A National Survey on the Practice Patterns of Anesthesia Intensivists in the Use of Muscle Relaxants

Klessig, Heidi; Geiger, Hartmut; Murray, Michael J.; Coursin, Douglas B.

doi:10.1097/00000542-199109001-00290

Cited by 3 publications

(5 citation statements)

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“…Klessig et al führten eine Befragung bei Anästhesisten und Intensivmedizinern in den USA durch, bei der die häufigsten Indikationen für neuromuskuläre Blockaden auf der Intensivstation zusammengetragen wurden [22]. Klessig et al führten eine Befragung bei Anästhesisten und Intensivmedizinern in den USA durch, bei der die häufigsten Indikationen für neuromuskuläre Blockaden auf der Intensivstation zusammengetragen wurden [22].…”

Section: Monitoring Des Relaxationsgradesunclassified

Prolongierte Muskelschwäche des Intensivpatienten unter besonderer Berücksichtigung der sog. Intensiv-Polyneuromyopathie

Hinder¹,

Lüdemann

Hinder³

et al. 1997

Anaesthesist

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Generalized muscle weakness in critically ill patients can result in prolonged periods of artificial ventilation and longer stays in the intensive care unit. Both neuropathic (critical illness polyneuropathy) and myopathic (critical illness myopathy) abnormalities seem to play an important role for this prolonged weakness. This article reviews its complex differential diagnosis with special emphasis on the current understanding of the neuromuscular syndromes. An efficient diagnostic plan is necessary for the exclusion of other curable causes of prolonged muscle weakness even in the presence of polyneuromyopathic changes. Psychological support of the patient and prophylaxis of secondary complications of prolonged immobilization are crucial when specific therapy is not possible.

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Section: Monitoring Des Relaxationsgradesunclassified

Prolongierte Muskelschwäche des Intensivpatienten unter besonderer Berücksichtigung der sog. Intensiv-Polyneuromyopathie

Hinder¹,

Lüdemann

Hinder³

et al. 1997

Anaesthesist

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“…infusion of pancuronium 400 ug kg" 1 h" 1 for 48 h. Residual paralysis present at the end of the study (72 h) was antagonized until fade in TOF was abolished as follows. Initial antagonism was attempted with neostigmine 30 ug kg 1 , which was repeated twice if recovery of fade remained incomplete. If TOF fade persisted after three doses of neostigmine, 4-aminopyridine 500 ug kg" 1 (Hospital Pharmacy, Groningen) was administered.…”

Section: Neuromuscular Functionmentioning

confidence: 99%

“…Anaesthesia and prolonged artificial ventilation were tolerated well for 72 h by the four animals and no signs of infection or changes in end-tidal carbon dioxide partial pressure, temperature or urinary output were observed. The rate of infusion of pentobarbitone was reduced from 1 mg kg" 1 h" 1 to approximately 20 % of the initial infusion rate in the course of the study. Maintenance of mean arterial pressure greater than 80 mm Hg required the infusion of dopamine in three animals (cat No.…”

Section: Experimental Conditionsmentioning

confidence: 99%

“…In the intensive care unit (ICU), neuromuscular blocking agents are used in doses and for periods of time far exceeding those used in the operating room [1]. Their long-term administration to ICU patients is associated with the development of prolonged peripheral muscle paralysis [2][3][4][5][6].…”

mentioning

confidence: 99%

“…However, it is not clear if alterations in the pharmacokinetics of neuromuscular blockers or in neuromuscular transmission secondary to "pharmacological denervation" (possibly related to absolute or relative overdosage [2]) are responsible for this prolonged paralysis. As the existence of the post-treatment paralysis syndrome is clinically well documented for pancuronium [1,6], we developed an experimental animal model in an attempt to resemble the conditions in the ICU. With this model we studied the effects of prolonged administration of high-dose pancuronium on neuromuscular function and its pharmacokinetics.…”

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confidence: 99%

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Prolonged Paralysis After Long-Term, High-Dose Infusion of Pancuronium in Anaesthetized Cats

Henning¹,

Houwertjes²,

Scaf³

et al. 1993

British Journal of Anaesthesia

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We have studied the neuromuscular effects of a 48-h infusion of high-dose pancuronium (400 micrograms kg-1 h-1) in four cats anaesthetized with pentobarbitone, using contraction of tibialis anterior muscles after direct and indirect stimulation. After cessation of the pancuronium infusion, prolonged paralysis existed. The first twitch in the train-of-four stimuli (TOF) reappeared 8-12 h after termination of the pancuronium infusion. Twenty-four hours after termination of the infusion, TOF ratios were less than 0.08 and twitch contraction averaged 39 (SE 8)% of initial values. Twitch contraction after direct stimulation did not differ from initial values. Antagonism of paralysis was accomplished with neostigmine 60 micrograms kg-1 in two animals and neostigmine 90 micrograms kg-1 and 4-aminopyridine 500 micrograms kg-1 in the others. Steady-state plasma concentration of pancuronium (2000 ng ml-1) decreased rapidly after termination of the infusion, but then stabilized at about 130 ng ml-1. These results indicate that prolonged paralysis after long-term administration of high-dose pancuronium is caused primarily by failure of neuromuscular transmission, most likely caused by the persistent plasma concentrations of the drug in the pharmacologically active range.

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Acute Myopathy during Treatment of Status Asthmaticus with Corticosteroids and Steroidal Muscle Relaxants

Griffin

Fairman

Coursin

et al. 1992

Chest

169

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A National Survey on the Practice Patterns of Anesthesia Intensivists in the Use of Muscle Relaxants

Cited by 3 publications

References 0 publications

Prolongierte Muskelschwäche des Intensivpatienten unter besonderer Berücksichtigung der sog. Intensiv-Polyneuromyopathie

Prolongierte Muskelschwäche des Intensivpatienten unter besonderer Berücksichtigung der sog. Intensiv-Polyneuromyopathie

Prolonged Paralysis After Long-Term, High-Dose Infusion of Pancuronium in Anaesthetized Cats

Acute Myopathy during Treatment of Status Asthmaticus with Corticosteroids and Steroidal Muscle Relaxants

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