Methods of Administration of Neuromuscular Blocking Drugs
Basically, with the exception of emergency intubations, the depolarising blockers have gone out of use in most places. This makes my job much easier, as it is superfluous to discuss the complex topic of the use of suxamethonium (succinylcholine) infusions. Although relaxants have been administered clinically by arterial or intramuscular injection and by Bier blocks1 (Table 1.), for practical purposes, I can confine this discussion to the bolus or infusional administration of competitive blockers. Now what are our objectives, for the use of neuromuscular blocking drugs (NMB)? In my opinion there are two. The first is to provide muscle flaccidity for intubation, surgery or whatever the procedure may be. The second is to do so in the most controllable manner possible. I mean by this that it is not sufficient to have the patient completely flaccid at all times. This invites the spectre of awareness as well as increasing the probability of delays at the end of a procedure, due to failure of return of neuromuscular transmission. In fact the objective, as I see it, is to provide only that degree of ‘relaxation’ which is needed to facilitate the procedure, at any given moment, no more, so that termination of action of the NMB will be as rapid as possible. These objectives can be summed up by saying that the skilful use of NMB consists of providing adequate relaxation with the minimal drug dose possible.
KeywordsInfusion Rate Bolus Dose Infusion Regime Neuromuscular Blocking Drug Dose Parameter
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