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Anesth Analg 1979; 58:107-115
© 1979 International Anesthesia Research Society
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Mutual Potentiation of the Neuromuscular Effects of Antibiotics and Relaxants

Leo Burkett, MD*, George B. Bikhazi, MD{dagger}, Kelly C. Thomas, Jr., BS{ddagger}, Desiree A. Rosenthal, MD*, Mary G. Wirta, BS{ddagger}, and Francis F. Foldes, MD§

*Resident in Anesthesiology. Department of Anesthesiology, University of Miami, School of Medicine, Miami, Florida 33101. {dagger} Assistant Professor. Department of Anesthesiology, University of Miami, School of Medicine, Miami, Florida 33101. {ddagger}Research Assistant. Department of Anesthesiology, University of Miami, School of Medicine, Miami, Florida 33101. §Professor. Department of Anesthesiology, University of Miami, School of Medicine, Miami, Florida 33101.

Abstract

The interaction of d-tubocurarine, pancuronium, or succinylcholine with neomycin, streptomycin, or polymyxin B was investigated using a rat phrenic nerve-hemidiaphragm preparation. All neuromuscular blocking agents (relaxants) mutually potentiated the neuromuscular blocking action of one another; combinations of ineffective concentrations of relaxants and antibiotics caused an 82 to 98% neuromuscular block. This extensive potentiation of the neuromuscular effects of relaxants by antibiotics can be attributed to the fact that antibiotics not only have a curare-like stabilizing effect on the post junctional membrane, but also decrease presynaptic acetylcholine release. Neostigmine (0.25 µg/ml) only partially antagonized the neuromuscular block caused by the various drug combinations. In contrast, 4 7mu;g/ml of 4-aminopyridine returned the twitch tension, depressed by combined administration of relaxants and antibiotics, to or above control values except in the case of neuromuscular block caused by the combinations of succinylcholine and polymyxin B.

Key Words: ANTIBIOTICS: neuromuscular junction • ANTIBIOTICS: interaction with muscle relaxants • MUSCLE RELAXANTS: interaction with antibiotics • INTERACTIONS (DRUG): antibiotics and relaxants.




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Lippincott, Williams & Wilkins 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 HighWire Press
Copyright © 1979 by the International Anesthesia Research Society.