Background
An estimated 24% to 70% of individuals have prolonged paralysis or severe weakness
after receiving neuromuscular blocking agents (NMBAs) when therapy is terminated.
Objectives
The purposes of this study were to (1) evaluate the relationship between recovery
of neuromuscular transmission (NMT) and functional muscle activity after NMBA administration;
(2) evaluate the relationship between delayed recovery of NMT or muscle activity and
functional performance; and (3) determine the predictors of delayed recovery of NMT,
muscle activity, and functional performance.
Methods
This was a multisite study using a prospective, nonexperimental, descriptive design
with convenience sampling techniques. Instruments used included a five-point muscle
score, Actigraph, and peripheral nerve stimulator.
Results
Key findings were as follows: (1) NMT returned promptly, whereas muscle activity remained
severely depressed; (2) only two subjects (5%) recovered functional performance within
24 hours; (3) degree of muscle weakness immediately after neuromuscular blockade was
associated with prolonged time to extubation and mobility; and (4) predictors of delayed
recovery included cumulative dose of aminosteroid NMBAs, age, and renal function.
Conclusion
Prolonged recovery of muscle activity and extreme weakness may occur despite brisk
recovery of NMT after neuromuscular blockade.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical guidelines for sustained neuromuscular blockade in the adult critically ill patient.Crit Care Med. 2002; 30: 142-156
- Severe myopathy after status asthmaticus.Lancet. 1977; 2: 615
- Persistent paralysis in the intensive care unit. A clinical conundrum.Crit Care Med. 1994; 2: 1
- Vecuronium (V) dosing by peripheral nerve stimulation (PNS) reduces paralytic dosing requirements and recovery times in critically ill medical patients.Crit Care Med. 1996; 24: A71
- Acute myopathy following treatment of severe life threatening asthma.Am Rev Respir Dis. 1990; 141: A397
- Neuromuscular blockade in the intensive care unit more than we bargained for.Am Rev Respir Dis. 1993; 147: 234-236
- Critical illness myopathy and neuropathy.Lancet. 1996; 347: 1579-1582
- Physiology and pharmacology of neuromuscular blocking transmission, with special reference to the possible consequences of prolonged blockade.Intensive Care Med. 1993; 19: S45-S53
- Acute necrotizing myopathy of intensive care.Muscle Nerve. 1994; 17: 285-292
- The control of movement.in: Kandel E.R. Schwartz J.H. Jessel T.M. Principles of neural science. 4th edition. McGraw-Hill, Health Professions Division, New York2000: 533-547
- Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of critically ill patients.Clin Pharmacokinet. 1997; 33: 426-453
- Mechanisms of neuromuscular block.in: Standaert D.G. Neuromuscular block in perioperative and intensive care. JB Lippincott, Philadelphia1994: 11-22
- A national survey of critical care nurses’ practices related to administration of neuromuscular blocking agents.Am J Crit Care. 2001; 10: 139-145
- Duration of action of vecuronium after intubating dose of rapacuronium, vecuronium, or succinylcholine.Anesth Analg. 2001; 92: 1199-1202
- The pharmacodynamics and pharmacokinetics of the metabolite 3-desacetylvecuronium (ORG7268) and its parent compound vecuronium in human volunteers.J Pharmacol Exp Ther. 1994; 270: 1216-1222
- Use of nondepolarizing agents in mechanically ventilated patients.Clin Pharmacol. 1991; 10: 32-48
- Muscle weakness in mechanically ventilated patients with severe asthma.Am J Respir Care Med. 1996; 153: 1686-1690
- The nature of gentamicin-induced neuromuscular block.Br J Anesth. 1980; 52: 325-328
- Interaction of other drugs with muscle relaxants.Semin Anesth. 1985; 4: 52-64
- Pharmacokinetics of vecuronium after long-term administration.Anesth Analg. 1990; 70 (abstract): S1-S450
- Effects of patient status and condition on nondepolarizing relaxants.in: Standaert D.G. Neuromuscular block in perioperative and intensive care. JB Lippincott, Philadelphia1994: 11-22
- Prolonged paralysis after treatment with neuromuscular blocking agents.Crit Care Med. 1991; 19: 1125-1131
- Drug-induced, toxic and nutritional myopathies.in: Mastaglia F.L. Detchant L.W. Skeletal muscle pathology. Churchill Livingstone, Edinburgh1992: 511-540
- Aids to the examination of the peripheral nervous system. Her Majesty’s Stationary Office, London1976
- Activity measurement in psychology and medicine. Plenum Press, New York1991
- Automated physical activity monitoring.Psychopathology. 1993; 30: 296-305
- Statistical Package for the Social Sciences. SPSS base 10.0 applications guide. SPSS, Inc, Chicago1999
- Critical illness polyneuropathy and myopathy in patients with acute respiratory distress syndrome.Crit Care Med. 2005; 33: 711-715
- Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.Crit Care Med. 2002; 30: 119-140
- A post hoc descriptive study of patients receiving propofol.Am J Crit Care. 1999; 8: 507-513
Article info
Footnotes
This research was supported by a grant provided by the American Association of Critical Care Nurses Houston-Gulf Coast Chapter.
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
