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 5 Effects of acid-base disorders on neuromuscular blockade made by non-depolarizing and depolarizing muscle agents.

	Effect of acid/base disorder on blockade
Drug	Metabolic acidosis	Respiratory acidosis	Metabolic alkalosis	Respiratory alkalosis

Rocuronium	Enhance	Enhance; prolongs the duration	Diminish	Diminish
Vecuronium	Enhance;	Enhance; prolongs the duration and recovery	Diminish	Diminish; shortens the duration and recovery
Pancuronium	Enhance	Enhance	Diminish	Diminish
Atracurium	Enhance	Enhance	Diminish	Diminish
Cisatracurium	Not clear

Succinylcholine	Diminish	Diminish	Enhance	Enhance
NMBAs – neuromuscular blocking agents.

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