Effects of succinylcholine on the pharmacodynamics of pipecuronium and pancuronium

M. Y. Dubois, Neal Fleming, D. E. Lea

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To study the effects of succinylcholine on subsequent pharmacodynamics of nondepolarizing muscle relaxants, a comparative pharmacodynamic study was carried out in patients having balanced anesthesia (thiopental, fentanyl, nitrous oxide/oxygen) in whom equipotent doses of pipecuronium (80 μg/kg) and pancuronium (100 μg/kg) were given with or without prior administration of succinylcholine (1 mg/kg). Fifty-two patients were randomly assigned to one of the following four groups: 1, pancuronium (100 μg/kg); 2, pipecuronium (80 μg/kg); 3, succinylcholine (1 mg/kg) plus pancuronium (100 μg/kg); and 4, succinylcholine (1 mg/kg) plus pipecuronium (80 μg/kg). In groups 3 and 4, the nondepolarizing relaxant was given after succinylcholine when the twitch height recovered to 75% of its control value. For maintenance of neuromuscular blockade, additional increments of pancuronium (20 μg/kg) or pipecuronium (15 μg/kg) were given. Neuromuscular function was monitored throughout induction, maintenance, spontaneous recovery, and pharmacologic reversal of the neuromuscular block. Mean onset times for pancuronium (group 1) and pipecuronium (group 2) given without succinylcholine were (mean ± SEM) 2.5 ± 0.3 and 2.8 ± 0.2 min, respectively. Mean onset times (times to maximum twitch depression) of the two drugs given after succinylcholine (groups 3 and 4) were significantly shorter (1.4 ± 0.4 and 1.6 ± 0.1 min, respectively). Clinical durations (i.e., until 25% twitch recovery of pancuronium and pipecuronium) were not significantly different among the four groups, varying from 81.1 ± 5.4 (group 4) to 107.0 ± 17.0 (group 2) min. Incremental doses used for maintenance of neuromuscular blockade had durations of action ranging from 44.5 ± 5.1 min (group 1) to 52.8 ± 7.3 min (group 3) and were not altered by the prior administration of succinylcholine. After the administration of nondepolarizing relaxant, times for spontaneous recovery of twitch height from 10% to 25% of baseline levels were comparable in all groups (from 15.1 ± 1.7 to 19.8 ± 2.2 min). The response to reversal of residual neuromuscular blockade with neostigmine (2.5 mg) and glycopyrrolate (0.5 mg) was identical in all groups. We conclude that during balanced anesthesia, the use of succinylcholine for intubation does not necessitate subsequent alteration in doses of pancuronium or pipecuronium.

Original languageEnglish (US)
Pages (from-to)364-368
Number of pages5
JournalAnesthesia and Analgesia
Issue number3
StatePublished - 1991
Externally publishedYes


  • neuromuscular relaxants, pipecuronium, pancuronium, succinylcholine
  • pharmacodynamics, neuromuscular relaxants

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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