Articles: neuromuscular-blocking-agents-adverse-effects.
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A 51-year-old woman was admitted to the intensive care unit for exacerbation of chronic obstructive pulmonary disease. She received antibiotics, neuromuscular blocking agents, and steroids. ⋯ Her weakness rapidly improved within 1 month after treatment of her hyperthyroidism with iodine-131 and methimazole. The metabolic alterations associated with hyperthyroidism may enhance the risk of developing critical illness myopathy after the administration of antibiotics, neuromuscular blocking agents, and steroids in the intensive care unit.
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Curr Allergy Asthma Rep · Jan 2004
Review Comparative StudyAdverse reactions to neuromuscular blocking agents.
Neuromuscular blocking agents (NMBAs) play a predominant role in the incidence of severe adverse reactions occurring during anesthesia. Most hypersensitivity reactions are of immunologic origin (IgE-mediated) or are related to direct stimulation of histamine release. The incidence of IgE-mediated hypersensitivity or anaphylaxis is estimated between 1 in 10,000 and 1 in 20,000 anesthesias, and NMBAs represent the most frequently involved substances, with a range of 50% to 70%. ⋯ This should help provide documented advice for future administration of anesthesia. There is no demonstrated evidence for systematic preoperative screening in the general population at this time. Other well-known adverse effects have been described, such as the succinylcholine-triggered cytotoxic effects on muscle cells, but these are responsible for characteristic clinical symptoms, which are usually easy to distinguish from anaphylactic reactions
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Acta Anaesthesiol Belg · Jan 2004
ReviewPostoperative residual curarisation: complication or malpractice?
Neuromuscular blocking drugs are often used in anaesthesia; in some types of surgery, their continuous infusion is indicated to limit the otherwise high incidence of movement. A large amount of postoperative residual curarisation is found after a single bolus, but more especially when continuous infusions are used in healthy patients and even more so in those with organ dysfunction or undergoing special types of surgery. Therefore, one should always optimise the dose requirements over time using neuromuscular transmission monitoring. ⋯ At present, then, the only objective and reliable guide to facilitating the decision for selective antagonisation is the neuromuscular transmission monitor. Recent data and editorials warning about postoperative residual curarisation after boluses and infusions of neuromuscular blocking drugs have made residual curarisation one of the most feared complications in anaesthesia. There may be a consequent issue of malpractice if neuromuscular transmission monitoring is not used and/or pharmacological antagonisation is not performed.