THE EFFECT OF SOME GURARIZING DRUGS IN UNANAESTHETIZED MAN. II: Succinylcholine Iodide and Its Bis‐Monoethyl‐Substituted Derivative in Continuous Intravenous Infusion

Poulsen, H; Hougs, Willy

doi:10.1111/j.1399-6576.1958.tb05256.x

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…The finding could also indicate that the phenomenon of tachyphylaxis and the alteration in the mode of action of suxamethonium might be closely related. It has been reported in man that tachyphylaxis develops after repeated or continuous injection of suxamethonium (Poulsen & Hougs, 1958;Payne & Holmdahl, 1959;Katz et al, 1963;Crul et al, 1966;Katz & Ryan, 1969). These reports differ, however, in the percentage of patients who developed tachyphylaxis.…”

mentioning

confidence: 39%

“…If suxamethonium is administered repeatedly or continuously either to man or to animals, its neuromuscular blocking activity is reduced as repeated or continuous administrations proceed (Mohelsky & Ruben, 1953;Hodges & Foldes, 1956;Stenberg & Orndahl, 1956;Poulsen & Hougs, 1958;Iwatsuki, Yamada, Ueda, Nishimura & Kanemaru, 1958;Payne & Holmdahl, 1959;Katz, Wolf & Papper, 1963;Crul, Long, Brunner & Coolen, 1966;Katz & Ryan, 1969). This tachyphylaxis has been most frequently studied by the use of single twitch contractions of skeletal muscle; the response of tetanic contractions of skeletal muscle has been less extensively examined in such studies during the administration of suxamethonium.…”

Section: Introductionmentioning

confidence: 99%

“…These reports differ, however, in the percentage of patients who developed tachyphylaxis. Poulsen & Hougs (1958) used a continuous infusion in conscious subjects and reported that 73.3% of the patients studied developed a tachyphylaxis. Payne & Holmdahl (1959) used an intermittent dose of 10 mg and reported that 73.9% of the patients developed tachyphylaxis under light trichloroethylene and nitrous oxide anaesthesia.…”

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confidence: 99%

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The skeletal muscle response to the repeated administration of suxamethonium and its interaction with edrophonium in anaesthetised man.

Sugai¹,

Hughes²,

Payne³

1975

Brit J Clinical Pharma

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1 Tetanic and single twitch contractions of the adductor pollicis muscle in man were recorded during repeated injections of suxamethonium (0.2 mg/kg or 0.1 mg/kg) every 15 minutes. 2 Tachyphylaxis to suxamethonium developed rapidly in every patient studied when single twitch contractions were observed but tetanic contractions later showed an increasingly prolonged recovery with repeated injections. 3 Edrophonium administered at the point of 50% recovery of the tetanic contractions in *patients given suxamethonium (0.2 mg/kg) repeatedly first potentiated the blockade but when the tachyphylaxis had developed fully on the single twitch, usually after the third or fourth injection, the blockade of the tetanic contractions was reversed. 4 These findings indicate that the tachyphylaxis and the change in the nature of the blockade produced by suxamethonium in man take place at the same time and might be part of the same phenomenon.

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confidence: 39%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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The skeletal muscle response to the repeated administration of suxamethonium and its interaction with edrophonium in anaesthetised man.

Sugai¹,

Hughes²,

Payne³

1975

Brit J Clinical Pharma

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“…The diversity of these changes is great. Thus, an ittoease in artmial bloodpressure has been observed by many authors (4, 22, 25, 33-36, 38, 44, 46, 57, 62-65, 71,91,93,94,99,102,108,117,130,131,137,139,142,143,153,158,162,163,166,170,189,194,199,204,208,212,216,220,222,228,229,244,245,259,260,267,269,274,276,277,281,290,[295][296][297][298]301), while a &crease in arterial bloodpressure m a y also occur…”

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confidence: 77%

Circulatory Effects of Succinylcholine in Man

Gräf

Ström

Wåhlin

1963

Acta Anaesthesiol Scand

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SUMMARY The effects of intravenous (standard apnoeic) and intra‐arterial doses of succinylcholinc chloride (SCh) on peripheral circulation (forearm, hand, skeletal musculature, skin, mucosa of the sigmoid colon), arterial blood pressure and heart rate were studied in 15 unanaesthetized and 17 anaesthetized subjects. Standard apnoeic doses of SCh injected intravenously in anaesthetized subjects produced circulatory changes usually of a biphasic character, a sudden initial decrease in peripheral blood flow and heart rate followed by an increase throughout The apnoeic period; there was also a rise in arterial blood pressure. The initial decrease occurred synchronously with the preparalytic activity of the skeletal musculature (twitchings), but unlike the latter also after repeated injections of SCh. The magnitude of the initial decrease was, on an average, 16 per cent for the peripheral circulation, and 7 per cent for heart rate. The subsequent average increase amounted to 16 per cent above the initial control value for the peripheral circulation, 8 per cent (5 mm Hg) for the systolic, 21 per cent (6 mm Hg) for the diastolic and 9 per cent (4 mm Hg) for the mean arterial blood pressures. Doses of SCh which caused local muscular relaxation on continuous infusion into the brachial artery of unanaesthetized subjects also caused an average blood flow increase in forearm and hand of 43 per cent. This blood flow response remained only during the first few minutes, and then gradually decreased to the control level during the course of the next 10–15 minutes. After the second or third repeated intravenous injection of SCh, but not after further injections, a sudden and marked bradycardia sometimes occurred, with a duration of up to 3 minutes. With repeated intravenous injections of SCh in a standard apnoeic dose, the size and duration of both the circulatory reactions and the duration of the apnoeic period gradually decreased (‘tachyphylaxis’). The individual sensitivity to SCh was rather variable. This was particularly evident in patients with a labile and hyperkinetic circulation (‘vasoregulatory asthenia’) in whom the average blood flow increase during continuous intra‐arterial infusion of SCh was considerably higher than in the control group. The circulatory changes after an intravenous injection of an apnoeic SCh dose should be evaluated in relation to the various interfering factors, such as anaesthesia, atropine premedication, endotracheal intubation, positive‐pressure ventilation, hypoxia, hypercapnia, hypothermia during anaesthesia, and acidosis. The possible mechanisms by which SCh exerts its circulatory effects are discussed, especially the direct effects on the vessels and heart and the indirect effects via nervous or humoral mediators. It is concluded that SCh seems to be a general vasodilator substance. A review of the literature shows that the vasodilator effect of SCh also exists in circulatory areas of the body not directly studied in the present investigation. The vasodilatation is partially caused by a ...

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“…203 Its first manifestation is a gradually decreasing sensitivity (tachyphylaxis) to the effects of repeated identical doses. 2 0 1 , 285,317,318,381 This °ln terms of milligrams per kilograrn of body weight. decreased sensitivity to depolarizing relaxants is accompanied by an increased sensitivity to nondepolarizing agents.…”

Section: Neuromuscular Transmission and Neuromuscular Block In Manmentioning

confidence: 99%

The pharmacology of neuromuscular blocking agents in man

Foldes

1960

Clin Pharma and Therapeutics

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Because of great species variation in the effectsThe pharmacology of neuromuscular blocking agents has been studied extensively in laboratory animals and has been the subject of numerous publications. Because of the large quantitative and qualitative species variation in the neuromuscular and other effects of relaxants,125,303,406 the results of animal experiments are frequently not applicable to man and it has been emphasized repeatedly that their pharmacologic actions should be studied in human subjects. 124 ,304.376,382 Considerable information is available on the human pharmacology of neuromuscular blocking agents in monographs 124 ,331 and symposia,321,368 but so far no attempt has been made to review in a single publication the literature on the human pharmacology of muscle relaxants.In the foUowing pages an attempt will be made to correlate the pharmacologic effects of neuromuscular blocking agents with their safe and efficient clinical administration. This survey will deal primarily with the quaternary ammonium type myoneural blocking agents and, of these, only those compounds will be discussed which have been widely used clinically or the study of which serves to emphasize basic principles of the human pharmacology of relaxants.The list of neuromuscular blocking agents to be reviewed is presented in Table 1.Limitations inherent in the pharmacologic study of any drug in human subjects have also influenced the investigation of neuromuscular blocking agents. Thus, little or no information is available on their acute and chronic toxicity in man and, with few exceptions, all observations were made in the intact organism, instead of on isolated nerve-muscle preparations. On the other hand, in eonjunetion with their clinieal use, there has been ample opportunity to observe the influence of various pathologie conditions and of other drugs on the pharmacologic action of relaxant drugs. Further- 345

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THE EFFECT OF SOME GURARIZING DRUGS IN UNANAESTHETIZED MAN. II: Succinylcholine Iodide and Its Bis‐Monoethyl‐Substituted Derivative in Continuous Intravenous Infusion

Cited by 8 publications

References 5 publications

The skeletal muscle response to the repeated administration of suxamethonium and its interaction with edrophonium in anaesthetised man.

The skeletal muscle response to the repeated administration of suxamethonium and its interaction with edrophonium in anaesthetised man.

Circulatory Effects of Succinylcholine in Man

The pharmacology of neuromuscular blocking agents in man

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