NMBs

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  • NMBs
    • Depolarising
      • Succinylcholine Suxamethonium
        • Two ach molecules back to back
        • causes initial depolarisation => fasiculation
          • muscle then flaccidly paralysed
        • non competitive neuromuscular blockade
        • no fade produced
        • binds to alpha receptors longer than usual ach molecule
        • plasma/pseudocholinesterases responsible for breakdown
        • Problems with sux
          • muscle fasiculatins
          • muscle pain/soreness
          • inreased IOP, ICP, intra-abdominal pressure
          • increased serum potassium
          • malignant hyperthermia trigger
          • occasional histamine release
    • Non depolarising
      • large polar molecules with N+ atom
        • this binds to alpha sub unit
          • competes with ach for NAchR
            • needs to block 75% of receptors to create a block
              • fade present
      • Amino steroid
        • Pancuronium
          • tachycardia
            • hypertension
              • long half life
                • Untitled
                  • 80% renal excretion
        • Vecuronium
          • dry powder
            • can store 24 hrs
              • 20% renal excretion rest is hepatic
        • Rocuronium
          • fastest onset
            • stable 3 mnths
              • more CV effects
                • less hepatic metabolism (more billary excretion)
                  • diabetic dogs need increased doses
        • Parchycurare molecule
          • tend not to cause histimine release
            • liver metabolises
              • more likely to have active metabolites
      • Benzylisoquinoliniums
        • leptocurares
          • may cause histamine release
            • tend to be degraded by hydrolysis and plasma enterases
        • Atracurium
          • contains 10 isomers
            • causes histamine release
              • must be kept in the fridge
                • 10% excreted urine, 40% Hoffmanns degradation, 50% plasma hydrolysis
                  • Laudenosine
        • Cisatracurium
          • 1 of the active isomers of atracurium
            • cis - cis
              • more potent
                • much less histamine release
                  • more cleared by Hoffmanns degradation
        • Mivacurium
          • 3 isomers, 2 of which active
            • wrong shape for Hoffmanns degradation
              • ester hydrolysis by plasma cholinesterase
                • histamine release
                  • no other cardiac effects
    • effects on anaesthesia
      • cant monitor
        • respiratory parameters
        • eye position or palpebral reflex
        • jaw tone
        • movement
      • can monitor
        • heart rate
        • blood pressure
        • lacrimation
        • salivation
        • diaphragmatic twitches
      • how to monitor
        • peripheral nerve stimulator
          • sends electrical stimulus over nerve which supplies a motor muscle unit
            • positive goes proximal
          • small animals
            • facial
            • ulnar
            • peroneal
          • equine
            • facial
            • peroneal
        • monitoring reflexes returning

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