The Effects of Small Incremental Doses of d-Tubocurarine on Neuromuscular Transmission in Anesthetized Man

Heisterkamp, David V.; Skovsted, P.; Cohen, Peter J.

doi:10.1097/00000542-196905000-00006

Cited by 20 publications

(15 citation statements)

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“…potentiation and the block is desensitizing in nature ( de Jong and Freund, 1967). On the other hand, it has been suggested that after tubocurarine there is no fade and no post-tetanic potentiation (Heisterkamp, Skovsted and Cohen, 1969). Thus we have a reversal of the original concept.…”

mentioning

confidence: 60%

“…The present study was stimulated in large measure by the papers of Heisterkamp, Skovsted and Cohen (1969) and de Jong and Freund (1967). The former group stated that with a 65 % block of the mechanical twitch response produced by tubocurarine, 63% of patients did not show evidence of fade during tetanic stimulation at 30 Hz and that even with a degree of block greater than 90% fade was not demonstrable in the majority of patients.…”

Section: Discussionmentioning

confidence: 98%

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Electromyographic and Mechanical Effects of Suxamethonium and Tubocurarine on Twitch, Tetanic and Post-Tetanic Responses

Katz

1973

British Journal of Anaesthesia

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In an effort to reconcile conflicting reports in the literature concerning suxamethonium and tubocurarine, we studied the effects of these agents on the adductor pollicis mechanical twitch, adductor pollicis brevis compound action potential and abductor digiti quinti compound action potential. It was observed that the magnitude of block of the adductor pollicis differed from that of the abductor digiti quinti. In addition the magnitude of adductor pollicis block recorded mechanically differed from that recorded electrically. It was further observed that the presence or absence and magnitude of fade and post-tetanic potentiation depended upon the muscle studied, the rate of stimulation, the anaesthetic technique employed, the degree of block and whether electrical or mechanical responses were recorded. Nevertheless, by recording electrical and mechanical effects, it was possible to distinguish clearly the depolarizing block produced by suxamethonium from the desensitizing block produced by this agent as well as from the non-depolarizing block produced by tubocurarine. The effects of suxamethonium and tubocurarine on neuromuscular transmission in man were once regarded as simple. The block produced by tubocurarine was non-depolarizing and characterized by the presence of: (1) fade; (2) post-tetanic potentiation (facilitation); and (3) antagonism by cholinesterase inhibitors (Churchill-Davidson and Christie, 1959). The block initially produced by suxamethonium was depolarizing and was characterized by the absence of: (1) fade; (2) post-tetanic potentiation; and (3) antagonism by cholinesterase inhibitors (Churchill-Davidson and Christie, 1959). With sufficient dosage and the passage of time the suxamethonium block came to resemble the tubocurarine block and was labelled desensitizing (dual, mixed, phase II non-depolarizing) (Churchill-Davidson, Christie and Wise, 1960; Katz, Wolf and Papper, 1963). The present status is much more confusing. It has been suggested that after the first small dose of suxamethonium there is fade and post-tetanic

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mentioning

confidence: 60%

Section: Discussionmentioning

confidence: 98%

Electromyographic and Mechanical Effects of Suxamethonium and Tubocurarine on Twitch, Tetanic and Post-Tetanic Responses

Katz

1973

British Journal of Anaesthesia

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“…One study reports the effects of 1.0 mg increments of tubocurarine on twitch tension in man during barbiturate, nitrous oxide, narcotic anaesthesia. 13 Though the authors have not commented on the observation their results suggest an initial increase in twitch tension at the lower doses.…”

Section: Discussionmentioning

confidence: 93%

Anomalous Action of Tubocurarine in the Tibialis Anterior Muscle of the Cat

Potter

Edeson

Forbes

1982

Anaesth Intensive Care

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Low dose infusion of luhocurarine causes an increase in muscle conlraction in libialis anlerior of the cal. Tibialis anterior muscle of 13 adult cals was indirectly slill7ulated via Ihe sciatic nerve using a square wave pulse qfO.2 ms dural ion and supramaximal vollage at 0.06 Hz. The increase is from 5-/33 % of control wilh a mean of 36%. This is sustained for a mean of 97 min, if the infusion is ceased when maximum potentiation is achieved. Duration of potentiation is decreased by increasing the frequency of stimulation. The potentiation occurs in the presence of either rising or falling concenlrations (d llIhocurarine, and continuing Ihe infusion results in neuromuscular blockade. One explanalion (~f Ihese ohservalions is Ihat low dose lUiJocurarine may inlefjere with presynaptic negative feedback con(rol (~f acerylcholine release.

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“…Previous investigators have examined this issue of CNS versus periphery as regards potentiation of neuromuscular blockade. Heisterkamp et al (1969) studied patients who received an axillary block in one arm, which prevented any proximal influences from the spinal cord or brain. The effect of a d-tubocurarine blockade during methoxyflurane was no different in the blocked arm compared to unblocked arm.…”

Section: Discussionmentioning

confidence: 99%

“…Several sites are possible, including the central nervous system (CNS), the neuromuscular junction or muscle (Savarese et al 1994). Anaesthetic action in the brain or spinal cord could directly influence the evoked muscular twitch, and by cutting the stimulated nerve to one extremity (or anaesthetising the nerve with lignocaine; Heisterkamp et al 1969), a comparison of the twitch response of the cut side to the uncut side could provide data about any direct influence of the brain or spinal cord. However, anaesthetic action in the CNS could influence a blockade indirectly by changing the concentration of catecholamines, which are well known to have an antagonising effect on neuromuscular blockade (Bowman and Raper 1966;Bowman and Nott 1969;Baiios et al 1988).…”

Section: Introductionmentioning

confidence: 99%

Isoflurane potentiates metocurine via peripheral not central nervous system action

Antognini

1997

Journal of Veterinary Anaesthesia

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The Effects of Small Incremental Doses of d-Tubocurarine on Neuromuscular Transmission in Anesthetized Man

Cited by 20 publications

References 0 publications

Electromyographic and Mechanical Effects of Suxamethonium and Tubocurarine on Twitch, Tetanic and Post-Tetanic Responses

Electromyographic and Mechanical Effects of Suxamethonium and Tubocurarine on Twitch, Tetanic and Post-Tetanic Responses

Anomalous Action of Tubocurarine in the Tibialis Anterior Muscle of the Cat

Isoflurane potentiates metocurine via peripheral not central nervous system action

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