The importance of myorelaxants in anesthesia.
Neuromuscular blocking drugs were introduced into clinical practice in 1942. Although these drugs made new surgical techniques possible, they also led to morbidity and mortality owing to respiratory muscle paralysis and paralysis in the face of inadequate anesthesia. Newer competitive antagonists at the neuromuscular junction have been developed that have a more rapid onset of action, including rocuronium and mivacurium, making them suitable for use at the onset of anesthesia. Rapid titratable offset of action has been more difficult to achieve, but has been attempted with the inclusion of ester bonds (mivacurium) and binding agents that are in clinical trials. These novel approaches to pharmaceuticals, along with improved understanding of the physiology of the neuromuscular junction in health and disease, have made surgical treatment possible in a wide breadth of clinical situations.
Flood
Pamela
P
Department of Anesthesiology, Columbia University, 630 West 169th St, New York, NY 10032, USA. pdf3@columbia.edu
D000368:Aged; D000375:Aging / Q000502:physiology; D000732:Androstanols / Q000494:pharmacology*; D000768:Anesthesia, General; D006801:Humans; D007546:Isoquinolines / Q000494:pharmacology*; D000077590:Mivacurium; D009126:Muscle Relaxation / Q000187:drug effects* / Q000528:radiation effects; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D000077123:Rocuronium; D013329:Structure-Activity Relationship
D000732:Androstanols; D007546:Isoquinolines; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D000077123:Rocuronium