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1

&NA;. "Neuromuscular blocker interactions." Reactions Weekly &NA;, no. 315 (1990): 7. http://dx.doi.org/10.2165/00128415-199003150-00026.

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2

Braga, Angélica de Fátima de Assunção, Derli Conceição Munoz, Franklin Sarmento da Silva Braga, Daniele Ribeiro de Araujo, Glória Maria Braga Potério, and Mario Mantovani. "Influence of stimulus frequency on blockade induced by pancuronium and rocuronium: study on rats phrenic nerve-diaphragm preparation." Acta Cirurgica Brasileira 22, no. 6 (2007): 446–50. http://dx.doi.org/10.1590/s0102-86502007000600006.

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PURPOSE: To evaluate the influence of two stimulation frequencies on the installation of neuromuscular blockade produced by pancuronium and rocuronium on the rat diaphragm. METHODS: Diaphragms were submitted to an indirect frequency stimulation of 0.1 and 1Hz (Groups I and II, respectively). Subgroups were formed (n=5) according to the neuromuscular blocker employed (pancuronium-2µg/ml and rocuronium-4µg/ml). The twitch height depression was evaluated at 5, 15 and 30 minutes after adding the neuromuscular blocker. RESULTS: The decrease in twitch height was greater (p<0.01) with a frequency
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3

&NA;. "Enflurane see Neuromuscular blocker interactions." Reactions Weekly &NA;, no. 315 (1990): 5. http://dx.doi.org/10.2165/00128415-199003150-00018.

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4

&NA;. "Halothane see Neuromuscular blocker interactions." Reactions Weekly &NA;, no. 315 (1990): 5. http://dx.doi.org/10.2165/00128415-199003150-00020.

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5

&NA;. "Savings with neuromuscular blocker guidelines." Inpharma Weekly &NA;, no. 1006 (1995): 7. http://dx.doi.org/10.2165/00128413-199510060-00009.

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6

Grillot, Nicolas, Gilles Lebuffe, Olivier Huet, et al. "Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration." JAMA 329, no. 1 (2023): 28. http://dx.doi.org/10.1001/jama.2022.23550.

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ImportanceIt is uncertain whether a rapid-onset opioid is noninferior to a rapid-onset neuromuscular blocker during rapid sequence intubation when used in conjunction with a hypnotic agent.ObjectiveTo determine whether remifentanil is noninferior to rapid-onset neuromuscular blockers for rapid sequence intubation.Design, Setting, and ParticipantsMulticenter, randomized, open-label, noninferiority trial among 1150 adults at risk of aspiration (fasting for <6 hours, bowel occlusion, recent trauma, or severe gastroesophageal reflux) who underwent tracheal intubation in the operating ro
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7

Miller, Jane L. "New short-acting neuromuscular blocker released." American Journal of Health-System Pharmacy 56, no. 21 (1999): 2178. http://dx.doi.org/10.1093/ajhp/56.21.2178a.

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8

&NA;. "New improved neuromuscular blocker for the US." Inpharma Weekly &NA;, no. 1019 (1996): 22. http://dx.doi.org/10.2165/00128413-199610190-00046.

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9

&NA;. "Vecuronium bromide preferred neuromuscular blocker in ICU." Inpharma Weekly &NA;, no. 861 (1992): 15. http://dx.doi.org/10.2165/00128413-199208610-00034.

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10

Pino, Richard M. "Neuromuscular blocker studies of critically ill patients." Intensive Care Medicine 28, no. 12 (2002): 1695–97. http://dx.doi.org/10.1007/s00134-002-1510-4.

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11

Fields, Aaron M., and Nalini Vadivelu. "Sugammadex: a novel neuromuscular blocker binding agent." Current Opinion in Anaesthesiology 20, no. 4 (2007): 307–10. http://dx.doi.org/10.1097/aco.0b013e32814b1612.

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12

Losavio, Adriana, and S. Muchnik. "Spontaneous acetylcholine release in mammalian neuromuscular junctions." American Journal of Physiology-Cell Physiology 273, no. 6 (1997): C1835—C1841. http://dx.doi.org/10.1152/ajpcell.1997.273.6.c1835.

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Spontaneous secretion of the neurotransmitter acetylcholine in mammalian neuromuscular synapsis depends on the Ca2+ content of nerve terminals. The Ca2+ electrochemical gradient favors the entry of this cation. We investigated the possible involvement of three voltage-dependent Ca2+ channels (VDCC) (L-, N-, and P/Q-types) on spontaneous transmitter release at the rat neuromuscular junction. Miniature end-plate potential (MEPP) frequency was clearly reduced by 5 μM nifedipine, a blocker of the L-type VDCC, and to a lesser extent by the N-type VDCC blocker, ω-conotoxin GVIA (ω-CgTx, 5 μM). On th
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13

Kumar Pulyapudi, Pavan, Gurulingappa A Patil, Venkatesh Babu T, Pratima Kamareddy, and Vijayalakshmi Vijayalakshmi. "Comparison of Rocuronium and Vecuronium: Onset and Duration of Apnea and Desaturation Time during Intubation." International Journal of Advanced Research 13, no. 05 (2025): 126–35. https://doi.org/10.21474/ijar01/20884.

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Background: Rapid and reliable neuromuscular blockade is crucial for successful endotracheal intubation. Rocuronium and Vecuronium are commonly used non-depolarising neuromuscular blockers, each with unique pharmacologic properties that impact intubation conditions and patient safety. Methods: This randomised, single-blinded clinical study was conducted after obtaining approval from the Institutional Ethical Committee. A total of 30 adult patients, aged between 18 and 60 years, classified as American Society of Anaesthesiologists (ASA) physical status I or II, scheduled for intubation under ge
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14

&NA;. "Neuromuscular blocker costs differ in longer surgical procedures." Inpharma Weekly &NA;, no. 1060 (1996): 6. http://dx.doi.org/10.2165/00128413-199610600-00011.

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15

&NA;. "Cisatracurium besilate least costly neuromuscular blocker in children." Inpharma Weekly &NA;, no. 1306 (2001): 8. http://dx.doi.org/10.2165/00128413-200113060-00014.

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16

Gravlee, Glenn P., Frederic M. Ramsey, Raymond C. Roy, Kevin C. Angert, Anne T. Rogers, and Alfredo L. Pauca. "Rapid Administration of a Narcotic and Neuromuscular Blocker." Anesthesia & Analgesia 67, no. 1 (1988): 39???47. http://dx.doi.org/10.1213/00000539-198801000-00008.

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17

Blundon, J. A., S. N. Wright, M. S. Brodwick, and G. D. Bittner. "Presynaptic calcium-activated potassium channels and calcium channels at a crayfish neuromuscular junction." Journal of Neurophysiology 73, no. 1 (1995): 178–89. http://dx.doi.org/10.1152/jn.1995.73.1.178.

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1. We used a two-microelectrode current clamp to investigate various characteristics of the Ca(2+)-activated K+ conductance [gK(Ca)] and Ca2+ conductance (gCa), and transmitter release in presynaptic terminals of excitatory neuromuscular junctions in the crayfish walking leg. 2. Voltage-activated Na+ conductances (gNa) and K+ conductances [gK(v)] were blocked with tetrodotoxin and 3,4-diaminopyridine, respectively. Under these conditions, presynaptic depolarization produced by a first (conditioning) pulse admitted Ca2+ into the presynaptic terminals and activated gK(Ca), which modulated the am
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18

Koo, Bon-Wook, Kyu-Whan Jung, Ah-Young Oh, et al. "Is neuromuscular blocker needed in children undergoing inguinal herniorrhaphy?" Medicine 96, no. 26 (2017): e7259. http://dx.doi.org/10.1097/md.0000000000007259.

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19

Ozkul, Yasar. "Influence of calcium channel blocker drugs in neuromuscular transmission." Clinical Neurophysiology 118, no. 9 (2007): 2005–8. http://dx.doi.org/10.1016/j.clinph.2007.06.002.

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20

Sasongko, Lucy, Iqbal Ramzan, Kenneth M. Williams, and Andrew J. McLachlan. "Muscle Distribution of the Neuromuscular Blocker gallamine Using Microdialysis." Journal of Pharmaceutical Sciences 91, no. 3 (2002): 769–75. http://dx.doi.org/10.1002/jps.10082.

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21

Ramos, Jose. "Neuromuscular blocker agents in mechanically ventilated patients with ARDS." Southwest Respiratory and Critical Care Chronicles 11, no. 47 (2023): 5–9. http://dx.doi.org/10.12746/swrccc.v11i47.1165.

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The clinical use of neuromuscular blocker agents (NMBAs) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) is a controversial topic in critical care medicine. Of the two classes of NMBAs, the most widely used are the non-depolarizing agents including cisatracurium. Some of the benefits attributed to this class of medications for patients with ARDS include a decreased inflammatory response, prevention of ventilator dyssynchrony, and improved oxygenation. The mortality benefit of this intervention was recently studied by two main trials, ACURASYS and ROSE, which show
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22

Khaziev, E. F., D. V. Samigullin, A. N. Tsentsevitsky, E. A. Bukharaeva, and E. E. Nikolsky. "ATP Reduces the Entry of Calcium Ions into the Nerve Ending by Blocking L-type Calcium Channels." Acta Naturae 10, no. 2 (2018): 93–96. http://dx.doi.org/10.32607/20758251-2018-10-2-93-96.

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At neuromuscular junctions, ATP inhibits both the evoked and spontaneous acetylcholine release and inward calcium current operating via presynaptic P2Y receptors. It was shown in the experiments with the frog neuromuscular synapse using specific calcium-sensitive dye Oregon Green Bapta 1 that exogenous ATP reduces the amplitude of calcium transient, which reflects the changes in the entry of calcium ions in response to the nerve pulse. The depressing effect of ATP on the transient was prevented by suramin, the blocker of P2 receptors. Nitrendipine, a specific blocker of L-type calcium channels
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23

Train, Sarah E., Karen E. A. Burns, Brian L. Erstad, et al. "Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS." Journal of Critical Care 72 (December 2022): 154165. http://dx.doi.org/10.1016/j.jcrc.2022.154165.

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24

Abed, H. E. A., and A. M. R. Abdelaziz. "Comparative study between sugammedex and neostigmine as a reversal agent of rocuronium for pediatric patients 2-12 years old going for surgery under general anaesthesia." CARDIOMETRY, no. 27 (May 4, 2023): 181–93. http://dx.doi.org/10.18137/cardiometry.2023.27.181193.

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Aim. The neuromuscular blocker has long been used during surgical procedures. The neuromuscular blockade produced by rocuronium can be reversed with sugammadex and neostigmine as reversal agents. This systematic review aims to determine the impact of sugammadex and neostigmine comparison as a reversal agent of rocuronium for pediatric patients 2-12 years old going for surgery under general anesthesia. Materials and Methods. This review examined recent studies assessing the impact of sugammadex and neostigmine comparison as a reversal agent of rocuronium for pediatric patients 2-12 years old go
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25

Sonmez, Emine, Betul Guven Aytac, and Aysun Postaci. "Postoperative residual curization in geriatric patients: a prospective, observational cohort study." Journal of the Pakistan Medical Association 74, no. 4 (2024): 689–94. http://dx.doi.org/10.47391/jpma.9525.

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Objective: To evaluate the occurrence and potential risk factors of residual curarisation after surgery and the subsequent acute respiratory events in elderly patients. Method: The prospective, cohort study was conducted at Ankara City Hospital from July to December 2021, and comprised data of geriatric patients undergoing elective surgery under general anaesthesia using moderate-acting nondepolarising muscle relaxants. Postoperative acute respiratory events in the post-anaesthesia care unit were subsequently noted. Data was analysed using SPSS 25. Results: Of the 185 patients aged >65 year
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26

Awad, Nadia, Scott Zalut, and Evan Deutsch. "Successful Management of Subcutaneous Infiltration of an Intubating dose of Rocuronium in a Morbidly Obese Patient: A Case Report." Journal of Anaesthesia and Critical Care Reports 4, no. 2 (2018): 21–23. http://dx.doi.org/10.13107/jaccr.2018.v04i02.094.

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Introduction: Induction of anesthesia relies on multiple factors including appropriate monitoring, administration, and dosing of induction agents. In morbidly obese patients, placement and maintenance of intravenous lines may be difficult and accidental subcutaneous infiltration of medications may be challenging to identify. The treatment of accidental subcutaneous administration of neuromuscular blocking agents may be complex as the absorption and subsequent elimination is altered and not well known, and the inadvertent prolonged dosing could lead to catastrophic complications. Case Report: W
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27

Lines, D. "Neuromuscular blocking agents - when is the block deep enough? And how to safely reverse the neuromuscular blocker." South African Family Practice 60, no. 4 (2018): 5. http://dx.doi.org/10.4102/safp.v60i4.4909.

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28

Train, Sarah, Karen E. A. Burns, Brian Erstad, et al. "951: PHYSICIANS’ ATTITUDES AND PERCEPTIONS OF NEUROMUSCULAR BLOCKER INFUSIONS IN ARDS." Critical Care Medicine 50, no. 1 (2021): 472. http://dx.doi.org/10.1097/01.ccm.0000810128.86991.1b.

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29

Kendrick, Dawn B., Kathy W. Monroe, David W. Bernard, and Nancy M. Tofil. "Sedation After Intubation Using Etomidate and a Long-Acting Neuromuscular Blocker." Pediatric Emergency Care 25, no. 6 (2009): 393–96. http://dx.doi.org/10.1097/pec.0b013e3181a7923b.

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30

Elofson, Kathryn A., Sarah F. Rhoads, Andrew Tang, Joshua B. Gaither, and Asad E. Patanwala. "Long-Acting Neuromuscular Blocker Use During Prehospital Transport of Trauma Patients." Air Medical Journal 32, no. 4 (2013): 203–7. http://dx.doi.org/10.1016/j.amj.2012.10.021.

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31

Elmansi, Heba, Rasha Aboshabana, and Mohamed I. El-Awady. "Insights into the spectrofluorometric determination of the neuromuscular blocker mivacurium chloride." Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy 289 (March 2023): 122236. http://dx.doi.org/10.1016/j.saa.2022.122236.

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32

Kandukuri, Divya Sarma, Jacqueline K. Phillips, Mark Tahmindjis, and Cara M. Hildreth. "Effect of anaesthetic and choice of neuromuscular blocker on vagal control of heart rate under laboratory animal experimental conditions." Laboratory Animals 52, no. 3 (2017): 280–91. http://dx.doi.org/10.1177/0023677217725365.

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Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensi
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33

Freund, Peter R., T. Andrew Bowdle, Karen L. Posner, Evan D. Kharasch, and V. dePaul Burkhart. "Cost-effective Reduction of Neuromuscular-blocking Drug Expenditures." Anesthesiology 87, no. 5 (1997): 1044–49. http://dx.doi.org/10.1097/00000542-199711000-00006.

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Background Anesthetic drug expenditures have been a focus of cost-containment efforts. The aim of this study was to determine whether expenditures for neuromuscular-blocking agents could be reduced without compromising outcome, and to determine whether such a cost-effective pattern of neuromuscular blocker use could be sustained. Methods Education, practice guidelines, and paperwork barriers were used to persuade anesthesiologists to substitute low-cost neuromuscular-blocking drugs (pancuronium or a metocurine-pancuronium combination) for a more costly neuromuscular-blocking drug (vecuronium).
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34

Kothary, S. P., S. K. Pandit, M. Lebenbom-Mansour, L. Levy, and G. I. Randel. "Tracheal Intubation After Propofol Anesthesia Without a Neuromuscular Blocker Is Not Practical." Anesthesiology 75, no. 3 (1991): A1111. http://dx.doi.org/10.1097/00000542-199109001-01110.

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35

Neely, A., and C. J. Lingle. "Trapping of an open-channel blocker at the frog neuromuscular acetylcholine channel." Biophysical Journal 50, no. 5 (1986): 981–86. http://dx.doi.org/10.1016/s0006-3495(86)83538-x.

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36

Ishida, M., and H. Shinozaki. "TI-233 as a glutamate channel blocker at the crayfish neuromuscular junction." British Journal of Pharmacology 86, no. 1 (1985): 105–16. http://dx.doi.org/10.1111/j.1476-5381.1985.tb09440.x.

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37

Kendrick, D. B., D. W. Bernard, and N. M. Tofil. "121: Sedation after Intubation Using Etomidate and a Long-Acting Neuromuscular Blocker." Annals of Emergency Medicine 50, no. 3 (2007): S39—S40. http://dx.doi.org/10.1016/j.annemergmed.2007.06.153.

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38

Niiya, Tomohisa, Eichi Narimatsu, and Akiyoshi Namiki. "Acute Late Sepsis Attenuates Effects of a Nondepolarizing Neuromuscular Blocker, Rocuronium, by Facilitation of Endplate Potential and Enhancement of Membrane Excitability In Vitro." Anesthesiology 105, no. 5 (2006): 968–75. http://dx.doi.org/10.1097/00000542-200611000-00018.

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Background Sepsis attenuates the muscle-relaxing effects of nondepolarizing neuromuscular blockers. The authors investigated the effects of acute late sepsis on neuromuscular transmission and neuromuscular actions of rocuronium to clarify the mechanisms by which sepsis attenuates the effects of nondepolarizing neuromuscular blockers. Methods Sepsis was induced by cecal ligation and puncture operation. Endplate potentials, acetylcholine potentials, and electrotonic potentials were recorded from the motor endplates of isolated diaphragms from acute late septic and nonseptic rats. Results (1) Sep
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39

Sun, Xiao-Ping, Bo-Ming Chen, Olav Sand, Yoshi Kidokoro, and Alan D. Grinnell. "Depolarization-Induced Ca2+ Entry Preferentially Evokes Release of Large Quanta in the Developing Xenopus Neuromuscular Junction." Journal of Neurophysiology 104, no. 5 (2010): 2730–40. http://dx.doi.org/10.1152/jn.01041.2009.

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The amplitude histogram of spontaneously occurring miniature synaptic currents (mSCs) is skewed positively at developing Xenopus neuromuscular synapses formed in culture. To test whether the quantal size of nerve-evoked quanta (eSCs) distributes similarly, we compared the amplitude histogram of single quantum eSCs in low external Ca2+ with that of mSCs and found that nerve stimulation preferentially released large quanta. Depolarization of presynaptic terminals by elevating [K+] in the external solution or by direct injection of current through a patch pipette increased the mSC frequency and p
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40

Lobaz, Steven, Mark Clymer, and Mario Sammut. "Safety and Efficacy of Sugammadex for Neuromuscular Blockade Reversal." Clinical Medicine Insights: Therapeutics 6 (January 2014): CMT.S10241. http://dx.doi.org/10.4137/cmt.s10241.

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Since its first human use in 2005, the γ-cyclodextrin sugammadex (Org 25969) has had the potential to become the reversal agent of choice, for rocuronium- or vecuronium-induced neuromuscular blockade. Sugammadex binds to the aminosteroid neuromuscular blocker, encapsulating it and extracting it from the neuromuscular junction, effectively ceasing activity and allowing neuromuscular transmission to recover rapidly. Phases I–III and subsequent trials have found sugammadex to be safe and effective in a wide range of doses and for the reversal of a range of depth of muscle relaxation in healthy vo
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41

Oppenheim, R. W., S. Bursztajn, and D. Prevette. "Cell death of motoneurons in the chick embryo spinal cord. XI. Acetylcholine receptors and synaptogenesis in skeletal muscle following the reduction of motoneuron death by neuromuscular blockade." Development 107, no. 2 (1989): 331–41. http://dx.doi.org/10.1242/dev.107.2.331.

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Treatment of chick embryos with neuromuscular blocking agents such as curare during periods of naturally occurring motoneuron death results in a striking reduction of this normal cell loss. Inactivity-induced changes in motoneuron survival were found to be associated with increased levels of AChRs and AChR-clusters in skeletal muscle and with increased focal sites of AChE that are innervated (‘synaptic sites’). Treatment of embryos with curare after the normal cell death period (E12-E15) resulted in no change in motoneuron survival. Although AChR-clusters and focal sites of AChE were increased
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42

Tomak, Yakup, Basar Erdivanli, and Ahmet Sen. "Steroidal Nondepolarizing Neuromuscular Blocker Induced Allergic Reactions and Role of Sugammadex in Treatment." Abant Medical Journal 2, no. 1 (2013): 63–67. http://dx.doi.org/10.5505/abantmedj.2013.96268.

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43

Devlin, John, Sarah Train, Karen E. A. Burns, et al. "950: CRITICAL CARE PHARMACIST ATTITUDES AND PERCEPTIONS OF NEUROMUSCULAR BLOCKER INFUSIONS IN ARDS." Critical Care Medicine 50, no. 1 (2021): 472. http://dx.doi.org/10.1097/01.ccm.0000810124.49603.b5.

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44

Yoon, Sang Bog, Chang Young Jeong, and Woong Mo Im. "The Effect of Succinylcholine on the Action Duration of Vecuronium , Nondeporlarizing Neuromuscular Blocker." Korean Journal of Anesthesiology 25, no. 2 (1992): 381. http://dx.doi.org/10.4097/kjae.1992.25.2.381.

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45

YORULMAZ, İlknur Suidiye, Yavuz DEMİRARAN, Onur ÖZLÜ, and Burhan DOST. "The effect of vitamin D status on different neuromuscular blocker agents reverse time." TURKISH JOURNAL OF MEDICAL SCIENCES 50, no. 4 (2020): 749–55. http://dx.doi.org/10.3906/sag-1901-115.

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46

MONERET-VAUTRIN, D. A., S. WIDMER, J. L. GUEANT, et al. "SIMULTANEOUS ANAPHYLAXIS TO THIOPENTONE AND A NEUROMUSCULAR BLOCKER: A STUDY OF TWO CASES." British Journal of Anaesthesia 64, no. 6 (1990): 743–45. http://dx.doi.org/10.1093/bja/64.6.743.

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47

Tarver, G. "2-O-Substituted Cyclodextrins as Reversal Agents for the Neuromuscular Blocker Rocuronium Bromide." Bioorganic & Medicinal Chemistry 10, no. 6 (2002): 1819–27. http://dx.doi.org/10.1016/s0968-0896(02)00026-3.

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48

DeAngelis, R., P. Loebs, R. Maehr, J. Savarese, and R. Welch. "High-performance liquid chromatographic analysis of doxacurium, a new long-acting neuromuscular blocker." Journal of Chromatography B: Biomedical Sciences and Applications 525 (January 1990): 389–400. http://dx.doi.org/10.1016/s0378-4347(00)83415-5.

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49

Fedorov, Nikita S., Guzel V. Sibgatullina, and Artem I. Malomouzh. "Impairment of Skeletal Muscle Contraction by Inhibitors of GABA Transporters." International Journal of Molecular Sciences 25, no. 23 (2024): 12510. http://dx.doi.org/10.3390/ijms252312510.

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γ-Aminobutyric acid (GABA) has a significant impact on the functioning of not only the central but also the peripheral part of the nervous system. Recently, various elements of the GABAergic signaling system have been discovered in the area of the neuromuscular junction of mammals. At the same time, the functional activity of membrane-bound GABA transporters (GATs) and their role in neuromuscular transmission have not been identified. In the present study, performed on a neuromuscular preparation of the mouse diaphragm, the effect of GABA transporter inhibitors (nipecotic acid and β-alanine) o
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50

Hellsten, Ylva, Peter Krustrup, F. Marcello Iaia, Niels H. Secher, and Jens Bangsbo. "Partial neuromuscular blockade in humans enhances muscle blood flow during exercise independently of muscle oxygen uptake and acetylcholine receptor blockade." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 296, no. 4 (2009): R1106—R1112. http://dx.doi.org/10.1152/ajpregu.90477.2008.

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This study examined the role of acetylcholine for skeletal muscle blood flow during exercise by use of the competitive neuromuscular blocking agent cisatracurium in combination with the acetylcholine receptor blocker glycopyrrone. Nine healthy male subjects performed a 10-min bout of one-legged knee-extensor exercise (18 W) during control conditions and with cisatracurium blockade, as well as with cisatracurium blockade with prior glycopyrrone infusion. Thigh blood flow and vascular conductance in control and with cisatracurium infusion were similar at rest and during passive movement of the l
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