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Atracurium and vecuronium interaction with gentamicin and tobramycin
J Y Dupuis1, R Martin, J P Tétrault
1Department of Anaesthesia, University of Sherbrooke, P. Que.
Abstract:
Drug interactions between the aminoglycosides (tobramycin and gentamicin) and atracurium and vecuronium were studied prospectively in 44 patients. Twenty-two patients had therapeutic serum levels of tobramycin or gentamicin and 22 served as controls. Onset time, clinical duration, and time to spontaneous recovery of T4/T1 ratio of 0.70 after atracurium or vecuronium injection were measured. No statistically significant differences were found in onset time, but clinical duration and time to recovery were significantly longer in patients receiving tobramycin or gentamicin and paralyzed with vecuronium than for controls (P less than 0.01 for clinical duration and P less than 0.0005 for recovery). The neuromuscular block produced by atracurium was not significantly influenced by the presence of therapeutic serum levels of tobramycin or gentamicin. We conclude that for patients treated with these antibiotics, atracurium may present some advantages over vecuronium when a prolonged block is not desired.
Insights
Aminoglycoside antibiotics like tobramycin and gentamicin prolong neuromuscular blockade from vecuronium but not atracurium. Atracurium may be a safer choice for patients on these antibiotics when prolonged block is not desired.
Area of Science:
- Pharmacology
- Anesthesiology
- Critical Care Medicine
Background:
- Aminoglycosides are commonly used antibiotics.
- Neuromuscular blocking agents are used in anesthesia and critical care.
- Potential drug interactions between these classes require investigation.
Purpose of the Study:
- To investigate the interaction between aminoglycosides (tobramycin, gentamicin) and neuromuscular blocking agents (atracurium, vecuronium).
- To determine if therapeutic aminoglycoside levels affect the onset, duration, and recovery of neuromuscular blockade.
Main Methods:
- Prospective study in 44 patients.
- 22 patients with therapeutic aminoglycoside levels vs. 22 controls.
- Measured onset time, clinical duration, and recovery time of neuromuscular blockade after atracurium or vecuronium administration.
Main Results:
- No significant difference in onset time for either drug.
- Vecuronium's clinical duration and recovery time were significantly prolonged in patients receiving aminoglycosides (P<0.01 and P<0.0005, respectively).
- Atracurium's neuromuscular block was not significantly affected by aminoglycoside therapy.
Conclusions:
- Aminoglycosides prolong vecuronium-induced neuromuscular blockade.
- Atracurium's neuromuscular blockade is not significantly influenced by aminoglycosides.
- Atracurium may offer an advantage over vecuronium in patients receiving aminoglycosides when a prolonged block is undesirable.