Background: Neuromuscular blocking agents may exert central nervous system effects when they reach the brain. This study assessed the Concentrations and the time course of passage of vecuronium, atracurium, and its metabolite laudanosine in the cerebrospinal fluid (CSF) of patients undergoing intracranial aneurysm clipping. Methods: Twenty-five patients with subarachnoid hemorrhage were randomly allocated to receive an intravenous infusion of vecuronium (n=13) or atracurium (n=12). Arterial blood and lumbar CSF were sampled before and 1, 2, 3, 4 and 8h after the start of the relaxant infusion. The samples were analyzed by liquid chromatography-electrospray ionization mass spectrometry (vecuronium) and high-pressure liquid chromatography (atracurium and laudanosine). Results: The data of 20 patients (10 in both groups) were analyzed. In 11 CSF samples from five patients atracurium was detected in concentrations from 10 to 50ng/ml. Laudanosine was retrieved in all CSF samples at 1, 2, 3, 4 and 8h; the highest CSF concentration of laudanosine occurred at 3h [38 (18-63) ng/ml: median (range)]. Vecuronium was not found in any CSF sample. Conclusion: Significant concentrations of atracurium and laudanosine but not of vecuronium were detected in the CSF of patients during and immediately after intracranial aneurysm surgery.
- Blood brain barrier
- Central nervous system
- Electrospray mass spectrometry
- High pressure liquid chromatography
- Neuromuscular blocking agents
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine