Use of neuromuscular blocking agents in the intensive care unit

SUMMARY Neuromuscular blocking agents, together with sedatives and analgesic drugs, provide the pharmacologic basis for controlled ventilation that can be a life-saving procedure in critically ill patients. During the last few years, an increasing number of reports focused attention on the possible role of neuromuscular blocking agents in muscle weakness, prolonged paralysis, and other neuromuscular dysfunctions after their long-term use in critically ill patients. Of the various mechanisms suggested, the use of absolute or relative overdoses is probably the most likely explanation for the above complications. Prominent reasons for the use of excessive doses seem to be the limited familiarity of the ICU staff with the pharmacologic properties of this class of agents and the omission of monitoring of the neuromuscular transmission during their long-term administration. Consequently, pharmacologic misconceptions among health professionals should be corrected by a suitable educational program and the use of at least a peripheral nerve stimulator for monitoring the neuromuscular blockade must be made mandatory whenever muscle relaxants are used in the ICU.