Does abstinence from smoking or a transdermal nicotine system influence atracurium-induced neuromuscular block?
| Autor: | M. G. F. Rorarius, Gerhard A. Baer, Pekka Laippala, Arto I. E. Puura |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male Nicotine Time Factors media_common.quotation_subject Placebo Administration Cutaneous Fentanyl Double-Blind Method medicine Atracurium besilate Humans Prospective Studies media_common Transdermal Maintenance dose business.industry Electromyography Smoking Abstinence Middle Aged Anesthetics Combined Anesthesiology and Pain Medicine Isoflurane Anesthesia Atracurium Neuromuscular Blockade Female Smoking Cessation business medicine.drug Neuromuscular Nondepolarizing Agents |
| Zdroj: | Anesthesia and analgesia. 87(2) |
| ISSN: | 0003-2999 |
| Popis: | The purpose of the present study was to investigate the interaction of chronic smoking and the actions of atracurium (ATR).Twenty nonsmokers (NON-SMOK) were compared with 80 smokers, who were randomized into three groups: 30 patients received 21 mg/d transdermal nicotine system >or=to10 h before fentanyl/thiopental/N2 O/O2/isoflurane anesthesia (TD-NICO), whereas the abstinent group received a placebo transdermal system (ABST, n = 30). The TD-NICO and ABST groups refrained from smoking for at least 10 h before the induction of anesthesia. A third group was allowed to smoke until 1-3 h before anesthesia (SMOK, n = 20). Neuromuscular block was monitored using a Relaxograph[trade mark sign] (Datex, Helsinki, Finland). The electromyographic response was recorded from the first dorsal interosseus muscle of the hand. The inspiratory isoflurane concentration was kept constant at 0.7 vol% in all patients. After an initial bolus dose of 0.5 mg/kg ATR, no significant difference was observed among the groups regarding onset time and maximal neuromuscular block. In Group ABST, the duration of block until 25% recovery of T1 was 48.2 +/- 10.1 min, which was significantly longer (analysis of variance post hoc tests) than in Groups TD-NICO, SMOK, and NON-SMOK (42.7 +/- 7.1, 41.4 +/- 10.4, and 42.8 +/- 7.3 min, respectively). The maintenance dose of ATR in Group ABST (0.23 +/- 0.03 mg [center dot] kg-1 [center dot] h (-1)) was smaller than in Groups TD-NICO, SMOK, and NON-SMOK (0.30 +/- 0.07, 0.32 +/- 0.06, and 0.32 +/- 0.05 mg [center dot] kg-1 [center dot] h-1, respectively). We conclude that abstinence from smoking increases the duration of ATR-induced neuromuscular block and reduces the maintenance dose of ATR in smokers. Perioperative use of a transdermal nicotine system prevents these abstinence-induced changes in duration and maintenance-dose. Implications: The purpose of the present study was to investigate the interaction of chronic smoking and atracurium. Smokers who refrain from smoking for >10 h require a smaller maintenance dose of atracurium than nonsmokers. However, using a transdermal nicotine system prevents the decrease in maintenance dose during abstinence. (Anesth Analg 1998;87:430-3) |
| Databáze: | OpenAIRE |
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