Effect of an Intubating Dose of Succinylcholine and Atracurium on the Diaphragm and the Adductor Pollicis Muscle in Humans

Abstract

This study compares the neuromuscular blocking effect of succinylcholine (0.8 mg • kg−1) and atracurium (0.6 mg • kg−1) on the diaphragm (D) and the adductor pollicis (AP) in 20 patients anesthetized with nitrous oxide, oxygen, and fentanyl. The diaphragm was monitored by measuring transdiaphragmatic pressure following bilateral phrenic nerve stimulation. After succinylcholine, the time from injection of succinylcholine to maximum depression of the single twitch response (onset time) was of 50 ± 11 s (±SD) for D compared to 80 ± 24 s for AP (P < 0.001). After succinylcholine, recovery from paralysis was earlier for D than AP. Single twitch height (TH) returned to 25% of its control value (T25) after 5 ± 2 min for D compared to 7 ± 3 min for AP (P < 0.001). Complete recovery of TH (T100) was achieved after 9 ± 4 min for D and 11 ± 5 min for AP (P < 0.01). Recovery index (T25–75) was of 2 ± 1 min for both muscles. After atracurium, the onset time for D was of 137 ± 31 s compared to 181 ± 45 s for AP (P < 0.001). The T25 was achieved after 38 ± 7 min for D compared to 63 ± 13 min for AP (P < 0.001). The TH of D returned to T100 after 60 ± 12 min compared to 87 ± 17 min for AP (P < 0.01). The train-of-four ratio returned to 1 after 64 ± 15 min for D compared to 99 ± 21 min for AP (P < 0.001). After an intubating dose of succinylcholine (0.8 mg • kg−1) or atracurium (0.6 mg • kg−1), D was always completely paralyzed, when the TH of AP was abolished and the TH of D had completely recovered when the TH of the AP had returned to 100%.

Succinylcholine and vecuronium blockade of the diaphragm, laryngeal and limb muscles in the anaesthetized goat

“…7 However, both onset time and duration of depolarizing and nondepolarizing blockade were shorter in the masseter, laryngeal adductor muscles and the diaphragm than in limb muscles. [4][5][6][7][8][9]25 The current results are in agreement with the latter. On the other hand, studies comparing the responses of laryngeal muscles and the diaphragm to NMBDs have yielded conflicting results.…”

Evaluation of Tracheal Intubating Conditions and Serum Potassium Levels With Different Doses of Succinylcholine : A Prospective Randomized Comparative Study

“…It can be explained on the basis of the fact that neuromuscular block develops more rapidly in the airway than in the thumb. 16,17 Donati et al 18 also reiterated similar fact suggesting that time to maximum blockade was shorter for vocal cords than for the adductor pollicis while using lower doses of succinlycholine.…”

Influence of stimulus frequency on blockade induced by pancuronium and rocuronium: study on rats phrenic nerve-diaphragm preparation

“…Consequently, a larger number of neuromuscular blocker molecules may reach the neuromuscular junction at a shorter time interval 1,3,15 . Muscle blood fl ow is important because muscles close to the central circulation and with a better perfusion such as the diaphragm tend to be more rapidly paralyzed than peripheral and less perfused muscles such as the adductor pollicis 16,17 . Another explanation is that more frequent stimulation may lead to neurotransmitter depletion at the stimulation site, causing a greater and earlier blockade of muscle response 7,14,18 .…”