Neuromuscular relaxants--1997.

T HE sixth International Neuromuscular Meeting was held in Paris in August. The original meeting, in London in 1975, was to act as a forum for investigators and industry (Burroughs Wellcome and Organon) in the hope that such a liaison would lead to the development of muscle relaxants needed by the clinician. In so far as the intermediate relaxants, atracttrium and vecuronium, were developed, the meetings can claim some success. The inaugural meeting is seldom counted as the first which was held in San Francisco in 1979 followed by Boston (1983), Los Angeles (1987), Montrtal (1992) and Tokyo (1994). Strictly, the Paris meeting was the Seventh! In Paris, a combination of basic scientists, clinical pharmacologists and anaesthetists led to detailed discussion of many aspects of the pharmacological modification of signal transduction by the pentameric acetylcholine receptor at the neuromuscular junction. Three topics had particular relevance for clinicians. Perhaps the most important was the presentation by J. Viby-Mogensen (Copenhagen, Denmark) of a controlled study examining the incidence of postoperative pulmonary complications (POPC) after the use ofpancuronium, atracurium or vecuronium during anaesthesia. 1 Pulmonary complications were defined as the combination of clinical signs and radiological evidence of atelectasis or infiltration occurring up to six days following surgery. (One of the authors, H. Berg, had previously received the Radiometer prize for original research after presentation of the paper at the Scandinavian Anaesthesia Society Congress in June). Although residual neuromuscular block, particularly after the use of long-acting relaxants, has been recognised for nearly 20 years, z no previous investigation has been able to demonstrate that this resulted in adverse effects. In this multicentre, prospective, study of 691 patients undergoing abdominal, gynaecological or major orthopaedic procedures and randomized for the choice of relaxant (pancuronium, vecuronium, atracurium), POPC occurred in 20 (8.7%) who had received pancuronium, 14 (6.1%) after vecuronium and 13 (5.6%) in the atracurium group. Multiple regression analysis demonstrated that abdominal surgery, age, and