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Nondepolarizing agents....back to pharmacology

Nondepolarizing neuromuscular blocking drugs have very limited lipid solubility. This is due to the highly ionized state of nondepolarizing neuromuscular blocking drugs at physiologic pH. This limits their accessibility to the various tissues and results in a small volume of distribution. 

The small volume of distribution implies that neuromuscular blocking drugs are limited primarily to the extracellular fluid. Physiologically, the highly ionized state of nondepolarizing neuromuscular blocking drugs minimizes their transfer across lipid membrane barriers. This includes lipid membranes such as the blood-brain barrier, renal tubular epithelium, gastrointestinal epithelium, and placenta. 

Clinically, nondepolarizing neuromuscular blocking drugs therefore produce minimal central nervous system effects, undergo minimal renal tubular absorption, are ineffective when administered orally, and do not affect the fetus when administered to a parturient. 

miller anesthesia

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