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Related Concept Videos

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Depolarizing Blockers: Mechanism of Action01:28

Depolarizing Blockers: Mechanism of Action

Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...

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Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
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Consensus guidelines for sustained neuromuscular blockade in critically ill children.

Stephen Playfor1, Ian Jenkins, Carolyne Boyles

  • 1Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK. stephen.playfor@cmmc.nhs.uk

Paediatric Anaesthesia
|August 9, 2007
PubMed
Summary

This study provides the first consensus guidelines for neuromuscular blockade in critically ill children, addressing a gap in pediatric intensive care. Further research is needed due to limited high-quality evidence.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Practice Guidelines

Background:

  • Established adult guidelines exist for neuromuscular blockade in critical care.
  • No prior clinical practice guidelines were available for critically ill pediatric patients.

Framework:

  • A multidisciplinary expert panel, the UK Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group, was formed.
  • Consensus guidelines were developed for sedation, analgesia, and neuromuscular blockade.

Implementation:

  • A modified Delphi technique was utilized for anonymous deliberation on draft recommendations.
  • Four consensus conferences supported the Delphi process, followed by a systematic literature review.

Implications:

  • Developed consensus guidelines for maintenance neuromuscular blockade in critically ill children (excluding neonates).
  • Highlighted the scarcity of high-quality evidence, emphasizing the need for future randomized clinical trials.