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Two Questions about neuromuscular physio

Discussion in 'Anesthesiology' started by tsip, Aug 24, 2015.

  1. tsip

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    Please forgive me if this is not the appropriate place to post this, but I figure the best people to answer my questions are here are on this forum.

    1. Can dantrolene be used to provide standard muscular paralysis in place of or in conjunction with succinylcholine/vecuronium etc. ?

    2. Could nicotine theoretically be used for reversal of nondepolarizing neuromuscular blockade?

    A med student asked me these questions and I didn't have any good answers.
     
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  3. Direct Laryngoscopy

    Direct Laryngoscopy Account on Hold
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  4. Noyac

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    I don't want to be a jerk here but, really?
    A med student asks you a question that you can't answer and you come to SDN for the answer.
    Look it up!
    Read everything you don't know about this subject!
    I think you are just being lazy here.
    I would be ashamed.
     
  5. Noyac

    Noyac ASA Member
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    And another thing, do you think your attendings come here for answers to questions they don't know when residents ask them?

    Do you think that would be appropriate?


    Here's a hint, how does Dantrolene work? Now go look it up and report back to us.
     
  6. Docuronium

    Docuronium ASA Member
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  7. tsip

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    I am not a resident in Anesthesia, I just asked in this forum because I thought the people here would be able to provide the best answer. It was an off topic discussion with a med student, but it was interesting to me. I would be happy to read if someone directed me to a paper or textbook chapter.
    I thought dantrolene's exact mechanism of action was not currently known for sure; it is known that it has something to do with the Ryanodine receptor in skeletal muscle. It interferes with excitation contraction coupling, and so it seemed to make sense that it could cause muscle paralysis, but maybe it is not suited for that type of use due to a long half life or inability to completely block contraction.
    I will go look some things up, I just wanted to see if I could get some direction.
     
  8. NightNight

    NightNight ASA Member
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  9. Noyac

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    Good idea!
     
  10. tsip

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    I'm not sure if anyone still cares but I asked an anesthesia colleague and got the answers.

    To Noyac: Your 'hint' was completely off target and suggests that you need to do some reading yourself. I think you are the one who should be ashamed of yourself.
     
  11. Noyac

    Noyac ASA Member
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    Fair enough
    But allow me to ask you something, how do you know your colleague gave you the right answer? Did you look it up to check the facts? Or did you just get a plausible response and go with it?

    And all I hinted to was to look up the pharmacology of dantrolene. So I don't see how I could have been right or wrong. It was a suggestion for you to start with.

    Have a nice day
     
  12. VanDiemen

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    Tsip you should probably look up the dunning kruger effect cause that's what happened on this thread. The two people who responded arrogantly probably know less about these topics than you.
    Anyway, looking up 'how dantrolene works' isn't going to tell you the answer since you already knew that and i'm guessing that's what led you to ask this question. Dantrolene was shown in the 70s to cause near total inhibition of skeletal muscle contraction at the right doses. However, there are several logistic problems:
    It's very expensive
    Long half life
    Poor water solubility
    Not able to reverse it. Nothing like sugammadex for dantrolene.

    As far as your nicotine question, remember that nicotine will cross the bb barrier and have cns effects way before you can get levels high enough at the neuromuscular junction. Exogenous Nicotine does have an effect on blockade. This paper is an example:http://www.ncbi.nlm.nih.gov/pubmed/9706945
     
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