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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2012 April;78(4):473-82

language: English

Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade

Fink H. 1, Hollmann M. W. 2

1 Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany;
2 Department of Anesthesiology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands


Pharmacologic reversal of neuromuscular blockade is a topic not very well acknowledged and controversially discussed. Reasons for this are numerous and include missing perception of the potential complications of residual neuromuscular paralysis including an increased morbidity and mortality, as well as low efficacy and numerous unwanted side effects of the available antagonists. Duration of action of muscle relaxants cannot be pharmacologically predicted. Objective neuromuscular monitoring is the only way to detect residual paralysis. This review article would like to discuss in its first part some of the myths which revolve around the use of muscle relaxants, then highlight the problems regarding the use of acetylcholine esterase inhibitors and, in the third part, discuss the steroidal muscle relaxant encapsulator sugammadex.

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