Neuromuscular-blocking agents (NMBA) have been used in clinical anesthesia for nearly 60 years. In the perioperative period, a variety of factors can influence a patient’s response to these drugs. To precisely titrate NMBAs to clinical effects in the anesthetized patient, the application of neuromuscular monitoring is essential. The use of a peripheral nerve stimulator allows the clinician to a...

Neuromuscular blocking drugs are designed to bind to the nicotinic receptor at the neuromuscular junction. However, they also interact with other acetylcholine receptors in the body. Binding to these receptors causes adverse effects that vary with the specificity for the cholinergic receptor in question. Moreover, all neuromuscular blocking drugs may cause hypersensitivity reactions. Often the ...

Vecuronium-induced neuromuscular blocks in 42 ASA physical status I and II females were antagonized with atropine and equipotent doses of edrophonium, neostigmine and pyridostigmine. Recovery characteristics including speed of reversal, dysrhythmias and mean arterial pressure changes were studied. Edrophonium was associated with the fastest neuromuscular recovery. No clinically significant card...

BACKGROUND Neuromuscular block is estimated by comparing the evoked peak twitch with a control value measured in the absence of neuromuscular block. In practice, this control value is often difficult to determine because repeated motor nerve stimulation enhances the evoked mechanical response of the corresponding muscle, resulting in an increased twitch response. This is known as twitch potenti...

We describe the successful use of the short-acting, non-depolarizing neuromuscular blocking agent, mivacurium, in a patient with myotonic dystrophy. Increased sensitivity to mivacurium was demonstrated using train-of-four monitoring, with a single dose of mivacurium providing adequate block for 90 min of surgery. Spontaneous recovery appeared prolonged with a recovery index (25-75% T1) of 10 mi...

• Neuromuscular blocking agents (NMBAs) are often administered during surgical procedures to provide muscle relaxation and prevent patient movement, which may increase the risk of surgical complications • When neuromuscular block no longer needs to be maintained, patients may either be allowed to spontaneously recover neuromuscular function or be administered a reversal agent for more rapid rec...

BACKGROUND AND OBJECTIVES Neuromuscular blockers (NMB) have been used for more than half of a century in anesthesia and have always been a challenge for anesthesiologists. Until recently, the reversal of nondepolarizing neuromuscular blockers had only one option: the use of anticholinesterase agents. However, in some situations, such as deep neuromuscular blockade after high doses of relaxant, ...

4.5. Bisbenzyl-isoquinolinium compounds 4.5.2. Mivacurium 4.6. Reversal of non-depolarizing neuromuscular block by anticholinesterases 4.7. Other neuromuscular uses of anticholinesterases 4.8. Pharmacokinetics of non-depolarizing neuromuscular blocking drugs 4.8.1 Clearance of non-depolarizing neuromuscular blocking drugs and duration of action 5. Depolarizing neuromuscular blocking drugs 5.1. ...

Sugammadex is a revolutionary investigational reversal drug currently undergoing Phase III testing whose introduction into clinical practice may change the face of clinical neuromuscular pharmacology. A modified gamma-cyclodextrin, sugammadex exerts its effect by forming very tight water-soluble complexes at a 1:1 ratio with steroidal neuromuscular blocking drugs (rocuronium > vecuronium >> pan...