New Relaxants in the Operating Room

  • Rajinder K. Mirakhur
Conference paper


The introduction of atracurium and vecuronium in the early 1980s was an important advance in the development of muscle relaxants for clinical use. These drugs have an intermediate duration of action, they lack cumulation to a certain extent and are easily reversible. They also in general terms provide good cardiovascular stability. However, even their introduction, although a vast improvement, did not fulfil some of the criteria for an ideal relaxant proposed by Savarese and Kitz (1). There are some reports of bradycardia with the use of both agents; atracurium may liberate histamine and both have a relatively slow onset of effect.


Plasma Cholinesterase Rapid Sequence Induction Equipotent Dose Intermediate Duration Plasma Cholinesterase Activity 
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  1. 1.
    Savarese JJ, Kitz RJ. Does clinical anesthesia need new neuromuscular blocking agents? Anesthesiology 1975; 42: 236–239.PubMedCrossRefGoogle Scholar
  2. 2.
    Mirakhur RK. Newer neuromuscular blocking drugs. An overview of their clinical pharmacology and therapeutic use. Drugs 1992; 44: 182–199.PubMedCrossRefGoogle Scholar
  3. 3.
    Mirakhur RK, McCoy EP. The new relaxants. Current Opinion in Anaesthesiology 1994; 7: 365–369.CrossRefGoogle Scholar
  4. 4.
    Maddineni VR, Cooper AR, Stanley JC, Mirakhur RK, Clarke RSJ. Clinical evaluation of doxacurium chloride. Anaesthesia 1992; 47: 554–557.PubMedCrossRefGoogle Scholar
  5. 5.
    Stanley JC, Mirakhur RK. Comparative potency of pipecuronium bromide and pancuronium bromide. British Journal of Anaesthesia 1989;63: 754–755.PubMedCrossRefGoogle Scholar
  6. 6.
    Stanley JC, Carson IW, Gibson FM, McMurray TJ, Elliott P, Lyons SM, Mirakhur RK. Comparison of the haemodynamic effects of pipecuronium and pancuronium during fentanyl anaesthesia. Acta Anaesthesiologica Scandinavica 1991; 35: 262–266.PubMedCrossRefGoogle Scholar
  7. 7.
    Emmott RS, Bracey BJ, Goldhill DR, Yate PM, Flynn Pi. Cardiovascular effects of doxacurium, pancuronium and vecuronium in anaesthetised patients presenting for coronary artery bypass surgery. British Journal of Anaesthesia 1990; 65: 480–486.PubMedCrossRefGoogle Scholar
  8. 8.
    Savarese JJ, Ali HH, Basta SJ, Embree PB, Scott RP, Sunder N, Weakly JN, Wastila WB, El-Sayad HA. The clinical neuromuscular pharmacology of mivacurium chloride (DW B 109U), a short acting norndepolarising ester neuromuscular blocking drug. Anesthesiology 1988; 68: 723–732.PubMedCrossRefGoogle Scholar
  9. 9.
    Cook DR, Stiller RL, Chakravorti S, Welch RM, Brandom BW. In vitro metabolism of BW B109U. Anesthesiology 1987; 67: A610.CrossRefGoogle Scholar
  10. 10.
    Maddineni VR, Mirakhur RK, McCoy EP, Fee JPH, Clarke RSJ. Neuromuscular effects and intubating conditions following mivacurium. A comparison with suxamethonium. Anaesthesia 1993; 48: 940–945.PubMedCrossRefGoogle Scholar
  11. 11.
    Connolly FM, Loan PB, McCoy EP, Mirakhur RK. Antagonism of mivacurium block with edrophonium from various degrees of spontaneous recovery. British Journal of Anaesthesia 1994; 73: 723P-724P.Google Scholar
  12. 12.
    Savarese JJ, Ali HH, Basta SJ, Scott RP, Embree PB, Wastila WB, Abou-Donia MM, Gelb C. The cardiovascular effects of mivacurium chloride (BW B 109U) in patients receiving nitrous oxide-opiate-barbiturate anesthesia. Anesthesiology 1989; 70: 386–394.PubMedCrossRefGoogle Scholar
  13. 13.
    Loan PB, Bhanamurthy S, Mirakhur RK, McCoy EP, McMurray TJ, Connolly FM. Haemodynamic effect of mivacurium under high dose fentanyl anaesthesia. Comparison with atracurium. British Journal of Anaesthesia 1994; 73: 715P.Google Scholar
  14. 14.
    Maddineni VR, Mirakhur RK, McCoy EP. Recovery of mivacurium block with or without anticholinesterases following administration by continuous infusion. Anaesthesia 1994; 49: 946–948.PubMedCrossRefGoogle Scholar
  15. 15.
    Maddineni VR, Mirakhur RK. Prolonged neuromuscular block following mivacurium. Anesthesiology 1993; 78: 1181–1184.PubMedCrossRefGoogle Scholar
  16. 16.
    Goudsouzian NG, D’Hollander AA, Viby-Mogensen J. Prolonged neuromuscular block from mivacurium in two patients with cholinesterase deficiency. Anesthesia and Analgesia 1993; 77: 183–185.PubMedCrossRefGoogle Scholar
  17. 17.
    Frampton JE, McTavish D. Mivacurium: a review of its pharmacology and therapeutic potential in general anaesthesia. Drugs 1993; 45: 1066–1089.PubMedCrossRefGoogle Scholar
  18. 18.
    Cooper AR, Mirakhur RK, Elliott P, McCarthy JG. Estimation of the potency of ORG 9426 using two different modes of nerve stimulation. Canadian Journal of Anaesthesia 1992; 39: 139–142.PubMedCrossRefGoogle Scholar
  19. 19.
    Cooper AR, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of ORG 9426 (rocuronium) and suxamethonium. British Journal of Anaesthesia 1992; 69: 269–273.PubMedCrossRefGoogle Scholar
  20. 20.
    Cooper AR, Mirakhur RK, Maddineni VR. Neuromuscular effects of rocuronium (ORG 9426) during fentanyl and halothane anaesthesia. Anaesthesia 1993; 48: 103–105.PubMedCrossRefGoogle Scholar
  21. 21.
    Connolly FM, Loan PB, Mirakhur RK, McCoy EP. Comparison of succinylcholine and rocuronium for rapid sequence induction of anesthesia. Anesthesiology 1994; 81: A1072.CrossRefGoogle Scholar
  22. 22.
    Abouleish E, Abboud T, Lechevailer T, Zhu J, Chalian A, Alford K. Rocuronium (ORG 9426) for Caesarean section. British Journal of Anaesthesia 1994; 73: 336–341.PubMedCrossRefGoogle Scholar
  23. 23.
    McCoy EP, Maddineni VR, Elliott P, Mirakhur RK, Carson IW, Cooper AR. Haemodynamic effects of rocuronium during fentanyl anaesthesia. Comparison with vecuronium. Canadian Journal of Anaesthesia 1993; 40: 703–708.PubMedCrossRefGoogle Scholar
  24. 24.
    McCoy EP, Mirakhur RK, Maddineni VR, Loan PB, Connolly FM. Administration of rocuronium (ORG 9426) by continuous infusion and its reversibility with anticholinesterases. Anaesthesia 1994; 49: 940–945.PubMedCrossRefGoogle Scholar
  25. 25.
    Lien CA, Belmont MR, Abalos A, Abou-donia M, Savarese JJ. Dose-response relations of 51W89 under nitrous oxide-opioid-barbiturate anesthesia. Anesthesiology 1993; 79: A948.CrossRefGoogle Scholar
  26. 26.
    Lepage JY, Malinovosky JM, Malinge M, Cozian A, Pinaud M. Comparison of equipotent doses of 51W89 and atracurium. Anesthesiology 1994; 81: A1090.CrossRefGoogle Scholar
  27. 27.
    Stout RG, Belmont MR, Pavlin EG, Abalos A, Lien CA. Evaluation of intubation at 90 and 120 seconds following 51W89 administration. Anesthesiology 1994; 81c: A1078.CrossRefGoogle Scholar
  28. 28.
    Lepage JY, Malinovosky JM, Malinge M, Cozian A, Pinaud M. Pharmacodynamics and histamine releasing potency of high dose of 51W89. Anesthesiology 1994; 81: A 1077.CrossRefGoogle Scholar
  29. 29.
    Wierda JMKH, van den Broek L, Proost JH, Verbaan BW, Hennis PJ. Time course of action and endotracheal intubating conditions of ORG 9487: a new short acting steroidal muscle relaxant. Comparison with succinylcholine. Anesthesia and Analgesia 1993; 77: 579–584.PubMedCrossRefGoogle Scholar
  30. 30.
    Connolly FM, Mirakhur RK, Loan PB, McCoy E, Morrow BC. Time course of action of ORG 9487 with and without reversal: comparison with suxamethonium. British Journal of Anaesthesia 1995; in press.Google Scholar

Copyright information

© Springer Japan 1995

Authors and Affiliations

  • Rajinder K. Mirakhur
    • 1
  1. 1.Department of AnaestheticsThe Queen’s University of BelfastBelfastUK

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