Vermeidung unerwünschter Wirkungen bei der Anwendung nichtdepolarisierender Muskelrelaxanzien

  • C. Diefenbach
  • W. Buzello
Conference paper
Part of the Klinische Anästhesiologie und Intensivtherapie book series (KAI, volume 42)


Etwa 10 Jahre nach der Einführung der künstUchen Muskelerschlaffung in die Anästhesie ergab eine Analyse von fast 600000 Narkosen, daß die Verwendung von Curare die postoperative Mortalität auf das 5- bis 6fache erhöht [7]. Obwohl dieser Untersuchung zahlreiche methodische Mängel vorgeworfen wurden, zeigt sie, daß bei der Anwendung von Muskelrelaxanzien mit unerwünschten Wirkungen zu rechnen ist, die im Einzelfall zu schwerwiegenden Komplikationen führen können.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anderson KA, Marshall RJ (1985) Interactions between calcium entry blockers and vecuronium bromide in anaesthetized cats. Br J Anaesth 57: 775–781PubMedGoogle Scholar
  2. 2.
    Arden JR, Cannon JC, Lynam DP, Castagnoli KP, Canfell PC, Miller RD (1987) Vecuronium pharmacokinetics and pharmacodynamics in hepatocellular disease. Anesth Analg 66: S3Google Scholar
  3. 3.
    Assem ESK (1984) Characteristics of basophil histamine release by neuromuscular blocking drugs in patients with anaphylactoid reactions. Agents Actions 14: 435–440PubMedGoogle Scholar
  4. 4.
    Baldo BA, Fisher MM (1983) Substituted ammonium ions as allergenic determinants in drug allergy. Nature 306: 262–264PubMedGoogle Scholar
  5. 5.
    Baldo BA, Harle DG, Fisher MM (1985) In vitro diagnosis and studies on the mechanism(s) of a naphylactoid reactions to muscle relaxant drugs. Ann Fr Anesth Réanim 4: 139–145PubMedGoogle Scholar
  6. 6.
    Baraka A, Gabali F (1968) Correlation between tubocurarine requirements and plasma protein pattern. Br J Anaesth 40: 89–93PubMedGoogle Scholar
  7. 7.
    Beecher KH, Todd DP (1954) A study of the death associated with anaesthesia and surgery. Ann Surg 140: 2–34PubMedCentralPubMedGoogle Scholar
  8. 8.
    Beemer GH, Rozental P (1986) Postoperative neuromuscular function. Anaesth Intens Care 14: 41–45Google Scholar
  9. 9.
    Beemer GH, Dennis WL, Platt PR, Bjorksten AR, Carr AB (1988) Adverse reactions to atracurium and alcuronium. Br J Anaesth 61: 680–684PubMedGoogle Scholar
  10. 10.
    Berntman L, Rosenberg B, Shweikh I, Yousef H (1989) Atracurium and pancuronium in renal insufficiency. Acta Anaesthesiol Scand 33: 48–52PubMedGoogle Scholar
  11. 11.
    Bevan DR, Donati F, Gyasi H, Williams A (1984) Cumulation of vecuronium in renal failure. Anesthesiology 61: A296Google Scholar
  12. 12.
    Boileau S, Hummer-Sigiel M, Moeller R, Drouet N (1985) Réévaluation des risques respectifs d’anaphylaxie et d’histaminolibération avec les substances anaesthésiolo-giques. Ann Fr Anesth Réanim 4: 195–204PubMedGoogle Scholar
  13. 13.
    Brady MM, Mirakhur RK, Clarke RSJ (1988) Administration of vecuronium, atracurium and pancuronium in divided doses: effect on onset and duration of action. Eur J Anaesthesiol 5: 243–249PubMedGoogle Scholar
  14. 14.
    Buzello W, Noeldge G, Krieg N, Brobmann GF (1986) Vecuronium for muscle relaxation in patients with myasthenia gravis. Anesthesiology 64: 507–509PubMedGoogle Scholar
  15. 15.
    Cannon JE, Fahey MR, Moss J, Miller RD (1988) Large doses of vecuronium and plasma histamine concentrations. Can J Anaesth 35: 350–353PubMedGoogle Scholar
  16. 16.
    Chappie DJ, Miller AA, Ward JB, Wheatley PL (1987) Cardiovascular and neurological effects of laudanosne. Studies in mice and rats, and in conscious and anaesthetized dogs. Br J Anaesth 59: 218–225Google Scholar
  17. 17.
    Clarke RSJ (1982) Epidemiology of adverse reactions in anaesthesia in the United Kingdom. Klin Wochenschr 60: 1003–1005PubMedGoogle Scholar
  18. 18.
    Cody MW, Dormon FM (1987) Recurarisation after vecuronium in a patient with renal failure. Anaesthesia 42: 993–995PubMedGoogle Scholar
  19. 19.
    Conil C,Bornet JL, Jean-Noel JM, Brouchet A (1985) Choc anaphylactique au pancuronium et au vécuronium. Ann Fr Anesth Réanim 4: 241–243PubMedGoogle Scholar
  20. 20.
    Cook DR, Brandom BW, Stiller RL,Woelfel MD, Lai A, Slater J (1984) Pharmacokinetics of atracurium in normal and liver failure patients. Anesthesiology 61: A433Google Scholar
  21. 21.
    Cork RC, Gallo JA, Puchi P (1987) Histamine and hemodynamic response after atracurium vs. vecuronium. Anesth Analg 66: S32Google Scholar
  22. 22.
    Descotes J, Benoit Y, Bertrix L, Chadenson O, Miellet CC, Fanton H, Evreux JC1, Motin J (1982) Anesthésie et réactions de type anaphylactique: étude épidemiologique portant sur 4452 observations. Therapie 37: 451–454PubMedGoogle Scholar
  23. 23.
    Doenicke A, Ennis M, Lorenz W (1985) Histamine release in anesthesia and surgery: A systematic approach to risk in the perioperative period. In: Sage DJ (ed) Anaphylactoid reactions in anaesthesia. International Anesthesiology Clinics vol 23 no 3 Boston, Little, Brown pp 41–66Google Scholar
  24. 24.
    Dundee JW, Gray TC (1953) Resistance to d-tubocurarine chloride in the presence of liver damage. Lancet 2: 16–17Google Scholar
  25. 25.
    Durant NN, Marshall IG, Savage DS, Nelson DJ, Sleigh T, Cariyle IC (1979) The neuromuscular and autonomic blocking activities of pancuronium, ORG 45 NC and other pancuronium analogues in the cat. J Pharm Pharmacol 31: 831–836PubMedGoogle Scholar
  26. 26.
    Durrani Z, O’Hara J (1987) Histaminoid reaction from vecuronium priming: a case report. Anesthesiology 67: 130–132PubMedGoogle Scholar
  27. 27.
    Duvaldestin P, Agoston S, Henzel D, Kersten UW, Desmonts JM (1978) Pancuronium pharmacokinetics in patients with liver failure. Br J Anaesth 50: 1131–1136PubMedGoogle Scholar
  28. 28.
    Duvaldestin P, Berger JL, Videcoq M, Desmonts JM (1982a) Pharmacokinetics and pharmacodynamics of Org NC 45 in patients with cirrhosis. Anesthesiology 57: A 238Google Scholar
  29. 29.
    Duvaldestin P, Henzel D (1982b) Binding of d-tubocurarine, fazadinium, pancuronium and Org NC 45 to serum protein in normal man and patients with cirrhosis. Br J Anaesth 54: 513–516PubMedGoogle Scholar
  30. 30.
    Duvaldestin P (1989) Les myorelaxants. In: Duvaldestin P Pharmacologie en pratique anesthé;sique. Masson, Paris, pp 110Google Scholar
  31. 31.
    Enoki T, Naito Y, Hirokawa Y, Nomura R, Hatano Y, Mori K (1989) Marked sensitivity to pancuronium in a patient without clinical manifestations of myasthenia gravis. Anesth Analg 69: 840–842PubMedGoogle Scholar
  32. 32.
    Fahey MR, Rupp SM, Canfell C et al (1985) Effect of renal failure on laudanosme excretion in man. Br J Anaesth 57: 1049–1051PubMedGoogle Scholar
  33. 33.
    Fisher MM, Munro I (1983) Life-threatening anaphylactoid reactions to muscle relaxants. Anesth Analg 62: 559–564PubMedGoogle Scholar
  34. 34.
    Fisher MM (1985) Skin testing in the preoperative diagnosis of anaesthetic allergy. Ann Fr Anesth Réanim 4: 192–194PubMedGoogle Scholar
  35. 35.
    Foldes FF (1985) The priming principle. In: Agoston S, Bergmann H, Schwarz S, Steinbereithner K (Hrsg) Muskelrelaxantien-Therapeutische Grenzen. Maudrich,Wien München Bern, S 113–120Google Scholar
  36. 36.
    Galletly DC (1986) Comparative cutaneous histamine release by neuromuscular blocking agents. Anaesth Intens Care 14: 365–369Google Scholar
  37. 37.
    Gibson FM, Mirakhur RK (1987) Dose-response curves for pancuronium and tubocura-rine: cmparison of single and cumulative dose techniques. Eur J Anaesthesiol 4: 143–147PubMedGoogle Scholar
  38. 38.
    Ginsberg B, Glass PSA, Shafron D, Mace J, Quill T, Mardekian J (1987) Onset, duration and recovery following high dose vecuronium. Anesthesiology 67: A 341Google Scholar
  39. 39.
    Glass PSA, Wilson W, Mace JA, Wagoner R (1989) Is the priming principle both effective and save? Anesth Analg 68: 127–134PubMedGoogle Scholar
  40. 40.
    Goldberg ME, Marr AT, Starsnic MA, Ritter DE, Sosis M, Larijani GE (1987) Does vecuronium accumulate in renal transplant patients? Anesth Analg 66: S 68Google Scholar
  41. 41.
    Goudsouzian N, DiBiase P, Gelb C (1990) Histamin release from short and intermediate acting muscle relaxants in adolescents. Anesth Analg 70: S 133Google Scholar
  42. 42.
    Gramstad L, Lilleaasen P, Minsaas B (1983) Comparative study of atracurium, vecuronium (ORG NC 45) and pancuronium. Br J Anaesth 55: 95 S–96 SPubMedGoogle Scholar
  43. 43.
    Griffiths RB, Hunter JM, Jones RS (1986) Atracurium infusions in patients with renal failure on an ITU. Anaesthesia 41: 375–381PubMedGoogle Scholar
  44. 44.
    Hackl W, Plainer B, Mauritz W (1988) Protrahierte Vecuroniumwirkung bei einem Patienten mit dialysepflichtiger chronischer Niereninsuffizienz. Anaesthesist 37: 598–600PubMedGoogle Scholar
  45. 45.
    Harle DG, Baldo BA, Fisher MM (1985) Assays for, and cross-reactivities of, IgE antibodies to the muscle relaxants gallamine, decamethonium and succinylcholine (suxamethonium). J Immunol Methods 78: 293–305PubMedGoogle Scholar
  46. 46.
    Hughes R, Chappie DJ (1976) Effects of non-depolarizing neuromuscular blocking agents on peripheral autonomic mechanisms in cats. Br J Anaesth 48: 59–67PubMedGoogle Scholar
  47. 47.
    Hughes R, Chapple DJ (1981) The pharmacology of atracurium: a new competitive neuromuscular blocking agent. Br J Anaesth 53: 31–44PubMedGoogle Scholar
  48. 48.
    Hunter JM (1983) Bradycardia after the use of atracurium. Brit Med J 287: 759–760Google Scholar
  49. 49.
    Hunter JM (1985) The use of atracurium in anephric patients and in patients with hepatic cirrhosis. In: Agoston S, Bergmann H, Schwarz S, Steinbereithner K (Hrsg.) Muskelre-laxantien, Therapeutische Grenzen. Maudrich,Wien München Bern. S 64–67Google Scholar
  50. 50.
    INSERM (1983) Enquête épidémiologique sur les anesthésies. Ann Fr Anesth Réanim 2: 333–385Google Scholar
  51. 51.
    Inoue K, Reichelt W (1987) Combination of fentanyl, etomidate and vecuronium may cause severe vagotonic state. Br J Anaesth 59: 1475PubMedGoogle Scholar
  52. 52.
    Inoue K, El-Banayosy A, Stolarsky L, Reichelt W (1988) Vecuronium induced bradycardia following induction of anaesthesia with etomidate or thiopentone, with or without fentanyl. Br J Anaesth 60: 10–17PubMedGoogle Scholar
  53. 53.
    Jansen EC, Hansen PH (1979) Objective measurement of succinylcholine-induced fasciculations and the effect of pretreatment with pancuronium or gallamine. Anesthesiology 51: 159–160PubMedGoogle Scholar
  54. 54.
    Jedeikin R, Dolgunski E, Kaplan R, Hoffman S (1987) Prolongation of neuromuscular blocking effect of vecuronium by antibiotics. Anaesthesia 42: 858–860PubMedGoogle Scholar
  55. 55.
    Jones RM, Cashman JN, Casson WR, Broadbent MP (1985) Verapamil potentiation of neuromuscular blockade: Failure of reversal with neostigmine but prompt reversal with edrophonium. Anesth Analg 64: 1021–1025PubMedGoogle Scholar
  56. 56.
    Katz RL (1967) Neuromuscular effects of d-tubocurarine, edrophonium and neostigmine in man. Anesthesiology 28: 327–336PubMedGoogle Scholar
  57. 57.
    Katz RL (1971) Clinical neuromuscular pharmacology of pancuronium. Anesthesiology 34: 550–556PubMedGoogle Scholar
  58. 58.
    Katz J, Fragen R, Shanks C, Dunn K, McNulty B, Williams T (1987) The cumulative dose-response relationships of BW A938U during four anesthetic techniques. Anesthesiology 67: A 361Google Scholar
  59. 59.
    Keens SJ, Hunter JM, Snowdon SL, Utting JE (1987) Potentiation of the neuromuscular blockade produced by alcuronium with halothane, enflurane and isoflurane. Br J Anaesth 59: 1011–1016PubMedGoogle Scholar
  60. 60.
    Krieg N, Kopp K-H, Crul JF (1983) Die Wirkungsverstärkung von Vecuronium (Norcuron) durch Halothan und Ethrane. Anaesthesist 32: 221 (Suppl.)Google Scholar
  61. 61.
    Langrehr D, Newton D, Agoston S (1982) Epidemiology of adverse reactions in anaesthesia in Germany and the Netherlands. Klin Wochenschr 60: 1010–1016PubMedGoogle Scholar
  62. 62.
    Lavery GG, Clarke RSJ, Watkins J (1986) Histaminoid response after intradermal and intravenous administration of atracurium, vecuronium and tubocurarine: a comparative study. Eur J Anaesthesiol 3: 439–447PubMedGoogle Scholar
  63. 63.
    Laxenaire MC, Manel J, Borgo J, Moneret-Vautrin DA (1985a) Facteurs de risque d’histaminolibération: étude prospective dans une population anesthésiée. Ann Fr Anesth Réanim 4: 158–166PubMedGoogle Scholar
  64. 64.
    Laxenaire MC, Moneret DA,Vervolet D (1985b) The french experience of anaphylactoid reactions. In: Sage D (ed) Anaphylactoid reactions in anesthesia International Anesthesiology Clinics vol 23 no 3, Boston: Little, Brown, 145–160Google Scholar
  65. 65.
    Lebrault C, Berger JL, d’Holander AA, Gomeni R, Henzel D, Duvaldestin P (1985) Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC 45) in patients with cirrhosis. Anesthesiology 62: 601é605PubMedGoogle Scholar
  66. 66.
    Lee C, Durant NN (1979) Mechanism of neomycin-induced neuromuscular block. Anesthesiology 51: S 273Google Scholar
  67. 67.
    Lennmarken C, Löfstöm JB (1984) Partial curarisation in the postoperative period. Acta Anaesthesiol Scand 28: 260–262PubMedGoogle Scholar
  68. 68.
    Leynadier F, Sansariq M, Dry J (1987) Reproductibilité des tests cutanés intradermiques apres anaphylaxie aux myorelaxants. Presse Médicale 16: 523–525Google Scholar
  69. 69.
    Lorenz W, Doenicke A, Schöming B, Ohmann H, Grote B, Neugebauer E (1982) Definition and classification of the histamin-release response to drugs in anaesthesia and surgery: Studies in the conscious human subject. Klin Wochenschr 60: 896–913PubMedGoogle Scholar
  70. 70.
    Lowenstein E, Goldfine C, Flacke WE (1970) Administration of gallamine in the presence of renal failure Reversal of neuromuscular blockade by peritoneal dialysis. Anesthesiology 30: 556–558Google Scholar
  71. 71.
    Luce JM (1988) Neuromuscular blockade. In: Luce JM, Pierson DJ (eds) Critical care medicine. Saunders, Philadelphia, P 474Google Scholar
  72. 72.
    Lunn JN, Hunter AR, Scott DB (1983) Anesthesia-related surgical mortality. Anaesthesia 38: 1090–1096PubMedGoogle Scholar
  73. 73.
    Lynam DL, Cronnelly R, Arden J, Castagnoli K, Canfell C, Miller RD (1986) The pharmacodynamics and pharmacokinetics of vecuronium in patients with an without renal failure. Anesthesiology 65: A 296Google Scholar
  74. 74.
    Maria Y, Grosdidier R, Haberer JP, Moneret-Vautrin DA (1989) Enquête prospective préopératoire chez 300 patients par prick-test aux myorelaxants. Ann Fr Anesth Réanim 8: 301–305PubMedGoogle Scholar
  75. 75.
    Martin C, Bonnern J-J, Brun J-P, Albanese J, Gouin F (1987) Vecuronium or suxamethonium for rapid sequence intubation: which is better? Br J Anaesth 59: 1240–1244PubMedGoogle Scholar
  76. 76.
    Mayrhofer O (1959) Die Wirksamkeit von d-Tubocurarin zur Verhütung der Muskelschmerzen nach Succinylcholin. Anaesthesist 8: 313–315Google Scholar
  77. 77.
    McHutchon A, Lawler PG (1983) Bradycardia following atracurium. Anaesthesia 38: 597–598PubMedGoogle Scholar
  78. 78.
    Miller RD, Rupp SM, Fahey MR, Morris RB, Gencarelli PJ, Sohn YJ (1983) Pharmacokinetics of vecuronium in patients with kidney disease. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J (eds) Clinical Experience with Norcuron. Symposium Geneva 1983, Current Clinical Practice Series 11 Excerpta Medica, PP 124–126Google Scholar
  79. 79.
    Miller RD (1989) How should residual neuromuscular blockade be detected? Anesthesiology 70: 379PubMedGoogle Scholar
  80. 80.
    Milligan KR, Beers HT (1985) Vecuronium associated cardiac arrest. Anaesthesia 40: 385Google Scholar
  81. 81.
    Moneret-Vautrin DA, Mouton C,Widmer S (1985) Anaphylaxie aux myorelexants.Valeur prédictive des intradermoréactions et recherche de I’anaphylaxie croisée. Ann Fr Anesth Réanim 4: 186–191PubMedGoogle Scholar
  82. 82.
    Moneret-Vautrin DA, Widmer S, Gueant J-L, Kamel L, Laxenaire MC, Mouton C, Gerard H (1990) Simultaneous anaphylaxis to thiopentone and a neuromuscular blocker: a study of two cases. Br J Anaesth 64: 743–745PubMedGoogle Scholar
  83. 83.
    Moss J, Philbin DM, Rosow CE, Basta SJ, Gelb C, Savarese JJ (1982) Histamine release by neuromuscular blocking agents in man. Klin Wochenschr 60: 891–895PubMedGoogle Scholar
  84. 84.
    Motsch J, Fuchs W, Hoch P, Kaas V, Hutschenreuter K (1987) Side effects and changes in pulmonary function after fixed dose precurarisation with alcuronium, pancuronium or vecuronium. Br J Anaesth 59: 1528–1532PubMedGoogle Scholar
  85. 85.
    Musich J, Waltz LF (1986) Pulmonary aspiration after a priming dose of vecuronium. Anesthesiology 64: 517–519PubMedGoogle Scholar
  86. 86.
    Nöldge G, Krieg N, Bauman B, Scholler KL (1985) Der Einfluß von Isofluran auf die Wirkungsstärke und den Wirkungsablauf von Vecuronium. Anaesthesist 34: 71 (Suppl.)Google Scholar
  87. 87.
    North FC, Kettelkamp N, Hirshman CA (1987) Comparison of cutaneous and in vitro histamine release by muscle relaxants. Anesthesiology 66: 543–546PubMedGoogle Scholar
  88. 88.
    Orko R, Alila A, Rosenberg PH (1988) Effect of biliary obstruction on muscle relaxation with vecuronium. Eur J Anaesthesiol 5: 9–14PubMedGoogle Scholar
  89. 89.
    Paton WDM, Waud DR (1967) The margin of safety of neuromuscular transmission. J Physiol 191: 59–90PubMedCentralPubMedGoogle Scholar
  90. 90.
    Parker CJR, Jones JE, Hunter JM (1988) Disposition of infusions of atracurium and its metabolite, laudanosine, in patients in renal and respiratory failure in an ITU. Br J Anaesth 61: 531–540PubMedGoogle Scholar
  91. 91.
    Pinchak AC, Shepard LS, Patterson L, Hagen J (1990) Atracurium vs pancuronium inhibition of succinylcholine fasciculations. Anesth Analg 70: S 450Google Scholar
  92. 92.
    Pittinger CB, Adamson R (1972) Antibiotic blockade of neuromuscular function. Ann Rev Pharmacol 12: 169–184PubMedGoogle Scholar
  93. 93.
    Pollard BJ (1989) Priming with alcuronium and tubocurarine accelerates the onset of neuromuscular block. Br J. Anaesth 63: 7–11PubMedGoogle Scholar
  94. 94.
    Priddy R (1984) Bradycardia after atracurium. Anesth Intens Care 12: 175Google Scholar
  95. 95.
    Rowlands DE (1987) Harmless cutaneous reactions associated with the use of atracurium. Br J Anaesth 59: 693–696PubMedGoogle Scholar
  96. 96.
    Rupp SM, Miller RD, Gencarelli P (1984) Vecuronium-induced neuromuscular blockade during enflurane, isoflurane and halothane anesthesia in humans. Anesthesiology 60: 102–105PubMedGoogle Scholar
  97. 97.
    Schuh FT (1977) Zur Überwachung der Muskelrelaxation während der Narkose. Anaesthesist 26: 107–115PubMedGoogle Scholar
  98. 98.
    Schwarz S, Ilias W, Lackner F, Mayrhofer O, Foldes FF (1985) Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology 62: 388–391PubMedGoogle Scholar
  99. 99.
    Schwarz S, Lackner FX, Hrska F, Weindlmayr-Goettel M, Tüchy G, Steinbereithner (1990) Metabolism of atracurium in patients with renal failure. Anesthesiology 72: A 917Google Scholar
  100. 100.
    Scott RPF, Savarese JJ, Basta SJ, Sunder N, Ali HH, Gargarian M, Gionfriddo M, Batson AG (1985) Atracurium: clinical strategies for preventing histamine release and attenuating the haemodynamic response. Br J Anaesth 57: 550–553PubMedGoogle Scholar
  101. 101.
    Shanks AB, Long T, Aitkenhead AR (1985) Prolonged neuromuscular blockade following vecuronium. Br J Anaesth 57: 807–810PubMedGoogle Scholar
  102. 102.
    Shearer ES, O’Sullivan EP, Hunter JM (1990) Urinary clearance of atracurium, laudanosme and monoquaternary alcohol in the intensive care patient with normal renal function. Br J Anaesth 65: 586 PGoogle Scholar
  103. 103.
    Slater RM, Pollard BJ, Doran BRH (1988) Prolonged neuromuscular blockade with vecuronium in renal failure. Anesthesia 43: 250Google Scholar
  104. 104.
    Sosis M, Stiner A, Larijani GE, Marr AT (1987) An evaluation of priming with vecuronium. Br J Anaesth 59: 1236–1239PubMedGoogle Scholar
  105. 105.
    Smith CL, Hunter JM, Jones RS (1987a) Vecuronium infusions in patients with renal failure in an ITU. Anaesthesia 42: 387–393PubMedGoogle Scholar
  106. 106.
    Smith CL, Hunter JM, Jones RS (1987b) Prolonged paralysis following an infusion of alcuronium in a patient with renal dysfunction. Anaesthesia 42: 552–525Google Scholar
  107. 107.
    Stoelting RK (1983) Allergic reactions during anesthesia. Anesth Analg 62: 314–356Google Scholar
  108. 108.
    Storella RJ, Jaffe J, Mehr E, Rosenberg H (1989) In vitro investigations of the priming principle for rapid neuromuscular block. Br J Anaesth 62: 478–482PubMedGoogle Scholar
  109. 109.
    Swen J, Rashkovsky OM, Ket JM, Koot HWJ, Hermans J, Agoston S (1989) Interaction between nondepolarizing neuromuscular blocking agents and inhalational anesthetics. Anesth Analg 69: 752–755PubMedGoogle Scholar
  110. 110.
    Thomas PD,Worthley LIG, Russell WJ (1984) How useful is visual and tactile assessment of neuromuscular blockade using a peripheral nerve stimulator? Anaesth Intens Care 12: 68–69Google Scholar
  111. 111.
    Tullock WC, Diana P, Cook DR,Wilks DH, Brandon BW, Stiller RL, Beach CA (1990) Neuromuscular and cardiovascular effects of high-dose vecuronium. Anesth Analg 70: 86–90PubMedGoogle Scholar
  112. 112.
    Ulsamer B (1988) Vecuroniumbromid: Beeinflussung der Pharmakodynamik durch Etomidat, Cimetidin und Ranitidin. Anaesthesist 37: 504–509PubMedGoogle Scholar
  113. 113.
    Ulsamer B, Markreiter M,Taeger K, Doenicke A (1990) Einfluß von Antihistaminika auf die Wirkdauer von Atracurium und Vecuronium. Anaesthesist 39: S 102Google Scholar
  114. 114.
    Utting JE, Hunter JM, Jones RS (1982) Atracurium in patients with no renal function. Anesthesiology 57: A 252Google Scholar
  115. 115.
    van den Brom RH,Wierda JMKH, Agoston S (1987) Pharmacokinetics of atracurium and metabolites in normal and renal failure patients. Anesthesiology 67: A 606Google Scholar
  116. 116.
    Viby-Mogensen J, Jorgensen BC, Ording H (1979) Residual curarisation in the recovery room. Anesthesiology 50: 539–541PubMedGoogle Scholar
  117. 117.
    Viby-Mogensen J (1982) Clinical assessment of neuromuscular blockade. Br J Anaesth 54: 209–223PubMedGoogle Scholar
  118. 118.
    Viby-Mogensen J, Jensen NH, Engbaek J, Ording H, Skovgaard LT, Chraemmer-Jorgensen B (1985) Tactile and visual evaluation of the response to train of four nerve stimulation. Anesthesiology 63: 440–443PubMedGoogle Scholar
  119. 119.
    Wali FA, Hayter A, Greenidge E, Makinde V (1988) Histamine release by some new skeletal muscle relaxants studied at the rat ileum. Acta Physiol Hung 71: 435–444PubMedGoogle Scholar
  120. 120.
    Ward S, Boheimer N, Weatherley BC, Simmonds RJ, Dopson TA (1987) Pharmacokinetics of atracurium and its metabolites in patients with normal renal function and in patients in renal failure. Br J Anaesth 59: 697–706PubMedGoogle Scholar
  121. 121.
    Waser PG (1973) Localisation of C14-Pancuronium by histo- and whole body-autoradiography in normal and pregnant mice. Naunyn Schmiedebergs Arch Pharmacol 279: 399–412PubMedGoogle Scholar
  122. 122.
    Watkins J (1987) Investigation of allergic and hypersensitivity reactions to anaesthetic agents. Br J Anaesth 59: 104–111PubMedGoogle Scholar
  123. 123.
    Watkins J (1988) Anaphylactoid response to neuromuscular blockers: atracurium in perspective In: Jones RM, Payne JP (eds) Recent developments in muscle relaxation: Atracurium in perspective. Royal Soc Med Serv International Congress and Symposium Series No. 131, London, pp 13–20Google Scholar
  124. 124.
    Waud BE,Waud DR (1971) The relation between the response to train-of-four stimulation and receptor occlusion during competitive neuromuscular block. Anesthesiology 35: 456–464PubMedGoogle Scholar
  125. 125.
    Waud BE (1972) The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology 37: 417–422PubMedGoogle Scholar
  126. 126.
    Waud BE (1981) Was sollte der Kliniker über das Konzept der relativen Rezeptorblok-kade wissen? In: Buzello W (Hrsg) Muskelrelaxantien INA Bd. 30, Thieme Verlag, Stuttgart, New York, S 48–57Google Scholar
  127. 127.
    Westra P, Vermeer GA, deLange AR, Scaf AHJ, Meijer DKF,Wesseling H (1981) Hepatic and renal disposition of pancuronium and gallamine in patients with extrahepatic cholestasis. Br J Anaesth 53: 331–338PubMedGoogle Scholar
  128. 128.
    Wood M,Watkins J,Wild G, Levy CJ, Harrington C (1985) Skin testing in the investigation of reactions to intravenous anaesthetic drugs. A prospective trial of atracurium and tubocurarine. Ann Fr Anesth Réanim 4: 176–179PubMedGoogle Scholar
  129. 129.
    Yate PM, Flynn PJ, Arnold RW,Weatherly BC, Simmonds RJ, Dopson T (1987) Clinical experience and plasma laudanosme concentrations during the infusion of atracurium in the intensive therapy unit. Br J Anaesth 59: 211–217PubMedGoogle Scholar
  130. 130.
    Zahl K, Eisenkraft JB, Sampson IH, Miller R (1989) Lidocaine potentiates vecuronium: a dose-response neuromuscular study. Anesthesiology 71: A 789Google Scholar
  131. 131.
    Zukaitis MG, Hoech GP (1979) Tram of four measurement of potentiation of curare by lidocaine. Anesthesiology 51: A 288Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • C. Diefenbach
  • W. Buzello

There are no affiliations available

Personalised recommendations