Muscle Relaxants

(Neuromuscular Blocking Drugs)

dr. Isngadi, M.Kes., SpAn.

Departement of Pharmacology
Departement of Anesthesiology & Reanimation
Dr Saiful Anwar Hospital, Brawijaya University
Malang
 Muscle Relaxants
"The principal pharmacologic effect of neuromuscular
blocking drugs is to interrupt transmission of nerve impulses
at the neuromuscular junction".

- Cause a flaccid paralysis of skeletal musculature

- Binding to motor endplate cholinoceptors
- Blocking neuromuscular transmission
- As adjuncts to general anesthetics
(Chatzung,2006)
Cholinoceptors Types with Documented or Probable Effects
on Peripheral Autonomic Effector Tissue
 Key Concepts
 
 Muscle relaxation does not ensure
unconsciousness, amnesia, or analgesia.
 Depolarizing muscle relaxants act as
acetylcholine (ACh) receptor agonists, whereas
nondepolarizing muscle relaxants function as
competitive antagonists.
 Depolarizing muscle relaxants are hydrolyzed in
the plasma and liver by pseudocholinesterase .
 Key Concepts
 Succinylcholine is considered contraindicated
in the routine management of children and
adolescents because of the risk of hyperkalemia,

rhabdomyolysis, and cardiac arrest in children

with undiagnosed myopathies.
 Succinylcholine-induced depolarization to
raise serum potassium by 0.5 mEq/L.
Doxacurium, pancuronium, vecuronium, and
pipecuronium are partially excreted by the
kidneys, and their action is prolonged in
 Key Concepts
Atracurium and cisatracurium undergo degradation by organ-
independent Hofmann elimination

monoquaternary acrylate and laudanosine

no intrinsic neuromuscular blocking effects.

Pancuronium caused Hypertension and tachycardia by

the combination of vagal blockade and
catecholamine release from adrenergic
nerve endings.
 Rocuronium (0.9–1.2 mg/kg) has an onset of
action that approaches succinylcholine (60–90
s), making it a suitable alternative for rapid-
sequence inductions, but at the cost of a much
longer duration of action.
 
Depolarizing and Nondepolarizing Muscle Relaxants.
Drug Interactions