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Australian Society of Anaesthetists Annual General Meeting 1978

Recovery from Non-depolarizing Block S. Feldman (Westminster Hospital, London, U.K.) Recent work supports the hypothesis that the rate of recovery from neuromuscular block depends upon two factors. (i) The primary rate limiting factor is the dissociation rate constant of each particular drug with the receptor. The rate of this separation of the drug from the receptor depends upon the molecular structure of the drug. (ii) The secondary factor is the provision of adequate concentration gradient to allow drug to leave the neuromuscular junction once it has been displaced from the receptor. This secondary factor is controlled by the plasma level. Structure activity studies on various steroid muscle relaxants and derivatives of pancuronium has demonstrated some of the ways in which the chemical structure of the drug relates to its dissociation rate constant and to the duration of its action. It is suggested that acetylcholine and neostigmine increase the rate of the drug receptor dissociation and so cause a reversal of neuromuscular block. This can only occur if the plasma level of drug is low and an adequate diffusion gradient exists to encourage the displaced drug to leave the receptor area. If there is a high plasma level of drug and no diffusion gradient is present then neostigmine cannot reverse the neuromuscular block.