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Related Experiment Videos

Is the priming principle both effective and safe?

P S Glass1, W Wilson, J A Mace

  • 1Duke University Medical Center, Durham, NC 27707.

Anesthesia and Analgesia
|February 1, 1989
PubMed
Summary

Priming neuromuscular blockers like vecuronium, pancuronium, and atracurium can speed up the onset of neuromuscular blockade. However, the optimal priming dose for rapid onset also increases the risk of muscle weakness side effects.

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Neuromuscular Pharmacology

Background:

  • Neuromuscular blockade (NMB) onset is critical for intubation.
  • Priming with a small dose of neuromuscular blocker can accelerate NMB onset.
  • Vecuronium, pancuronium, and atracurium are commonly used nondepolarizing agents.

Purpose of the Study:

  • To determine the optimal priming dose of vecuronium, pancuronium, and atracurium for the most rapid onset of NMB.
  • To compare the efficacy of priming with these agents.
  • To evaluate the effect of increasing intubating doses after priming.

Main Methods:

  • 150 patients received either vecuronium, pancuronium, or atracurium.
  • Patients were primed with varying percentages (5-20%) of the total dose or received no priming.

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  • Succinylcholine was used as a positive control in some patients.

    • Main Results:

    • Priming significantly shortened the onset of NMB for all three agents.
    • Optimal priming doses were identified: 0.012 mg/kg for vecuronium, 0.015 mg/kg for pancuronium, and 0.09 mg/kg for atracurium.
    • Succinylcholine produced a faster NMB at 60 seconds than primed nondepolarizing agents. Increasing intubating doses did not improve onset. The optimal priming dose led to significant muscle weakness.

    Conclusions:

    • Priming shortens NMB onset similarly across vecuronium, pancuronium, and atracurium.
    • The priming dose for the most rapid NMB onset is associated with a high incidence of side effects, particularly muscle weakness.
    • The priming principle should be applied cautiously in clinical practice.