Ketamine Atracurium

Calcium ions play an important role in the presynaptic release of acetylcholine, and prolonged neuromuscular blockade has been reported after calcium antagonist administration during anesthesia that includes concurrent nondepolarizing neuromuscular blockade. Ketamine potentiates neuromuscular blockade produced by tubocurarine and atracurium, but not that produced by pancuronium or succinylcholine. 

Ketamine has been shown to prolong the action of atracurium slightly (67). 

Toft P, Helbo-Hansen S. Interaction of ketamine with atracurium. Br J Anaesth 1989 62(3) 319-20. 

Intravenous anesthetic agents have much less influence on the neuromuscular blocking effects of relaxants and most have no clinically significant effect. However, ketamine (SEDA-14, 113) has been reported to significantly potentiate atracurium (137), and also D-tubocurarine but not pancuronium (138) in man. Animal studies suggest that all relaxants will be potentiated by ketamine in a dose-dependent manner (139,140). It has been suggested that had Johnston et al. (138) used a higher dose of ketamine (than 75 mg/m ), they would have seen potentiation of pancuronium. The main effect of ketamine appears to be a reduction in the sensitivity of the postjunctional membrane to acetylchohne, possibly by ion-channel blockade. Propofol has been reported to potentiate vecuronium-induced and atracurium-induced blocks (141). 

Fentanyl, ketamine, midazolam, > propofol, thiopental Depolarizing succinylcholine Nondepolarizing atracurium, mivacurium, tubocurarine... 

The inhalational anaesthetics increase the effects of the neuromuscular blockers to differing extents, but nitrous oxide appears not to interact significantly. Ketamine has been reported to potentiate the effects of atracurium. Propofol does not appear to interact with mivacurium or vecuronium. Xenon is reported not to interact with mivacurium or rocuronium, and has less effect than sevoflurane on vecuronium neuromuscular blockade. Bradycardia has been seen in patients given vecuronium with eto-midate or thiopental. Propofol can cause serious bradycardia if it is given with suxamethonium (succinylcholine) without adequate antimuscarinic premedication, and asystole has been seen when fentanyl, propofol and suxamethonium were given sequentially. 

Ketamine prolonged the duration of neuromuscular blockade induced by atracurium, but did not influence suxamethonium (succinylcholine)-induced neuromuscular blockade. However, the UK manufacturers of suxamethonium still warn of a possible interaction because they say that ketamine may reduce normal plasma cholinesterase activity. ... 

Interfering alizapride, atracurium, ketamine, ketogan, lidocaine, metoclopramide, nimodipine, prochlorperazine, tubocurarine... 

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See also in sourсe #XX -- [ ]

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