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Department of Anesthesiology - Residents Section

Anesthesia Knowledge - Muscle Relaxants

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Drug Metabolism Histamine Release Active Metabolism Special
d-Tubocurarine Renal 45%
Biliary 10-40%
+++   Useful in Liver Failure
Atracurium -Ester Hydrolysis 2/3
-Hoffman Elimination
Attenuated by injection over 1-3 min.
CNS Stimulant
Cisatracurium (Nimbex) -Hoffman Elimination
-Less on Ester Hydrolysis
-5 Fold less than Atracurium
-More potent than Atracurium
-Devoid of Histamine release
Mivacurium Ester Hydrolysis +
With rapid infusion of 3X ED95
  Reversal may not be necessary
0.1 mg/kg
Exc. -Renal 80%
-Hepatic 10-40%
-Biliary 20%
  3-OH Pancuronium
-50% as potent as parent compound
-Ø MAC 25%
Pipecuronium Exc.-Renal 70%
-Hepatic 10%
-Biliary 20%
    No Cardiovascular effects
Doxacurium Exc.-Renal 70%
-Biliary 30%
-Minimal Hydrolysis in Plasma
    Useful inpatients with CAD for prolonged Anesth. or Mech. Vent.
Exc.-Biliary 50-70%
-Renal 10-25%
-Hepatic 10-20%
    Onset 60 Sec. With 2X ED95
Vecuronium Exc.-Biliary 40-75%
-Renal 15-25%
-Hepatic 20-30%
  3-OH Vecuronium
-60% as active as vecuronium
-Useful in patients with CAD
-Useful in ESRD
Liver Disease: Prolong: Pancuronium, d-Tubocurarine,
Normal: Atracurium and Vecuronium, Sux. Prolonged in theory but not in practice.