Sedation and neuromuscular blockade in paediatric intensive care: a review of current practice in the UK

Playfor, Stephen; Thomas, David A.; Choonara, Imti

doi:10.1046/j.1460-9592.2003.00989.x

Cited by 59 publications

(43 citation statements)

References 13 publications

(12 reference statements)

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“…[3][4][5] In the United Kingdom, 31% of critically ill children are likely to receive NBDs, but the depth of the blockade is routinely assessed in only 16% of patients. 2 Results of a recent survey 4 indicated that only 22% of Canadian ICUs use standardized protocols for NBD application and that 16% of all Canadian intensive care providers do not use neuromuscular transmission monitoring at all. Absence of neuromuscular transmission monitoring during repetitive administration of NBDs may be a patient safety issue, because partial paralysis is difficult to detect without neuromuscular transmission monitoring 6 and has been known to persist more than 72 h in critically ill patients.…”

Section: Methodsmentioning

confidence: 99%

Clinical Predictors of Duration of Action of Cisatracurium and Rocuronium Administered Long-Term

Faßbender

Geldner

Blobner

et al. 2009

American Journal of Critical Care

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BackgroundThe duration of action of neuromuscular blocking drugs (NBDs) varies between individuals and even within individuals in different settings. Objectives To define predictors of variance in duration of action of rocuronium and cisatracurium administered long-term. Methods A prospective, double-blind, multicenter trial that included 113 patients scheduled for major abdominal surgery and postoperative admission to the intensive care unit. Patients received repetitive (median, 7) equipotent doses of rocuronium or cisatracurium to maintain deep relaxation (twitch height of the adductor pollicis muscle <25% of baseline). Effects of weight, age, sex, American Society of Anesthesiologists risk score, lowest core temperature, duration of NBD administration, and tobacco smoking history on duration of action of cisatracurium and rocuronium were determined via multiple regression analysis. Results Only duration of NBD administration was predictive of the duration of action of rocuronium. The predicted increase in time to recovery of the train-of-4 ratio to 0.9 (duration TOF 0.9) per hour of continuous NBD treatment was 12.4 minutes. In contrast, only lowest core body temperature was predictive of cisatracurium's duration of action, and the predicted in crease in duration TOF 0.9 per degree Celsius decrease was 9.8 min. Conclusion Duration of NBD treatment is strongly predictive of the duration of action of rocuronium, and body temperature is predictive of the duration of action of cisatracurium. These data may help decrease the incidence of drug-induced muscle weakness in recovery rooms and surgical intensive care units, particularly if neuromuscular transmission monitoring is not available.

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Section: Methodsmentioning

confidence: 99%

Clinical Predictors of Duration of Action of Cisatracurium and Rocuronium Administered Long-Term

Faßbender

Geldner

Blobner

et al. 2009

American Journal of Critical Care

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“…Peripheral nerve stimulation may be used to assess the level of neuromuscular blockade, and routine daily discontinuation of the drug can help monitor likely time to recovery. A survey of the UK paediatric intensive care practice suggested 16 % (range 0-60 %) of children receiving neuromuscular blockers would have routine monitoring using a peripheral nerve stimulator (Playfor et al 2003 ). Only 38 % of units reported using temporary discontinuation of paralysis to assess neuromuscular recovery (Playfor et al 2003 ).…”

Section: Assessing Adequacymentioning

confidence: 99%

Sedation, Analgesia and Neuromuscular Blockade in the Neonatal ICU

Boyle

Anand

2014

Pediatric and Neonatal Mechanical Ventilation

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“…The main indications for use of sedatives include reducing anxiety and agitation, inducing amnesia, facilitating mechanical ventilation, preventing displacement of endotracheal tubes, and reducing cellular metabolism. [64][65][66][67][68] The consequences of prolonged use of sedative agents in the PICU www.ajcconline.org Pressure injuries remain a common problem in critically ill infants and children.…”

Section: Sedationmentioning

confidence: 99%