Safer alternatives, such as cisatracurium and rocuronium, have largely replaced it as an adjunct for clinical anesthesia and it is now rarely used.
[3] Tubocurarine is so-called because some of the plant extracts designated curare were stored, and subsequently shipped to Europe, in bamboo tubes.
The tripartite classification into "tube", "calabash", and "pot" curares early became untenable, due to inconsistencies in the use of the different types of vessels and the complexities of the dart poison recipes themselves.
[4] 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.
[11] Regardless, all in all some 30,000 patients had been given tubocurarine by 1941, although it was Griffith and Johnson's 1942 publication[5] that provided the impetus to the standard use of neuromuscular blocking agents in clinical anesthetic practice – a revolution that rapidly metamorphosized into the standard practice of "balanced" anesthesia: the triad of barbiturate hypnosis, light inhalational anesthesia and muscle relaxation.
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.
Unna et al. reported the effects of tubocurarine on humans: Forty-five seconds after the beginning of the injection, heaviness of the eyelids and transitory diplopia were perceived.
Shortly after the injection was completed the subjects experienced a sensation of increased difficulty in breathing, as if an extra effort was necessary to maintain an adequate respiratory exchange.
In the majority of the experiments the respiratory rate was increased by about 50–100 per cent the first minutes after the injection of any one of the drugs while the tidal volume decreased.
Histamine release is associated with bronchospasms, hypotension, and salivary secretions, making it dangerous for asthmatics, children, and those who are pregnant or lactating.
Because of the shortcomings of tubocurare, much research effort was undertaken soon after its clinical introduction to find a suitable replacement.
The venom is the most damaging to nerve endings, but the introduction of d-tubocurarine chloride blocks the nAChr, alleviating pain and muscle spasms while an antivenom can be administered.