Category: signaling
Neuromuscular blockers paralyze skeletal muscle for surgical anesthesia + ICU + ECT. Depolarizing blockers (succinylcholine) are nAChR agonists that bind + persist → continuous depolarization → fasciculations then flaccid paralysis (cannot be repolarized); cleared by plasma cholinesterase (pseudocholinesterase deficiency → prolonged paralysis); malignant hyperthermia trigger in RYR1-susceptible patients (cross-trigger with volatile anesthetics). Non-depolarizing blockers (rocuronium, vecuronium, atracurium) are competitive nAChR antagonists; reversed by sugammadex (γ-cyclodextrin selective for rocuronium/vecuronium) or AChE inhibitors (neostigmine — must co-administer glycopyrrolate for muscarinic side effects). Atracurium clears by Hofmann elimination (organ-independent); rocuronium hepatic; vecuronium renal.