Medicines that relax skeletal muscles are widely used not only during medium and long-term surgical interventions, but also in traumatological practice with the aim of repositioning or prosthetics of the joints. "Pipecuronium bromide" refers to the group of antidepolarizing muscle relaxants and has a maximum duration of action of up to 50-70 minutes, depending on the characteristics of the body. Let's look at the instructions for the use of this drug, as well as the features of its use in anesthetic practice.
Pharmacological characteristics
The mechanism of action of the drug is associated with the blocking of synaptic transmission in the neuromuscular synapse. Due to this, the occurrence of the action potential on the membrane of the muscle fiber is inhibited, and accordingly, the muscle cell loses its ability to contract.
With a conditionally prolonged exposure to the drug “Pipecuronium bromide”, skeletal muscle relaxes. Considering that nicotine-type cholinergic receptors are located not only in the contact area of the efferent fibers of the somatic nervous system with skeletal muscle muscle cells, but also in the ganglia of the autonomic nervous system, a low ganglion blocking effect is caused when large doses of the drug are administered. This is due to the cessation of the transmission of a nerve impulse to the postsynaptic membranes of neurons, which leads to a decrease in both sympathetic and parasympathetic effects.
Indications for use
The drug "Pipecuronium bromide" is indicated for the implementation of the relaxation of skeletal muscles during surgical interventions. The drug is effective for tracheal intubation for mechanical ventilation.
Contraindications
As the instruction for the drug “Pipecuronium Bromide” says, the drug is absolutely contraindicated in the presence of hypersensitivity, as well as in the presence of myasthenia gravis (a rare, genetically caused disease, which is a violation of the excitation in the neuromuscular synapse and the development of muscle weakness).
The drug is contraindicated for use in patients in early pregnancy. In the later stages, the use of the drug is possible, since it penetrates in small quantities through the placental barrier.
Side effects
The drug is able to inhibit the activity of the central nervous system, cause hyperesthesia.
On the part of the cardiovascular system, side effects are due to inhibition of transmission in cholinergic synapses. In this case, a decrease in heart rate, a decrease in blood pressure, ischemic lesions of the myocardium, cerebral disorders associated with a decrease in perfusion are possible.
When exposed to the respiratory system, respiratory function may be suppressed, shortness of breath or apnea may occur (especially during the aftereffect of the drug).
The drug affects the metabolism and can cause an increase in potassium in the blood, an increase in the level of endogenous creatinine and a decrease in plasma glucose levels.
The drug "Pipecuronium bromide" - instructions for use
The drug is used only under the supervision of a specialist. Before administering the drug, it is necessary to verify the presence of anticholinesterase agents (Neostegmine or Pyridostigmine) or anticholinergics (Atropine).
After the manipulations, continuous monitoring of the patient is carried out during the entire recovery period after anesthesia and until the patient's muscle tone is normalized.
The dosage of the drug is carried out on the basis of a comprehensive examination of the patient and analysis of data from laboratory research methods. In the presence of insufficiency of excretory function of the kidneys, functional liver failure, obesity - the dose of the drug must be reduced.
The solution is prepared immediately before the introduction of the drug "Pipecuronium bromide." The release form of the drug is vials with lyophilized powder containing 0.004 g of the active substance.
For patients with impaired electrolyte balance of the blood or acid-base balance, dose adjustment is also necessary. The predominant decrease in the ionic concentration in blood plasma, hypothermia and the use of cardiac glycosides (during digitalization) can lengthen the duration of the drug. In the case of muscle relaxation in such a group of patients, it is initially necessary to normalize the electrolyte blood counts, and then to carry out muscle relaxation. In the case of patients with chronic heart failure, slowing down blood circulation, an extension of the latent period of the drug's action is possible (increase in the time between administration and the onset of the effect).
It is possible to use the drug in children from 1 year. In this case, it must be remembered that the child's body is less sensitive to the effects of muscle relaxant, and accordingly, to achieve the desired effect, the dose of the drug should be increased.
Drug Leave
Even the attending physician cannot write out a prescription for the drug "Pipecuronium bromide" in Latin. The medical institution receives potent substances from list A only upon request and on a state basis. In a particular case, a specialist can write a prescription for Pipecuronium Bromide using the “red” form, but not all hospital networks have the right to sell narcotic and potent substances, including muscle relaxants.
Trade names
In the pharmaceutical market, the drug is available under such trade names as “Arduan”, “Vero-pipecuronium”, “Aperamide”, “Pipecuronium bromide”. The trade name of the drug depends on the manufacturer that supplies the drug to the pharmaceutical market.
Overdose
An overdose of the drug and a decrease in the effect is possible due to the introduction of anticholinesterase agents. These drugs contribute to an increase in the concentration of the acetylcholine mediator, thereby competing with the muscle relaxant for binding sites on the receptor.
Also, therapeutic measures in case of an overdose are aimed at increasing blood pressure, maintaining the vital functions of the body, including through mechanical ventilation.
Drug interactions
The drug should not be mixed with various infusion solutions, with the exception of isotonic solutions of sodium chloride and dextrose. The development of the effect of the drug is slowed down, the effective therapeutic dose is increased provided that cholinesterase inhibitors are introduced into the patient's body before surgery.
With the combined use of muscle relaxant with narcotic analgesics, inhibition of the respiratory center with the development of apnea is possible.
The use of a drug with muscle relaxants of a depolarizing type of action can both enhance and weaken the overall muscle relaxing effect. This circumstance is due to the dosage of drugs, the time of administration and individual sensitivity to drugs.
Conclusion
Muscle relaxation during surgery is an important part of complex anesthesia. The drug "Pipecuronium bromide" has been successfully used in medical practice for these purposes.
It must be remembered that the introduction of the drug not only causes relaxation of the skeletal muscles responsible for voluntary movements, but also causes paralysis of the respiratory muscles. Given this, the drug is used only in surgical and resuscitation departments.