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Published on: April 12, 2011
Neuromuscular-blocking drugs. Use and misuse in the intensive care unit
1Department of Anesthesiology, Northwestern University, Evanston Northwestern Healthcare, Evanston, Illinois, USA.
Critical Care Clinics
|January 5, 2002
Summary
Prolonged use of neuromuscular-blocking agents (NMBAs) in critically ill patients risks complications. Use NMBAs judiciously, with clear indications, appropriate monitoring, and adequate sedation/analgesia to optimize patient care and outcomes.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Pharmacology
Background:
- Prolonged administration of neuromuscular-blocking agents (NMBAs) in critically ill patients is linked to significant complications.
- NMBAs are essential in specific clinical scenarios but require careful management to mitigate risks.
Purpose of the Study:
- To review the potential complications associated with NMBA use in intensive care units (ICUs).
- To provide guidance on the appropriate and safe use of NMBAs in critical care settings.
Main Methods:
- Literature review and synthesis of current evidence regarding NMBA complications and management.
- Emphasis on clinical evaluation, peripheral nerve monitoring, and risk factor identification.
Main Results:
- Extended NMBA use (>24-48 hours) is associated with myopathies, neuropathies, and neuromuscular junction alterations.
- Risk factors such as sepsis and high-dose steroid use increase susceptibility to these complications.
- Optimal patient care necessitates clear indications, minimal effective doses, and concurrent sedation/analgesia.
Conclusions:
- Judicious use of NMBAs, guided by clinical assessment and monitoring, is crucial.
- Awareness of risk factors and potential complications can guide avoidance or modification of NMBA therapy.
- Early recognition and management of iatrogenic neuromuscular complications may improve patient outcomes.
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