Newly Published
Editorial Views  |   June 2019
Reversing Neuromuscular Blockade: Not Just the Diaphragm, but Carotid Body Function Too
Author Notes
  • From the Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, United Kingdom (J.J.P.), and the Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institute, and Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden (L.I.E.).
  • Accepted for publication April 19, 2019.
    Accepted for publication April 19, 2019.×
  • Correspondence: Address correspondence to Dr. Pandit: jaideep.pandit@dpag.ox.ac.uk
Article Information
Editorial Views / Central and Peripheral Nervous Systems / Neuromuscular Diseases and Drugs / Neurosurgical Anesthesia / Respiratory System / Technology / Equipment / Monitoring
Editorial Views   |   June 2019
Reversing Neuromuscular Blockade: Not Just the Diaphragm, but Carotid Body Function Too
Anesthesiology Newly Published on June 13, 2019. doi:10.1097/ALN.0000000000002814
Anesthesiology Newly Published on June 13, 2019. doi:10.1097/ALN.0000000000002814
Neuromuscular blocking drugs have—for years—enabled anesthesiologists beneficially to relax skeletal muscles to improve anesthetic management, increase safety and quality of tracheal intubation, and to provide favorable intraoperative conditions for complex surgical procedures. While achieving these goals, a growing body of evidence has uncovered a price to pay in potential side effects, most frequently associated with the respiratory system having an increased risk of adverse pulmonary outcomes1  or, more rarely, “accidental intraoperative awareness,” which occurs almost exclusively in cases where neuromuscular blockade has been used.2 
In the late 1990s, it was shown that subparalyzing concentrations of neuromuscular blocking drugs markedly impaired the acute ventilatory response to hypoxia3  in volunteers. Later animal studies located this effect to the carotid body, where these drugs blocked acetylcholine-dependent oxygen signaling pathways.4  In this issue of Anesthesiology, Broens et al. show that partial rocuronium block in volunteers depresses the acute ventilatory response to hypoxia—and also to hypercapnia.5  This confirms and extends earlier work,3,4  and also explores the effect of neuromuscular block reversal with neostigmine or sugammadex. A key finding is that even when the adductor pollicis train-of-four ratio had recovered to 1.0, the acute hypoxic response remained significantly depressed in several subjects. In this Editorial View, we will discuss the clinical implications of these results, and touch upon some relevant physiology.