Walid AA ABDELTAWABL, Mohamed E. ABDELRAHİM, Amira SA SAİD, Ahmed ABDELAAL, Ahmed MAHMOUD, Mahmoud Ateya NASSEF

The Effect of Gentamicin on the Action of Atracurium in Adult Patients

The aim of the trial was to study the effect of Gentamicin as an aminoglycoside on Atracurium as a neuromuscular blocker. Forty patients (20-60 years old) who had minor surgical procedures were enrolled in the study. All the patients were with the American Society of Anaesthesiologists (ASA) physical status I-II with elective surgery in supine position. Patients were represented to full history, clinical examination and laboratory tests at Beni suef University Hospital to be sure that they met the criteria. Patients were divided into two equal groups. Group I (atracurium-gentamicin) and Group II (atracurium alone). Group I received gentamicin at dose of 2 mg/kg 5 minutes before starting the general anesthesia. The degree of muscle relaxation was monitored by using peripheral nerve stimulator with recording of Train of Four (TOF) ratio every 10 minutes, clinical duration (p=0.89), onset time (p=0.76), time to spontaneous recovery T4/T1 ratio(0.84) and occurrence of recurrence of the neuromuscular blockade were assessed. At the end of anesthesia it was noticed that there was no significant difference according to onset time, clinical duration or time to spontaneous recovery. Hence, there was no effect of using gentamicin preoperatively on the action of the atracurium

PDF

___

1. Cheng EY, Nimphius N, Hennen CR. Antibiotic therapy and the anesthesiologist. J Clin Anesth. 1995; 7(5): 425-39.

2. Sokoll MD, Gergis SD. Antibiotics and neuromuscular function. Anesthesiology. 1981;55(2):148-59.

3. 3. Ahdal O, Bevan DR. Clindamycin-induced neuromuscular blockade. Can J Anaesth. 1995;42:614.

4. Lee C, de Silva AJC. Acute and subchronic neuromuscular blocking characteristics of streptomycin. A comparison with neomycin. Br J Anaesth. 1979;51:431.

5. Singh YN, Harvey AL, Marshall IG. Antibiotic-induced paralysis of the mouse phrenic nerve–hemidiaphragm preparation and reversibility by calcium and by neostigmine. Anesthesiology. 1978;48(6):418.

6. Singh YN, Marshall IG, Harvey AL. Depression of transmitter release and postjunctional sensitivity during neuromuscular block produced by antibiotics. Br J Anaesth. 1979;51:1027.

7. Stenlake JB. Ions-cyclic nucleotids-cholinergy. In: Stoclet JC, ed. Advances in pharmacology and therapeutics.New York:Pergamon Pres.1979:303.

8. Hasfurther DL, Bailey PL. Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin. Can J Anaesth. 1996;43:617.

9. Martinez EA, Mealey KL, Woolridge AA. Pharmacokinetics, effects on renal function,and potentiation of atracurium-induced neuromuscular blockade after administration of a high dose of gentamicin in isoflurane-anesthetized dogs. Am J Vet Res. 1996;57:1623.

10. Torda T. The nature of gentamicin-induced neuromuscular block. BrJ Anaesth. 1980;52:325-9.

11. Stoelting RK. Pharmacology and physiology in anesthetic practice. JB, Lippincott, Philadelphia,1987;205.

12. Fogdall RP, Miller RD. Prolongation of a pancuronium induced neuromuscular blockade by clindamycin. Anesthesiology. 1974;41:407-9.

13. Jedeikin R, Dolgunski E, Kaplan R, Hoffman S. Prolongation of neuromuscular blocking effect of vecuronium by antibiotics. Anaesthesia. 1987;42:858-60.

14. de Gouw NE, Crul JF, Vandermeersch E, Muller JP, van Egmond J, Van Aken H. Interaction of antibiotics on pipecuronium-induced neuromuscular blockade. J Clin Anesth. 1993;5(3):212-5.

15. Pittinger CB, Eryasa Y, Adamson R. Antibiotic induced paralysis. Anesth Analg. 1970;49(3):487-501.

16. Potter JM, Edeson RO, Campbell RJ, Forbes AM. Potentiation by gentamicin of nondepolarizing neuromuscular block in the cat. Anaesth Intensive Care. 1980;8(1):20-5.

17. Chinyanga HM, Stoyka WW. The effect of colymycin M, gentamycin and kanamycin on depression of neuromuscular transmission induced by pancuronium bromide. Can Anaesth Soc J. 1974;21(6):569-79.

18. Dotan ZA, Hana R, Simon D, Geva D, Pfeffermann RA, Ezri T. The effect of vecuronium is enhanced by a large rather than a modest dose of gentamicin as compared with no preoperative gentamicin. Anesth Analg. 2003;96(3):750-4.

19. Singh YN, Marshall IG, Harvey AL. Pre- and postjunctional effects of aminoglycoside, polymyxin, tetracycline and lincosamide antibiotics. Br J Anaesth. 1982;54(12):1295- 306.

20. Lee C, Zhang X, Kwan WF. Electromyographic and mechanomyographic characteristics of neuromuscular block by magnesium sulphate in the pig. Br J Anaesth 1996;76(2):278-83.

21. Sokoll MD, Gergis SD, Mehta M, Ali NM, Lineberry C. Safety and efficacy of atracurium (BW33A) in surgical patients receiving balanced or isoflurane anesthesia. Anesthesiology. 1983;58(5):450-5.

22. Hughes R, Chapple DJ. The pharmacology of atracurium; a new competitive neuromuscular blocking agent. Br J Anaesth. 1981;53:31-43.

23. Ali HH. Savarese JJ. Monitoring of neuromuscular function. Anesthesiology. 1976;45(2):216-49.

24. Emery ERJ. The influen ce of drugs used in therapeutics on the action of muscle relaxants. Br J Anaesth. 1963;35:565-9.

25. Argov Z, Mastagtia FL. Disorders of neuromuscular transmission caused by drugs. N Engl J Med. 1979;301(8):409-13.

26. Miller RD. Factors affecting the action of muscle relaxants. In: Muscle relaxants. Edited by Katz RL, Excerpta Medica, Amsterdam,1975;165-93.

27. Lippmann M. Yang E, Au E, Lee C. Neuromuscular block- ing effects of tobramycin, gentamicin, and cefazolin. Anesth Analg. 1982;61(9):767-70.

28. Dupuis JY, Martin R, Tetrault JP. Atracurium and vecuronium interactiong with gentamicin and tobramycin. Can J Anaesth. 1989;36:407-11.