A Comparative Evaluation of Pretreatment with Nondepolarizing Neuromuscular Blockers Prior to the Administration of Succinylcholine

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Abstract
The interaction of subparalyzing doses of nondepolarizing neuromuscular blockers and paralyzing doses of depolarizing neuromuscular blockers was studied. The use of a small dose of a nondepolarizing neuromuscular blocking agent prior to the administration of succinylcholine (SCh) has become routine anesthetic practice for humans in the USA. Reasons for pretreating with a nondepolarizer include: prevention of increased intragastric pressure, attenuation of K release, attenuation of increased intraocular pressure, decreased incidence of postoperative myalgia, and obliteration of fasciculations. Four commonly used nondepolarizing neuromuscular blockers (d-tubocurarine, gallamine, metocurine, pancuronium) were compared as pretreatment agents. Metocurine has not been previously studied as a pretreatment drug and an attempt was made to determine the optimum dosage of metocurine for this purpose.