The antagonism of the nondepolarizing neuromuscular blockade is accomplished many times in a given day. Fortunately, the incidents of complications are low. If they do occur and are not recognized and treated properly, however, the results can be serious. In this article, the author reviews the curariform group of drugs, anticholinesterases, and anticholinergics, evaluating the antagonism of th...

Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscul...

Neuromuscular blockade is a desirable or even essential component of general anesthesia for major surgical operations. As the population continues to age, and more operations are conducted in the elderly, due consideration must be given to neuromuscular blockade in these patients to avoid possible complications. This review considers the pharmacokinetics and pharmacodynamics of neuromuscular bl...

Purpose: Recovery of the train-of-four ratio (TOFR) to > 0.9 in the upper limb is commonly used to determine that neuromuscular function has returned to the preoperative level. It is not known whether recovery of neuromuscular function can be determined in the same way using lower limb acceleromyography. We compared measurements of recovery from neuromuscular blockade using upper limb electromy...

BACKGROUND Dosage guidelines for muscle relaxants are based on dose-response studies, normally performed after several minutes of stable nitrous oxide (N O)-opioid anesthesia. However, relaxants are used immediately after induction of anesthesia. The study was designed to determine the influence of the duration of anesthesia and N O on the onset time at the adductor pollicis (AP) and the corrug...

We have evaluated in 10 anaesthetized patients the time course of action, infusion requirements, reversibility and pharmacokinetics of Org 9487. Org 9487 was administered as a bolus dose of 1.5 mg kg-1, followed by an infusion to maintain a block of 75-85% for 60 min. After recovery from the bolus dose, a mean dose of Org 9487 3.4 (SD 1.0) mg kg-1 h-1 was administered to maintain a mean neuromu...

l,rAzobis[3-methyl-2-phenyl-lH-imidazo(l,2-a)pyridinium] dibromide, AH 8165, produced a competitive neuromuscular block in the mouse, chick, cat, dog and monkey. The paralysis was characterized by a very rapid onset of action and, in all species except the monkey, by a short duration of action comparable to that of suxamethonium. In the monkey, the effect of AH 8165 was more persistent but was ...

Study of the literature on the physiology of neuromuscular transmission suggested two new methods of assessing the degree of neuromuscular block in the human subject. These were, first, a comparison of the height of the recorded twitch tensions developed in response to repeated single stimuli applied at differing frequencies and, second, examination of the extent of reduction in amplitude of tw...

Infusion rates for atracurium were calculated from multiple bolus injection data for normothermic (38 degrees C; n = 4) and hyperthermic (42 degrees C; n = 14) dogs anesthetized with thiopental and oxymorphone while undergoing whole-body hyperthermia treatment. The calculated infusion rate for atracurium at 38 degrees C was 6.2 +/- 0.3 micrograms/kg/min and the calculated infusion rate at 42 de...

We have studied the train-of-four (TOF) response mechanomyographically during onset of neuromuscular block produced by subclinical doses of suxamethonium in order to follow the augmentation of the first twitch of the TOF (T1) and TOF fade compared with control TOF responses before the drug was given. In the groups given suxamethonium 0.05, 0.1, 0.2 and 0.3 mg kg-1, the increments in T1 after ad...