9. Appropriate use of muscle relaxants in anaesthesia, intensive and emergency care

Leo H.D.J. Booij

Radboud University Medical Centre Nijmegen, The Netherlands

Abstract

In this short review are the physiological processes involved in neuromuscular transmission described. Muscle relaxants are used in clinical anaesthesia to block this transmission and the requirements for an ideal drug are defined. The disadvantages of the currently available drugs are summarized including those for succinylcholine. Some focus is placed on rocuronium. The main disadvantage, i.e. residual paralysis, can be treated and/or prevented by reversal of such a block. However, currently used compounds have serious adverse effects and are not always efficacious. Therefore also the requirements for an ideal reversal agent are defined. Against this profile is sugammadex discussed. The possibility to replace succinylcholine with a combination of succinylcholine and sugammadex is discussed.

Keywords: neuromuscular transmission, neuromuscular block, succinylcholine, rocuronium, residual block, sugammadex

J Rom Anest Terap Int 2011; 18: 136-144