Rapacuronium

The rate of non-lgE-mediated immediate hypersensitivity reactions usually varies between 20 and 50% [1-7, 9], They are assumed to result from direct non-specific mast cell and basophil activation, which causes direct histamine release [19], Histamine release is predominantly found with the use of the benzylisoquinoUnes d-tubocurarine, atracurium and mivacurium, and the aminosteroid rapacuronium. Severe bronchospasm related to rapacuronium administration has been reported in children and adults. It might be related to the higher affinity of rapacuronium for M2 versus M3 muscarinic receptors [20]. Rapacuronium has been withdrawn from the market in the USA. 

Jooste E, Klafter F, Hirshman CA, Emala CW A 31 mechanism for rapacuronium-induced bronchos-pasm M2 muscarinic receptor antagonism Anesthesiology 2003 98 906. 

Stuth, E.A.E., Stucke, A.G. and Setlock, M.A. (2002) Another possible mechanism for bronchospasm after rapacuronium. Anesthesiology, 96, 1528-1529. 

Rapacuronium bromide Raplon Organon Anesthetic, muscle relaxant 9/19/1999 3/30/2001 7 months Bronchospasm 23 million... 

Nondepolarizing Blockers d-Tdbocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium, and Rapacuronium... 

L C. Rapacuronium is a skeletal muscle relaxant that works by competing with ACh for receptors at the postjunctional membrane. Nicotine and succinylcholine also act at the end plate receptors but cause depolarization. Hexamethonium is a ganglion blocker that has essentially no activity at the end plate receptors, and scopolamine blocks cholinergic muscarinic receptors and thus does not act at the end plate receptors. 

A very short-acting steroidal nondepolarizing agent (rapacuronium) was briefly introduced in the 1990s for rapid-sequence intubation and induction of anesthesia. It was withdrawn by the manufacturer because of concerns about life-threatening airway... 

A major adverse effect of rapacuronium is an increase in heart rate (3). Plasma histamine concentrations may increase after rapacuronium injection, but this was not correlated with changes in blood pressure or heart rate (4). 

Rapacuronium plasma clearance was reduced in patients with renal insufficiency, but this did not result in an increased duration of action (9). 

Although not completely understood, hepatic uptake is assumed to be the reason for the short duration of action of rapacuronium. However, neither recovery time nor drug half-Ufe after a single bolus of rapacuronium was prolonged in patients with liver cirrhosis compared with healthy controls (10). 

Sparr HJ, Mellinghoff H, Blobner M, Noldge-Schomburg G. Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients. Br J Anaesth 1999 82(4) 537-41. 

Levy JH, Pitts M, Thanopoulos A, Szlam F, Bastian R, Kim J. The effects of rapacuronium on histamine release and hemodynamics in adult patients undergoing general anesthesia. Anesth Analg 1999 89(2) 290-5. 

Tobias JD, Johnson JO, Sprague K, Johnson G. Effects of rapacuronium on respiratory function during general anesthesia a comparison with cis-atracurium. Anesthesiology 2001 95(4) 908-12. 

Abouleish El, Abboud TK, Bikhazi G, Kenaan CA, Mroz L, Zhu J, Lee J, Abboud TS. Rapacuronium for modified rapid sequence induction in elective caesarean section neuromuscular blocking effects and safety compared with succinylcholine, and placental transfer. Br J Anaesth 1999 83(6) 862-7. 

Szenohradszky J, Caldwell JE, Wright PM, Brown R, Lau M, Luks AM, Fisher DM. Influence of renal failure on the pharmacokinetics and neuromuscular effects of a single dose of rapacuronium bromide. Anesthesiology 1999 90(l) 24-35. 

Duvaldestin P, Slavov V, Rebufat Y. Pharmacokinetics and pharmacodynamics of rapacuronium in patients with cirrhosis. Anesthesiology 1999 91(5) 1305-10. 

Prolongation of rapacuronium-induced neuromuscular blockade by sevoflurane has been studied in a... 

Cara DM, Armory P, Mahajan RP. Prolonged duration of neuromuscular block with rapacuronium in the presence of sevoflurane. Anesth Analg 2000 91(6) 1392-3. 

Clinically important, potentially hazardous interactions with cisatracurium, doxacurium, mivacurium, pancuronium, rapacuronium... 

Clinically important, potentially hazardous interactions with aminophylline, atracurium, cisatracurium, doxacurium, epinephrine, ergometrine, mivacurium, non-depolarizing muscle relaxants, oxprenolol, oxytocin, pancuronium, rapacuronium, rifampin, vecuronium, xanthines... 

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