Neuromuscular Blockers

Considerations for selecting most appropriate NMB
  • Onset time - Succinylcholine is most ideal for emergent airway followed by Rocuronium
  • Duration of action- Succinylcholine is shortest (7 minutes), Rocuronium, vecuronium and atracurium are intermediate (approximately 30 minutes), Cisatracurium DOA- 1 hour approx.
  • Organ Function- Aminosteroids are organ dependent and can have a prolonged duration in hepatic patients. Use benzylisoquinolines instead that rely on hoffman elimination. A high pH (alkalotic state) will result in faster elimination whereas hypothermia can prolong elimination.
  • Histamine Release- This can be important to consider in patients with severe asthma. Histamine can result in bronchoconstriction. Succinylcholine and atracurium are both known to release histamine.

Common Clinical Question**
  • NMBs are the most commonly the cause of allergic reaction in anesthesia followed by antibiotics