Esmolol Succinylcholine

The in human blood half-life of esmolol is around 25-27 min (50, 51). As a nice confirmation of the soft drug design principles, the presence of other ester-containing drugs, such as acetylcholine, succinylcholine, procaine, or chloroprocaine, have been shovm to have no effect on this hydrolytic half-life, and consequently no metabolic interactions are to be expected (50). 

Cocaine, esmolol, aspirin, enalapril, capecitabine, succinylcholine... 

Esmolol is a class 11 antiarrhythmic agent with ultra-short-acting beta-adrenergic-blocking activity that is used (50 to 200 mcg/kg/minute) to treat supraventricular tachycardia such as atrial fibrillation or atrial flutter. It is rapidly metabolized by erythrocyte esterases via hydrolysis of the methyl ester. Unlike succinylcholine, esmolol is not metabolized by plasma cholinesterase (see also Eigures 67 and 83). 

B. Recovery from succinylcholine-induoed neuromuscular blockade may be slightly delayed (5-10 minutes). Similarly, esmolol metabolism may be inhibited by anticholinesterase agents (eg, organophosphates). 

A. May potentiate agents metabolized by the cholinesterase enzyme (eg, depolarizing neuromuscular blocking agents—succinylcholine, cocaine, esmolol), cholinesterase inhibitors (eg, organophosphate and carbamate insecticides), and other cholinergic agents (eg, pilocarpine). 

A study of 16 patients who had been taking various beta blockers (propranolol 5, atenolol 5, metoprolol 2, bisoprolol 2, oxprenolol 1, celiprolol 1) for longer than one month found no difference in the onset and duration of action of rocuronium, when compared with a control group. Similarly, intra-operative esmolol did not affect the onset and recovery time from suxamethonium (succinylcholine) blockade in patients with normal plasma cholinesterase (pseudocholinesterase) activity, but see also (b) above. 

McCammon RL, Hilgenberg JC, Sandage BW, Stoelting RK. The effect of esmolol cm the onset and duration of succinylcholine-induced neuromuscular blockade. Anesthesiology... 

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