Nondepolarizing neuromuscular blocking drugs

These drugs compete with acetylcholine and block its access to the postsynaptic receptor sites on the muscle but do not cause depolarization. (They may also block prejunctional receptors responsible for facilitating the release of acetylcholine.) They are sometimes referred to as competitive neuromuscular blockers. The time to maximum effect, that is when relaxation is adequate to allow tracheal intubation, is relatively slow compared with suxamethonium, generally 1.5-3mins. A synopsis of the drugs used is given in Table 2.6.

They are used in two ways:

• following suxamethonium to maintain muscle relaxation during surgery;

• to facilitate tracheal intubation in non-urgent situations.

Although recovery of normal neuromuscular function eventually occurs spontaneously after the use of these drugs, it is often accelerated by the administration of an anticholinesterase (see below).

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