Atracurium administration, as an infusion, to induce neuromuscular blockade in clinically normal and temporarily immune-suppressed cats

J.E. Ilkiw From the Department of Surgery, School of Veterinary Medicine, University of California, Davis, CA 95616.

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S.F. Forsyth From the Department of Surgery, School of Veterinary Medicine, University of California, Davis, CA 95616.

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T. Hill From the Department of Surgery, School of Veterinary Medicine, University of California, Davis, CA 95616.

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C.R. Gregory From the Department of Surgery, School of Veterinary Medicine, University of California, Davis, CA 95616.

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Summary

Atracurium besylate, a nondepolarizing neuromuscular blocking agent, was administered by infusion to 10 cats that were anesthetized with isoflurane and oxygen to allow transplantation of a myocutaneous flap. Five of the cats were given cyclosporine (20 mg/kg of body weight, po, q 12 h in divided doses) for 2 days prior to anesthesia, and prednisolone (0.25 mg/kg, po) on the morning of surgery. The other 5 cats were not given either drug. Neuromuscular blockade was assessed, using the train-of-four stimulation, and throughout surgery, the infusion rate was adjusted to maintain the first-twitch response (T1) at 90 to 95% depression from baseline. At completion of surgery, atracurium was discontinued, and the infusion rate and the time for recovery (the time for the train-of-four ratio to increase from 50 to 75%) were recorded. Once the train-of-four ratio had been stable for 10 minutes, edrophonium (0.5 mg/kg), a cholinesterase inhibitor, was administered iv, and neuromuscular blockade was monitored for another 10 minutes.

Mean (±sd) duration of the atracurium infusion was 302.1 ± 70.5 minutes for the control group and was 323.9 ± 61.7 minutes for the cats given cyclosporine and prednisolone. In the cats of the control group, the infusion rate required to induce 90 to 95% T1 depression from baseline was 3.7 ± 0.7 μg/kg/min. This rate was not significantly different from that of 2.8 ± 1.2 μg/kg/min in cats given cyclosporine and prednisolone. Significant difference in recovery time was not evident between the control group and the treated group (6.4 ± 4.5 minutes vs 6.2 ± 2.5 minutes).

In this study, administration of atracurium by continuous infusion proved to be a suitable method of obtaining neuromuscular blockade for a prolonged period. Administration of cyclosporine and prednisolone did not affect the infusion rate of atracurium required to depress the first twitch by 90 to 95% and did not affect return of neuromuscular function.

Summary

Atracurium besylate, a nondepolarizing neuromuscular blocking agent, was administered by infusion to 10 cats that were anesthetized with isoflurane and oxygen to allow transplantation of a myocutaneous flap. Five of the cats were given cyclosporine (20 mg/kg of body weight, po, q 12 h in divided doses) for 2 days prior to anesthesia, and prednisolone (0.25 mg/kg, po) on the morning of surgery. The other 5 cats were not given either drug. Neuromuscular blockade was assessed, using the train-of-four stimulation, and throughout surgery, the infusion rate was adjusted to maintain the first-twitch response (T1) at 90 to 95% depression from baseline. At completion of surgery, atracurium was discontinued, and the infusion rate and the time for recovery (the time for the train-of-four ratio to increase from 50 to 75%) were recorded. Once the train-of-four ratio had been stable for 10 minutes, edrophonium (0.5 mg/kg), a cholinesterase inhibitor, was administered iv, and neuromuscular blockade was monitored for another 10 minutes.

Mean (±sd) duration of the atracurium infusion was 302.1 ± 70.5 minutes for the control group and was 323.9 ± 61.7 minutes for the cats given cyclosporine and prednisolone. In the cats of the control group, the infusion rate required to induce 90 to 95% T1 depression from baseline was 3.7 ± 0.7 μg/kg/min. This rate was not significantly different from that of 2.8 ± 1.2 μg/kg/min in cats given cyclosporine and prednisolone. Significant difference in recovery time was not evident between the control group and the treated group (6.4 ± 4.5 minutes vs 6.2 ± 2.5 minutes).

In this study, administration of atracurium by continuous infusion proved to be a suitable method of obtaining neuromuscular blockade for a prolonged period. Administration of cyclosporine and prednisolone did not affect the infusion rate of atracurium required to depress the first twitch by 90 to 95% and did not affect return of neuromuscular function.

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