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Basic principles of neuromuscular transmission J. A. J. Martyn,1,2

Summary: Basic principles of neuromuscular transmission
J. A. J. Martyn,1,2
M. Jonsson Fagerlund3
and L. I. Eriksson4
1 Professor, Harvard Medical School, Director Clinical & Biological Pharmacology Laboratory, Department of
Anesthesiology, Massachusetts General Hospital, 2 Anaesthetist-in-Chief, Shriners Hospital for Children, Boston, MA,
3 Resident in Anesthesiology and Intensive Care Medicine, 4 Professor and Academic Chairman, Department of
Anesthesiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
Neuromuscular transmission at the skeletal muscle occurs when a quantum of acetylcholine from
the nerve ending is released and binds to the nicotinic acetylcholine receptors on the postjunctional
muscle membrane. The nicotinic acetylcholine receptors on the endplate respond by opening
channels for the influx of sodium ions and subsequent endplate depolarisation leads to muscle
contraction. The acetylcholine immediately detaches from the receptor and is hydrolysed by
acetylcholinesterase enzyme. Suxamethonium is a cholinergic agonist stimulating the muscle ni-
cotinic acetylcholine receptors prior to causing neuromuscular block. Non-depolarising neuro-
muscular blocking drugs bind to the nicotinic acetylcholine receptors preventing the binding of
acetylcholine. Non-depolarising neuromuscular blocking drugs also inhibit prejunctional a3b2
nicotinic acetylcholine autoreceptors, which can be seen in the clinical setting as train-of-four fade.


Source: Alford, Simon - Department of Biological Sciences, University of Illinois at Chicago


Collections: Biology and Medicine