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Neuromuscular Blocking Agents: Suxamethonium (Succinylcholine)

Neuromuscular blocking agents include depolarizing agents like suxamethonium which causes rapid paralysis but has risks of hyperkalemia and malignant hyperthermia, and non-depolarizing agents which compete for acetylcholine receptors and decrease its release. Non-depolarizing agents have less severe side effects and include vecuronium, atracurium, rocuronium, and mivacurium which is the shortest acting but has slow onset of action.

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463 views5 pages

Neuromuscular Blocking Agents: Suxamethonium (Succinylcholine)

Neuromuscular blocking agents include depolarizing agents like suxamethonium which causes rapid paralysis but has risks of hyperkalemia and malignant hyperthermia, and non-depolarizing agents which compete for acetylcholine receptors and decrease its release. Non-depolarizing agents have less severe side effects and include vecuronium, atracurium, rocuronium, and mivacurium which is the shortest acting but has slow onset of action.

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Montaser Badran
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Neuromuscular blocking agents

Depolarizing Agents : Suxamethonium (succinylcholine)


drug kinetics uses contraindications Adverse effects
Suxamethonium Short acting To allow rapid 1- In pts with 1- Hyperkalemia
muscle relaxant intubation in the recent burns (in normal
trachea (hyperkalemia). patients K rise
. ok in the first by 0.2- 0.4
For modification of 24 hr mmol\L..
fits after 2- Raised K levels 2- Malignant
electroconvulsive 3- Spinal cord Hyperthermia
therapy trauma causing 3- Anaphylaxix
paraplasia.. can 4- CVS:
be given bradycardia,
immediately can be
after the injury prevented by
(but avoid it giving Atropin
btw day 10 and 5- CNS: raised
day 100) intracranial
** give with pressure and
caution in intraocular
patients known pressure
to have atypical 6- Prolonged
plasma paralysis..
cholinesterase Succinylcholine
or muscle Apnea\ read
diseases doseye
7- Muscle pain

Non- depolarizing reagents (compete, also work on the presynaptic receptors to decrease Ach
release)
Ve: very short ,, Pan,, Atra,, Rocu,, Miva
Drug kinetics uses contraindications Side effects
A) Vecuronium Short acting relaxant Cardiovascular
effects are minimal
Doesn’t have to be
refrigerated ^_^ Histamine release is
minimal
Excreted in bile and
urine.. in renal failure Placental transfer is
t1\2 slightly prolonged minimal

B) Pancuroinum Onset in 3-5 minutes Cardiovascular ..


Duration 45-60 minutes increased HR, BP,
CO ‫عكس السكسينيل‬
60-80% is excreted
through the kidneys, Respiratory
the remainder through depression and
the liver in the bile,, so apnea ‫متل سكسينسل‬
avoid it in pts with renal
impairment Rashes, flushing,
sweating

Histamine release is
minimal

Placental transfer is
minimal

** can be used
safely in pts with
asthma
C) Atracurium In 25% of cases, Should not be Histamine release is
recovery within 35 to administered before a concern ( same as
45 minutes, and induction of succinylcholine and
recovery is 95% after 60 unconsciousness tubocurare)
minutes
Should not be mixed Note that cardiac
in the same syringe effects can be
with ALKALINE neglected
solutions
(barbiturates)
D) Rocuronium CVS.. minimal
effects, but with
large doses: increase
HR, BP (due to
vagolytic effect)

Respiratory: no
significant Histamine
release,
bronchospasm is
extremely rare
C) Mivacurium The shortest acting Used for rapid Can’t be used for
non-depolarizing agentprocedures that emergent conditions
but has slow onset of require full because it has
action muscle delayed onset of
relaxation and action
airway
Metabolized by plasma manipulation
cholinesterases (like such as ENT
suxamethonium) surgeries
It’s advantage
over
succhinylcholine
is that it
produces no
muscle pain

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