Review Article

Muscle Relaxants in Anesthesia Practice: A Narrative Review

Abstract

Background: The objective of this study is to review the literature about the muscle relaxants in anesthetic practice.
Methods: In this review, our search includes, the studies performed and applied between 2000 and 2016. Therefore, for review of muscle relaxants in anesthesia practice in major surgeries, we referred to Google scholar, UpToDate, science direct, Ovid MEDLINE, Springer, free journals and the references of reviewed articles in the English language.
Results: Neuromuscular blocking agents are a chore and essential part of balanced anesthesia. These are used to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery. The main disadvantage, i.e. residual paralysis, can be treated or prevented by reversing of such a block.
Conclusion: The muscle relaxant plays an important role in adequate muscle relaxation, which allows efficient and safe surgery, requiring automated ventilatory control.

Bösenberg AT. Pediatric anesthesia in developing countries. Curr Opin Anesthesiol. 2007; 20(3):204-10.

Cherian M, Merry A, Wilson I. The World Health Organization and Anaesthesia. Anaesthesia. 2007; 62(s1):65-6.

Tonner P. Balanced anaesthesia today. Best Practice & Research Clinical Anaesthesiology. 2005; 19(3):475-84.

Bufler J, Wilhelm R, Parnas H, Franke C, Dudel J. Open channel and competitive block of the embryonic form of the nicotinic receptor of mouse myotubes by (+)‐tubocurarine. J Physiol 1996; 495(1):83-95.

Buzello W, Diefenbach C, Nigrovic V. Muscle relaxants: a clinical update. Acta Anaesthesiol Scand Supplementum. 1995; 109:165-7.

Lee C. Structure, conformation, and action of neuromuscular blocking drugs. Br J Anaesth. 2001; 87(5):755-69.

Waser P. Chemistry and pharmacology of natural curare compounds. Neuromuscular Blocking and Stimulating Agents. Int Enc Pharmacol Ther. 1972; 14(1):205-39.

Hill SA, Scott RP, Savarese JJ. Structure-activity relationships: from tubocurarine to the present day. Baillière's Clinical Anaesthesiology. 1994; 8(2):317-48.

Gandiha A, Marshall I, PAUL D, SINGH H. Neuromuscular and other blocking actions of a new series of mono and bisquaternary aza steroids. Journal Pharmacy and Pharmacology. 1974; 26(11):871-7.

Naguib M, Lien CA. Pharmacology of muscle relaxants and their antagonists. Miller's anesthesia. 2005; 7:859-911.

Appiah-Ankam J, Hunter JM. Pharmacology of neuromuscular blocking drugs. Continuing Education in Anaesthesia Critical Care & Pain. 2004; 4(1):2-7.

Naguib M, Lien CA. Pharmacology of muscle relaxants and their antagonists.Miller anesthesia.2005; 859-911.

Fodale V, Santamaria L. Laudanosine, an atracurium and cisatracurium metabolite. Eur J Anaesthesiol. 2002; 19(7):466-73.

Basta SJ, Savarese JJ, Ali HH, Embree PB, Schwartz AF, Rudd GD, et al. Clinical pharmacology of doxacurium chloride. A new long-acting nondepolarizing muscle relaxant. Anesthesiology. 1988; 69(4):478-86.

Bevan DR. Newer neuromuscular blocking agents. Basic & Clinical Pharmacology & Toxicology. 1994; 74(1):3-9.

Savarese JJ, Ali HH, Basta SJ, Embree PB, Scott R, Sunder N, et al. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U). A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology. 1988; 68(5):723-32.

Maddineni V, Mirakhur R, McCoy E, Fee J, Clarke R. Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium. Anaesthesia. 1993; 48(11):940-5.

Buckett W, Hewett C, Savage D. Pancuronium bromide and other steroidal neuromuscular blocking agents containing acetylcholine fragments. J Medicinal Chemistry. 1973; 16(10):1116-24.

Bowman WC. Pharmacology of neuromuscular function: Butterworth-Heinemann; 2013.

durant nn, marshall ig, savage ds, nelson dj, sleigh t, carlyle ic. The neuromuscular and autonomic blocking activities of pancuronium, Org NC 45, and other pancuronium analogues, in the cat. Journal Pharmacy and Pharmacology. 1979; 31(1):831-6.

McCoy EP, Maddineni VR, Elliott P, Mirakhur RK, Carson IW, Cooper RA. Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium. Can J Anesth. 1993; 40(8):703-8.

Goudsouzian NG, Martyn JJ, Liu LM, Gionfriddo M. Safety and efficacy of vecuronium in adolescents and children. Anesth Analg. 1983; 62(12):1083-8.

Mertes PM, Laxenaire M-C, Alla F. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999–2000. Journal American Society of Anesthesiologists. 2003; 99(3):536-45.

Bhananker SM, O’Donnell JT, Salemi JR, Bishop MJ. The risk of anaphylactic reactions to rocuronium in the United States is comparable to that of vecuronium: an analysis of food and drug administration reporting of adverse events. Anesth Analg. 2005; 101(3):819-22.

Bevan DR. Neuromuscular Blocking Agents François Donati.

Keegan RD. Muscle Relaxants and Neuromuscular. Veterinary Anesthesia and Analgesia. 2015:260-76.

Moore E, Hunter J. The new neuromuscular blocking agents: do they offer any advantages? Br J Anaesth. 2001; 87(6):912-25.

Naguib M, Samarkandi A, Bakhamees H, Magboul M, El-Bakry A. Comparative potency of steroidal neuromuscular blocking drugs and isobolographic analysis of the interaction between rocuronium and other aminosteroids. Br J Anaesth. 1995; 75(1):37-42.

Proost J, Eriksson L, Mirakhur R, Roest G, Wierda J. Urinary, biliary and faecal excretion of rocuronium in humans. Br J Anaesth. 2000; 85(5):717-23.

Naguib M. How serious is the bronchospasm induced by rapacuronium? Anesthesiology: Journal American Society of Anesthesiologists. 2001; 94(5):924-5.

Kron SS. Severe bronchospasm and desaturation in a child associated with rapacuronium. Journal American Society of Anesthesiologists. 2001; 94(5):923-4.

Meakin GH, Pronske EH, Lerman J, Orr R, Joffe D, Savaree AM, et al. Bronchospasm after rapacuronium in infants and children. Journal American Society of Anesthesiologists. 2001; 94(5):926-7.

Goudsouzian NG. Rapacuronium and bronchospasm. Anesthesiology. 2001; 94(5):727-8.

Sparr H, Mellinghoff H, Blobner M, Nöldge-Schomburg G. Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients. Br J Anaesth. 1999; 82(4):537-41.

Miller cn. Implementation of medicinal leech preparation to investigate the connection between the motor neuron and muscle fiber via sharp electrode electrophysiology. 2011; (5):18-20.

Zaimis E, Head S. Depolarising neuromuscular blocking drugs. Neuromuscular junction: Springer; 1976. p. 365-419.

Cisterna BA, Cardozo C, Sáez JC. Neuronal involvement in muscular atrophy. Front Cell Neurosci. 2014; 8: 405.

Follansbee WP. The cardiovascular manifestations of systemic sclerosis (scleroderma). Current Problems In Cardiology. 1986; 11(5):244-98.

Brull SJ, Naguib M. Selective reversal of muscle relaxation in general anesthesia: focus on sugammadex. Drug Design, Development and Therapy. 2009;3: 119-21.

Bowman W. Neuromuscular block. Br J Pharmacol. 2006; 147(S1).

Brunton LL, Lazo JS, Parker KL. Goodman & Gilman’s the pharmacological basis of therapeutics. New York: McGraw-Hill; 2006.

Lee C. Goodbye suxamethonium! Anaesthesia. 2009; 64(s1):73-81.

Lee C, Jones T. Molecular conformation–activity relationship of decamethonium congeners. Br J Anaesth. 2002; 88(5):692-9.

Tranquilli WJ, Thurmon JC, Grimm KA. Lumb and Jones' veterinary anesthesia and analgesia: John Wiley & Sons; 2013.

Ganzberg SI. Emergency Management. Oral Sedation for Dental Procedures in Children: Springer; 2015. p. 195-209.

Savarese JJ, Kitz RJ, Ginsburg S. Neuromuscular blocking agents. Google Patents; 1980.

Belmont MR, Lien CA, Quessy S, Abou-Donia MM, Abalos A, Eppich L, et al. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology: Journal American Society of Anesthesiologists. 1995; 82(5):1139-45.

Bowman W, Rodger I, Houston J, Marshall R, McIndewar I. Structure: action relationships among some desacetoxy analogues of pancuronium and vecuronium in the anesthetized cat. Anesthesiology. 1988; 69(1):57-62.

Booij L, Crul J. A comparison of vecuronium with the hypothetical ideal neuromuscular blocking drug. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide) Amsterdam: Excerpta Medica. 1983:3-8.

Robertson EN, Booij L, Fragen R, Crul J. Intradermal histamine release by 3 muscle relaxants. Acta Anaesthesiologica Scandinavica. 1983; 27(3):203-5.

Florvaag E, Johansson S, Öman H, Harboe T, Nopp A. Pholcodine stimulates a dramatic increase of IgE in IgE‐sensitized individuals. A pilot study. Allergy. 2006; 61(1):49-55.

Harboe T, Johansson S, Florvaag E, Öman H. Pholcodine exposure raises serum IgE in patients with previous anaphylaxis to neuromuscular blocking agents. Allergy. 2007; 62(12):1445-50.

Godoy DA, Piñero GR. Intensive Care in Neurology and Neurosurgery: Pathophysiological Basis for the Management of Acute Cerebral Injury: SEEd; 2013:1305-1327.

Berg H, Viby-Mogensen J, Roed J, Mortensen C, EngbÊk J, Skovgaard LT, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. Acta Anaesthesiologica Scandinavica. 1998(41):1-9.

Eriksson LI. The effects of residual neuromuscular blockade and volatile anesthetics on the control of ventilation. Anesth Analg. 1999; 89(1):243-51.

Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology: Journal American Society of Anesthesiologists. 2005; 102(2):257-68.

Murphy GS, Szokol JW, Marymont JH, Franklin M, Avram MJ, Vender JS. Residual paralysis at the time of tracheal extubation. Anesth Analg. 2005; 100(6):1840-5.

Baurain M, Hoton F, d'Hollander A, Cantraine F. Is recovery of neuromuscular transmission complete after the use of neostigmine to antagonize block produced by rocuronium, vecuronium, atracurium and pancuronium? Br J Anaesth. 1996; 77(4):496-9.

Kim KS, Lew SH, Cho HY, Cheong MA. Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine. Anesth Analg. 2002; 95(6):1656-60.

Keys TE. Anaesthesia: essays on its history: Springer Science & Business Media; 2012.

Eriksson LI. Miller's Anesthesia: 1: Elsevier Health Sciences; 2009:859-912p.

Euliano TY, Gravenstein JS, Gravenstein N, Gravenstein D. Essential anesthesia: from science to practice: Cambridge University Press; 2011.

Hopkin DB. Hazards and errors in anaesthesia: Springer Science & Business Media. 2012; (2):89-95.

Hemmerling TM, Donati F. Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review. Canadian Journal of Anesthesia. 2003; 50(8):779-94.

Fisher D. Neuromuscular blocking agents in paediatric anaesthesia. Br J Anaesth. 1999;83(1):58-64.

Mertes P-M, Laxenaire MC. Adverse reactions to neuromuscular blocking agents. Current Allergy and Asthma Reports. 2004; 4(1):7-16.

Mertes P, Aimone-Gastin I, Gueant-Rodriguez R, Mouton-Faivre C, Audibert G, O'Brien J, et al. Hypersensitivity reactions to neuromuscular blocking agents. Current Pharmaceutical Design. 2008; 14(27):2809-25.

Nagelhout JJ. Neuromuscular Blocking Agents, Monitoring. Nurse Anesthesia-E-Book. 2013:158.

Martyn JAJ, Richtsfeld M. Succinylcholine-induced Hyperkalemia in Acquired Pathologic StatesEtiologic Factors and Molecular Mechanisms. Anesthesiology: Journal American Society of Anesthesiologists. 2006; 104(1):158-69.

Claudius C, Garvey L, Viby‐Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009; 64(s1):10-21.

Barohn RJ, Jackson CE, Rogers SJ, Ridings LW, McVey AL. Prolonged paralysis due to nondepolarizing neuromuscular blocking agents and corticosteroids. Muscle & Nerve. 1994; 17(6):647-54.

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IssueVol 4 No 4 (2018): Autumn QRcode
SectionReview Article(s)
Keywords
Muscle relaxant anesthesia practice

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How to Cite
1.
Khan Z, Hajipour A, Zebardast J, Alomairi S. Muscle Relaxants in Anesthesia Practice: A Narrative Review. Arch Anesth & Crit Care. 2018;4(4):547-552.