A 61-year-old man underwent surgery to remove a prostate cancer. The anesthesia was induced by thiopental and maintained by halothane. Tubocurarine was also added to ensure adequate muscle relaxation. Which of the following was most likely the correct sequence of the paralysis of skeletal muscles induced by tubocurarine on this patient?
A. Eye extrinsic muscles, limb muscles, diaphragm B. Limb muscles, diaphragm, eye extrinsic muscles C. Diaphragm, eye extrinsic muscles, limb muscles D. Diaphragm, limb muscles, eye extrinsic muscles E. Limb muscles, eye extrinsic muscles, diaphragm
Eye extrinsic muscles, limb muscles, diaphragm-learning objective: describe the sequence of muscle paralysis induced by tubocurarine.answer: athe skeletal muscle paralysis induced by nondepolarizing neuromuscular blocking drugs followsa sequence that is related to the innervation of the skeletal muscles. muscles that are small,rapidly moving and richly innervated (like extrinsic eye muscles, small muscles of the face andpharynx) are affected first. the paralysis of the extrinsic eye muscles causes a lack ofparallelism of the visual axes of the eyes which leads to double vision. as a rule, large muscles(like limb muscles) are paralyzed after small muscles. ultimately the intercostal muscles andfinally the diaphragm are paralyzedb, c, d, e) (see explanation above)