Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Pharmacodynamic behaviour of vecuronium in primary hyperparathyroidism


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.


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.


  1. 1

    Miller RD. Factors affecting the action of muscle relaxants. In: Katz RL (Ed.) Muscle Relaxants, Amsterdam: North Holland Publishing Co., 1975; 163–91.

  2. 2

    Waud BE, Waud DR. Interaction of calcium and potassium with neuromuscular blocking agents. Br J Anaesth 1980; 52: 863–6.

  3. 3

    Gramstad L, Hysing ES. Effect of ionized calcium on the neuromuscular blocking actions of atracurium and vecuronium in the cat. Br J Anaesth 1990; 64: 199–206.

  4. 4

    Åkerström G, Rastad J, Ljunghall S, Ridefelt P, Juhlin C, Gylfe E. Cellular physiology and pathophysiology of the parathyroid glands. World J Surg 1991; 15: 672–80.

  5. 5

    Patten B, Bilezikian J, Mallette L, Prince A, Engel WK, Aurbach GD. Neuromuscular disease in primary hyperparathyroidism. Ann Intern Med 1974; 80: 182–93.

  6. 6

    Harrison B, Wheeler MH. Asymptomatic primary hyperparathyroidism. World J Surg 1991; 15: 724–9.

  7. 7

    Ljunghall S, Hellman P, Rastad J, Åkerström G. Primary hyperparathyroidism: epidemiology, diagnosis and clinical picture. World J Surg 1991; 15: 681–7.

  8. 8

    Jansson S, Grimby G, Hagne I, Hedman I, Tisell L-E. Muscle structure and function before and after surgery for primary hyperparathyroidism. Eur J Surg 1991; 157: 13–6.

  9. 9

    Al-Mohaya S, Naguib M, Abdelatif M, Farag H. Abnormal responses to muscle relaxants in a patient with primary hyperparathyroidism. Anesthesiology 1986; 65: 554–6.

  10. 10

    Caldwell JE, Heier T, Miller RD. Hyperparathyroidism and vecuronium-induced neuromuscular blockade. Anesthesiology 1989; 71: A814.

  11. 11

    Kleef UW, Proost JH, Roggeveld J, Wierda JMKH. Determination of rocuronium and its putative metabolites in body fluids and tissue homogenates. J Chromatogr 1993; 621: 65–76.

  12. 12

    Rupp SM, Miller RD, Gencarelli PJ. Vecuronium-induced neuro-muscular blockade during enflurane, isoflurane, and halothane anesthesia in humans. Anesthesiology 1984; 60: 102–5.

  13. 13

    d’Hollander A, Agoston S, Capouet V, Barrais L, Bomblet JP, Esselen M. Failure of metronidazole to alter a vecuronium neuromuscular blockade in humans. Anesthesiology 1985; 63: 99–102.

  14. 14

    Fisher DM, Fahey MR, Cronnelly R, Miller RD. Potency determination for vecuronium (ORG NC45): comparison of cumulative and single-dose techniques. Anesthesiology 1982; 57: 309–10.

  15. 15

    Gibson FM, Mirakhur RK, Clarke RSJ, Lavery G. Comparison of cumulative and single bolus dose techniques for determining the potency of vecuronium. Br J Anaesth 1985; 57: 1060–2.

  16. 16

    d’Hollander A, Massaux F, Nevelsteen M, Agoston S. Age-dependant dose-response relationship of ORG NC45 in anaesthetized patients. Br J Anaesth 1982; 54: 653–7.

  17. 17

    Sohn YJ, Bencini AF, Scaf AHJ, Kersten UW, Agoston S. Comparative pharmacokinetics and dynamics of vecuronium and pancuronium in anesthetized patients. Anesth Analg 1986; 65: 233–9.

  18. 18

    Brautbar N, Kleeman CR. Hypophosphatemia and hyperphosphatemia: clinical and pathophysiologic aspects. In: Maxwell MH, Kleeman CR, Narins RG (Eds.). Clinical Disorders of Fluid and Electrolyte Metabolism, 4th ed. New York: McGraw-Hill, 1987: 789–830.

Download references

Author information

Correspondence to Eric J. L. Roland.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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).

Download citation

Key words

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