Effects of tizanidine premedication on the duration of perioperative maintenance dose of vecuronium bromide

Authors

  • Ceyhan Oflezer Department of Anesthesiology, University of Health Sciences, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul/Turkey. https://orcid.org/0000-0001-5396-5939

DOI:

https://doi.org/10.20883/medical.e578

Keywords:

Alpha 2 agonist, inguinal hernie, premedication, tizanidine, vecuronium bromide

Abstract

Aim. The aim of this study was to evaluate the effects of preoperative administration of tizanidine on the maintenance dose duration of the nondepolarizing muscle relaxant, i.e. vecuronium bromide.
Material and Methods. This prospective clinical study was conducted in 30 adult male patients scheduled for elective inguinal hernia surgery. Patients were categorised into two randomised groups based on the premedication use. Group 1 included patients (n = 15) who received oral diazepam (Diazem) in the evening prior to the surgery, as well as meperidine (Dolantin) 1 mg/kg-1 (max. 50 mg) i.m. with 50 ml water by mouth 1 hour before the procedure. Group 2 comprised patients (n = 15) who were given oral tizanidine 4 mg in the evening before the surgery, as well as oral tizanidine 4 mg with 50 ml water 1 hour prior to the operation. The following parameters were recorded in both groups: pre-operative and perioperative diastolic arterial blood pressure, systolic arterial blood pressure, mean arterial blood pressure, heart rate, respiratory rate, pre-operative vecuronium bromide maintenance doses, procedure time and postoperative score according to the Ramsay scale in 1st, 2nd and 3rd hour.
Results. No significant difference was observed between the two groups with regard to the pre-operative and perioperative haemodynamic variables and the respiratory rate (P > 0.05), although it was found that vecuronium maintenance dose duration was significantly higher in the tizanidine premedicated group (P = 0.015). In addition, the operative time (P = 0.128) and the postoperative patients’ Ramsay scores did not differ statistically between the two groups (P > 0.05).
Conclusions. The prolonged duration of vecuronium maintenance dose, the increased nondepolarizing block time, as well as haemodynamic stability preservation in patients undergoing inguinal hernia surgery following preoperative oral administration of tizanidine support the view that tizanidine can be used as an effective and safe myotonolytic premedication agent.

Downloads

Download data is not yet available.

References

Coward DM. Tizanidine: neuropharmacology and mechanism of action. Neurology. 1994;44:6–10. PMID: 7970012.

Henney HR, Runyan JD. A clinically relevant review of tizanidine hydrochloride dose relationships to pharmacokinetics, drug safety and effectiveness in healthy subjects and patients. Int J Clin Pract. 2008;62(2):314–24. doi:10.1111/j.1742-1241.2007.01660.x.

Wajima Z, Yoshikawa T, Ogura A, Imanaga K, Shiga T, Inoue T. Oral tizanidine, an α2-adrenoceptor agonist, reduces the minimum alveolar concentration of sevoflurane in human adults. Anesth Analg. 2002;95(2):393–6. doi: 10.1097/00000539-200208000-00028.

Nance PW. Alpha adrenergic and serotonergic agents in the treatment of spastic hypertonia. Phys Med Rehabil Clin N Am 2001;12(4): 889-905. PMID:11723869.

Taricco M, Adone R, Pagliacci C, Telaro E. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database Syst Rev 2000(2):CD001131.doi: 10. 1002 /14651858.CD001131.

Wagstaff AJ, Bryson HM. Tizanidine. A review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs 1997;53(3): 435-52. doi: 10.2165/00003495-199753030-00007.

Nance PW, Bugaresti J, Shellenberger K, Sheremata W, Martinez-Arizala A. Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group. Neurology 1994;44 (11 Supply 9): 44-51. PMID:7970010.

Paisley S, Beard S, Hunn A, Wight J. Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review. Mult Scler 2002;8(4):319-29. doi: 10.1191/1352458502ms795rr.

Groves L, Shellenberger MK, Davis CS. Tizanidine treatment of spasticity: a meta-analysis of controlled, double-blind, comparative studies with baclofen and diazepam. Adv Ther 1998;15 (4):241-51. PMID:10186943.

Lataste X, Emre M, Davis C, Groves L. Comparative profile of tizanidine in the mana gement of spasticity. Neurology 1994; 44(11 Supply 9): 53-9. PMID:7970011.

Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage 2004;28(2):140-75. doi: 10.1016/j.jpainsymman.2004.05.002.

Hord AH, Denson DD, Azevedo MI. Systemic tizanidine hydrochloride (zanaflex) partially decreases experimental postoperative pain in rats. Anesth Analg 2001; 93(5):1307-9. doi: 10.1097/00000539-200111000-00056.

Malanga GA, Gwynn MW, Smith R, Miller D. Tizanidine is effective in the treatment of myofascial pain syndrome. Pain Physician 2002;5(4): 422-32. PMID:168821.

Manfredini D, Romagnoli M, Cantini E, Bosco M. Efficacy of tizanidine hydrochloride in the treatment of myofascial face pain. Minerva Med 2004;95(2):165-71. PMID:15 272252.

Semenchuk MR, Sherman S. Effectiveness of tizanidine in neuropathic pain: an open-label study. J Pain 2000;1(4): 285-92. doi: 10.1054/jpai.2000.9435.

Saper JR, Lake AE 3rd, Cantrell DT, Winner PK, White JR. Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study. Headache 2002; 42(6):470-82. doi: 10.1046/j.1526-4610.2002.02122.x.

Gorska J. Effects of back pain treatment with tizanidine. Ortop Traumatol Rehabil 2005;7(3): 306-9. PMID:17611479.

Miettinen TJ, Kanto JH, Salonen MA, Scheinin M. The sedative and sympatholytic effects of oral tizanidine in healthy volunteers. Anesth Analg 1996;82(4):817-820. doi.org/10.1097/00000539-199604000-00024.

Tabari M, Alipour M, Esalati H. Evaluation of oral tizanidine effects on intra operative hemodynamic responses during direct laryngoscopy under general anesthesia. Iran Red Crescent Med J 2013;15(7):541-6. doi: 10.5812/ircmj.11540.

Takenaka M, Iida H, Kasamatsu M, Katoh H,Tashiro T, Dohi S, Tetsuo I et al. Tizanidine for preanesthetic medication. Masui 1996;45(8):971-5. doi: 10.5812/ ircmj. 11540

Sanket B, Samudyatha TJ, Nethra SS, Kannan S, Nagaraj S. A randomised controlled double blind study to assess the effect of oral tizanidine premedication on intraoperative isoflurane consumption in patients undergoing laparoscopic surgeries under general anaesthesia. Indian J Clin Anaesth 2021;8(2):214-20. doi:10.18231/j.ijca.2021.043

Omote K, Satoh O, Sonoda H, Kumeta Y,Yamaya K, Namiki A. Effects of oral alpha 2 adrenergic agonists, clonidine and tizanidine, on tetracaine spinal anesthesia. Masui 1995; 44(6):816-23. PMID:7637157.

Skoog B. A comparison of the effects of two antispastic drugs, tizanidine and baclofen, on synaptic transmission from muscle spindle afferents to spinal interneurones in cats. Acta Physiol Scand 1996;156(1):81-90. doi: 10.1046/j.1365-201X.1996.444159000.x.

Davies J. Selective depression of synaptic excitation in cat spinal neurones by baclofen: an iontophoretic study. Br J Pharmacal 1981;72(2):373-84. doi: 10.1111/j.1476-5381.1981.tb09137.x.

Tanabe M, Kaneko T, Tonohiro T, Iwata N. The pharmacological properties of CS-722, a newly synthesized centrally acting muscle relaxant. Neuropharmacology 1992;31(10):1059-66. doi: 10.1016/0028-3908(92)90108-2.

Thompson DC, Diamond L Altiere RJ. Atypical presynaptic alpha-adrenoceptor modulation of neurally-mediated cholinergic responses in quinea-pig tracheal smooth muscle. Pulm Pharmacol 1992;5(4):251-5. doi: 10.1016/0952-0600(92)90067-q.

Morgan GE, Mikhail MS. Clinical Anestesiology 2nd. ed., Appleton/Lange,1996 :180,155.

Maeda-Hagiwara M, Watanabe H, Kanaoka R, Watanabe K. Influence of clonidine and a new related imidazoline derivative (tizanidine) on rat gastric mucosa. Pharmacology 1986;32(2):109-13. doi: 10.1159/000138158.

Chen DF, Bianchetti M, Wiesendanger M. The adrenergıc agonıst tızanıdıne has dıfferantial effects on flexor reflexes of ıntact and spınalızed rat Neuroscience 1987; 23(3): 641-7.

Matsumiya T, Shimura H, Shibuya T. The effects of Tizanidine on C fiber reflex and heat evoked discharge in the cats. Pharmacometrics 1986;31:81-6.

Milanov I, Georgiev D. Mechanism of tizanidine action on spasticity. Acta Neurol Scand 1994;89(4):274-9. doi: 10.1111/j.1600-0404.1994.tb01680.x.

Curtis DR, Leah JD, Peet MJ. Spinal interneurone depression by DS 103-282. Br J Pharmacol 1983 79(1); 9-11. doi: 10.1111/j.1476-5381.1983.tb10487.x

Kameyama T, Nabeshima T, Yamada S. Hypotermic and antiinflamatory effects of tizanidine. Pharmacometrics 1985;30(5): 867-71.

Yanagita T, Yamamura H, Igarashi S. Effects of tizanidine in healthy volunteers: double blind study compared with diazepam and a placebo. Int J Clin Pharmacol Res 1988;8(2):75-94. PMID:3378856.

Taittonen M, Raty H, Kirvela O Aantaa R, Kanto J. The metabolic effects of oral tizanidine in healthy volunteers. Acta Anaesthesiol Scand 1995;39(3):628-32. doi: 10.1111/j.1399-6576.1995.tb04139.x.

Downloads

Published

2022-03-31

Issue

Section

Original Papers

How to Cite

1.
Oflezer C. Effects of tizanidine premedication on the duration of perioperative maintenance dose of vecuronium bromide. JMS [Internet]. 2022 Mar. 31 [cited 2024 Nov. 2];91(1):e578. Available from: https://jmsnew.ump.edu.pl/index.php/JMS/article/view/578
Received 2021-10-08
Accepted 2021-11-08
Published 2022-03-31