Neuromuscular blockers Given to relax muscles in the surgical field, neuromuscular blockers are categorized as depolarizing and nondepolarizing. Depolarizing agents cause the muscle cells to depolarize before blocking the neuromuscular transmitter acetylcholine at the myoneural junction. Succinylcholine can't be reversed pharmacologically, and it's a known trigger of malignant hyperthermia, cardiac arrhythmias, and increased intracranial pressure. Vecuronium offers cardiovascular stability with little histamine release for patients with cardiovascular compromise. Atracurium may be useful for patients with kidney or liver dysfunction because neither organ is needed to eliminate the drug.
Muscle strength is regained in the reverse order, with the smaller muscles regaining strength last.
A patient who can open her eyes, lift her eyebrows, and perform a tongue thrust on command has recovered from neuromuscular blockade. She should also be able to lift her head for 5 seconds, have a strong hand grip, and be able to follow commands. After surgery, the effects of muscle-relaxing drugs may need to be reversed. Alleviating pain Analgesics are given to prevent pain during surgery and to reduce the need for intraoperative anesthesia. The length of action is prolonged with larger or repeat doses.