Intubating conditions after pipecuronium bromide: the influence of dose and time.
OBJECTIVE
To determine the intubating conditions following the administration of pipecuronium bromide in doses of two (0.07 mg/kg) or three (0.1 mg/kg) times ED95 (average dose that gives 95% block of the first twitch).


METHODS
To compare intubating conditions at 11/2 and 21/2 minutes in 41 patients receiving balanced anesthesia.


METHODS
Surgical patients at Thomas Jefferson University Hospital.


METHODS
Forty-one patients undergoing surgical procedure who received general anesthesia.


METHODS
After obtaining a stable baseline of train-of-four (TOF), 41 patients randomly received either 0.07 mg/kg or 0.1 mg/kg of pipecuronium as a single intravenous (IV) bolus dose, and the trachea was intubated either at 11/2 or 21/2 minutes.


RESULTS
Intubating conditions at 21/2 minutes appeared significantly better than those at 11/2 minutes, regardless of the pipecuronium dose. The mean time for T1 (first twitch of TOF) to reach 50% and 90% suppression was 1.36 +/- 0.51 minutes and 2.29 +/- 0.8 minutes, respectively, for the 0.07 mg/kg dose and 1.07 +/- 0.27 minutes and 1.72 +/- 0.45 minutes, respectively, for the 0.1 mg/kg dose. This did not make a significant difference in intubating conditions at either time. The time to 25% recovery of T1 was 68.2 +/- 22 minutes for the 0.07 mg/kg dose and 121.5 +/- 49 minutes for the 0.1 mg/kg dose. In patients who had spontaneous recovery of T1 to between 10% and 25% of control, administration of neostigmine or edrophonium resulted in identical recovery in 10 minutes. However, in patients with less than 10% spontaneous recovery of T1, neostigmine appeared to be superior to edrophonium.


CONCLUSIONS
Pipecuronium has a relatively rapid onset. The trachea could be intubated successfully in 11/2 minutes with a dose of either 0.07 mg/kg or 0.1 mg/kg. If the clinical situation requires perfect relaxation with no movement or bucking, we recommend waiting at least 21/2 minutes.
Azad
S S
SS
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Larijani
G E
GE
Bartkowski
R
R
Seltzer
J L
JL
Weinberger
M
M
Marr
A
A
Goldberg
M E
ME
D000328:Adult; D015113:Androstane-3,17-diol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D000768:Anesthesia, General; D003964:Diaphragm / Q000187:drug effects; D004491:Edrophonium / Q000494:pharmacology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007537:Isometric Contraction / Q000187:drug effects; D008297:Male; D009388:Neostigmine / Q000494:pharmacology; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D017300:Pipecuronium; D010879:Piperazines / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D009435:Synaptic Transmission / Q000187:drug effects; D013997:Time Factors; D014827:Vocal Cords / Q000187:drug effects
D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D010879:Piperazines; D017300:Pipecuronium; D015113:Androstane-3,17-diol; D009388:Neostigmine; D004491:Edrophonium