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CNS - NMB - INTRO - Non-Depolarizing NMB

25 important questions on CNS - NMB - INTRO - Non-Depolarizing NMB

What is the duration of action for Rocuronium and what procedures is it suitable for?

Rocuronium has a duration of action of 20-60 minutes, making it suitable for very short procedures. It is less potent than Vecuronium and is metabolized in the liver.

What is the onset and duration of Atracurium?

Atracurium has an onset of 2-4 minutes and an intermediate duration of 30-60 minutes, making it suitable for short surgical procedures.

What are the merits of Rocuronium regarding histamine release and renal disease?

Rocuronium has no histamine release, no ganglion blockade, and is not contraindicated in renal disease. It also has a rapid onset of action (1-2 minutes).
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How is Atracurium metabolized and eliminated?

Atracurium is hydrolysed by plasma esterases and is renally eliminated.

How is the action of Non-depolarizing NMB's reversed?

  • Action of Non-depolarizing NMB's reversed by Anticholinesterase agents e.g. Neostigmine.
  • Usually preceded by Atropine to block its muscarinic effects, especially bradycardia.

How does Rocuronium compare to Succinylcholine for endotracheal intubation?

Rocuronium can be used as an alternative to Succinylcholine to facilitate endotracheal intubation, with a rapid onset of action of 1-2 minutes.

When is the technique to reverse NMB effects applied?

  • This technique is applied at end of an elective surgical operation to shorten the duration of action of NMBs.

What are the merits of Atracurium over Tubocurarine?

Atracurium is more potent, causes less histamine release, and has no ganglion blockade. It is not contraindicated in renal or liver disease due to spontaneous hydrolysis.

What are the merits of Pancuronium over Tubocurarine?

  • No histamine release.
  • No ganglion blockade.

What type of compound is Pancuronium?

Pancuronium is an ammonio-steroid compound. It acts as a competitive antagonist at the NMJ. It is more potent, with a rapid onset of action of 4-6 minutes and a long duration of 120-180 minutes. It is eliminated renally.

Why is Atracurium not contraindicated in renal or liver disease?

Atracurium undergoes spontaneous hydrolysis (Hoffman's reaction), so its clearance is not dependent on the kidney or liver.

What are the side effects of Tubocurarine related to histamine release?

  • Bronchospasm (contraindicated in asthmatic patients)
  • Hypersensitivity reaction e.g. Allergy (contraindicated in allergic patients)
  • Hypotension
  • Excessive bronchial & salivary secretion

What is a side effect of Tubocurarine related to ganglion blockade?

Ganglion blockade leads to hypotension.

What is Tubocurarine and where is it derived from?

Tubocurarine is a natural alkaloid (cyclic benzylisoquinoline) derived from South American trees (Strychnos curare spp). It is a competitive antagonist at NMJ and has a long duration of action (~80-120 min). It is seldom used clinically.

What can toxicity of non-depolarizing neuromuscular blockers cause?

Toxicity of non-depolarizing neuromuscular blockers may cause paralysis of the respiratory muscles and hypoxia. It is treated by artificial respiration and a combination of neostigmine plus atropine.

In which condition is Tubocurarine contraindicated?

Tubocurarine is contraindicated in renal disease.

What are the therapeutic uses of N.M.B. as adjuvants to general anaesthetics?

They produce skeletal muscle relaxation, thus reducing the dose of the general anaesthetics.

What effects do non-depolarizing NMB have?

Non-depolarizing NMB have no sedative or analgesic effects. They bind to nicotinic receptors at the neuromuscular junction preventing binding of Acetylcholine thus preventing skeletal muscle depolarization.

How do N.M.B. assist in mechanical ventilation?

N.M.B. are used to assist mechanical ventilation.

What is the onset of action for non-depolarizing neuromuscular blockers compared to depolarizing agents?

Non-depolarizing neuromuscular blockers have a slower onset of action than depolarizing agents such as suxamethonium.

What role do N.M.B. play in endotracheal intubation?

N.M.B. are used to facilitate endotracheal intubation.

What are the classifications listed in the document?

The classifications listed are:
  1. Aminosteroids:
    • Pancuronium, rocuronium, vecuronium
  2. Benzylisoquinoliniums:
    • Atracurium, cisatracurium, mivacurium

How are non-depolarizing neuromuscular blockers classified by duration?

They are classified by duration into:
  • Short acting: 15-30 minutes
  • Intermediate acting: 30-40 minutes
  • Long acting: 60-120 minutes

How do N.M.B. contribute to electroconvulsive therapy?

N.M.B. are used in electroconvulsive therapy to reduce the pain and damage produced by excessive muscle contraction.

What factors influence the duration of action for non-depolarizing neuromuscular blockers?

Duration of action is dose dependent. Shorter or intermediate duration agents like atracurium and vecuronium are more widely used than longer duration agents like pancuronium.

The question on the page originate from the summary of the following study material:

Phamarcology

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