Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (939 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
Drugs that interrupt transmission of nerve impulses at the skeletal neuromuscular junction. They can be of two types, competitive, stabilizing blockers (neuromuscular nondepolarizing agents) or noncompetitive, depolarizing agents (neuromuscular depolarizing agents). Both prevent acetylcholine from triggering the muscle contraction and they are used as anesthesia adjuvants, as relaxants during electroshock, in convulsive states, etc.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Agents, Neuromuscular Blocking; Blocking Agents, Neuromuscular; Neuromuscular Blocking Agent; Agent, Neuromuscular Blocking; Blocking Agent, Neuromuscular; Neuromuscular Blockers; Blockers, Neuromuscular; Neuromuscular Blocker.
Where it fits in the MeSH classification
- Broader topics
- Neuromuscular Agents
- Narrower topics
- Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents
Related concepts
- Neuromuscular Nondepolarizing Agents
- Neuromuscular Depolarizing Agents
Research landscape
PubMed indexes 11,089 records tagged with the MeSH heading “Neuromuscular Blocking Agents” (counts retrieved 2026-10-29). 833 of them (7.5%) were published from 2020 onward, and the busiest period so far is through 1999 with 5,839 records.
Reviews account for 1,303 records (11.8%) and meta-analyses for 85. Randomized controlled trials number 1,416 (12.8%) as a share of all records on the topic. Randomized trials make up a comparatively large share of this literature, which means many treatment questions have been tested directly.
Show the data
| Period | Records |
|---|---|
| through 1999 | 5,839 |
| 2000-2009 | 2,427 |
| 2010-2019 | 1,990 |
| 2020 onward | 833 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 1,303 | 11.8% |
| Meta-analyses | 85 | 0.8% |
| Randomized controlled trials | 1,416 | 12.8% |
Method: PubMed query "Neuromuscular Blocking Agents"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-29.
Reading the evidence in pharmacology
Drug evidence builds in layers: laboratory pharmacology describes how a compound acts, pharmacokinetic studies describe how the body handles it, and randomized trials test whether it helps and what harms it causes. Post-marketing surveillance and observational studies reveal rarer adverse effects but cannot prove causation. This page is educational and is not a recommendation to start, stop or change any medicine; decisions about treatment belong with a qualified clinician.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
Merits and Limitations of Studying Neuronal Depolarization-Dependent Processes Using Elevated External Potassium [1]
Abstract reading summary — source excerpts
- Opening excerpt
- Elevated extracellular potassium chloride is widely used to achieve membrane depolarization of cultured neurons.
- Closing excerpt
- In this review, we discuss the intracellular consequences of elevated extracellular potassium chloride treatment in vitro, the variability of such treatments in the literature, the strengths and limitations of this tool, and relevance of these studies to brain functions and dysfunctions.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (142 words)
Elevated extracellular potassium chloride is widely used to achieve membrane depolarization of cultured neurons. This technique has illuminated mechanisms of calcium influx through L-type voltage sensitive calcium channels, activity-regulated signaling, downstream transcriptional events, and many other intracellular responses to depolarization. However, there is enormous variability in these treatments, including durations from seconds to days and concentrations from 3mM to 150 mM KCl. Differential effects of these variable protocols on neuronal activity and transcriptional programs are underexplored. Furthermore, potassium chloride treatments in vitro are criticized for being poor representatives of in vivo phenomena and are questioned for their effects on cell viability. In this review, we discuss the intracellular consequences of elevated extracellular potassium chloride treatment in vitro, the variability of such treatments in the literature, the strengths and limitations of this tool, and relevance of these studies to brain functions and dysfunctions.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 33256465 · DOI · PMC7711227
Novel Insights on MRGPRX2-Mediated Hypersensitivity to Neuromuscular Blocking Agents And Fluoroquinolones [2]
Abstract reading summary — source excerpts
- Opening excerpt
- Neuromuscular blocking agents (NMBAs) like atracurium and rocuronium as well as fluoroquinolones (FQs) cause mast cell-mediated anaphylaxis by activating Mas-related G protein-coupled receptor X2 (MRGPRX2), but many questions remain unanswered.
- Closing excerpt
- These findings further improve our understanding of the role and relevance of MRGPRX2-driven mast cell activation in anaphylactic reactions to NMBAs and FQs and may help to improve their prediction, prevention, and treatment.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (218 words)
Neuromuscular blocking agents (NMBAs) like atracurium and rocuronium as well as fluoroquinolones (FQs) cause mast cell-mediated anaphylaxis by activating Mas-related G protein-coupled receptor X2 (MRGPRX2), but many questions remain unanswered. Here, we address three of them, namely whether primary human mast cells show similar activation by these drugs as murine mast cells and mast cell lines, how sugammadex protects from atracurium-induced MRGPRX2-mediated mast cell activation, and why some but not all patients treated with rocuronium develop anaphylaxis. We used peripheral blood-derived cultured mast cells from healthy donors and patients, assessed mast cell activation and degranulation by quantifying intracellular calcium and CD63 expression, respectively, and made use of MRGPRX2-silencing, via electroporation with Dicer-substrate small interfering RNAs, and single cell flow cytometric analyses. Atracurium, ciprofloxacin, and levofloxacin activated and degranulated primary human mast cells, but only MRGPRX2-positive and not MRGPRX2-negative or -silenced mast cells. Sugammadex attenuated the atracurium-induced and MRGPRX2-mediated activation and degranulation of human mast cells by reducing free atracurium levels. The mast cells of patients with IgE-independent anaphylaxis to rocuronium were similar, in their MRGPRX2 expression and function, to those of patients with IgE-mediated anaphylaxis. These findings further improve our understanding of the role and relevance of MRGPRX2-driven mast cell activation in anaphylactic reactions to NMBAs and FQs and may help to improve their prediction, prevention, and treatment.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 34385999 · DOI · PMC8353374
Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: a systematic review [3]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundNeuromuscular blocking drugs (NMBD) are administered intra-operatively to facilitate intubation and to achieve muscle relaxation for surgical procedures.
- Closing excerpt
- More high-quality studies are needed.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (338 words)
BackgroundNeuromuscular blocking drugs (NMBD) are administered intra-operatively to facilitate intubation and to achieve muscle relaxation for surgical procedures. Incomplete reversal of NMBD can lead to adverse events in the postoperative period. Patients with obstructive sleep apnea (OSA) may be at higher risk of complications related to the use of NMBD. The objectives of this systematic review were to determine whether: 1) OSA patients are at higher risk of postoperative complications from the use of NMBD than non-OSA patients, and 2) the choice of NMBD reversal agent affects the risk of postoperative complications in OSA patients.MethodsA literature search of multiple databases was conducted up to April 2017. The inclusion criteria were: (1) adult surgical patients (≥18 years old) with OSA diagnosed by polysomnography, or history, or suspected by screening questionnaire; (2) patients who were given NMBD and/or NMBD reversal agents intraoperatively; (3) reports on postoperative adverse events, particularly respiratory events were available; (4) published studies were in English; and (5) RCTs or observational cohort studies. The quality of evidence was determined by the Oxford Center for Evidence Based Medicine levels of evidence.ResultsOut of 4123 studies, five studies (2 RCTs and 3 observational studies) including 1126 patients were deemed eligible. These studies were heterogeneous precluding a meta-analysis of the results. Two of three studies (1 RCT, 2 observational studies) reported that OSA patients given NMBD may be at higher risk of developing postoperative pulmonary complications (PPCs) like hypoxemia, residual neuromuscular blockade or respiratory failure compared to non-OSA patients. Two studies (1 RCT, 1 observational study) reported that OSA patients who were reversed with sugammadex vs. neostigmine had less PPCs and chest radiographic changes, but the quality of the included studies was Oxford level of evidence: low to moderate.ConclusionsOSA patients who receive intraoperative NMBD may be at higher risk for postoperative hypoxemia, respiratory failure and residual neuromuscular blockade compared to non-OSA patients. There is some, albeit very limited evidence that NMBD reversal with sugammadex may be associated with less PPCs than neostigmine in patients with OSA. More high-quality studies are needed.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 30025517 · DOI · PMC6053808
Effects of Rocuronium on Ischemia-reperfusion Injury and Intracellular ATP Consumption: A Randomized Controlled Trial [4]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundMuscle relaxants reduce "total" oxygen consumption, and 1.
- Closing excerpt
- While the present results suggest that rocuronium reduced intracellular ATP consumption, no clinically beneficial effects were observed.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (241 words)
BackgroundMuscle relaxants reduce "total" oxygen consumption, and 1.2 mg/kg of rocuronium has been shown to attenuate ischemia-reperfusion injury (IRI). Therefore, we herein investigated whether 0.9 mg/kg of rocuronium reduced "local" oxygen consumption and IRI indirectly by measuring changes in hypoxanthine (HPX), an indicator of intracellular adenosine triphosphate (ATP) consumption, and malondialdehyde (MDA), an indicator of IRI, respectively.MethodsThis study was designed as a randomized controlled trial. Female patients aged 50-79 years old who were scheduled for elective knee arthroplasty under general anesthesia were recruited. After the collection of pre-ischemia blood samples, 0.9 mg/kg of rocuronium was administered to patients in group R and a placebo to those in group C 3 minutes before tourniquet inflation. Five minutes after tourniquet deflation, post-ischemia blood samples were collected. The primary outcome was the change in the concentration of MDA (Δ MDA) after ischemia.ResultsMedians [interquartile ranges] for Δ MDA (μmol/L) in group R (n = 19) and group C (n = 18) were -0.47 [-1.25 to 0.13] and -0.58 [-0.67 to -0.28], respectively, with no significant difference (p = 0.796). Means ± standard deviations for Δ HPX (μmol/L) were 1.09 ± 0.70 and 1.71 ± 1.09 in groups R and C, respectively, and the difference between the groups was significant (p = 0.046).ConclusionsWe were unable to confirm that 0.9 mg/kg of rocuronium attenuates IRI or postoperative quadriceps muscle weakness. While the present results suggest that rocuronium reduced intracellular ATP consumption, no clinically beneficial effects were observed.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42463418 · DOI · PMC13653758
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline [5]
- Research article Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities [6]
- Research article Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care [7]
- Research article Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient [8]
- Research article Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults [9]
- Research article Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials [10]
References
- Rienecker KDA, Poston RG, Saha RN. Merits and Limitations of Studying Neuronal Depolarization-Dependent Processes Using Elevated External Potassium. . 2020. PMID 33256465 · DOI · PMC7711227
- Elst J, Maurer M, Sabato V, Faber MA, Bridts CH, Mertens C, et al.. Novel Insights on MRGPRX2-Mediated Hypersensitivity to Neuromuscular Blocking Agents And Fluoroquinolones. . 2021. PMID 34385999 · DOI · PMC8353374
- Hafeez KR, Tuteja A, Singh M, Wong DT, Nagappa M, Chung F, et al.. Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: a systematic review. . 2018. PMID 30025517 · DOI · PMC6053808
- Taguchi S, Makino S, Obata N, Mizobuchi S. Effects of Rocuronium on Ischemia-reperfusion Injury and Intracellular ATP Consumption: A Randomized Controlled Trial. . 2026. PMID 42463418 · DOI · PMC13653758
- Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, et al.. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024. PMID 38032683 · DOI · PMC10870893
- Brull SJ, Kopman AF. Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities. Anesthesiology. 2017. PMID 27820709 · DOI
- Fuchs-Buder T, Romero CS, Lewald H, Lamperti M, Afshari A, Hristovska AM, et al.. Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2023. PMID 36377554 · DOI
- Murray MJ, DeBlock H, Erstad B, Gray A, Jacobi J, Jordan C, et al.. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016. PMID 27755068 · DOI
- Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017. PMID 28806470 · DOI · PMC6483345
- Alhazzani W, Alshahrani M, Jaeschke R, Forel JM, Papazian L, Sevransky J, et al.. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2013. PMID 23497608 · DOI · PMC3672502
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-29.
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Evidence strength
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