Neuromuscular drugs are chemical agents that are used to alter the transmission of nerve impulses to muscles, causing effects such as temporary paralysis of targeted skeletal muscles. Most neuromuscular drugs are available as quaternary ammonium compounds which are derived from acetylcholine (ACh).[1] This allows neuromuscular drugs to act on multiple sites at neuromuscular junctions, mainly as antagonists or agonists of post-junctional nicotinic receptors.[2] Neuromuscular drugs are classified into four main groups, depolarizing neuromuscular blockers, non-depolarizing neuromuscular blockers, acetylcholinesterase inhibitors, and butyrylcholinesterase inhibitors.[2]
Clinically, neuromuscular drugs are used in anesthesia to cause paralysis of targeted skeletal muscles. It is most commonly applied in endotracheal intubation by reducing the incidence of hoarseness in vocal cord and esophageal injuries.[2] It is also applied to improve surgical operating conditions by aiding mechanical ventilation in patients with lowered lung compliance.[1] Other than surgical indications, neuromuscular drugs can also be indicated for the use of Alzheimer's disease, Parkinson's disease, etc.[3] Common adverse effects of neuromuscular drugs include abnormal heart rate, blood pressure, and cardiac output.[4]
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