A Guidebook to Neuromuscular Transmission, Blockade and Monitoring for Anesthesia and Intensive Care 2007

It is quite some time that a new textbook on neuromuscular transmission, blockade and monitoring was published.

Modern trends in anesthesia, especially the widespread use of sophisticated regional techniques and the popularity of laryngeal mask airways, have lead to a substantial reduction of muscle relaxants in our daily practice.

In addition, since the introduction and rapid subsequent withdrawal- of rapacuronium, there has not been any new muscle relaxant or reversal drug. With the first clinical trials of sugammadex, a revolutionary new form of reversal drug, there is new dynamics in neuromuscular research.

Still, the question arises: is there need for an updated textbook on neuromuscular research and, if yes, which topics should be included?

When the publishing company asked me to edit this book, I was very enthusiastic being involved in neuromuscular research for the last 15 years, a so-called twitcher , but with a rather broad spectrum of other interests. Working at McGill University, I wondered whether residents, young staff or mature clinicians really needed a new and separate textbook. How to make this book interesting and accessible for different focus groups?

I immediately decided against a mere repetition of all classical subjects of neuromuscular research and clinical use. Therefore, you will find an initial chapter trying to briefly update you with basic and advanced, but very clinically oriented information on neuromuscular transmission, blockade and how to measure it. Readers eager to delve deeper, are advised to resort to recent review articles on the subject of neuromuscular monitoring. The second chapter is, I believe, a novelty, the first attempt to summarize the current knowledge on the staircase effect, which plays an important role for neuromuscular monitoring. Prof. Lien offers in the next chapter a very concise and much appreciated update on new developments in the field of pharmaceutical research in search of the holy grail: ultra-short acting neuromuscular blocking agents and reversal drugs.

The absence of a chapter on the current non-depolarizing neuromuscular blocking agents was a conscious one: there is no new non-depolarizing neuro-muscular blocking agent on the market, and hasn t been for the last couple of years; it seemed superfluous to repeat the facts of the current drugs. However, I asked my colleague and re-known expert Prof Donati to give us a fresh take on the place of succinylcholine in current practice; I equally felt the idea of writing a chapter about rapacuronium, even though it is no longer on the market a chance to highlight certain interesting features and failures which occurred in our field. Prof Geldner, whom I know well from our days together at the University of Erlangen, a prominent figure in the German scene , has done a very good job in presenting rapacuronium.

No textbook on muscle relaxants would be complete without chapters on the use of neuromuscular blocking agents in the intensive care unit my colleague and friend David Bracco has compiled this, without a reminder of the problems of postoperative residual paralysis - Bertrand Debaene has assembled some Swiss and French musketeers in order to do so, and without a chapter on allergic reactions after the use of neuromuscular blocking agents. My former colleague Louis-Philippe Fortier from Université de Montréal has written an update on muscle relaxants and neuromuscular disease; David Bracco presents one of the most concise chapters on malignant hyperthermia I have ever come across.