- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 206) Muscle relaxants in critical illness
- Chapter:
- (p. 206) Muscle relaxants in critical illness
- Author(s):
Brian J. Pollard
- DOI:
- 10.1093/med/9780199600830.003.0047
The place of neuromuscular blocking agents in the intensive care unit (ICU) has changed markedly over the last 20 years. Originally regarded as a mainstay of the process of ‘sedation’, they are now only used for specific indications. The principal disadvantage is probably the difficulty in neurological assessment when a muscle relaxant is used coupled with the increased risk of awareness, because inadequate sedation will be masked. Of the available agents, the intermediate acting ones are the most popular. The degree of relaxation can be readily controlled and they have few side effects. In the presence of renal and/or hepatic disease atracurium or cisatracurium are preferred. Succinylcholine is only used for securing the airway due to its very rapid onset of action. Rocuronium given in a higher dose also possesses a rapid onset in situations when succinylcholine might be contraindicated. When using a muscle relaxant, its effect should always be monitored with a simple train of four pattern of stimulation from a hand-held nerve stimulator. This will ensure that an adequate and not excessive block is secured. If a more rapid reversal is required then a dose of neostigmine with glycopyrrolate may be used. Alternatively, if rocuronium is the relaxant in use then the new agent sugammadex is effective.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care