A Perspective on Application and Efficiency of Neuromuscular Relaxants

Kimichi Nakamura^*
*Correspondence: Kimichi Nakamura, Editorial Office, Journal of Anaesthesiology and Pain Research, Brussels, Belgium, Email:

Introduction

Anesthesiologists typically provide more sedatives and analgesics to deepen anaesthesia or, as an alternative, utilise fast-acting muscle relaxants to achieve deep neuromuscular blockade. It indicates that the patient's motor function has not entirely recovered from surgery when there is residual muscular relaxation. Residual muscular relaxation can result in hypoxia, respiratory depression, and airway blockage. The neuromuscular blockade brought on by rocuronium or vecuronium is reversed because the interaction between muscle relaxants and nicotinic cholinergic receptors at the neuromuscular junction is disturbed.

Neuromuscular relaxants are used to reduce the convulsive motor activity, which is necessary in patients with osteoporosis or spinal injuries to avoid bone fractures and physical harm during the seizure. Although succinylcholine has a number of negative side effects, including increased internal gastric pressure, myalgia, hyperkalemia, and a potential link to malignant hyperthermia; it is the most effective and widely used neuromuscular relaxant due to its short duration of action and quick recovery. Even after taking sugammadex, the danger of recurrence should not be taken lightly, especially in patients with severe renal impairment causes extended elimination of rocuronium and sugammadex [1].

Electrical stimulation can momentarily undo the effects of muscle relaxation. Non-depolarizing muscle relaxants are therefore only used in patients who are thought to have malignant hyperthermia at this time. Because succinylcholine is frequently utilised, the optimum neuromuscular relaxant should have quick neuromuscular blocking effects and rapid recovery from the effects. The use of rocuronium-sugammadex as an alternative to succinylcholine appears to be the most promising technique for muscle relaxation in some circumstances, such as those with a history of neuroleptic malignant syndrome or neuromuscular illnesses [2].

A selective oestrogen receptor modulator called toremifene has a strong affinity for sugammadex. When the medication is administered, it has the ability to displace the sugammadex's steroidal neuromuscular blocking agents, and reparalysis may result. Drugs that might potentiate neuromuscular blockade may potentially contribute to the recurrence of paralysis. A significant development and innovation in the realm of anaesthetic is sugamadex. Sugammadex allows anesthesiologists greater flexibility and better control over various levels of neuromuscular blockade, particularly deep neuromuscular blockade and strong neuromuscular blockade, when used in the proper dosage [3]. More extensive, multi-center research on sugammadex are urgently required in order to have a clearer, more complete understanding of its harmful effects.

The action of neuromuscular function on various myoneural junction components can be disrupted by local anaesthetics. As a result, the interaction between local anaesthetics and neuromuscular blocking medications involves a number of mechanisms. Numerous studies have attempted to explain the direct effects of local anaesthetics on the neuromuscular plaque, but it is still unknown how exactly they disrupt neuromuscular transmission [4]. Since the combination of anaesthetic techniques that imply the simultaneous use of local anaesthetics and neuromuscular blocking drugs can have undesirable effects during and after surgical procedures, the potentiating effect of the neuromuscular blockade produced by atracurium lidocaine and bupivacaine becomes relevant in clinical practise.

In order to facilitate endotracheal intubation and mechanical ventilation, muscle relaxants are utilized. Additionally, they are utilised to make certain kinds of surgery possible. For instance, without muscle relaxants, laparoscopic treatments would frequently be impossible, and during open abdominal surgery, the abdominal contents would more easily protrude, making the procedure very difficult. Muscle relaxants have risks of their own when used by people with neuromuscular diseases. At the level of the central nervous system, peripheral nerves, neuromuscular junction, or muscle fibre, these illnesses may have a pathophysiologic foundation. These disorders may be accompanied by aberrant reactions to muscle relaxants as well as systemic issues that may have a significant impact on how anaesthesia is administered.

Premedication medications like diazepam are beneficial since they could ease spasticity. However, as it may affect temperature regulation, any premedication that contains a medication with anticholinergic characteristics should be avoided. Intravenous anaesthetics like propofol, thiopental, or etomidate can be used to safely induce anaesthesia. An injectable drug or a volatile drug can be used to maintain anaesthesia. The volatile substances alone significantly impede neuromuscular transmission in individuals. Due to these patients' apparent vulnerability to the respiratory depression side effects of opiates and sedatives, postoperative pain may be challenging to treat. Care should be taken during neuraxial anaesthesia to prevent a high level of blockage and ensuing muscle weakness. Neuromuscular blockers may cause unexpected reactions in patients receiving intensive care. Inactivity alone can increase acetylcholine receptors, which can result in hyperkalemia and cardiac arrest when depolarizing neuromuscular blocking medications are used [5].

Conclusion

Numerous illnesses fall under the umbrella of neuromuscular disease, and either symptom directly related to the disorder or concomitant conditions call for anaesthetic management. The pathophysiology of the diseases usually allows for the prediction of the diseases' unique difficulties. The anaesthesiologist is responsible for carrying out a complete preoperative evaluation, selecting the best anaesthetic method and neuromuscular blocking medication, and carefully monitoring hemodynamic parameters and the level of neuromuscular blockade.

Conflict of Interest

Author declares no conflicts.

References

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