The Neuromuscular Junction: Pharmacologic Applications During Anesthesia

Introduction The neuromuscular junction and neuromuscular transmission are well-studied phenomenon. The system is designed to allow translation of an electrical impulse into a motor action potential and subsequent muscular contraction. While at first glance relatively simple in design, an appreciation of its complexity has added to the understanding and development of drugs used to modulate its function. That being said, there is increasing evidence that while monitors of depth of neuromuscular block lessen the degree of postoperative residual neuromuscular block, patients continue to arrive to the postanesthesia care unit with unacceptable levels of neuromuscular block and are prone to an increased incidence of critical respiratory events. A recent survey of practices of attitudes toward the use of neuromuscular blockers and use of neuromuscular blockers indicated that while approximately 20% of respondents felt that postoperative NMB was a significant problem, 66% of practitioners do not routinely administer an anticholinesterase and when they don’t approximately 40% base their decisions on clinical tests of residual neuromuscular block and absence of visible or palpable fade in response to train-of-four monitoring with conventional nerve stimulators. Quantitative monitors are available in only 5% of practices and only 10% feel that they should be part of minimal monitoring standards.