(1989; 60 pages) [French]
Group: non-depolarizing muscle relaxant
Injection: 40 mg (triethiodide)/ml in 2-ml ampoule
Gallamine is a synthetic non-depolarizing neuromuscular blocking agent. Its effect becomes apparent within 2 minutes of intravenous administration and persists for up to 40 minutes. It is excreted in the urine largely unchanged.
To produce relaxation of skeletal muscle during surgery.
Dosage and administration
Muscle relaxants should be administered only after induction of anaesthesia and when a secure airway has been established. The dosage must be adjusted according to the response. As a guide:
Adults: 1-1.5 mg/kg i.v. initially, then 0.5-1 mg/kg as required at about 40-minute intervals.
Children: 1.5 mg/kg initially, then 0.5 mg/kg as required.
Infants of less than 1 month: 250-750 micrograms/kg initially, then 100-500 micrograms/kg as required.
• Known hypersensitivity to gallamine.
• Myasthenia gravis.
• Shock and impaired renal function.
• Cardiac disease predisposing to dysrhythmias.
Gallamine should be used, whenever possible, by an experienced specialist anaesthetist. Facilities for endotracheal intubation and mechanically assisted ventilation should be immediately to hand and ready for use.
Gallamine should not be administered before evidence of recovery from the effect of any suxamethonium given previously.
Use in pregnancy
Gallamine should be used in pre-term pregnancy only when the need outweighs any possible risk to the fetus. Its use is best avoided in obstetric practice since gallamine crosses the placenta.
Gallamine may produce vagolytic tachycardia. Anaphylactoid reactions rarely occur.
The effect of gallamine may be appreciably prolonged by many other drugs including streptomycin, neomycin, polymyxin B, kanamycin, quinidine, propranolol and procainamide.
Ether and halothane potentiate the action of gallamine and other non-depolarizing muscle relaxants. The dose of gallamine should be reduced by 40% when used with ether, and by 20% when used with halothane.
Used concomitantly with gallamine, potassium-depleting agents, particularly thiazide diuretics and furosemide, may cause prolonged neuromuscular blockade.
Ventilation must be mechanically assisted until spontaneous respiration is fully re-established and the patient must be closely monitored until all risk of recrudescence of muscular paralysis has passed.
Muscular paralysis can generally be rapidly reversed by neostigmine after atropine has been administered to prevent excessive autonomic stimulation. This reversal occurs more rapidly if some return of muscle tone is evident before neostigmine is given.
Gallamine injection should be kept protected from light, and should not be allowed to freeze.