Pancuronium bromide—A new non-depolarizing muscle relaxant

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MUSCLE relaxants are used to provide better operating conditions for the surgeon, by lessening the depth of anesthesia required for a specific degree of muscle relaxation.

According to Bennett,1 Bernard was the first physician to demonstrate the ability of curare to block neuromuscular transmission in 1850. The drug was not used clinically until 100 years later, when it was employed to prevent traumatic complications of electroconvulsive therapy. In 1942, curare (intercostrin) was used during general anesthesia to provide muscular relaxation.2 The next year, d-tubocurarine methyliodide was introduced and has remained the most widely used non-depolarizing muscle relaxant2 despite much research work directed toward developing new and better agents.

Our report concerns the use of a new drug, pancuronium bromide, as a muscle relaxant in 50 patients who each underwent one of 20 different operative procedures. We believe that pancuronium has these advantages over other non-depolarizing muscle relaxants currently in use: rapid onset of action; no release of histamine; and only slight ganglionic blocking action.

Pharmacologic features

One way of developing new therapeutic agents is to incorporate a biologically active group into a substance occurring naturally in the body. This method is the basis of the synthesis of the new muscle relaxant, pancuronium bromide.3 Quaternary ammonium and ester groups were incorporated into a steroid nucleus (Fig. 1) to produce the new drug, which was found to be a potent neuromuscular blocking agent.

The neuromuscular block produced by this drug was studied3 in anesthetized cats and conscious mice and rabbits, and proved . . .



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