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Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 4/2023

06-11-2023 | Acute Respiratory Distress-Syndrome | Neuromuscular Blockade (CA Lien, Section Editor)

Physiology of Neuromuscular Transmission and Applied Pharmacology of Muscle Relaxants

Authors: Jamie L. Sparling, J. A. Jeevendra Martyn

Published in: Current Anesthesiology Reports | Issue 4/2023

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Abstract

Purpose of Review

The 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 Findings

Recent 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 by l-cysteine. Additionally, reversal of existing NMRs (both aminosteroids and benzylisoquinolones) by calabadion 1 and 2 is under investigation.

Summary

New 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).
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Metadata
Title
Physiology of Neuromuscular Transmission and Applied Pharmacology of Muscle Relaxants
Authors
Jamie L. Sparling
J. A. Jeevendra Martyn
Publication date
06-11-2023
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 4/2023
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-023-00584-y

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