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Anesth Analg 1989; 68:5-8
© 1989 International Anesthesia Research Society
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Ketamine Potentiates Nondepolarizing Neuromuscular Relaxants in a Primate

Shen Kou Tsai, MD, and Chingmuh Lee, MD

Received from the Department of Anesthesiology, National Yang-Ming Medical College, Veterans General Hospital, Taipei, Taiwan, Republic of China, and the Department of Anesthesiology, Harbor-UCLA Medical Center, Torrance, California.

Abstract

Ketamine has many neuromuscular effects in vitro. Its neuromuscular effects in vivo have been controversial and inconsistent. To systematically examine its neuromuscular effects over a wide dose range and its interaction with all popular nondepolarizing neuromuscular relaxants, the effects of ketamine 2, 5, and 10 mg/kg IV were studied on a continuous but incomplete (50%) neuromuscular block preestablished by an IV infusion of d-tubocurarine, atracurium, vecuronium, and pancuronium. Indirectly stimulated adductor pollicis muscle response of monkeys anesthetized with 0.5–1.0% halothane in oxygen were quantified. Ketamine in the absence of a neuromuscular relaxant had no effect on the thumb twitch. In a dose-dependent manner, ketamine significantly enhanced the 50% depression of the thumb twitch preestablished by a constant IV infusion of each of the four muscle relaxants studied. Ketamine 2 mg/kg potentiated the neuromuscular relaxants in the following order of magnitude: vecuronium > atracurium > d-tubocurarine > pancuronium. However, with a 10 mg/kg dose of ketamine, pancuronium became as potentiated as was vecuronium, i.e., pancuronium = vecuronium > atracurium > d-tubocurarine. It is concluded that in the primate, ketamine potentiates all nondepolarizing muscle relaxants in a dose-dependent manner.

Key Words: ANESTHETICS—intravenous • NEUROMUSCULAR RELAXANTS—ketamine potentiation • INTERACTIONS, DRUG—ketamine and relaxants
Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 1989 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1989 by the International Anesthesia Research Society.