Conclusion
Even with the introduction of the priming technique, the time course of succinylcholine blockade is thus far unrivalled.54 Large doses may be administered to obtain profound relaxation without undue concern about recovery. However, many clinicians prefer the use of atracurium or vecuronium because of the side effects of succinylcholine. The induction technique must then allow for the longer onset time of the non-depolarizing blockers and the inadvisability of administering large doses for short duration procedures. Until a shorter acting non-depolarizer is available, anaesthetists will have to choose and base their decision on their own experience, the expected duration of the procedure, and most importantly, a good evaluation of the patient.
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References
Miller RD, Way WL. The interaction between succinylcholine and subparalyzing doses of d-tubocurarine and gallamine in man. Anesthesiology 1971; 35: 567–71.
Cullen DJ. The effect of pretreatment with nondepolarizing muscle relaxants on the neuromuscular blocking action of succinylcholine. Anesthesiology 1971; 35: 572–8.
Blackburn CL, Morgan M. Comparison of speed of onset of fazaditiium, pancuronium, tubocurarine and suxamethonium. Br J Anaesth 1978; 50: 361–4.
Ferguson A, Bevan DR. Mixed neuromuscular block. The effect of precurarization. Anaesthesia 1981; 36: 661–6.
Blitt CD, Carlson GL, Rolling GD, Hameroff SR, Otto CW. A comparative evaluation of pretreatment with nondepolarizing neuromuscular blockers prior to the administration of succinylcholine. Anesthesiology 1981; 55: 687–9.
Gergis SD, Sokoll MD, Mehta M, Kemmatsu O, Rudd GD. Intubation conditions after atracurium and suxamethonium. Br J Anaesth 1983; 55: 83S-6S.
Manchicanti L, Grow JB, Colliver JA, Canella MG, Hadley CH. Atracurium pretreatment for succinylcholineinduced fasciculations and postoperative myalgia. Anesth Analg 1985; 64: 101–4.
Durant NN, Katz RL. Suxamethonium. Br I Anaesth 1982; 54: 195–208.
Donati F, Bevan DR. Suxamethonium — current status. Clin Anaesthesiol 1985; 3: 371–85.
Fahey MR, Morris RB, Miller RD, Sohn YJ, Cronnelly R, Gencarelli P. Clinical pharmacology of ORG NC45 (Norcmon): a new nondepolarizing muscle relaxant. Anesthesiology 1981; 55: 6–11.
Mirakhur RK, Ferres CJ, Clarke RSJ, Balil M, Dundee JW. Clinical evaluation of ORG NC45. Br J Anaesth 1983; 55: 119–24,
Healy TEJ, Pugh ND, Kay B, Sivalingham T, Pens HV. Atracurium and vecuronium; effect of dose on time of onset. Br J Anaesth 1986; 58: 620–4.
Harrison GA, Junius F. The effect of circulation time on the neuromuscular action of suxamethonium. Anaesth Intensive Care 1972; 1: 33–9.
Bevan JC, Donati F, Bevan DR. Attempted acceleration of the onset of pancuronium. Effect of divided doses in infants and children. Br J Anaesth 1985; 57: 1205–8.
Smith CE, Baxter M, Bevan JC, Donati F, Bevan DR. Accelerated onset and delayed recovery of d-tubocurarine blockade with pancuronium priming in infants and children. Can J Anaesth 1987; 34: 555–9.
Donati F, Bevan DR. The influence of patient’s sex, age and weight on pancuronium onset time. Can Anaesth Soc J 1986; 33: S86.
Chauvin M, Lebreault C, Duvaldestin P The neuromuscular blocking effect of vecuronium on the human diaphragm. Anesth Analg 1987; 66: 117–22.
Pansard JL, Chauvin M, Lebreault C, Gauneau P, Duvaldestin P. Effect of an intubating dose of succinylcholine and atracurium on the diaphragm and the adductor pollicis muscle in humans. Anesthesiotogy 1987; 67: 326–30.
Goat VA, Yeung ML, Blakeney C, Feldman SA. The effect of blood flow upon the activity of gallamine triethiodide. Br J Anaesth 1976; 48: 69–73.
Saxena PR, Dhasmana KM, Prakash O. A comparison of systemic and regional hemodynamic effects of d-tubocurarine, pancuronium, and vecuronium. Anesthesiology 1983; 59: 102–8.
Curran MJ, Donati F, Bevan DR. Onset and recovery of atracurium and suxamethonium-induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation. Br J Anaesth 1987; 59: 989–94.
Shanks CA. Pharmacokinetics of the nondepolarizing neuromuscular relaxants applied to the calculation of bolus and infusion dosage regimens. Anesthesiology 1986; 64: 72–86.
Cohen EN, Corbascio A, Fleischli G. The distribution and fate of d-tubocurarine. J Pharmacol Exp Ther 1965; 147: 120–9.
Stanski DR, Ham J, Miller RD, Sheiner LB. Pharmacokinetics and pharmacodynamics of d-tubocurarine during nitrous oxide-narcotic anesthesia in man. Anesthesiology 1979: 51: 235–41.
Eccles JC, Jaeger JC. The relationship between the mode of operation and the dimension of the junctional regions at synapses and motor end-organs. Proc Roy Soc B 1958; 148: 38–56.
Armstrong DL, Lester HA, The kinetics of d-tubocurarine action and restricted diffusion within the synaptic cleft. J Physiol (Lond) 1979; 294: 365–86.
Paton WDM, Waud DR. The margin of safety of neuromuscular transmission. J Physiol (Lond) 1967; 191: 59–90.
Minsaas B, Stovner J. Artery-to-muscle onset time for neuromuscularblockingdrugs. BrJ Anaesth 1980; 52: 403–7.
Hull CJ, Van Beem HBH, McLeod K, Sibbald A, Watson MJ. A pharmacodynamic model for pancuronium. Br J Anaesth 1978; 50: 1113–22.
Sheiner LB, Stanski DR, Vozeh S, Miller RD, Ham J. Simultaneous modeling of pharmacokinetics and dynamics: application to d-tubocurarine. Clin Pharmacol Ther 1979; 25: 358–71.
Hennis PJ, Stanski DR. Pharmacokinctic and pharmacodynamic factors that govern the clinical use of muscle relaxants. Sem Anesth 1985; 4: 21–30.
Fisher DM, Castagnoli K, Miller RD. Vecuronium kinetics and dynamics in anaesthetized infants and children. Clin Pharmacol Ther 1985; 37: 402–6.
Weatherley BC, Williams SG, Neill EAM. Pharmacokinetics, pharmacodynamics and dose-response relationships of atracurium administered I.V. Br J Anaesth 1983; 55: 39S-45S.
Gramstad L, Lileaasen P, Minsaas B. Onset time and duration of action for atracurium, ORG NC 45 and pancuronium. Br J Anaesth 1982; 54: 827–30.
Cass NM, Doolan LA, Gutteridge GA. Repeated adminstration of suxamethonium in a patient with atypical cholinesterase. Anaesth Intensive Care 1982; 10: 25–8.
Hickey DR, O’Connor JP, Donati F. Comparison of atracurium and succinylcholine for electroconvulsive therapy in a patient with atypical cholinesterase. Can J Anaesth 1987; 34: 280–3.
Basta SJ, Savarese JJ, Ali HH et al. The neuromuscular pharmacology of NW B1090U in anesthetized patients. Anesthesiology 1985; 63: A318.
Casson WR, Jones RM. Vecuronium induced neuromuscular blockade. The effect of increasing dose on speed of onset. Anaesthesia 1986; 41: 354–7.
Donati F, Antzaka C, Bevan DR. Potency of pancuronium at the diaphragm and the adductor pollicis muscle in humans. Anesthesiology 1986; 65: 1–5.
Lay cock JRD, Donati F, Bevan DR. Potency of atracurium and vecuronium at the diaphragm and adductor pollicis muscle in humans. Br J Anaesth 1987; 59: 1321P.
Naguib M, Abdullatif M, Ahsood GH. The optimal priming dose for atracurium. Can Anaesth Soc J 1986; 33: 453–7.
Lennon RL, Olson RA, Gronert GA. Atracurium or vecuronium for rapid sequence endotracheal intubation. Anesthesiology 1986; 64: 510–3.
Miller RD, Way WL, Dolan WM, Stevens WC, Eger Elll. Comparative neuromuscular effects of pancuronium, gallamine, and succinylcholine during Forane and halothane anesthesia in man. Anesthesiology 1971; 35: 509–14.
Cook DR. Pharmacokinetics of succinylcholine in infants, children and adults. Clin Pharmacol Ther 1976; 20: 493–8.
Smith CE, Donati F, Bevan DR. Dose response curves for succinylcholine: single versus cumulative techniques. Anesthesiology 1987; 67: A358.
Schwarz S, Mas W, Lackner F, Mayhofer O, Foldes FF. Rapid trachea! intubation with vecuronium: the priming principle. Anesthesiology 1985; 62: 388–91.
Taboada JA, Rupp SM, Miller RD. Refining the priming principle for vecuronium during rapid-sequence induction of anesthesia. Anesthesiology 1986; 64: 243–7.
Brady MM, Mirakhur RK, Gibson FM. Influence of “priming” on the potency of non-depolarizing neuromuscular blocking agents. Br J Anaesth 1987; 59: 1145–9.
Engbaek J, Howardy-Hansen P, ørding H, Viby-Mogensen J. Precurarization with pancuronium and vecuronium in awake, healthy volunteers: the influence on neuromuscular transmission and pulmonary function. Acta Anaesthesiol Scand 1985; 29: 117–20.
Sosis M, Larijani GE, Marra AT. Priming with atracurium. Anesth Analg 1987; 66: 329–32.
Musich J, Walts LF. Pulmonary aspiration after a priming dose of vecuronium. Anesthesiology 1986; 64: 517–9.
Black AMS, Hutton P, Ei-Hassen M, Morgan G, Clutton-Brock TH. Priming and the onset of neuromuscular blockade with alcuronium. Br J Anaesth 1986; 58: 827–33.
Doherty WG, Breen PJ, Donati F, Bevan DR. Accelerated onset of pancuronium with divided doses. Can Anaesth Soc J 1985; 32: 1–4.
Martin C, Bonneru JJ, Brun JP, Albanese J, Gouin F. Vecuronium or suxamethonium for rapid sequence intubation: which is better? Br J Anaesth 1987; 59: 1240–4.
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Donati, F. Onset of action of relaxants. Can J Anaesth 35 (Suppl 1), S52–S58 (1988). https://doi.org/10.1007/BF03026928
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DOI: https://doi.org/10.1007/BF03026928