neuromuscular depolarizing agents


Summary: Drugs that interrupt transmission at the skeletal neuromuscular junction by causing sustained depolarization of the motor end plate. These agents are primarily used as adjuvants in surgical anesthesia to cause skeletal muscle relaxation.

Top Publications

  1. Lysakowski C, Suppan L, Czarnetzki C, Tassonyi E, Tramer M. Impact of the intubation model on the efficacy of rocuronium during rapid sequence intubation: systematic review of randomized trials. Acta Anaesthesiol Scand. 2007;51:848-57 pubmed
    ..Propofol-rocuronium is thought to be superior to thiopental-rocuronium for rapid sequence intubation (RSI). The role of the intubation model per se has never been investigated...
  2. Sluga M, Ummenhofer W, Studer W, Siegemund M, Marsch S. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg. 2005;101:1356-61 pubmed
    ..We conclude that during rapid sequence induction of anesthesia in emergent cases, succinylcholine allows for a more rapid endotracheal intubation sequence and creates superior intubation conditions compared with rocuronium...
  3. Giordano G, Klintworth H, Kavanagh T, Costa L. Apoptosis induced by domoic acid in mouse cerebellar granule neurons involves activation of p38 and JNK MAP kinases. Neurochem Int. 2008;52:1100-5 pubmed publisher
    ..Inhibitors of p38 (SB203580) and of JNK (SP600125) antagonize DomA-induced apoptosis. These results indicate the importance of oxidative stress-activated JNK and p38 MAP kinase pathways in DomA-induced apoptosis in CGNs. ..
  4. Pollock A, Langton E, Couchman K, Stowell K, Waddington M. Suspected malignant hyperthermia reactions in New Zealand. Anaesth Intensive Care. 2002;30:453-61 pubmed
    ..This test also demonstrated the shortcomings of the Malignant Hyperthermia Clinical Grading Scale...
  5. Marsch S, Steiner L, Bucher E, Pargger H, Schumann M, Aebi T, et al. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial. Crit Care. 2011;15:R199 pubmed publisher
    ..Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI...
  6. Martyn J, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology. 2006;104:158-69 pubmed
  7. Levin E, Pang W, Harrison J, Williams P, Petro A, Ramsdell J. Persistent neurobehavioral effects of early postnatal domoic acid exposure in rats. Neurotoxicol Teratol. 2006;28:673-80 pubmed
    ..However, the sublethal persistent neurobehavioral toxicity appears to be less pervasive than reported effects following DA administered mid-gestation. ..
  8. Mallon W, Keim S, Shoenberger J, Walls R. Rocuronium vs. succinylcholine in the emergency department: a critical appraisal. J Emerg Med. 2009;37:183-8 pubmed publisher
    ..Non-depolarizing drugs have the advantage of causing less pain due to post-paralysis myalgias...
  9. Gill D, Ramsay S, Tasker R. Selective reductions in subpopulations of GABAergic neurons in a developmental rat model of epilepsy. Brain Res. 2010;1331:114-23 pubmed publisher

More Information


  1. Perez Gomez A, Tasker R. Enhanced neurogenesis in organotypic cultures of rat hippocampus after transient subfield-selective excitotoxic insult induced by domoic acid. Neuroscience. 2012;208:97-108 pubmed publisher
  2. Sari P, Kerr D. Domoic acid-induced hippocampal CA1 hyperexcitability independent of region CA3 activity. Epilepsy Res. 2001;47:65-76 pubmed
  3. Laurin E, Sakles J, Panacek E, Rantapaa A, Redd J. A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients. Acad Emerg Med. 2000;7:1362-9 pubmed
    ..Although succinylcholine had a faster onset and provided more relaxation, the difference had no clinical significance. Approximately a fourth of ED RSI patients qualified for use of rocuronium using these high-risk criteria. ..
  4. Tryphonas L, Truelove J, Nera E, Iverson F. Acute neurotoxicity of domoic acid in the rat. Toxicol Pathol. 1990;18:1-9 pubmed
    ..The results of this study suggest that domoic acid is excitotoxic and causes a characteristic syndrome with clinical signs and histopathologic lesions similar to those reported for kainic acid. ..
  5. Tryphonas L, Truelove J, Iverson F. Acute parenteral neurotoxicity of domoic acid in cynomolgus monkeys (M. fascicularis). Toxicol Pathol. 1990;18:297-303 pubmed
    ..It was concluded that D.A., administered intravenously, is neuroexcitatory and a powerful emetic at doses of 0.025 to 0.2 mg/kg. At higher doses (0.5 mg/kg intravenously and 4 mg/kg intraperitoneally), D.A. is strongly excitotoxic. ..
  6. Berman F, LePage K, Murray T. Domoic acid neurotoxicity in cultured cerebellar granule neurons is controlled preferentially by the NMDA receptor Ca(2+) influx pathway. Brain Res. 2002;924:20-9 pubmed
    ..Neurochem. 71 (1998) 2349], which suggests that elevation of [Ca(2+)](i) in the vicinity of the NMDA receptor ion channel activates processes leading to neuronal death. ..
  7. Booij L. Is succinylcholine appropriate or obsolete in the intensive care unit?. Crit Care. 2001;5:245-6 pubmed
    ..The adverse effect profile of succinylcholine is such that its use in the ICU must be considered obsolete. Suitable alternatives are the intermediately long-acting nondepolarizing relaxants, of which rocuronium is probably preferable. ..
  8. Ummenhofer W, Kindler C, Tschalèr G, Hampl K, Drewe J, Urwyler A. Propofol reduces succinylcholine induced increase of masseter muscle tone. Can J Anaesth. 1998;45:417-23 pubmed
  9. Burns B, Aguirrebarrena G. Occult traumatic loculated tension pneumothorax--a sonographic diagnostic dilemma. Prehosp Emerg Care. 2013;17:92-4 pubmed publisher
    ..We have subsequently added scanning the lateral chest wall in the fifth intercostal space to the algorithm. ..
  10. Hor J. Cardiac arrhythmia after succinylcholine administration in a patient with Guillain-Barré syndrome--a case report. Middle East J Anaesthesiol. 2010;20:881-3 pubmed
  11. Myers C, Gopalka A, Glick D, Goldman M, Dinwiddie S. A case of negative-pressure pulmonary edema after electroconvulsive therapy. J ECT. 2007;23:281-3 pubmed
    ..He recovered fully and received 43 subsequent ECT treatments without complication. This case illustrates the importance of taking steps to prevent airway obstruction as well as recognizing this rare but serious complication. ..
  12. Gibson J. Unusual effect of suxamethonium. Anaesth Intensive Care. 2004;32:290 pubmed
  13. Huggins R, Kennedy W, Melroy M, Tollerton D. Cardiac arrest from succinylcholine-induced hyperkalemia. Am J Health Syst Pharm. 2003;60:694-7 pubmed
  14. Rizzi R. Neuromuscular monitoring advancement. Anesthesiology. 2004;100:454; author reply 455 pubmed
  15. Gries A, Motsch J, Ulmer H, Springer W. [Emergency from anesthesia in small children. From laryngospasm to prolonged apnea]. Anaesthesist. 2003;52:127-31 pubmed
    ..risk factors and treatment of perioperative airway obstruction 2. factors and treatment of prolonged apnea, and 3. delayed arousal reactions and their management in an outpatient setting. ..
  16. Mollerup H, Gätke M. Butyrylcholinesterase gene mutations in patients with prolonged apnea after succinylcholine for electroconvulsive therapy. Acta Anaesthesiol Scand. 2011;55:82-6 pubmed publisher
    ..The aim of the study was to assess the clinical significance of genetic variants in butyrylcholinesterase gene (BCHE) in patients with a suspected prolonged duration of action of succinylcholine after ECT...
  17. Lu Z, Wang Y, Yu B. The ideal dose of succinylcholine for tracheal intubation. Anesth Analg. 2006;103:1581; author reply 1582 pubmed
  18. Taha S, El Khatib M, Baraka A, Haidar Y, Abdallah F, Zbeidy R, et al. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anaesthesia. 2010;65:358-61 pubmed publisher
    ..However, time to desaturation is prolonged whenever lidocaine and fentanyl precede suxamethonium. ..
  19. Cantiello F, Imperatore V, Iannuzzo M, Scibelli G, Di Meo S, Fusco F, et al. Periprostatic nerve block (PNB) alone vs PNB combined with an anaesthetic-myorelaxant agent cream for prostate biopsy: a prospective, randomized double-arm study. BJU Int. 2009;103:1195-8 pubmed publisher
    ..There was no difference in pain perception the day after biopsy (VAS6, 0.32 vs 0.22, P = 0.14). Antrolin placed with PNB is better than PNB alone in reducing pain and discomfort during transrectal-ultrasonography guided prostate biopsy. ..
  20. Markowitz K, Pashley D. Personal reflections on a sensitive subject. J Dent Res. 2007;86:292-5 pubmed
  21. Yong P, Birns J, Ibrahim M. Anaphylactic shock: the great mimic. South Med J. 2007;100:295-7 pubmed
    ..The cases we present highlight the necessity of good clinical assessment when evaluating such patients. ..
  22. Ichihara Y, Kikuchi H. [Drug-induced malignant hyperthermia]. Nihon Rinsho. 2007;65 Suppl 8:326-30 pubmed
  23. Tiedeken J, Ramsdell J. Embryonic exposure to domoic Acid increases the susceptibility of zebrafish larvae to the chemical convulsant pentylenetetrazole. Environ Health Perspect. 2007;115:1547-52 pubmed
  24. Gawande A, Denno D, Truog R, Waisel D. Physicians and execution--highlights from a discussion of lethal injection. N Engl J Med. 2008;358:448-51 pubmed publisher
  25. Shiba K, Yano T, Sato W, Mori H, Tonami N. Characterization of radioiodinated (-)-ortho-iodovesamicol binding in rat brain preparations. Life Sci. 2002;71:1591-8 pubmed
    ..These results showed that (-)-oIV binds to vesicular acetylcholine transporters (VAChT) more selectively than (-)-mIV, previously reported as a VAChT mapping agent, and may be suitable for VAChT imaging studies. ..
  26. Li J, Zhang D, Wang L, Zhang D, Zhang R. [Myasthenia gravis occurring after resection of thymoma]. Zhonghua Wai Ke Za Zhi. 2004;42:540-2 pubmed
    ..An intensive care should be put on the cases with the tendency of occurring postoperative MG. ..
  27. Benhamou D, Bouaziz H, Chassard D, Ducloy J, Fuzier V, Laffon M, et al. Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey. Eur J Anaesthesiol. 2009;26:694-700 pubmed publisher
    ..Some deficits were of limited importance (antibiotic prophylaxis and oxytocin administration), whereas others (use of succinylcholine and cricoid pressure) remain of concern. ..
  28. Vidal A, Correa J, Blanco J. Effect of some habitual cooking processes on the domoic acid concentration in the cockle (Cerastoderma edule) and Manila clam (Ruditapes philippinarum). Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2009;26:1089-95 pubmed publisher
  29. Di Filippo A, Gonnelli C. Rapid sequence intubation: a review of recent evidences. Rev Recent Clin Trials. 2009;4:175-8 pubmed
    ..This problem can be solved through the use of Sugammadex. As a muscle relaxant chelating Sugammadex antagonizes the effects induced by Rocuronium on muscle tissue and quickly resolve the blockade. ..
  30. Li S, Liu Y, Tan F, Chen J, Chen L. Efficacy of manual jet ventilation using Manujet III for bronchoscopic airway foreign body removal in children. Int J Pediatr Otorhinolaryngol. 2010;74:1401-4 pubmed publisher
    ..05). This study confirmed the safety and efficacy of performing manual jet ventilation with Manujet III in foreign body removal by rigid bronchoscopy in children. ..
  31. Li Wan Po A, Girard T. Succinylcholine: still beautiful and mysterious after all these years. J Clin Pharm Ther. 2005;30:497-501 pubmed
  32. Escudero A, Castillo R, Ibanez Esteve C, González Tadeo M, Llubiá C, Canet J. [Rhabdomyolysis after succinylcholine administration]. Rev Esp Anestesiol Reanim. 2005;52:184-5 pubmed
  33. Guttormsen A, Johansson S, Oman H, Wilhelmsen V, Nopp A. No consumption of IgE antibody in serum during allergic drug anaphylaxis. Allergy. 2007;62:1326-30 pubmed
    ..A serum sample intended to trace the drug involved in an IgE-mediated anaphylactic reaction can be drawn in direct relation to the reaction. ..
  34. Al Takrouri H, Martin T, Mayhew J. Hyperkalemic cardiac arrest following succinylcholine administration: The use of extracorporeal membrane oxygenation in an emergency situation. J Clin Anesth. 2004;16:449-51 pubmed
    ..The patient required extracorporeal membrane oxygenation support from which he was eventually weaned successfully. He died eleven days after the cardiac arrest as a result of apparent ischemic brain injury. ..
  35. Lee W, Kao S, Liu I, Cheng J. Increase of insulin secretion by ginsenoside Rh2 to lower plasma glucose in Wistar rats. Clin Exp Pharmacol Physiol. 2006;33:27-32 pubmed
    ..ginseng root. Thus, ginsenoside Rh2 may be applied as an adjuvant for the management of diabetes...
  36. Swartz C. Aspiration and postictal agitation after electroconvulsive therapy with propofol but no succinylcholine or atropinic agent. J ECT. 2005;21:50-1 pubmed
  37. Sawant P, Tyndall J, Holland P, Peake B, Mountfort D, Kerr D. In vivo seizure induction and affinity studies of domoic acid and isodomoic acids-D, -E and -F. Neuropharmacology. 2010;59:129-38 pubmed publisher
    ..This study has shed new light on structural conformations affecting non-NMDA ionotropic glutamate receptor binding and functional potency, and provides a foundation for future work in areas of AMPA and KA receptor modeling. ..
  38. Ulsenheimer K. [Legal liability problems in outpatient operations. View from an anesthesiological perspective]. Anaesthesist. 2012;61:156-62 pubmed publisher
    ..Particularly prone to liability problems are the postoperative phase and discharge of patients which will be demonstrated in some exemplary cases. ..
  39. Stelzhammer V, Rothermundt M, Guest P, Michael N, Sondermann C, Kluge W, et al. Proteomic changes induced by anaesthesia and muscle relaxant treatment prior to electroconvulsive therapy. Proteomics Clin Appl. 2011;5:644-9 pubmed publisher
  40. Karanovic N, Carev M, Kardum G, Tomanović N, Stuth E, Gal J, et al. Succinylcholine use in adult anesthesia - A multinational questionnaire survey. Coll Antropol. 2011;35 Suppl 1:183-90 pubmed
    ..The regional differences in SCh usage may be considered through anesthesia cultures and practice variations depending on country...
  41. Turan A, Mendoza M, Gupta S, You J, Gottlieb A, Chu W, et al. Consequences of succinylcholine administration to patients using statins. Anesthesiology. 2011;115:28-35 pubmed publisher
  42. Karcioglu O, Arnold J, Topacoglu H, Ozucelik D, Kiran S, Sonmez N. Succinylcholine or rocuronium? A meta-analysis of the effects on intubation conditions. Int J Clin Pract. 2006;60:1638-46 pubmed
    ..1% increase (95% CI = 13.7-24.5) in the frequency of excellent ETI conditions. SCH appears to be superior to RCR in creating excellent ETI conditions and avoiding unacceptable ETI conditions. ..
  43. Tenkir A, Tibebu T. Leech on the eye in a child. Ethiop Med J. 2010;48:177-80 pubmed
    ..The possibility of leech infestation need to be considered in the differential diagnosis of open-globe injury with prolapse of uveal tissue. The use of a muscle relaxant for leech removal was not previously documented. ..
  44. Erin N, Billingsley M. Domoic acid enhances Bcl-2-calcineurin-inositol-1,4,5-trisphosphate receptor interactions and delayed neuronal death in rat brain slices. Brain Res. 2004;1014:45-52 pubmed
    ..These experiments further define the mechanisms by which neurons respond to excitotoxic insults, and suggest that interactions between calcineurin and its target proteins may influence cellular responses to injury. ..
  45. Liu C, Huang C, Lau H, Yeh H. Anesthetic management for two infants undergoing surgery for tension pneumatoceles. Paediatr Anaesth. 2007;17:189-90 pubmed
  46. Qiu S, Jebelli A, Ashe J, Curras Collazo M. Domoic acid induces a long-lasting enhancement of CA1 field responses and impairs tetanus-induced long-term potentiation in rat hippocampal slices. Toxicol Sci. 2009;111:140-50 pubmed publisher
    ..The observed impairment of tetanus LTP and misregulation of CaMKII and GluR1 phosphorylation may partially account for DOM neurotoxicity and underlie the molecular basis for DOM-induced memory deficit. ..
  47. Baraka A. Depolarizing block is an endplate-muscular block, not a neuromuscular block. Anesthesiology. 2007;106:399-400; author reply 400 pubmed
  48. Nafiu O. Morbid obesity: a risk factor for maternal mortality. Int J Obstet Anesth. 2007;16:187; author reply 187-8 pubmed
  49. Smith C, Gibson D, Tait J. Transmembrane voltage regulates binding of annexin V and lactadherin to cells with exposed phosphatidylserine. BMC Biochem. 2009;10:5 pubmed publisher
    ..Alterations in membrane potential regulate the binding of annexin V and lactadherin to cell membranes, and may also influence the membrane binding of other classes of phosphatidylserine-binding proteins. ..
  50. Adams A, Doucette T, Ryan C. Altered pre-pulse inhibition in adult rats treated neonatally with domoic acid. Amino Acids. 2008;35:157-60 pubmed
    ..Results indicate that neonatal treatment with DOM leads to lowered PPI in adult males and an increased startle response in adult females. ..
  51. Delogu G, Antonucci A, Moretti S, Marandola M, Tellan G, Signore M, et al. Oxidative stress and mitochondrial glutathione in human lymphocytes exposed to clinically relevant anesthetic drug concentrations. J Clin Anesth. 2004;16:189-94 pubmed
    ..Drugs commonly used in anesthesia practice may significantly alter the oxidative state of peripheral T cells. This mechanism could contribute to the immune suppression that occurs transiently in the early postoperative period. ..
  52. Bouhajja B, Haddad F, Ben Ammar M. [Malignant hyperthermia]. Tunis Med. 2002;80:395-401 pubmed
    ..Confirmation of the susceptibility to malignant hyperthermia can be provided by in vitro contracture test with halothane or caffeine after muscle biopsy. ..
  53. Cabaton J, Rondelet B, Gergele L, Besnard C, Piriou V. [Tako-Tsubo syndrome after anaphylaxis caused by succinylcholine during general anaesthesia]. Ann Fr Anesth Reanim. 2008;27:854-7 pubmed publisher
    ..We report here a case of Tako-Tsubo syndrome related to an anaphylactic shock caused by succinylcholine during general anaesthesia of a female patient, wearing an unadjustable gastric band...