Residual Neuromuscular Blockade in Critical Care

Abstract

<jats:p>Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.</jats:p>

Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure

“…22 In addition to the therapeutic effects, reviews and continuing education modules on NMBAs also highlight the importance of nursing competency in drug pharmacokinetics, selection of patients and agents, adverse effects, and titration. 16,[23][24][25] Unfortunately, we are unaware of published studies measuring such knowledge. In our study, ICU nurses commonly misidentified the correct mechanism of drug elimination, perceived durations of action of NMBAs varied widely, and certain adverse effects were underrecognized.…”

Residual Neuromuscular Blockade in the Critical Care Setting

“…15 For example, inhaled nitrous oxide has the potential to reduce the effective dose of rocuronium by 50%. 15 Local anesthetizing agents can enhance the effect of a paralytic.…”

“…15 For example, inhaled nitrous oxide has the potential to reduce the effective dose of rocuronium by 50%. 15 Local anesthetizing agents can enhance the effect of a paralytic. For example, vecuronium will linger in the system longer in a patient who has an epidural for pain management that includes a local anesthetic medication such as mepivacaine.…”

“…For example, vecuronium will linger in the system longer in a patient who has an epidural for pain management that includes a local anesthetic medication such as mepivacaine. 15 Antibiotics, such as aminoglycosides, stop the release of ACh from the presynaptic neuron, thus delaying muscle contraction. 15 Magnesium, given frequently in the cardiovascular population, will slow the onset of a NMB.…”

“…15 Antibiotics, such as aminoglycosides, stop the release of ACh from the presynaptic neuron, thus delaying muscle contraction. 15 Magnesium, given frequently in the cardiovascular population, will slow the onset of a NMB. Magnesium counteracts the opening of calcium channels, which are necessary for discharge of ACh into the synapse and subsequent muscle contraction.…”