Neuromuscular blockers
:Or post-synaptically
non-depolarizing (competitive)- 1
depolarizing (non-competitive)- 2
Succinylcholine.
Decamethonium.
cardiac arrest )
by : Amaal Nabil sadek
Depolarizing (non-competitive):
succinylcholine (partial agonist )
Its action involves 2 phases:
phase 1 (depolarization):
ventilation) .
by : Amaal Nabil sadek
Pharmacokinetics
(non-depolarizing)
All NM blockers are injected IV.
( as all of them highly polar
compounds & so poor lipid soluble
(limit entry to CNS),,, inactive orally)
MANY OF THEM ARE NOT
METABOLIZED, & then excreted
unchanged in urine like
tubocurarine or bile like vecuronium
by : Amaal Nabil sadek
Atracurium is degraded spontaneously in
plasma by esterase enzyme (Hofmann
elimination) , in addition to liver
metabolism, so it is relatively safe in hepatic
or renal patients. .
pseudocholinesterase.
Usually given by continuous
infusion.
by : Amaal Nabil sadek
Adverse effects of
:depolarizing NMBs
Malignant hyperthermia.
Hyperkalemia.
Apnea.
Post-operative muscle pain.
Increase intraocular & gastric
pressure.
by : Amaal Nabil sadek
Malignant hyperthermia:
When taken with halothane.
Sk. Muscles fail to sequester Ca in sarcoplasmic
reticulum
Muscular rigidity & hyperthermia.
In genetically susceptible.
Treatment:
1- Rapidly cooling.