Articles: neuromuscular-blocking-agents-adverse-effects.
-
Arch Phys Med Rehabil · Nov 1991
Review Case ReportsRehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids.
Patients with severe status asthmaticus who do not respond to intensive medical therapy are often given neuromuscular blocking agents to facilitate mechanical ventilation. Of 51 consecutive asthmatic patients treated with mechanical ventilation, 27 were treated with neuromuscular blocking agents. Of these 27 patients, all receiving high-dose intravenous steroids, four were noted to develop quadriparesis that was more severe distally. ⋯ They were followed as outpatients until full recovery. Although the exact etiology of the complication is not known, acute steroid myopathy facilitated by the use of neuromuscular blocking agents is a likely cause. Based on the excellent recovery potential of these patients, early rehabilitation in this uncommon complication is strongly urged.
-
Critical care medicine · Sep 1991
Case ReportsProlonged paralysis after treatment with neuromuscular junction blocking agents.
Previous reports have described prolonged paralysis after treatment with neuromuscular junction blocking agents in critically ill patients. The purpose of this study was to further describe a group of patients who developed prolonged weakness after treatment with these agents. ⋯ Although alternative explanations cannot be excluded with certainty, the use of neuromuscular junction blocking agents may lead to neurogenic atrophy and care must be taken when using them.
-
In a retrospective one-year study, we documented respiratory failure or prolonged neuromuscular blockade in eight of 65 patients with chronic renal failure who had received either vecuronium (four of 29 patients) or atracurium (four of 36 patients) during anaesthesia for kidney transplantation. We reviewed the charts of the patients and recorded all aspects of medication and anaesthesia to try to determine whether there might be a single factor associated with this high incidence (12 per cent) of respiratory failure. Anaesthesia for all patients was induced with thiopentone, isoflurane, and N2O/O2. ⋯ Neuromuscular blockade was reversed with edrophonium (0.75-1 mg.kg-1) or neostigmine (0.06-0.08 mg.kg-1). The eight patients with prolonged neuromuscular blockade received ventilatory support for one to three hours after operation. Respiratory failure was significantly more frequent in patients who received cyclosporine (P less than 0.05).
-
Med Toxicol Adverse Drug Exp · Sep 1989
ReviewAdverse reactions and interactions of the neuromuscular blocking drugs.
The adverse reactions seen following administration of neuromuscular blocking agents are mainly cardiovascular. Due to the lack of specificity for the nicotinic receptor at the neuromuscular junction, these agents may interact with receptors in autonomic ganglia and muscarinic receptors in the heart. Furthermore, muscle relaxants may have histamine-releasing properties. ⋯ Precurarisation with a non-depolarising drug prolongs the onset of succinylcholine, and conversely a prolonged effect of non-depolarising drugs is seen following succinylcholine. The effect of succinylcholine is markedly prolonged if the drug is administered during recovery from pancuronium blockade or following neostigmine for reversal. Succinylcholine is hydrolysed by plasma cholinesterase, and drugs which decrease the activity of this enzyme may produce a prolonged block, i.e. contraceptive pills, cyclophosphamide, echothiopate and organophosphate.