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Which of the following statements about neuromuscular blocking agents is false?
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Teaching Points
- The actions of nondepolarizing blocking agents are readily reversed by increasing the concentration of normal transmitters at the receptors.
- Reversal of nondepolarizing drugs is best accomplished by administering choline esterase inhibitors such as neostigmine.
- In contrast, the paralysis produced by depolarizing blockers is increased by cholinesterase inhibitors.
- The drugs block neuromuscular transmission at the neuromuscular junction causing paralysis of the skeletal muscles. This is accomplished either by acting presynaptically via the inhibition of acetylcholine synthesis or release or by acting postsynaptically at the acetylcholine receptors of the motor nerve end-plate. In clinical use, neuromuscular blockade is used adjunctively to anesthesia to paralyze the vocal cords and permit intubation of the trachea as well as to optimize the surgical field by inhibiting spontaneous ventilation to cause relaxation of skeletal muscles. Because the appropriate dose of neuromuscular-blocking drug may paralyze the muscles of the diaphragm, mechanical ventilation should be available. Patients are still aware of pain; hence, general anesthetics or analgesics must also be given.
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PubMed References
| Neuromuscular blocking agents and postoperative pulmonary complications., Ball L,de Abreu MG,Schultz MJ,Pelosi P,, The Lancet. Respiratory medicine, 2018 Sep 14 [PubMed PMID: 30224326] | |
| Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study., Kirmeier E,Eriksson LI,Lewald H,Jonsson Fagerlund M,Hoeft A,Hollmann M,Meistelman C,Hunter JM,Ulm K,Blobner M,, The Lancet. Respiratory medicine, 2018 Sep 14 [PubMed PMID: 30224322] | |
| Effects of Neostigmine and Sugammadex for Reversal of Neuromuscular Blockade on QT Dispersion Under Propofol Anesthesia: A Randomized Controlled Trial., Yamashita Y,Takasusuki T,Kimura Y,Komatsuzaki M,Yamaguchi S,, Cardiology and therapy, 2018 Sep 14 [PubMed PMID: 30218410] | |
| Hypersensitivity to Neuromuscular Blocking Agents: Can Skin Tests Give the Green Light for Re-Exposure?, Sabato V,Ebo DG,, The journal of allergy and clinical immunology. In practice, 2018 Sep - Oct [PubMed PMID: 30197072] | |
| Pharmacological characterization of cnidarian extracts from the Caribbean Sea: evaluation of anti-snake venom and antitumor properties., Oliveira CS,Caldeira CAS,Diniz-Sousa R,Romero DL,Marcussi S,Moura LA,Fuly AL,de Carvalho C,Cavalcante WLG,Gallacci M,Pai MD,Zuliani JP,Calderon LA,Soares AM,, The journal of venomous animals and toxins including tropical diseases, 2018 [PubMed PMID: 30181737] |
