01 July 2024 : Review article
The Influence of Acid-Base Balance on Anesthetic Muscle Relaxants: A Comprehensive Review on Clinical Applications and Mechanisms
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
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. | |||