The effect of succinylcholine on atracurium-induced neuromuscular block

Background: The interaction between prior succinylcholine and atracurium has been found only after full recovery of succinylcholine block. We investigated whether the effect of succinylcholine on atracurium block may depend on the level of recovery from succinylcholine. Methods: Fifty patients in 4 groups received atracurium 0.2 mg/kg when first response (T1) in train-of-four (TOF) after succinylcholine 1 mg/kg had recovered to 5%, 25%, 75% or 100%. A control group received only atracurium. The following indices were compared: the time from injection of atracurium to maximum block (onset time) and to return of T1 to 25% (duration 25%), maximal depression of T1, time from 25% to 75% recovery of T1 (interval 25-75%) and time from injection of atracurium to a TOF ratio of 0.75 (duration TOF 0.75). Results: Onset time was shorter, max T1 depression was greater and duration 25% increased the more succinylcholine recovery progressed. Neither interval 25-75% nor duration TOF 0.75 varied with the level of recovery from succinylcholine. The control group showed a shorter latency and onset time compared to the early (5%) recovery group and a longer onset time and less depressed T1 compared to the late (100%) recovery group. There was no difference between the control group and the early or late recovery groups, respectively for duration 25% or duration TOF 0.75. Conclusion: The effect of prior administration of succinylcholine on atracurium block depends on the state of recovery from succinylcholine and concerns both its potency, onset and duration characteristics.