The Effect of Neuromuscular Blockade on Oxygen Supply, Consumption, and Total Chest Compliance in Patients with High Oxygen Requirements Undergoing Mechanical Ventilation

Abstract

We investigated the effects of neuromuscular blockade with atracurium on oxygen consumption, oxygen delivery and total chest compliance in 20 sedated intensive care patients who required mechanical ventilation with an inspired oxygen fraction of at least 0.6.The reverse Fick method was used to measure oxygen consumption. Total chest compliance was measured from the ventilator pneumotachograph and pressure transducer. Measurements were made before neuromuscular blockade, at a standard level of neuromuscular blockade, and after demonstrated recovery of neuromuscular function.There was no statistical difference in any of the parameters measured. However there were large changes in oxygen consumption (range -35% to +17%) and total chest compliance (range -19.7% to + 9.7%) in individuals.We conclude that in the setting of critical oxygenation, neuromuscular blockade cannot be assumed to reduce oxygen requirements or improve total lung compliance. If, however, neuromuscular blockade is selected as an adjunct to therapy, we recommend that the indices of oxygenation are calculated.

Use of Neuromuscular Blockade for Neck Dissection and Association with Iatrogenic Nerve Injury

“…The use of deep neuromuscular blockade has been shown to optimize surgical conditions during laparoscopic surgery and soft tissue operations, including hip arthroplasty, as well as yielding optimal conditions for airway management and endoscopic laryngeal surgery [25][26][27]. In addition to improved surgical conditions, use of neuromuscular blockade has been demonstrated to result in decreased blood loss in spine surgery [28] and has been demonstrated to reduce oxygen requirements and improve total lung compliance in critically ill patients [29]. Theoretically, use of neuromuscular blockade can also reduce necessity for a deep anesthetic level to prevent movement and muscle response to surgical stimulation in the nonparalyzed patient [30].…”

Muscle relaxation does not influence venous oxygen saturation during cardiopulmonary bypass

“…Some form of continued neuromuscular relaxation could, in these circumstances, be essential. However, in a study of the effect of neuromuscular block on oxygen supply, oxygen consumption, and total chest compliance in patients with high oxygen requirements undergoing mechanical ventilation in the ICU, it was found that neuromuscular block could not be assumed to reduce the oxygen requirements or improve total lung compliance [9].…”

Clinical manifestations and neurodevelopmental outcome following an event of accidental intramuscular injection of atracurium in newborns

“…Atracurium is a neuromuscular blockade widely used to provide muscle relaxation during surgery and in critically ill patients [9,27]. Pharmacokinetic studies have shown that below the usual therapeutic dose (0.5 mg/kg for pediatric patients and 0.6 mg/kg for adult patients), atracurium produces maximum neuromuscular blocking effect 3-5 min following injection, and recovery is generally 95% complete 1 h postinjection [9,12,24,25].…”