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Related Concept Videos

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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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...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

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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...
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Neuromuscular Junction And Blockade01:29

Neuromuscular Junction And Blockade

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The site of chemical communication between a motor neuron and a muscle fiber is called the neuromuscular junction (NMJ). The end of the motor neuron at the NMJ divides into a cluster of synaptic end bulbs. The cytoplasm of these bulbs consists of synaptic vesicles enclosing acetylcholine molecules, the principal neurotransmitter released at the NMJ. The region opposite the synaptic bulb that ends in the muscle fiber is called the motor end plate, which has acetylcholine receptors. Within the...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

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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...
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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

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Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
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Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

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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...
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Neuromuscular blockade in the elderly.

Michał Stankiewicz-Rudnicki1

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Postoperative residual curarization (PORC) is a significant risk for elderly patients after general anesthesia. Understanding age-related pharmacokinetic changes aids in selecting appropriate muscle relaxants to prevent complications.

Keywords:
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Area of Science:

  • Anesthesiology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Postoperative residual curarization (PORC) presents a notable clinical challenge, particularly in the elderly population undergoing general anesthesia.
  • Age-related physiological changes can alter the pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBAs).

Purpose of the Study:

  • To review the clinical problem of PORC in elderly patients.
  • To describe potential complications associated with PORC.
  • To elucidate age-induced pharmacokinetic alterations of neuromuscular blocking agents.

Main Methods:

  • Literature review focusing on PORC in elderly patients.
  • Analysis of pharmacokinetic data for long and intermediate-acting NMBAs in older adults.
  • Synthesis of information on clinical implications and management strategies.

Main Results:

  • Elderly patients exhibit altered responses to NMBAs due to age-related pharmacokinetic and pharmacodynamic changes.
  • PORC can lead to significant postoperative respiratory and other complications.
  • Specific selection and intraoperative management of NMBAs are crucial in this demographic.

Conclusions:

  • Awareness of PORC and its associated risks is critical for anesthesiologists caring for elderly patients.
  • Tailoring NMBA selection and administration based on age-specific pharmacokinetic profiles can mitigate PORC.
  • This review aims to guide safer anesthetic practices in geriatric patients receiving NMBAs.