Semin Respir Crit Care Med 2001; 22(2): 175-188
DOI: 10.1055/s-2001-13831
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Neuromuscular Blockade in the Intensive Care Unit

Lynne C. Gehr1 , Curtis N. Sessler2
  • 1Department of Anesthesiology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia and
  • 2Division of Pulmonary and Critical Care Medicine, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

Neuromuscular blocking agents (NMBA) are frequently utilized in the ICU, primarily to facilitate mechanical ventilation. An ideal NMBA is nondepolarizing, has no propensity to accumulate, is easily titrated, has a rapid onset and offset, does not rely on organ function for metabolism, and has no toxic or active metabolites. Current NMBAs are classified as aminosteroids or benzylisoquinoliniums and have different features, but none are ideal. Selection of the best NMBA is determined by individual patient characteristics. Proper use of these agents includes a comprehensive plan to manage all aspects of care affected by NMBA, as well as monitoring of clinical effect and degree of neuromuscular blockade via periodic peripheral nerve stimulation. There are well-recognized complications of NMBA, including prolonged drug effect and acute quadriplegic myopathy. The latter condition can result in prolonged rehabilitation. The use of an NMBA can be essential for the successful outcome from critical illness; however, cautious use of these agents with a structured approach to minimize complications is urged.

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