Department of Anesthesiology

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Clinical pharmacology of doxacurium chloride. A new long-acting nondepolarizing muscle relaxant.

TitleClinical pharmacology of doxacurium chloride. A new long-acting nondepolarizing muscle relaxant.
Publication TypeJournal Article
Year of Publication1988
AuthorsBasta SJ, Savarese JJ, Ali HH, Embree PB, Schwartz AF, Rudd GD, Wastila WB
JournalAnesthesiology
Volume69
Issue4
Pagination478-86
Date Published1988 Oct
ISSN0003-3022
KeywordsAdolescent, Adult, Blood Pressure, Chemical Phenomena, Chemistry, Dose-Response Relationship, Drug, Female, Heart Rate, Histamine, Humans, Hydrolysis, Isoquinolines, Male, Middle Aged, Muscle Contraction, Neuromuscular Nondepolarizing Agents, Osmolar Concentration, Pancuronium, Time Factors
Abstract

Doxacurium chloride (BW A938U) is a bis-quaternary benzylisoquinolinium diester nondepolarizing neuromuscular blocking compound that is minimally hydrolyzed by human plasma cholinesterase. The effect of bolus doses of doxacurium ranging from 10 to 80 micrograms/kg were studied in 81 consenting ASA physical status I and II patients anesthetized with nitrous oxide-oxygen-fentanyl-thiopental. The neuromuscular and cardiovascular effects of doxacurium were compared with those of eight patients receiving 100 micrograms/kg of pancuronium receiving identical anesthesia. The calculated ED95 for evoked twitch inhibition of the adductor pollicis at 0.15 Hz was 30 micrograms/kg. At 1.3 times the ED95 dose of doxacurium, recovery times to 5% and 25% of control twitch height were 59.2 +/- 4.1 (n = 23 of 26) and 75.7 +/- 5.6 (n = 23 of 26) min respectively. For pancuronium comparable recovery times were 81.7 +/- 10.3 (n = 8 of 8) and 83.0 +/- 8.4 (n = 5 of 8) min. Residual doxacurium blockade was readily antagonized by neostigmine. No dose-related effect on heart rate or mean arterial pressure was seen with doxacurium at doses up to and including 2.7 times the ED95 (80 micrograms/kg). Doxacurium administration did not result in any elevation of plasma histamine at doses up to and including 2.7 times the ED95. In this study doxacurium appears to be a long-acting nondepolarizing relaxant with readily reversible neuromuscular blocking effects and devoid of cardiovascular effects. This profile offers clinical advantages over current long-acting agents and further clinical trials seem appropriate.

Alternate JournalAnesthesiology
PubMed ID2972233