Molecular mechanisms of neuromuscular blocking agents: is the increased understanding of importance to the practising anaesthetist?

A neuromuscular blocking agent is an essential component of many general anaesthetics. Although a great deal is known about the neuromuscular junction, the site of action of these agents, their precise mode of action remains unclear. This article reviews our present knowledge of the anatomy and physiology of neuromuscular transmission and the ways in which clinically useful drugs may modify this system. The decisions involved in clinical choice of which agent to use are described with particular respect to basic physiology and pharmacology and also to potential interactions with other drugs.