Disease relevance of Vecuronium

• Prolonged neuromuscular blockade after the termination of long-term treatment with vecuronium is associated with metabolic acidosis, elevated plasma magnesium concentrations, female sex, and probably more important, the presence of renal failure and high plasma concentrations of 3-desacetylvecuronium [1].
• Neuromuscular paralysis lasting up to seven days may occur after the termination of long-term administration (i.e., more than two days) of vecuronium in critically ill patients [1].
• In the patients without prolonged neuromuscular blockade, the mean (+/- SD) plasma clearance, elimination half-life, and volume of distribution of vecuronium were 2.5 +/- 1.0 ml per kilogram of body weight per minute, 299 +/- 154 minutes, and 1.1 +/- 0.6 liters per kilogram, respectively [1].
• Pharmacokinetic studies in obesity show that the behaviour of molecules with weak or moderate lipophilicity (e.g. lithium and vecuronium) is generally rather predictable, as these drugs are distributed mainly in lean tissues [2].
• The mechanism of the bradycardia produced by vecuronium is unclear [3].

High impact information on Vecuronium

• Clinical factors and plasma concentrations of vecuronium and 3-desacetylvecuronium, the active metabolite of vecuronium, were compared in patients with and without prolonged neuromuscular blockade [1].
• We maintained anesthesia with an N2O/O2/opioid technique supplemented with a halogenated inhalational agent and maintained partial neuromuscular blockade using a vecuronium infusion [4].
• LU did not inhibit the carrier-mediated hepatic uptake of the model organic cationic compounds tributylmethyl ammonium (type 1) and vecuronium (type 2) in isolated hepatocytes, whereas the uptake of LU in the perfused liver was not affected by either type of cation or by the cardiac glycoside cymarin, a potent type 2 inhibitor [5].
• Pharmacokinetics and pharmacodynamics of vecuronium administered by bolus and infusion during halothane or balanced anesthesia [6].
• Vecuronium kinetics and dynamics in anesthetized infants and children [7].

Chemical compound and disease context of Vecuronium

• The main ones are the atracurium group, which possess a built-in self-destruct mechanism that makes them especially useful in kidney or liver failure, and the vecuronium group, which are especially free from unwanted side effects [8].
• Pancuronium (20, 40, and 80 micrograms X kg-1) only caused a moderate tachycardia, while vecuronium (40, 80, and 160 micrograms X kg-1) was devoid of any systemic hemodynamic effect [9].
• The prejunctional effect of vecuronium explains its effectiveness in preventing succinylcholine-induced fasciculations [10].
• METHODS: In 60 patients scheduled to undergo craniotomy and removal of supratentorial brain tumors with no evidence of midline shift, anesthesia was induced with intravenous fentanyl, thiopental, and vecuronium and was maintained with 60% nitrous oxide in oxygen [11].
• CONCLUSIONS: The efficacy of neostigmine as an antagonist of vecuronium-induced neuromuscular block is not altered by mild hypothermia [12].

Biological context of Vecuronium

• Neither the pharmacokinetics nor the pharmacodynamics of vecuronium in humans differed between these two patient groups [6].
• The clinical duration of vecuronium in term and postpartum women is twice that reported in nonpregnant women [13].
• Vecuronium for muscle relaxation in patients with myasthenia gravis [14].
• Heart rate and systemic mean arterial pressure did not change following vecuronium, while increasing 22% and 24%, respectively, following pancuronium [15].
• The increases in systolic blood pressure were unaffected by vecuronium [16].

Anatomical context of Vecuronium

• The cardiovascular effects of vecuronium (ORG NC45) and pancuronium in patients undergoing coronary artery bypass grafting [15].
• It was hypothesized that vecuronium impairs carotid body chemoreceptor function during hypoxia [17].
• This study explored the prejunctional actions of vecuronium using the in vivo cat soleus nerve-muscle preparation [18].
• Notably, there was variation in the effect of vecuronium; some chemoreceptor preparations showed only minimal impairment, whereas some showed an almost abolished response to hypoxia [17].
• METHODS: Train-of-four stimulation was applied every 12 s to both ulnar nerves and adductor pollicis twitch tension was measured in anesthetized participants given 30 micrograms/kg vecuronium [19].

Associations of Vecuronium with other chemical compounds

• DESIGN: Patients were randomized to receive an intravenous injection of saline (0.15 mL/kg), pancuronium bromide (0.1 mg/kg), or vecuronium bromide (0.15 mg/kg) after induction of general anesthesia and tracheal intubation [20].
• Quantification of the aminosteroidal non-depolarizing neuromuscular blocking agents rocuronium and vecuronium in plasma with liquid chromatography-tandem mass spectroscopy [21].
• Sixty patients undergoing elective surgery under general anesthesia were divided randomly into four groups of 15 patients and received as a priming dose either vecuronium (10 or 15 micrograms/kg) or atracurium (50 or 75 micrograms/kg) [22].
• For 0.03 mg/kg vecuronium, onset time was 3.6-5.9 times longer than for succinylcholine, increasing from 219 +/- 15 s in 3-10-yr-old patients to 473 +/- 30 s in 60-80-yr-old patients (P < 0.00001 by linear regression) [23].
• General anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 1.5 microg/kg fentanyl and maintained with isoflurane (1.5 +/- 0.4%) in 70% nitrous oxide [24].

Gene context of Vecuronium

• The interaction of three new non-depolarizing neuromuscular blocking agents--atracurium, vecuronium and Duador--on human red cell acetylcholinesterase (AChE; EC 3.1.1.7) and human plasma butyrylcholinesterase (BuChE; EC 3.1.1.8) was investigated [25].
• T1/control twitch height and TOF ratio (T4/T1) in the N-TOF group were higher than those in the C-TOF group 80-120 min and 100-120 min after administration of vecuronium, respectively [26].
• In the vecuronium and succinylcholine groups, CD4/CD8 fractions decreased in the postoperative period [27].
• It was determined that vecuronium is a strong inhibitor of HNMT; apparent Ki = 1 microM [28].
• Therefore, transepithelial transport of the P-gp substrate vinblastine, the steroidal (type 2) cation vecuronium, the relatively small (type 1) cationic compound azidoprocainamide methoiodide and the aliphatic cation tri-n-butylmethylammonium were measured [29].

Analytical, diagnostic and therapeutic context of Vecuronium

• We investigated the role of clinical factors and plasma concentrations of vecuronium and its metabolite in causing this prolonged neuromuscular blockade [1].
• We studied 16 critically ill adult patients (8 women and 8 men) who had received vecuronium to facilitate mechanical ventilation for at least two consecutive days [1].
• On the other hand, an increase in the clearance clearance of vecuronium during cesarean sections has been reported [13].
• It also offers a more predictable recovery profile than vecuronium after prolonged use in patients in intensive care [30].
• Atracurium or vecuronium for rapid sequence endotracheal intubation [31].

References