The introduction of drugs that specifically block neuromuscular transmission was a landmark in anesthesia. The need for deep anesthesia disappeared, allowing faster recovery. Improved circulatory stability resulted in better tolerance of anesthesia by...
The introduction of drugs that specifically block neuromuscular transmission was a landmark in anesthesia. The need for deep anesthesia disappeared, allowing faster recovery. Improved circulatory stability resulted in better tolerance of anesthesia by the very ill. The requirement for artificial ventilation allowed better control of oxygenation and acid-base state. Intense relaxation provided improved surgical conditions. However, as the criteria for ideal pattern of relaxation are not fulfilled by the current generation of muscle relaxants when used alone, we therefore need to accelerate recovery with reversal agents. Unfortunately, one of the consequences of relaxant anesthesia is that respiratory inadequacy may occur in the recovery room. Central to avoiding this is the assurance of adequate skeletal muscle function in the postoperative period.
This article reviews the pharmacology of reversal agents, the factors influencing the reversal of muscle relaxant, the choice of reversal agent and dose, and the clinical approach to the problem of reversal.