Authors: Sunny Fong
Reviewers: Joseph Tropiano Billy Sun Melinda Davis, MD
Non-Depolarizing Neuromuscular Blockers (NDNMBs) Eg. pancuronium, rocuronium, atracurium, vecuronium
Abbreviations NDNMBs — Non-Depolarizing Neuromuscular Blockers ACh — Acetylcholine
Quick Facts 1° Indication = Skeletal muscle paralysis to facilitate tracheal intubation, and used during indicated surgeries or mechanical ventilation
Route of Administration = IV
Metabolism & Excretion = Redistribution, hepatic clearance/renal excretion (extent varies greatly by drug). NOT degraded by acetylcholinesterase or pseudocholinesterase
See Acetylcholinesterase Inhibitors slide for reversal of NDN M Bs
Competitive antagonism at post-synaptic nicotinic receptors on muscles
Competitive antagonism at the pre-synaptic nicotinic receptors on neurons
Vagolytic effect (esp. pancuronium)
Anaphylactic/ anaphylactoid reactions
4, Binding sites for ACh at post-synaptic nicotinic receptors on muscles
4, Binding sites for ACh at pre-synaptic nicotinic receptors on neurons
Blockage of vagal muscarinic receptors in sinoatrial nodes
IgE antibodies attach to ammonium ion components of NDNMBs Non-immunologic mast cell degranulation (esp. atracurium)
4, Muscle cell depolarization
4, Positive feedback for continued ACh ► release in response to high frequency stimulation
Skeletal muscle paralysis
Tetanic fade, Train-of-Four fade
4, —• Parasympathetic Tachycardia effects on heart
Release of histamine from mast cells and basophils
Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications I Published March 3, 2018 on
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