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Related Concept Videos

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Depolarizing Blockers: Mechanism of Action01:28

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Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Updated: Aug 27, 2025

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Persistent Facial Blanching after Botulinum Toxin Injection.

Fouad Mitri1, Katharina Anna Kälber1, Alexander H Enk1

  • 1Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.

Case Reports in Dermatology
|September 26, 2022
PubMed
Summary

Facial blanching after exercise, a rare side effect of botulinum toxin injections, persisted longer than usual in a patient. Current therapies are lacking due to the condition

Keywords:
Botulinum toxinFacial blanchingVasodilation

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Area of Science:

  • Neurology
  • Dermatology
  • Pharmacology

Background:

  • Botulinum toxin injections are commonly used for cosmetic and therapeutic purposes.
  • Facial blanching is a rare, typically transient side effect associated with botulinum toxin.
  • The pathophysiology involves neurotransmitters like acetylcholine and vasodilation co-transmitters.

Observation:

  • A 38-year-old male experienced facial blanching post-strenuous exercise.
  • Symptoms resolved upon relaxation.
  • The patient had received botulinum toxin injections three years prior.

Findings:

  • This case presents persistent facial blanching, unlike the usual short-lived post-botulinum effect.
  • The prolonged duration suggests a potential deviation from typical pathophysiology or a delayed response.

Implications:

  • The lack of effective therapies for persistent post-botulinum facial blanching is highlighted.
  • Further research is needed to understand the mechanisms behind prolonged facial blanching.
  • This case underscores the importance of considering rare, persistent side effects of cosmetic treatments.