The Effect of Tubocurarine and Alcuronium on Suxamethonium-Induced Changes in Cardiac Rate and Rhythm

Abstract

The effect of prior administration of tubocurarine ( 5 mg) or alcuronium ( 3 mg) on changes in cardiac rate and rhythm caused by the second dose of suxamethonium ( 1 mg/kg) during halothane-nitrous oxide-oxygen anaesthesia was studied in 60 patients. Tubocurarine and, particularly alcuronium were found to prevent bradyarrhythmias caused by the second dose of suxamethonium. These non-depolarizing relaxants had a moderate stabilizing action on the cardiac rhythm also during intubation and the commencement of artificial ventilation. The relaxation obtained by the first dose of suxamethonium (1 mglkg) was sufficient to permit quiet intubation in all cases.The use of a non-depolarizing muscle relaxant prior to suxamethonium during halothane-nitrous oxide-oxygen anaesthesia is recommended. 42, 501. GOLOGORSKY, V. A. & UMANOV, J. M. (1970) The mechanism of succinylcholine effect on heart rate and rhythm. Progress in Anaesthesiology (Proc.

Halothane Anaesthesia and Suxamethonium II The Significance of Preoperative Gallamine Administration

“…MATHIAS et al (1970) and KARHUNEN et al (1 972) found that prior administration of small doses of the non-depolarizing muscle-relaxants tubocurarine, alcuronium, c-toxiferine and pancuronium protected against these arrhythmias. This difference between our results with gallamine and the results of MATHIAS et al (1970) and KARHUNEN et al (1972) with the other non-depolarizing muscle-relaxants can, of course, be explained assuming gallamine to have a lesser ability than the other relaxants to prevent the bradyarrhythmias. However, the studies of MATHIAS et al (1970) and KARHUNEN et al (1972) are not directly comparable with the present study.…”

“…This difference between our results with gallamine and the results of MATHIAS et al (1970) and KARHUNEN et al (1972) with the other non-depolarizing muscle-relaxants can, of course, be explained assuming gallamine to have a lesser ability than the other relaxants to prevent the bradyarrhythmias. However, the studies of MATHIAS et al (1970) and KARHUNEN et al (1972) are not directly comparable with the present study. In the study of KARHUNEN et al (1972), atropine 0.01 mg/kg (and pethidine 1 mg/kg) were given intramuscularly 30 min before anaesthesia, and the patients were intubated.…”

“…Precurarization with small doses of nondepolarizing muscle-relaxants has been shown to have a certain protective effect against suxamethonium-induced changes in cardiac rate and rhythm ( MATHIAS et al 1970, KARHUNEN et al 1972. Gallamine, being a commonly used non-depolarizing musclerelaxant, has, however, to our knowledge never been investigated in this respect.…”

Effects of Precurarization on the Blood Pressure and Heart Rate Changes Induced by Suxamethonium Facilitated Laryngoscopy and Intubation

“…The incidence was highest in the pancuronium group, whereas in the alcuronium group only one patient showed a marked change in cardiac rhythm. This is in agreement with the results of KARHUNEN et al (1972), who found that d-tubocurarine and alcuronium pretreatments had a moderate stabilizing action on the cardiac rhythm during intubation. On the other hand, MATHIAS et al (1970) showed that bradycardia caused by a second dose of suxamethonium in man can be prevented in the same manner by d-tubocurarine, alcuronium and pancuronium.…”

Halothane Anaesthesia and Suxamethonium III. Atropine 30 s Before a Second Dose of Suxamethonium During Inhalation Anaesthesia: Effects and Side‐Effects

“…MARTIN (1958) and BULLOUGH (1959) were the first to report that intermittent injections of suxamethonium in adults may provoke serious bradycardia. Several methods have been proposed to prevent this bradycardia : for example, the preanaesthetic administration of atropine or a small dose of a nondepolarizing muscle-relaxant (LEIGH et al 1957, LUPPRIAN & CHURCHILL-DAVIDSON 1960, KARHUNEN et al 1972. We have shown previously, however, that preanaesthetic intravenous injection of atropine before halothane inhalation anaesthesia does not protect against severe bradycardia following the second dose of suxamethonium, unless doses of atropine are used which cause potentially dangerous tachycardia (VIBY-MOGENSEN et al 1976).…”