Physiology of Neuromuscular Transmission and Applied Pharmacology of Muscle Relaxants

AbstractPurpose of ReviewThe purpose of this clinical review is to summarize the physiology of the neuromuscular junction (NMJ) in the normal and denervated state, discuss the pharmacology of the neuromuscular relaxants (NMRs) within and outside the NMJ, and review recent advances in the development of new NMRs and their reversal agents.Recent FindingsRecent studies have delineated the mechanisms of the non-NMJ, anti-inflammatory effects of non-depolarizing NMRs, mediated by the α7 acetylcholine receptors expressed in innate immune cells (e.g., macrophages). Several chlorofumarate molecules (including gantacurium) have been developed as experimental NMRs, with specific reversal byl-cysteine. Additionally, reversal of existing NMRs (both aminosteroids and benzylisoquinolones) by calabadion 1 and 2 is under investigation.SummaryNew NMRs and reversal agents hold promise for the use in anesthesiology and critical care, with improved pharmacokinetic parameters and more favorable side-effect profiles compared with existing agents. Further research is warranted to exploit the systemic anti-inflammatory properties exhibited by NMRs for other disease processes aside from acute respiratory distress syndrome (ARDS).
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research