Monitoring neuromuscular blockade in the adult ICU

Although neuromuscular blocking agents are now administered in intensive care units for extended periods, no standard has been established for their use in critically ill patients. Also, despite wide variations in individual response to neuromuscular blockade, the level of paralysis is not monitored consistently. Paralytic agents are associated with numerous side effects such as prolonged weakness, which is gaining widespread attention. Side effects may be minimized or prevented by consistent and precise monitoring of the degree of blockade. Monitoring is best accomplished by the expert use of the peripheral nerve stimulator. The evoked responses must be correlated with clinical signs of muscle movement. Furthermore, staff education regarding the pharmacology of these agents and the proper operation of the peripheral nerve stimulator must be ongoing.