reversal of neuromuscular blockade by the agent rocuronium in general anesthesia
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However, at the end of the surgery, it is necessary to reverse this blockade to facilitate the patient's recovery and ensure they can breathe independently. Show more…
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Suxamethonium (succinylcholine) is a fast-acting depolarising muscle relaxant commonly used to facilitate tracheal intubation (as an adjunct to general anaesthesia). Following administration by single intravenous injection, neuromuscular blockade develops in ~1 minute and within 2-10 minutes the patient recovers. However, 1 in 3000 patients develops Suxamethonium Apnoea following administration. Please explain the phenomenon of Suxamethonium Apnoea and the underlying cause of it. (10 marks)
Madhur L.
The addition of neostigmine did not reverse the muscle relaxation induced by suxamethonium. Which one of the following statements regarding the effect of neostigmine on suxamethonium best explains this? Suxamethonium is a more potent acetylcholinesterase inhibitor than neostigmine and so prevents an increase in ACh levels. Neostigmine blocks the degradation of suxamethonium by binding to plasma (pseudo) cholinesterase. Because suxamethonium is an agonist, only a competitive reversible antagonist can reverse its actions. Suxamethonium prevents neostigmine from binding to the nicotinic receptors present on the skeletal muscle. By enhancing ACh levels, neostigmine perpetuates the maintained stimulation of nicotinic receptors responsible for the muscle relaxation.
Sri K.
Prior to intubation for a surgical procedure, the anesthesiologist administered a single dose of the neuromuscular blocking agent, succinylcholine, to a 23-year-old female to provide muscular relaxation during surgery and to facilitate the insertion of the endotracheal tube. Following this, the inhalation anesthetic was administered, and the surgical procedure was completed. A1. Beginning with depolarization at the neuromuscular junction, describe the normal sequence of events that lead to muscle contraction. A2. What prevents acetylcholine (ACh) from accumulating in the neuromuscular junction and causing a sustained contraction in a normal individual? A3. Succinylcholine acts as a depolarizing agent that prevents repolarization of the nerve. Therefore, no further ACh is released until the drug is cleared. Name another site within the neuromuscular junction that might be affected to prevent muscle contraction. (Hint: curare acts by this mechanism.)
Adi S.
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