Neuromuscular blocking agents

What are Neuromuscular blocking agents?

Neuromuscular blocking agents are potent muscle relaxants typically only used during surgery to prevent muscle movement. They are structurally related to acetylcholine (the main neurotransmitter in the body) and they cause muscle relaxation by binding to acetylcholine receptors postsynaptically (which prevents acetylcholine from binding). This blocks neuromuscular transmission and causes paralysis of the muscle.

Neuromuscular blocking agents should only be used as an adjunct to anesthesia when artificial ventilation is available.

Neuromuscular blocking agents (NMBAs) come in two forms: depolarizing neuromuscular blocking agents (eg, succinylcholine) and nondepolarizing neuromuscular blocking agents (eg, rocuronium, vecuronium, atracurium, cisatracurium, mivacurium).

Options include succinylcholine, rocuronium or vecuronium if sugammadex is available for rapid reversal block. Any short or intermediate acting neuromuscular blocking agents can be applied for endotracheal intubation for long procedures (≥ 30 minutes).

Neuromuscular blocking (NMB) drugs or ‘muscle relaxants’ produce paralysis of the skeletal muscles. They may be used either to aid stable mechanical ventilation by blocking spontaneous respiratory movements or, more frequently, to provide more suitable conditions for surgery.