Neuromuscular Blockers Flashcards
Rocuronium: Class
Steroidal non depolarizing muscle blocker
Rocuronium: Use
RSI
NMB Maintenance
Rocuronium: Mechanism of Action
Combines with nicotinic receptors of the channels of the motor end-plate. Competitively blocks acetylcholine from attaching to the receptors. Postsynaptic membrane remains polarized.
Rocuronium: Dose
Induction: 0.6-1.2 mg/kg
RSI: 1.2 mg/kg
Rocuronium: Pharmacokinetics
Absorption: IV
Onset: 3 minutes
Duration of action: 60 minutes
Metabolism: Hepatic and Renal
Excretion: Hepatic and Renal
Rocuronium Considerations
May reverse with Sugammadex
Common cause of allergic reaction
DOA Prolonged with, inhaled gases, Lithium, Mg
DOA Shortened with, anti-epileptics, Steroids, Ca
Rocuronium: Contraindications
Known hypersensitivity to Bromides
Vecuronium: Class
Steroidal non depolarizing muscle blocker
Vecuronium: Use
Maintenance of NMB
Vecuronium: Mechanism of Action
Combines with nicotinic receptors of the channels of the motor end-plate. Competitively blocks acetylcholine from attaching to the receptors. Postsynaptic membrane remains polarized.
Vecuronium: Dose
Induction Dose: 0.1 mg/kg
Vecuronium: Pharmacokinetics
Absorption: IV
Onset: 4 minutes
Duration of action: 60 minutes
Metabolism: Hepatic and Renal
Excretion: Hepatic and Renal
Vecuronium: Contraindications
Known allergy to Bromides
Vecuronium: Considerations
May reverse with Sugammadex
Must be reconstituted
DOA Prolonged with, inhaled gases, Lithium, Mg
DOA Shortened with, anti-epileptics, Steroids, Ca
Cistracurium: Class
Benzylisoquinolinium
Cistracurium: Use
Standard Induction
Maintenance of NMB
Cistracurium: Mechanism of action
Combines with nicotinic receptors of the channels of the motor end-plate. Competitively blocks acetylcholine from attaching to the receptors. Postsynaptic membrane remains polarized.
Cistracurium: Dose
Induction: 0.1mg/kg
Cistracurium: Pharmacokinetics
Absorption: IV
Onset: 4 minutes
Duration: 60 minutes
Metabolism: Hofman elimination and esterase hydrolysis
ACTIVE METABOLITE : Laudanosine
Excretion: Kidneys
Cistracurium: Contraindications
Hypersensitivity
Cistracurium: Considerations
Hofmann elimination is dependent on temperature and pH
Active metabolite (is CNS stimulant) that is really excreted
Prolonged DOA: inhaled gases, hypothermia, MA, Lithium
Shortened DOA: Anti-epileptics, Steroids
Succinylcholine: Class
Depolarizing muscle blocker
Succinylcholine: Use
RSI
Laryngospasm
ECT
Succinylcholine: Mechanism of Action
Succinylcholine attaches to nicotinic receptors and cause motor end-plate to open and depolarize. Medication stays on the receptor because it can not be broken down by acetylcholinesterase. Does not allow the channel to repolarize.
Succinylcholine: Dose
IV Induction: 1 mg/kg
IM Induction: 4 mg/kg
Laryngospasm: 40mg IV
Succinylcholine: Pharmacokinetics
Absorption: IV, IM
Onset: 60 seconds
Duration of Action: 15 minutes
Metabolism: Plasma Cholinesterases
Prolonged with plasma cholinesterase deficiency
Excretion: Kidneys
Succinylcholine: Contraindications
Hyperkalemia
Risk for Malignant Hyperthermia
Severe Burns
Neurologic Injury
Plasma Cholinesterase Deficiency
Succinylcholine: Considerations
Can cause Bradycardia, can pair with atropine
Will cause an increase in plasma K levels
Increased Intraocular pressure and Intracranial pressures
Myalgias
