Abstract
Understand the pharmacokinetics and pharmacodynamics of various neuromuscular blocking (NMB) agents. Understand the complications associated with the prolonged use of NMB agents in the critically ill patient and how to minimize them. Recognize the potential for interaction among commonly used drugs and NMB agents. Make recommendations regarding the use and dose of NMB agents in the critically ill. Understand the need for routine and effective sedation and analgesia in the critically ill patient receiving NMB agents in order to prevent awareness and pain. Understand the need for evaluation and monitoring of neuromuscular function in the critically ill patient receiving NMB agents.
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Additional Reading
Murray M, Cowen J, DeBlock H et al (2002) Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 30:142–156
Arroliga A, Frutos-Vivar F et al (2005) Use of sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation. Chest 128:496–506
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Ballard N, Robley L et al (2006) Patient’s recollection of therapeutic paralysis in the intensive care unit. Am J Crit Care 16:86–95
Barohn RJ, Jackson CE, Rogers SJ et al (1994) Prolonged paralysis due to nondepolarizing neuromuscular blocking agents and corticosteroids. Muscle Nerve 17:647–654
Caldwell JE, Szenohradszky J, Segredo V et al (1994) The pharmacodynamics and pharmacokinetics of the metabolite 3-desacetylvecuronium (ORG 7268) and its parent compound, vecuronium, in human volunteers. JPET 270:1216–1222
Gooch JL (1995) AAEM case report #29: prolonged paralysis after neuromuscular blockade. Muscle Nerve 18:937–942
Hoyt JW (1994) Persistent paralysis in critically ill patients after the use of neuromuscular blocking agents. New Horiz 2:48–55
Lee C (1995) Intensive care unit neuromuscular syndrome? AnesÂthesiology 83:237–240
Lopez DM, Singer LP, Weingarten-Arams JS et al (1999) Use of neuromuscular blocking agents and sedation in pediatric patients and associated prolonged neuromuscular weakness. Pharm Ther 24: 290–296
Martyn JAJ, White DA, Gronert GA et al (1992) Up-and-down regulation of skeletal muscle acetylcholine receptors. Anesthesiology 76:822–843
Rich MM, Teener JW, Raps EC et al (1996) Muscle is electrically inexcitable in acute quadriplegic myopathy. Neurology 46: 731–736
Standaert FG (1994) Doughnuts and holes: molecules and muscle relaxants. Semin Anesth 13:286–96
Tsukagoshi H, Morita T, Takahashi K et al (1999) Cecal ligation and puncture peritonitis model shows decreased nicotinic acetylÂcholine receptor numbers in rat muscle. Anesthesiology 91:448–460
Wagner BKJ, Zavotsky KE, Sweeney JB et al (1998) Patient recall of therapeutic paralysis in a surgical critical care unit. PharmaÂcotherapy 18:358–363
Watling SM, Dasta JF (1994) Prolonged paralysis in intensive care unit patients after the use of neuromuscular blocking agents: a review of the literature. Crit Care Med 22:884–893
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Barnette, R.E., Kamel, I.R., Fermin, L., Criner, G.J. (2010). Use of Neuromuscular Blocking Agents in the Intensive Care Unit. In: Criner, G., Barnette, R., D'Alonzo, G. (eds) Critical Care Study Guide. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77452-7_58
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DOI: https://doi.org/10.1007/978-0-387-77452-7_58
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