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[[Acetylcholine]], a natural [[neurotransmitter]] found at the [[neuromuscular junction]], causes muscles to contract when it is released from nerve endings. Muscle paralytic drugs work by preventing acetylcholine from attaching to its receptor. Paralysis of the muscles of respiration—the [[diaphragm (anatomy)|diaphragm]] and [[intercostal muscle]]s of the chest—requires that some form of artificial respiration be implemented. Because the muscles of the [[larynx]] are also paralysed, the airway usually needs to be protected by means of an [[endotracheal tube]].<ref name=":11" />
Paralysis is most easily monitored by means of a peripheral nerve stimulator. This device intermittently sends short electrical pulses through the skin over a peripheral nerve while the contraction of a muscle supplied by that nerve is observed. The effects of muscle relaxants are commonly reversed at the end of surgery by [[Cholinesterase inhibitor|anticholinesterase]] drugs, which are administered in combination with muscarinic [[anticholinergic]] drugs to minimize side effects. Examples of skeletal muscle relaxants in use today are [[pancuronium]], [[rocuronium]], [[vecuronium]], [[cisatracurium]], [[atracurium]], [[mivacurium]], and [[succinylcholine]]. Novel neuromuscular blockade reversal agents such as [[sugammadex]] may also be used; it works by directly binding muscle relaxants and removing it from the neuromuscular junction. Sugammadex was approved for use in the United States in 2015, and rapidly gained popularity. A study from 2022 has shown that Sugammadex and neostigmine are likely similarly safe in the reversal of neuromuscular blockade.<ref>{{cite journal | vauthors = Ruetzler K, Li K, Chhabada S, Maheshwari K, Chahar P, Khanna S, Schmidt MT, Yang D, Turan A, Sessler DI | display-authors = 6 | title = Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects | journal = Anesthesia and Analgesia | volume = 134 | issue = 5 | pages = 1043–1053 | date = May 2022 | pmid = 35020636 | doi = 10.1213/ANE.0000000000005842 | s2cid = 245907059 }}</ref>
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