title: The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia.
abstract: BACKGROUND
  Atracurium consists of a mixture of ten stereoisomers. One of these isomers, 51W89, is a potent intermediate-acting nondepolarizing neuromuscular blocking agent. Its ED95 is 0.05 mg.kg-1 in patients receiving nitrous oxide/opioid anesthesia. In preclinical trials, 51W89 did not show evidence of histamine release in cats at doses up to 80 times the human ED95. This study was undertaken to determine the cardiovascular effects and histamine-releasing properties of 51W89 in patients undergoing elective surgical procedures.
  
  
  METHODS
  Sixty patients, ASA physical status 1 or 2, anesthetized with nitrous oxide/fentanyl/thiopental were studied. Patients received either 2 times the ED95 of atracurium or 51W89 or 4 or 8 times the ED95 of 51W89 as a rapid intravenous bolus under stable anesthesia, before surgical stimulation. Blood pressure and heart rate were measured by oscillometry and the electrocardiogram in patients receiving 2 times the ED95 of 51W89 or atracurium and by an intraarterial catheter and a tachograph triggered by the arterial pulse waveform in patients receiving 4 or 8 times the ED95 of 51W89. Maximal blood pressure and heart rate changes during the 5 min after administration of the muscle relaxant were recorded. Venous blood samples were obtained before the administration of relaxant and at 2 and 5 min after the administration of relaxant for determination of plasma histamine concentrations by radioenzymatic assay.
  
  
  RESULTS
  Maximal blood pressure and heart rate changes in all groups of patients receiving 51W89 were small and similar to those observed in patients receiving 2 times the ED95 of atracurium. The mean maximum percent changes (+/- SE) in heart rate and mean arterial pressure were -0.6 +/- 1.5 and 0.4 +/- 2.5, respectively, in the group receiving 2 times the ED95 atracurium; -1.3 +/- 3.3 and 2.3 +/- 4.4, respectively, in the group receiving 2 times the ED95 51W89; -2.6 +/- 1.0 and 2.6 +/- 1.5, respectively, in the group receiving 4 times the ED95 51W89; and -2.4 +/- 1.5 and -1.0 +/- 1.3, respectively, in the group receiving 8 times the ED95 51W89. No patient developed a decrease in blood pressure > or = 20% or an increase in heart rate > or = 20% that was attributable to muscle relaxant administration. There was no dose-related change in plasma histamine concentration associated with the administration of 51W89. One patient in the study developed transient facial flushing after the administration of atracurium.
  
  
  CONCLUSIONS
  51W89 is a benzylisoquinolinium-type, nondepolarizing muscle relaxant that does not affect plasma histamine concentrations. No cutaneous flushing or clinically important cardiovascular effects were noted after rapid injection of doses up to and including 8 times its ED95 (0.4 mg.kg-1) in healthy patients undergoing elective surgical procedures.
authors.affiliation: New York Hospital-Cornell Medical Center, New York 10021, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Lien
authors.forename: M R
authors.initials: MR
authors.lastname: Belmont
authors.forename: A
authors.initials: A
authors.lastname: Abalos
authors.forename: L
authors.initials: L
authors.lastname: Eppich
authors.forename: S
authors.initials: S
authors.lastname: Quessy
authors.forename: M M
authors.initials: MM
authors.lastname: Abou-Donia
authors.forename: J J
authors.initials: JJ
authors.lastname: Savarese
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D001279:Atracurium / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects*; D006636:Histamine Release / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage; D013237:Stereoisomerism; D013874:Thiopental / Q000008:administration & dosage
chemical_list: D001279:Atracurium; D013874:Thiopental; D009609:Nitrous Oxide; D005283:Fentanyl