Muscle Relaxants 2006: a clinical and basic science update and commentary

As muscle relaxants remain a mainstay of modern anesthesia practice, it behooves the anesthesiologists to keep themselves up-to-date on the theory and clinical practice of neuromuscular pharmacology. Progress continues to be made in the basic and clinical aspects of neuromuscular pharmacology, including mechanism of action, blocking drugs, and reversal agent. The new mechanism of action is based on the molecular shape of the relaxants. Although the so-called “ideal relaxant” is still not in sight, and may never be, the new relaxant AV430A and the new reversal agent Org 25969 hold potential to significantly improve patient care. AV430 has superior clinical profile, although it is still considerably slower and longer in action than succinylcholine. The fast onset of rocuronium combined with its complete and immediate reversibility with Org 25969 may match succinylcholine in onset and offset. Both drugs are undergoing clinical trials.