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[Neuromuscular blockade monitoring. Part 1]
J J Ariño-Irujo1, A Calbet-Mañueco, P A De la Calle-Elguezabal
1Servicio de Anestesiología, Reanimación, Hospital Clínico San Carlos, Madrid. jarinoirujo@yahoo.es
Revista Espanola De Anestesiologia Y Reanimacion
|April 29, 2010
Summary
Quantitative neuromuscular monitoring is crucial for preventing residual block after surgery. This evidence-based practice ensures appropriate patient recovery and guides the use of reversing agents, improving surgical outcomes.
Area of Science:
- Anesthesiology and critical care medicine.
- Neuroscience and pharmacology.
Context:
- Residual neuromuscular block is common despite using intermediate-acting nondepolarizing neuromuscular blockers.
- Effective neuromuscular monitoring is essential for safe surgical practice.
Purpose:
- To review the physiology of neuromuscular junctions.
- To outline principles of nerve stimulation and clinical monitoring.
- To emphasize the importance of quantitative neuromuscular monitoring.
Summary:
- The review covers neuromuscular junction physiology, nerve stimulation, and monitoring techniques.
- It highlights the high incidence of residual block and the benefits of quantitative monitoring.
- Literature up to December 2008 was reviewed, focusing on case series and reviews.
Impact:
- Promotes evidence-based practice for neuromuscular monitoring.
- Aims to reduce the incidence of residual neuromuscular block.
- Enhances patient safety and recovery by guiding anesthetic management and reversal agents.
Related Concept Videos
01:27Nondepolarizing (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...
Although all competitive neuromuscular blockers are designed...
01:29Neuromuscular Junction And Blockade
The site of chemical communication between a motor neuron and a muscle fiber is called the neuromuscular junction (NMJ). The end of the motor neuron at the NMJ divides into a cluster of synaptic end bulbs. The cytoplasm of these bulbs consists of synaptic vesicles enclosing acetylcholine molecules, the principal neurotransmitter released at the NMJ. The region opposite the synaptic bulb that ends in the muscle fiber is called the motor end plate, which has acetylcholine receptors. Within the...
01:11Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics
All neuromuscular blocking agents are injected intravenously because they are poorly absorbed from the GI tract. Rapid onset is achieved with intravenous administration, although absorption is also adequate from an intramuscular injection. Since these agents are highly ionized, they do not readily penetrate cell membranes or cross the blood-brain barrier.
Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
01:17Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action
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Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
01:28Depolarizing 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.
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