The Need for Additional Succinylcholine after <i>d</i> -Tubocurarine

Freund, Felix G.; Rubin, Anthony P.

doi:10.1097/00000542-197202000-00025

Cited by 28 publications

(10 citation statements)

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“…However, it is important that any pretreatment regimen, devised to decrease the frequency of this complication should not only work, but be totally safe. It is well documented that the use of subparalysing doses of non-depolarizing neuromuscular blockers decreased the neuromuscular blocking activity of suxamethonium (Cullen, 1971;Freud and Rubin, 1972), and this occurred in this small series also.…”

Section: Discussionsupporting

confidence: 59%

“…The first twitch in the train-of-four is in itself an unconditioned twitch as long as it is not preceded by any other nerve stimulation in the preceding 10 s (Lee and Katz, 1980). This first unconditioned twitch was used to ascertain the maximum twitch depression during pretreatment, by measuring the height of the most depressed first twitch during pretreatment, and expressing it as a percentage of the control first twitch.…”

Section: Methodsmentioning

confidence: 99%

“…For example, subparalysing amounts of a non-depolarizing neuromuscular blocking drug have been given before injection of suxamethonium (Foster, 1960;White, 1962). Most of the non-depolarizing agents have been used with varying degrees of success, but interactions between these drugs and suxamethonium have caused further problems, of which the most frequent is a decrease in the neuromuscular blocking activity of suxamethonium (Freud and Rubin, 1972;Brodsky, Brock-Utne and Samuels, 1979).…”

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confidence: 99%

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Suxamethonium: A New Look at Pretreatment

Masey

Glazebrook

Goat

1983

British Journal of Anaesthesia

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Fifty patients were pretreated with either suxamethonium 10 mg or gallamine 20 mg before an injection of suxamethonium 1 mg kg-1. The effect of the pretreatment upon neuromuscular transmission was monitored by recording the mechanical response of the adductor pollicis muscle to indirect stimulation, using a 2-Hz train-of-four stimulus repeated every 12 s. The pretreatment injection of suxamethonium caused fasciculation in one-quarter of the patients studied. Significant neuromuscular blockade occurred during pretreatment in 16 of the 25 patients investigated. Pretreatment with gallamine 20 mg predictably decreased the efficacy of the intubating injection of suxamethonium, making intubation more difficult. The frequency of muscle pain was similar in both groups.

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Section: Discussionsupporting

confidence: 59%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Suxamethonium: A New Look at Pretreatment

Masey

Glazebrook

Goat

1983

British Journal of Anaesthesia

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“…In jedem Fall bewirkt die nichtdepolarisierende Substanz einen antagonistischen Effekt für das folgende Succinylcholin. Deshalb muss dessen Dosis erhöht werden [10]. Damit steigt aber wieder die Inzidenz potentieller Nebenwirkungen.…”

Section: Ergebnisseunclassified

Anwendung von Muskelrelaxanzien zur Routineeinleitung in Deutschland

Geldner¹,

Fuchs-Buder²,

Hofmockel

et al. 2003

Der Anaesthesist

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The aim of this study was to evaluate the use of muscle relaxants during induction of anesthesia in patients without risk of aspiration of stomach contents. Of the 2,996 questionnaires sent out, 2,054 (68.6%) could be analysed and the results show that succinylcholine is used regularly in 13.6% of anesthesia departments. The next most commonly used muscle relaxants are atracurium, vecuronium and mivacurium, followed by cis-atracrium, rocuronium and pancuronium. Alcuronium is the least frequently used muscle relaxant. During induction of an elective anesthesia procedure, a priming technique is used by 19% of anesthesiologists, 22% utilize precurarization, and a timing technique is performed in 7.1%. The use of muscle relaxants for on-going relaxation follows the same pattern as for induction of neuromuscular blockade and succinylcholine is used in 1.4% if further relaxation is needed. The desire for specific qualities of muscle relaxants is correlated with higher use of the specific substance: short onset time for rocuronium, good controllability with mivacurium, no side-effects with cisatracurium and economical aspects with alcuronium. Of the participants 76.6% voiced the desire for a non-depolarizing replacement for succinylcholine.Private practices use mivacurium more often than hospitals, level one hospitals use rocuronium and cisatracurium more often. This survey could not show a definite standard of use in terms of muscle relaxants for an elective case.Precurarization, priming and timing are used frequently in patients not at risk of aspiration. This should be reduced by on-going teaching.

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“…It is hydrolysed by plasma cholinesterase at a rate 70% of that of suxamethonium [3]. The effects of the interaction between suxamethonium and nondepolarizing neuromuscular blocking agents depend upon the order of administration and doses used [4][5][6][7][8][9][10][11][12][13][14][15][16]. Previous studies of the effects of suxamethonium on the neuromuscular effects of subsequently administered non-depolarizing neuromuscular blocking drugs in patients have produced conflicting results.…”

mentioning

confidence: 99%

Dose-response studies of the interaction between mivacurium and suxamethonium

Naguib

Abdulatif

Selim

et al. 1995

British Journal of Anaesthesia

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We have determined the effect of pretreatment with mivacurium on the potency of suxamethonium and the effect of prior administration of suxamethonium on the potency of mivacurium. We studied 100 ASA I or II patients during thiopentone-fentanyl-nitrous oxide-isoflurane anaesthesia. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 12-s intervals). Single dose-response curves were determined by probit analysis. Pretreatment with mivacurium had a marked antagonistic effect on the development of subsequent depolarizing block produced by suxamethonium. The dose-response curves for suxamethonium alone and after pretreatment with mivacurium did not deviate from parallelism, but those constructed after mivacurium were shifted significantly to the right (P < 0.0001). The calculated doses producing 50% depression of T1 (ED50) were 86 (95% confidence intervals 83-88) and 217 (208-225) micrograms kg-1 for suxamethonium alone and after mivacurium, respectively. This study also demonstrated that prior administration of suxamethonium did not appear to influence either the slope of the regression lines or the potency of mivacurium. Combining the results of this study with a previous study (mivacurium ED50 = 20.8 (20.3-21.3) micrograms kg-1 during isoflurane-nitrous oxide anaesthesia), we suggest that the potency of mivacurium did not differ from that observed after suxamethonium (17.4 (16.9-17.9) micrograms kg-1).

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The Need for Additional Succinylcholine after d -Tubocurarine

Cited by 28 publications

References 0 publications

Suxamethonium: A New Look at Pretreatment

Suxamethonium: A New Look at Pretreatment

Anwendung von Muskelrelaxanzien zur Routineeinleitung in Deutschland

Dose-response studies of the interaction between mivacurium and suxamethonium

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