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New Muscle Relaxants

  1. Other agents
     
    Other new agents, such as G-1-64 and GW 280430A are at various stages of development

Recent advances- AV 430A- STEROIDAL compound with onset, duration, and offset similar to succinylcholine. Though it does not have any side effects of suxa. It is metabolized by chemical degradation.

  1. Factors prolonging the n-m blockade
    1. Elderly patients
    2. Pediatric patients
    3. Obese
    4. Renal disease (except Atracurium)
    5. Hepatic disease (except Atracurium)
    6. Inhaled anesthetics
       
      Ether > Isoflurane> halothane
       
      Pancuronium & DTC more sensitive
    7. Hypothermia
    8. Antibiotics
      1. Neomycin
      2. Gentamicin
      3. Polymyxin
      4. Clindamycin
      5. Streptomycin
      6. Kanamycin
      7. Lincomycin
      8. Tetracycline
    9. Local anaesthetics (stabilizes post synaptic & muscle except Procaine which can reverse the block membrane.
    10. Ca2+ channel blockers
    11. Hypokalemia
    12. Acidosis
    13. Dantrolene
  2. Drugs which can reverse the block
    1. Phenytoin
    2. Carbamazepine
    3. Magnesium
    4. Calcium
  3. Drugs which can cause Desensitization & phase II block (of nicotinic cholinergic receptors)
    1. Volatile anaesthetics
      1. Halothane
      2. Methoxyflurane
    2. Antibiotics: Polymyxin B
    3. Cocaine
    4. Alcohol
    5. Barbiturates:
      1. Thiopental
      2. Pentobarbital
    6. Ach Agonist:
      1. Decamethonium
      2. Carbachol
    7. Ach inhibitor:
      1. Neostigmine
      2. Pyridostigmine
    8. Local anaesthetics:
      1. Dibucaine
      2. Lidocaine
      3. Prilocaine
    9. Phenothiazine: CPZ
    10. Phencyclidine
    11. Ca2+ channel blockers: verapamil




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