Ketamine Succinylcholine

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. 

Tsai SK, Lee CM, Tran B. Ketamine enhances phase I and phase II neuromuscular block of succinylcholine. Can J Anaesth 1989 36(2) 120-3. 

Johnston RR, Miller RD, Way WL. The interaction of ketamine with D-tubocurarine, pancuronium, and succinylcholine in man. Anesth Analg 1974 53(4) 496-501. 

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. ... 

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See also in sourсe #XX -- [ ]

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