The response to neuromuscular blocking agents, as exemplified by suxamethonium and tubocurarine, may differ between symmetrical muscles. Increased rates of stimulation and fatigue both increase sensitivity to blocking agents. During recovery from suxamethonium block muscles may show a transitory failure to react to each stimulus with a contraction. Fatigue caused by prolonged indirect stimulation is prevented equally well by suxamethonium and tubocurarine in doses producing a complete block. The mechanism and significance of these findings are discussed.Sensitivity to neuromuscular blocking agents varies between different muscles; for instance, the external muscles of the eye are paralysed by smaller doses than are necessary to paralyse the muscles of the limbs (Paton, 1953). These disparities may be related to the frequency of the impulses which the various muscles receive in vivo from the central nervous system. This rate is much higher in the external ocular muscles than in those of the extremities (Denny-Brown, 1929;Adrian and Bronk, 1929; Cooper and Eccles, 1930). Quantitative studies on the influence of rate of stimulation on neuromuscular block have been made in the rat phrenic nerve-diaphragm preparation (Chou, 1947), in dogs by means of electromyograms (Guyton and Reeder, 1949), in cats and dogs with regard to respiratory depression (Li, Jacobs, Aviado, and Schmidt, 1952), and in the rat sciatic nerve-gastrocnemius preparation (Preston and Maanen, 1953). All these investigations showed that increased frequency of stimulation resulted in a decrease in the amount of drug required to produce the same degree of block.The response to blocking agents may also be altered by fatigue because during fatigue, as in partial block, the twitch tension of the muscle is diminished (Gilson, Schoepfle, and Walker, 1947;Brown and Burns, 1949). Symptoms resembling those that follow violent exercise may appear in man after an injection of suxamethonium though not after tubocurarine (Churchill-Davidson, 1954;Price, 1954).The experiments described in this paper, some of which have been briefly reported (Wislicki, 1956), concern the influence exerted by variations in the rate of stimulation and by fatigue on the paralysis caused by suxamethonium and tubocurarine. The effect of prolonged block on the response of the muscle to a further dose of the same drug was also investigated. Suxamethonium chloride and tubocurarine chloride were the blocking agents used. Doses are given in terms of these salts. In those animals which received
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