Abstract
The medication drawer of a modern anesthesiology workstation may contain up to five neuromuscular-blocking drugs (NMBs): succinylcholine, vecuronium, rocuronium, and possibly pancuronium and cisatracurium. With such an extensive armamentarium for providing muscle relaxation, why would an anesthesiologist require additional compounds? Although the depolarizing neuromuscular-blocking compound succinylcholine has been at anesthesiologists’ disposal since 1952 and remains the sole short-acting neuromuscular-blocking agent capable of providing adequate conditions for rapid tracheal intubation, succinylcholine nevertheless possesses an adverse effect profile well known to all practicing anesthesiologists: muscle fasciculations, hyperkalemia, cardiac arrest, and increased intraocular and intracranial pressures. Vecuronium, rocuronium, and pancuronium all possess a much more favorable adverse effect profile, but all three exhibit altered pharmacokinetics in the setting of end-organ perturbations. Cisatracurium is currently the only clinically available nondepolarizing neuromuscular-blocking compound with organ-independent metabolism and thus a lack of cumulative effects; however, this compound has an intermediate duration of action, a high potency, and therefore a relatively slow onset of action insufficient for rapidly securing a patient’s airway. Clearly, additions to the current armamentarium of neuromuscular-blocking compounds would prove useful in clinical practice, and the search for new molecules to fill the clinical voids has been ongoing since the 1970s.
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Murrell, M.T., Savarese, J.J. (2015). New Vistas in Neuromuscular Blockers. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8948-1_52
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