70 or Higher

Duration 3-5 mins

Dibucaine 40-60

Duration 1.5-2 times prolonged 

Dibucaine Number < 30

Duration 4-8 hours longer 

Serum K+ increases 0.5 mEq/L

Bradycardia resistant to atropine

Sore throat, myalgia

Myoglobinuria

Sustained Massester muscle contraction

Increased IOP, ICP, and gastric pressure 

Allergy

MH

Infants

Male Children

Neuro cases

Open Globe Injuries

Denervation States 

Hyperkalemia

Muscle Weakness

Pseudocholinesterase Deficiency 

1- 1.5 mg/kg IV

3 mg/kg IM

Duration 3-5 mins

Onset 30-60 seconds 

Succ doses > 2mg/kg 

Tachyphylaxis, abrupt onset

Resembles non-depolarizers

Atracurium

Mivacurium 

Volatile Agents

Aminoglycosides

LA

Anti-dysrhythmics

Diuretics

Magnesium and Lithium

Calcium Channel Blockers 

Hypothermia

Respiratory Acidosis

Hyper/Hypo kalemia

Adrenocortical dysfunction 

Hyperkalemia

Anticonvulsants

Burns 

(enzyme induced) 

Allergy

Inability to secure the airway

Inability to support ventilation 

Myasthenia gravis- destruction of Ach receptors 

Dense surgical block

Renal and Hepatic Metabolism 

Weak surgical block

Hoffman elimination and Pseudocholinesterase 

Aminosteroid- pancuronium, pipecuronium 

Benzylisoquinoline- tubocurarine 

0.1 mg/kg 

Peak 3-5 mins

Duration 60-90 mins 

After succ 0.5 mg/kg

Maintenance: 0.01-0.02 mg/kg 

Vagolytic- good for CV patients

Stay away from renally impaired 

Good for long cases 

Amintosteroid- vecuronium, rocuronium

Benzyliquinolines- atracurium, cisatracurium 

0.1 mg/kg 

Peak 1-2 mins

Duration 25-30 mins 

After Succ- 0.05 mg/kg

Maintenance: 0.01-0.015 mg/kg 

1 mcg/kg/min: drip

0.6-1.2 mg/kg 

Peak 1-2  mins

Duration 25 mins 

After succ 0.06-0.6 mg/kg

Maintenance- 0.1-0.15 mg/kg 

0.5- 1 mg/kg

Peak 3-5 mins

Duration 20-25 mins 

After succ: 0.2 mg/kg

Maintenance: 0.1 mg/kg 

0.1-0.2 mg/kg

Peak 3-5 mins

Duration 20-25 min 

After succ: 0.03 mg/kg

Maintenance: 0.01 mg/kg 

0.4-4 mcg/kg/min: drip

0.25 mg/kg

Peak 2-3 mins

Duration 12-25 mins 

After succ: 0.05- 0.1 mg/kg

Maintenance: 0.025 mg/kg 

Intermediate Duration of Action 

Benzylisoquinolinum furmate ester based compound

Testing phase

Histamine Release

Approx 71 min

Elimination: cysteine adduction and hydrolisis 

Reversible > 25% twitch height

60-90 mins

Spontaneous recovery >0.9% TOF 130-220 mins 

Edrophonium

Neostigmine

Pyridostigmine

Physostigmine and Echothiopate- medicine

Poisons- organophosphates and nerve gas 

Reversibly binds to acetylchoinesterase

weaker bond that neostigmine 

Reversibly binds to acetylcholinesterase

Contain carbamyl group that does hydrogen bond at esteratic site 

Creates a more stable bond

1/2 time: 15-30 

50% Neo metabolized in the liver and metabolite 1/10th of activity 

Young and elederly require less

Excretion altered in renal patients 

Ulnar nerve--> adductor pectoralis 

Facial nerve--> orbicularis oculi 

Posterior tibial nerve--> flexor hallicus longus 

Place distal electrode at the wrist 

Sustain 5 sec tetany is extubation criteria 

100% Blocked

Do Not Give 

90% Blocked

0.07 mg/kg

NG 5 mg/ G 1 mg 

85% Blocked 

0.05 mg/kg

N 3.5 mg/ G 0.7 mg

80% block

0.05 mg/kg

N 3.5 mg/G 0.7 mg

0-75% Blocked

0.03mg/kg

N 2 mg/ G 0.4 mg 

0.5-1 mg/kg

Peak 0.8-2 mins

Duration: 66 mins 

Give with atropine 

0.03-0.07 mg/kg

Peak: 7-11 mins

Duration: 76 mins

Give with atropine or glycopyrulate 

0.01-0.02 mg/kg

Onset 1 min

Duration: 30-60 mins

1/2 time 2.3 hours

0.1 mg minimum dose of atropine 

1:5 ratio

Onset 2-3 mins

Duration 30-60 mins

1/2 time: 1.25 hours 

Restlessness, hallucinations, somnolence, unconsciousness

Dry flush skin, tachycardia, photophobia, blurred vision, increase MV 

Physostigmine 15-60 mcg/kg 

Confusion, ataxia, seizures, depressed ventilation, coma

SLUDGEM 

Anticholinesterase overdose

Organophophate or nerve gas posioning 

Atropine 35-70 mcg/kg 

3.6 mg Sugammedex/ 1 mg Rocuronium 

2/4 Twitches give 2 mg/kg > return to 4/4 in 2-4 mins 

Mainly renal- stay away from renally impaired 

Small hepatic 

132 mins

Elimination dependent on renal and heptic function 

50-110 mins 

Elimination dependent on renal and hepatic function 

87 mins

Elimination NOT dependent on renal and hepatic function 

Hoffmann elimination 

21 mins

Elimination NOT dependent on renal or hepatic function

Hoffman elimination 

Possible dependent on renal and hepatic function

psuedocholinesterase 1-3 mins