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Muscle relaxants

  1. Sequence of onset – eyes and digits, trunk and abdomen, Intercostal muscle and diaphragm.
  2. Recovery the same order
  3. Fastest and shortest acting non depolarizing blocker- succinylcholine
  4. Fastest onset of action among non depolarizing group – Rapacuronium (1 min)
  5. Second Fastest of action- Rocuronium (90 seconds)
  6. Shortest duration of action – Mivacurium/ Rapacuronium
  7. Calcium channel blockers potentiate both competitive and depolarizing neuromuscular blockers. (MC.)
  8. Adrenaline and other sympathomimetics reduce competitive block by increasing ACh release. (MC.)
  9. Hydrolysis in plasma – Atracurium (Hoffmann degradation; Non enzymatic self hydrolysis of muscle    
  10. relaxant in the plasma), Mivacurium (By Pseudocholinesterase)
  11. Ganglion blocker – DTC > Metocurine
  12. Vagal blocker – Gallamine Pancuronium and Rocuronium – increased H.R.
  13. Histamine release – DTC > Metoc> Atrac > Miva. (Avoided in asthmatics)
  14. Doxacurium is devoid of side effects.
  15. Rapacuronium cause severe bronchospasm
  16. Laudanosine – Toxic metabolite of Atracurium cause CNS excitation.
  17. Liver metabolism – Pancuronium, Rocuronium, Rapa and Vecuronium
  18. Renal excretion – Gallamine, DTC and Metocurine
  19. Muscle relaxant of choice in hepatic and renal failure: Cisatracurium > atracurium .
  20. Succinyl choline is C/I in burns for 1 year
  21. Phase II block is seen with Succinylcholine and its treatment is continue IPPV
  22. Most cardistable muscle relaxant: vecuronium
  23. Muscle relaxant for rapid sequence induction in full stomach patients: Sch > rocuronium
  24. Muscle relaxant increases intracranial pressure: Suxamethonium.
  25. Muscle resistant to anaesthesia: Diaphragm

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