Neurologic function and neuromuscular blocking agents in critical care

Neuromuscular blocking agent (NMBA) use in critical care units is generally reserved for life threatening situations. The goal of any life-support effort, including efficient mechanical ventilation, maintenance of hemodynamic stability, and NMBA use, is to optimize cerebral preservation. Yet, although all other organ systems are aggressively monitored, very little is done to assess neurologic stability during NMBA therapy. This article addresses the neurologic issues associated with NMBA use: identification of those patients at risk for a neurologic event; rationale for monitoring cerebral changes during paralytic therapy; and potential means of assessing and intervening before, during, and after chemical paralysis.