Neuromuscular blockers during general anaesthesia

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6989.1218 (Published 13 May 1995) Cite this as: BMJ 1995;310:1218
  1. Jose Ponte
  1. Consultant anaesthetist King's College Hospital, London SE5 9RS

    Less may be better

    The recall of events occurring during surgery, including the suffering of pain, remains a problem experienced by at least one in 3000 patients.1 In about half of these cases the problem is due to failure of equipment or an error in anaesthetic technique. In many cases, however, no cause other than individual “resistance” to anaesthetics can be found. Being “awake” during general anaesthesia without the knowledge of the anaesthetist was almost unheard of until the middle of this century, and its possibility is a direct consequence of modern techniques of anaesthesia. It may be time to re-examine these techniques.

    In 1942, in Montreal, Griffith and Johnson introduced the use of small amounts of curare to enhance abdominal muscle relaxation during laparotomy, still relying on the diaphragm to ventilate the lungs.2 Patients were made merely weak and not paralysed while receiving a full inhalation anaesthetic. A few years later, in Liverpool, Gray and others introduced a technique whereby much less …

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