Physiology and biology of neuromuscular transmission in health and disease.
The introduction of powerful and contemporary research techniques has allowed for an increasingly detailed understanding of neuromuscular transmission. The classic model of nerve signaling to muscle using acetylcholine has been well described. Newer discovery points toward a more complex signaling system with adaptive receptor physiology and a multifaceted action response scheme for muscle relaxants. Although adding complexity, these newer discoveries help align experimentally derived knowledge with clinical observations. In this review, new concepts relative to neuromuscular transmission in health and disease are discussed, including a detailed discussion of acetylcholine and acetylcholine receptor physiology. Recent elucidations of the pathophysiologic responses to neuromuscular injury and its clinical implications are also detailed.
Shear
Torin D
TD
Department of Anesthesia and Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Martyn
J A Jeevendra
JA
D000109:Acetylcholine / Q000037:antagonists & inhibitors / Q000502:physiology; D000110:Acetylcholinesterase / Q000502:physiology; D000200:Action Potentials / Q000187:drug effects / Q000502:physiology; D001667:Binding, Competitive / Q000502:physiology; D002800:Cholinesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019148:Neuromuscular Blockade / Q000009:adverse effects / Q000379:methods; D009467:Neuromuscular Depolarizing Agents / Q000037:antagonists & inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D009469:Neuromuscular Junction / Q000187:drug effects / Q000502:physiology; D020511:Neuromuscular Junction Diseases / Q000188:drug therapy / Q000503:physiopathology; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D011950:Receptors, Cholinergic / Q000737:chemistry / Q000187:drug effects / Q000502:physiology; D055366:Synaptic Potentials / Q000502:physiology; D009435:Synaptic Transmission / Q000187:drug effects / Q000502:physiology; D015854:Up-Regulation / Q000187:drug effects / Q000502:physiology
D002800:Cholinesterase Inhibitors; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D011950:Receptors, Cholinergic; D000110:Acetylcholinesterase; D000109:Acetylcholine