Pancuronium Succinylcholine

Noninterfering atropine, diazepam, neostigmine, pancuronium, succinylcholine, thiopental... 

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. 

Tubocurarine, metocurine, and succinylcholine have all been shown to elicit histamine release in humans. However, histamine release is less common with pancuronium and alcuronium. Vecuronium does not cause histamine release. 

General anesthetics are rarely given alone. In addition to the analgesic agents just mentioned, benzodiazepines (midazolam, Versed diazepam, Valium ) are commonly used as adjuncts for the relief of anxiety, amnesia, and sedation prior to induction of anesthesia. Neuromuscular blockers (e.g., succinylcholine or pancuronium) can also be administered during the induction of anesthesia to relax skeletal muscles. 

Cronnelly R, Morris RB, Miller RD. Comparison of thiopental and midazolam on the neuromuscular responses to succinylcholine or pancuronium in humans. Anesth Analg 1983 62(l) 75-7. 

Figure 9.14. Stmctures of muscle-relaxants. a d-Tubocu-rarine (top) and pancuronium. The two acetylcholine moieties in the pancuronium molecule are highlighted, b Stmctures of the depolarizing muscle relaxants succinylcholine (top) and de-camethonium (bottom).

Sato Y, Tsuchida H, Harada Y, Namiki A. [Effect of cimetidine on neuromuscular blockade by succinylcholine and pancuronium.] Masui 1990 39(2) 168-73. 

Glisson SN, Sanchez MM, El-Etr AA, Lim RA. Nitroglycerin and the neuromuscular blockade produced by gallamine, succinylcholine, D-tubocurarine, and pancuronium. Anesth Analg 1980 59(2) 117-22. 

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. 

Ebeling BJ, Keienburg T, Hausmann D, Apffelstaedt C. Das Wirkungsprofil von Succinylcholin nach Pracurarisierung mit Atracurium, Vecuronium oder Pancuronium. [Profile of the effect of succinylcholine after pre-curarization with atracurium, vecuronium or pancuronium.] Anasthesiol Intensivmed Notfallmed Schmerzther 1996 31(5) 304-8. 

Katz RL. Modification of the action of pancuronium by succinylcholine and halothane. Anesthesiology 1971 35(6) 602-6. 

Skeletal muscle relaxants fall into three major categories those that reduce spasticity, those that cause neuromuscular blockade and those that work at the cellular level. Spasmolytic agents (e.g. metho-carbamol, guaifenesin) act centrally whereas neuromuscular blockers (e.g. succinylcholine (suxamethonium), pancuronium, atracurium) act at the neuromuscular end plate to produce muscular relaxation. Dantrolene falls into the third category and acts within the muscle cell itself to produce relaxation. 

Clinically important, potentially hazardous interactions with adefovir, aldesleukin, aminoglycosides, atracurium, bumetanide, carbenicillin, cephalexin, cephalothin, doxacurium, ethacrynic acid, furosemide, methoxyflurane, non-polarizing muscle relaxants, pancuronium, pipecuronium, polypeptide antibiotics, rocuronium, succinylcholine, teicoplanin, torsemide, tubocurarine, vecuronium... 

NMBAs are further differentiated by their duration of action during anesthesia. Succinylcholine and mivacurium are common ultra-short-acting competitive NMBAs (5-10 min). An intermediate duration of action (30-45 min) is maintained with the use of atracurium, cisatracurium, rocuronium and vecuronium. A long-lasting duration of action (90-100 min) is observed with d-tubocurarine, doxacurium, metocurine, pancuronium and pipecuronium. 

Many drugs of therapeutic importance, e.g., hexafluorenium, pancuronium (S9, SIO), and succinylcholine itself, are bis quaternary ammonium complexes which are reversible inhibitors of cholinesterase. One of the charged groups occupies the anionic site, but there is uncertainty regarding the attachment of the second quaternary nitrogen group. Experimental evidence shows that the bis quaternary compoimds are more than twice as potent (mole for mole) as inhibitors of cholinesterase than are simple quaternary ammonium compounds (M4). 

Skeletal neuromuscular junction effectors act as competitive inhibitors of the NM muscle end-plate receptor or as depolarizing agonists. Tubocurarine, atracurium, and pancuronium are competitive antagonists, whereas succinylcholine is a depolarizing agent. Both the antagonists and agonists are... 

Nondepolarizing atracurium, pancuronium, tubocurarine Depolarizing succinylcholine... 

The skeletal muscle reiaxants provide muscle relaxation and/or immobility via N-receptor interactions. Most including d-tubocurarine, pancuronium, atracurium, and mivacurium, are competitive and nondepolarizing and can be reversed by AChE inhibitors. Succinylcholine is a depolarizing, noncompetitive agonist. 

Lidocaine, bupivacaine, mepivacaine, procaine, cocaine Depolarizing D-tubocurarine, atracurium, pancuronium Nondepolarizing succinylcholine... 

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