New Neuromuscular Blocking Drugs

Abstract

The new nondepolarizing neuromuscular blocking drugs have specific advantages over succinylcholine. Rocuronium has an onset of action that is almost as rapid as that of succinylcholine and may be useful in patients with residual gastric contents. This drug may replace vecuronium, since the two agents are otherwise similar. The onset of action of mivacurium is similar to that of atracurium, but recovery from the blockade is more rapid (if the plasma cholinesterase level is normal), making mivacurium useful for short procedures. Although pipecuronium and doxacurium have minimal effects on the cardiovascular system, their long and variable onset and duration of action limit their usefulness. The need for either drug is questionable. There is still a need, however, for a nondepolarizing drug that has an onset of action as rapid as that of succinylcholine but a duration of action similar to that of mivacurium, with no adverse cardiovascular effects and clearance from the body that is independent of organ function.

Adverse reactions to neuromuscular blocking agents

“…They can also, as with pancuronium, block the release of norepinephrine and its reuptake at sympathetic nerve endings [27].…”

Reversal of rocuronium-induced neuromuscular block by sugammadex is independent of renal perfusion in anesthetized cats

“…In patients receiving rocuronium, the drug is mainly taken up by the liver and excreted into the bile [1]. The mean percentage of rocuronium recovered from the urine within 48 h after administration is 26% of the administered dose [9].…”

“…Rocuronium is a non-depolarizing aminosteroidal neuromuscular blocking agent, widely used in anesthesia [1]. Recovery from neuromuscular block occurs spontaneously as the muscle relaxant diffuses away from the neuromuscular junction and is eliminated.…”

The Use of Sugammadex in a Patient with Myasthenia Gravis

“…(8) Roküronyum gibi steroidal nöromüsküler blokerler genel anestezide endotrakeal entübasyon, ventilasyon ve rahat bir cerrahi için yaygın olarak kullanılmak-tadır. (9) Bunun yanında yeterli derecede antagonize edilmezlerse postoperatif dönemde rekürarizasyona neden olup, hava yolu obstrüksiyonu, hipoventilasyon ve hipoksiye neden olabilmektedirler. (10) Bu komplikasyonlar özellikle miyastenia gravisli hastalarda daha belirgindir.…”