Use, Abuse and Misuse of Drugs in the ICU: Muscle Relaxants

  • G. Conti
  • R. Marella
  • M. C. Marini
Conference paper


Twenty years ago, muscle relaxants were frequently used in the ICU in almost all critically ill patients (91%), but ten years later a large survey reported frequent use of nondepolarizing muscle relaxants in only 16%, and recently, only 1% of adults and 5% of neonatal and other paediatric patients were therapeutically paralysed, because of new sedative techniques [1].


Muscle Relaxant Neuromuscular Blockade Neuromuscular Blocking Agent Status Asthmaticus Sedate Patient 
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  1. 1.
    Durbin CG (1991) Neuromuscular blocking agents and sedative drugs. Crit Care Clin 7 (3): 489–506PubMedGoogle Scholar
  2. 2.
    Elliot JM, Bion JF (1995) The use of neuromuscular blocking drugs in the intensive care practice. Acta Anaesth Scand 39 [Suppl 106]: 70–82CrossRefGoogle Scholar
  3. 3.
    Sharpe MD (1992) The use of muscle relaxants in Intensive Care Unit. Can J Anaesth 39 (9): 949–962PubMedCrossRefGoogle Scholar
  4. 4.
    Conti G, Vilardi V, Rocco M et al (1995) Paralysis has no effect on chest wall and respiratory system mechanics of mechanically ventilated, sedated patients. Intens Care Med 21: 808–812CrossRefGoogle Scholar
  5. 5.
    Werba A, Gilly H, Weindlmayr-Goettel M et al (1992) Porcine model for studying the passage of non-depolarizing neuromuscular blockers through the blood brain barrier. Br J Anaesth 69: 382–386PubMedCrossRefGoogle Scholar
  6. 6.
    Berger J, Waldrom RE (1995) Analgesia, sedation and paralysis in the intensive care unit. Am Fam Physician 51 (1): 166–172PubMedGoogle Scholar
  7. 7.
    Casale LM, Siegel R (1993) Neuromuscular blockade in the ICU. Chest 104 (5): 1639–1640PubMedGoogle Scholar
  8. 8.
    Sharpe MD (1992) The use of muscle relaxants in the Intensive Care Unit. Can J Anaesth 39 (9): 949–962PubMedCrossRefGoogle Scholar
  9. 9.
    Isenstein DA, Venner DS, Duggan J (1992) Neuromuscular blockade in the Intensive Care Unit. Chest 102: 1258–1266PubMedCrossRefGoogle Scholar
  10. 10.
    Shapiro BA, Warren J, Egol AB et al (1995) Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Crit Care Med 23(9): 16011605Google Scholar
  11. 11.
    Gamrin L, Essen P, Forsberg AM et al (1996) A descriptive study of skeletal muscle metabolism in critically ill patients: free amino acids, energy-rich phosphates, protein, nucleic acids, fat, water and electrolytes. Crit Care Med 24 (4): 575PubMedCrossRefGoogle Scholar
  12. 12.
    Bolton CF (1993) Neuromuscular complications of sepsis. Intens Care Med 19: S58 - S63CrossRefGoogle Scholar
  13. 13.
    Mercatello A, Coronel B, Mosckovtchenko JF (1995) La neuropathie de réanimation: un defi pour le futur. Ann Fr Anesth Réanim 14: 209–212CrossRefGoogle Scholar
  14. 14.
    Tobias J, Lynch A, McDuffee A et al (1995) Pancuronium infusion for neuromuscular block in children in the pediatric Intensive Care Unit. Anaesth Analg 81: 13–16Google Scholar
  15. 15.
    Silverman DG, Mirakhur RK (1994) Non-depolarizing relaxants of the 1990s. In: Silverman DG (ed) Neuromuscular block in perioperative and intensive care. JB Lippincott Company, Philadelphia, pp 200–216Google Scholar
  16. 16.
    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 (5): 884–893PubMedCrossRefGoogle Scholar
  17. 17.
    Lamaire F (1993) Difficult weaning. Intens Care Med 19: S69 - S73CrossRefGoogle Scholar
  18. 18.
    Bolton CF (1994) Muscle weakness and difficulty in weaning from the ventilator in the critical care unit. Chest 106 (1): 1–2PubMedCrossRefGoogle Scholar
  19. 19.
    Al-Muhandis WM, Lauretti GR, Pleuvry BJ (1991) Modification by drugs use in anaesthesia of CNS stimulation induced in mice by laudanosine and strychnine. Br J Anaesth 67: 608–613PubMedCrossRefGoogle Scholar
  20. 20.
    Eddleston JM, Harper NJN, Pollard BJ et al (1989) Concentrations of atracurium and laudano-sine in cerebrospinal fluid and plasma during intracranial surgery. Br J Anaesth 63: 525–530PubMedCrossRefGoogle Scholar
  21. 21.
    Gwinnutt CL, Edleston JM, Edwards D et al (1990) Concentration of atracurium and laudanosine in cerebrospinal fluid plasma in three intensive care patients. Br J Anaesth 65: 829–832PubMedCrossRefGoogle Scholar
  22. 22.
    Maestrone E, Magnelli V, Nobile (1994) Extracellular pancuronium affects sodium current in chick embryo sensory neurones. Br J Pharmachol 11: 283–287Google Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • G. Conti
  • R. Marella
  • M. C. Marini

There are no affiliations available

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