Drugs that relax skeletal muscles are widely used not only for medium and long-term surgical interventions, but also in trauma practice for the purpose of repositioning or prosthetic joints. "Pipecuronium bromide" belongs 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 organism. Let's look at the instructions for using this drug, as well as the features of its use in anesthesia 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 an action potential on the membrane of the muscle fiber is inhibited, and accordingly, the muscle cell loses its ability to contract.
With conditionally long-term exposure to the drug"Pipecuronium bromide" skeletal muscles relax. Considering that cholinergic nicotinic receptors are located not only in the area of contact of the efferent fibers of the somatic nervous system with muscle cells of the skeletal muscles, but also in the ganglia of the autonomic nervous system, when large doses of the drug are administered, a weak ganglioblocking effect is caused. This is due to the termination of the transmission of the 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 relaxation of skeletal muscles during surgical interventions. The drug is effective for tracheal intubation for the purpose of artificial ventilation of the lungs.
Contraindications
As the instruction says to the drug "Pipecuronium bromide", the drug is absolutely contraindicated in the presence of hypersensitivity, as well as in the presence of myasthenia gravis (a rare, genetically determined disease, which consists in a violation of the conduction of 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 the placental barrier in small quantities.
Side effects
The drug is capable of inhibiting the activity of the central nervous system,cause hyperesthesia phenomena.
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 myocardial damage, and cerebral disorders associated with a decrease in perfusion are possible.
When exposed to the respiratory system, respiratory depression, dyspnea or apnea may occur (especially during the aftereffect of the drug).
The drug affects metabolism and can cause an increase in blood potassium levels, an increase in endogenous creatinine levels and a decrease in plasma glucose levels.
Drug "Pipecuronium bromide" - instructions for use
The drug is used only under the supervision of a specialist. Before the introduction of the drug, it is necessary to make sure that there are anticholinesterase drugs ("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 normalizes.
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 the excretory function of the kidneys, functional insufficiency of the liver, obesity - the dose of the drug must be reduced.
The solution is prepared directlybefore the introduction of the drug "Pipecuronium bromide". The release form of the medicinal product is vials with lyophilized powder containing 0.004 g of the active substance.
For patients with electrolyte imbalance or acid-base imbalance, dose adjustment is also necessary. The predominant decrease in the ionic concentration in the blood plasma, hypothermia and the use of cardiac glycosides (during digitalization) can lengthen the time of action of the drug. In the case of muscle relaxation in such a group of patients, it is initially necessary to normalize blood electrolyte parameters, and then muscle relaxation should be performed. If patients have chronic heart failure, slowing blood circulation, it is possible to lengthen the latent period of the drug (an increase in the time between administration and the onset of the effect).
It is possible to use the drug in children from 1 year old. In this case, it must be remembered that the child's body is less sensitive to the effects of a muscle relaxant, and accordingly, to achieve the desired effect, the dose of the drug should be increased.
Drug dispensing
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 on demand and on a government basis. In a separate case, a specialist can write a prescription for "Pipecuronium bromide" using the "red" form,however, not all hospital networks have the right to sell narcotic and potent substances, including muscle relaxants.
Trade names
On the pharmaceutical market, the drug is available under trade names such 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 increase 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 artificial ventilation of the lungs.
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 slows down, the effective therapeutic dose increases under the condition of preoperative administration of cholinesterase inhibitors into the patient's body.
When a muscle relaxant is used together with narcotic analgesics, respiratory center depression with the development of apnea is possible.
Applicationdrugs with muscle relaxants of the depolarizing type of action can both enhance and weaken the overall muscle relaxant effect. This circumstance is due to the dosage of drugs, the time of administration and individual sensitivity to drugs.
Conclusion
Miorelaxation during surgical interventions is an important part of complex anesthesia. The drug "Pipecuronium bromide" is successfully used in medical practice for these purposes.
It must be remembered that the administration 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 the conditions of surgical and intensive care units.
