muscle relaxants

use of succinylcholine in children should be limited to situations involving emergency intubation, or instances where immediate securing of the airway is necessary (e.g. laryngospasm, difficult airway, full stomach or ..??)

non-depolarizing muscle relaxants take longer to initiate (at least 30mins)
and can be categorized into: benzylisoquinolone, steroidal

benzylisoquinolone --> histamine release
steroidal --> vagol blockade (HR increases i.e. pancuronium)

~~~

atracurium: hoffman elimination (1/3 in plasma)
- metabolic product: laudanosine (toxic)
- associated with cns excitation, extremely
high dose or hepatic failure
- not recommended for use in asthmatic patients, due to increased
risk of bronchospasm

cisatracurium: hoffman elimination (mostly in plasma)
- greater potency, insignificant histamine release, less
laundanosine than atracurium

cisatracurium >>>> atracurium.

STEROIDAL
pancuronium: metabolized by the liver
hypertension and tachycardia due to vagal blockade and
catecholamine release from adrenergic nerve endings (however,
this is good for patients with low bp)

rocuronium: onset is FAST (suitable for rapid sequence intubation 1~1.5min)