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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(3):119-123; doi:10.1093/bjaceaccp/mkl017
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 3 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Neuromuscular blocking drugs in the critically ill

SS Tripathi, MBBS MD FRCA
Honorary Lecturer, University Department of Anaesthesia, University Clinical Department The Duncan Building, Daulby Street, Liverpool L69 3GA, UK

JM Hunter, MB ChB PhD FRCA
Professor of Anaesthesia, University Department of Anaesthesia, University Clinical Department The Duncan Building, Daulby Street, Liverpool L69 3GA, UK Tel: 0151 706 4008 Fax: 0151 706 5884 E-mail: jennie@liv.ac.uk (for correspondence)
The first 150 words of the full text of this article appear below.


Key points

NMBDs are now less frequently required to manage the critically ill patient.

Neuromuscular block should be monitored if relaxants are used in these patients.

Succinylcholine can cause cardiac arrest from hyperkalaemia in the critically ill.

Repeated doses or infusions of neuromuscular blocking agents can cause prolonged muscle weakness in patients who are artificially ventilated for several days.

 

Neuromuscular blocking drugs (NMBDs) are now used less frequently in critically ill patients than they were 15 years ago, mainly because of improved techniques of artificial ventilation.1 Some indications for their use are given in Table 1.2 It is inappropriate to extrapolate experience with the use of NMBDs in the operating theatre in healthy patients to the management of the critically ill. These sick patients often have multiple organ failure and are receiving concomitant medications. The pharmacokinetic and pharmacodynamic properties of NMBDs in this population are poorly understood. There have . . . [Full Text of this Article]


   Depolarizing agents
 
Succinylcholine


   Non-depolarizing agents
 
Aminosteroids

Pancuronium

Vecuronium

Pipecuronium

Rocuronium

Benzylisoquinoliniums

d-Tubocurarine

Alcuronium

Atracurium

Cisatracurium

Laudanosine controversy

Mivacurium

Doxacurium


   Monitoring of neuromuscular block
 

   Prolonged neuromuscular block
 
Overdosage

Drug interactions

Pathological defects in the motor unit

Myopathy

Neuropathy

Neuromuscular junction


   Complications in the ICU
 

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