Tubocurarine
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| AHFS/Drugs.com | International Drug Names |
| MedlinePlus | a682860 |
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IV |
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| Bioavailability | 100% (IV) |
| Protein binding | 50% |
| Biological half-life | 1–2 hours |
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| ECHA InfoCard | 100.108.489 |
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| Formula | C37H42Cl2N2O6 |
| Molar mass | 681.65 g/mol |
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Tubocurarine (also known as d-tubocurarine or DTC) is a toxic alkaloid historically known for its use as an arrow poison. In the mid-1900s, it was used in conjunction with an anesthetic to provide skeletal muscle relaxation during surgery or mechanical ventilation. It is now rarely used as an adjunct for clinical anesthesia because safer alternatives, such as cisatracurium and rocuronium, are available.
Tubocurarine is a naturally occurring mono-quaternary alkaloid obtained from the bark of the South American plant Chondrodendron tomentosum, a climbing vine known to the European world since the Spanish conquest of South America. Curare had been used as a source of arrow poison by South American natives to hunt animals, and they were able to eat the animals' contaminated flesh subsequently without any adverse effects because tubocurarine cannot easily cross mucous membranes.Thus, tubocurarine is effective only if given parenterally, as demonstrated by Bernard, who also showed that the site of its action was at the neuromuscular junction. Virchow and Munter confirmed the paralyzing action was limited to voluntary muscles.
The word "curare" comes from the South American Indian name for the arrow poison, ourare. Presumably, the initial syllable was pronounced with a heavy glottal stop. Tubocurarine is so-called because the plant samples containing the curare were stored and shipped to Europe in tubes. Likewise, curare stored in calabash containers was called calabash curare.
Griffith and Johnson are credited with pioneering the formal clinical introduction of tubocurarine as an adjunct to anesthetic practice on 23 January 1942, at the Montreal Homeopathic Hospital. In this sense, tubocurarine is the prototypical adjunctive neuromuscular non-depolarizing agent. However, others before Griffith and Johnson had attempted use of tubocurarine in several situations: some under controlled study conditions while others not quite controlled and remained unpublished. Regardless, all in all some 30,000 patients had been given tubocurarine by 1941, although it was Griffith and Johnson's 1942 publication that provided the impetus to the standard use of neuromuscular blocking agents in clinical anesthestic practice – a revolution that rapidly metamorphosized into the standard practice of "balanced" anesthesia: the triad of barbiturate hypnosis, light inhalational anesthesia and muscle relaxation. The technique as described by Gray and Halton was widely known as the "Liverpool technique", and became the standard anesthetic technique in England in the 1950s and 1960s for patients of all ages and physical status. Present clinical anesthetic practice still employs the central principle of balanced anesthesia though with some differences to accommodate subsequent technological advances and introductions of new and better gaseous anesthetic, hypnotic and neuromuscular blocking agents, and tracheal intubation, as well as monitoring techniques that were nonexistent in the day of Gray and Halton: pulse oximetry, capnography, peripheral nerve stimulation, noninvasive blood pressure monitoring, etc.
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