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Effects of rapacuronium on respiratory function during general anesthesia: a comparison with cis-atracurium
J D Tobias1, J O Johnson, K Sprague
1Department of Anesthesiology, The University of Missouri, Columbia, 65212, USA. tobiasj@health.missouri.edu
Anesthesiology
|October 19, 2001
Summary
Rapacuronium causes significant airway effects, including increased peak inflating pressure and decreased dynamic compliance, in intubated adults. Cis-atracurium did not produce these adverse respiratory changes.
Area of Science:
- Anesthesiology
- Pharmacology
- Respiratory Medicine
Background:
- Reports of bronchospasm linked to rapacuronium use have increased.
- Rapucuronium is frequently used for rapid sequence intubation.
- Airway effects may be related to anesthetic depth.
Purpose of the Study:
- To investigate the airway effects of rapacuronium in anesthetized adults.
- To compare rapacuronium's effects with cis-atracurium in intubated patients.
Main Methods:
- Adult patients undergoing endotracheal intubation without neuromuscular blockers.
- Measurements included dynamic compliance, tidal volume, and flow/pressure rates.
- Patients received either rapacuronium (1.5 mg/kg) or cis-atracurium (0.2 mg/kg) under propofol-remifentanil anesthesia.
Main Results:
- Rapucuronium significantly increased peak inflating pressure (22 to 28 cm H2O) and decreased dynamic compliance (108 to 77 ml/cm H2O).
- Rapucuronium also reduced peak inspiratory and expiratory flow rates and tidal volume.
- Cis-atracurium administration showed no significant changes in these parameters.
Conclusions:
- Rapucuronium exhibits significant adverse airway effects in intubated, mechanically ventilated adults.
- Cis-atracurium does not appear to cause similar respiratory complications.
- These findings highlight potential risks associated with rapacuronium administration.