title: [Reduced neuromuscular blocking potency of atracurium in patients with purulent intrathoracic diseases].
abstract: OBJECTIVE
  Based on personal observations the neuromuscular blocking potency of atracurium was supposed to be diminished in purulent intrathoracic diseases. This hypothesis was tested in a prospective clinical trial.
  
  
  METHODS
  52 adult patients undergoing general anaesthesia (methohexitone, sufentanil, flunitrazepam, N2O, enflurane) for elective thoracic surgery were investigated. After the intubation dose of 0.6 mg/kg atracurium was applied continuously to maintain a 90% suppression of the evoked compound electromyogram. According to the intraoperatively established diagnosis patients were allocated to three categories: 1) non-malignant tumor as the control group (n = 15), 2) lung cancer (n = 22), 3) purulent intrathoracic process without tumor (n = 15). The groups were compared regarding onset time, DUR 10% and maintenance dose of atracurium.
  
  
  RESULTS
  Patients with lung cancer did not differ significantly from the controls regarding efficiency of atracurium. In contrast, patients with a purulent intrathoracic process showed a significantly longer onset time (6.3 +/- 2.5 vs. 2.9 +/- 0.8 min, p < 0.001), and a significantly shorter DUR 10% (23 +/- 6 vs. 36 +/- 10 min, p < 0.001) compared to the control group. Mean infusion rate of atracurium to maintain a 90% suppression of the evoked compound electromyogram was significantly higher in patients with a purulent process compared to the controls (10.5 +/- 3.2 vs. 6.0 +/- 1.2 micrograms/kg.min, p < 0.001).
  
  
  CONCLUSIONS
  Our results support the hypothesis that patients with a purulent intrathoracic disease show a clear reduction in neuromuscular blocking potency of atracurium.
authors.affiliation: Abteilung für Anästhesiologie, Kliniken der Stadt Köln, Krankenhaus Merheim, Köln.
authors.forename: D
authors.initials: D
authors.lastname: Knüttgen
authors.forename: D
authors.initials: D
authors.lastname: Zeidler
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.forename: M R
authors.initials: MR
authors.lastname: Müller-Gorges
authors.forename: M
authors.initials: M
authors.lastname: Doehn
mesh_terms: D000328:Adult; D001279:Atracurium; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D003473:Neuromuscular Nondepolarizing Agents; D011446:Prospective Studies; D013896:Thoracic Diseases / Q000150:complications*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium
vernacular_title: Verminderte Wirksamkeit von Atracurium bei Patienten mit intrathorakalem Eiterherd.