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MODE OF ACTION OF DEPOLARIZING AGENTS

1959; Wiley; Volume: 3; Issue: 2 Linguagem: Inglês

10.1111/j.1399-6576.1959.tb00010.x

1399-6576

Phiroze B. Sabawala, John B. Dillon,

Anesthesia and Sedative Agents

SUMMARY It has been shown that with suitable doses of decamethonium, succinylcholine, or succinylmonocholine, a two‐phase neuromuscular block can always be seen in isolated human intercostal muscle. The first phase consists of a neuromuscular block of rapid onset which reaches a maximum in about 15 minutes and then recovers spontaneously in spite of the continued presence of C 10 in the same concentration. Recovery is maximum at approximately 60 minutes, after which time the second phase begins. The second phase consists of a slow, progressive neuromuscular block which reaches a steady reproducible state after 6 to 8 hours. If undisturbed, this state remains constant for hours. This phase represents a true competitive neuromuscular block, as evidenced by the fact that it can be reversed by a suitable dose of neostigmine. Experiments have been described in which these two phases were modified by the addition of d‐tubocurarine and neostigmine. Attempts are made to explain various phenomena on a molecular basis. The clinical significance of this work is presented.