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• W2019836568 abstract "Cuantificar las variaciones del sodio, potasio, calcio, magnesio, cloro, osmolaridad y pH en el intraoperatorio y valorar su influencia sobre el bloqueo neuromuscular (atracurio y vecuronio) durante anestesia inhalatoria o intravenosa. Estudio prospectivo aleatorizado. Se incluyeron 119 pacientes ASA I-III. El 52,1% recibieron atracurio (atracurio e isoflurano, 26,8%, atracurio y propofol, 25,2%) y 47,9% vecuronio (vecuronio e isoflurano, 23,5%, vecuronio y propofol, 24,3%) respectivamente. El BNM se objetivó mediante electromiografía del músculo adductor pollicis con estimulación del nervio cubital. Se extrajeron dos muestras venosas, determinando BUN (nitrógeno ureico en sangre), creatinina, glucosa, iones (sodio, cloro, potasio, calcio y magnesio) la osmolaridad y una gasometría arterial. La primera muestra se obtuvo al canalizar la vía y la segunda coincidiendo con recuperación del BNM correspondiente a la duración de acción del 25%. Atracurio o vecuronio, a dosis equipotentes presentan un inicio de acción, duración y recuperación similares. Durante la cirugía existe una tendencia al aumento de los niveles plasmáticos de cloro y glucosa, y a la disminución de los de sodio, potasio, magnesio y de la osmolaridad plasmática efectiva y total, siendo la fluidoterapia intraoperatoria responsable, al menos en parte, de ello. La hipocalcemia, la hipomagnesemia y la alcalosis prolongan al menos algunas fases de la recuperación del atracurio, mientras que la hiponatremia lo acorta y las variaciones de la cloremia ejercen un efecto errático. Para el vecuronio, la hipercloremia, la hipocalcemia y sobre todo la hiponatremia, acortan algunas fases del bloqueo, mientras que la alcalosis prolonga su duración. las variaciones hidroelectrolíticas y del pH derivadas de una fluidoterapia estándar son moderadas, bien toleradas y no producen una repercusión acentuada sobre el bloqueo neuromuscular. To determine changes in sodium, potassium, calcium, magnesium and chloride ion concentrations in blood, osmolarity, and pH during surgery, and to assess the influence of such changes on atracurium- or vecuronium-induced neuromuscular blockade under inhaled or intravenous anesthesia. Prospective study randomizing 119 ASA 1–2 patients; 52.1% of the patients received atracurium (26.8%, with isoflurane; 25.2%, with propofol) and 47.9% received vecuronium (23.5%, with isoflurane; 24.3%, with propofol). The neuromuscular blockade was confirmed by electromyography of the adductor pollicis muscle (stimuli delivered to the cubital nerve). Two venous blood samples were extracted to measure ureic nitrogen, creatinine, glucose, ion concentrations (sodium, chloride, potassium, calcium, and magnesium), and osmolarity. Arterial blood gases and pH were also assessed. The first blood sample was extracted on inserting the venous catheter and the second on recovery of 25% of the first train-of-four twitch. The onset and duration of action for equipotent doses of atracurium and vecuronium were similar. Likewise, recovery was also similar. Plasma chloride ion and glucose levels tended to rise during surgery, while sodium, potassium and magnesium ion concentrations fell. Both total and effective plasma osmolarities also decreased. Fluid replacement therapy during surgery was at least partly responsible for these changes. Low calcium and magnesium concentrations and alkalosis prolonged some phases of atracuriumrecovery, while low sodium levels shortened the duration of some atracurium-induced blockade recovery phases. The effect of changes in chloride ion concentrations on recovery was variable. High chloride, low calcium, and especially low sodium ion concentrations shortened some phases of the vecuronium-induced blockade, while alkalosis prolonged its duration. Changes in electrolyte concentrations and pH as a result of standard fluid replacement therapy are moderate, well tolerated, and do not exercise a strong effect on the behavior of the neuromuscular blockade." @default.
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• W2019836568 title "Efecto de las variaciones iónicas, la osmolaridad y el pH sobre la recuperación del bloqueo neuromuscular no despolarizante por atracurio y vecuronio" @default.
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• W2019836568 doi "https://doi.org/10.1016/s0034-9356(09)70420-7" @default.
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