ABSTRACT
There are certain neurosurgeries where neuromuscular monitoring is recommended to prevent injury to neural structures in which muscle relaxants are generally avoided. The acetylcholine (ACh) molecules reach the muscle membrane where the motor end plate contains ligand-gated, nicotinic acetylcholine receptors (nAChRs), which convert the chemical signal into electrical signals. Neuromuscular blockers are classically divided into two types—depolarizing and nondepolarizing blockers. The risk of succinylcholine-induced hyperkalemia in neurosurgical patients increases over time and the precise time of onset and the duration of the risk period are unknown. There is no clear evidence in the literature indicating that administration of succinylcholine alone induces malignant hyperthermia in susceptible individuals. Five methods are available for detecting and measuring evoked responses more accurately. They are as follows: mechanomyography (MMG), electromyography (EMG), acceleromyography (AMG), piezoelectric neuromuscular monitor [PZEMG] and phonomyography (PMG). The chapter reviews the clinical uses of opioids with an emphasis on their use in neuroanesthesia.
