title: Neuromuscular interaction between cisatracurium and mivacurium, atracurium, vecuronium or rocuronium administered in combination.
abstract: We compared the dose-response relationships of cisatracurium, mivacurium, atracurium, vecuronium and rocuronium and examined the interactions of cisatracurium with mivacurium, atracurium, vecuronium and rocuronium in humans by isobolographic and fractional analyses. We studied 180 adult patients during nitrous oxide-fentanyl-propofol anaesthesia. Neuromuscular block was monitored using mechanomyography to detect the twitch response of the ulnar nerve at the wrist. The dose-response curves were determined by probit analysis. The calculated ED50 values and their 95% confidence intervals were 40.9 (38.1-43.7), 49.8 (47.0-52.6), 187.2 (175.1-199.3), 36.6 (34.7-38.5) and 136.4 (129.2-143.6) micrograms.kg-1 for cisatracurium, mivacurium, atracurium, vecuronium and rocuronium, respectively. Corresponding ED95 values were 57.6 (53.5-61.7), 91.8 (88.1-95.5), 253.1 (238.9-267.3), 52.9 (49.1-56.7) and 288.7 (276.2-301.2) micrograms.kg-1, respectively. The interaction between cisatracurium and mivacurium, vecuronium or rocuronium was found to be synergistic, but the interaction between cisatracurium and atracurium was found to be additive. Synergy between cisatracurium and vecuronium or rocuronium was greater than between cisatracurium and mivacurium.
authors.affiliation: Department of Anaesthesiology, Hanyang University Hospital, Seoul, South Korea.
authors.forename: K S
authors.initials: KS
authors.lastname: Kim
authors.forename: Y S
authors.initials: YS
authors.lastname: Chun
authors.forename: S U
authors.initials: SU
authors.lastname: Chon
authors.forename: J K
authors.initials: JK
authors.lastname: Suh
mesh_terms: D000328:Adult; D000732:Androstanols / Q000494:pharmacology; D000768:Anesthesia, General; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D000077590:Mivacurium; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D000077123:Rocuronium; D014673:Vecuronium Bromide / Q000494:pharmacology
chemical_list: D000732:Androstanols; D007546:Isoquinolines; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D000077590:Mivacurium; D014673:Vecuronium Bromide; C101584:cisatracurium; D000077123:Rocuronium