title: Atracurium-induced neuromuscular block is not affected by chronic anticonvulsant therapy with carbamazepine.
abstract: BACKGROUND
  Patients on chronic anticonvulsant therapy are relatively resistant to some nondepolarizing neuromuscular blockers. Because of the controversial reports on atracurium, the purpose of the present study was to determine the effect of long-term carbamazepine treatment on the neuromuscular block produced by this muscle relaxant.
  
  
  METHODS
  Eighteen otherwise healthy individuals scheduled for neurosurgical interventions were studied. Eight patients had received carbamazepine for an average of 41 weeks (range 4-156 weeks) prior to surgery. Ten patients without carbamazepine exposure served as controls. After premedication with oral diazepam, anaesthesia was induced with fentanyl and thiopental and maintained with nitrous oxide and isoflurane in oxygen. Atracurium was given for neuromuscular blockade and the evoked electromyogram (EMG) was recorded with a Datex Monitor NMT.
  
  
  RESULTS
  The lag time, the onset time, the duration 10%, 25%, 50%, 75% and the interval 25-75% did not differ between the groups.
  
  
  CONCLUSIONS
  Our results with atracurium differ from previous data demonstrating an influence of carbamazepine therapy on the pharmacokinetics and/or pharmacodynamics of other non-depolarizing muscle relaxants. As documented in this study, atracurium produces adequate neuromuscular block in patients chronically exposed to carbamazepine. Chronic carbamazepine therapy does not influence the onset time and duration of action of atracurium-induced neuromuscular block.
authors.affiliation: Department B of Anesthesia and General Intensive Care, University of Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Spacek
authors.forename: F X
authors.initials: FX
authors.lastname: Neiger
authors.forename: C K
authors.initials: CK
authors.lastname: Spiss
authors.forename: H G
authors.initials: HG
authors.lastname: Kress
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000494:pharmacology*; D001279:Atracurium / Q000494:pharmacology*; D002220:Carbamazepine / Q000494:pharmacology*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009469:Neuromuscular Junction / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*
chemical_list: D000927:Anticonvulsants; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D002220:Carbamazepine