Neuromuscular blocking agents - when is the block deep enough? And how to safely reverse the neuromuscular blocker

Abstract

Neuromuscular blocking agents have revolutionised the practice of anaesthesia and surgery. Before the introduction of these neuromuscular blockers into clinical practice, muscle paralysis was induced with high dose volatile anaesthesia with its attendant risks of respiratory and cardiac depression. Suxamethonium, d-tubocurarine and gallamine were generally available for clinical use by the late 1950s. It was after this that the modern concept of balanced anaesthesia was introduced into routine clinical practice.