Articles: neuromuscular-blocking-agents-adverse-effects.
-
AACN clinical issues · Feb 1998
ReviewAdverse responses to analgesia, sedation, and neuromuscular blocking agents in infants and children.
Analgesics, sedation, and neuromuscular blocking agents are commonly used in treating critically ill infants and children. Although these medications are beneficial and imperative to the care of the child, their use is not risk free. Adverse responses occur in these children. With improved methods for use and monitoring, adverse responses can be minimized.
-
Many anaesthetic drugs and adjuvants can cause the release of histamine by chemical (anaphylactoid) or immunologic (anaphylactic) mechanisms. While both types of reactions can be clinically indistinguishable, they are mechanistically different. In anaphylactoid reactions, only preformed mediators are released, of which histamine may be the most clinically important. ⋯ Anaphylactoid reactions may occur commonly under anaesthesia in response to many drugs, including induction agents, some opiates, plasma expanders, and curariform relaxants. Anaphylactic reactions are far less common than anaphylactoid reactions, but they nevertheless represent more than half of the life-threatening reactions that occur in anaesthetic practice. Muscle relaxants are the most frequently implicated class of drugs; suxamethonium is the most common agent implicated in anaphylactic reactions during anaesthesia, but even drugs without apparent chemical histamine release (i.e., vecuronium) are frequently implicated in anaphylactic reactions.
-
Review
Persistent paralysis in critically ill patients after the use of neuromuscular blocking agents.
Neuromuscular blocking agents (NMBAs), an important part of the pharmacologic armamentarium of the intensivist, have a long and admirable history of safety when used in the operating room for periods of time (almost always < 12 hrs). Since 1985, dozens of medical journals have reported a multitude of studies on persistent paralysis when these same agents are exported from the operating room to the ICU. Most of these reports are case presentations of patients who failed to move for days to weeks after discontinuation of NMBAs. ⋯ This article sorts through the issues surrounding persistent paralysis, and defines it as a short-term and a long-term problem. The short-term problem seems to have a pharmacologic explanation that is not difficult to correct. The long-term problem is much more complex and may have a toxic explanation that may also be more difficult to manage.
-
Ventilatory failure after administration of neuromuscular blocking agents is an important factor in anaesthesia-related perioperative morbidity and mortality. Improved knowledge and new monitoring methods may avoid ventilatory failure caused by incomplete recovery of neuromuscular function in the postoperative period. Central respiratory muscles are less sensitive than, and their time course of neuromuscular block is different from those of, pharyngeal muscles and those of the upper airway. ⋯ Hence, partial paralysis may interfere with ventilatory regulation in hypoxaemia. Consequently, monitoring neuromuscular function by peripheral nerve stimulation in one muscle yields limited information about total ventilatory capacity, especially the function of the upper airway and ventilatory regulation. Therefore, neuromuscular monitoring should be used with caution during recovery and should always be combined with bedside clinical tests if possible.
-
Vet. Clin. North Am. Small Anim. Pract. · Mar 1992
ReviewDisadvantages of neuromuscular blocking agents.
Neuromuscular blocking agents have few indications and significant contraindications or problems associated with their use. The need for controlled ventilation and the difficulties of monitoring anesthetic depth when using neuromuscular blocking agents are overriding factors that mitigate against their routine use.