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Pharmacodynamic behaviour of vecuronium in primary hyperparathyroidism

Abstract

This study evaluated the potency and time course of action of vecuronium in patients with primary hyperparathyroidism (HPT) and marked hypercalcaemia during nitrous oxide-opioid anaesthesia. Twenty ASA physical status I and II patients were studied by measuring the force of contraction of the adductor pollicis in response to stimulation of the ulnar nerve: ten control patients and ten patients with HPT and ionized calcium concentration over 2.80 mEq · L−1. After induction of anaesthesia with thiopentone and maintenance with N2O/O2 and fentanyl, vecuronium was administered to determine cumulative doseresponse curves. When maximum block had been obtained, twitch height was maintained at 10% of baseline value over 20 min by adjusting the infusion rate of a syringe-pump containing vecuronium and vecuronium plasma concentration (EC90ss) was determined. During spontaneous recovery, after termination of infusion, the recovery index, the time from 25 to 75% recovery, was measured. The dose to produce 90% block was greater in the HPT than in control group: 69 (24) vs 54 (18) μg · kg−1 (P < 0.02). The calculated ED50 was also greater in HPT: 42 (4) vs 31 (5) μg · kg−1 in controls (P < 0.001). (Values are given as mean and coefficient of variation). The slope of the dose-response curve, the dose necessary to maintain 90% block, and the EC90ss did not differ. The RI25–75 was slower in the HPT group although the difference did not reach statistical significance. It is concluded that hyperparathyroidism with hypercalcaemia increases vecuronium requirement; only during the onset of neuromuscular blockade.

Résumé

Cette étude évalue la puissance et le décours temporel, pendant une anesthésie au protoxyde d’azote-morphinique, du vécuronium chez des patients souffrant d’hyperparathyroïdie primaire (HPT) avec hypercalcémie importante. Vingt patients ASA I et II sont étudiés par la mesure de la force de contraction de l’adducteur du pouce en réponse à une stimulation du nerf cubital: dix patients servent de contrôles à dix patients souffrant d’HPT et dont le concentration de calcium ionisé dépasse 2,80 mEq · L−1. Après induction au thiopentone et entretien au N2O/O2 avec fentanyl, on administre du vécuronium pour déterminer les courbes cumulatives doses-effets. Après l’obtention d’un bloc maximal, la hauteur du twitch est maintenu à 10% au-dessus de la ligne de base pendant plus de 20 min en ajustant la vitesse de perfusion d’un pousse-seringue contenant du vécuronium; on détermine à ce moment la concentration plasmatique de vécuronium (ED90ss). Pendant la récupération spontanée, après l’arrêt de la perfusion, l’index de récupération, la durée requise pour une récupération de 25 à 75% est mesuré. La dose requise pour produire un bloc à 90% est plus élevée dans l’HPT que dans le groupe contrôle: 69 (24) vs 54 (18) μg · kg−1 (P < 0,02). L’ED50 calculée est aussi plus élevée dans l’HPT: 42 (4) vs 31 (5) μg · kg−1 dans le groupe contrôle (P < 0,001). (Les valeurs reproduites sont la moyenne et le coefficient de variation). La pente de la courbe dose-effet, la dose nécessaire au maintien du bloc à 90% et l’EC90ss sont identiques. Le RI25–75 est plus lent dans le groupe HPT mais sans différence statistique. En conclusion, l’hyperparathyroïdie associée à une hypercalcémie importante n’augmente les besoins en vécuronium que pendant l’installation du bloc neuromusculaire.

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Correspondence to Eric J. L. Roland.

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Roland, E.J.L., Wierda, J.M.K.H., Eurin, B.G. et al. Pharmacodynamic behaviour of vecuronium in primary hyperparathyroidism. Can J Anaesth 41, 694–698 (1994). https://doi.org/10.1007/BF03015623

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Key words

  • neuromuscular relaxants: vecuronium
  • interactions: hyperparathyroidism, hypercalcaemia
  • pharmacokinetics: dose-response relationships