Describe the overall strategy for terminating the action of nondepolarizing neuromuscular blockade

Describe the overall strategy for terminating the action of nondepolarizing neuromuscular blockade.

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.