Interaction of antibiotics on pipecuronium-induced neuromuscular blockade.
OBJECTIVE
To measure the interaction of two antibiotics (clindamycin and colistin) on neuromuscular blockade induced by pipecuronium bromide (a new long-acting, steroidal, nondepolarizing neuromuscular blocking drug).


METHODS
Prospective, randomized, placebo-controlled study.


METHODS
Inpatient gynecologic and gastroenterologic service at a university medical center.


METHODS
Three groups of 20 ASA physical status I and II patients with normal kidney and liver function, taking no medication, and undergoing elective surgery under general anesthesia.


METHODS
Anesthesia was induced with propofol and alfentanil intravenously (IV) and maintained with a propofol infusion and 60% nitrous oxide in oxygen. Pipecuronium bromide 50 micrograms/kg was administered after reaching a stable baseline of single-twitch response. At 25% recovery of pipecuronium-induced neuromuscular blockade, patients received one of two antibiotics, clindamycin 300 mg or colistin 1 million IU, or a placebo.


RESULTS
The recovery index (RI, defined as time from 25% to 75% recovery of neuromuscular blockade) was measured using the single-twitch response of the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve at the wrist. RI after administration of an antibiotic (given at 25% recovery) was measured and compared with RI of the control group using Student's unpaired t-test. Statistical analyses of the results showed a significant prolongation of the recovery time (from 25% to 75% recovery) of 40 minutes for colistin.


CONCLUSIONS
When this type of antibiotic is used during anesthesia with pipercuronium as a muscle relaxant, one must be aware of a significant prolongation of an already long-acting neuromuscular blockade and (although not observed in this study) possible problems in antagonism.
de Gouw
N E
NE
Department of Anesthesiology, University Hospital, Katholieke Universiteit Leuven, Belgium.
Crul
J F
JF
Vandermeersch
E
E
Mulier
J P
JP
van Egmond
J
J
Van Aken
H
H
D000293:Adolescent; D000328:Adult; D000771:Anesthesia, Intravenous; D002981:Clindamycin / Q000494:pharmacology*; D003091:Colistin / Q000494:pharmacology*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000494:pharmacology; D009469:Neuromuscular Junction / Q000187:drug effects*; D017300:Pipecuronium / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D010919:Placebos; D011446:Prospective Studies; D013933:Thumb / Q000294:innervation; D013997:Time Factors; D014459:Ulnar Nerve / Q000187:drug effects
D010919:Placebos; D017300:Pipecuronium; D009388:Neostigmine; D002981:Clindamycin; D003091:Colistin