The undesirable effects of neuromuscular blocking drugs

Abstract

SummaryNeuromuscular blocking drugs are designed to bind to the nicotinic receptor at the neuromuscular junction. However, they also interact with other acetylcholine receptors in the body. Binding to these receptors causes adverse effects that vary with the specificity for the cholinergic receptor in question. Moreover, all neuromuscular blocking drugs may cause hypersensitivity reactions. Often the symptoms are mild and self-limiting but massive histamine release can cause systematic reactions with circulatory and respiratory symptoms and signs. At the end of anaesthesia, no residual effect of a neuromuscular blocking drug should be present. However, the huge variability in response to neuromuscular blocking drugs makes it impossible to predict which patient will suffer postoperative residual curarization. This article discusses the undesirable effects of the currently available neuromuscular blocking drugs including the definitions, diagnosis and causes of hypersensitivity reactions and postoperative residual curarisation.

Neostigminin başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadeks kullanımı

“…Kas gevşeticilerin kullanılması istemli ve refleks kas hareketlerini baskılayarak daha uygun entübasyon koşulları sağlar. Ayrıca daha az anestezik madde gereksinimi altında cerrahi girişim için yeterli kas gevşemesi elde edilir [5,6]. Bununla birlikte nöromusküler bloker kullanılan operasyonlarda rezidüel kürarizasyon riski vardır.…”

Residual Neuromuscular Blockade in Critical Care

“…2,3 However, these medications are also associated with the risk for residual neuromuscular blockade (RNMB) after surgery (also termed postoperative residual curarization or PORC). 4 RNMB rates are linked to incomplete metabolism and excretion of the drugs at the end of surgery; the reported rate is 11% to 88%. [4][5][6][7][8][9] The wide range is due to the differences in methods and control of confounding variables, such as S urgery, anesthesia, and other interventions in critical care are facilitated by the use of nondepolarizing neuromuscular blocking agents (NMBAs).…”

“…4 RNMB rates are linked to incomplete metabolism and excretion of the drugs at the end of surgery; the reported rate is 11% to 88%. [4][5][6][7][8][9] The wide range is due to the differences in methods and control of confounding variables, such as S urgery, anesthesia, and other interventions in critical care are facilitated by the use of nondepolarizing neuromuscular blocking agents (NMBAs). 1 NMBAs are used in critical care units, emergency departments, and operating Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions.…”

“…A possible clinical problem is blockade within the muscarinic receptors in the lungs and heart, which may produce bronchospasm and cardiac dysrhythmias, respectively. 3,4 Each NMBA has a different pharmacokinetic profile (Table 1).…”

“…Clinically, the effects are manifested as bradycardia, broncho spasm, and excessive salivation. In order to minimize these parasympathetic Based on information in Drain, 2 Claudius et al, 4 Jonsson Fagerlund et al, 9 and Burton and Alexander. effects, anticholinergic medications, including atropine and glycopyrrolate, must be administered along with the neostigmine.…”