Journal of Critical Care
Volume 24, Issue 1 , Pages 5-10, March 2009

Physiology and biology of neuromuscular transmission in health and disease☆

Department of Anesthesia and Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA

Shriners Hospital for Children, Boston, MA, USA

published online 19 January 2009.

Abstract 

The introduction of powerful and contemporary research techniques has allowed for an increasingly detailed understanding of neuromuscular transmission. The classic model of nerve signaling to muscle using acetylcholine has been well described. Newer discovery points toward a more complex signaling system with adaptive receptor physiology and a multifaceted action response scheme for muscle relaxants. Although adding complexity, these newer discoveries help align experimentally derived knowledge with clinical observations. In this review, new concepts relative to neuromuscular transmission in health and disease are discussed, including a detailed discussion of acetylcholine and acetylcholine receptor physiology. Recent elucidations of the pathophysiologic responses to neuromuscular injury and its clinical implications are also detailed.

Keywords: Neuromuscular junction, Acetylcholine, Acetylcholine receptor, Up-regulation

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☆ This study was supported in part by grants from the National Institute of General Medical Services (GM31569-25, GM21500-32 Project IV and GM 55082-10), Bethesda, Md, and from the Shriners Hospital Philanthropy, Tampa, FL (grants 8740, 8891, 8670, and 8530) to JAJM.

PII: S0883-9441(08)00178-0

doi:10.1016/j.jcrc.2008.08.002

Journal of Critical Care
Volume 24, Issue 1 , Pages 5-10, March 2009

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