"Pipecuronium bromide": instructions for use

Medicines that relax the skeletal muscles are widely used not only in conducting interventions of medium and long duration, but also in traumatological practice with the aim of repositioning or joint replacement. "Piperkuroniya bromide" refers to the group of antidepolarizing muscle relaxants and has a maximum duration of action up to 50-70 minutes, depending on the characteristics of the organism. Let's consider the instruction on the use of this medication, 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 occurs, and accordingly, the muscle cell loses its ability to contract.

With a conditionally prolonged exposure to the drug "Piperkuroniya bromide" skeletal muscle relaxes. Given that the nicotinic cholinoreceptors are located not only in the area of contact of the efferent fibers of the somatic nervous system with muscular cells of the skeletal musculature, but also in the ganglia of the autonomic nervous system, with the introduction of large doses of the drug, a weak ganglion blocking effect is caused. This is due to the cessation of nerve impulse transmission to postsynaptic membranes of neurons, which leads to a reduction in both sympathetic and parasympathetic effects.

Indications for use

The preparation "Piperkuroniya bromid" is shown for the relaxation of skeletal muscles during surgical interventions. The drug is effective for intubation of the trachea for the purpose of artificial ventilation.

Contraindications

As the instruction to the preparation "Piperkuroniya bromide" says, 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 the violation of excitation in the neuromuscular synapse and the development of muscle weakness).

The drug is contraindicated for use in patients in the early stages of pregnancy. In the later stages, the use of the drug is possible, since it penetrates insignificantly through the placental barrier.

Side effects

The drug is able to inhibit the central nervous system, cause hyperesthesia.

From the side of the cardiovascular system, side effects are due to the inhibition of transmission in the cholinergic synapses. It is possible to reduce the heart rate, lower blood pressure, ischemic damage to the myocardium, cerebral disorders associated with a decrease in perfusion.

When exposed to the respiratory system may oppression of respiratory function, the appearance of dyspnea or apnea (especially during the after-effect of the drug).

The drug affects the metabolism and is able to cause a rise in the level of potassium in the blood, increase the level of endogenous creatinine and reduce the plasma glucose level.

Piperkuroniya 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 verify the presence of anticholinesterase agents ("Neostegmina" or "Pyridostigmine") or holinoblokatorov ("Atropina").

After the manipulation, continuous monitoring of the patient is carried out throughout the recovery period after anesthesia and before the patient's muscle tone is normalized.

The dosage of the medicinal product is carried out on the basis of a comprehensive examination of the patient and analysis of the data of laboratory methods of investigation. If there is a deficiency in the excretory function of the kidneys, functional liver failure, obesity, the dose of the drug should be reduced.

The solution is prepared immediately before the introduction of the preparation "Pipecuronium bromide". The form of the drug is vials with a lyophilized powder containing 0.004 g of active substance.

For patients with impaired electrolyte balance of blood or acid-base balance, dose adjustment is also necessary. The primary decrease in the ion concentration in the blood plasma, supercooling and the use of cardiac glycosides (during digitalization) can prolong the duration of the drug. In the case of carrying out the muscle relaxation in such a group of patients, it is necessary initially to normalize the electrolyte indices of the blood, and then carry out the muscle relaxation. If patients have chronic heart failure, slowing blood circulation, the latent period of action of the drug may be prolonged (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. In this case, it must be remembered that the children'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.

Release of medicinal product

To prescribe for the preparation "Piperkuroniya bromide" a recipe in Latin can not even be treated by a doctor. The medical institution receives potent substances from list A only on demand and on a state basis. In a separate case, a recipe may be written out by a specialist using the "red" form, but not all hospital networks have the right to sell narcotic and potent substances, including muscle relaxants, to "Pipecuronium bromide".

Trade names

In the pharmaceutical market, the drug is available under trade names such as Arduan, Vero-pipecuronium, Aperamid, Piperecuronium Bromide. The trade name of the drug depends on the manufacturer supplying the drug to the pharmaceutical market.

Overdose

Overdosing of the drug and reducing the effect is possible due to the introduction of anticholinesterase drugs. These drugs help increase the mediator concentration of acetylcholine, thereby competing with the muscle relaxant for binding sites at the receptor.

Also, medical measures in case of overdose are aimed at increasing blood pressure, maintaining vital functions of the body, including through artificial 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 slows down, an effective therapeutic dose increases with the preoperative introduction of cholinesterase inhibitors into the patient's body .

With the joint use of muscle relaxant with narcotic analgesics, the oppression of the respiratory center with the development of apnea is possible.

The use of a drug with muscle relaxants of a depolarizing effect type can both enhance and weaken the overall muscle relaxant effect. This is due to the dosage of drugs, the time of administration and individual sensitivity to medicines.

Conclusion

Conducting muscle relaxation during surgical interventions is an important part of complex anesthesia. The preparation "Piperkuroniya 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 muscle 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 resuscitation departments.