Non-depolarizing muscle relaxants act by blocking the acetylcholine receptors on the postjunctional membrane. In myasthenia gravis the number of acetylcholine receptors is so dramatically reduced that muscle paralysis occurs with very low concentrations of relaxant drug ( BarakaJ992). Thus myasthenic patients are extremely sensitive to non-depolarizing muscle relaxants, and profound and prolonged paralysis may result from the administration of normal doses. Atracurium is the non-depolarizing muscle relaxant of choice since its breakdown and elimination is reasonably predictable. However, neuromuscular transmission should be monitored continuously when using non-depolarizing muscle relaxants.
The following drugs have been shown to exacerbate myasthenic weakness: aminoglycoside antibiotics; ciprofloxacin; quinine, quinidine, and procainamide; pencillamine ( KudcI. et.. al 1986).
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