Muscle relaxants in neurosurgical anaesthesia: a critical appraisal

The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of neurosurgery including the advent of new surgical techniques, the evolution of anaesthesia having the benefit of new drugs and devices, and the rationale for using muscle relaxants balanced against their potential side-effects and possible pharmacodynamic alterations in neurosurgical patients.

Keywords

ANAESTHESIA, GENERAL anaesthesia, inhalation NEUROMUSCULAR BLOCKING AGENTS SPECIALTIES, SURGICAL, neurosurgery

Type

Review

Information

European Journal of Anaesthesiology , Volume 20 , Issue 8 , September 2003 , pp. 600 - 605

DOI: https://doi.org/10.1017/S0265021503000966

2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below.

References

Durieux M. Changes in neurosurgery: implications for neuroanaesthesia. Cur Opin Anaesthesiol 2001; 14: 467–468.Google Scholar

Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg 1998; 86: 45–49.Google Scholar

Adams DC, Emerson RG, Heyer EJ, et al. Monitoring of intraoperative motor-evoked potentials under conditions of controlled neuromuscular blockade. Anesth Analg 1993; 77: 913–918.Google Scholar

Sloan TB, Erian R. Effect of vecuronium-induced neuromuscular blockade on cortical motor evoked potentials. Anesthesiology 1993; 78: 966–973.Google Scholar

Sloan TB, Erian R. Effect of atracurium-induced neuromuscular block on cortical motor-evoked potentials. Anesth Analg 1993; 76: 979–984.Google Scholar

Maertens de Noordhout A, Born JD, Hans P, Remacle JM, Delwaide PJ. Intraoperative localisation of the primary motor cortex using single electrical stimuli. J Neurol Neurosurg Psychiatry 1996; 60: 442–444.Google Scholar

Lennon RL, Hosking MP, Daube JR, Welna JO. Effect of partial neuromuscular blockade on intraoperative electromyography in patients undergoing resection of acoustic neuromas. Anesth Analg 1992; 75: 729–733.Google Scholar

Chan KL, Chan MTV, Gin T, Lam MK, Tong M. Is low level neuromuscular block compatible with intraoperative facial nerve monitoring? J Neurosurg Anesth 2001; 13: 375.Google Scholar

Modica PA, Tempelhoff R. Intracranial pressure during induction of anaesthesia and tracheal intubation with etomidate-induced EEG burst suppression. Can J Anaesth 1992; 39: 236–241.Google Scholar

Lanier WL, Albrecht RF II, Laizzo PA. Divergence of intracranial and central venous pressures in lightly anesthetized, tracheally intubated dogs that move in response to a noxious stimulus. Anesthesiology 1996; 84: 605–613.Google Scholar

Matteo RS, Pua EK, Khambatta HJ, Spector S. Cerebrospinal fluid levels of d-tubocurarine in man. Anesthesiology 1977; 46: 396–399.Google Scholar

Segredo V, Matthay MA, Sharma ML, Gruenke LD, Caldwell JE, Miller RD. Prolonged neuromuscular blockade after long-term administration of vecuronium in two critically ill patients. Anesthesiology 1990; 72: 566–570.Google Scholar

Eddleston JM, Harper NJ, Pollard BJ, Edwards D, Gwinnutt CL. Concentrations of atracurium and laudanosine in cerebrospinal fluid and plasma during intracranial surgery. Br J Anaesth 1989; 63: 525–530.Google Scholar

Fahey MR, Canfell PC, Taboada T, Hosobuchi Y, Miller RD. Cerebrospinal fluid concentrations of laudanosine after administration of atracurium. Br J Anaesth 1990; 64: 105–106.Google Scholar

Tassonyi E, Fuchs-Buder T, Chiodini FC, et al. Cerebrospinal fluid concentrations of atracurium in neurosurgical patients. Br J Anaesth 1997; 78: A246.Google Scholar

Dasheiff RM. d-Tubocurarine causes neuronal death when injected direcly into rat brain. Exp Neurol 1985; 89: 172–188.Google Scholar

Goonewardene TW, Sentheshanmuganathan S, Kamalanathan S, Kanagasunderam R. Accidental subarachnoid injection of gallamine. A case report. Br J Anaesth 1975; 47: 889–893.Google Scholar

Mesry S, Baradaran J. Accidental intrathecal injection of gallamine triethiodide. Anaesthesia 1974; 29: 301–304.Google Scholar

Peduto VA, Gungui P, Di Martino MR, Napoleone M. Accidental subarachnoid injection of pancuronium. Anesth Analg 1989; 69: 516–517.Google Scholar

Szenohradszky J, Trevor AJ, Bickler P, et al. Central nervous system effects of intrathecal muscle relaxants in rats. Anesth Analg 1993; 76: 1304–1309.Google Scholar

Cardone C, Szenohradszky J, Yost S, Bickler PE. Activation of brain acetylcholine receptors by neuromuscular blocking drugs. A possible mechanism of neurotoxicity. Anesthesiology 1994; 80: 1155–1161.Google Scholar

Chiodini FC, Tassonyi E, Fuchs-Buder T, Fathi M, Bertrand D, Muller D. Effects of neuromuscular blocking agents on excitatory transmission and gamma-aminobutyric acid_A-mediated inhibition in the rat hippocampal slice. Anesthesiology 1998; 88: 1003–1013.Google Scholar

Chiodini F, Charpantier E, Muller D, Tassonyi E, Fuchs-Buder T, Bertrand D. Blockade and activation of the human neuronal nicotinic acetylcholine receptors by atracurium and laudanosine. Anesthesiology 2001; 94: 643–651.Google Scholar

Martyn JA, White DA, Gronert GA, Jaffe RS, Ward JM. Up-and-down regulation of skeletal muscle acetylcholine receptors. Effects on neuromuscular blockers. Anesthesiology 1992; 76: 822–843.Google Scholar

Raines A, Standaert FG. Pre- and postjunctional effects of diphenylhydantoin at the cat soleus neuromuscular junction. J Pharmacol Exp Ther 1966; 153: 361–366.Google Scholar

Melton AT, Antognini JF, Gronert GA. Prolonged duration of succinylcholine in patients receiving anticonvulsants: evidence for mild up-regulation of acetylcholine receptors? Can J Anaesth 1993; 40: 939–942.Google Scholar

Kuntzman R. Drugs and enzyme induction. Annu Rev Pharmacol 1969; 9: 21–36.Google Scholar

Nation RL, Evans AM, Milne RW. Pharmacokinetic drug interactions with phenytoin (Part II). Clin Pharmacokinet 1990; 18: 131–150.Google Scholar

Abramson FP, Lutz MP. The effects of phenytoin dosage on the induction of alpha 1-acid glycoprotein and antipyrine clearance in the dog. Eur J Drug Metab Pharmacokinet 1986; 11: 135–143.Google Scholar

Kim CS, Arnold FJ, Itani MS, Martyn JA. Decreased sensitivity to metocurine during long-term phenytoin therapy may be attributable to protein binding and acetylcholine receptor changes. Anesthesiology 1992; 77: 500–506.Google Scholar

Alderdice MT, Trommer BA. Differential effects of the anticonvulsants phenobarbital, ethosuximide and carbamazepine on neuromuscular transmission. J Pharmacol Exp Ther 1980; 215: 92–96.Google Scholar

Gage PW, Lonergan M, Torda TA. Presynaptic and post-synaptic depressant effects of phenytoin sodium at the neuromuscular junction. Br J Pharmacol 1980; 69: 119–121.Google Scholar

Platt PR, Thackray NM. Phenytoin-induced resistance to vecuronium. Anaesth Intensive Care 1993; 21: 185–191.Google Scholar

Kremer JM, Wilting J, Janssen LH. Drug binding to human alpha-1-acid glycoprotein in health and disease. Pharmacol Rev 1988; 40: 1–47.Google Scholar

Garcia E, Calvo R, Rodriguez-Sasiain JM, Jimenez R, Troconiz IF, Suarez E. Resistance to atracurium in rats with experimental inflammation: role of protein binding. Acta Anaesthesiol Scand 1995; 39: 1019–1023.Google Scholar

Alloul K, Whalley DG, Shutway F, Ebrahim Z, Varin F. Pharmacokinetic origin of carbamazepine-induced resistance to vecuronium neuromuscular blockade in anesthetized patients. Anesthesiology 1996; 84: 330–339.Google Scholar

Hans P, Ledoux D, Bonhomme V, Brichant JF. Effect of plasma anticonvulsant level on pipecuronium-induced neuromuscular blockade: preliminary results. J Neurosurg Anesthesiol 1995; 7: 254–258.Google Scholar

Lanier WL, Iaizzo PA, Milde JH. Cerebral function and muscle afferent activity following intravenous succinylcholine in dogs anesthetized with halothane: the effects of pretreatment with a defasciculating dose of pancuronium. Anesthesiology 1989; 71: 87–95.Google Scholar

Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology 1981; 55: 578–581.Google Scholar

Minton MD, Grosslight K, Stirt JA, Bedford RF. Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade. Anesthesiology 1986; 65: 165–169.Google Scholar

Stirt JA, Grosslight KR, Bedford RF, Vollmer D. ‘Defasciculation’ with metocurine prevents succinylcholine-induced increases in intracranial pressure. Anesthesiology 1987; 67: 50–53.Google Scholar

Kovarik WD, Mayberg TS, Lam AM, Mathisen TL, Winn HR. Succinylcholine does not change intracranial pressure, cerebral blood flow velocity, or the electroencephalogram in patients with neurologic injury. Anesth Analg 1994; 78: 469–473.Google Scholar

Brown MM, Parr MJ, Manara AR. The effect of suxamethonium on intracranial pressure and cerebral perfusion pressure in patients with severe head injuries following blunt trauma. Eur J Anaesthesiol 1996; 13: 474–477.Google Scholar

Burney RG, Winn R. Increased cerbrospinal fluid pressure during laryngoscopy and intubation for induction of anesthesia. Anesth Analg 1975; 54: 687–690.Google Scholar

Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 1975; 43: 89–99.Google Scholar

John DA, Tobey RE, Homer LD, Rice CL. Onset of succinylcholine-induced hyperkalemia following denervation. Anesthesiology 1976; 45: 294–299.Google Scholar

Gronert GA. Cardiac arrest after succinylcholine: mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology 2001; 94: 523–529.Google Scholar

Schramm WM, Papousek A, Michalek-Sauberer A, Czech T, Illievich U. The cerebral and cardiovascular effects of cisatracurium and atracurium in neurosurgical patients. Anesth Analg 1998; 86: 123–127.Google Scholar

Schramm WM, Strasser K, Bartunek A, Gilly H, Spiss CK. Effects of rocuronium and vecuronium on intracranial pressure, mean arterial pressure and heart rate in neurosurgical patients. Br J Anaesth 1996; 77: 607–611.Google Scholar

Ornstein E, Matteo RS, Young WL, Diaz J. Resistance to metocurine-induced neuromuscular blockade in patients receiving phenytoin. Anesthesiology 1985; 63: 294–298.Google Scholar

Hickey DR, Sangwan S, Bevan JC. Phenytoin-induced resistance to pancuronium. Use of atracurium infusion in management of a neurosurgical patient. Anaesthesia 1988; 43: 757–759.Google Scholar

Ornstein E, Matteo RS, Schwartz AE, Silverberg PA, Young WL, Diaz J. The effect of phenytoin on the magnitude and duration of neuromuscular block following atracurium or vecuronium. Anesthesiology 1987; 67: 191–196.Google Scholar

Whalley DG, Ebrahim Z. Influence of carbamazepine on the dose–response relationship of vecuronium. Br J Anaesth 1994; 72: 125–126.Google Scholar

Ornstein E, Matteo RS, Weinstein JA, Halevy JD, Young WL, Abou-Donia MM. Accelerated recovery from doxacurium-induced neuromuscular blockade in patients receiving chronic anticonvulsant therapy. J Clin Anesth 1991; 3: 108–111.Google Scholar

Jellish WS, Modica PA, Tempelhoff R. Accelerated recovery from pipecuronium in patients treated with chronic anticonvulsant therapy. J Clin Anesth 1993; 5: 105–108.Google Scholar

Driessen JJ, Robertson EN, Booij LH, Vree TB. Accelerated recovery and disposition from rocuronium in an end-stage renal failure patient on chronic anticonvulsant therapy with sodium valproate and primidone. Br J Anaesth 1998; 80: 386–388.Google Scholar

Spacek A, Nickl S, Neiger FX, et al. Augmentation of the rocuronium-induced neuromuscular block by the acutely administered phenytoin. Anesthesiology 1999; 90: 1551–1555.Google Scholar

Soriano SG, Kaus SJ, Sullivan LJ, Martyn JA. Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy. Paediatr Anaesth 2000; 10: 133–136.Google Scholar

Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, Perez-Ayala M. Rocuronium-induced neuromuscular blockade is affected by chronic phenytoin therapy. J Neurosurg Anesthesiol 2001; 13: 79–82.Google Scholar

Tempelhoff R, Modica PA, Jellish WS, Spitznagel EL. Resistance to atracurium-induced neuromuscular blockade in patients with intractable seizure disorders treated with anticonvulsants. Anesth Analg 1990; 71: 665–669.Google Scholar

Spacek A, Neiger FX, Spiss CK, Kress HG. Atracurium-induced neuromuscular block is not affected by chronic anticonvulsant therapy with carbamazepine. Acta Anaesthesiol Scand 1997; 41: 1308–1311.Google Scholar

Koenig MH, Edwards LT. Cisatracurium-induced neuromuscular blockade in anticonvulsant treated neurosurgical patients. J Neurosurg Anesthesiol 2000; 12: 314–318.Google Scholar

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0

Total number of PDF views: 2 *

View data table for this chart

* Views captured on Cambridge Core between September 2016 - 27th January 2021. This data will be updated every 24 hours.

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Muscle relaxants in neurosurgical anaesthesia: a critical appraisal

Volume 20, Issue 8
P. Hans ^(a1) and V. Bonhomme ^(a1)
DOI: https://doi.org/10.1017/S0265021503000966

Your Kindle email address

@free.kindle.com @kindle.com (service fees apply)

Available formats PDF

By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services.

Reply to: Submit a response

Title * Please enter a title for your response.

Contents * Please enter your response.

Your details

First name * Please enter your first name.

Last name * Please enter your last name.

Email * Please enter a valid email address.

Occupation Please enter your occupation.

Affiliation Please enter any affiliation.

Conflicting interests

Do you have any conflicting interests? *

Yes No

More information * Please enter details of the conflict of interest or select 'No'.

Please tick the box to confirm you agree to our Terms of use. *

Please accept terms of use.

Please tick the box to confirm you agree that your name, comment and conflicts of interest (if accepted) will be visible on the website and your comment may be printed in the journal at the Editor’s discretion. *

Please confirm you agree that your details will be displayed.

Article contents

Muscle relaxants in neurosurgical anaesthesia: a critical appraisal

Abstract

Keywords

Access options

References

Full text views

Send article to Kindle

Send article to Dropbox

Send article to Google Drive

Reply to: Submit a response

Your details

Conflicting interests