Flood Pamela
Department of Anesthesiology, Columbia University, 630 West 169th St, New York, NY 10032, USA.
Curr Opin Pharmacol. 2005 Jun;5(3):322-7. doi: 10.1016/j.coph.2004.12.009.
Neuromuscular blocking drugs were introduced into clinical practice in 1942. Although these drugs made new surgical techniques possible, they also led to morbidity and mortality owing to respiratory muscle paralysis and paralysis in the face of inadequate anesthesia. Newer competitive antagonists at the neuromuscular junction have been developed that have a more rapid onset of action, including rocuronium and mivacurium, making them suitable for use at the onset of anesthesia. Rapid titratable offset of action has been more difficult to achieve, but has been attempted with the inclusion of ester bonds (mivacurium) and binding agents that are in clinical trials. These novel approaches to pharmaceuticals, along with improved understanding of the physiology of the neuromuscular junction in health and disease, have made surgical treatment possible in a wide breadth of clinical situations.
神经肌肉阻滞药物于1942年被引入临床实践。尽管这些药物使新的外科手术技术成为可能，但由于呼吸肌麻痹以及在麻醉不足情况下出现的麻痹，它们也导致了发病和死亡。已经开发出作用起效更快的新型神经肌肉接头竞争性拮抗剂，包括罗库溴铵和米库氯铵，使其适用于麻醉诱导期。实现作用的快速可滴定消退一直比较困难，但通过引入酯键（米库氯铵）和正在进行临床试验的结合剂进行了尝试。这些新颖的药物研发方法，以及对健康和疾病状态下神经肌肉接头生理学的深入理解，使得在广泛的临床情况下进行手术治疗成为可能。
