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Related Concept Videos

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

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

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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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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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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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Depolarizing Blockers: Mechanism of Action01:28

Depolarizing Blockers: Mechanism of Action

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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...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Muscles of the Vertebral Column01:27

Muscles of the Vertebral Column

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The back muscles that lie deep into the thoracolumbar fascia are called intrinsic or true back muscles. These muscles are divided into four layers: superficial, intermediate, deep, and deepest layers.
Superficial Layer:
The superficial layer consists primarily of the splenius muscles, which include the splenius capitis and splenius cervicis. These muscles are mainly responsible for the head and cervical spine movements, including extension, rotation, and lateral bending. The splenius capitis...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics

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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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Related Experiment Video

Updated: Aug 10, 2025

Intraspinal Cell Transplantation for Targeting Cervical Ventral Horn in Amyotrophic Lateral Sclerosis and Traumatic Spinal Cord Injury
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Erector spinae plane block: the ultimate 'plan A' block?

Amit Pawa1, Christopher King2, Christopher Thang3

  • 1Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK.

British Journal of Anaesthesia
|February 12, 2023
PubMed
Summary
This summary is machine-generated.

The erector spinae plane block (ESPB) offers broad application for pain management. However, current evidence does not fully support its claim as the ultimate

Keywords:
Plan A blocksacute painerector spinae plane blocknerve blockpublication biasregional anaesthesia

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Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
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Last Updated: Aug 10, 2025

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Area of Science:

  • Pain Management
  • Regional Anesthesia
  • Surgical Analgesia

Background:

  • The erector spinae plane block (ESPB) is a proposed 'Plan A' regional anesthesia technique.
  • ESPB offers versatility in spinal level application and broad somatic analgesia.

Discussion:

  • While ESPB shows strong evidence for thoracoabdominal surgery analgesia, its efficacy in limb surgeries is less clear.
  • Comparative studies indicate limited benefits over local infiltration or other 'Plan A' blocks for extremity procedures.

Key Insights:

  • ESPB is a versatile regional anesthesia technique with potential for widespread pain management.
  • Evidence supports ESPB in thoracoabdominal surgeries but not conclusively for limb surgeries.

Outlook:

  • Further research is needed to clarify the role of ESPB in various surgical contexts.
  • Establishing definitive evidence for ESPB's superiority across all procedures remains an ongoing objective.