Neuromuscular Blockers- a review from historical perspective to recent advances
Keywords:
Neuromuscular blockers, Depolarizers, NondepolarizersAbstract
The type of neuromuscular blocking agent (NMBA); the type, timing, and dose of their reversal drugs; the means of monitoring NMB; and the site of monitoring are potentially on the verge of a paradigm shift.
The authors believe that selecting the right NMBA, administering concomitant sedation and analgesic therapy, and using appropriate monitoring techniques mitigate risks for anaesthetized patients. Therefore, the authors review the use of NMBAs in the operation theatre (OT) and critical care setting based on their structure, mechanism of action, side effects, and recognized clinical indications. Further, we highlight the available pharmacologic antagonists, and potential complications related to the use of NMBAs in the OT and ICU setting. Lastly, we describe briefly about neuromuscular monitoring in the clinical setting.
Downloads
References
Raghavendra T. Neuromuscular blocking drugs: discovery and development. J R Soc Med. 2002; 95: 363–7.
Crul JF. Relaxant drugs: from native drugs to the selective agents of today. Acta Anaesthesiologica Scandinavica 1982; 26: 409-15.
Morgan GE Jr, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. Singapore: McGraw-Hill; 2008. Chapter 9, Neuromuscular blocking agents; p. 205-26.
Bowman WC, Rodger IW, Houston J, Marshall RJ, McIndewar I. Structure: action relationships among some desacetoxy analogues of pancuronium and vecuronium in the anaesthetised cat. Anesthesiology 1988; 69: 57–62.
De Jong A, Molinari N, Pouzeratte Y, Verzilli D, Chanques G, Jung B, et al. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. Br J Anaesth 2015; 114: 297–306.
Lapinsky SE. Endotracheal intubation in the ICU. Crit Care 2015; 19: 258.
Taboada M, Doldan P, Calvo A, Almeida X, Ferreiroa E, Baluja A, et al. Comparison of tracheal intubation conditions in operating room and intensive care unit: a prospective, observational study. Anesthesiology 2018; 129: 321–8.
Simpson GD, Ross MJ, McKeown DW, Ray DC. Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. Br J Anaesth 2012; 108: 792–9.
Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 2006; 34: 2355–61.
Nag K, Singh DR, Shetti AN, Kumar H, Sivashanmugam T, Parthasarathy S. Sugammadex: A revolutionary drug in neuromuscular pharmacology. Anesth Essays Res 2013; 7: 302-6.
Haerter F, Simons JC, Foerster U, Duarte IM, Diaz-Gil D, Ganapati S, et al. Comparative Effectiveness of Calabadion and Sugammadex to Reverse Non-depolarizing Neuromuscular-blocking Agents. Anesthesiology 2015; 123: 1337–49.
Blobner M, Frick CG, Stäuble RB, Feussner H, Schaller SJ, Unterbuchner C, et al. Neuromuscular blockade improves surgical conditions (NISCO). Surg Endosc 2015; 29: 627–36.
Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth 2014; 112: 498–505.
Torensma B, Martini CH, Boon M, Olofsen E, Veld B, Liem RSL et al. Deep Neuromuscular Block Improves Surgical Conditions during Bariatric Surgery and Reduces Postoperative Pain: A Randomized Double Blind Controlled Trial. PLoS One 2016; 11: e0167907.
Yoo YC, Kim NY, Shin S, Choi YD, Hong JH, Kim CY, et al. The Intraocular Pressure under Deep versus Moderate Neuromuscular Blockade during Low-Pressure Robot Assisted Laparoscopic Radical Prostatectomy in a Randomized Trial. PLoS One 2015; 10: e0135412.
Savarese JJ, McGilvra JD, Sunaga H, Belmont MR, Ornum SGV, Savard PM, et al. Rapid chemical antagonism of neuromuscular blockade by L-cysteine adduction to and inactivation of the olefinic (double-bonded) isoquinolinium diester compounds gantacurium (AV430A), CW002, and CW011. Anesthesiology 2010; 113: 58-73.
Morgan GE Jr, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. Singapore: McGraw-Hill; 2008. Chapter 6, Patient monitors; p. 117-54.
