of sample volume, and stability in the biological matrix. The method was found to be sensitive (lower limit of quantification for rocuronium in plasma is 10 ng/ml) and accurate. The interference of concomitant drugs with the assay of rocuronium and its putative metabolites has been studied extensively. In order to confirm the identity of rocuronium and its putative metabolites, a TLC method was developed. The method has been applied successfully in several pharmacokinetic studies with rocuronium.
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Affiliation(s)
- U W Kleef
- Research Group for Experimental Anesthesiology and Clinical Pharmacology, University Hospital, Groningen, Netherlands
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