Hindawi Publishing Corporation
ISRN Anesthesiology
Volume 2013, Article ID 103289, 6 pages
http://dx.doi.org/10.1155/2013/103289
Clinical Study
Pharmacoeconomics and Pharmacodynamic Interactions of
Rocuronium and Pancuronium
HariSrinivas Shyam Kumar,
1
Padmaja Durga,
2
Rama Mohan Pathapati,
3
Sujith Tumkur Rajashekar,
4
Pothula Narasimha Reddy,
5
and Gopinath Ramachandran
2
1
Department of Anesthesiology and Intensive Care, Narayana Hrudayalaya Malla Reddy Hospital, No. 1-1-216, Suraram “X” Road,
Jeedimetla, Hyderabad 500055, India
2
Department of Anesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad 500082, India
3
Departments of Clinical Pharmacology and Medical Research, Narayana Medical College and Super Specialty Hospital,
Chinthareddypalem, Nellore 524002, Andhra Pradesh, India
4
Department of Clinical Pharmacology, Narayana Medical College and Super Specialty Hospital, Chinthareddypalem,
Nellore 524002, Andhra Pradesh, India
5
Department of Anesthesiology and Intensive Care, Narayana Medical College and Super Specialty Hospital,
Chinthareddypalem, Nellore 524002, Andhra Pradesh, India
Correspondence should be addressed to Rama Mohan Pathapati; pill4ill@yahoo.co.in
Received 17 December 2012; Accepted 3 January 2013
Academic Editors: E. Freye and C. H. Wong
Copyright © 2013 HariSrinivas Shyam Kumar et al. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. We evaluated the pharmacodynamic interaction of the combination of pancuronium and Rocuronium by analyzing
time-response relationship, quality of intubating conditions, changes in the hemodynamics, and cost effectiveness as compared to
individual drugs. Methods. Sixty patients in the ASA-I category received either 10 ml of 0.9 mg/kg rocuronium (R) plus 10 ml of
saline or 10 ml of 0.1 mg/kg pancuronium (P) plus 10 ml of saline or a combination (C) of 10 ml of 0.45 mg/kg R plus 10 ml of
0.05 mg/kg P according to randomization list. Neuromuscular function was measured up to maximal suppression of twitch height.
Results. e mean times (sec) taken for twitch height to decrease to 50% of baseline in R, P, and C were 36.84 ± 2.54, 74.60 ± 4.94,
and 40.81 ± 2.34, respectively. e mean cost of intubation per patient was 316.71 ± 83.61 INR in group R, 52.30 ± 14.94 INR in
group P, and 93.33 ± 20.65 INR in group C. Conclusions. e combination of P and R provides rapid and smooth intubation with
minimal hemodynamic changes at a reasonably priced cost.
1. Introduction
Over the last few decades the focus of research has been on
the development of muscle relaxants with a short onset of
action that can be used for rapid sequence intubation. It has
been shown that speed of onset is inversely related to molar
potency [1, 2]. e major disadvantage of use of less potent
drugs is pharmacoeconomics burden of intubation [3, 4]. So
far, it has been very di�cult to �nd the optimal compromise
between potency and rapid onset of action. e pharma-
cokinetic options to achieve rapid onset of action are use
of supramaximal doses, priming, and cocktails of relaxants.
Many experimental combinations of amino steroid relaxants
and benzo-isoquinolinium relaxants failed to demonstrate
either synergism or pharmacoeconomics advantage [5].
Pancuronium is one of the most potent and least expen-
sive nondepolarizing neuromuscular blocking drugs avail-
able. However, its onset of action is slow. Pancuronium
has predominant postsynaptic mechanism of action, whereas
rocuronium, a monoquaternary analogue of Pancuronium
has a predominant presynaptic action [6]. It has been
hypothesized that combination of these drugs with different
pharmacodynamic characteristics might confer advantage
of synergism resulting in rapid onset of action at a lesser
cost. To this purpose we evaluated the pharmacodynamic
interaction by analyzing time-response relationship, quality