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Related Concept Videos

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics

All neuromuscular blocking agents are injected intravenously because they are poorly absorbed from the GI tract. Rapid onset is achieved with intravenous administration, although absorption is also adequate from an intramuscular injection. Since these agents are highly ionized, they do not readily penetrate cell membranes or cross the blood-brain barrier.
Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

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Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
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Published on: June 25, 2013

Residual neuromuscular blockade affects postoperative pulmonary function.

Gopalaiah Venkatesh Kumar1, Anita Pramod Nair, Hanuman Srinivasa Murthy

  • 1Department of Anesthesia, Manipal Hospital, Bangalore, India.

Anesthesiology
|October 24, 2012
PubMed
Summary
This summary is machine-generated.

Residual neuromuscular blockade (RNMB) impairs respiratory function post-surgery. Patients with RNMB showed significantly reduced pulmonary function test parameters, including forced vital capacity and peak expiratory flow.

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Area of Science:

  • Anesthesiology
  • Respiratory Physiology

Background:

  • Residual neuromuscular blockade (RNMB) is a known risk factor for postoperative respiratory complications.
  • Neuromuscular blocking agents are frequently used during general anesthesia.

Purpose of the Study:

  • To investigate the impact of RNMB on pulmonary function test (PFT) parameters in the immediate postoperative period.
  • To determine if RNMB affects PFTs irrespective of the neuromuscular blocking agent used.

Main Methods:

  • A prospective randomized cohort study involving 150 patients receiving vecuronium, atracurium, or rocuronium.
  • Train-of-four ratio (TOF) was measured post-extubation until TOF >= 0.9.
  • PFTs (including forced vital capacity and peak expiratory flow) were performed preoperatively and postoperatively.
  • Patients were classified as RNMB absent (TOF >= 0.9) or RNMB present (TOF < 0.9) at the time of PFT.

Main Results:

  • 39 patients exhibited RNMB upon PFT performance.
  • No significant difference in PFT reductions was observed among different neuromuscular blocking agents.
  • Patients with RNMB showed lower postoperative PFT values: 49% of baseline forced vital capacity and 38% of baseline peak expiratory flow, compared to 62% and 47% in the RNMB-absent group.
  • RNMB-present patients had significantly reduced forced vital capacity (13% absolute, 21% relative) and peak expiratory flow (9% absolute, 19% relative) compared to RNMB-absent patients.

Conclusions:

  • Residual neuromuscular blockade significantly reduces forced vital capacity and peak expiratory flow in the immediate postoperative period.
  • RNMB indicates impaired respiratory muscle function following anesthesia.
  • Monitoring and prevention of RNMB are crucial for optimizing postoperative respiratory outcomes.