Muscle relaxants non-depolarizing

Muscle relaxants Non-depolarizing neuromuscular blockers Short-lasting muscle paralysis Pancuronium, atracurium... 

Atracurium - muscle relaxant (non-depolarizing neuromuscular blocker) adjunct to... 

BETA-BLOCKERS NON-DEPOLARIZING 1. Modest t in efficacy of muscle relaxants, particularly with propanolol 2. Risk of 1 BP with atracurium and alcuronium 1 and 2. Uncertain 1. Watch for prolonged muscular paralysis after muscle relaxants 2. Monitor BP at least weekly until stable... 

CALCIUM CHANNEL BLOCKERS NON-DEPOLARIZING t effect of non-depolarising muscle relaxants with parenteral calcium channel blockers the effect is less certain with oral therapy. In two cohort studies, vecuronium requirements were halved in patients on diltiazem. Nimodipine does not seem to share this interaction Uncertain postulated that ACh release at the synapse is calcium dependent 1 calcium concentrations at the nerve ending may 1 ACh release, which in turn prolongs the nerve blockade Monitor nerve blockade carefully in patients on calcium channel blockers, particularly near to the end of surgery, when muscle relaxation may be prolonged and difficult to reverse... 

LITHIUM NON-DEPOLARIZING Antagonism of effects of nondepolarizing muscle relaxants Uncertain Monitor intraoperative muscle relaxation closely may need t doses of muscle relaxants... 

DONEPEZIL SUXAMETHONIUM Possible t efficacy of suxamethonium Suxamethonium is metabolized by cholinesterase parasympatho-mimetics inhibit cholinesterase and so prolong the action of suxamethonium Avoid co-administration. Ensure that the effects of suxamethonium have worn off before administering a parasympathomimetic to reverse non-depolarizing muscle relaxants. A careful risk-benefit analysis should be made before considering the use of suxamethonium for emergency anaesthesia in patients taking parasympathomimetics. The short half-life of edrophonium means that it can be used to diagnose suspected dual block with suxamethonium... 

PARASYMPATHOMIMETICS NON-DEPOLARIZING 1 efficacy of nondepolarizing muscle relaxants The anticholinesterases oppose the action of non-depolarising muscle relaxants Used therapeutically... 

DEPOLARIZING, NON-DEPOLARIZING CLINDAMYCIN, COLISTIN, PIPERACILLIN T efficacy of muscle relaxants Piperacillin has some neuromuscular blocking activity Monitor neuromuscular blockade carefully... 

DEPOLARIZING, NON-DEPOLARIZING VANCOMYCIN 1. t efficacy of these muscle relaxants 2. Possible risk of hypersensitivity reactions 1. Vancomycin has some neuromuscular blocking activity 2. Animal studies suggest additive effect on histamine release 1. Monitor neuromuscular blockade carefully 2. Be aware... 

PANCURONIUM THEOPHYLLINE Antagonism of neuromuscular blockade Uncertain Larger doses of pancuronium may be needed to obtain the desired muscle relaxation during anaesthesia other non-depolarizing muscle relaxants do not seem to be affected... 

DEPOLARIZING AND NON-DEPOLARIZING MAGNESIUM (PARENTERAL) t efficacy of these muscle relaxants, with risk of prolonged neuromuscular blockade Additive effect magnesium inhibits ACh release and 1 postsynaptic receptor sensitivity Monitor nerve blockade closely... 

Basta SJ, Ali HH, Savarese JJ, Sunder N, Gionfriddo M, Cloutier G, Lineberry C, Cato AE. Clinical pharmacology of atracurium besylate (BW 33A) a new non-depolarizing muscle relaxant. Anesth Analg 1982 61(9) 723-9. 

Tryba M. Wirkungsverstarkung nicht-depolarisierender Muskelrelakantien durch AcylaminopenciUine. Untersuchungen am Beispiel von Vecuronium. [Potentiation of the effect of non-depolarizing muscle relaxants by acylami-nopenicillins. Studies on the example of vecuronium.] Anaesthesist 1985 34(12) 651-5. 

Gallamine is a non-depolarizing muscle relaxant. For intubation about 2 mg/kg (some authors say 3-4 mg/kg) are necessary, and the duration of effect is then similar to the usual intubating doses of D-tubocurarine or pancuronium. A dose of 1-1.5 mg/kg is usually sufficient to produce apnea and adequate abdominal relaxation. Such doses are said to be short-acting (20 minutes) but can provide clinical relaxation (75% or more depression of twitch height) for some 30-40 minutes. Individual variation is considerable, and complete spontaneous reversal of blockade is relatively slow. 

Metronidazole can potentiate the effects of non-depolarizing muscle relaxants (41). 

Mivacurium chloride is a non-depolarizing muscle relaxant, a benzylisoquinolinium diester compound with a duration of approximately twice that of suxamethonium. In vitro (1), it is metabolized to a significant extent by plasma cholinesterase, and minimally by acetylcholinesterase. The rate of metabolism in vitro is directly related to plasma cholinesterase activity. In pooled human plasma the rate of hydrolysis of mivacurium was 70% that of suxamethonium. Its half-life is 5-10 minutes compared with 2-5 minutes for suxamethonium. The in vitro hydrolysis of mivacurium by purified human plasma cholinesterase occurs at 88% of the rate for suxamethonium (2). There was a poor correlation between the duration of action of bolus doses of mivacurium and the plasma cholinesterase activity in individual patients (2), a finding that has also been reported by others (3). However, the average infusion rate to maintain around 95 % blockade in individual patients correlated significantly with the patients plasma cholinesterase activities (4). While metabolites have been detected in both urine and bile, mivacurium seems to depend principally on ester hydrolysis for its plasma clearance, so that reduced activity of plasma cholinesterase is likely to result in a prolonged duration of action. 

Goudsouzian NG, Liu LM, Cote CJ. Comparison of equipotent doses of non-depolarizing muscle relaxants in children. Anesth Analg 1981 60(12) 862-6. 

Ono K, Ohta Y, Morita K, Kosaka F. The influence of respiratory-induced acid-base changes on the action of non-depolarizing muscle relaxants in rats. Anesthesiology 1988 68(3) 357-62. 

Many efforts have been made to find a technique to prevent the suxamethonium-associated increase in intraocular pressure. Some attenuation of the pressure response has been demonstrated with defasciculation doses of non-depolarizing muscle relaxants (122), but this could not be reproduced in subsequent studies (100-102,123). The same is true for self-taming, that is... 

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