Rocuronium Mivacurium

Vecuronium Rocuronium Pancuronium Atracurium Cis-atracurium Mivacurium Gallamine Tubocurare... 

Nondepolarizing Blockers d-Tdbocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium, and Rapacuronium... 

Agent Tubocuranine Pancuronium Vecuronium Atracurium Rocuronium Cisatracurium Mivacurium Cis-trans isomer Trans-trans isomer C/s-c/s isomer... 

Clinically important, potentially hazardous interactions with cisatracurium, erythromycin, kaolin, mivacurium, rocuronium, saquinavir... 

Clinically important, potentially hazardous interactions with abarelix, amisulpride, arsenic, astemizole, ciprofloxacin, enoxacin, gatifloxacin, glycopyrrolate, glycopyrronium, imidapril, lomefloxacin, mivacurium, moxifloxacin, nilotinib, norfloxacin, ofloxacin, quinolones, rocuronium, sparfloxacin, zofenopril... 

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. 

B. Neuromuscular blockers provide prompt flaccid paralysis to facilitate orotracheal intubation. The preferred agents for this purpose are rapid-onset agents such as succinylcholine, rapacurium, mivacurium, rocuronium, and vecuronium. They also are used to treat laryngospasm. 

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. 

Anticipate the need to use more (possibly up to twice as much) doxacu-rium, metocurine, pancuronium, pipecuronium, rocuronium and vecuronium in patients who have taken these antiepileptics for more than a week, and expect an accelerated recovery. The effects on tubocurarine and atracurium appear only to be small or moderate, whereas mivacurium appears not to interact. 

Kim KS, Chun YS, Choi SU, Suh IK. Neuromuscular intemction between cisatracurium and mivacurium, atracurium, vecurcnium or rocuronium administered in combination. Anaesthesia (1998) 53, 872-8. 

Naguib M. Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination. Anes iesiology (1994) 81,388-95. 

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