Advertisement

Update 1987 pp 462-468 | Cite as

Indications of Muscle Relaxants and Methods of Paralysis Control in the Intensive Care Unit

  • L. Barvais
  • D. Hennart
  • A. d’Hollander
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 3)

Abstract

Neuromuscular blocking agents (NBA) are sometimes used in the Intensive Care Unit (ICU) to facilitate endotracheal intubation and artificial ventilation, to decrease the tone of the striated muscles or to strictly immobilize the patient during technical investigations or therapeutical manoeuvres. These drugs are also of interest in reducing the oxygen consumption in some very critical conditions. To limit some undesirable effects of the NBA, their amount given must be accurately adjusted, according to the real hour by hour and day by day patient’s needs. Moreover, partial or complete paralysis must always be associated with adequate sedation to avoid psychological problems. Prolonged administration of NBA beyond a couple of days remains highly questionable in view of the danger of temporary and sometimes irreversible lesions produced by concomitant use of NBA and other molecules, such as some antibiotics interferring with the neuromuscular junction.

Keywords

Neuromuscular Blockade Neuromuscular Transmission Neuromuscular Blocking Agent Tetanic Stimulation Thumb Adduction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gronert GA, They RA (1975) Pathophysiology of hyperkaliemia induced by succinylchol-ine. Anesthesiology 43:89PubMedCrossRefGoogle Scholar
  2. 2.
    Waud BE, Waud DR (1971) The relation between tetanic fade, and receptor occlusion in the presence of competitive neuromuscular block. Anesthesiology 35:456PubMedCrossRefGoogle Scholar
  3. 3.
    Epstein RA, Wyte SR, Jackson SH, et al (1969) The electromechanical response to stimulation by the block-Aid monitor. Anesthesiology 30:43PubMedCrossRefGoogle Scholar
  4. 4.
    Ali HH, Savarese JJ (1976) Monitoring of neuromuscular function. Anesthesiology 45:216PubMedCrossRefGoogle Scholar
  5. 5.
    Ali HH, Wilson RS, Savarese JJ, et al (1975) The effect of Tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurement in humans. Br J Anaesth 47:570PubMedCrossRefGoogle Scholar
  6. 6.
    Ali HH, Savarese JJ, Lebowitz PW, et al (1981) Twitch, tetanus and train-of-four as indices of recovery from non depolarizing neuromuscular blockade. Anesthesiology 54:294PubMedCrossRefGoogle Scholar
  7. 7.
    Merton PA (1954) Voluntary strength and fatigue. J Physiol (Lond) 123:553Google Scholar
  8. 8.
    Desmedt JE, Godaux E (1977) Ballistic contractions in man: characteristics recruitment pattern of single motor unit of the tibialis anterior muscle. J Physiol (Lond) 264:673PubMedGoogle Scholar
  9. 9.
    Viby-Mogensen J, Howardy-Hansen P, Chraemmer-Jorgensen B, et al (1981) Post-tetanic count (PTC): a new method of evaluating an intense non depolarizing neuromuscular blockade. Anesthesiology 55:458PubMedCrossRefGoogle Scholar
  10. 10.
    Viby-Mogensen J, Engbaek J, Jensen NH, Chraemmer-Jorgensen B, Ording H (1983) New developpements in clinical monitoring of neuromuscular transmission: monitoring without equipment. In: Clinical experiences with Norcuron. Excerpta Medica, Amsterdam, pp 66–71Google Scholar
  11. 11.
    Argov Z, Mastaglia FL (1979) Disorders of neuromuscular transmission caused by drugs. N Engl J Med 301:409PubMedCrossRefGoogle Scholar
  12. 12.
    Duvaldestin P, Saada J, Berger JL, d’Hollander A, Desmonts JM (1982) Pharmacokinetics, pharmacodynamics and dose-response relationships of pancuronium in middle-aged and elderly subjects. Anesthesiology 56:36PubMedCrossRefGoogle Scholar
  13. 13.
    d’Hollander A, Barvais L, Massaut J, Duvaldestin P, Desmonts JM (1983) Vecuronium in geriatric patients. In: Clinical experiences with Norcuron. Excerpta Medica, Amsterdam, pp 171–174Google Scholar
  14. 14.
    d’Hollander A, Luyckx C, Barvais L, Deville A (1983) Clinical evaluation of atracurium besylate requirement for stable muscle relaxation during surgery: lack of age related effects. Anesthesiology 59:237PubMedGoogle Scholar
  15. 15.
    De Vries JW, Ros HH, Booij LHDJ (1986) Infusion of vecuronium controlled by a closed-loop system. Br J Anaesth 58:1100PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • L. Barvais
  • D. Hennart
  • A. d’Hollander

There are no affiliations available

Personalised recommendations