Neuromuscular blocking agents and reversal agents

The neuromuscular junction is a complex structure consisting of the muscle cell, the nerve terminal of a motor neuron and the synaptic cleft. It is the site of action for neuromuscular blocking drugs, which are a cornerstone of anaesthetic practice. These drugs can be divided into depolarizing and non-depolarizing drugs; the latter can be further subdivided into benzylisoquinolinium and aminosteroid compounds. Reversal agents are also discussed. The pharmacology of neuromuscular blocking drugs and reversal agents is discussed including mechanism of action, metabolism, factors influencing choice of drug as well as adverse effect profile.