title: [Update on muscle relaxation : What comes after succinylcholine, rocuronium and sugammadex?]
abstract: Due to the great advantages, it is not possible to imagine current practice in anesthesia without the adminstration of muscle relaxants. For a long time the administration of succinylcholine for rapid sequence induction (RSI) was considered to be the state of the art for patients at risk for aspiration. The favorable characteristics are, however, accompanied by many, sometimes severe side effects. Due to the development of non-depolarizing muscle relaxants, in particular rocuronium in combination with sugammadex, there is the possibility to achieve a profile of action similar to succinylcholine with low side effects. After the introduction of sugammadex onto the market, further substances were conceived, which enable a complete encapsulation of muscle relaxants. Calabadion is a very promising new substance for the antagonization of muscle relaxants, which can antagonize the action of steroid as well as benzylisoquinoline types. In the USA new muscle relaxants are currently being tested, which have a rapid onset and the effect can be reversed by L‑cysteine. One of the most promising substances is gantacurium, which is currently being tested in the USA in phase III trials. It remains to be seen whether these muscle relaxants, which are not yet on the market and drugs for reversal of neuromuscular blockade have the potential to become a real alternative to the combination of rocuronium and sugammadex.
authors.affiliation: Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Sankt Elisabeth Hospital Gütersloh, Stadtring Kattenstroth 130, 33332, Gütersloh, Deutschland. norbert.zoremba@sankt-elisabeth-hospital.de.
authors.forename: N
authors.initials: N
authors.lastname: Zoremba
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum, RWTH Aachen, Aachen, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Schälte
authors.affiliation: Klinik für operative Intensivmedizin und intermediate Care, Universitätsklinikum, RWTH Aachen, Aachen, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Bruells
authors.affiliation: Klinik für Anästhesiologie und operative Intensivmedizin, Kreiskliniken Reutlingen GmbH, Reutlingen, Deutschland.
authors.forename: F K
authors.initials: FK
authors.lastname: Pühringer
mesh_terms: D000732:Androstanols / Q000037:antagonists & inhibitors; D000758:Anesthesia / Q000379:methods*; D000818:Animals; D006801:Humans; D007546:Isoquinolines; D009125:Muscle Relaxants, Central / Q000037:antagonists & inhibitors; D009467:Neuromuscular Depolarizing Agents / Q000037:antagonists & inhibitors; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors; D000077123:Rocuronium; D013390:Succinylcholine / Q000037:antagonists & inhibitors; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D007546:Isoquinolines; D009125:Muscle Relaxants, Central; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D013390:Succinylcholine; C451919:gantacurium; D000077123:Rocuronium
keywords: Calabadion; Dose-response relationship, drug; Gantacurium; Neuromuscular blockade; Train of four