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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

The clinical pharmacology of doxacurium in young adults and in elderly patients.

Neuromuscular blockade induced by doxacurium 30 was compared in 21 young (18-55 years) and 17 elderly (65-85 years) patients. Anaesthesia was induced with thiopentone and maintained with fentanyl, nitrous oxide in oxygen and isoflurane. Neuromuscular blockade was measured electromyographically (Datex Relaxograph) at the adductor pollicis using train-of-four stimuli at 20 s intervals. The depth of maximum neuromuscular blockade was similar in young and elderly patients (median 100% compared to 96%). However, the onset was significantly slower in the elderly: their mean (SD) time to 90% suppression of the first response of the train-of-four was 7.7 (1.8) min compared to 5.7 (1.7) min in the young (p = 0.002). Four min after doxacurium, the conditions for tracheal intubation were significantly poorer in the elderly (p < 0.001). Mean (SD) recovery of first response of the train-of-four to 25% of control was unaffected by age: young 79.0 (41.6) min; elderly 66.2 (32.1) min (p > 0.05). When the first response had reached 25% of control, neuromuscular blockade was antagonised with neostigmine 60 The mean time to first response to 90% of control was similar in the young and the elderly patients (9.1 min compared to 10.4 min). Recovery of the train-of-four ratio to 0.7 was significantly slower in the elderly: mean (SD) 17.1 (10.6) min compared to 10.1 (7.0) min (p = 0.03). Doxacurium was associated with clinically insignificant haemodynamic changes in both groups.[1]


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