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Neuromuscular Block by Antibiotics

Polymyxin B

CHINGMUH LEE, MD^*, DENNIS CHEN, MD, and EUGENE L. NAGEL, MD

*Associate Professor, Department of Anesthesiology, UCLA School of Medicine, Harbor General Hospital Campus, Torrance, California 90509. Fellow, Department of Anesthesiology, UCLA School of Medicine, Harbor General Hospital Campus, Torrance, California 90509. Professor and Chairman, Department of Anesthesiology, UCLA School of Medicine, Harbor General Hospital Campus, Torrance, California 90509.

Abstract

Characteristics of neuromuscular block produced by polymyxin B (PXB) were examined in 12 anesthetized cats, using sciatic nerve-tibialis anticus muscle preparations. The ED₅₀ was 6.7 (± 1.4, SD) PXB base/kg body weight. The ED₉₅ was 10.8 (± 2.4) mg/kg. Spontaneous recovery from 25 percent of control to 75 percent of control required 72 (± 16) minutes. During a 50 percent block, train-of-four twitches elicited at 2 Hz faded with a train-of-four ratio of 0.42 (± 0.13), but the tetanus did not fade. Edrophonium CI, neostigmine methylsulfate, and pyridostigmine Br at subclinical dosages weakly antagonized the block but enhanced the block at anti-curare dosages. All 3 cholinesterase inhibitors were short acting, lasting 10 to 15 minutes, and noncumula-tive on repeated injection. The potency ratio was approximately 20:10:1 in the order of edrophonium, neostigmine, and pyridostigmine on a weight-for-weight basis. Calcium partially antagonized the block. The authors conclude that neuromuscular blocks produced by various antibiotics differ from each other and from that produced by other groups of neuromuscular blocking agents, including curare.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999