caa a22 4500 465825621 CHVBK 20180323112148.0 cr unu---uuuuu 170327e19900101xx s 000 0 eng 10.1007/BF02832179 doi (NATIONALLICENCE)springer-10.1007/BF02832179 A simulation of neuromuscular function and heart rate during induction, maintenance, and reversal of neuromuscular blockade [Elektronische Daten] [Roman Jaklitsch, Dwayne Westenskow] We developed a two-compartment model to simulate neuromuscular function and heart rate following the administration of four nondepolarizing neuromuscular blocking agents (atracurium, vecuronium, pancuronium, and d-tubocurarine), three neuromuscular block reversal agents (edrophonium, neostigmine, and pyridostigmine), and two anticholinergic agents (atropine and glycopyrrolate). Twitch depression, train-of-four ratio, and heart rate were modeled during fentanyl, halothane, enflurane, or isoflurane anesthesia, optionally supplemented with nitrous oxide. Simulation results, compared with published values for each drug, fell within the clinical accuracy range (onset time 6.1 ± 3.9% [mean ±SEM]; duration, 1.7 ±3.5%, 50% effective dose, 0.5 ±5.7%; and 95% effective dose, 2.1 ±1.1%). The simulation graphically demonstrates the pharmacokinetics, pharmacodynamics, and interactions between neuromuscular blocking agents, reversal agents, and anticholinergic agents. During a simulation, the need for frequent monitoring and repeated delivery of a neuromuscular blocking agent to keep neuromuscular blockade stable becomes apparent, especially with the intermediate-acting neuromuscular blocking agents. When inhalational agents are given concomitantly, the task becomes even more difficult, since potentiation changes with anesthetic uptake. Recurarization, tachycardia, or bradycardia may be seen with the simulation if an improper drug regimen is followed. Concurrent simulation of two identical patients allows comparison of different modes of administration, choice of anesthetic agents, and drug doses. Little, Brown and Company, 1990 Neuromuscular blocking drugs nationallicence Measurement techniques: neuromuscular blockade nationallicence Monitoring: neuromuscular blockade nationallicence Heart: rate nationallicence Parasympathetic nervous system nationallicence Jaklitsch Roman Department of Anesthesiology, University of Utah, 84132, Salt Lake City, UT aut Westenskow Dwayne Department of Anesthesiology, University of Utah, 84132, Salt Lake City, UT aut Journal of Clinical Monitoring Springer Netherlands 6/1(1990-01-01), 24-38 0748-1977 6:1<24 1990 6 10877 https://doi.org/10.1007/BF02832179 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02832179 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Jaklitsch Roman Department of Anesthesiology, University of Utah, 84132, Salt Lake City, UT aut NATIONALLICENCE 700 1- Westenskow Dwayne Department of Anesthesiology, University of Utah, 84132, Salt Lake City, UT aut NATIONALLICENCE 773 0- Journal of Clinical Monitoring Springer Netherlands 6/1(1990-01-01), 24-38 0748-1977 6:1<24 1990 6 10877 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer