PARALYTICS

Question 1

· Succinylcholine/Anectine and suxamethonium

Answer 1

o Dose Range: 1.2 mg/kg IV (actual weight) or 1.5 mg/kg after defasciculation dose
o Concentration: 20mg/mL
o Onset: 30-60 seconds
o ½ Life: 3-5 minutes
o S/E: fasciculations [can give small dose ndNMBD (eg 5-10mg Rocuronium)]; Tachycardia first dose to brady second dose; myalgia
o C/I: Pediatric use for induction Black Box warning (if used still… give glyco to negate HR drop since children have stronger vagal tone); burn patients, hx of MH, ocular trauma d/t 10 mmHg inc in IOP; hyperK+, Severe muscle trauma, neuro injury, severe sepsis, muscle wasting/disorders, muscular dystrophy (Duchenne Muscular Dystrophy in children), allergy
o Precautions: Histamine release; hyperkalemia especially with fetal/immature and neuronal nACh-Rs (5-10mOsm in short time); inc in plasma K+ by 0.5 mEq,
-Why you shouldn’t give sux after you’ve reversed a patient? If reversed with Neostigmine, this will cause a reduction in pseudocholinesterase activity and prolonged block. Also, reversal of a nondepolarizer will increase Ach at the synapse causing cholinergic syndrome and an increased depolarization of Succ. Possibility of phase II block

Question 2

· Rocuronium/Zemuron, Esmeron

Answer 2

-Paralysis dose: 0.6 mg/kg IV (IBW)
-Modified RSI dose: 1.2 mg/kg IV (IBW)
-Defasciculating dose: 10 mg IV 3 minutes before Succinylcholine
o Concentration: 10mg/mL
o Onset: 3 min typical; 1-2 min Mod RSI
o ½ Life: 35 min typical; 60-75 min Mod RSI
Precautions: Most common allergic reaction of ndNMBDs (Succinylcholine has greatest reaction); affected by liver/renal disease (prolonged reversal agent too, so all good); prolonged slightly in pregnant and elderly;

Question 3

· Vecuronium/Norcuron

Answer 3

-Paralysis dose: 0.1 mg/kg IV (IBW)
-Defasciculating dose: 1 mg IV 3 minutes before Succinylcholine
o Concentration: 10mg in 10mL syringe= 1mg/mL
o Onset: 3-4 minutes
o ½ Life: 45 min duration
o C/I: Don’t use with renal/liver pts d/t prolonged effect and recurarization; PACU hypercarbia after Vec prolongs blockade (vicious cycle); ICU prolonged use= tolerance (Rec dysfxn/ paralysis)
o Precautions: acidosis will prolong blockade if after NMBD; increased clearance during 3rd trimester d/t progesterone; prolonged duration early postpartum; prolonged in obese