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PubMed2006

Interference between muscle relaxation and facial nerve monitoring during parotidectomy.

CONCLUSION: There is a worst case scenario involving a small risk of facial nerve injury and dysfunction of facial nerve monitoring. With regard to patient safety the use of a short-acting muscle relaxant and the analysis of neuromuscular blockade are necessary because these permit documentation of the temporal course of relaxation and the progress of surgery. OBJECTIVES: The use of muscle relaxant may disturb facial nerve monitoring during parotidectomy. The aim of the study was to analyze the duration of muscle relaxation in relation to the progress of surgery. STUDY DESIGN/METHODS: Twenty-one patients who underwent parotidectomy were enrolled in this prospective study, where the short-acting muscle relaxant mivacurium (0.2 mg/kg) was used. The neuromuscular blockade was monitored on the basis of train-of-four (TOF) peripheral stimulation. The time of intubation, skin incision, facial nerve identification and the end of surgery were documented. RESULTS: The mean times of the TOF ratios (2/4; 3/4; 4/4), skin incision, and facial nerve identification differed significantly (chi(2)=0.05; df=1; p>0.05). For the earliest skin incision (21 min), 14.3% of patients have a TOF ratio smaller than 2/4 at which a neuromuscular block of the facial nerve is possible.

Adult↗
PubMed1987

A pharmacologic study on the histamine releasing effect of atracurium and other muscle relaxants in rat isolated ileum.

In this study, the effects of histamine, antihistamines (terfenadine and mepyramine), 5-hydroxytryptamine, and muscle relaxants, atracurium, vecuronium and gallamine, on the tone and contractility of rat ileum were studied and compared in vitro. The aim of the present investigation was to measure, pharmacologically, the histamine releasing effect of muscle relaxants, e.g atracurium, vecuronium and gallamine, by comparing their contractile response in the absence and presence of antihistamines and comparing their mechanical responses with those produced by histamine and 5-hydroxytryptamine (5-HT). The results showed that the antihistamines, triludan(terfenadine) and mepyramine produced opposite effects in rat ileum. Terfenadine (0.1-20 microM) produced concentration-dependent contractions in the rat ileum, whereas mepyramine (0.1-10 microM) relaxed the muscle, e.g. by 1.2 g tension. Atracurium (0.5-500 microM), vecuronium (0.2-200 microM), and gallamine (0.1-7.0 microM) produced marked contractions (1.5-4.0 g tension) in rat ileum, and these contractions were markedly reduced by mepyramine (1.3 microM) or terfenadine (5 microM), implicating histamine release in the generation of these contractions. However, there was some residual contraction which was not blocked by mepyramine, but by 5-HT antagonist, methysergide (1 microM), indicating that a mechanism other than histamine release may be responsible for the residual contraction, i.e. release of other mediators such as 5-HT, prostaglandins, or calcium. 5-HT (0.5-500 microM) and histamine (0.5-500 microM) produced contractions in the rat ileum, but 5-HT was more effective than histamine in producing these contractions. Similarly, gall amine was more effective than atracurium and vecuronium in contracting the rat ileum.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Effects of muscle relaxation therapy using specially designed plates in patients with pulmonary emphysema.

It has been suggested that respiratory muscle dysfunction plays a major role in the development of acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD). In this study, we devised a respiratory muscle relaxation maneuver using wedge-shaped wooden plates, with which pressure was exerted on the intercostal and accessory respiratory muscles by hand, or by tapping with a wooden hammer, for 15-20 minutes twice a day. The muscle relaxation maneuver was performed in 5 moderate to severe pulmonary emphysema patients for 4 weeks and in 7 emphysema patients for 6 weeks, and the effects on pulmonary function were examined. After the therapy, inspiratory capacity (IC) and vital capacity (VC) in both the 4 weeks-and 6 weeks-treated groups, and the forced expiratory volume in 1 second (FEV 1.0) in the 6 weeks-treated group were significantly increased, and CO2 retention had also improved. Daily peak expiratory flow (PEF) showed significant increases from 2 weeks after the initiation of the therapy. These results suggest that the respiratory muscle relaxation maneuver is effective for improving the pulmonary function of pulmonary emphysema patients.

Aged↗
PubMed2003

[Application of muscle relaxants for rapid-sequence induction of anaesthesia].

The present study evaluates the use of muscle relaxants for rapid-sequence induction (RSI) and different application techniques (pre-curarisation, priming, timing) as a part of a nationwide survey in Germany. In 86.8% of anaesthesia departments succinylcholine is used for RSI and an average of 56.5% of respondents used only succinylcholine for RSI. Of all non-depolarising muscle relaxants rocuronium is the most frequently used alternative. Of the anaesthesia departments 2.6% use rocuronium regularly in patients with increased risk for aspiration of stomach contents; level one centres significantly more than others, 12.9% answered that pre-curarisation techniques were never used, whereas 45.6% use non-depolarising neuromuscular blocking drugs before giving succinylcholine in 80-100% of cases. Priming is not used by 64.4% of respondents, as opposed to 9.8% who utilise this technique regularly. The statements regarding timing are 71.1% and 5.4%, respectively. Alcuronium is used for RSI in departments in which the financial aspect is the primary decision criteria. Despite ist known side-effects and the on-going discussion over the past years, succinylcholine is still the most frequently used muscle relaxants for RSI. Priming is often declined by anaesthetists in Germany, most probably due to the absence of clear advantages and the possibility of severe complications. It is the opinion of the authors that timing but also drugs with a slow onset (e.g., alcuronium and Pancuronium) are obsolete in the context of RSI.

Alcuronium↗
PubMed1984

Effect of prior administration of a non-depolarising muscle relaxant on the action of suxamethonium in the dog.

The non-depolarising muscle relaxants alcuronium (0.1 mg kg-1), gallamine (1 mg kg-1) and pancuronium (0.06 mg kg-1) were administered to six dogs. At 50 per cent return of neuromuscular activity, as measured by the train-of-four technique, the depolarising muscle relaxant suxamethonium (0.3 mg kg-1) was injected intravenously. At 50 per cent return of neuromuscular activity, atropine and neostigmine were administered to reverse the neuromuscular block. The duration of action of suxamethonium was reduced by each of the non-depolarising muscle relaxants.

Alcuronium↗
PubMed2006

[Muscle relaxants in Germany 2005: a comparison of application customs in hospitals and private practices].

Aim of this study was to evaluate application customs of muscles relaxants in hospitals compared to their use in private practice. Of the 3,260 questionnaires sent-out, 66.9% could be analyzed. Of these 54% were from anesthetists in private practice, 41% from heads of hospital anesthesia departments and 5% from heads of level one hospital anesthesia departments. The first difference between private practices and hospitals was the number of available muscle relaxants: 87% of private practices use 1-3 relaxants, whereas 79% of hospitals use 3-5. Another apparent difference was the relationship between general anesthesia and the number of intubations: 60% of private practices have over 80% of general anesthesia cases, but only 50% of these patients are intubated. On the contrary, two thirds of the hospitals have 50-80% general anesthesia cases and 60-70% of patients are intubated. The main wish for an ideal muscle relaxant was independent of private practice or hospital, short onset time, followed by fast recovery. In accordance 74% of anesthetists in hospitals and 72% of anesthetists in private practice voiced the wish for a non-depolarizing succinylcholine substitute. The results of this nationwide survey suggest that time pressure in combination with an increased specialization of anesthetists in private practice are the main factors for availability and use of muscle relaxants in routine anesthesia.

Anesthesia↗
PubMed1985

Muscle relaxant action of 2-chloroadenosine in genetically spastic rats is independent of gamma-aminobutyric acid-mediated inhibition.

The role played by benzodiazepine (BDZ) receptors and GABAergic mechanisms in the muscle relaxant effect of the adenosine receptor agonist, 2-chloroadenosine (2-CLA) was evaluated in genetically spastic rats. 2-CLA reduced in a dose-related manner the spontaneous tonic activity in the electromyogram (EMG) of the gastrocnemius-soleus muscle. While the muscle relaxant effect produced by the adenosine analogue was abolished by aminophylline, a methylxanthine with potent antagonistic activity of adenosine-mediated inhibition, the two gamma-aminobutyric acid (GABA) antagonists bicuculline and picrotoxin did not reverse it. Neither Ro 15-1788 nor CGS 8216, specific BDZ receptor antagonists, nor beta-carboline-3-carboxylic acid methyl ester, an inverse agonist at BDZ receptors, affected the depressant effect of 2-CLA in the EMG. These results suggest that 2-CLA does not interact with GABA or BDZ receptor-mediated events in vivo to produce the muscle relaxant action. It is proposed that purinergic mechanisms may be involved in the muscle relaxant effects of a variety of drugs.

2-Chloroadenosine↗
PubMed1983

Separation of clonazepam-induced head twitches and muscle relaxation in mice.

Stereotyped head twitches in mice were induced by clonazepam. The number of head twitches produced was directly related to the clonazepam dose. In addition to head twitches, clonazepam produced dose-related muscle relaxation. Methysergide antagonized the action of clonazepam on head twitches. However, methysergide failed to block the muscle relaxant action. In contrast to methysergide, the benzodiazepine receptor antagonists CGS 8216 and Ro 15-1788 blocked the muscle relaxant effects of clonazepam. Neither CGS 8216 nor Ro 15-1788 blocked the clonazepam-induced head twitches. These data suggest that the muscle relaxant effects of clonazepam are mediated by benzodiazepine/GABA receptor systems that can be blocked by CGS 8216 and Ro 15-1788. On the other hand, it is proposed that the benzodiazepine-induced head twitch effect is mediated by a benzodiazepine/serotonin 2 receptor system.

Animals↗
PubMed1991

[Requisite muscle relaxation using vecuronium for tracheobronchial suction in neurosurgical intensive care patients].

Coordination of respiratory care with protection of the brain is critical in neurosurgical intensive care. Therefore, in addition to hyperventilation, adequate sedation and muscle relaxation are applied to mitigate the difficulties with control of intracranial pressure (ICP) during routine tracheobronchial suctioning (TBS). Although hypnotics have been shown to be effective in mitigating increases in ICP in response to endotracheal suctioning in paralyzed patients, brisk bucking and coughing with further increases in ICP may occur without muscle relaxation. Long-term neuromuscular (nm) paralysis may be undesirable in neurosurgical critical care because clinical evaluation with early detection of neurological deterioration will be impossible in the paralyzed patient. Therefore, the effects of TBS without and after nm blockade with an intermediate-acting nondepolarizing muscle relaxant on ICP were studied. PATIENTS AND METHODS. Nine patients with moderate increases in mean ICP of 19.2 +/- 8 mmHg due to head injuries and spontaneous subarachnoid hemorrhage were investigated. All patients were on-line sedated with midazolam and sufentanil and controlled ventilation was adjusted to maintain a paCO2 of 30 +/- 2 mmHg. Respiratory and hemodynamic parameters and ICP (epidural probe) were continuously monitored and recorded on an integrated data bank. After a bolus dose of propofol, routine TBS was performed without the use of muscle relaxants. Before the next TBS, nm monitoring was initiated and train-of-four (TOF) stimulation was imposed at the ulnar nerve using supramaximal pulses. The response of the adductor pollicis muscle was recorded by accelerometry. After supramaximal stimulation had been achieved, a bolus dose of 2 times the ED95 of vecuronium (0.12 mg/kg) was given. Depth of nm blockade was quantified by the posttetanic count (PTC). ICP and CPP were measured before, during, and after TBS. Diaphragmatic movement, bucking, and coughing were registered by visual observation and graded as absent, slight, moderate, or severe. STATISTICS. Student's t-test and the Wilcoxon test for paired data (P less than 0.05; values as mean +/- SD) were used. RESULTS. (see Table and Figure). Despite adequate sedation, moderate to severe diaphragmatic movements in response to carinal stimulation with significant increases in ICP (18.2 +/-7 to 24 +/- 8 mmHg) an d subsequent decreases in cerebral perfusion pressure (CPP) (68.9 +/- 2 to 62.4 +/- 8 mmHg) could be observed without muscle relaxation. After a bolus of vecuronium, profound nm paralysis quantified by a PTC of 5 was observed after an onset time of 4.2 +/- 1 min. ICP (20.2 +/- 8 vs. 20.1 +/- 8 mmHg) and CPP (64.0 +/- 13 vs. 64.8 +/- 13 mmHg) remained unchanged. Slight diaphragmatic movements could be elicited in only two patients during TBS. DISCUSSION. TBS is a potent trigger of diaphragmatic movement, bucking, and coughing by reflex activation of the phrenic nerve. A major determinant of the magnitude of ICP increase during TBS is the transmission of the cough-induced increase in intrathoracic pressure to the cerebral venous system. Vecuronium was utilized for nm blockade because of its proven lack of cerebral and cardiovascular side effects, its relatively short onset, and its intermediate duration of action. Despite the postulated faster onset of nm blockade in the diaphragm, suppression of thumb-twitch response to TOF stimulation does not necessarily predict absence of diaphragmatic movement elicited by excessive tracheal stimulation. As demonstrated, intense nm blockade quantified by a PTC of 5 is necessary to rule out any bucking and coughing, i.e., to ensure total diaphragmatic paralysis in response to tracheal stimulation. On-line neurological evaluation, one of the essentials in the approach to the neurosurgical patient, will not be prevented by the intermittent bolus regime utilized in this study.

Adult↗
PubMed1984

Muscle relaxation techniques: a therapeutic tool for family physicians.

Muscle relaxation techniques are important adjunctive therapy for anxiety-related conditions. Family physicians can learn to teach the techniques so as to try helping anxious patients themselves rather than automatically referring them to a psychiatrist. The exercises are generally acceptable to patients, are easy to learn and do not require expensive equipment. They are beneficial in insomnia and tension headache, of some value in chronic anxiety states and a useful adjunct in hypertension. In this paper the evidence supporting the value of muscle relaxation therapy is briefly reviewed, methods of teaching and of practising the techniques are described in detail, and answers to some of the questions and problems that may arise are presented.

Anxiety Disorders↗
PubMed2004

Muscle relaxants in the treatment of myofascial face pain. A literature review.

Among the different pharmacological approaches that could be adopted in the treatment of myofascial pain of masticatory muscles, attention has to be paid to muscle relaxants drugs, since very few studies evaluated their efficacy, despite most authors suggest their use. The present paper is a critical review of the literature on the use of the most common drugs with muscle relaxant effects (benzodiazepines, tricyclic antidepressants) and of a muscle relaxant drug (tizanidine hydrochloride) in the treatment of such condition. From literature data it emerged that these drugs had phases of alternate enthusiasm, characterized by a not constant clinical use and a fair interest in research. Nevertheless, within all the limitations that have been discussed in this paper, the use of muscle relaxants in patients with myofascial pain of masticatory muscles seems to be justifiable, even though further research is needed to verify their usefulness in terms of risk-benefit ratio.

Antidepressive Agents, Tricyclic↗
PubMed2006

Muscle relaxation therapy for anxiety disorders: it works but how?

Muscle relaxation therapy (MRT) has continued to play an important role in the modern treatment of anxiety disorders. Abbreviations of the original progressive MRT protocol [Jacobson, E. (1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press] have been found to be effective in panic disorder (PD) and generalized anxiety disorder (GAD). This review describes the most common MRT techniques, summarizes recent evidence of their effectiveness in treating anxiety, and explains their rationale and physiological basis. We conclude that although GAD and PD patients may exhibit elevated muscle tension and abnormal autonomic and respiratory measures during laboratory baseline assessments, the available evidence does not allow us to conclude that physiological activation decreases over the course of MRT in GAD and PD patients, even when patients report becoming less anxious. Better-designed studies will be required to identify the mechanisms of MRT and to advance clinical practice.

Anxiety Disorders↗
PubMed1990

Skeletal muscle relaxant ingestion.

We retrospectively analyzed 56 consecutive cases involving acute skeletal muscle relaxant exposure that were reported to the Poison Control Center over a 1-year period. The age range was 9 mo to 56 years (mean 18.9 +/- 13.1) with the site of exposure being the primary residence in 54 cases (96.4%). The reasons for inquiry to the Poison Center were reported to be intentional suicide in 26 cases (46.4%), accidental in 21 cases (37.5%), with intentional misuses in 5 cases (8.9%). No deaths were reported. Eighteen cases (32.1%) were reported with co-ingestants (average number of substances taken was 2.7 +/- 0.8). Of these cases 3 patients (16.7%) had major effects with life-threatening symptoms with 6 (33.3%) patients having no symptoms. Of the remaining 38 cases, 17 (44.7%) wer cyclobenzaprine, 6 (15.8%) were methocarbamol, 5 (13.2%) were carisoprodol, 5 (13.2%) were chlorzoxazone, 3 (7.89%) were Baclofen and the remainder were either life-threatening symptoms (2.6%), while 29 (74.3%) had no or minor effects with symptoms that subsided. We conclude that morbidity and mortality are low in pure skeletal muscle relaxant ingestion, however it may be increased in multiple ingestions.

Adolescent↗
PubMed1987

Inhibition of cytomegalovirus replication by smooth-muscle relaxing agents.

The effect of the smooth-muscle relaxing agents, papaverine, sodium nitroprusside, and verapamil, on the replication of human cytomegalovirus (CMV) was investigated. At a concentration of 100 microM, infectious yields of CMV were reduced by 1.23 to 5.72 log10 by these drugs (papaverine, 5.72 log10; nitroprusside, 1.85 log10; verapamil, 1.23 log10). The ED50 for papaverine was found to be somewhat less than 1 microM, a concentration which appears to be within the range achieved clinically. Papaverine did not irreversibly modify treated cells to a virus-resistant state since treatment of cells with papaverine from 24 hr before until immediately prior to CMV infection did not significantly reduce CMV yields. Replication of CMV was most sensitive to inhibition when papaverine was added at or before 6 hr after CMV infection. Addition of papaverine at later times resulted in a substantial reduction of the inhibitory effect on virus yields, suggesting that the phase of CMV replication sensitive to papaverine inhibition occurred early in the replication cycle. These results, particularly in light of the potency of papaverine, indicate that some smooth-muscle relaxing agents have significant antiviral activity toward the replication of CMV.

Cytomegalovirus↗
PubMed1985

[Histamine release due to ganglion blocking agent and muscle relaxants from rat mast cells].

The mechanisms of histamine release due to d-tubocurarine from rat mast cells have long been known to anesthesiologists, such as degranulatory process, Ca++ dependent process and energy coupled process. However, not much is known about histamine release due to some drugs such as trimethaphan and muscle relaxants other than d-tubocurarine, like alcuronium, pancuronium or succinylcholine, although many clinical reports related to hypersensitivity reactions due to muscle relaxants can be found. In this experiment, the histamine releasing activities of trimethaphan and muscle relaxants were examined using the laboratory model created by Ellis (1970) who reported the selective release of histamine due to d-tubocurarine. Also observed the effects of autonomic neuro-effective drugs such as theophylline, isoproterenol or carbamylcholine on histamine release due to d-tubocurarine. From this experiment, it is suggested that trimethaphan releases histamine through nonselective process but muscle relaxants release histamine selectively. It is also found that pancuronium had little effects on rat mast cells and its histamine releasing activity was selective, if any. Histamine release from rat mast cells due to d-tubocurarine was clearly depressed by pretreatment of theophylline or isoproterenol. In the case of carbamylcholine, low doses inhibited histamine release, but higher doses allowed histamine to be liberated from mast cells. From these findings, it is concluded that some drugs like theophylline or isoproterenol may diminish the side effects of d-tubocurarine and perhaps some other muscle relaxants. Also, as theophylline and isoproterenol are concerned, increase of cyclic AMP may play a role in the inhibition of histamine release. The data using carbamylcholine suggested that the cholinergic receptors on the rat mast cells may be involved through the process of histamine release.

Alcuronium↗
PubMed1992

Sigma receptor modulation of the muscle relaxant action of eperisone.

We examined the mechanism of the muscle relaxant action of eperisone, using Straub tail and binding studies. In vivo, eperisone (50 and 100 mg/kg i.p.) produced a dose-dependent inhibition of the Straub tail in mice and this inhibitory effect was significantly reversed by haloperidol (0.5 mg/kg i.p.). This drug in itself had no effect on the Straub tail. Sulpiride (50 mg/kg i.p.) failed to reverse the inhibitory effect of eperisone. In vitro, (+)-3-(3-[3H]hydroxyphenyl)-N-(1-propylpiperidine) ((+)-[3H]3-PPP) specific binding, in rat brain membrane, was prevented by eperisone and the IC50 value was 0.43 nM. The muscle relaxant action of eperisone may be modulated by sigma receptors.

Animals↗