Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Concept Videos

Neuromuscular Junction And Blockade01:29

Neuromuscular Junction And Blockade

4.0K
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...
4.0K
Depolarizing Blockers: Mechanism of Action01:28

Depolarizing Blockers: Mechanism of Action

2.2K
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...
2.2K
Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

2.3K
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...
2.3K
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

423
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...
423
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

658
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...
658
Drugs Acting on Autonomic Ganglia: Blockers01:28

Drugs Acting on Autonomic Ganglia: Blockers

1.4K
Ganglionic blockers inhibit autonomic activity by blocking nicotinic receptors in the autonomic ganglia, suppressing impulse transmission. These blockers lack selectivity between sympathetic and parasympathetic ganglia and are ineffective as neuromuscular junction antagonists. They can be categorized into two groups:
1.4K

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same authorSame journal

The management of sternal mediastinitis in heart and lung transplant patients: An 8-year experience and application of reconstructive algorithm.

Journal of plastic, reconstructive & aesthetic surgery : JPRAS·2026
Same author

WAFER Trial: A randomized controlled trial comparing Wide-awake Local Anesthesia No Tourniquet (WALANT) to General and Regional Anesthesia with tourniquet for Flexor Tendon Repair.

Plastic and reconstructive surgery·2026
Same author

Clinical and Patient Satisfaction Outcomes from Southern Osseointegrated Fixtures for Craniofacial Reconstruction: A Retrospective Study.

The Journal of craniofacial surgery·2026
Same author

Diagnostic performance of photoplethysmography for early vascular compromise in a customisable<i>in vitro</i>flap model.

Medical engineering & physics·2026
Same author

Secondary breast reconstruction using a cross-chest profunda artery perforator flap in a vessel-depleted chest: A case report.

JPRAS open·2026
Same author

A multipurpose flowing vascular phantom for microsurgical training and flap-monitoring research.

Journal of plastic, reconstructive & aesthetic surgery : JPRAS·2026

Related Experiment Video

Updated: Oct 31, 2025

Wild-type Blocking PCR Combined with Direct Sequencing as a Highly Sensitive Method for Detection of Low-Frequency Somatic Mutations
10:41

Wild-type Blocking PCR Combined with Direct Sequencing as a Highly Sensitive Method for Detection of Low-Frequency Somatic Mutations

Published on: March 29, 2017

12.0K

WALANT Protocol: Stop before you block.

David Zargaran1, Alexander Zargaran2, Dariush Nikkhah1

  • 1Royal Free Hospital, Pond St, London NW3 2QG.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|July 1, 2021
PubMed
Summary

Wide Awake Local Anaesthetic No Tourniquet (WALANT) offers significant benefits for hand surgery. A new checklist is proposed to enhance safety by addressing contraindications and ensuring awareness of reversal agents like Phentolamine.

Keywords:
AdrenalineHand surgerySafetyTraumaWALANT

More Related Videos

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
10:46

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

Published on: May 26, 2015

13.5K
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.6K

Related Experiment Videos

Last Updated: Oct 31, 2025

Wild-type Blocking PCR Combined with Direct Sequencing as a Highly Sensitive Method for Detection of Low-Frequency Somatic Mutations
10:41

Wild-type Blocking PCR Combined with Direct Sequencing as a Highly Sensitive Method for Detection of Low-Frequency Somatic Mutations

Published on: March 29, 2017

12.0K
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
10:46

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

Published on: May 26, 2015

13.5K
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.6K

Area of Science:

  • Hand Surgery
  • Anaesthesiology
  • Patient Safety

Background:

  • The COVID-19 pandemic accelerated the adoption of Wide Awake Local Anaesthetic No Tourniquet (WALANT) in hand surgery due to general anaesthesia risks.
  • WALANT offers advantages including a bloodless surgical field, faster recovery, intraoperative testing, and cost-effectiveness.

Discussion:

  • There is a lack of consensus regarding contraindications for WALANT, posing potential risks.
  • A survey revealed low awareness among trainees regarding the appropriate reversal agent for inadequate perfusion during WALANT procedures.
  • Developing a standardized checklist for WALANT administration is crucial for patient safety.

Key Insights:

  • A proposed WALANT checklist should incorporate contraindications and information on Phentolamine, the reversal agent.
  • Checklists can enhance the safe and effective application of WALANT in hand surgery.
  • Standardized protocols are needed to improve trainee knowledge and preparedness for WALANT complications.

Outlook:

  • Further clinical trials are necessary to fully establish the safety and efficacy of WALANT.
  • Implementing a WALANT checklist can improve surgical outcomes and patient safety.
  • Wider adoption of standardized protocols will facilitate the integration of WALANT into routine hand surgery practice.