The Neuromuscular

Junction

DEPOLARIZING AGENTS

Depolarizing Agents

SUCCINYLCHOLINE
Other name : diacetylcholine or
suxamethonium
Rapid onset (30-60 s) & short
duration of action (< 10 min)
Small volume distribution e.c very
low lipid solubility
Doses :
Adult : 1-1,5 mg/kg iv

SIDE EFFECT
1. cardiovascular
Low dose > negative
chronotropic &
inotropic effects
High dose > increase
heart rate &
contractility
Elevate circulating
catecholamine levels
Children > bradicardia

2. fasiculation
3. hyperkalemia
4. muscle pain
5. intragastric
pressure elevation
6. intraocular pressure
elevation
7 massester muscle
rigiddity
8. malignant
hyperthermia

SIDE EFFECT
9. generelazied
contractions
10.Prolonged
paralysis
11. increase
intracranial
pressure
12. histamin
release

NON DEPOLARIZING AGENTS

Mechanism of Action of
Nondepolarizing Neuromuscular
Blocking Drugs

ATRACURIUM
A benzylisoquinoline structure
Metabolisme & excreation :
Ester hydrolysis
Hofmann elimination

Dosage : 0,5 mg/kg BB

SIDE EFFECT
Hypotension & tachycardia
Unsual unless doses in excess of 0,5 mg/kg

Broncospasm
Avoided in asthma patients

Laudanosine toxicity
Precipitation of seizure

Temperature & pH sensitivity

Chemical incompatibility
Allergic reactions

CISATRACURIUM
Stereoisomer of atracurium that 4
times more potent
Metabolism & excretion
Undergoes degradation in plasma by
hofmann elimination

Dosage : 0,1 0,15 mg/kgbb

SIDE EFFECT

Not increase plasma histamine levels

Not alter heart rate or blood pressure
Produce laudanosine
pH & temperature sensityvity
Chemical incompatibility

PANCURONIUM
A steroid structure
Metabolism & excretion
Metabolized by liver
Excretion is primerly renal (40%) and
bile (10%)

Dosage : 0,08 0,12 mg/kg

SIDE EFFECT
Hypertension & tachycardia
Vagal blokade & sympathetic stimulation

Arrhythmias
Allergic reactions

VECURONIUM
A steroid structure
Metabolite & excretions
Primarily by bile and renal (25%)

Dosage : 0,08 0,12 mg/kg

SIDE EFFECT
Cardiovascular
Even at dose 0,28 mg/kg, vecuronium is
devoid of significant cardiovascular
effect

Liver failure
The duratio of action of vecuronium is
usually not significantly prolonged in
patient with cirrhosis