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Resistance to nondepolarizing neuromuscular blocking agents
S J Tschida1, K J Graupe, L L Hoey
1College of Pharmacy, University of Minnesota, Minneapolis, USA.
Pharmacotherapy
|May 1, 1996
Summary
Resistance to nondepolarizing neuromuscular blocking agents (NNMBAs) can occur in critically ill patients, leading to adverse outcomes and increased costs. Understanding the causes of NNMBAs resistance is crucial for effective patient management.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Anesthesiology
Background:
- Nondepolarizing neuromuscular blocking agents (NNMBAs) are used for paralysis in critical care.
- Resistance to NNMBAs has been reported in surgical and critical care settings.
- Prolonged paralysis therapy in critically ill patients may be associated with NNMBAs resistance.
Purpose of the Study:
- To review the phenomenon of NNMBAs resistance in critically ill patients.
- To discuss potential adverse outcomes and pharmacoeconomic implications of NNMBAs resistance.
- To explore potential pharmacodynamic and pharmacokinetic etiologies of NNMBAs resistance.
Main Methods:
- Literature review of case reports and studies on NNMBAs resistance.
- Analysis of potential contributing factors to resistance, including disease states and drug interactions.
- Discussion of physiological alterations affecting drug response.
Main Results:
- NNMBAs resistance can lead to inadequate ventilation and patient movement suppression.
- Resistance may increase the risk of dose-dependent cardiovascular adverse effects.
- Significant pharmacoeconomic burden associated with treating resistant patients.
Conclusions:
- The exact causes of NNMBAs resistance are not fully understood.
- Pharmacodynamic alterations (e.g., acetylcholine receptor changes) and pharmacokinetic changes (e.g., altered clearance) may contribute to resistance.
- Further research is needed to elucidate the mechanisms and optimize management strategies for NNMBAs resistance.
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