The Influence of Acid-Base Balance on Anesthetic Muscle Relaxants: A Comprehensive Review on Clinical Applications and Mechanisms

01 July 2024 : Review article

Paweł Radkowski

^123ABCDEFG, Maciej Szewczyk

^4ABCDEFG*, Aleksandra Czajka

^12F, Milena Samiec

^12F, Małgorzata Braczkowska-Skibińska

^1FG

DOI: 10.12659/MSM.944510

Med Sci Monit 2024; 30:e944510

Introduction Acid-Base Balance Disturbances Characteristic of Non-Depolarizing Muscle Relaxants The Use of Non-Depolarizing Muscle Relaxants in Acidosis and Alkalosis Characteristic of Depolarizing Muscle Relaxants The Use of Depolarizing Muscle Relaxants in Acidosis and Alkalosis Monitoring and Management Use of Muscle Relaxants in Metabolic and Neuromuscular Disorders Future Directions Conclusions References

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Table 2 Structural and clinical classification of subcategories of NMBDs based on drug reversal patterns and additional activity.

Subcategories	Drugs	Additional activity	Reversal pattern
Steroidal	Rocuronium, vecuronium, pancuronium	Vagolytic activity (especially pancuronium)	Sugammadex, Anticholinesterases (neostigmine, edrophonium, pyridostigmine), Calabadion 1 and 2
Benzylisoquinolinium	Atracurium, cisatracurium, mivacurium,	More likely to release histamine	Neostigmine or edrophonium (must be accompanied by an anticholinergic drug such as glycopyrrolate or atropine to block the ACH activity at the muscarinic receptors), Calabadion 1 and 2
Asymmetrical mixed-onium chlorofumarate	Gantacurium	Histamine release	l-cysteine, anticholinesterases (eg, edrophonium)
NMBDs – non-depolarizing muscle drugs.

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