Paweł Radkowski, Michał Mazuchowski, Justyna Opolska, Kamil Sobolewski, Hubert Oniszczuk

History of striated muscle relaxants used in anaesthesiology

2024-11-20

Striated muscle relaxants have undoubtedly revolutionised anaesthesiology and other areas of medicine, enabling the safe and effective delivery of general anaesthesia. Prior to the introduction of this group of drugs, anaesthesia techniques were based on inhalation methods, which were associated with a higher risk of complications, including more frequent patient deaths. The first use of curare for muscle relaxation in surgery was in 1912, thanks to German surgeon Arthur Läwen. Curare, which is a mixture of plant alkaloids, was known for its myorelaxant properties, used outside Europe for centuries, mainly in hunting and fighting. In 1939, curare and its derivatives entered widespread anaesthetic use. Despite numerous side effects, such as prolonged muscle block and respiratory depression, curare laid the foundation for the development of modern neuromuscular conduction blocking agents. A breakthrough was the 1951 study by Burns and Paton, which elucidated the mechanisms of action of depolarising and non-depolarising blocks depending on the chemical structure of the substance. Suxamethonium, currently the only depolarising muscle relaxant in use, was discovered in 1906, first used in 1951 and began to be used on a large scale nine years later. In the 1950s and 1960s, substances such as mauletin were extensively studied, leading to the development of modern muscle relaxants, including vecuronium and pancuronium. During this time, other muscle relaxants were also discovered, but these were withdrawn from practice or did not reach clinical use at all due to adverse effects. This article provides a history of the development of neuromuscular conduction blocking drugs, chronologically discussing the evolution of these substances - from the first uses of curare and its derivatives, to the modern muscle relaxants currently under investigation. This comprehensive look at advances in this field of anaesthesiology shows not only the evolution of drugs, but also advances in the understanding of the mechanisms of muscle blockade, which has significantly affected the safety and effectiveness of modern medical procedures.

Keywords: history, curare, muscle relaxants, succinylcholine, neuromuscular nondepolarizing agents.

© Farm Pol, 2024, 80(6): 367–374