action-neuro

Patient received NIMBEX 0.1 mg/kg (n=20), rocuronium 0.6 mg/kg (n=20) or vecuronium 0.1 mg/kg(n=20) under opioid/N2O/O2/sevoflurane/barbiturate anesthesia.

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Patients received NIMBEX 0.1 mg/kg (n=20), rocuronium 0.6 mg/kg (n=20) or vecuronium 0.1 mg/kg (n=20) under opioid/N2O/O2/sevoflurane/barbiturate anesthesia.

  • The median of the measure of variability of the durations of action was significantly less in the NIMBEX group compared with the other 2 groups1
  • The median durations of action of the 3 agents were not significantly different1
  • Duration of action was defined as return of T1 twitch height to 25%1
  • The more profound the NMB block at the time of reversal, the longer the time required for recovery of neuromuscular function2
  • Plasma clearances of NIMBEX were not affected by age after a single dose of
    0.1 mg/kg. One minute slower times to maximum block were seen in elderly patients compared to healthy young adult patients2
  • Significantly lower variability in spontaneous recovery was seen in elderly patients given NIMBEX vs vecuronium3
    • Adults 18-64 years – mean duration of spontaneous sufficient recovery following the last administration of study drug:
      • NIMBEX – 28.3 min
      • Vecuronium – 38.5 min
      • P<0.001
    • Elderly patients (≥65 yrs) – mean duration of recovery:
      • NIMBEX – 31.7 min
      • Vecuronium – 60.3 min
      • P<0.001
  • Repeated administration of maintenance doses of NIMBEX for up to 3 hours are not associated with development of tachyphylaxis or cumulative NMB effects2
  • The time needed to recover from successive maintenance doses does not change with the number of doses administered as long as partial recovery is allowed to occur between doses2

Patients received either an initial bolus dose of NIMBEX 0.15 mg/kg and 0.6 mg/kg, or vecuronium 0.1 mg/kg and .04 mg/kg followed by maintenance dose(s) of NIMBEX 0.03 mg/kg or vecuronium 0.02 mg/kg under opioid/N2O/O2/propofol anesthesia.

STUDY DESIGN

  • Randomized study
  • 66 elderly patients (>60 years of age) with normal renal and liver function undergoing elective surgery of ≥90 minutes were enrolled (2 from each group were dropped after enrollment due to equipment failure or shorter than expected surgery (<90 min)
  • ASA status III-IV
  • Preoperative midazolam (1 mg) was given by IV. Anesthesia was induced with thiopental
    5 mg/kg and fentanyl 2 µg/kg and maintained with sevoflurane in oxygen/nitrous oxide
  • Patients received rocuronium 0.6 mg/kg (2xED95) (n=20), vecuronium 1 mg/kg (2 x ED95) (n=20) and cisatracurium 0.1 mg/kg (2 x ED95) (n=20)
  • Endpoints were duration of action (range, minimum) and median of the variability of action

SUMMARY

  • NIMBEX provides for predictable offset in a variety of patient types, including the elderly1-3
  • Once recovery begins, the rate of recovery is independent of dose2,4,5
  • Time to recovery from successive doses does not change with the number of doses administered as long as partial recovery is allowed to occur between doses2
  • In long surgical procedures during enflurane or isoflurane anesthesia, less frequent maintenance dosing or lower maintenance doses of NIMBEX may be necessary2
  • Repeated administration of maintenance doses of NIMBEX for up to 3 hours are not associated with development of tachyphylaxis or cumulative NMB effects2
  • The more profound the NMB block at the time of reversal, the longer the time required for recovery of neuromuscular function2