Use of neuromuscular blocker in ICU

Keyword

Neuromuscular Blockers in the ICU, Muscle relaxant

Recommendations for the Use of Neuromuscular Blockers in the ICU

• Avoid the use of neuromuscular blockers by

Maximal use of analgesics and sedatives

Manipulation of ventilatory parameters and modes

• Minimize the dose of neuromuscular blocker

Use a peripheral nerve stimulator with train-of-four monitoring

Do not administer for more than 2 days continuously

Administer by bolus rather than infusion

Administer only when required and to achieve a well-defined goal

Continually allow recovery from paralysis

• Consider alternative therapies

Consideration

• Vecuronium 사용 시 weakness 연장 :근이완제 6일 이상 지속 시, steroid tx. asthma 환자, renal failure
• Cisatracurium
  • Hoffmann elimination - 간, 신장 대사 영향없음
  • atracurium 보다 역가 높아 적은 용량 사용 가능 - 중추신경계 영향 미치는 laudanosine effect 최소화 가능

Reference

Miller’s anesthesia, 8th edition, Chapter 34: Pharmacology of Neuromuscular Blocking Drugs, P.991