Structure-Onset Relationship of Steroidal Neuromuscular Blocking Agents
Since the introduction of the long-acting agent pancuronium in clinical practice several other related steroidal non-depolarizing neuromuscular blocking agents have been synthetized, developed and finally tested in clinical practice to investigate their safety and efficacy. Vecuronium, the monoquaternary analogue of pancuronium, was introduced in clinical practice as it showed two major improvements over pancuronium: a better time course of action, i.e., a shorter duration and a faster recovery, and an higher selectivity for the nicotinic cholinoceptor. This increased selectivity resulted in a remarkable, cardiovascularly clean profile comparable to that of the long-acting compound pipecuronium, the 2,16 piperazino analogue of pancuronium, which was developed at almost the same time. All mentioned compounds so far showed a significantly longer duration of action than the depolarizing agent succinylcholine. The main reason, however, to use this relatively “dirty” depolarizing agent in large numbers of patients, was its rapid onset of action, promoting safety by allowance of early intubation.
KeywordsOnset Time Early Intubation Receptor Affinity Neuromuscular Blocking Agent Effect Compartment
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