Adverse Effects of Neuromuscular Blocking Drugs

Hunter, Jennifer M.

doi:10.1093/bja/59.1.46

Cited by 36 publications

(12 citation statements)

References 140 publications

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“…Although histamine release can cause hypotension and bronchospasm, histamine effects can be minimized by slow drug administration and by pretreatment with H 1 and H 2 blockers. [190][191][192][193] Malignant hyperthermia is a rare genetic disorder that can be precipitated by use of neuromuscular blocking agents usually in combination with an inhalational anesthetic. 194,195 The mechanism of malignant hyperthermia is unknown but involves abnormal cellular calcium metabolism.…”

Section: Cautionsmentioning

confidence: 99%

Analgesia, Sedation, and Therapeutic Paralysis in the Critically Ill

Wheeler¹

1997

Semin Respir Crit Care Med

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Section: Cautionsmentioning

confidence: 99%

Analgesia, Sedation, and Therapeutic Paralysis in the Critically Ill

Wheeler¹

1997

Semin Respir Crit Care Med

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“…Postoperative muscle pain is common, and hyperkalemia and increased intraocular and intragastric pressure may occur. 4 The drug may also trigger malignant hyperthermia, a rare but potentially fatal muscle disorder. 5…”

Section: Depolarizing Neuromuscular Blocking Drugsmentioning

confidence: 99%

New Neuromuscular Blocking Drugs

Hunter

1995

N Engl J Med

146

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The new nondepolarizing neuromuscular blocking drugs have specific advantages over succinylcholine. Rocuronium has an onset of action that is almost as rapid as that of succinylcholine and may be useful in patients with residual gastric contents. This drug may replace vecuronium, since the two agents are otherwise similar. The onset of action of mivacurium is similar to that of atracurium, but recovery from the blockade is more rapid (if the plasma cholinesterase level is normal), making mivacurium useful for short procedures. Although pipecuronium and doxacurium have minimal effects on the cardiovascular system, their long and variable onset and duration of action limit their usefulness. The need for either drug is questionable. There is still a need, however, for a nondepolarizing drug that has an onset of action as rapid as that of succinylcholine but a duration of action similar to that of mivacurium, with no adverse cardiovascular effects and clearance from the body that is independent of organ function.

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“…The preferred paralytics are the non-depolarizing agents, vecuronium and atracurium, which have minimal cardiac toxicity. A potential disadvantage of atracurium is that at high doses it can result in histamine release and worsened bronchospasm [84]. Other potential side effects of paralysis include in increased risk of venous thromboembolism and severe intensive care unit myopathy.…”

Section: Sedation and Paralysismentioning

confidence: 99%

Medical and ventilatory management of status asthmaticus

1998

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Despite improved understanding of the basic mechanisms underlying asthma, morbidity and mortality remain high, especially in the "inner cities." The treatment of choice in status asthmaticus includes high doses of inhaled beta 2-agonists, systemic corticosteroids, and supplemental oxygen. The roles of theophylline and anticholinergics remain controversial, although in general these agents appear to add little to the bronchodilator effect of inhaled beta-agonists in most patients. Anti-leukotriene medications have not yet been evaluated in acute asthma. Other therapies, such as magnesium sulfate and heliox, have their advocates but are not recommended as part of routine care. If pharmacological therapy does not reverse severe airflow obstruction in the asthmatic attack, mechanical ventilation may be temporarily required. Based on our current understanding of ventilator-induced lung injury, optimal ventilation of asthmatic patients avoids excessive lung inflation by limiting minute ventilation and prolonging expiratory time, despite consequent hypercapnia. Unless respiratory function is extremely unstable, the use of paralytic agents is discouraged because of the increased risk of intensive care myopathy. Patients who have suffered respiratory failure due to asthma are at increased risk for subsequent death due to asthma (14% mortality at 3 years) and should receive very close medical follow-up. In general, severe asthmatic attacks can best be prevented by early intervention in the outpatient setting. In the words of Dr. Thomas Petty, "... the best treatment of status asthmaticus is to treat it three days before it occurs".

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Adverse Effects of Neuromuscular Blocking Drugs

Cited by 36 publications

References 140 publications

Analgesia, Sedation, and Therapeutic Paralysis in the Critically Ill

Analgesia, Sedation, and Therapeutic Paralysis in the Critically Ill

New Neuromuscular Blocking Drugs

Medical and ventilatory management of status asthmaticus

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