The physiology of the nicotinic acetylcholine receptor and its importance in the administration of anesthesia.

The nicotinic acetylcholine receptor (nAChR) can be found widely throughout the body. Although the activation of this receptor leads to multiple functions dependent on its location within the body and subunit composition, all nAChRs aid in the communication between the extracellular and intracellular compartments. The nAChR is composed of 3 domains: the extracellular, transmembrane, and intracellular. The receptor functions in response to ligands that act as an agonist or antagonist that binds to the extracellular domain causing activation or inactivation of the receptor. The activation of the nAChR causes a twisting motion of the receptor, which opens a gate allowing for the passage of sodium, potassium, and calcium cations through the cell membrane. The muscle-type nAChR and neuronal-type nAChR have important roles during the administration of anesthesia. The muscle-type nAChR, located in the neuromuscular junction, is the target of neuromuscular blockers and local anesthetics to prevent muscle contraction. General anesthetics affect the neuronal-type nAChR by inhibiting functions of the central nervous system, including memory formation. The importance of the nAChR cannot be underestimated, for it is through the manipulation of this receptor that many anesthetic goals are achieved.