Suxamethonium Aprotinin

Aprotinin slightly reduces plasma cholinesterase activity and would be expected to prolong the action of suxamethonium in combination with other factors. However, re-paralysis has been reported when aprotinin was used after operations during which suxamethonium had been given alone or in combination with normal doses of D-tubocurarine (36). 

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. ... 

Not fully understood. Aprotinin is only a very weak inhibitor of serum cholinesterase (100 000 KIU caused a maximd 16% inhibition in man) and on its own would have little effect on the metabolism of suxamethonium. However, it might tip the balance in those whose cholinesterase was already very depressed. 

Doenicke A, Gesing H, Knimey 1, Schmidii er St. Influence of aprotinin (Trasylol) on the action of suxamethonium. BrJAnae (1970) 42,948-60. 

---

See also in sourсe #XX -- [ ]

---