Articles: neuromuscular-blocking-agents-adverse-effects.
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Multicenter Study
Functional recovery after neuromuscular blockade in mechanically ventilated critically ill patients.
An estimated 24% to 70% of individuals have prolonged paralysis or severe weakness after receiving neuromuscular blocking agents (NMBAs) when therapy is terminated. ⋯ Prolonged recovery of muscle activity and extreme weakness may occur despite brisk recovery of NMT after neuromuscular blockade.
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Minerva anestesiologica · Mar 2006
ReviewResidual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period.
The residual effects of neuromuscular blocking agents may persist into the early postoperative recovery period, even when neuromuscular blockade is carefully monitored and reversed in the operating room. Recent data suggest that mild degrees of residual paresis (train-of-four TOF ratios of 0.7-0.9) may be associated with significant impairment of respiratory and pharyngeal muscle function. Therefore, the new gold standard reflecting acceptable neuromuscular recovery is a TOF ratio > or =0.9. ⋯ Several techniques may be used to reduce the risk of postoperative residual paresis, which include avoidance of long-acting muscle relaxants, use of neuromuscular monitoring in the operating room, routine reversal of neuromuscular blockade at a TOF count of 2-3, and early administration of reversal agents. Careful management of neuromuscular blockade may limit the occurrence of adverse events associated with residual postoperative paralysis. Large-scale outcome studies are needed to clearly define the impact of residual neuromuscular block on major morbidity and mortality in surgical patients.
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Comparative Study
Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils.
Immunoglobulin E (IgE)-mediated hypersensitivity reactions to neuromuscular blocking agents (NMBA) are common and life threatening. Basophil activation based upon the expression of CD63 in the presence of specific allergens was found to be of importance for the diagnosis of IgE-mediated hypersensibility. ⋯ Basotest may be useful for the diagnosis of NMBA allergy in patients with a suspicion of recent IgE-mediated hypersensitivity reaction to NMBA.
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Review
[Residual neuromuscular blockades. Clinical consequences, frequency and avoidance strategies].
Even after administration in routine clinical dosages, muscle relaxants can lead to long-lasting residual blockades which increase the risk of severe postoperative pulmonary complications. Even without the additional effects from analgetics, sedatives or anaesthetics, a partial neuromuscular blockade, which cannot reliably be avoided either by the anaesthetist alone or by the additional use of nerve stimulators (train-of-four [TOF] ratio 0.5-0.9), can cause reductions in the vital capacity and the hypoxic breathing response, as well as obstruction of the upper airway and disruption of pharangeal function. ⋯ If the course of a neuromuscular blockade is continually monitored during the whole anaesthetic procedure using the TOF ratio and not only occasionally at the end, a TOF ratio of 1 measured with an acceleromyograph (e.g. TOF-watch) promises an adequate neuromuscular recovery from the effects of muscle relaxants.