title: The effect of d-tubocurarine priming on an ED95 dose of vecuronium bromide.
abstract: OBJECTIVE
  To examine how priming with ED10 d-tubocurarine prior to the administration of ED95 vecuronium bromide affects onset and duration of neuromuscular blockade.
  
  
  METHODS
  Prospective, randomized, observer-blinded study.
  
  
  METHODS
  Operating room at a university cancer center.
  
  
  METHODS
  40 ASA physical status I and II patients undergoing ambulatory surgical procedures.
  
  
  METHODS
  Patients were randomized to one of two groups. Group 1 patients received d-tubocurarine 50 micrograms/kg intravenously (IV), followed by vecuronium 60 micrograms/kg IV. Group 2 patients received vecuronium 60 micrograms/kg IV without priming. All patients received a total IV anesthetic consisting of alfentanil and propofol for induction of anesthesia and propofol alone for maintenance of anesthesia.
  
  
  RESULTS
  Onset of muscle relaxation was determined with an electromyograph (Datex Relaxograph), documenting time to 80% depression of the first twitch in a train-of-four (T(1)80%), percent depression of T1 at 60 and 90 seconds (T(1)60 and T(1)90, respectively), T4:T1 ratio at 90 seconds, and time to achieve maximal blockade (Bmax). Recovery was evaluated by measuring the time required for return of T1 to 25% of the baseline value. Intubating conditions were assessed at 90 seconds after vecuronium administration and graded on a 1 (jaw tight, impossible to intubate) to 4 (jaw relaxed, vocal cords immobile) scale. All criteria measuring onset of neuromuscular blockade (i.e., T(1)80%, T(1)60, T(1)90, T4:T1, and Bmax) were significantly shorter (p < 0.05) in patients who received d-tubocurarine. Recovery was similar in both groups. Intubation scores were significantly better 90 seconds after priming (p < 0.05).
  
  
  CONCLUSIONS
  These results indicate that crossover dosing of nondepolarizing muscle relaxants may have synergistic effects. Priming with ED10 d-tubocurarine prior to an ED95 dose of vecuronium shortens the time to 80% T1 depression and produces satisfactory intubating conditions at 90 seconds, without prolonging the duration of the Therefore, d-tubocurarine is an attractive drug for priming vecuronium in short operative procedures that require muscle relaxation.
authors.affiliation: Department of Anesthesiology, University of South Florida College of Medicine, Tampa.
authors.forename: R V
authors.initials: RV
authors.lastname: Miguel
authors.forename: I K
authors.initials: IK
authors.lastname: Barlow
authors.forename: D L
authors.initials: DL
authors.lastname: Dombrowski
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D004357:Drug Synergism; D004576:Electromyography / Q000187:drug effects; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009126:Muscle Relaxation / Q000187:drug effects; D009469:Neuromuscular Junction / Q000187:drug effects; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D014403:Tubocurarine / Q000008:administration & dosage / Q000494:pharmacology*; D014459:Ulnar Nerve / Q000187:drug effects; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D014673:Vecuronium Bromide; D014403:Tubocurarine