Development of Bronchoconstriction After Administration of Muscle Relaxants in Rabbits with Normal or Hyperreactive Airways

In Brief Neuromuscular blocking drugs can induce intraoperative bronchospasm. We characterized the magnitude and the temporal profile of the constriction in normal or in hyperresponsive airways after injections of neuromuscular blocking drugs. Respiratory system impedance (Zrs) was measured continuously over a 90-s apneic period in naïve and rabbits sensitized to allergens by ovalbumin. Fifteen s after the start of Zrs recordings, succinylcholine, mivacurium, or pipecuronium was administered in random order. Zrs was then also recorded during the administration of increasing doses of exogenous histamine. To monitor the changes in the airway mechanics during these maneuvers, Zrs was averaged for 2-s time windows, and the airway resistance (Raw) was determined by model fitting. The increases in Raw were significantly larger in the sensitized rabbits than in the naïve animals. The largest increases in Raw and the maximum rate of change in Raw were obtained for succinylcholine (146% ± 29% and 0.80 ± 0.12 cm H2O/L, respectively) and mivacurium (80% ± 25% and 0.71 ± 0.13 cm H2O/L) and the smallest were obtained for pipecuronium (40% ± 12% and 0.41 ± 0.04 cm H2O/L). Allergic sensitization leads to severe and rapidly developing bronchospasm after administrations of mivacurium or succinylcholine. These deleterious side effects should be considered when succinylcholine or mivacurium is administered in the presence of bronchial hyperreactivity. IMPLICATIONS: Bronchial hyperreactivity substantially increases the magnitude and rate of airway constriction after the administration of mivacurium or succinylcholine, whereas pipecuronium responses are milder. Anesthesiologists should be alert when considering the former anesthetics in the presence of airway hyperresponsiveness.