Relaxants
Muscle Relaxants
Muscle Relaxants
Muscle Relaxants
Muscle Relaxants
Neuromuscular junction
Nerve terminal
Motor endplate of a muscle
Synaptic cleft
Nerve stimulation
Release of Acetylcholine (Ach)
Postsynaptic events
Neuromuscular Junction
(NMJ)
Muscle Relaxants
Succinylcholine
Nondepolarizing muscle
relaxants
Short acting
Intermediate acting
Long acting
Depolarizing Muscle
Relaxant
Succinylcholine
What is the mechanism of action?
Depolarizing Muscle
Relaxant
Succinylcholine
Depolarizing Muscle
Relaxant
Succinylcholine
What is phase I neuromuscular
blockade?
Depolarizing Muscle
Relaxant
Succinylcholine
Does it has side effects?
Cardiovascular
Fasciculation
Muscle pain
Increase intraocular pressure
Increase intragastric pressure
Increase intracranial pressure
Hyperkalemia
Malignant hyperthermia
Nondepolarizing Muscle
Relaxants
Nondepolarizing Muscle
Relaxants
Long acting
Intermediate acting
Pancuronium
Atracurium
Vecuronium
Rocuronium
Cisatracurium
Short acting
Mivacurium
Nondepolarizing Muscle
Relaxants
Pancuronium
Aminosteroid compound
Onset 3-5 minutes, duration 60-90
minutes
Intubating dose 0.08-0.12 mg/kg
Elimination mainly by kidney (85%),
liver (15%)
Side effects : hypertension, tachycrdia,
dysrhythmia,
Nondepolarizing Muscle
Relaxants
Vecuronium
Analogue of pancuronium
much less vagolytic effect and shorter
duration than pancuronium
Onset 3-5 minutes duration 20-35
minutes
Intubating dose 0.08-0.12 mg/kg
Elimination 40% by kidney, 60% by liver
Nondepolarizing Muscle
Relaxants
Atracurium
Metabolized by
Ester hydrolysis
Hofmann elimination
Nondepolarizing Muscle
Relaxants
Cisatracurium
Isomer of atracurium
Metabolized by Hofmann elimination
Onset 3-5 minutes, duration 20-35
minutes
Intubating dose 0.1-0.2 mg/kg
Minimal cardiovascular side effects
Much less laudanosine produced
Nondepolarizing Muscle
Relaxants
Rocuronium
Analogue of vecuronium
Rapid onset 1-2 minutes, duration 2035 minutes
Onset of action similar to that of
succinylcholine
Intubating dose 0.6 mg/kg
Elimination primarily by liver, slightly
by kidney
Alteration of responses
Temperature
Acid-base balance
Electrolyte abnormality
Age
Concurrent diseases
Drug interactions
Alteration of responses
Concurrent diseases
Neurologic diseases
Muscular diseases
Myasthenia gravis
Myasthenic syndrome (Eaton-Lambert
synrome)
Liver diseases
Kidney diseases
Alteration of responses
Drug interactions
Inhalation agents
Intravenous anesthetics
Local anesthetics
Neuromuscular locking drugs
Antibiotics
Anticonvulsants
Magnesium
Monitoring
Neuromuscular
Function
Monitoring
Neuromuscular
Function
How to monitor?
Clinical signs
Use of nerve stimulator
Monitoring
Neuromuscular
Function
Clinical signs
Monitoring
Neuromuscular
Function
Antagonism of
Neuromuscular
Blockade
Effectiveness of anticholinesterases
Anticholinesterases
Neostigmine
Onset 3-5 minutes, elimination halflife 77
minutes
Dose 0.04-0.07 mg/kg
Pyridostigmine
Edrophonium
Antagonism of
Neuromuscular
Blockade
Inhibiting activity of
acetylcholineesterase
More Ach available at NMJ, compete for
sites on nicotinic cholinergic receptors
Action at muscarinic cholinergic receptor
Bradycardia
Hypersecretion
Increased intestinal tone
Antagonism of
Neuromuscular
Blockade
Atropine
Scopolamine
glycopyrrolate
Reversal of
Neuromuscular
Blockade
Goal : re-establishment of
spontaneous respiration and
the ability to protect airway from
aspiration