Sample Solution

Definitive control of the airway, a skill anaesthesiologists now consider paramount, developed only after many harrowing and apneic episodes spurred the development of safer airway management techniques1[barash pg no 7]. Anaesthesiologists who practised before muscle relaxants recall the anxiety they felt when a premature attempt to intubate the trachea under cyclopropane caused persisting laryngospasm[ barash chapter 1 page 17]
Curare and the drugs that followed transformed anaesthesia profoundly. Because intubation of the trachea could now be taught in a deliberate manner, a neophyte could fail on the first attempt without compromising on the safety of the patient.2 [barash chapter 1 page 17]
Successful clinical use of curare led to the introduction of other muscle relaxants. Succinylcholine was prepared by Nobel laureate Daniel Bovet in 1949 and was in wide international use before historians noted that the drug had been synthesized and tested long beforehand. [barsh chapter 1 page 18]
In the 1970s and 1980s, research shifted towards identification of specific receptor biochemistry and development of receptor specific drugs. From these isoquinolones, four related products emerged : vecuronium, pipecuronium, rocuronium and pancuronium.3 [barash chapter 1 page 18]
With the introduction of endotracheal anaesthesia during World War I and balanced anaesthesia in 1926, a search began for a drug which could cause jaw relaxation to facilitate endotracheal intubation. Most of the intubations were done with inhalational technique which was associated with problems like laryngospasm and bronchospasm. Further there was a need to take the patient sufficiently deep before intubation which lead to haemodynamic disturbances.4 (1 in old)

The first skeletal muscle relaxant d-tubocurarine which was non-depolarizing in nature was introduced in 1942 to fulfil the need for jaw relaxation. Though this drug provided excellent muscle relaxation, it had additional ganglion blocking properties causing tachycardia, hypotension even in clinical doses. Further it had a delayed onset at jaw, making it unsuitable for use during rapid sequen