This is an automatically translated article.
The article was written by Specialist Doctor II Nguyen Trung Thanh - Anesthesiologist and Anesthesiologist, Department of Surgical Anesthesia - Vinmec Central Park International General Hospital.In surgical anesthesia, anesthesiologists often combine many drugs to achieve good anesthesia for the patient, in which 3 indispensable drugs are anesthetics, analgesics and muscle relaxants. Muscle relaxants are drugs that have the effect of causing paralysis of skeletal muscles including reversible respiratory muscles to facilitate anesthesia and surgery. In order to avoid post-anesthesia respiratory depression due to residual muscle relaxants, the anesthesiologist may add an anti-muscle relaxant.
1. What is a muscle relaxant?
Muscle relaxants are drugs given to patients at the end of surgery (under general anesthesia using muscle relaxants) with the aim of antagonizing the effects of muscle relaxants, speeding up recovery. muscle contraction, especially respiratory muscle.
2. Muscle relaxation recovery
Usually the time to recovery from a depolarizing muscle relaxant is 10-15 minutes and may take longer for patients with decreased or inhibited cholinesterase.
For non-depolarizing muscle relaxants, spontaneous recovery begins when the drug leaves the site of action to make room for receptor-bound Acetylcholine (Ach). The duration depends on the half-life of each drug. To promote faster muscle relaxation, the anesthesiologist may inject the patient with a muscle relaxant.
According to the mechanism of action, muscle relaxants are divided into 2 types: indirect and direct. Indirect antidotes are used to reverse the use of non-depolarizing muscle relaxants and can only be used to reverse depolarizing muscle relaxants in special situations. Currently, there is only one type of direct antidote and can only be resolved after the use of aminosteroid muscle relaxants such as vecuronium and rocuronium.
3. Mechanism of action of anti-muscle relaxants
Sugammadex là thuốc hóa giải giãn cơ thế hệ mới
3.1 Anticholinesterase antagonist Neostigmine is often used.
As described in the section on the mechanism of action of muscle relaxants (“the role of muscle relaxants in anesthesia”), Ach after binding to the receptor will be cleaved to acetyl and choline by cholinesterase.
Anticholinesterase antagonists work by inhibiting cholinesterase enzymes from breaking down Ach, thereby increasing Ach levels competing with muscle relaxants for binding to nicotinic receptors (desired effect) and also increasing Ach available at the muscarinic receptors (source of side effects).
3.2 Sugammadex Sugammadex is a new generation muscle relaxant, the structure has 8 attached glucopyranoside units that maintain the ring-like shape. When injected into the circulation, sugammadex binds to the free steroidal non-depolarizing muscle relaxant molecules (rocuronium, vecuronium) reducing its free plasma concentration resulting in a concentration gradient between the neuromuscular junctions and the neuromuscular junction. and plasma lead to the movement of rocuronium out of the neuromuscular junction back into the plasma, where it will be taken up by the sugammadex molecule.
The neuromuscular blockade ceases rapidly. Unlike anticholinesterase agents, sugammadex has no effect on Ach, so side effects such as anticholinergic can be avoided. Sugammadex is rapidly eliminated by the kidneys and carries rocuronium molecules, so the subsequent muscle relaxation can be avoided.
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