Effects of Succinylcholine on the Pharmacodynamics of Pipecuronium and Pancuronium

Abstract

To study the effects of succinylcholine on subsequent pharmacodynamics of nondepolarizing muscle relaxants, a comparative pharmacodynamic study was carried out in patients having balanced anesthesia (thiopental, fentanyl, nitrous oxide/oxygen) in whom equipotent doses of pipecuronium (80 micrograms/kg) and pancuronium (100 micrograms/kg) were given with or without prior administration of succinylcholine (1 mg/kg). Fifty-two patients were randomly assigned to one of the following four groups: 1, pancuronium (100 micrograms/kg); 2, pipecuronium (80 micrograms/kg); 3, succinylcholine (1 mg/kg) plus pancuronium (100 micrograms/kg); and 4, succinylcholine (1 mg/kg) plus pipecuronium (80 micrograms/kg). In groups 3 and 4, the nondepolarizing relaxant was given after succinylcholine when the twitch height recovered to 75% of its control value. For maintenance of neuromuscular blockade, additional increments of pancuronium (20 micrograms/kg) or pipecuronium (15 micrograms/kg) were given. Neuromuscular function was monitored throughout induction, maintenance, spontaneous recovery, and pharmacologic reversal of the neuromuscular block. Mean onset times for pancuronium (group 1) and pipecuronium (group 2) given without succinylcholine were (mean +/- SEM) 2.5 +/- 0.3 and 2.8 +/- 0.2 min, respectively. Mean onset times (times to maximum twitch depression) of the two drugs given after succinylcholine (groups 3 and 4) were significantly shorter (1.4 +/- 0.4 and 1.6 +/- 0.1 min, respectively). Clinical durations (i.e., until 25% twitch recovery of pancuronium and pipecuronium) were not significantly different among the four groups, varying from 81.1 +/- 5.4 (group 4) to 107.0 +/- 17.0 (group 2) min.(ABSTRACT TRUNCATED AT 250 WORDS)

Halothane augments the interaction between succinylcholine and pancuronium

“…Our finding suggests that even the intubating dose of succinylcholine induces the phase II block and thereby increases the pancuronium-induced neuromuscular block during halothane anesthesia. This potentiation by halothane may explain the differences among the previous reports [1][2][3] on the interaction between succinylcholine and pancuronium.…”

Neuromuscular effects of pipecuronium during sevoflurane anesthesia compared with isoflurane and enflurane anesthesia

“…Dubois et al 10 demonstrated that prior administration of succinylcholine shortened the onset time of pancuronium and pipecuronium but did not modify the clinical duration. In his study, the nondepolarizing neuromuscular blocking agents pipecuronium and pancuronium were administrated before full succinylcholine recovery, and the twitch height was 75% of the control level.…”

Adverse Effects of Nondepolarising Neuromuscular Blocking Agents

“…These were seen in patients maintained with halothane-nitrous oxide anaesthesia (Scott & Norman 1989). Pipecuronium may similarly be associated with bradycardia (Dubois et al 1991), as well as decreased cardiac output, even in the absence of bradycardia (Wierda et al 1990a).…”

“…Potentiation of small doses of atracurium (0.15 mglkg) following suxamethonium has been demonstrated (Stirt et al 1983) while large doses (0.24 mglkg) of doxacurium are not potentiated by prior suxamethonium administration (Katz et al 1988). A recent study failed to demonstrate significant potentiation of large (> ED95) doses of pancuronium or pipecuronium following suxamethonium (Dubois et al 1991). Other studies have demonstrated increased block intensity following pancuronium 0.02 mg/kg or tubocurarine 0.1 mg/kg.…”

“…Other studies have demonstrated increased block intensity following pancuronium 0.02 mg/kg or tubocurarine 0.1 mg/kg. Most data indicate that prior administration of suxamethonium has little or no effect on subsequent large doses ofNDMRs approximating ED95, whereas smaller doses are potentiated by prior suxamethonium administration (Dubois et al 1991;Katz 1971;Katz et al , 1988Stirt et al 1983). …”