|
|
Sota
Omoigui's
Anesthesia Drug Handbook
3rd Edition:
:
D-tubocurarine Chloride
|
Click here to order |
SECTION
ONE:
Uses, Dosing,
Elimination
SECTION TWO:
Preparation, Pharmacology, Pharmacokinetics
SECTION THREE:
Interactions, Toxicity
Guidelines/Precautions
Principal Adverse Reactions
|
|
|
Uses
skeletal muscle relaxation
Dosing
Intubating: IV 0.3-0.6 mg/kg
Maintenance: IV 0.05-0.3 mg/kg (10-50% of
Intubating Dose) Infusion: 1-6 mcg/kg/min.
Pretreatment/Priming: IV 10% of Intubating Dose given 3-5 minutes prior to Depolarizer/Nondepolarizer relaxant dose
Elimination
renal, hepatic
How supplied
Injection: 3 mg/ml
Storage
Room temperature (15-30 degrees Celsius). Do not permit to freeze.
DILUTION FOR INFUSION 15 mg in 100 mls D5W (0.15 mg/ml)
Pharmacology
D-Tubocurarine is an intermediate acting, nondepolarizing neuromuscular blocking agent. It competes for cholinergic receptors at the motor end plate. The hypotension associated with clinical doses is secondary to autonomic ganglion blockade and release of histamine. Repeated doses may have a cumulative effect.
Pharmacokinetics
ONSET OF ACTION: < 2 minutes
PEAK EFFECT: 2-6 minutes
DURATION OF ACTION: 25-90 minutes
Interactions
effects potentiated by volatile anesthetics, aminoglycoside antibiotics, local anesthetics, diuretics, magnesium, lithium, ganglionic blocking drugs, respiratory acidosis, hypokalemia; enhanced neuromuscular blockade will occur in patients with myasthenia gravis or inadequate adrenocortical function; effects antagonized by anticholinesterase agents such as neostigmine, edrophonium, pyridostigmine; resistance with concomitant use of phenytoin and in patients with burn injury and paresis; pretreatment doses of d-tubocurarine decrease fasciculations but reduce intensity and shorten duration of succinylcholine neuromuscular blockade; priming doses decrease the time to onset of maximal blockade by about 30 -60 seconds; increased resistance or reversal of effects with use of theophylline, and in patients with burn injury and paresis; reduces MAC requirement for volatile anesthetics.
Guidelines
(1) Monitor response with peripheral nerve stimulator to minimize risk of overdose.
(2) Use with caution in patients with history of bronchial asthma and anaphylactoid reactions.
(3) Reverse effects with anticholinesterases such as neostigmine, edrophonium or pyridostigmine bromide in conjunction with atropine or glycopyrrolate.
(4) Pretreatment doses may induce a degree of neuromuscular blockade sufficient to cause hypoventilation in some patients.
Principal Adverse Reactions
CVS: hypotension, vasodilation, sinus tachycardia, sinus bradycardia
PULM: hypoventilation, apnea, bronchospasm, laryngospasm, dyspnea.
MUSCULOSKELETAL: inadequate block, prolonged block
DERM: rash, urticaria
Reactions
|
|
|
Address:
4019 W. Rosecrans Ave., Hawthorne, CA 90250-7913
Toll-Free: (800) 9-MEDIC-9, Phone: (310) 675-9121,
Fax: 310 675-7989, E-mail: medicinechief@aol.com
NOTICE:
Every effort has been made to ensure that the drug dosage schedules
herein are accurate and in accord with the standards accepted
at the time of publication. As new research and experience broaden
our knowledge, changes in treatment and drug therapy occur. The
medications described do not necessarily have specific approval
by the Food and Drug Administration for use in the situations
and the dosages for which they are recommended. This information
is advisory only. The package insert should be consulted for use
and dosage as approved by the FDA, for any changes in indications
and dosages and for added warnings and precautions. The ultimate
responsibility lies with the prescribing physician.
No part of this information may be reproduced or transmitted electronically
in any information storage or retrieval system, or within any
monitoring system without prior permission in writing from S.O.T.A.
Technologies (Electronic Publishers).
The Universal Drug Infusion Slide Ruler (patent pending) is now
available. It incorporates an infusion data guide and enables
infusion calculations for any drug at any dose and at any concentration.
It may be obtained by calling S.O.T.A Technologies (800 9-MEDIC-9)
|
 |
COMPOUNDED
TOPICAL MEDICATIONS MAY BE ORDERED (BY PRESCRIPTION ONLY) FROM L.A.
PAIN CLINIC. CALL 310 675-9121 or 1 800 9-MEDIC-9. |
Copyright 2000. Sota Omoigui, M.D. All rights reserved.
|
