RT Book, Section
A1 Yeung, Albert C.
A2 Ellinas, Herodotos
A2 Matthes, Kai
A2 Alrayashi, Walid
A2 Bilge, Aykut
SR Print(0)
ID 1176457135
T1 Muscle Relaxants
T2 Clinical Pediatric Anesthesiology
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781259585746
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1176457135
RD 2024/09/19
AB FOCUS  POINTSNeuromuscular  blocking  drugs  (NMBDs)  are  quaternary  ammonium  compounds  that  have  structural  similarities  to  acetylcholine  (Ach).The  potency  of  a  NMBD  is  a  measure  of  the  dose  required  to  produce  the  corresponding  twitch  suppression.The  onset  time  is  the  time  from  administration  to  maximum  blockade.The  duration  of  action  is  the  time  to  return  to  25%  of  baseline  single  twitch  height  (T25).Succinylcholine  is  the  only  clinically  available  depolarizing  NMBD  and  is  hydrolyzed  by  plasma  cholinesterase  (also  referred  to  as  butyrylcholinesterase  or  pseudocholinesterase).The  efficacy  of  a  patient’s  plasma  cholinesterase  can  be  expressed  by  the  dibucaine  number.Contraindications  to  succinylcholine  administration  include  personal  or  family  history  of  malignant  hyperthermia,  known  or  suspected  myopathy,  hyperkalemia,  and  medical  conditions  that  result  in  increased  extrajunctional  acetylcholine  receptors  such  as  burns,  trauma,  and  immobility.The  routine  use  of  succinylcholine  in  infants  and  children  should  be  avoided  due  to  the  risk  of  hyperkalemic  cardiac  arrest  in  patients  with  undiagnosed  skeletal  muscle  myopathy.There  are  two  chemical  classes  of  clinically  available  nondepolarizing  NMBDs:  the  aminosteroid  compounds  (pancuronium,  vecuronium,  rocuronium)  and  the  benzylisoquinolinium  compounds  (atracurium,  cisatracurium,  mivacurium).There  are  two  classes  of  agents  for  reversal  of  neuromuscular  blockade:  anticholinesterases  and  cyclodextrins.