GasGasGas - The FRCA Primary Exam Podcast VivaCast 003 - Paralysing the NMJ - Roc vs Sux - Reversal
Dec 23, 2024
Join Willing Victim Tom, an anaesthetics trainee diving deep into neuromuscular pharmacology, as he engages in a lively viva with Dr. Gas. They dissect the differences between succinylcholine and rocuronium, exploring onset times and potential risks like hyperkalaemia. Tom offers insights into malignant hyperthermia and the critical role of dantrolene in its management. The conversation flows to the nuances of reversing rocuronium with sugammadex and neostigmine, including potential pitfalls. Plus, they share tips on structuring responses for exam success!
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Multiple Points Of NMJ Vulnerability
- The neuromuscular junction can be modulated at multiple steps including synthesis, storage, release, and receptor action.
- Drugs, toxins and pathologies (e.g., botulinum, tetanus, gentamicin, magnesium) each act at distinct points to alter transmission.
Succs Versus Roc: Onset, Offset, Metabolism
- Succinylcholine gives very rapid onset and short duration via plasma cholinesterase breakdown, but carries depolarising-specific risks.
- Rocuronium has slower offset, hepatic/kidney clearance and variable duration, allowing dose-dependent faster onset but less predictable recovery.
Avoid Succinylcholine In High‑Risk States
- Avoid succinylcholine in patients with recent burns, myopathies, or conditions with upregulated extrajunctional receptors.
- Expect dangerous potassium surges, myalgia, bradycardia in children, and beware malignant hyperthermia triggering.