title: The effect of vecuronium is enhanced by a large rather than a modest dose of gentamicin as compared with no preoperative gentamicin.
abstract: We compared the effect of two doses of gentamicin versus no gentamicin (NG) given before surgery on the neuromuscular relaxant effect of vecuronium. Seventy patients (intraabdominal procedures) were randomly allocated to receive preoperative large-dose (4 mg/kg) gentamicin (LD), a modest dose (1.2 mg/kg) of gentamicin (MD), or NG. No more than one dose of gentamicin was given before the vecuronium administration. Serum gentamicin levels, the time for 25% recovery of the first twitch in the train-of-four after a bolus of vecuronium, and the time from cessation of the vecuronium infusion to extubation of the trachea were estimated. Serum gentamicin levels were higher (P < 0.001) for LD than MD. The time for 25% recovery of the first twitch after the vecuronium bolus was slightly longer with LD than MD (P = 0.06) and longer in LD than NG (P = 0.001) (42.9 +/- 23.6 min versus 36.2 +/- 17 min and 27.4 +/- 9 min, respectively). The time to extubation was similar with LD and MD and longer for LD than NG (P = 0.008) (34.7 +/- 19.2 min versus 27.4 +/- 19.3 min and 19.4 +/- 10.1 min, respectively). The differences in these times were insignificant between MD and NG. Gentamicin administered as a LD rather than MD enhanced the neuromuscular blockade of vecuronium as compared with NG given before surgery.
  
  
  CONCLUSIONS
  We demonstrated that the neuromuscular relaxant effect of vecuronium is enhanced by a large (4 mg/kg) rather than a modest (1.2 mg/kg) dose of gentamicin as compared with no gentamicin given before surgery.
authors.affiliation: *Department of Urology, Sheba Medical Center, Ramat Gan; Departments of †General Surgery and ‡Anesthesia, Kaplan Medical Center, Rehovot; and §Department of Anesthesia, Wolfson Medical Center, Holon, Israel (Affiliated with *§Sackler School of Medicine, Tel Aviv and †‡Hadassah Medical School, Jerusalem, Israel).
authors.forename: Zohar A
authors.initials: ZA
authors.lastname: Dotan
authors.forename: Rene
authors.initials: R
authors.lastname: Hana
authors.forename: Daniel
authors.initials: D
authors.lastname: Simon
authors.forename: Daniel
authors.initials: D
authors.lastname: Geva
authors.forename: Reuven A
authors.initials: RA
authors.lastname: Pfeffermann
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D013505:Digestive System Surgical Procedures; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000494:pharmacology; D003473:Neuromuscular Nondepolarizing Agents / Q000493:pharmacokinetics / Q000494:pharmacology*; D013390:Succinylcholine / Q000494:pharmacology; D014673:Vecuronium Bromide / Q000493:pharmacokinetics / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D013390:Succinylcholine