Interaction between Succinylcholine and Nondepolarizing Neuromuscular Blockers

The interaction between succinylcholine and nondepolarizing neuromuscular blockers depends on the order of administration and the doses used.^{[155] [436] [437] [438]} Administration of small doses of different nondepolarizing neuromuscular blockers before succinylcholine to prevent fasciculations has an antagonistic effect on development of the subsequent depolarizing block produced by succinylcholine.^{[63] [155]} Therefore, it is recommended that the dose of succinylcholine be increased after the administration of a defasciculating dose of a nondepolarizing neuromuscular blocker.^{[63] [439]}

Studies on the effects of administration of succinylcholine before nondepolarizing neuromuscular blockers have produced conflicting results. Several investigators reported potentiation of the effects of dTc,^[440] pancuronium,^[437] and vecuronium and atracurium ^{[438] [441]} by previous administration of succinylcholine. In contrast, others noted the opposite for dTc ^[436] or found no significant influence of succinylcholine on subsequent administration of pancuronium, doxacurium, pipecuronium, rocuronium, or mivacurium.^{[155] [442] [443] [444] [445]}