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Related Concept Videos

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

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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...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics

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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...
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Depolarizing Blockers: Mechanism of Action01:28

Depolarizing Blockers: Mechanism of Action

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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...
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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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...
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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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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...
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Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
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Neuromuscular blocking agents in the intensive care unit.

Jonathan Rodríguez-Blanco1, Tomás Rodríguez-Yanez2, Jesús Daniel Rodríguez-Blanco3

  • 1Divission of Pain Medicine, Department of Anesthesiology, University of Antioquia, Medellin, Colombia.

The Journal of International Medical Research
|September 29, 2022
PubMed
Summary

Neuromuscular blocking agents (NMBA) are controversial for critically ill patients, lacking evidence for routine intensive care unit use. If used, monitoring is crucial to prevent complications and residual effects.

Keywords:
Neuromuscular blocking agentintensive care unitmuscle weaknesspost-tetanic countreviewtrain of four

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Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Neuromuscular Physiology

Background:

  • Neuromuscular blocking agents (NMBA) present a debated therapeutic choice for critically ill individuals.
  • Evidence does not currently support the widespread, routine administration of NMBA in intensive care units (ICUs).
  • The use of NMBA is associated with potential risks and complications if not carefully managed.

Purpose of the Study:

  • To review the established indications for utilizing NMBA in critical care settings.
  • To discuss the available methods and tools for monitoring neuromuscular blockade in the ICU.
  • To highlight the need for further research to guide NMBA application in critical care.

Main Methods:

  • This study employed a narrative review methodology.
  • Literature search focused on current indications and monitoring techniques for NMBA in critically ill patients.
  • Analysis of existing evidence regarding NMBA efficacy and safety in the ICU.

Main Results:

  • The routine use of NMBA in ICUs is not supported by current evidence.
  • Effective monitoring protocols are essential to mitigate risks such as residual neuromuscular blockade and adverse events.
  • Specific indications for NMBA use exist but require careful consideration.

Conclusions:

  • NMBA are not benign and should not be routinely used in critically ill patients.
  • Implementing robust monitoring is imperative when NMBA are deemed necessary.
  • Further prospective studies are warranted to better define the role and optimal use of NMBA in critical care.