the overall strategy for terminating the action of nondepolarizing
Two strategies have traditionally existed for
terminating the action of nondepolarizing neuromuscular blockade. Strength
returns as neuromuscular muscle relaxants diffuse away from the receptor sites,
so that spontaneous recovery occurs over time. Alternatively, drugs that
inhibit the enzyme acetylcholinesterase can be administered. This inhibition
causes a “flood” of acetylcholine at the neuromuscular junc-tion, favoring
competitive interaction of acetylcholine with its receptor. Depending on the
relative amounts of acetyl-choline and nondepolarizing muscle relaxant present,
the block will be partially or completely antagonized.
A radical new approach for reversal of
neuromuscular blockade is currently under investigation. Cyclodextrins are
agents that encapsulate nondepolarizing muscle relaxants, effectively reducing
their plasma concentration to zero.