Skip to main content

Table 2 Comparative analysis of early onset NMBAs at different doses expressed as multiples of ED95 (effective dose 95)

From: Neuromuscular blockers and their reversal: have we finally found the on-off switches?

Drug (ED95) Dose Onset time Histamine (Savarese et al. 2004; Belmont et al. 2004) Duration of action (recovery to TOFr ≥ 0.90) reversal/recovery
Succinylcholine (Heerdt et al. 2004) (0.3 mg/kg) 0.45 mg/kg 65 s Yes 5 min (Spont. recovery)
0.6 mg/kg 55 s Yes 6.4 min (Spont. recovery)
3–4 ED95, 1 mg/kg 45 s Yes 12.5 min, hyperkalemia, bradycardia, masseter muscle spasm, fasciculations, postoperative myalgia, ↑IOP
Mivacurium (Lien 2013; Diefenbach et al. 1995) 0.06–0.08 mg/kg 2–3 ED95 2.5 min Yes 10–12 min (withdrawn from the US market 2006), erythema, hypotension, bronchospasm
3 ED95 NA Yes 22 min (Rh)
Rapacuronium (ORG-9487) (Blobner et al. 2000; Sunaga et al. 2010a; Heerdt et al. 2016) 1 mg/kg 1.5 ED95 60–90 s No < 20 min, withdrawn from market (2001): fatal bronchospasm
1.5–2.5 ED95 50–60 s Yes 20 min, tachycardia, hypotension, and bronchospasm
Cisatracurium (Savarese et al. 2018) 0.05 mg/kg 3–4ED95 5–6 min No 30–45 min (Hoffman degradation)
Not affected by hepatic/renal disease
Rocuronium (De May et al 1994; Sunaga et al. 2010b; Chavan et al 2016, Kaullen et al. 2018) 0.3 mg/kg 1–1.5× ED95 60–180 s No 18–20 min (Spont)
Duration prolonged in liver disease
2× ED95 60–90 s No 3.75 times SCH; 3.75 × 6 min (Spont)
3–4× ED95 50–60 s No 7.5 times SCH; RSI dose; reversible by high dose sugammadex, as early as 3 min post-administration
Gantacurium (Savarese et al. 2010; Boer and Carlos 2018; Heerdt et al. 2015; Lien et al. 2009) (0.19 mg/kg)
Not available for clinical use
2× ED95 70 s No 15 min (Spont.)
2.5× ED95 60 s No 8 min (Spont. recovery identical to Sch) (Lien et al. 2009)
4–5× ED95
(rhesus)
60 s No 10.4 min (Spont.)
2–3 min(l-cysteine 50 mg/kg 1 min after gantacurium)
4–5× ED95 90 s Yes 15 min (Spont) study on human volunteers (Ma et al. 2012a)
CW002 (Savarese et al. 2010; Boer and Carlos 2018; Ma et al. 2012b) (0.077 mg/kg)
Not available for clinical use
1.8 x ED95 90 s No 33.8 min (clinical duration of action), 73 min (spont. reversal; TOFr 0.9), minimal cardiopulmonary effects
4–5×ED95 (rhesus) NA Yes 2–3 min with l-cysteine (50 mg/kg) given 60 s after CW002
CW011 (Savarese et al. 2010; Boer and Carlos 2018) (0.025 mg/kg); not clinically used 4–5×ED95 (rhesus) NA Yes 20.8 min (clinical duration of action)
2–3 min with l-cysteine(50 mg/kg) reversal
  1. IV intravenous, MG Myasthenia gravis, S/E side effects, TOF train of four, TOFR train of four ratio