Drug interactions with neuromuscular blockers

Drug Safety

Volumn 15, Issue 4, 1996, Pages 261-273

  Feldman, Stanley ^a   Karalliedde, Lakshman ^b  

^a CHELSEA AND WESTMINSTER HOSPITAL   (United Kingdom)

^b GUY S HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLCHOLINE; ANESTHETIC AGENT; ANTIARRHYTHMIC AGENT; ANTIBIOTIC AGENT; ANTICONVULSIVE AGENT; BAMBUTEROL; CALCIUM ANTAGONIST; CHOLINESTERASE; CHOLINESTERASE INHIBITOR; CORTICOSTEROID; ECOTHIOPATE; FUROSEMIDE; INHALATION ANESTHETIC AGENT; LITHIUM; LOCAL ANESTHETIC AGENT; MAGNESIUM SULFATE; METOCLOPRAMIDE; NEUROMUSCULAR BLOCKING AGENT; NICOTINIC RECEPTOR; ORGANOPHOSPHATE; PHENOTHIAZINE; PHENYTOIN; POSTSYNAPTIC RECEPTOR; PROCAINAMIDE; PROPANIDID; QUINIDINE; TACRINE;

ACETYLCHOLINE RELEASE; ACTION POTENTIAL; ENZYME ACTIVITY; HUMAN; MOTOR NERVE CONDUCTION; MUSCLE CONTRACTILITY; MUSCLE CONTRACTION; NERVE ENDING; NEUROMUSCULAR BLOCKING; NEUROTRANSMITTER RELEASE; PRIORITY JOURNAL; REVIEW; SPINAL REFLEX; URINARY EXCRETION;

EID: 0029910789     PISSN: 01145916     EISSN: None     Source Type: Journal    
DOI: 10.2165/00002018-199615040-00004     Document Type: Review

References (131)

1. Bowman WC, editor. Pharmacology of neuromuscular function. London: Butterworth, 1990
2. Feldman SA, England AJ. Neuromuscular function and block. In: Wood M, editor. Curr Opin Anaesthesiol 1995; 4: 351-6
3. Riker WF, Wescoe WC. The pharmacology of Flaxedil with observations on certain analogues. Ann NY Acad Sci 1951; 54: 373-94
4. Lebowitz PW, Ramsey FH, Savarese JJ, et al. Potentiation of neuromuscular blockade in man produced by combinations of pancuronium and metocurine or pancuronium and d-tubocurarine. Anesth Analg 1980; 59 (8): 604-9
5. Martyn JA, Leibel WS, Matteo RS. Competitive non specific binding does not explain the potentiating effects of muscle relaxant combinations. Anesth Analg 1983; 62 (2): 160-3
6. Waud BE, Waud DR. Quantitative examination of the interaction of competitive neuromuscular blocking agents on the indirectly elicited muscle twitch. Anesthesiology 1984; 61 (4): 420-7
7. Krieg N, Hendrick HH, Crul JF. Influence of suxamethonium on the potency of ORGH NC45 in anaesthetized patients. Br J Anaesth 1981; 53 (3): 259-62
8. d'Hollander A, Agoston S, DeVille A, et al. Chemical and pharmacological actions of a bolus injection of suxamethonium: two phenomena of distinct duration. Br J Anaesth 1983; 55 (2): 131-4
9. Feldman SA, Fauvel N. Potentiation and antagonism of vecuronium by decamethonium. Anesth Analg 1993; 76 (3): 631-4
10. Campkin NTA, Hood JR, Feldman SA. Resistance to decamethonium neuromuscular block after prior administration of vecuronium. Anesth Analg 1993; 77 (1): 78-80
11. Booij LH, Miller RD, Crul JF. The comparative influence of gamma hydroxy butyric acid, althesin and etomidate on the neuromuscular blocking potency of pancuronium in man. Acta Anesthesiol Belg 1979; 30: 219-23
12. Krieg N, Rutten M, Crul JF, et al. Preliminary review of the interactions of ORG NC45 with anaesthetics and antibiotics in animals. Br J Anaesth 1980; 52 Suppl. 1: 33S-6S
13. 90 dose of rocuronium bromide: tracheal intubation conditions and time course of action. Eur J Anaesthesiol 1995; 74 Suppl. 85-90
14. Keaveny JP, Knell PJ. Intubation under induction doses of propofol. Anaesthesia 1988; 43 Suppl. 1: 80-1
15. Torda TA, Gage PW. Postsynaptic effect of iv anaesthetic agents at the neuromuscular junction. Br J Anaesth 1977; 49 (8): 771-6
16. Doenicke A, Dittmann-Kessler I, Sramoto A, et al. Etomidate and suxamethonium. The duration of relaxation and pseudocholinesterase activity. A clinical experimental study. Anaesthesist 1980; 29 (3): 120-4
17. Sharma KK, Sharma UC. Influence of diazepam on the effect of neuromuscular blocking agents. J Pharm Pharmacol 1978; 30 (1): 64
18. Asbury AJ, Henderson PD, Brown BH, et al. Effect of diazepam on pancuronium-induced neuromuscular blockade maintained by a feedback system. Br J Anaesth 1981; 53 (8): 859-63
19. Bradshaw EG, Maddison S. Effect of diazepam at the neuromuscular junction: a clinical study. Br J Anaesth 1979; 51 (10): 955-60
20. Cronnelly R, Morris RB, Miller RD. Comparison of thiopental and midazolam on the neuromuscular responses to succinylcholine or pancuronium in humans. Anesth Analg 1983; 62 (1): 75-7
21. Kaieda R, Maekewa T, Takeshita, et al. Effects of diazepam on evoked electrospinogram and electromyogram in man. Anesth Analg 1981; 60 (4): 197-200
22. Cronnelly R, Dretchen KL, Sokoll MD, et al. Ketamine: myoneural activity and interaction with neuromuscular blocking agents. Eur J Pharmacol 1973; 22 (1): 17-22
23. Durrant NN, Ngwyen N, Lee C, et al. The interaction between ketamine and norcuron. In: Boulton TB, Atkinson RS, Lunn JN, et al, editors. Proceedings of the 6th European Congress on Anaesthesiology; 1982 Sep: London. London: Academic Press, 1982: 149-50
24. Chapple DJ, Clark JS, Hughes R. Interaction between atracurium and drugs used in anaesthesia. Br J Anaesth 1983; 55 Suppl. 1: 17S-22S
25. Engbaek J, Ording H, Pendersen T, et al. Dose-response relationships and neuromuscular blocking effects of vecuronium, pancuronium during ketamine anaesthesia. Br J Anaesth 1984; 56 (9): 953-7
26. Adams PR. Drug blockade of open end-plate channels. J Physiol 1976; 260 (3): 531-52
27. Bowman WC. The neuromuscular junction: recent developments. Eur J Anaesthesiol 1985; 2 (1): 59-93
28. Maleque MA, Warnick JE, Albuquerque EX. The mechanism and site of action of ketamine on skeletal muscle. J Pharmacol Exp Ther 1981; 219 (3): 638-45
29. Torda TA, Gage PW. Postsynapyic effects of iv anaesthetic agents at the neuromuscular junction. Br J Anaesth 1977; 49 (8): 771-6
30. Stanski DR, Ham J, Miller RD, et al. Time-dependent increase in sensitivity to d-tubocurarine during enflurane anesthesia in man. Anesthesiology 1980; 52 (6): 483-7
31. Rupp SM, McChristian JW, Miller RD. Neuromuscular effects of atracurium during halothane-nitrous oxide and enflurane-nitrous oxide anaesthesia in humans. Anesthesiology 1985; 63 (1): 16-9
32. Miller RD, Eger EH, Way WL, et al. Comparative neuromuscular effects of Forane and halothane alone and in combination with d-tubocurarine in man. Anesthesiology 1971; 35: 38-42
33. Donati F, Bevan DR. Long term succinylcholine infusion during isoflurane anesthesia. Anesthesiology 1983; 58 (1): 6-10
34. Hilgenberg JC, Stoelting RK. Characteristics of succinylcholine produced phase II neuromuscular block during enflurane, halothane and fentanyl anesthesia. Anesth Analg 1981; 60 (4): 192-6
35. Donati F, Bevan DR. Effect of enflurane and fentanyl on the clinical characteristics of long-term succinylcholine infusion. Can Anaesth Soc J 1982; 29 (1): 59-64
36. Rupp SM, Miller RD, Gencarelli PJ. Vecuronium induced neuromuscular blockade during enflurane, isoflurane and halothane anesthesia in humans. Anesthesiology 1984; 60 (2): 102-5
37. Swen J, Gencarelli PJ, Koot HW. Vecuronium infusion dose requirements during fentanyl and halothane anesthesia in humans. Anesth Analg 1985; 64 (4): 411-4
38. Miller RD, Rupp SM, Fisher DM, et al. Clinical pharmacology of vecuronium and atracurium. Anesthesiology 1984; 61: 444-53
39. Foldes FF, Bencini A, Newton D. Influence of halothane and enflurane on the neuromuscular effects of ORG NC45 in man. Br J Anaesth 1980; 52 Suppl. 1: 64S-5S
40. Swen J, Agoston S, Koot H. Interactions between inhalation anaesthetics and muscle relaxants during steady state blockade. In: Boulton J, Atkinson RS, Lunn JN, et al, editors. Proceedings of the 6th European Congress on Anaesthesiology; 1982 Sep: London. London: Academic Press, 1982: 181-2
41. Gage PW, Hamill PO. Effects of several inhalation anaesthetics on the kinetics of postsynaptic conductance changes in mouse diaphragm. Br J Pharmacol 1976; 57 (2): 263-72
42. Waud BE, Waud DR. Comparison of the effects of general anesthetics on the end plate of skeletal muscle. Anesthesiology 1975; 43 (5): 540-7
43. Bean BP, Shrager P, Goldstein DA. Modification of sodium and potassium channel gating kinetics by ether and halothane. J Gen Physiol 1981; 77 (3): 233-53
44. ++ release by skeletal muscle sarcoplasmic reticulum: differing sensitivity to inhalation of anaesthetics. Anesthesiology 1988; 69 (4): 571-7
45. Komatsu T, Mori K, Uchida M, et al. The effects of halothane on the contractile properties of human skeletal muscles. Hiroshera J Anaesth 1979; 15: 81-7
46. Waud BE. Decrease in dose requirements of d-tubocurarine by volatile anesthetics. Anesthesiology 1979; 51 (4): 298-302
47. Forbes AR, Cohen WH, Eger EI. Pancuronium reduces halothane requirement in man. Anesth Analg 1979; 58 (6): 497-9
48. Shi WZ, Fahey MR, Fisher DM, et al. Laudanosine (a metabolite of atracurium) increases the minimum alveolar concentration of halothane in rabbits. Anesthesiology 1985; 63 (6): 584-8
49. Van Poznak A. The effect of inhalation anesthetics on repetitive activity generated at motor nerve endings. Anesthesiology 1967; 28 (1): 124-7
50. Bruckner J, Thomas KC, Bikhazi GB, et al. Neuromuscular drug interactions of clinical importance. Anesth Analg 1980; 59 (9): 678-82
51. Aracava Y, Ikeda SR, Daly JW, et al. Interactions of bupivacaine with ionic channels of the nicotinic receptor. Mol Pharmacol 1984; 26 (2): 304-13
52. Prostran M, Varagic VM. The effects of local anaesthetics on the isometric contraction of the isolated hemidiaphragm of the rat. Arch Int Pharmacodyn Ther 1981; 250 (1): 30-9
53. Huang CL. Effects of local anaesthetics on the relationship between charge movements and contractile thresholds in frog skeletal muscle. J Physiol 1981; 320: 381-91
54. Marquis JK, Deschenes RJ. A re-evaluation of calcium - local anaesthetic antagonism. Exp Neurol 1982; 76 (3): 547-52
55. Eppens H, Kleine JW. Antibiotics and muscle relaxants: a dangerous combination. Arch Chir Neerl 1971; 23 (3): 241-4
56. Giala M, Sareyiannis C, Cortsaris N, et al. Possible interaction of pancuronium and tubocurarine with oral neomycin [letter]. Anaesthesia 1982; 37 (7): 776
57. Bowen JM, McMullan WC. Influence of induced hypermagnesemia and hypocalcemia on neuromuscular blocking property of oxytetracycline in the horse. Am J Vet Res 1975; 36 (7): 1025-8
58. Pittinger C, Adamson R. Antibiotic blockade of neuromuscular function. Annu Rev Pharmacol 1972; 12: 169-84
59. Wright JM, Collier B. The site of neuromuscular block produced by polymyxin B and rolitetracycline. Can J Physiol Pharmacol 1976; 54 (6): 926-36
60. Hashimoto Y, Shima T, Matsukawa S, et al. Neuromuscular blocking property of minocycline in the rabbit. Tohoku J Exp Med 1979; 129 (2): 203-4
61. Singh YN, Harvey AL, Marshall IG. Antibiotic induced paralysis of the mouse phrenic nerve-hemidiaphragm preparation, and reversibility by calcium and by neostigmine. Anesthesiology 1978; 48 (6): 418-24
62. Pittinger CB, Eryasa Y, Adamson R. Antibiotic-induced paralysis. Anesth Analg 1970; 49 (3): 487-501
63. Durant NN, Lee C, Katz RL. Cumulation of neomycin and its residual potentiation of tubocurarine in the cat. Brit J Anaesth 1981; 53 (6): 571-6
64. Orts A, Marti JL, Baltar I, et al. Neuromuscular inhibition of new aminoglycoside antibiotics. Ann Anesthesiol Fr 1979; 20 (1): 25-30
65. Barnett A, Ackerman E. Neuromuscular blocking activity of gentamicin in cals and mice. Arch Int Pharmacodyn Ther 1969; 181 (1): 109-17
66. Singh YN, Marshall IG, Harvey AL. Pre-and postjunctional blocking effects of aminoglycoside, polymyxin, tetracycline, and lincosamide antibiotics. Br J Anaesth 1982; 54 (12): 1295-306
67. Sobek V. The effect of calcium, neostigmine and 4-aminopyridine upon respiratory arrest and depression of cardiovascular functions after aminoglycosidic antibiotics. Arzneimittelforschung 1982; 32 (3): 222-4
68. Fiekers JF, Henderson F, Marshall IG, et al. Comparative effects of clindamycin and lincomycin on end-plate currents and quantal contents at the neuromuscular junction. J Pharmacol Exp Ther 1983; 227 (2): 308-15
69. Lee C, Chen D, Nagel EL. Neuromuscular block by antibiotics: polymyxin B. Anesth Analg 1977; 56 (3): 373-7
70. Singh YN, Marshall IG, Harvey AL. The mechanism of the muscle paralysing actions of antibiotics and their interactions with neuromuscular blocking drugs. In: Bickell M, Breimer DD, Feuer S, et al., editors. Drug metabolism and drug interactions. London: Springer Verlag, 1980: 129-53
71. Wright JM, Collier B. Characterization of the neuromuscular block produced by clindamycin and lincomycin. Can J Physiol Pharmacol 1976; 54 (6): 937-44
72. Futamachi KJ, Prince DA. Effect of penicillin on an excitatory synapse. Brain Res 1975; 100 (3): 589-97
73. Noebels JL, Prince DA. Presynaptic origin of penicillin after discharges at mammalian nerve terminals. Brain Res 1977; 138: 59-74
74. Grongano AW. Anaesthesia for atrial defibrillation. Effect of guidance on muscular relaxation. Lancet 1963; II: 1039-40
75. Harrah MD, Way WL, Katzung BG. The interaction of d-tubocurarine with antiarrhythmic agents. Anesthesiology 1970; 33: 406-10
76. Kornfeld P, Horowitz SH, Genkins G, et al. Myasthenia gravis unmasked by antiarrhythmic agents. Mt Sinai J Med 1976; 43 (1): 10-4
77. Walsh MP. Calmodulin and its role in skeletal muscle function. Can Anaesth Soc J 1983; 30 (4): 390-8
78. Zalman F, Perloff JK, Durant NN, et al. Acute respiratory failure following intravenous verapamil in Duchenne's muscular dystrophy. Am Heart J 1983; 105 (3): 510-1
79. Anderson KA, Marshall RJ. Interactions between calcium entry blockers and vecuronium bromide in anaesthetised cats. Br J Anaesth 1985; 57 (8): 775-81
80. Kraynack BJ, Lawson NW, Gintautas J. Neuromuscular blocking action of verapamil in cats. Can Anaesth Soc J 1983; 30: 242-7
81. 4 in the pig. Anesth Analg 1995; 80: 5270
82. James MF. Clinical use of magnesium infusions in anaesthesia Anesth Analg 1992; 74 (1): 129-36
83. del Castillo J, Engback L. The nature of the neuromuscular block produced by magnesium. J Physiol (Lond) 1954; 124: 370-84
84. Ramanthan J, Sibai BM, Pillai R, et al. Neuromuscular transmission studies in preeclamptic women receiving magnesium sulphate. Am J Obstet Gynecol 1988; 158 (1): 40-6
85. Van Wilgenburg H. The effect of prednisolone on neuromuscular transmission in the rat diaphragm. Eur J Pharmacol 1979; 55 (4): 355-61
86. Crul JF, Long GJ, Brunner HA, et al. The changing pattern of neuromuscular blockade caused by succinylcholine in man. Anesthesiology 1966; 27 (16): 729-35
87. Meyers EF. Partial recovery from pancuronium neuromuscular blockade following hydrocortisone administration. Anesthesiology 1977; 46 (2): 148-50
88. Laflin MJ. Interaction of puncuronium and corticosteroids. Anesthesiology 1977; 47 (5): 471-2
89. Hall ED. Glucocorticoid modification of the responsiveness of fast (type 2) neuromuscular system to edrophonium and d-tubocurarine. Exp Neurol 1980; 69 (2): 349-58
90. Robinson BJ, Lee E, Rees D, et al. Betamethasone-induced resistance to neuromuscular blockade: a comparison of atracurium and vecuronium in vitro. Anesth Analg 1992; 74 (5): 762-5
91. Van Wilgenburg H. Effects of glucocorticoids on acetylcholine release at the neuromuscular junction [abstract]. Br J Pharmacol 1980; 68 (1): 144P
92. Caldwell JE. Muscle relaxants in the Intensive Care Unit. In: Fukushima K, Ochai R, editors. Muscle relaxants. Tokyo: Springer, 1995: 95-104
93. Ornstein E, Matteo RS, Schwartz AE, et al. The effect of phenytoin on the magnitude and duration of neuromuscular block following atracurium or vecuronium. Anesthesiology 1987; 67: 191-6
94. Baumgardner JE, Bagshaw R. Acute versus chronic phenytoin therapy and neuromuscular blockade. Anaesthesia 1990; 45: 493-4
95. Blanc-Bimur MC, Jadot G, Bruguerolle B. Modification of curarizing action of two curare like agents after administration of two antiepileptic agents. Ann Anesthesiol Fr 1979; 20: 685-90
96. Alderdice MT, McMillan JE. Comparison of the effects of trimethadione and its primary metabolite dimethadione on neuromuscular function and the effects of altered pH on the action of dimethadione. J Pharmacol Exp Ther 1982; 221: 547-51
97. Talbot PA, Alderice MT. Effects of primidone, phenobarbital and phenylethylmalonamide in the stimulated frog neuromuscular junction. J Pharmacol Exp Ther 1984; 228: 121-7
98. Platt PR, Thackray WM. Phenytoin-induced resistance to vecuronium. Anaesth Intensive Care 1993; 21 (2): 185-91
99. Thalji Z, Jellish WS, Mardoch J, et al. The effect of anticonvulsant therapy on recovery from mivacurium induced paralysis [abstract]. Anesthesiology 1993; 79 Suppl. 965: S965
100. Donati F, Bevan DR. Controlled succinylcholine infusion in a patient receiving ecothiophate eye drops. Can Anaesth Soc J 1981; 28 (5): 488-90
101. Davies-Lepie SR. Tacrine may prolong effect of succinylcholine. Anesthesiology 1994; 81 (2): 524
102. Walker IR, Zapf PW, Mackay IR. Cyclophosphamide, cholinesterase and anaesthesia. Aust N Z J Med 1972; 2 (3): 247-51
103. Kao YJ, Turner DR. Prolongation of succinylcholine block by metoclopramide. Anesthesiology 1989; 70 (6): 905-8
104. Kao YJ, Tellez J, Turner DR. Dose-dependent effect of metoclopramide on cholinesterases and suxamethonium metabolism. Br J Anaesth 1990; 65 (2): 220-4
105. Vincent A, Newsom-Davis J, Martin V. Anti-acetylcholine receptor antibodies in D-penicillamine associated myasthenia gravis. Lancet 1978; I: 1254
106. Russell AS, Lindstrom JM. Penicillamine-induced myasthenia gravis associated with antibodies to acetylcholine receptor. Neurology 1978; 28 (8): 847-9
107. Azar I, Cottrell J, Gupta B, et al. Furosemide facilitates recovery of evoked twitch response after pancuronium. Anesth Analg 1980; 59: 55-7
108. Staun P, Lennmarken C, Eriksson LI, et al. The influence of 10mg and 20mg of bambuterol on the duration of succinylcholine-induced neuromuscular blockade. Acta Anaesthesiol Scand 1990; 34 (6): 498-500
109. Fisher DM, Caldwell JE, Sharma M, et al. The influence of bambuterol (carbamylated terbutaline) on the duration of action of succinylcholine-induced paralysis in humans. Anesthesiology 1988; 69 (5): 757-9
110. Bang V, Viby-Mogensen J, Wiren JE. The effect of bambuterol on plasma cholinesterase activity and suxamethonium-induced neuromuscular blockade in subjects heterozygous for abnormal plasma cholinesterase. Acta Anaesthesiol Scand 1990; 34 (7): 600-4
111. Bodley PO, Halwax K, Potts L. Low serum pseudocholinesterase levels complicating treatment with phenelzine. BMJ 1969; 3 (669): 510-2
112. Vizi ES, Illes P, Ronai A, et al. Effect of lithium on acetylcholine release and synthesis. Neuropharmacology 1972; 11 (4): 521-30
113. Waud BE, Farrell L, Waud DR. Lithium and neuromuscular transmission. Anesth Analg 1982; 61 (5): 399-402
114. Hill GE, Wong KC, Hodges MR. Lithium carbonate and neuromuscular blocking agents. Anesthesiology 1977; 46 (2): 122-6
115. Harrah MD, Way WL, Katzung BG. The interaction of d-tubocurarine with antiarrhythmic drugs. Anesthesiology 1970; 33 (4): 406-10
116. Glynne GL. Drug interaction? Anaesthesia 1984; 39 (3): 293
117. Rozen MS, Whan FM. Prolonged curarization associated with propranolol. Med J Aust 1972; 1 (10): 467-8
118. Dreichen KL, Standaert FG, Skirboll LR, et al. Evidence for a prejunctional role of cyclic nucleotides in neuromuscular transmission. Nature 1976; 264: 79-81
119. Azar I, Kumar D, Betcher AM. Resistance to pancuronium in an asthmatic patient treated with aminophylline and steroids. Can Anaesth Soc J 1982; 29 (3): 280-2
120. Argov Z, Mastaglia FL. Drug therapy: disorders of neuromuscular transmission caused by drugs. N Engl J Med 1979; 301: 409-13
121. Cheah LS, Lee HS, Gwee MCE. Anticholinesterase activity of and possible ion channel block by cimetidine, ranitidine and oxmetridine in the toad isolated rectus abdominis muscle. Clin Exp Pharmacol Physiol 1985; 12: 353-7
122. 2 antagonists on duration of action of suxamethonium in the parturient. Anaesthesia 1989; 44 (7): 591-3
123. Aw LLF, Cheah LS, Gwee MCE, et al. Inhibition of acetylcholinesterase activity by cimetidine and ranitidine. Pharmacologist 1983; 25: 626
124. 2 receptor antagonist pretreatment on vecuronium and atracurium induced neuromuscular block. Br J Anaesth 1991; 66 (6): 713-5
125. 2 antagonists. In Vivo 1995; 9 (2): 163-6
126. Tewfik GI. Trimetaphan: its effect on the pseudocholinesterase level of man. Anaesthesia 1957; 12: 326
127. Poulton TJ, James FM, Lockridge O. Prolonged apnoea following trimetaphan and succinylcholine. Anesthesiology 1979; 50: 54
128. Nakamura K, Koide M, Imanaga T, et al. Prolonged neuromuscular blockade following trimetaphan infusion. Anaesthesia 1980; 35: 1202-7
129. Dale RC, Schroeder ET. Respiratory paralysis during treatment by hypertension with trimetaphan camsylate. Arch Intern Med 1976; 136: 816-8
130. Robertson GS, Aberd MB. Serum protein and cholinesterase changes in association with contraceptive pills. Lancet 1967; I: 232-5
131. Naguib M, Gyasi HK. Antioestrogenic drugs and atracurium - a possible interaction? Can Anaesth Soc J 1986; 33 (5): 682-3