ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

NEUROMUSCULAR BLOCKING AGENTS AND ANTAGONISTS

Filiz Kaya

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Kaya F. Neuromuscular Blocking Agents and Antagonists. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.123-133.

ABSTRACT

  • Neuromuscular blocking agents exert their paralytic effects by mimicking acetylcholine.
  • Depolarizing neuromuscular blocking agents (succinylcholine) act as agaonists and cause depolarization. Nondepolarizing drugs act as antagonists by preventing the binding of acetylcholine.
  • Succinylcholine is the only depolarizing neuromuscular blocking drug in clinical use. Its routine use in healthy children is not recommended.
  • Atracurium and cisatracurium are not significantly affected in patients with hepatic and renal impairment. Clearance of the drugs is prolonged due to hepatic and renal excretion. In these diseases, the loading dose should be kept high and the maintenance dose low.
  • Adductor pollicis TOF ratio should be at least 0.90 for complete recovery of neuromuscular function.
  • It should be kept in mind that residual blockade may pose a patient safety problem in the early postoperative period. Therefore, residual neuromuscular block should always be reversed.
  • When reversing neuromuscular blockade, our goal should be optimal nicotinic conduction and minimal muscarinic effect.
  • Sugammadexin has encapsulation properties and acts like steroidal neuromuscular blocking drugs. It should be used with caution in patients with renal insufficiency because of renal excretion.

Keywords: Neuromuscular junction; Acetylcholine receptors; Neuromuscular blocking agent; Neuromuscular depolarizing agents; Neuromuscular nondepolarizing agents; Sugammadex

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