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Adverse Effects of Neuromuscular Blockers and Their Antagonists

  • Review Article
  • Drug Experience
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Summary

Among all the drugs used for general anaesthesia, neuromuscular blockers appear to play a prominent role in the incidence of severe adverse reactions. It now seems likely that most serious adverse drug reactions occurring during anaesthesia are immunological in type. The frequency of life-threatening anaphylactic or anaphylactoid reactions occurring during anaesthesia has been estimated to be between 1 in 1000 and 1 in 25 000 anaesthetic procedures, with the neuromuscular blockers being involved in 80% of cases. The mortality from such serious reactions is reported to be in the range of 3.4 to 6%. The highly immunogenic drug, suxamethonium chloride (succinylcholine), was found to be the most hazardous agent. Drug-specific Immunoglobulin E antibodies to suxamethonium chloride and other neuromuscular blockers have been demonstrated. This sensitivity to neuromuscular blockers seems to be a long-lasting phenomenon.

During anaesthesia, the clinical features of an allergic reaction are often masked. Tachycardia and circulatory collapse may be the only signs of an allergic reaction, and they are easily misdiagnosed. Bronchospasm is reported to be present in about 40% of cases. Successful management of these patients includes stabilisation during the acute reaction and avoidance of future reactions. The latter is based on the identification of the causative drug and potentially cross-reacting compounds.

The use of suxamethonium chloride is associated with many other adverse effects, such as fasciculations, myalgia, potassium release, changes in the heart rate, increases in intragastric and intraocular pressures, and malignant hyperthermia. Because of the dangers of hyperkalaemic cardiac arrest after suxamethonium chloride administration in children with unrecognised muscular dystrophy, there have now been moves to limit the use of this drug in children.

Although neuromuscular blockers are designed to specifically block nicotinic cholinergic receptors at the neuromuscular junction, many bind to muscarinic cholinergic receptors on ganglia and smooth muscle, and alter parasympathetically mediated heart rate and airway calibre. Most benzylisoquinolinium muscle relaxants can induce histamine release, especially when they are administered rapidly, which can lead to disturbances of cardiovascular function. In addition, nondepolarising neuromuscular blockers have been implicated in causing generalised weakness following their long term administration to patients on an intensive care unit.

The problem with these adverse drug reactions is their unpredictable nature. Therefore, prompt recognition with appropriate therapy can help to improve the outcome.

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References

  1. Anaesthetists and the reporting of adverse drug reactions. BMJ 1986; 292: 949

  2. Watkins J. Second report from an anaesthetic reactions advisory service. Anaesthesia 1989; 44: 157–9

    Article  PubMed  CAS  Google Scholar 

  3. Watkins J. Adverse reaction to neuromuscular blockers: frequency, investigation, and epidemiology. Acta Anaesthesiol Scand 1994; 38 Suppl. 102: 6–10

    Article  Google Scholar 

  4. McKinnon RP, Wildsmith JAW. Histaminoid reactions in anaesthesia. Br J Anaesth 1995; 74: 217–28

    Article  PubMed  CAS  Google Scholar 

  5. Boston Collaborative Drug Surveillance Program. Drug induced anaphylaxis. JAMA 1973; 224: 613–5

    Google Scholar 

  6. Laxenaire M-C, Moneret-Vautrin DA, Watkins J. Diagnosis of causes of anaphylactoid anaesthetic reactions: a report of the recommendations of the joint Anaesthetic and Immuno-Allergological Workshop: 1982 Mar 19; Nancy, France. Anaesthesia 1983; 38: 147–8

    Article  PubMed  CAS  Google Scholar 

  7. Fisher MMcD, More DG. The epidemiology and clinical features of anaphylactic reactions in anaesthesia. Anaesth Intensive Care 1981; 9: 226–34

    PubMed  CAS  Google Scholar 

  8. Laxenaire M-C, Moneret-Vautrin DA, Widmer S, et al. Anaesthetic drugs responsible for anaphylactic shock: French multicenter study. Ann Fr Anesth Reanim 1990; 9: 501–6

    Article  PubMed  CAS  Google Scholar 

  9. Laxenaire M-C, Moneret-Vautrin DA, Vervloet D. The French experience of anaphylactoid reactions. Int Anesthesiol Clin 1985; 23: 145–60

    PubMed  CAS  Google Scholar 

  10. Thornton JA, Lorenz W. Histamine and antihistamine in anaesthesia and surgery: report of a symposium. Anaesthesia 1983; 38: 373–9

    Article  Google Scholar 

  11. Fisher MMcD, Munro I. Life-threatening anaphylactoid reactions to muscle relaxants. Anesth Analg 1983; 62: 559–64

    Article  PubMed  CAS  Google Scholar 

  12. Stoelting RK. Allergic reactions during anesthesia. Anesth Analg 1983; 62: 341–56

    Article  PubMed  CAS  Google Scholar 

  13. Raper RF, Fisher MMcD. Profound reversible myocardial depression after anaphylaxis. Lancet 1988; I: 386–8

    Article  Google Scholar 

  14. Parker CW. Drug allergy. N Engl J Med 1975; 292: 732–6

    Article  PubMed  CAS  Google Scholar 

  15. Van Arsdel PP. Diagnosing drug allergy. JAMA 1982; 247: 2576–81

    Article  PubMed  Google Scholar 

  16. Ryan JR, Kagen LJ, Hyman AI. Myoglobinemia after a single dose of succinylcholine. N Engl J Med 1971; 285: 824–7

    Article  PubMed  CAS  Google Scholar 

  17. Goudsouzian NG, Ryan JR. Recent advances in pediatric anesthesia. Pediatr Clin North Am 1976; 23: 345–60

    PubMed  CAS  Google Scholar 

  18. Watters DJ, Mapleson WW. Suxamethonium pains: hypothesis and observation. Anaesthesia 1971; 26: 127–41

    Article  Google Scholar 

  19. McLoughlin C, Leslie K, Caldwell JE. Influence of dose of suxamethonium on suxamethonium-induced muscle damage. Br J Anaesth 1994; 73: 194–8

    Article  PubMed  CAS  Google Scholar 

  20. Blanc VF, Vaillancourt G, Brisson G. Succinylcholine, fasciculations and myoglobinemia. Can Anaesth Soc J 1986; 33: 178–84

    Article  PubMed  CAS  Google Scholar 

  21. Cozanitis DA, Erkola O, Klemola U, et al. Precurarization in infants and children less than three years of age. Can J Anaesth 1987; 34: 17–20

    Article  PubMed  CAS  Google Scholar 

  22. Bennike KA, Jarnum S. Myoglobinuria with acute renal failure possibly induced by suxamethonium. Br J Anaesth 1964; 36: 730–6

    Article  PubMed  CAS  Google Scholar 

  23. Fanner JC. Rhabdomyolysis. In: Civetta JM, Taylor RW, Kirby RR, editors. Critical care. Philadelphia: JB Lippincott, 1988: 1569–73

    Google Scholar 

  24. Delphin E, Jackson D, Rothstein P. Use of succinylcholine during elective pediatric anesthesia should be reevaluated. Anesth Analg 1987; 66: 1190–2

    Article  PubMed  CAS  Google Scholar 

  25. Rosenberg H, Gronert GA. Intractable cardiac arrest in children given succinylcholine [letter]. Anesthesiology 1992; 77:1054

    Article  PubMed  CAS  Google Scholar 

  26. Sullivan M, Thompson WK, Hill GD. Succinylcholine-induced cardiac arrest in children with undiagnosed myopathy. Can J Anaesth 1994; 41: 497–501

    Article  PubMed  CAS  Google Scholar 

  27. Goudsouzian NG. Recent changes in the package insert for succinylcholine chloride: should this drug be contraindicated for routine use in children and adolescents? (Summary of the discussions of the anesthetic and life support drug advisory meeting of the Food and Drug Administration, FDA building, Rockville, MD, June 9, 1994) [letter]. Anesth Analg 1995; 80: 207–8

    PubMed  CAS  Google Scholar 

  28. Badgwell JM, Hall SC, Lockhart C. Revised label regarding use of succinylcholine in children and adolescents [letter]. Anesthesiology 1994; 80: 243–5

    Article  PubMed  CAS  Google Scholar 

  29. Bevan RB. Succinylcholine [editorial]. Can J Anaesth 1994; 41: 465–8

    Article  PubMed  CAS  Google Scholar 

  30. Schulte-Sasse U, Eberlein HJ, Schmucker I, et al. Should the use of succinylcholine during pediatric anesthesia be re-evaluated? [in German] Anaesthesiol Reanim 1993; 18: 13–9

    PubMed  CAS  Google Scholar 

  31. Hopkins PM. Use of suxamethonium in children [editorial]. Br J Anaesth 1995; 75: 675–7

    Article  PubMed  CAS  Google Scholar 

  32. Naguib M, Farag H, Magbagbeola JAO. Effect of pre-treatment with lysine acetyl salicylate on suxamethonium-induced myalgia. Br J Anaesth 1987; 59: 606–10

    Article  PubMed  CAS  Google Scholar 

  33. Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 1975; 43: 89–99

    Article  PubMed  CAS  Google Scholar 

  34. Mazze RI, Escue HM, Houston JB. Hyperkalemia and cardiovascular collapse following administration of succinylcholine to the traumatized patient. Anesthesiology 1969; 31: 540–7

    Article  PubMed  CAS  Google Scholar 

  35. Belin RP, Karleen CI. Cardiac arrest in the burned patient following succinylcholine administration. Anesthesiology 1966; 27: 516–8

    Article  PubMed  CAS  Google Scholar 

  36. Cooperman LH. Succinylcholine-induced hyperkalemia in neuromuscular disease. JAMA 1970; 213: 1867–71

    Article  PubMed  CAS  Google Scholar 

  37. Azar I. The response of patients with neuromuscular disorders to muscle relaxants: a review. Anesthesiology 1984; 61: 173–87

    Article  PubMed  CAS  Google Scholar 

  38. Kohlschutter B, Baur H, Roth F. Suxamethonium-induced hyperkalemia in patients with severe intra-abdominal infections. Br J Anaesth 1976; 48: 557–61

    Article  PubMed  CAS  Google Scholar 

  39. Stevenson PH, Birch AA. Succinylcholine-induced hyperkalemia in a patient with a closed head injury. Anesthesiology 1979; 51: 89–90

    Article  PubMed  CAS  Google Scholar 

  40. Durant MM, Katz RI. Suxamethonium. Br J Anaesth 1982; 54: 195–208

    Article  PubMed  CAS  Google Scholar 

  41. Craythorne NWB, Turndorf H, Dripps RD. Changes in pulse rate and rhythm associated with the use of succinylcholine in anesthetized children. Anesthesiology 1960; 21: 465–70

    Article  Google Scholar 

  42. Gibb DB. Suxamethonium — a review. Anaesth Intensive Care 1974; 2: 9–26

    PubMed  CAS  Google Scholar 

  43. Bevan DR, Donati F. Neuromuscular relaxants: complications. Semin Anesth 1985; 4: 65–72

    Google Scholar 

  44. Galindo AHF, Davis TB. Succinylcholine and cardiac excitability. Anesthesiology 1962; 23: 32–40

    Article  PubMed  CAS  Google Scholar 

  45. Mathias JA, Evans-Prosser CD, Churchill-Davidson HC. The role of the non-depolarizing drugs in the prevention of suxamethonium bradycardia. Br J Anesth 1970; 42: 609–13

    Article  CAS  Google Scholar 

  46. Basta SJ, Savarese JJ, Ali HH, et al. Histamine-releasing potencies of atracurium, dimethyl tubocurarine and tubocurarine. Br J Anaesth 1983; 55 Suppl. 1: 105S–6S

    PubMed  Google Scholar 

  47. Moss J, Philbin DM, Rosow CE, et al. Histamine release by neuromuscular blocking agents in man. Klin Wochenschr 1982; 60: 891–5

    Article  PubMed  CAS  Google Scholar 

  48. Naguib M, Samarkandi AH, Bakhamees HS, et al. Histaminerelease haemodynamic changes produced by rocuronium, vecuronium, mivacurium, atracurium and tubocurarine. Br J Anaesth 1995; 75: 588–92

    Article  PubMed  CAS  Google Scholar 

  49. Naguib M, Abdulatif M, Absood A. Comparative effects of pipecuronium and tubocurarine on plasma histamine in humans. Br J Anaesth 1991; 67: 320–2

    Article  PubMed  CAS  Google Scholar 

  50. Watkins J. Histamine release by atracurium. Br J Anaesth 1986; 58: 19S–22S

    Article  PubMed  Google Scholar 

  51. Murray DJ, Mehta MP, Choi WW, et al. The neuromuscular blocking and cardiovascular effects of doxacurium chloride in patients receiving nitrous oxide narcotic anesthesia. Anesthesiology 1988; 69: 472–7

    Article  PubMed  CAS  Google Scholar 

  52. Lien CA, Belmont MR, Abalos A, et al. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995; 82: 1131–8

    Article  PubMed  CAS  Google Scholar 

  53. Scott RPF, Savarese JJ, Basta SJ, et al. Atracurium: clinical strategies for preventing histamine release and attenuating the haemodynamic response. Br J Anaesth 1985; 57: 550–3

    Article  PubMed  CAS  Google Scholar 

  54. Flacke W, Gillis RA. Impulse transmission via nicotinic and muscarinic pathways in the stellate ganglion. J Pharmacol Exp Ther 1968; 163: 266–76

    PubMed  CAS  Google Scholar 

  55. Bowman WC. Non-relaxant properties of neuromuscular blocking drugs. Br J Anaesth 1982; 54: 147–60

    Article  PubMed  CAS  Google Scholar 

  56. Hammer R, Berrie BC, Birdsall NJM, et al. Pirenzepine distinguishes between different subclasses of muscarinic receptors. Nature 1980; 283: 90–2

    Article  PubMed  CAS  Google Scholar 

  57. Doods HN, Mathy MJ, Davidesko D, et al. Selectivity of muscarinic antagonists in radioligand and in vivo experiments for the putative M1, M2 and M3 receptors. J Pharmacol Exp Ther 1987; 242: 257–62

    PubMed  CAS  Google Scholar 

  58. Bonner TI, Buckley NJ, Young AC, et al. Identification of a family of muscarinic acetylcholine receptor genes. Science 1987; 237: 527–32

    Article  PubMed  CAS  Google Scholar 

  59. Kubo T, Fukuda K, Mikami A, et al. Cloning, sequencing and expression of complementary DNA encoding the muscarinic acetylcholine receptor. Nature 1986; 323: 411–6

    Article  PubMed  CAS  Google Scholar 

  60. Bonner TI, Young AC, Brann MR, et al. Cloning and expression of the human and rat m5 muscarinic acetylcholine receptor genes. Neuron 1988; 1: 403–10

    Article  PubMed  CAS  Google Scholar 

  61. Buckley NJ, Bonner TI, Buckley CM, et al. Antagonist binding properties of five cloned muscarinic receptors expressed in CHO-K1 cells. Mol Pharmacol 1989; 35: 469–76

    PubMed  CAS  Google Scholar 

  62. Lazareno S, Buckley NJ, Roberts FF. Characterization of muscarinic M4 binding sites in rabbit lung, chicken heart, and NG108-15 cells. Mol Pharmacol 1990; 38: 805–15

    PubMed  CAS  Google Scholar 

  63. Appadu BL, Lambert DG. Studies on the interaction of steroidal neuromuscular blocking drugs with cardiac muscarinic receptors. Br J Anaesth 1994; 72: 86–8

    Article  PubMed  CAS  Google Scholar 

  64. Tassonyi E, Neidhart P, Pittet JF, et al. Cardiovascular effects of pipecuronium and pancuronium in patients undergoing coronary artery bypass grafting. Anesthesiology 1988; 69: 793–6

    Article  PubMed  CAS  Google Scholar 

  65. Ivankovich AD, Miletich DJ, Albrecht RF, et al. The effect of pancuronium on myocardial contraction and catecholamine metabolism. J Pharm Pharmacol 1975; 27: 837–41

    Article  PubMed  CAS  Google Scholar 

  66. Durant NN, Marshall IG, Savage DS, et al. The neuromuscular and autonomic blocking activities of pancuronium, Org NC 45 and other pancuronium analogues, in the cat. J Pharm Pharmacol 1979; 31: 831–6

    Article  PubMed  CAS  Google Scholar 

  67. Gottlieb JD, Sweet RB. The antagonism of curare: the cardiac effect of atropine and neostigmine. Can Anaesth Soc J 1963; 10: 114–21

    Article  PubMed  CAS  Google Scholar 

  68. Naguib M, Gomaa M, Absood GH. Atropine-edrophonium mixture: a dose-response study. Anesth Analg 1988; 67: 650–5

    PubMed  CAS  Google Scholar 

  69. Naguib M, Gomaa M. Atropine-neostigmine mixture: a doseresponse study. Can Anaesth Soc J 1989; 36: 412–7

    Article  CAS  Google Scholar 

  70. O’sullivan EP, Childs D, Bush GH. Peri-operative dreaming in paediatric patients who receive suxamethonium. Anaesthesia 1988; 43: 104–6

    Article  PubMed  Google Scholar 

  71. Cottrell JE, Hartung J, Giffin JP, et al. Intracranial and hemodynamic changes after succinylcholine administration in cats. Anesth Analg 1983; 62: 1006–9

    Article  PubMed  CAS  Google Scholar 

  72. Hennis PJ, Fahey MR, Canfell PC, et al. Pharmacology of laudanosine in dogs. Anesthesiology 1986; 65: 56–60

    Article  PubMed  CAS  Google Scholar 

  73. Scheepstra GL, Vree TB, Crul JF, et al. Convulsive effects and pharmacokinetics of laudanosine in the rat. Eur J Anaesthesiol 1986; 3: 371–83

    PubMed  CAS  Google Scholar 

  74. Shi WZ, Fahey MR, Fisher DM, et al. Laudanosine (a metabolite of atracurium) increases the minimum alveolar concentration of halothane in rabbits. Anesthesiology 1985; 63: 584–8

    Article  PubMed  CAS  Google Scholar 

  75. Chappie DJ, Miller AA, Ward JB, et al. Cardiovascular and neurological effects of laudanosine: studies in mice and rats, and in conscious and anaesthetized dogs. Br J Anaesth 1987; 59: 218–25

    Article  Google Scholar 

  76. Fahey MR, Canfell PC, Taboada T, et al. Cerebrospinal fluid concentrations of laudanosine after administration of atracurium. Br J Anaesth 1990; 64: 105–6

    Article  PubMed  CAS  Google Scholar 

  77. Fahey MR, Rupp SM, Canfell C, et al. Effect of renal failure on laudanosine excretion in man. Br J Anaesth 1985; 57:1049–51

    Article  PubMed  CAS  Google Scholar 

  78. Lawhead RG, Matsumi M, Peters KR, et al. Plasma laudanosine levels in patients given atracurium during liver transplantation. Anesth Analg 1993; 76: 569–73

    Article  PubMed  CAS  Google Scholar 

  79. Boyd AH, Eastwood NB, Parker CJR, et al. A comparison of the pharmacodynamics and pharmacokinetics of an infusion of cis-atracurium (51W89) or atracurium in critically ill patients undergoing mechanical ventilation in the intensive therapy unit. Br J Anaesth 1996; 76: 382–8

    Article  PubMed  CAS  Google Scholar 

  80. Matteo RS, Pua EK, Khambatta HJ, et al. Cerebrospinal fluid levels of d-tubocurarine in man. Anesthesiology 1977; 46: 396–9

    Article  PubMed  CAS  Google Scholar 

  81. Szenohradszky J, Trevor AJ, Bickler P, et al. Central nervous system effects of intrathecal muscle relaxants in rats. Anesth Analg 1993; 76: 1304–9

    PubMed  CAS  Google Scholar 

  82. Greenblatt DJ, Shader RI. Drug therapy: anticholinergics. N Engl J Med 1973; 288: 1215–9

    Article  PubMed  CAS  Google Scholar 

  83. Schneck HG, Rupreht J. Central anticholinergic syndrome (CAS) in anesthesia and intensive care. Acta Anaesthesiol Belg 1989; 40: 219–28

    PubMed  CAS  Google Scholar 

  84. Granacher RP, Baldessarini RJ, Messner E. Physostigmine treatment of delirium induced by anticholinergics. Am Fam Physician 1976; 13: 99–103

    PubMed  CAS  Google Scholar 

  85. Britt BA, Kalow W. Malignant hyperthermia: aetiology unknown. Can Anaesth Soc J 1970; 17: 316–30

    Article  PubMed  CAS  Google Scholar 

  86. Gronert GA. Malignant hyperthermia. Anesthesiology 1980; 53: 395–423

    Article  PubMed  CAS  Google Scholar 

  87. Strazis KP, Fox AW. Malignant hyperthermia: a review of published cases. Anesth Analg 1993; 77: 297–304

    PubMed  CAS  Google Scholar 

  88. Britt BA. Dantrolene. Can Anaesth Soc J 1984; 31: 61–75

    Article  PubMed  CAS  Google Scholar 

  89. Few JD, Davies CT. The inhibiting effect of atropine on growth hormone release during exercise. Eur J Appl Physiol 1980; 43: 221–8

    Article  CAS  Google Scholar 

  90. Miller RD, Way WL. Inhibition of succinylcholine-induced increased intragastric pressure by nondepolarizing muscle relaxants and lidocaine. Anesthesiology 1971; 34: 185–8

    Article  PubMed  CAS  Google Scholar 

  91. Lind JF, Warrian WG, Wankling WJ. Responses of the gastroesophageal junctional zone to increases in abdominal pressure. Can J Surg 1966; 9: 32–8

    PubMed  CAS  Google Scholar 

  92. Smith G, Dalling R, Williams TI. Gastro-oesophageal pressure gradient changes produced by induction of anaesthesia and suxamethonium. Br J Anaesth 1978; 50: 1137–43

    Article  PubMed  CAS  Google Scholar 

  93. Cotton BR, Smith G. Single and combined effects of atropine and metoclopramide on the lower oesophageal sphincter pressure. Br J Anaesth 1981; 53: 869–74

    Article  PubMed  CAS  Google Scholar 

  94. Wilkins JL, Hardcastle JD, Mann CV, et al. Effects of neostigmine and atropine on motor activity of ileum, colon, and rectum of anaesthetized subjects. BMJ 1970; 1: 793–4

    Article  PubMed  CAS  Google Scholar 

  95. Whitaker BL. Observations on the blood flow in the inferior mesenteric arterial system and the healing of colonic anastomoses. Ann R Coll Surg Eng 1968; 43: 89–110

    CAS  Google Scholar 

  96. King MJ, Milazkiewicz R, Carli F, et al. Influence of neostigmine on postoperative vomiting. Br J Anaesth 1988; 61:403–6

    Article  PubMed  CAS  Google Scholar 

  97. Hovorka J, Korttila K, Nelskylä, et al. Reversal of neuromuscular blockade with neostigmine has no effect on the incidence or severity of postoperative nausea and vomiting. Anesth Analg 1997; 85: 1359–61

    PubMed  CAS  Google Scholar 

  98. Bell CM. Neostigmine and anastomotic disruption. Proc R Soc Med 1970; 63: 752

    PubMed  CAS  Google Scholar 

  99. Morisot P, Loygue J, Guilmet C. Influence of postoperative decurarization with neostigmine on digestive anastomoses. Can Anaesth Soc J 1975; 22: 144–8

    Article  PubMed  CAS  Google Scholar 

  100. Freeman J, Lesko SM, Mitchell AA, et al. Hyperbilirubinemia following exposure to pancuronium bromide in newborns. Dev Pharmacol Ther 1990; 14: 209–15

    PubMed  CAS  Google Scholar 

  101. Atracurium [editorial]. Lancet 1983; I: 394–5

  102. Vetterman J, Beck KC, Lindhahl SHE, et al. Actions of enflurane, isoflurane, vecuronium, atracurium, and pancuronium on pulmonary resistance in dogs. Anesthesiology 1988; 69: 688–95

    Article  Google Scholar 

  103. Okanlami OA, Fryer AD, Hirshman C. Interaction of nondepolarizing muscle relaxants with M2 and M3 muscarinic receptors in guinea pig lung and heart. Anesthesiology 1996; 84: 155–61

    Article  PubMed  CAS  Google Scholar 

  104. Eriksson LI, Lennmarken C, Johnson A. Attenuated ventilatory response to hypoxaemia at vecuronium-induced partial neuromuscular block. Acta Anaesthesiol Scand 1992; 36: 710–5

    Article  PubMed  CAS  Google Scholar 

  105. Polarz H, Bohrer H, Fleischer F, et al. Effects of thiopentone/suxamethonium on intraocular pressure after pretreatment with alfentanil. Eur J Clin Pharmacol 1992; 43: 311–3

    Article  PubMed  CAS  Google Scholar 

  106. Pandey K, Badola RP, Kumar S. Time course of intraocular hypertension produced by suxamethonium. Br J Anaesth 1972; 44: 191–6

    Article  PubMed  CAS  Google Scholar 

  107. Meyers EF, Krupin T, Johnson M, et al. Failure of nondepolarizing neuromuscular blockers to inhibit succinylcholine-induced increased intraocular pressure: a controlled study. Anesthesiology 1978; 48: 149–51

    Article  PubMed  CAS  Google Scholar 

  108. Kelly RE, Dinner M, Turner LS, et al. Succinylcholine increases intraocular pressure in the human eye with extraocular muscles detached. Anesthesiology 1993; 79: 948–53

    Article  PubMed  CAS  Google Scholar 

  109. Gooding JM, Holcomb MC. Transient blindness following intravenous administration of atropine. Anesth Analg 1977; 56: 872–3

    PubMed  CAS  Google Scholar 

  110. Garde JF, Aston R, Endler GC, et al. Racial mydriatic response to belladonna premedication. Anaesth Analg 1978; 57: 572–6

    CAS  Google Scholar 

  111. Cunningham AJ, Barry P. Intraocular pressure — physiology and implications for anaesthetic management. Can Anaesth Soc J 1986; 33: 195–208

    Article  PubMed  CAS  Google Scholar 

  112. Hartman GS, Fiamengo SA, Riker Jr WF. Succinylcholine: mechanism of fasciculations and their prevention by d-tubocurarine or diphenylhydantoin. Anesthesiology 1986; 65: 405–13

    Article  PubMed  CAS  Google Scholar 

  113. Pinchak AC, Smith CE, Shepard LS, et al. Waiting time after non-depolarizing relaxants after muscle fasciculation response to succinylcholine. Can J Anaesth 1994; 41: 206–12

    Article  PubMed  CAS  Google Scholar 

  114. Usubiaga JE, Wikinski JA, Usubiaga LE, et al. Intravenous lidocaine in the prevention of postoperative muscle pain caused by succinylcholine administration. Anesth Analg 1967; 46: 225–30

    PubMed  CAS  Google Scholar 

  115. Fahmy NR, Malek NS, Lappas DG. Diazepam prevents some adverse effects of succinylcholine. Clin Pharmacol Ther 1976; 26: 395–8

    Google Scholar 

  116. Savarese JJ, Ali HH, Basta SJ, et al. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U): a short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology 1988; 68: 723–32

    Article  PubMed  CAS  Google Scholar 

  117. Whittaker M. Plasma Cholinesterase variants and the anaesthetist. Anaesthesia 1980; 35: 174–97

    Article  PubMed  CAS  Google Scholar 

  118. Viby-Mogensen J, Hanel HK. Prolonged apnoea after suxamethonium: an analysis of the first 225 cases reported to the Danish Cholinesterase research unit. Acta Anaesthesiol Scand 1978; 22: 371–80

    Article  PubMed  CAS  Google Scholar 

  119. Goudsouzian NG, d’Hollander AA, Viby-Mogensen J. Prolonged neuromuscular block from mivacurium in two patients with Cholinesterase deficiency. Anesth Analg 1993; 77:183–5

    Article  PubMed  CAS  Google Scholar 

  120. Benzer A, Luz G, Oswald E, et al. Succinylcholine-induced prolonged apnea in a 3-week-old newborn: treatment with human plasma Cholinesterase. Anesth Analg 1992; 74: 137–8

    Article  PubMed  CAS  Google Scholar 

  121. Naguib M, El-Gammal M, Daoud W, et al. Human plasma Cholinesterase for antagonism of prolonged mivacurium-induced neuromuscular blockade. Anesthesiology 1995; 82: 1288–92

    Article  PubMed  CAS  Google Scholar 

  122. Naguib M, Daoud W, El-Gammal M, et al. Enzymatic antagonism of mivacurium-induced neuromuscular blockade: by human plasma Cholinesterase. Anesthesiology 1995; 83: 694–701

    Article  PubMed  CAS  Google Scholar 

  123. Gooch JL, Suchyta MR, Balbierz JM, et al. Prolonged paralysis after treatment with neuromuscular junction blocking agents. Crit Care Med 1991; 19: 1125–31

    Article  PubMed  CAS  Google Scholar 

  124. Vanderheyden BA, Reynolds HN, Gerold KB, et al. Prolonged paralysis after long-term vecuronium infusion. Crit Care Med 1992; 20: 304–7

    Article  PubMed  CAS  Google Scholar 

  125. Op de Coul AA, Lambregts PC, Koeman J, et al. Neuromuscular complications in patients given Pavulon® (pancuronium bromide) during artificial ventilation. Clin Neural Neurosurg 1985; 87: 17–22

    Article  CAS  Google Scholar 

  126. Apte Kakade S. Rehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids. Arch Phys Med Rehabil 1991; 72: 1024–8

    Google Scholar 

  127. Danon MJ, Carpenter S. Myopathy with thick filament (myosin) loss following prolonged paralysis with vecuronium during steroid treatment. Muscle Nerve 1991; 14: 1131–9

    Article  PubMed  CAS  Google Scholar 

  128. Partridge BL, Abrams JH, Bazemore C, et al. Prolonged neuromuscular blockade after long-term infusion of vecuronium bromide in the intensive care unit. Crit Care Med 1990; 18: 1177–9

    Article  PubMed  CAS  Google Scholar 

  129. Bolton CF, Gilbert JJ, Hahn AF, et al. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 1984; 47: 1223–31

    Article  PubMed  CAS  Google Scholar 

  130. Vital Brazil O, Prado-Franceschi J. The nature of neuromuscular block produced by neomycin and gentamicin. Arch Int Pharmacodyn Ther 1969; 179: 78–85

    Google Scholar 

  131. Sanders Jr WE, Sanders CC. Toxicity of antibacterial agents: mechanisms of action on mammalian cells. Ann Rev Pharmacol Toxicol 1979; 19: 53–83

    Article  CAS  Google Scholar 

  132. Segredo V, Caldwell JE, Matthay MA, et al. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med 1992; 327: 524–8

    Article  PubMed  CAS  Google Scholar 

  133. Prielipp RC, Coursin DB, Scuderi PE, et al. Comparison of the infusion requirements and recovery profiles of vecuronium and cisatracurium 51W89 in intensive care unit patients. Anesth Analg 1995; 81: 3–12

    PubMed  CAS  Google Scholar 

  134. Horton WA, Fergusson NV. Hyperkalaemia and cardiac arrest after the use of suxamethonium in intensive care. Anaesthesia 1988; 43: 890–1

    Article  PubMed  CAS  Google Scholar 

  135. Martyn JAJ, White DA, Gronert GA, et al. Up-and-down regulation of skeletal muscle acetylcholine receptors: effects on neuromuscular blockers. Anesthesiology 1992; 76: 822–43

    Article  PubMed  CAS  Google Scholar 

  136. Schwartz L, Rockoff MA, Koka BV. Masseter spasm with anesthesia: incidence and implications. Anesthesiology 1984; 61: 772–5

    Article  PubMed  CAS  Google Scholar 

  137. Donlon JV, Newfeld PA, Streter F, et al. Implications of masseter spasm after succinylcholine. Anesthesiology 1987; 49: 298–301

    Article  Google Scholar 

  138. Carroll JB. Increased incidence of masseter spasm in children with strabismus anesthetized with halothane and succinylcholine. Anesthesiology 1987; 67: 599–61

    Article  Google Scholar 

  139. Hannallah RS, Kaplan RK. Jaw relaxation after a halothane/succinylcholine sequence in children. Anesthesiology 1994; 81: 99–103

    Article  PubMed  CAS  Google Scholar 

  140. Rosenberg H, Fletcher JE. Masseter muscle rigidity and malignant hyperthermia susceptibility. Anesth Analg 1986; 65: 161–4

    PubMed  CAS  Google Scholar 

  141. Ellis FR, Halsall PJ. Suxamethonium spasm: a differential diagnosis conundrum. Br J Anaesth 1984; 56: 381–4

    Article  PubMed  CAS  Google Scholar 

  142. North FC, Kettelkamp N, Hirshman CA. Comparison of cutaneous and in vitro histamine release by muscle relaxants. Anesthesiology 1987; 66: 543–6

    Article  PubMed  CAS  Google Scholar 

  143. Rowlands DE. Harmless cutaneous reactions associated with the use of atracurium: a report of 1200 anaesthetics. Br J Anaesth 1987; 59: 693–6

    Article  PubMed  CAS  Google Scholar 

  144. Laxenaire MC, Moneret-Vautrin DA, Widmer S, et al. Anaesthetic drugs responsible for anaphylactic shock. French multicenter study. Ann Fr Anesth Reanim 1990; 9: 501–6

    Article  PubMed  CAS  Google Scholar 

  145. Guéant JL, Mata E, Monin B, et al. Evaluation of a new reactive-solid phase for radioimmunoassay of seric specific IgE against muscle relaxant drugs. Allergy 1991; 46: 452–8

    PubMed  Google Scholar 

  146. Moneret-Vautrin DA, Laxenaire MC. Predictive check-up for risk of anaphylactoid shock in anesthesia. Monogr Allergy 1992; 30: 156–61

    PubMed  CAS  Google Scholar 

  147. Birnbaum J, Vervloet D. Mechanisms of anaphylactic reactions to muscle relaxants: role of allergenic determinants. Monogr Allergy 1992; 30: 15–23

    PubMed  CAS  Google Scholar 

  148. Fisher MMcD, Baldo BA. The incidence and clinical features of anaphylactic reactions during anaesthesia in Australia. Ann Fr Anesth Réanim 1993; 12: 97–104

    Article  PubMed  CAS  Google Scholar 

  149. O’Callaghan AC, Scadding G, Watkins J. Bronchospasm following the use of vecuronium. Anaesthesia 1986; 41: 940–2

    Article  PubMed  Google Scholar 

  150. Durrani Z, O’Hara J. Histaminoid reaction from vecuronium priming: a case report. Anesthesiology 1987; 67: 130–2

    Article  PubMed  CAS  Google Scholar 

  151. Holt AW, Vedig AE. Anaphylaxis following vecuronium [letter]. Anaesth Intens Care 1988; 16: 378–9

    CAS  Google Scholar 

  152. Futo J, Kupferberg JP, Moss J, et al. Vecuronium inhibits histamine N-methyltransferase. Anesthesiology 1988; 69: 92–6

    Article  PubMed  CAS  Google Scholar 

  153. Futo J, Kupferberg JP, Moss J. Neuromuscular relaxants inhibit HNMT in vitro. Biochem Pharmacol 1990; 39: 415–20

    Article  PubMed  CAS  Google Scholar 

  154. Baldo BA, Fisher MMcD. Substituted ammonium ions as allergenic determinants in drug allergy. Nature 1983; 306: 262–4

    Article  PubMed  CAS  Google Scholar 

  155. Abel M, Book WJ, Eisenkraft JB. Adverse effects of non-depolarizing neuromuscular blocking agents: incidence, prevention and management. Drug Saf 1994; 10: 420–38

    Article  PubMed  CAS  Google Scholar 

  156. Naguib M. Anaphylactoid reactions following propofolatracurium sequence. Can J Anaesth 1989; 36: 358–9

    Article  Google Scholar 

  157. Laxenaire MC, Mata-Bermjo E, Moneret-Vautrin DA, et al. Life-threatening anaphylactoid reactions to propofol (Diprivan®) Anesthesiology 1992; 77: 275–80

    Article  PubMed  CAS  Google Scholar 

  158. Aguilera L, Martinez-Bourio R, Cid C, et al. Anaphylactic reaction after atropine. Anaesthesia 1988; 43: 955–7

    Article  PubMed  CAS  Google Scholar 

  159. Fujinaga M, Baden JM, Mazze RI. Developmental toxicity of nondepolarizing muscle relaxants in cultured rat embryos. Anesthesiology 1992; 76: 999–1003

    Article  PubMed  CAS  Google Scholar 

  160. Moorthy SS, Dierdorf SF. Pain on injection of rocuronium bromide [letter]. Anesth Analg 1995; 80: 1067

    PubMed  CAS  Google Scholar 

  161. Steegers MAH, Robertson EN. Pain on injection of rocuronium bromide [letter]. Anesth Analg 1996; 83: 203

    PubMed  CAS  Google Scholar 

  162. Ricardo O, Bands C, Laney G, et al. Drug allergies in the surgical population. Can J Anaesth 1994; 41: 1149–55

    Article  Google Scholar 

  163. Shapiro BA, Warren J, Egol AB, et al. Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Crit Care Med 1995; 23: 1601–5

    Article  PubMed  CAS  Google Scholar 

  164. Prielipp RC, Coursin DB, Wood KE. Complications associated with sedative and neuromuscular blocking drugs in critically ill patients. Crit Care Clin 1995; 11: 983–1003

    PubMed  CAS  Google Scholar 

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  1. Faculty of Medicine, Department of Anaesthesia, King Khalid University Hospital, PO Box 7805, Riyadh, 11472, Saudi Arabia

    Mohamed Naguib & Magboul M. A. Magboul

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  1. Mohamed Naguib
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  2. Magboul M. A. Magboul
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Correspondence to Mohamed Naguib.

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Naguib, M., Magboul, M.M.A. Adverse Effects of Neuromuscular Blockers and Their Antagonists. Drug-Safety 18, 99–116 (1998). https://doi.org/10.2165/00002018-199818020-00002

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