Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The adverse reactions seen following administration of neuromuscular blocking agents are mainly cardiovascular. Due to the lack of specificity for the nicotinic receptor at the neuromuscular junction, these agents may interact with receptors in autonomic ganglia and muscarinic receptors in the heart. Furthermore, muscle relaxants may have histamine-releasing properties. The cardiovascular effects vary with potency and specificity of the drug, depending mainly on the chemical structure. Pancuronium, fazadinium and especially gallamonium block cardiac muscarinic receptors, and tachycardia may be seen. Atracurium, metocurine and in particular d-tubocurarine have histamine-releasing properties and may cause flushing, hypotension and tachycardia. Vecuronium has no effect on the cardiovascular system. The effect of succinylcholine on heart rate differs between children, where bradycardia is seen, and adults in whom tachycardia may follow. However, bradycardia may occur in adults following a single dose. Succinylcholine increases plasma potassium, especially in patients with nerve damage, and arrhythmias may be observed. The neuromuscular adverse effects of succinylcholine, such as fasciculations and increased gastric and intraocular pressure, may be prevented by precurarisation. Many drugs interact with neuromuscular blocking agents and there is often a potentiation of the neuromuscular effect. This is of clinical importance in the case of antibiotics, inhalational anaesthetics, lithium and cyclosporin. Difficulty in reversing the block may occur with calcium channel blockers and polymyxin. However, some drugs, such as phenytoin, carbamazepine and lithium, may cause resistance to neuromuscular blocking agents. Furthermore, clinically important interactions exist between individual neuromuscular blocking drugs. Precurarisation with a non-depolarising drug prolongs the onset of succinylcholine, and conversely a prolonged effect of non-depolarising drugs is seen following succinylcholine. The effect of succinylcholine is markedly prolonged if the drug is administered during recovery from pancuronium blockade or following neostigmine for reversal. Succinylcholine is hydrolysed by plasma cholinesterase, and drugs which decrease the activity of this enzyme may produce a prolonged block, i.e. contraceptive pills, cyclophosphamide, echothiopate and organophosphate.
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PMID:Adverse reactions and interactions of the neuromuscular blocking drugs. 268 31

Atracurium was administered by a variety of techniques to determine whether these influence the onset or duration of muscular relaxation, and the frequency of cutaneous reactions, after a standard induction dose of thiopentone. One-hundred-and-fifty patients were allocated randomly to receive the drug by one of five methods: into a fast-flowing crystalloid infusion in the antecubital fossa; into a winged needle in the antecubital fossa with flushing after the thiopentone; into a winged needle in the antecubital fossa without flushing; into a winged needle in the dorsum of the hand without flushing. The above groups received atracurium freshly removed from the refrigerator whereas the fifth group were given atracurium which had been maintained at room temperature for at least 2 weeks. The frequency of cutaneous reactions was between 60 and 70% overall and there were no significant differences either in this or in the onset or duration of action between the groups. A further 25 patients with a history of drug allergy were also investigated by the first method and showed no significant differences in response, but 25 patients aged over 70 years had a significantly lower frequency of cutaneous reactions with a higher frequency of hypotension than the other groups.
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PMID:Factors that influence cutaneous reactions following administration of thiopentone and atracurium. 297 55

Atracurium has been reported to have minimal haemodynamic effects in healthy patients. The purpose of this study was to determine its effects in patients with coronary artery disease. Sixteen patients scheduled for elective coronary artery surgery were studied in two equal groups. Group 1 received a bolus injection of atracurium 0.3 mgkg-1 and group 2 0.4 mgkg-1. Under local anaesthesia, radial artery, pulmonary artery thermodilution and central venous catheters were placed and the appropriate vascular pressures continuously monitored, as were leads II and V5 of the electrocardiogram. Sleep was induced with lorazepam and fentanyl while the patients were breathing nitrous oxide in oxygen (50:50). Control measurements of arterial pressure (AP) (mean, systolic, diastolic), CO (thermodilution), CVP, PA, PCW and HR were obtained. Atracurium was administered as a bolus and measurements repeated at 2, 5, and 10 min. In group 1 mean and diastolic arterial pressure decreased significantly at 2 min (73 +/- 2 to 66 +/- 3 mm Hg, P less than 0.05; 58 +/- 3 to 51 +/- 2 mm Hg, P less than 0.05). The changes were not significant at 5 or 10 min. There were no significant changes in CO or SVR. One patient in this group exhibited a typical histamine response with vasodilatation and flushing. In this patient mean arterial pressure decreased from 70 to 55 mm Hg and CO increased from 4.90 to 7.24 litre min-1. Excluding this patient from group 1 eliminated the significance of the haemodynamic changes for the rest of the group (MAP = 73 +/- 2 to 68 +/- 2 mm Hg, n.s.; mean diastolic AP = 58 +/- 3 to 53 +/- 2 mm Hg, n.s.). In group 2 none of the haemodynamic parameters measured showed significant changes. These results demonstrate minimal haemodynamic effects with 0.3- or 0.4-mgkg-1 bolus injections of atracurium in 15 patients with coronary artery disease, but in one patient doses of 0.3 mgkg-1 produced a typical histamine response with marked cardiovascular changes.
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PMID:Haemodynamic effects of bolus injections of atracurium in patients with coronary artery disease. 668 8

Mivacurium is a short-acting nondepolarising muscle relaxant of the benzylisoquinoline type undergoing rapid breakdown by plasma cholinesterase. With 2.5 fold ED95, tracheal intubation can be accomplished within 2-3 min following injection. The ensuing DUR 25% (i.e. time from injection to 25% recovery of control twitch tension) is three times as long as with succinylcholine and about half as long as with equipotent doses of atracurium and vecuronium. The principal side effects of mivacurium are facial flushing and a transient fall in blood pressure due to a moderate histamine release following doses of 3-4 times the ED95. In patients with end stage liver or renal disease as well as in patients with atypical plasma cholinesterase the duration of action of mivacurium is prolonged. Rocuronium is a steroidal non-depolarising neuromuscular blocking agent chemically related to vecuronium. Compared with the latter, rocuronium is less potent, has a shorter onset of action, and no cumulative effects. Adequate intubating conditions are achieved within 60 to 90 s after i.v. injection of twice the ED95. Its elimination from the blood occurs primarily via liver uptake, while renal elimination is about 10 to 30%. Slight vagolytic effects are reported following injection of 0.6 mg/kg rocuronium, while histamine release is unlikely to occur. Atracurium is a mixture of ten stereoisomers. One of them, cis-atracurium, is five times as potent as the chiral mixture while having a similar pharmacodynamic and kinetic profile. It does not cause significant histamine release or clinically relevant cardiovascular effects at doses up to 8 times the ED95. Laudanosine release seems to be less with cis-atracurium than with atracurium.
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PMID:[New muscle relaxants]. 886 25