Neuromuscular blocking agents in the intensive care unit

Rodríguez-Blanco, Jonathan; Yánez, Tomás Rodríguez; Rodríguez-Blanco, Jesús Daniel; Almanza‐Hurtado, Amilkar; Martínez‐Ávila, María Cristina; Borré-Naranjo, Diana; Caballero, María Camila Acuña; Dueñas-Castell, Carmelo

doi:10.1177/03000605221128148

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…Critically ill patients often have multi-organ-system disorders and receive treatments for longer periods; thus, the elimination of NMBAs and metabolites can be delayed, resulting in greater accumulation [4,35] and adverse events, difficulty in weaning from the ventilator [36], and the risk of venous thrombosis [26].…”

Section: General Advantages and Disadvantages Of Using Nmbas In Criti...mentioning

confidence: 99%

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Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases

Iavarone,

Al-Husinat,

Vélez-Páez

et al. 2024

JCM

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The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to optimize mechanical ventilation, prevent spontaneous respiratory efforts, reduce the work of breathing and oxygen consumption, and avoid patient–ventilator asynchrony. In patients with acute respiratory distress syndrome (ARDS), NMBAs reduce the risk of barotrauma and improve oxygenation. Nevertheless, current guidelines and evidence are contrasting regarding the routine use of NMBAs. In status asthmaticus and acute exacerbation of chronic obstructive pulmonary disease, NMBAs are used in specific conditions to ameliorate patient–ventilator synchronism and oxygenation, although their routine use is controversial. Indeed, the use of NMBAs has decreased over the last decade due to potential adverse effects, such as immobilization, venous thrombosis, patient awareness during paralysis, development of critical illness myopathy, autonomic interactions, ICU-acquired weakness, and residual paralysis after cessation of NMBAs use. The aim of this review is to highlight current knowledge and synthesize the evidence for the effects of NMBAs for critically ill patients with lung diseases, focusing on patient–ventilator asynchrony, ARDS, status asthmaticus, and chronic obstructive pulmonary disease.

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Section: General Advantages and Disadvantages Of Using Nmbas In Criti...mentioning

confidence: 99%

“…Neuromuscular monitoring is indispensable for optimal management of NMBAs [35]. A peripheral nerve stimulator was introduced in the 1950s and is useful for monitoring neuromuscular blockade.…”

Section: Monitoring Of Neuromuscular Blockade and Adequacy Of Sedationmentioning

confidence: 99%

Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases

Iavarone,

Al-Husinat,

Vélez-Páez

et al. 2024

JCM

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Organophospate-Induced Pathology: Mechanisms of Development, Principles of Therapy and Features of Experimental Studies

Goncharov,

Belinskaia,

Avdonin

2023

J Evol Biochem Phys

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Organophospate-Induced Pathology: Mechanisms of Development, Principles of Therapy and Features of Experimental Studies

Goncharov,

Belinskaia,

Avdonin

2023

Rossijskij fiziologičeskij žurnal im. I.M. Sečenova

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Organophosphates (OP) are one of the most common neurotoxic xenobiotics. In acute OP poisoning, as a result of suppression of synaptic acetylcholinesterase (AChE) activity, a cholinergic syndrome develops, which can transform into status epilepticus. Within a few days after acute poisoning, the so-called an intermediate syndrome can develop, which is associated with prolonged inhibition of AChE, desensitization of nicotinic receptors, and functional degradation of synapses and muscle fibers. In 10–20 days after a single acute or repeated subacute poisoning, OP-induced delayed polyneuropathy (OPIDN) can develop – a neurodegenerative disease, the signs of which are ataxia, loss of function of the distal sensory and motor axons of peripheral nerves. The occurrence of a neuropsychiatric disorder (NPD) caused by chronic exposure to relatively low-toxicity organophosphorus compounds is usually not associated with acute poisoning; symptoms include cognitive impairment, chronic fatigue, and extrapyramidal symptoms. The list of possible diseases or pathological conditions (syndromes) that develop as a result of acute, subacute or chronic effects of OP on the human body has expanded in recent years due a number of known neurodegenerative diseases (Alzheimer’s, Parkinson’s, multiple sclerosis, etc.). The aging of the body in general and the aging of the brain in particular are considered in the review from the point of view of the consequences of OP poisoning, which can serve as a nonspecific trigger of aging and related neurodegenerative diseases. Gulf syndrome is not a consequence of OP intoxication, but is also of interest and is considered in the context of OP-induced pathology, since its etiology and pathogenesis are associated with the exposure to cholinesterase inhibitors. The review presents data indicating the important role of the vascular endothelium in the development of OP-induced pathology; The first suggestions were made by clinicians in the late 1980s, and the first experimental data were obtained in the early 2000s. The principles of therapy for acute poisoning are outlined, taking into account experimental data from recent years. Some methods for studying OP in experiments in vitro, ex vivo and in vivo with laboratory animals, including the use of carboxylesterase inhibitors, are presented. The most important part of in vivo investigations has been and remains the search for new biomarkers to assess the effectiveness of adjuvant and regenerative therapies.

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Neuromuscular blocking agents in the intensive care unit

Cited by 3 publications

References 40 publications

Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases

Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases

Organophospate-Induced Pathology: Mechanisms of Development, Principles of Therapy and Features of Experimental Studies

Organophospate-Induced Pathology: Mechanisms of Development, Principles of Therapy and Features of Experimental Studies

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