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Decamethonium, which has a short action time, is similar to acetylcholine and acts as a partial agonist of the nicotinic acetylcholine receptor. In the motor endplate, it causes depolarization, preventing further effects to the normal release of acetylcholine from the presynaptic terminal, and therefore preventing the neural stimulus from affecting the muscle. In the process of binding, decamethonium actually activates (depolarizes) the motor endplate - but since the decamethonium itself is not degraded, the membrane remains depolarized and unresponsive to normal acetylcholine release.
Decamethonium does not produce unconsciousness or anesthesia, and its effects may cause considerable psychological distress while simultaneously making it impossible for a patient to communicate. For these reasons, administration of the drug to a conscious patient is strongly contraindicated, except in necessary emergency situations.
Decamethonium was used clinically in the UK for many years, but it is now available only for research purposes.
- Lee C, Jones T (May 2002). "Molecular conformation-activity relationship of decamethonium congeners". Br J Anaesth 88 (5): 692–9. doi:10.1093/bja/88.5.692. PMID 12067008.
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