Recent Developments in the Field of Muscle Relaxants: Clinical Pharmacology and Pharmacokinetics
The search for the “ideal” neuromuscular blocking agent — a nondepolarizing drug with a time course of action similar to that of suxamethonium but without its well-known side effects — has been continuing for more than 20 years. In 1975, Savarese and Kitz , describing the desired clinical requisites for new neuromuscular blocking agents, proposed three classes: ultra-short-acting agents (similar to suxamethonium), drugs with an intermediate duration of action (i.e., between suxamethonium and pancuronium), and long-acting agents. New drugs should be free of side effects and belong to the category of nondepolarizing neuromuscular blocking agents in order to avoid the unwanted effects inherent in drugs with a depolarzing mode of action. An ultra-short-acting competitive agent has still not been discovered. During the last 2 years, however, three new nondepolarizing compounds have either been introduced into clinical practice or reached the stage of clinical investigation. These are vecuronium bromide (Org NC 45) and atracurium besilate, which both have a short to intermediate duration of action, and pipecuronium bromide, a drug with a long duration of action.
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