Affiliation:
1. NMD Pharma
2. NMD Pharma.com
3. Aarhus University
4. Department of Anesthesiology, Mayo Clinic College of Medicine and Science
5. 4Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen
Abstract
Abstract
Neuromuscular blocking agents (NMBAs) are commonly used to induce skeletal muscle relaxation during surgery. While muscle relaxation facilitates surgical procedures and tracheal intubation, adequate recovery of muscle function after surgery is required to support pulmonary function, and even mild residual neuromuscular block increases the risk of severe postoperative pulmonary complications. While recovery of muscle function after surgery involving NMBAs can be monitored and, in addition, be accelerated by use of current antagonists (reversal agents), there is a clear clinical need for a safe drug to antagonize all types of NMBAs. Here we show that inhibition of the skeletal muscle-specific chloride ion (Cl-) channel, the ClC-1 channel, markedly accelerates recovery of both single contraction (twitch) and physiologically important sustained contractions (tetanic) in a novel rat model mimicking NMBA-induced muscle block used during surgery. ClC-1 inhibition was found to reverse any NMBA with superior properties to existing reversal agents. This suggests ClC-1 inhibition as a novel mechanism for fast and efficacious reversal from neuromuscular block.
Publisher
Research Square Platform LLC
Reference47 articles.
1. Impact of anesthesia management characteristics on severe morbidity and mortality;Arbous MS;Anesthesiology,2005
2. Reversal of neuromuscular block;Hunter JM;BJA Educ,2020
3. Incidence of residual neuromuscular blockade and use of neuromuscular blocking agents with or without antagonists: A systematic review and meta-analysis of randomized controlled trials;Raval AD;J Clin Anesth,2020
4. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium;Berg H;Acta Anaesthesiol Scand,1997
5. Nondepolarizing Neuromuscular Blocking Agents, Reversal, and Risk of Postoperative Pneumonia;Bulka CM;Anesthesiology,2016