[Paralysis after long-term administration of neuromuscular blocking agents]

Paralysis after long-term administration of neuromuscular blocking agents especially pancuronium and vecuronium has been reported since 1970's. In this article, these papers were reviewed, and the etiology and the clinical features were analyzed. Most of the cases of muscle paralysis after prolonged use of pancuronium bromide were associated with concomitant use of large doses of steroids. In these cases, steroid myopathy and disuse atrophy have been implicated with causes of the paralysis. In patients with impaired hepatic and/or renal functions, metabolites of neuromuscular blocking agents might accumulate. In some patients with paralysis after neuromuscular blocking agents, underlying neuromuscular complications such as critical illness polyneuropathy have been implicated with the cause of the muscle paralysis. In order to avoid paralysis after long-term administration of neuromuscular blocking agents, following recommendations are made. 1) Monitor neuromuscular blockade. 2) Examine patient's neuromuscular status before starting to give relaxants. 3) Be careful in giving relaxants in patients with poor renal and/or hepatic functions. 4) Use smallest possible amount of relaxant. 5) Be careful about the drugs administered simultaneously especially steroids and antibiotics. 6) During the use of a neuromuscular blocking agent, perform physical therapy of extremities to avoid disuse atrophy especially when its administration is temporally terminated.