Doxacurium chloride: a preliminary clinical trial

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Neuromuscular blocking agents are crucial in anesthesia.
• Understanding doxacurium's profile is essential for safe clinical use.

Purpose of the Study:

• To evaluate the onset, duration, and reversibility of doxacurium.
• To assess the efficacy of antagonism with edrophonium and neostigmine.
• To monitor for adverse effects, including hemodynamic changes and histamine release.

Main Methods:

• Doxacurium was administered at two doses (1.5 x ED95 and 2.5 x ED95) to 27 anesthetized patients.
• Neuromuscular blockade was assessed via adductor pollicis response to ulnar nerve stimulation and integrated EMG.
• Antagonism was studied using edrophonium and neostigmine.

Main Results:

• Slow onset of action was observed, with suboptimal intubating conditions at 3-4 minutes.
• Higher doses achieved maximal block (97.6%) in approximately 10 minutes.
• Recovery to 20% of baseline took about 102 minutes; no cumulative effect was noted with incremental doses.
• Neostigmine provided satisfactory antagonism, while edrophonium was less effective.
• Bradycardia occurred in 12 patients but responded to other medications; no histamine release was observed.

Conclusions:

• Doxacurium exhibits a slow onset and prolonged duration of action.
• Neostigmine is an effective antagonist for doxacurium-induced neuromuscular blockade.
• Doxacurium appears safe regarding histamine release and major hemodynamic effects, though bradycardia requires monitoring.