500 Years after Curares Discovery: What has Changed, What has not? - Pages 1-8
Massimiliano Sorbello1, Ivana Zdravkovic2 and Radmilo Jankovic3
1Department of Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele, Catania, Italy; 2Department of Anaesthesia and Reanimation, Clinical Hospital Center “Zvezdara”, Belgrade; 3Center for Anaesthesiology and Reanimatology, Clinical Center of Niš; School of Medicine, University of Niš, Serbia
Curares were first discovered in 1500’s by pioneering explorer which were perfectly aware of their use as poisons but completely unaware of their potential as medications; it was to wait until late 1800’s to know some more on them, and only in middle 1940’s some medical applications started, resulting in important evolution towards modern anesthetic techniques, including balanced anesthesia and opportunity for more complex surgical procedures. New molecules, meaning new problems, including Postoperative Residual Curarization (PORC), anesthesia awareness, difficult airway management and related clinical problems. Many advancements have been performed in the last 50 years, new molecules are available and new opportunities for powerful, fast and effective antagonism are available. Nevertheless, curares remain poisons, and their use could be considered safe only in experienced hands, not less than native americans Men of Medicine, and always taking account of situation, strategy and patients characteristics before counting on onset, offset and possibility for reversal. All points showing that in 500 years many things changed and many others they probably remained the same, because in the end, it is not the drug, but the man who gives it.
Keywords: Intubation, muscle relaxants, reversal, postoperative residual curarization.