Jaganathan, S (2011) Effects of Intravenous Ephedrine on Onset Time and Intubating Conditions of Rocuronium Bromide. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: The introduction of d-tubocurarine - a neuromuscular blocking drug, by Griffith and Johnson1 in 1942 revolutionized clinical anaesthesia. The use of muscle relaxants became a vitally important aspect of modern anaesthesia practice. In 1967, Baird and Reid first reported on the clinical administration of the synthetic amino steroid pancuronium. Development of the intermediate acting neuromuscular blockers was built on compound metabolism and resulted in the introduction of vecuronium, an aminosteroid,and atracurium, a benzylisoquinolium, in the 1980s. The lack of cardiovascular effects of vecuronium and degradation of atracurium by Hoffmann elimination, reduced the effects of biologic disorders such as advanced age or organ failure on the pattern of neuromuscular blockade. Despite the above mentioned neuromuscular blocking drugs, succinylcholine still remains the favorite for achieving rapid, evanescent relaxation despite its dangers of triggering malignant hyperthermia, producing hyperkalemia in susceptible patients, raising intra ocular pressure, raising intra cranial pressure and muscle pains in many. Although succinylcholine is a reliable agent due to its rapid onset, its numerous side effects led to the search of newer muscle relaxants with a similar onset of action. The technique of administering established non depolarizing muscle relaxants has been variously modified in an attempt to reduce its onset time. Rocuronium is the first non-depolarizing relaxant considered to be an acceptable substitute for succinylcholine in facilitating rapid tracheal intubation. Ephedrine is a sympathomimetic drug which acts on alpha1 and beta receptors. It acts as agonist at these receptors and increases cardiac output and muscle blood flow. It increases the oxygen consumption of tissues but cardiac output is also increased to meet the demand. The onset time of muscle relaxants is partly determined by the speed with which these drugs reach the neuromuscular junction. This concept is used in the present study in which the effect of Intravenous Ephedrine on the onset time and Intubating conditions of Rocuronium bromide was studied. AIM OF THE STUDY: To compare the Effect of intravenous “Ephedrine” on the onset of action of Rocuronium and intubating conditions with a “placebo”. MATERIALS AND METHODS It was a prospective, Randomized, Double blinded(subject), Case control study conducted in the Institute of Anaesthesiology and Critical Care, Madras medical college and Government General Hospital, Chennai Inclusion Criteria: 1. Males And Females. 2. ASA Physical Status 1,2,3. 3. Age 15 Years and Older. 4. Elective Patients Given General Anesthesia. 5. Patient Who Had Given Informed Consent. Exclusion Criteria: 1. Not Satisfying Inclusion Criteria. 2. Emergency Surgeries Under GA. 3. Patients With Neuromuscular Disorders, Cardiovascular Disease. 4. Hepatic or Renal Disease 5. Patients with Difficult Airway. 6. Intake of Drugs Known to Interact with Meuromuscular Junction or Ephedrine. 7. Increased Risk Of Pulmonary Aspiration. MATERIALS: 1. Injection Ephedrine 70 Microgram/Kg. 2. Drugs – Fentanyl, Glycopyrrolate, Thiopentone, Xylocard, Rocuro Nium Bromide, Normal Saline, Emergency Drugs. 3. Macintosh Laryngoscope with 3, 4 Blades. 4. Endotracheal Tubes of Various Sizes. 5. Monitors‐ ECG, NIBP, SPO2, Neuromuscular Monitor. OBSERVATION AND RESULT: This prospective, randomized, single blind (subject), case controlled study compared the Effects of intravenous Ephedrine on the onset time of rocuronium bromide and intubating conditions measured by haemodynamic alterations and pogo score. Primary Outcome Measures: 1. Onset Time of Rocuronium After Test Drug And Placebo. Secondary Outcome Measures: Intubating Conditions Using : 1. Hemodynamic Variables, 2. Pogo Score and Cormack and Lehane Grading All Data were Collected and Tabulated. Demographic Variables: 60 patients were randomly selected and included in this study. Thirty patients were randomly assigned to receive PLACEBO of 5ml. saline (Group A) and thirty patients received the test drug of 70 microgram/kg EPHEDRINE (Group B). Mean age, sex distribution and weight of the patients in both the group were compared and there was no significant difference between the groups. SUMMARY: In our study, the effect of intravenous “Ephedrine” on the onset time and intubating conditions of rocuronium bromide was compared with “Placebo”. All the patients in Ephedrine group were pretreated with ephedrine 70microgram/kg prior to induction and rocuronium 0.6mg/kg was given . All the patients in “Placebo” group were given 5ml Saline prior to induction. Onset of action is determined by abolition T1 in TOF and absence of single twitch stimulation in Neuro muscular monitor. The onset of action of Rocuronium was significantly shorter in “Ephedrine”group when compared to “Placebo” group. Ephedrine group provided better intubating conditions when compared with Placebo group. There was no clinically significant difference between the two groups with respect to heart rate and blood pressure changes.There was no significant incidence of adverse effects in both groups. CONCLUSION: It may be concluded from this study that “Ephedrine given at the dose of 70microgram/kg significantly shortens the onset time of Rocuronium bromide and provides better intubating conditions with minimal haemodynamic changes”.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Effects ; Intravenous Ephedrine ; Onset Time ; Intubating Conditions ; Rocuronium Bromide. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 09:03 |
| Last Modified: | 22 Apr 2018 09:03 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7208 |
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