Clinical Use.docVIP

Clinical Use of Peripheral Nerve Stimulators and The Neuromuscular Junction The impulse passing down a motor nerve is transmitted to a muscle across the motor end plate or neuromuscular junction. The transmission of this impulse is mediated via acetylcholine, which becomes attached to specific receptors sites on the motor end plate. In general terms, it is blockade of transmission across the neuromuscular junction by muscle relaxants that produces muscle relaxation. Although all muscle relaxants act on the neuromuscular junction, the mode and duration of action and intensity of blockade differ for different agents. These specific aspects of the action of neuromuscular agents can be differentiated by nerve stimulation. Depolarizing and Non-Depolarizing BlockadePhysiological conduction across the neuromuscular junction is by depolarization of the motor end plate by acetylcholine. This depolarization is of exceedingly short duration. Depolarizing relaxants such as succinylcholine chloride cause depolarization of the end plate but the recovery period is much greater and extends to minutes rather than milliseconds. Prolonged depolarization causes neuromuscular blockade. Non-depolarizing relaxants such as d-tubocurarine chloride do not cause depolarization; rather they occupy the specific receptor sites on the motor end plate. This prevents acetylcholine from attaching to the receptor sites. The duration of action of these drugs is probably dependent on how long they occupy she receptor sites. The difference in the type of blockade produced by the depolarizing or non-depolarizing relaxants accounts for their differing response to nerve stimulation. Detection of the Type of Neuromuscular Blockade-GeneralDepolarizing blockade is associated with in intensity of muscle response to nerve stimulation. Non-depolarizing blockade is accompanied by a change in the character, as well as the intensity of the muscle response to nerve stimulation. These different types of respo