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The degree of train-of-four (TOF) fade, i.e., the reduction of the fourth to the first twitch height in a train, induced by d-tubocurarine (d-TC) and alpha-bungarotoxin (alpha-BX) was investigated. The fade induced by d-TC was pronounced in comparison with that by alpha-BX, and the difference was analyzed using a kinetic model. Based on the assumptions: (1) Acetylcholine (ACh) binds to the nicotinic receptor and evokes twitch response. (2) The amount of released ACh is dependent on stimulus interval. (3) d-TC interacts competitively with the receptor. (4) alpha-BX interacts irreversibly with the receptor. It was suggested that the fade by d-TC and alpha-BX can be explained by the difference of the receptor occupancy by ACh which was caused by different interaction mechanisms of the two muscle relaxants with receptors.

Kinetic Analysis of Neuromuscular Blockade. II. Train-of-Four Fade Induced by d-Tubocurarine and .ALPHA.-Bungarotoxin.