The role of nondepolarizing neuromuscular blocking agents in mechanically ventilated patients

Prolonged use of the nondepolarizing neuromuscular blocking agents in the critical care setting has greatly increased in the recent past. Accompanying the increased use of these agents are numerous accounts of long-lasting adverse outcomes such as muscular atrophy and neuropathy that can be attributed to pharmacologic paralysis. There has been a financial impact on hospitals as well. Responding to these facts, the medical staff at the Medical College of Georgia Hospital and Clinics recently approved guidelines for the use of nondepolarizing neuromuscular blocking agents in the intensive care setting. These guidelines recommend clinical indications for these agents and dosing ranges reflecting current medical opinion.