Korean J Anesthesiol.  2017 Oct;70(5):500-510. 10.4097/kjae.2017.70.5.500.

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

• Kim YB
• Sung TY
• Yang HS

• KMID: 2395603
• DOI: http://doi.org/10.4097/kjae.2017.70.5.500

Abstract

Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action. Factors that affect the onset time include the potency of the NMBDs, the rate of NMBDs reaching the effect site, the onset time by dose control, metabolism and elimination of NMBDs, buffered diffusion to the effect site, nicotinic acetylcholine receptor subunit affinity, drugs that affect acetylcholine (ACh) production and release at the neuromuscular junction, drugs that inhibit plasma cholinesterase, presynaptic receptors responsible for ACh release at the neuromuscular junction, anesthetics or drugs that affect muscle contractility, site and methods for monitoring neuromuscular function, individual variability, and coexisting disease. NMBDs with rapid onset without major adverse events are expected in the next few years, and the development of lower potency NMBDs will continue. Anesthesiologists should be aware of the use of NMBDs in the management of anesthesia. The choice of NMBD and determination of the appropriate dosage to modulate neuromuscular blockade characteristics such as onset time and duration of neuromuscular blockade should be considered along with factors that affect the effects of the NMBDs. In this review, we discuss the factors that affect the onset time of NMBDs.

Keyword

Acetylcholine receptor; Anesthesia; Drug interactions; Neuromuscular junction; Neuromuscular monitoring; Non-depolarizing neuromuscular blocking agents; Onset time; Pharmacodynamics; Pharmacokinetics

MeSH Terms

Acetylcholine
Anesthesia
Anesthesia, Obstetrical
Anesthetics
Cholinesterases
Diffusion
Drug Interactions
Emergencies
Humans
Metabolism
Neuromuscular Blockade*
Neuromuscular Blocking Agents*
Neuromuscular Junction
Neuromuscular Monitoring
Pharmacokinetics
Plasma
Receptors, Nicotinic
Receptors, Presynaptic
Respiration
Acetylcholine
Anesthetics
Cholinesterases
Neuromuscular Blocking Agents
Receptors, Nicotinic
Receptors, Presynaptic