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Muscle Relaxants in Clinical Anaesthesia: An Update

  • V. Vilardi
  • M. Sanfilippo
  • M. K. Verdi
Conference paper

Abstract

Most of the drugs actually used in general anaesthesia resemble high stere-ospecifity, receptors affinity, short duration of action, short recovery time, rapid distribution and redistribution in high degradation tissues. A short sleeping time and muscle relaxation is needed to ensure a rapid recovery and early deambulation. Since 60% of the total surgical procedures are nowadays performed in outpatient regimen, it is necessary to satisfy such requirements. The question is, whether this need has really improved the quality of the drugs currently available. In the case of non-depolarizing muscle relaxants (NMBAs), the short onset time, action and recovery are combined with low potency [1]. None of the muscle relaxants can substitute succinylcholine in terms of onset, duration, quality of muscle relaxation and recovery despite its well known side effects [2]. The other muscle relaxants have a different behaviour. The rate of maximal block reached at laryngeal muscles by rocuronium and mivacurium is 77% and 90% respectively [3], which is lower than thumb adductor muscle. In the case of mivacurium, the time of permanence on neuromuscular laryngeal endplates [4] is so short that it is impossible to perform any procedure on vocal chords even if a complete block is registered on the adductor pollicis muscle. Another problem concerns the method of measurement of the onset time. It is defined as the time interval from the beginning of the injection to the maximal action (peak effect) of a drug [5]. The measurement of the onset time should be performed without either any additive or synergistic drugs (propofol, etomidate, halotane, isoflu-rane, enflurane, etc.) [6, 7], or priming and timing principle [8] which often cause patient discomfort [9].

Keywords

Onset Time Neuromuscular Blocking Agent Rocuronium Bromide Adductor Pollicis Muscle Recovery Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • V. Vilardi
    • 1
  • M. Sanfilippo
    • 1
  • M. K. Verdi
    • 1
  1. 1.Dept. of Anaesthesia and Special Odontostomatologic AnaesthesiaUniversity of L’AquilaL’AquilaItaly

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