Anectine Flo-Pack Disease Interactions

Some neuromuscular blocking agents stimulate the release of histamine, which can cause wheezing, bronchospasm, increased bronchial secretions, hypotension, tachycardia, and circulatory collapse. Hypotension may also occur due to ganglionic blockade or as a complication of positive pressure respiration. Tubocurarine appears to be the most potent inducer of histamine, followed by metocurine (no longer commercially available in the U.S.) and succinylcholine. Other agents with varying but lesser degrees of histamine-releasing properties include atracurium, mivacurium, and pancuronium (at excessive dosages). Therapy with these neuromuscular blocking agents should be administered cautiously in patients with clinically significant cardiovascular disease and/or a history of asthma or severe allergic reactions. Certain agents may prolong the QTc interval, especially during general anesthesia in pediatric patients. The initial dosage and rate of administration may need to be reduced, and hemodynamic and respiratory status carefully monitored. Neuromuscular blocking agents that appear to have little or no histamine-inducing effects include cisatracurium, doxacurium, pipecuronium, rocuronium, and vecuronium.

Neuromuscular blocking agents can cause respiratory depression and paralysis. Therapy with neuromuscular blocking agents should be administered cautiously in patients with pulmonary impairment. Treatment of respiratory paralysis consists of positive-pressure artificial respiration with oxygen and maintenance of a patent airway until the recovery of normal respiration is assured.

The use of succinylcholine is contraindicated in patients after the acute phase of injury following major burns. These patients are more likely to develop significant hyperkalemia which may lead to cardiac arrest. The risk of hyperkalemia typically peaks at about 7 to 10 days after injury.

The use of succinylcholine is contraindicated in patients after the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury. has been associated with an elevation in potassium levels due to rapid release of potassium from intracellular sites. Therapy with succinylcholine should be administered cautiously in patients with hyperkalemic states such as extensive soft-tissue trauma, burns, chronic abdominal infections, and subarachnoid hemorrhage.

The use of succinylcholine is contraindicated in patients with a personal or family history of malignant hyperthermia. Succinylcholine administration has been associated with acute onset of malignant hyperthermia, especially during the concomitant use of volatile anesthetics. If malignant hyperthermia occurs, anesthesia should be discontinued and supportive measures rendered promptly, including rapid cooling, inhalation of 100% oxygen, control of acidosis, support of circulation, and assurance of adequate urinary output. In addition, intravenous dantrolene sodium is recommended.

The use of succinylcholine is contraindicated in patients with a personal or family history of skeletal muscle myopathies. Acute rhabdomyolysis with hyperkalemia followed by ventricular arrhythmias, cardiac arrest, and death have been reported following the administration of succinylcholine in apparently healthy children who were later found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy. Immediate treatment of hyperkalemia should be instituted whenever a healthy appearing infant or child develops cardiac arrest with no obvious cause soon after administration of succinylcholine.

The use of succinylcholine is contraindicated in patients with upper motor neuron injury that can be a sequelae of cerebral vasculopathy. The risk of hyperkalemia is increased in these patients.

The use of succinylcholine may exacerbate bradycardia via vagal stimulation leading to asystole, especially after a second dose. Therapy with succinylcholine should be administered cautiously in patients with bradycardia.

The use of succinylcholine has been associated with an increase in intraocular pressure. Therapy with succinylcholine should be administered cautiously in patients with narrow-angle glaucoma.

Depolarizing agents, including succinylcholine, should be used with caution in patients with known neuromuscular junction disease. The succinylcholine-induced neuromuscular blockade may be prolonged in patients with myasthenia gravis (MG). Care should be exercised when using this agent in patients with existing, previously diagnosed MG.