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A meta-analysis reported that the incidence of residual neuromuscular paralysis was 41% in patients receiving intermediate neuromuscular blocking agents during anaesthesia. [1] It is possible that > 100,000 patients annually in the USA alone, are at risk of adverse events associated with undetected residual neuromuscular blockade. [ 5 ]
Neuromuscular-blocking drugs, or Neuromuscular blocking agents (NMBAs), block transmission at the neuromuscular junction, [1] causing paralysis of the affected skeletal muscles. This is accomplished via their action on the post-synaptic acetylcholine (Nm) receptors.
It may be used from the induction of to recovery from neuromuscular blockade. Importantly, it is used to confirm adequacy of recovery after the administration of neuromuscular blocking agents. [3] The response of the muscles to electrical stimulation of the nerves can be recorded subjectively (qualitative) or objectively (quantitatively).
Sugammadex has been shown to have affinity for two other aminosteroid neuromuscular blocking agents, vecuronium and pancuronium. Although sugammadex has a lower affinity for vecuronium than for rocuronium, reversal of vecuronium is still effective because fewer vecuronium molecules are present in vivo for equivalent blockade: vecuronium is ...
Effective neuromuscular block by non-depolarizing neuromuscular drugs occurs only when 70-80% of acetylcholine receptors are occupied by the drug. [11] This is because at this occupancy rate, junctional potential cannot reach the threshold value required for muscle contraction. Diagram of nicotinic receptor (Acetylcholine receptor)
Use during pregnancy appears to be safe for the baby. [10] Suxamethonium is in the neuromuscular blocker family of medications and is of the depolarizing type. [7] It works by blocking the action of acetylcholine on skeletal muscles. [7] Suxamethonium was described as early as 1906 and came into medical use in 1951. [5]
It is unclear if use in pregnancy is safe for the baby. [2] Vecuronium is in the aminosteroid neuromuscular-blocker family of medications and is of the non-depolarizing type. [2] It works by competitively blocking the action of acetylcholine on skeletal muscles. [2] The effects may be reversed with sugammadex or a combination of neostigmine and ...
Neuraxial blockade is local anaesthesia placed around the nerves of the central nervous system, such as spinal anaesthesia, caudal anaesthesia, epidural anaesthesia, and combined spinal and epidural anaesthesia. [1] [2] The technique is used in surgery, obstetrics, and for postoperative and chronic pain relief. [3]