Ex4 NMBA 2 Flashcards
long acting NDMR
pancuronium
pancuronium ED95
0.07 mg/kg
pancuronium intubating dose
0.1mg/kg
pancuronium onset
slow
3-5minutes
pancuronium DOA
long
60-90min
DOA pancuronium will be prolonged with
renal dz
cirrhosis
biliary obstruction
aging
Pancuronium metabolism
Renal elimination: 80% unchanged in urine Hepatic deacetylation (10-40%) *3-desacetylpancuronium =50% as potent
Pancuronium - CV effects
Increased HR, MAP, CO, myocardial O2 consumption
- more profound increases w/ AV conduction abnormalities
- avoid in CAD pts (ischemia)
Pancuronium CV effects are due to
antagonism of cardiac mAChRs (SA node)
Pancuronium structure
bisquaternary aminosteroid
priming dose - intmd NMDR
hastens speed of onset
20% ED95 prior to induction
after induction: remaining balance adm
why is a priming dose used?
onset of intubating conditions is faster
defasciculating dose
20% of ED95 of NDMR prior to induction
** larger dose of Sux required
intermediate acting NDMRs
Vecuronium
Rocuronium
Atracurium
Cisatracurium
Vecuronium bromide structure
monoquaternary aminosteroid
Vecuronium ED95
0.05 mg/kg
Vecuronium intubating dose
0.1 mg/kg
Vecuronium onset
3-5 minutes
Vecuronium DOA
20-35min
Vecuronium elimination
renal + hepatic
vecuronium metabolism
deacetylation to 3-desacetylvecuronium (50-70%) as potent as vec
rocuronium structure
monoquaternary aminosteroid
rocuronium intubating:
dose
onset
DOA
0.6 mg/kg
1-2minute onset
20-35minute DOA
rocuronium RSI:
dose
onset
DOA
1.2 mg/kg
30-45s onset
60-90minute DOA
rocuronium metabolism
excreted
-unchanged in bile
-renally (30%)
liver/renal dz can prolong effects
rocuronium side effects
no CV effects
no histamine release
atracurium structure
bisquaternary benzylisoquinolinium
mix of 10 stereoisomers in solution
atracurium ED95
0.2 mg/kg
atracurium intubating dose
0.5mg/kg
atracurium onset
3-5min
atracurium DOA
20-35min
atracurium elimination
Cleared by:
Hofmann Elimination + hydrolysis by non-specific esterases
atracurium metabolism
laudanosine produced = CNS stimulant
-increases MAC, epileptogenic, cleared renally
atracurium rapid admin of 2xED95 results in
increased HR
decreased BP
atracurium rapid admin of 3xED95 results in
facial/truncal flushing (histamine release)
atracurium pediatric considerations
infants 1-6months = decrease dose 50% for same effect as full dose in adults
–recovery more rapid in infants
atracurium elderly considerations
no change in pharmacokinetics
cisatracurium bromide structure
benzylisoquinolinium
purified form of one of 10 stereoisomers of atracurium
cisatracurium ED95
0.04 mg/kg
cisatracurium onset
3-5min
cisatracurium DOA
20-35min
cisatracurium elimination
Hoffman –> laudanosine
*NO metabolism by nonspecific esterases
cisatracurium is similar to which other NMDA?
atracurium
*except slower onset, no histamine release
cisatracurium may be given to?
pts w/ renal/hepatic dz w/o prolonged effect
Which two NMDAs are indistinguishable regarding CV effects in CAD
cis + vec
