Dual Action of Suxamethonium Chloride

Brennan, H.J.

doi:10.1093/bja/28.4.159

Cited by 43 publications

(18 citation statements)

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“…Thus a tetanus and anticholinesterase drugs exert some antagonistic action, and tubocurarine augments the paralysis. Numerous reports have indicated that the blocks produced in man by the depolarizing type of muscle relaxant (for example decamethonium, suxamethonium and carbolonium) often change in type after prolonged administration (Grant, 1952;Guerrier & Huxley-Williams, 1954;Hodges, 1955;Argent, Dinnick & Hobbiger, 1955;Hodges & Foldes, 1956;Brennan, 1956;Foldes, Wnuck, Hodges, Thesleff & de Beer, 1957;Churchill-Davidson & Christie, 1959;Wiemers & Overbeck, 1960). Because, at a late stage of the block produced by these depolarizing drugs, a tetanus and neostigmine exert some antagonism, while tubocurarine augments the paralysis, many anaesthetists have concluded that the depolarization phase in man may give way to a competitive phase.…”

Section: Discussionmentioning

confidence: 99%

Effects of Some Polymethylene Bis(hydroxyethyl)dimethylammonium Salts on Neuromuscular Transmission

Bowman

Hemsworth

1965

British Journal of Pharmacology and Chemotherapy

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Section: Discussionmentioning

confidence: 99%

Effects of Some Polymethylene Bis(hydroxyethyl)dimethylammonium Salts on Neuromuscular Transmission

Bowman

Hemsworth

1965

British Journal of Pharmacology and Chemotherapy

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“…It may be assumed that a certain degree of membrane depolarization due to succinylcholine, made it possible for a reduced and nearly insufficient end-plate potential to reach the trigger level more safely, and so facilitate transmission. The absence of change in MIPI and the increase in jitter, effects normally seen after succinylcholine, may be due to a competitive action between curare and succinylcholine, which has been clinically and experimentally documented ( BRENNAN 1956). Higher doses of succinylcholine would perhaps have produced the effects described in the untreated end-plate.…”

Section: Results ( B )mentioning

confidence: 92%

Effect of Succinylcholine on Single Motor End‐plates in Man

Stålberg

Thiele

Hilton-Brown

1973

Acta Anaesthesiol Scand

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The effect of small doses of succinylcholine on nerJe muscle impulse transmission in situ was studied with single fibre electromyography. Extracellular muscle fibre action potentials were recorded at voluntary activation or on electrical stimulation. The results showed that the effect of succinylcholine was mainly localized in the the motor end-plate. An initial shortening of the neuromuscular delay, due to a slight depolarization, was followed by an increase in the neuromuscular transmission time of up to 3 ms, probably owing to an increased rise-time of the end-plate potential. I n some experiments a neuromuscular block appeared. After this, the neuromuscular transmission time was normalized within 30 s. The jitter, a measure of the variability in the neuromuscular delay, could usually be accurately measured only during the recovery phase after the maximal effect of succinylcholine. During the recovery phase it was considerably increased for a time period of up to 3 min. This jitter increase was most probably due to a reduced end-plate potential, that is, a desensitization to acetylcholine in the motor end-plate.Motor end-plates, even in the same motor unit, showed a great difference in sensitivity to succinylcholine. Tachyphylaxis also developed after the small doses administered, and lasted for at least 15 min.

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“…Several studies have documented potentiation of phase I block and antagonism of phase I1 block by anticholinesterases (1)(2)(3). With the advent of train-of-four monitoring, it became apparent that train-of-four fade could be used to separate phase I from phase I1 block (3,4).…”

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confidence: 99%

Antagonism of Phase II Succinylcholine Block by Neostigmine

Donati

Bevan

1985

Anesthesia & Analgesia

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The neuromuscular effect of neostigmine, 1.25 mgl70 kg, was assessed in 40 adult patients 10 min after cessation of a succinylcholine infusion. The patients had received a thiopental-nitrous oxide anesthetic supplemented by halothane or fentanyl during which they were given at least 5 mglkg succinylcholine over more than 90 min. Train-of-four monitoring was used. Neostigmine accelerated recovery of neuromuscular function in all patients. The degree of recovery was directly related to the train-of-four ratio, and the results in patients who had received halothane were 110 different from those who had received fentanyl. The findings are compatible with the hypothesis that phase I block depends upon the presence of circulating succinylcholine and decreases as the latter is cleared, whereas phase ll block decreases more slowly. Thus succinylcholine block can 6e antagonized by neostigmine if enough time is allowed for phase I block to disappear and for a pure phase 11 block to be present .Succinylcholine neuromuscular block changes from phase I (depolarizing) to phase II (nondepolarizing) during the intravenous infusion of succinylcholine, especially if prolonged. Several studies have documented potentiation of phase I block and antagonism of phase I1 block by anticholinesterases (1-3). With the advent of train-of-four monitoring, it became apparent that train-of-four fade could be used to separate phase I from phase I1 block (3,4). Using a wide range of succinylcholine doses administered by infusion, Lee (4) examined the effect of edrophonium given when first twitch height had recovered to 3040% of its initial value. He found that the succinylcholine block was antagonized by edrophonium when the train-of-four ratio, Tm1, was less than 0.4. However, when T4R1 was greater than 0.4, edrophonium was followed either by potentiation of the block or no change. The patients in Lee's study had received relatively small doses of succinylcholine, and edrophonium was probably given very shortly after cessation of succinylcholine infusion.In clinical practice, the need to antagonize succinylcholine block does not arise unless large doses have been given and some time has been allowed for ~~ ~~Received from the

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Dual Action of Suxamethonium Chloride

Cited by 43 publications

References 0 publications

Effects of Some Polymethylene Bis(hydroxyethyl)dimethylammonium Salts on Neuromuscular Transmission

Effects of Some Polymethylene Bis(hydroxyethyl)dimethylammonium Salts on Neuromuscular Transmission

Effect of Succinylcholine on Single Motor End‐plates in Man

Antagonism of Phase II Succinylcholine Block by Neostigmine

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