Neuromuscular Blockers

Musculoskeletal System
Dr. Nalamolu Koteswara Rao
 Learning outcomes
At the end of this lecture, students should be
able to:
Identify the agents acting at the
neuromuscular junction and neuromuscular
blocking agents
Depolarizing Decamethonium, suxamethonium
Blockers
Succinylcholine

Metocurine Pancuronium

Competitive D-tubocurarine Rocuronium

Blockers
Vecuronium Atracurium
Mivacurium
 Competitive/ Non-depolarizing
Blockers Mechanism of action
Tubocurarine combines with the
nicotinic cholinergic receptor at the
post junctional membrane and thereby
competitively blocks the transmitter
action of Acetylcholine
Prevent depolarization and inhibit
muscular contraction.
 Depolarizing Blockers
Mechanism of action
Succinylcholine binds to nicotinic receptors on
skeletal muscle cell membrane.
Drug assists depolarization of the cell membrane
and causes persistent depolarization of motor end
plate.
It results absence of repolarization. Blocks
renewed opening of Na+ channels.
This results in blockade of neuromuscular
transmission. This will leads to flaccid paralysis
 Classification of Blockers
Agent Pharmacological Onset time Duration Elimination
Properties (min) (min)
Succinylcholine Ultrashort acting; Plasma
1-1.5 6-10 cholinesterase
Depolarizing
D-tubocurarine Long duration; Renal and
4-6 80-120 liver
Competitive
Atracurium Intermediate duration; Plasma
2-4 30-40 cholinesterase
Competitive
Mivacurium Short duration; Plasma
2-4 12-18 cholinesterase
Competitive
Pancuronium Long duration; Renal and
4-6 4-6 hrs liver
Competitive
Rocuronium Intermediate duration; Renal and
1-2 1-2 hrs liver
competitive
Sequence of Paralysis

Fingers, orbit (small muscles)

limbs Trunk neck

Diaphragm Intercostals

Recovery in Reverse
 Other Effects of
Neuromuscular Blockers
Cardiovascular effects
Mediated through autonomic or histamine
receptors
Hypotension
Succinylcholine causes cardiac arrhythmias
Histamine Release
e.g. d-tubocurarine
bronchospasm, bronchial and salivary
secretions increases, hypersensitivity and
hypotension
 Adverse Effects/Toxicity
Hyperkalemia
Increased intraocular pressure
Increased intragastric pressure
Myalgias
 Drug Interactions
Cholinesterase Inhibitors (antagonize)
Inhalational Anesthetics (synergistic)
Aminoglycoside Antibiotics (synergistic)
Calcium Channel Blockers (synergistic)
 Therapeutic Uses
Surgical relaxation
Tracheal intubation
Control of ventilation
Treatment of convulsions
THANK YOU