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Atracurium during thoracic surgery: impaired efficiency in septic processes
D Knüttgen1, M Jahn, D Zeidler
1Department of Anesthesia, Municipal Clinics of Cologne, Germany.
Objective:
The aim of the study was to examine whether the neuromuscular blocking potency of atracurium changes in patients with a septic intrathoracic process.
Design:
Prospective clinical study.
Setting:
Community hospital.
Participants:
Thirty patients who underwent thoracic surgery for resection of a pulmonary carcinoma were examined. Fifteen patients showed typical signs of a concomitant bacterial superinfection (infection group), 15 age-matched patients without infection served as the control (no-infection) group.
Interventions:
Relaxation was induced with atracurium, 0.6 mg/kg intravenously for intubation, followed by a continuous infusion to maintain a 90% neuromuscular blockade. Relaxometry was performed electromyographically using the Datex Relaxograph by stimulating the ulnar nerve next to the wrist.
Measurements And Main Results:
The onset time was significantly longer (5.3 +/- 2.9 v 3.3 +/- 1.2 minutes; p < 0.05), and the recovery phase (DUR 10%) was significantly shorter (23.5 +/- 8.6 v 36.9 +/- 7.3 minutes; p < 0.001) in the infection group compared with the controls. The infusion rate within the first hour of continuous application was 77.4% higher in the infection group than in the control group (11.0 +/- 2.9 v 6.2 +/- 1.0 microg/kg/min; p < 0.001).
Conclusion:
The study showed that septic intrathoracic processes cause a clear reduction of the neuromuscular blocking potency of atracurium. To guarantee adequate muscle relaxation in such cases, precise neuromuscular monitoring is highly advisable.
Insights
Septic intrathoracic processes significantly reduce the neuromuscular blocking potency of atracurium. Careful neuromuscular monitoring is essential for effective muscle relaxation in infected patients.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Pharmacology
- Thoracic Surgery
Background:
- Septic processes can alter drug pharmacokinetics and pharmacodynamics.
- Atracurium is a commonly used non-depolarizing neuromuscular blocking agent.
- Understanding drug efficacy in infection is crucial for patient management.
Purpose of the Study:
- To investigate the impact of septic intrathoracic processes on the neuromuscular blocking potency of atracurium.
- To determine if infection influences the dose requirements for atracurium during surgery.
Main Methods:
- Prospective clinical study involving 30 patients undergoing thoracic surgery for pulmonary carcinoma.
- Patients were divided into an infection group (n=15) with bacterial superinfection and a control group (n=15) without infection.
- Neuromuscular blockade was induced with atracurium and monitored electromyographically.
Main Results:
- Atracurium onset time was significantly longer in the infection group (5.3 vs. 3.3 minutes).
- Recovery from neuromuscular blockade (DUR 10%) was significantly shorter in the infection group (23.5 vs. 36.9 minutes).
- The atracurium infusion rate required was 77.4% higher in the infection group compared to controls.
Conclusions:
- Septic intrathoracic processes significantly reduce the neuromuscular blocking potency of atracurium.
- Increased doses of atracurium are necessary to achieve adequate neuromuscular blockade in patients with infection.
- Precise neuromuscular monitoring is highly recommended in patients with septic intrathoracic processes to ensure effective muscle relaxation.