Apnoea tubocurarine

Aceclidine is mostly used in ophthalmology for constriction of the pupil and reduction of intraocular pressure in glaucoma. Oxylidine is being used as a tranquilliser in patients with neurotic states and early states of hypertension. It is also recommended for the treatment of cerebral atherosclerosis. Its oral dose is 0.02—0.5 g. Qualidile is a curare-like drug used in general anaesthesia. The preparation is injected intravenously at a dose of 1 mg kg S muscle relaxation lasts for 10 minutes, slight inhibition of respiration being observed. A dose of 2 mg kg produces complete relaxation of the skeletal muscles, accompanied by apnoea. In spite of the fact that the review is well documented, it is difficult to form an idea about the clinical merits of these compounds. Some clinical information has been published recently a comparison of Qualidile with NiV -diallyl-bisnortoxiferine or tubocurarine chlorides loc. cit.) would be of special interest. 

Respiratory insufficiency and prolonged apnoea occurred in a patient on two occasions while receiving cyclophosphamide and undergoing anaesthesia during which suxamethonium (succinylcholine) and tubocurarine were used. Plasma cholinesterase levels were found to be low. Anaesthesia without the suxamethonium was uneventful. Seven out of 8 patients subsequently examined also showed depressed plasma cholinesterase levels while taking cyclophosphamide. ... 

Apnoea developed in a number of patients after they were given aprotinin whiie recovering from neuromuscular blockade with suxamethonium (succinyichoiine) alone or with tubocurarine. 

Three patients undergoing surgery who had received suxamethonium (succinyichoiine), alone or with tubocurarine, were given aprotinin intravenously in doses of 2500 to 12 000 KIU (kallikrein inactivator units) at the end of, or shortly after the operation, when spontaneous breathing had resumed. In each case respiration rapidly became inadequate and apnoea lasting periods of 7, 30 and 90 minutes occurred. Seven other cases have been reported elsewhere. ... 

The effects of both depolarising neuromuscular blockers (e.g. suxamethonium (succinylcholine)) and competitive neuromuscular blockers (e.g. tubocurarine) can be increased by quinidine. Re-curarisation and apnoea have been seen in patients when quinidine was given during the recoveiy period from neuromuscular blockade. 

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