neuromuscular blocking agents


Summary: Drugs that interrupt transmission of nerve impulses at the skeletal neuromuscular junction. They can be of two types, competitive, stabilizing blockers (NEUROMUSCULAR NONDEPOLARIZING AGENTS) or noncompetitive, depolarizing agents (NEUROMUSCULAR DEPOLARIZING AGENTS). Both prevent acetylcholine from triggering the muscle contraction and they are used as anesthesia adjuvants, as relaxants during electroshock, in convulsive states, etc.

Top Publications

  1. Woods A, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Br J Anaesth. 2005;94:150-8 pubmed
  2. Fuchs Buder T, Claudius C, Skovgaard L, Eriksson L, Mirakhur R, Viby Mogensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789-808 pubmed
    The set of guidelines for good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents, which was developed following an international consensus conference in Copenhagen, has been revised and updated ..
  3. Lundstrøm L, Møller A, Rosenstock C, Astrup G, Gätke M, Wetterslev J. Avoidance of neuromuscular blocking agents may increase the risk of difficult tracheal intubation: a cohort study of 103,812 consecutive adult patients recorded in the Danish Anaesthesia Database. Br J Anaesth. 2009;103:283-90 pubmed publisher
    Previous studies indicate that avoiding neuromuscular blocking agents (NMBAs) may be a risk factor for difficult tracheal intubation (DTI). We investigated whether avoiding NMBA was associated with DTI...
  4. Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006;102:426-9 pubmed
    ..Although the incidence of residual paralysis was less frequent in surgical outpatients, predictive criteria were not evident. ..
  5. Maybauer D, Geldner G, Blobner M, Pühringer F, Hofmockel R, Rex C, et al. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia. 2007;62:12-7 pubmed
  6. Papazian L, Forel J, Gacouin A, Penot Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107-16 pubmed publisher
    In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness...
  7. Sorce L. Adverse responses: sedation, analgesia and neuromuscular blocking agents in critically ill children. Crit Care Nurs Clin North Am. 2005;17:441-50, xi-xii pubmed
    Advanced practice nurses (APNs) prescribe sedation, analgesia, and neuromuscular blocking agents in the management of critically ill children...
  8. Bulger E, Copass M, Sabath D, Maier R, Jurkovich G. The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury. J Trauma. 2005;58:718-23; discussion 723-4 pubmed
    ..studies have demonstrated that the success rate of prehospital intubation is improved by the use of neuromuscular blocking agents (NMBAs)...
  9. Harboe T, Johansson S, Florvaag E, Oman H. Pholcodine exposure raises serum IgE in patients with previous anaphylaxis to neuromuscular blocking agents. Allergy. 2007;62:1445-50 pubmed
    b>Neuromuscular blocking agents (NMBAs) can cause anaphylaxis through immunoglobulin E (IgE) antibodies that bind quaternary ammonium ion epitopes...

More Information


  1. Forel J, Roch A, Marin V, Michelet P, Demory D, Blache J, et al. Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome. Crit Care Med. 2006;34:2749-57 pubmed
    To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy...
  2. Fuchs Buder T, Eikermann M. [Residual neuromuscular blockades. Clinical consequences, frequency and avoidance strategies]. Anaesthesist. 2006;55:7-16 pubmed
    ..g. TOF-watch) promises an adequate neuromuscular recovery from the effects of muscle relaxants. ..
  3. Arain S, Kern S, Ficke D, Ebert T. Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49:312-5 pubmed
    ..05). When used with sevoflurane/N(2)O, there was a two-fold greater variability of duration of neuromuscular blockade in elderly patients receiving rocuronium or vecuronium compared with cisatracurium. ..
  4. Chamorro C, Borrallo J, Romera M, Silva J, Balandin B. Anesthesia and analgesia protocol during therapeutic hypothermia after cardiac arrest: a systematic review. Anesth Analg. 2010;110:1328-35 pubmed publisher
    ..Very often, the drug and the dose used do not seem the most appropriate. Only 3 ICUs routinely used electroencephalographic monitoring during paralysis. It is necessary to reach a consensus on how to treat this critical care population. ..
  5. Arroliga A, Thompson B, Ancukiewicz M, Gonzales J, Guntupalli K, Park P, et al. Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome. Crit Care Med. 2008;36:1083-8 pubmed publisher
    The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay...
  6. Mertes P, Aimone Gastin I, Guéant Rodriguez R, Mouton Faivre C, Audibert G, O Brien J, et al. Hypersensitivity reactions to neuromuscular blocking agents. Curr Pharm Des. 2008;14:2809-25 pubmed
    b>Neuromuscular blocking agents are the leading drugs responsible for immediate hypersensitivity reactions during anaesthesia. Most hypersensitivity reactions represent IgE-mediated allergic reactions...
  7. Slutsky A. Neuromuscular blocking agents in ARDS. N Engl J Med. 2010;363:1176-80 pubmed publisher
  8. Mehta S, Burry L, Fischer S, Martinez Motta J, Hallett D, Bowman D, et al. Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients. Crit Care Med. 2006;34:374-80 pubmed
    To characterize the perceived utilization of sedative, analgesic, and neuromuscular blocking agents, the use of sedation scales, algorithms, and daily sedative interruption in mechanically ventilated adults, and to define clinical ..
  9. Leysen J, De Witte L, Sabato V, Faber M, Hagendorens M, Bridts C, et al. IgE-mediated allergy to pholcodine and cross-reactivity to neuromuscular blocking agents: Lessons from flow cytometry. Cytometry B Clin Cytom. 2013;84:65-70 pubmed publisher
    ..the diagnosis of IgE-mediated allergy to the antitussive pholcodine and associated sensitizations to neuromuscular blocking agents (NMBA)...
  10. Florvaag E, Johansson S, Oman H, Venemalm L, Degerbeck F, Dybendal T, et al. Prevalence of IgE antibodies to morphine. Relation to the high and low incidences of NMBA anaphylaxis in Norway and Sweden, respectively. Acta Anaesthesiol Scand. 2005;49:437-44 pubmed
    ..IgE-sensitization to SUX, MOR and PHO was detected in Norway but not in Sweden. One possible explanation is the unrestricted use of cough mixtures containing MOR derivatives in Norway. ..
  11. Jooste E, Zhang Y, Emala C. Neuromuscular blocking agents' differential bronchoconstrictive potential in Guinea pig airways. Anesthesiology. 2007;106:763-72 pubmed
    b>Neuromuscular blocking agents are designed to antagonize nicotinic cholinergic receptors on skeletal muscle but also antagonize muscarinic receptors...
  12. Butterly A, Bittner E, George E, Sandberg W, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010;105:304-9 pubmed publisher
    ..PORC is associated with a delayed PACU discharge. The magnitude of the effect is clinically significant. In our system, PORC increases the chances of patients having to wait to enter the PACU. ..
  13. Laroche D, Chollet Martin S, Léturgie P, Malzac L, Vergnaud M, Neukirch C, et al. Evaluation of a new routine diagnostic test for immunoglobulin E sensitization to neuromuscular blocking agents. Anesthesiology. 2011;114:91-7 pubmed publisher
    b>Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion...
  14. Bowman W. Neuromuscular block. Br J Pharmacol. 2006;147 Suppl 1:S277-86 pubmed
  15. Lien C. Development and potential clinical impairment of ultra-short-acting neuromuscular blocking agents. Br J Anaesth. 2011;107 Suppl 1:i60-71 pubmed publisher
    ..residual neuromuscular block (NMB) is an increasingly recognized complication of non-depolarizing neuromuscular blocking agents. This occurs because of dosing choices for neuromuscular blocking agents and anticholinesterases as ..
  16. Gainnier M, Roch A, Forel J, Thirion X, Arnal J, Donati S, et al. Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome. Crit Care Med. 2004;32:113-9 pubmed
    To evaluate the effects of a 48-hr neuromuscular blocking agents (NMBA) infusion on gas exchange over a 120-hr time period in patients with acute respiratory distress syndrome...
  17. Newman P, Quinn A, Grounds R, Hunter J, Boyd A, Eastwood N, et al. A comparison of cisatracurium (51W89) and atracurium by infusion in critically ill patients. Crit Care Med. 1997;25:1139-42 pubmed
    ..51W89) and atracurium administered by continuous infusion to critically ill patients requiring neuromuscular blocking agents to facilitate mechanical ventilation...
  18. Tuba Z, Maho S, Vizi E. Synthesis and structure-activity relationships of neuromuscular blocking agents. Curr Med Chem. 2002;9:1507-36 pubmed
    The first use of neuromuscular blocking agents (muscle relaxants) in clinical practice (1942) revolutionised the practice of anaesthesia and started the modern era of surgery...
  19. Moore E, Hunter J. The new neuromuscular blocking agents: do they offer any advantages?. Br J Anaesth. 2001;87:912-25 pubmed
    ..Ninety per cent recovery of the first twitch of the train-of-four occurs after 5-7 min using one ED80. A recovery index of less than 2 min has been reported in rats. All the tropinyl diesters appear to produce vagal block. ..
  20. Lagneau F, D honneur G, Plaud B, Mantz J, Gillart T, Duvaldestin P, et al. A comparison of two depths of prolonged neuromuscular blockade induced by cisatracurium in mechanically ventilated critically ill patients. Intensive Care Med. 2002;28:1735-41 pubmed
  21. Martinez E. Neuromuscular blocking agents. Vet Clin North Am Equine Pract. 2002;18:181-8 pubmed
    In summary, with proper vigilance, neuromuscular blocking agents can be used safely in anesthetized equine patients to optimize conditions for certain surgical procedures...
  22. Murray M, Cowen J, DeBlock H, Erstad B, Gray A, Tescher A, et al. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med. 2002;30:142-56 pubmed
  23. Rhoney D, Murry K. National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit. J Intensive Care Med. 2003;18:139-45 pubmed
    The objectives of this study were to describe the sedative, neuromuscular blocking agents (NMBA) and reversal agents utilized in adult intensive care units across the United States and determine the adherence to American College of ..
  24. Joo H, Perks W, Belo S. Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents. Can J Anaesth. 2001;48:646-50 pubmed
    ..1 microg x kg(-1) or remifentanil 2 microg x kg(-1) on conditions for tracheal intubation without neuromuscular blocking agents. Before anesthetic induction, all patients were given 0...
  25. Pepys J, Pepys E, Baldo B, Whitwam J. Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents. Skin prick tests in aetiological diagnosis. Anaesthesia. 1994;49:470-5 pubmed
    ..The materials for performing the skin prick test are readily available and it can be very helpful in making important aetiological diagnoses. ..
  26. Axon A, Hunter J. Editorial III: Anaphylaxis and anaesthesia--all clear now?. Br J Anaesth. 2004;93:501-4 pubmed
  27. Laxenaire M, Mertes P. Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth. 2001;87:549-58 pubmed
    ..These results are consistent with changes in the epidemiology of anaphylaxis related to anaesthesia and are an incentive for the further development of allergo-anaesthesia clinical networks...
  28. Mertes P, Laxenaire M. Adverse reactions to neuromuscular blocking agents. Curr Allergy Asthma Rep. 2004;4:7-16 pubmed
    b>Neuromuscular blocking agents (NMBAs) play a predominant role in the incidence of severe adverse reactions occurring during anesthesia...
  29. Morbiato L, Carli L, Johnson E, Montecucco C, Molgo J, Rossetto O. Neuromuscular paralysis and recovery in mice injected with botulinum neurotoxins A and C. Eur J Neurosci. 2007;25:2697-704 pubmed
    ..The present study shows an extensive similarity in the biological activities of BoNT/A and BoNT/C, further supporting the suggestion that BoNT/C is a valid alternative to BoNT/A...
  30. Simpson D, Gracies J, Graham H, Miyasaki J, Naumann M, Russman B, et al. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008;70:1691-8 pubmed publisher
    ..To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of adult and childhood spasticity...
  31. Fink H, Hollmann M. Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade. Minerva Anestesiol. 2012;78:473-82 pubmed
  32. Ferguson N, Thompson B. Prone positioning and neuromuscular blocking agents are part of standard care in severe ARDS patients: no. Intensive Care Med. 2015;41:2198-200 pubmed publisher
  33. Brasseur J, Ulerich R, Dai Q, Patel D, Soliman A, Miller L. Pharmacological dissection of the human gastro-oesophageal segment into three sphincteric components. J Physiol. 2007;580:961-75 pubmed
    ..The distinct physiology of these three components may underlie aspects of normal sphincteric function, and complexity of sphincter dysfunction. ..
  34. Fraser B, Smart J. Anaphylaxis to cisatracurium following negative skin testing. Anaesth Intensive Care. 2005;33:816-9 pubmed
    ..However, the absence of a clearly identified triggering agent increases the difficulties facing the anaesthetist. We present a case of anaphylaxis to cisatracurium following a negative skin test. ..
  35. Kuwagata Y, Inoue H. Effects of estrogen on AF64A-induced apoptosis in NG108-15 cells. Brain Res. 2009;1297:9-16 pubmed publisher
  36. Patroniti N, Bellani G, Pesenti A. Nonconventional support of respiration. Curr Opin Crit Care. 2011;17:527-32 pubmed publisher
    ..Existing data suggest that some of the available nonconventional treatments may be effective in more severe ARDS patients. New techniques and drugs that should facilitate prevention or healing of lung injury are under investigation. ..
  37. Leykin Y, Dalsasso M, Setti T, Pellis T. The effects of low-dose ephedrine on intubating conditions following low-dose priming with cisatracurium. J Clin Anesth. 2010;22:425-31 pubmed publisher
    ..To determine whether low-dose ephedrine plus priming with low-dose cisatracurium improves intubating conditions...
  38. Bennett S, Hurford W. When should sedation or neuromuscular blockade be used during mechanical ventilation?. Respir Care. 2011;56:168-76; discussion 176-80 pubmed publisher
    ..Sedatives, opioids, and neuromuscular blocking agents are commonly used in the intensive care unit...
  39. Lu C, Man K, Ou Yang H, Chan S, Ho S, Wong C, et al. Composite auditory evoked potential index versus bispectral index to estimate the level of sedation in paralyzed critically ill patients: a prospective observational study. Anesth Analg. 2008;107:1290-4 pubmed publisher
  40. Ambulkar R, Tan A, Chia N, Low T. Comparison between use of neuromuscular blocking agent and placebo with the intubating laryngeal mask airway. Singapore Med J. 2008;49:462-5 pubmed
    ..The use of neuromuscular blocking agents in facilitating the use of the ILMA has been investigated in the Western population with a quoted ..
  41. Char D, Ibsen L, Ramamoorthy C, Bratton S. Volatile anesthetic rescue therapy in children with acute asthma: innovative but costly or just costly?. Pediatr Crit Care Med. 2013;14:343-50 pubmed publisher
    ..less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA...
  42. Gyermek L. Development of ultra short-acting muscle relaxant agents: history, research strategies, and challenges. Med Res Rev. 2005;25:610-54 pubmed
    ..g. structure-activity relationships, nicotinic receptor pharmacology, and investigation of side effects) behind the development of rapidly and short acting nondepolarizing muscle relaxants. ..
  43. Selcuk M, Celebioglu B, Celiker V, Basgul E, Aypar U. Infusion and bolus administration of cisatracurium--effects on histamine release. Middle East J Anaesthesiol. 2005;18:407-19 pubmed
    ..The infusion method of cisatracurium has a stable level of curarization without side effect and there were no significant recovery time differences between the groups. ..
  44. Serra C, Oliveira A. Cisatracurium: myographical and electrophysiological studies in the isolated rat muscle. Fundam Clin Pharmacol. 2006;20:291-8 pubmed
    ..13 microm is entirely because of a pre-synaptic blocking effect while the decrease in the twitch induced by cisatracurium at the concentration of 0.38 microm is due to a post-synaptic blocking effect. ..
  45. Estrada Soto S, Sánchez Recillas A, Navarrete Vazquez G, Castillo Espana P, Villalobos Molina R, Ibarra Barajas M. Relaxant effects of Artemisia ludoviciana on isolated rat smooth muscle tissues. J Ethnopharmacol. 2012;139:513-8 pubmed publisher
    ..Finally, spasmolytic activity induced by the extracts in the rat ileum was not significant, which suggests that the antidiarrheic effect of the plant is related to antimicrobial and antiparasitic properties previously described. ..
  46. Mungur A, Cochard G, Ozier Y, Lafère P. The effect of general anaesthesia and neuromuscular blockade on Eustachian tube compliance: a prospective study. Diving Hyperb Med. 2016;46:166-169 pubmed
    ..Therefore it may have favourable prophylactic effects on MEBt in ventilated intensive care unit patients scheduled for HBOT. ..
  47. Wen L, Lin W, Zhao W, Li G, Bai X, Xiao J. [Effect of sevoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade by continuous cisatracurium infusion]. Nan Fang Yi Ke Da Xue Xue Bao. 2010;30:163-5 pubmed
  48. Kopman A. Residual neuromuscular block and adverse respiratory events. Anesth Analg. 2008;107:1756; author reply 1756 pubmed publisher
  49. Scherer K, Ballmer Weber B, Bircher A. Highlights in nonhymenoptera anaphylaxis. Curr Opin Allergy Clin Immunol. 2008;8:348-53 pubmed publisher
    ..discussed, as well as the role of low-dose pholcodine exposure on the development of sensitization to neuromuscular blocking agents. In food-related anaphylaxis, a significant increase of incidents has been observed over the last few ..
  50. Sandiumenge A. [Recommendations of the Analgesia and Sedation Group of SEMICYUK for sedation/analgesia and neuromuscular blocking in the critical patient. Presentation]. Med Intensiva. 2008;32 Spec No. 1:1-2 pubmed
  51. Patterson E, Scherlag B, Zhou J, Jackman W, Lazzara R, Coscia D, et al. Antifibrillatory actions of cisatracurium: an atrial specific M2 receptor antagonist. J Cardiovasc Electrophysiol. 2008;19:861-8 pubmed publisher
    ..The data are consistent with allosteric binding of cisatracurium to the M(2) muscarinic receptor in canine atrium. ..
  52. Purohit P, Tate R, Pow E, Hill D, Connolly J. The role of the amino acid residue at alpha1:189 in the binding of neuromuscular blocking agents to mouse and human muscle nicotinic acetylcholine receptors. Br J Pharmacol. 2007;150:920-31 pubmed
    ..A variety of neuromuscular blocking agents (NMBAs) were tested for their ability to inhibit the binding of [(125)I]alpha-bungarotoxin to TE671 ..
  53. Añez Simón C, Camps Vidal M, Sala Payá J, Rull Bartomeu M. [Comments on the article "Emergency tracheostomy to resolve an unforeseen difficult airway]. Rev Esp Anestesiol Reanim. 2006;53:393-4; author reply 394 pubmed