Key messages

• Relaxants antagonize the action of acetylcholine.

• The principal differences are in onset, duration, elimination, and side-effects. Important factors which modify the action are acid-base and electrolyte changes, muscular diseases, and drug interactions.

• Succinylcholine (suxamethonium) is used for rapid tracheal intubation. Pancuronium, atracurium, vecuronium, or cisatracurium are used to maintain a block.

• Train of four is the most convenient method for monitoring the block following stimulation of the ulnar nerve using a handheld stimulator.

• Indications for the use of a relaxant are tracheal intubation, facilitation of procedures, to assist ventilation, critical gas exchange, tetanus, and transfer of patients.

• Disadvantages of using a relaxant are neurological assessment, disconnection, awareness, disuse atrophy, increased risk of thromboembolism, and increased risk of infection

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