Advertisement
Research Article| Volume 7, ISSUE 3, P489-506, July 1991

Neuromusclar Blocking Agents and Sedative Drags

Clinical Uses and Toxic Effects in the Critical Care Unit
  • Charles G. Durbin Jr
    Correspondence
    Address reprint requests to: Charles G. Durbin, Jr, MD, Department of Anesthesiology, University of Virginia Health Sciences Center, Box 238, Charlottesville, VA 22908
    Affiliations
    Associate Professor of Anesthesiology and Surgery, and Medical Director, Surgical Intensive Care Unit, the University of Virginia, Health Sciences Center, Charlottesville, Virginia
    Search for articles by this author
DOI:https://doi.org/10.1016/S0749-0704(18)30292-6
Neuromusclar Blocking Agents and Sedative Drags
Previous ArticlePreface
Next ArticleAntiarrhytmic: Agents
      This paper is only available as a PDF. To read, Please Download here.
      This article discusses the therapeutic and toxic effects of sedative drugs and neuromuscular blocking agents in the critically ill patient. Common misconceptions of drug properties are highlighted and dispelled. A rational plan for the use of each type of drag is described. The appropriate use of sedative drugs may cause withdrawal syndromes; treatment options are outlined.
      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 access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Critical Care Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Abramson N.S.
        • Safer P.
        • Detre K.M.
        • et al.
        Randomized clinical study of thiopental loading on comatose survivors of cardiac arrest: Brain resuscitation clinical trial (BRCT) I study group.
        N Engl J Med. 1986; 314: 397
        • Aitkenhead A.R.
        • Pepperman M.L.
        • Willatts S.M.
        • et al.
        Comparison of propofol and midazolam for sedation in critically ill patients.
        Lancet. 1989; 11: 704
        • Ali H.H.
        • Savarese J.J.
        Monitoring of neuromuscular function.
        Anesthesiology. 1976; 45: 216
        • Ali H.H.
        • Savarese J.J.
        • Lebowitz P.W.
        • et al.
        Twitch, tetanus, and train-of-four as indices of recovery from nondepolarizing neuromuscular blockade.
        Anesthesiology. 1981; 54: 294
        • Ali H.H.
        • Wilson R.S.
        • Savarese J.J.
        • et al.
        The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans.
        Br J Anaesth. 1975; 47: 570
        • Artru A.A.
        Muscle relaxation with succinylcholine or vecuronium does not alter the rate of CSF production or resistance to reabsorption of CSF in dogs.
        Anesthesiology. 1988; 68: 392
        • Basta S.J.
        • Savarese J.J.
        • Ali H.H.
        • et al.
        Histamine-releasing potencies of atracurium, dimethyltubocurarine, and tubocurarine.
        Br J Anaesth. 1983; 55: 105s
        • Belin R.P.
        • Karleen C.l.
        Cardiac arrest in the burned patient following succinyldicholine administration.
        Anesthesiology. 1966; 27: 516
        • Bennett H.L.
        • Davis H.S.
        • Giannini J.A.
        Nonverbal response to intraoperative conversation.
        Br J Anaesth. 1985; 57: 174
        • Bierman M.I.
        • Brown M.
        • Muren O.
        • et al.
        Prolonged isoflurane anesthesia in status asthmaticus.
        Crit Care Med. 1986; 14: 832
        • Birch A.A.
        • Mitchell C.D.
        • Playford G.A.
        • et al.
        Changes in serum potassium response to succinylcholine following trauma.
        JAMA. 1969; 210: 490
        • Blancher R.S.
        On awakening paralyzed during surgery: A syndrome of traumatic neurosis.
        JAMA. 1975; 234: 67
        • Bodenham A.
        • Park G.R.
        Reversal of prolonged sedation using fiumazenil in critically ill patients.
        Anaesthesia. 1989; 44: 603
        • Bogetz M.S.
        • Katz J.A.
        Recall of surgery for major trauma.
        Anesthesiology. 1984; 61: 6
        • Brownell A.K.W.
        Malignant hyperthermia: Relationship to other diseases.
        Br J Anaesth. 1988; 60: 303
        • Brownell A.K.W.
        • Paasuke R.T.
        • Elash A.
        • et al.
        Malignant hyperthermia in Duchenne muscular dystrophy.
        Anesthesiology. 1983; 58: 180
        • Byatt C.M.
        • Lewis L.D.
        • Dawling S.
        • et al.
        Accumulation of midazolam after repeated dosage in patients receiving mechanical ventilation in an intensive care unit.
        Br Med J. 1984; 289: 799
        • Byrne A.J.
        • Yeoman P.M.
        • Mace P.
        Accumulation of midazolam in patients receiving mechanical ventilation.
        Br Med J. 1984; 289: 1309
        • Chappie D.J.
        • Miller A.A.
        • Ward J.B.
        • et al.
        Cardiovascular and neurological effects of laudanosine: Studies in mice and rats and in conscious and anesthetized dogs.
        Br J Anaesth. 1987; 59: 218
        • Cody M.W.
        • Dormon F.M.
        Recurarisation after vecuronium in a patient with renal failure.
        Anaesthesia. 1987; 42: 993
        • Cooperman L.H.
        Succinylcholine-induced hyperkalemia in neuromuscular disease.
        JAMA. 1970; 213: 1867
        • Cooperman L.H.
        • Strobel Jr., GE
        • Kennell E.M.
        Massive hyperkalemia after administration of succinylcholine.
        Anesthesiology. 1970; 32: 161
        • de la Fuente J.R.
        • Rosenbaum A.H.
        • Martin H.R.
        • et al.
        Lorazepam-related withdrawal seizures.
        Mayo Clin Proc. 1980; 55: 190
        • Donati F.
        • Ferguson A.
        • Bevan D.R.
        Twitch depression and train-of-four ratio after antagonism of pancuronium with edrophonium, neostigmine, or pyridostigmine.
        Anesth Analg. 1983; 62: 314
        • Dretchen K.L.
        • Morgenroth V.H.
        • Standaert F.G.
        • et al.
        Azathioprine: Effects on neuromuscular transmissior.
        Anesthesiology. 1976; 45: 604
        • Durant N.N..
        • Morgenroth V.H.
        • Standaert F.G.
        • et al.
        Azathioprine: Effects on neuromuscular transmission.
        Anesthesiology. 1984; 60: 292
        • Fading P.A.
        • Johnston J.R.
        • Coppel D.L.
        Propofol infusion for sedation of patients with head injury in intensive care: A preliminary report.
        Anaesthesia. 1989; 44: 222
        • Fiewellen E.H.
        • Nelson T.E.
        • Jones W.P.
        • et al.
        Dantrolene dose response in awake man: Implications for management of malignant hyperthermia.
        Anesthesiology. 1983; 59: 275
        • Frank J.P.
        • Harati Y.
        • Butler I.J.
        • et al.
        Central core disease and malignant hyperthermia syndrome.
        Ann Neurol. 1980; 7: 11
        • Glen I.B..
        • Hunter S.C.
        Pharmacology of an emulsion formulation of ICI 35868.
        Br I Anaesth. 1984; 56: 617
        • Griffiths R.B.
        • Hunter J.M.
        • Jones R.S.
        Atracurium infusion in patients with renal failure on an ITU.
        Anaesthesia. 1986; 41: 375
        • Gronert G.A.
        Malignant hyperthermia.
        Anesthesiology. 1980; 53: 395
        • Grounds R.M.
        • Lalor J.M.
        • Lumley J.
        • et al.
        Propofol infusion for sedation in the intensive care unit: Preliminary report.
        Br Med J. 1987; 294: 397
        • Hallstrom C.
        • Lader M.
        Benzodiazepine withdrawal phenomena.
        International Pharmopsychiatry. 1981; 16: 235
        • Hantraye P.
        • Brouillet E.
        • Fukuda H.
        • et al.
        Benzodiazepine receptors studied in living primates by positron emission tomography: Antagonist interactions.
        Eur J Pharmacol. 1988; 153: 25
        • Hirshman C.A.
        • Edelstein G.
        • Peetz S.
        • et al.
        Mechanism of action of inhalation anesthesia on airways.
        Anesthesiology. 1982; 56: 107
        • Kaplan P.W.
        • Rocha W.
        • Sanders D.B.
        • et al.
        Acute steroid-induced tetraplegia followingstatus asthmaticus.
        Pediatrics. 1986; 78: 121
        • Katz R.L.
        Neuromuscular effects of d-tubocurarine, edrophonium and neostigmine in man.
        Anesthesiology. 1967; 28: 327
        • King J.O.
        • Denborough M.A.
        Anesthetic-induced malignant hyperpyrexia in children.
        J Pediatr. 1973; 83: 37
        • Koike W.A.
        • Young R.S.
        • Davis P.
        • et al.
        Isoflurane for refractory status epilepticus: A clinical series.
        Anesthesiology. 1989; 71: 653
        • Kohlschutter B.
        • Baur H.
        • Roth F.
        Suxamethonium-induced hyperkalemia in patients with severe intra-abdominal infections.
        Br J Anaesth. 1976; 48: 557
        • Kolb M.E.
        • Home M.L.
        • Martz R.
        Dantrolene in human malignant hyperthermia. A multicenter study.
        Anaesthesiology. 1982; 56: 254
        • Koide M.
        • Waud B.E.
        Serum potassium concentrations after succinylcholine in patients with renal failure.
        Anesthesiology. 1972; 36: 142
        • Larach M.G.
        • et al.
        • (Malignant Hyperthermia Group)
        Standardization of caffeine halothane muscle contracture test.
        Anesth Anal. 1989; 69: 511
        • Larsen U.T.
        • Juhl B.
        • Hein-Sorensen O.
        • et al.
        Complications during anesthesia in patients with Duchenne’s muscular dystrophy.
        Can J Anaesth. 1989; 36: 418
        • Lee D.C.
        • Kim Y.I.
        • Lui H.H.
        • et al.
        Presynaptic and postsynaptic actions of procainamide on neuromuscular transmission.
        Muscle Nerve. 1983; 6: 442
        • Leeuwin R.S.
        • Veldsema-Currie R.D.
        • Van Wilgenburg H.
        • et al.
        Effects of corticosteroids on neuromuscular blocking actions of d-tubocurarine.
        Eur J Pharmacol. 1981; 69: 165
        • Leigh M.D.
        • McCoy D.D.
        • Belton M.K.
        • et al.
        Bradycardia following intravenous administration of succinylcholine chloride to infants and children.
        Anesthesiology. 1957; 18: 698
        • Loper K.A.
        • Butler S.
        • Nessly M.
        • et al.
        Paralyzed with pain; the need for education.
        Pain. 1989; 37: 315
        • Lopez J.R.
        • Alamo L.
        • Caputo C.
        • et al.
        Intracellular ionized calcium concentration in muscles from humans with malignant hyperthermia.
        Muscle Nerve. 1985; 8: 355
        • Lowenstein E.
        Succinylcholine administration in the burned patient.
        Anesthesiology. 1966; 27: 494
        • Mark J.B.
        • Greenberg L.M.
        Intraoperative awareness and hypertensive crisis during high-dose fentanyl-diazepam-oxygen anesthesia.
        Anesth Analg. 1983; 62: 698
        • Matsuo S.
        • Rao D.B.S.
        • Chaudry I.
        • et al.
        Interaction of muscle relaxant and local anesthetics at the neuromuscular junction.
        Anesth Analg. 1978; 57: 580
        • Meakin G.
        • McKiernan E.P.
        • Morris P.
        • et al.
        Dose-response curves for suxamethonium in neonates, infants and children.
        Br J Anaesth. 1989; 62: 655
        • Memrnan V.I.M.
        Techniques used to sedate ventilated pa dents: A survey cf Pietboos nsed in 34 1CUs in Great Bricain.
        Intensive Care Medicine. 1981; 7: 217
        • Miller E.V.
        • Sanders D.B.
        • Rowlingson J.C.
        • et al.
        Anesthesia-nianeed rhabdomyolysis in a patient with Duchenne’s muscular dystrophy.
        Anesthesiology. 1978; 48: 146
        • Miller R.D.
        The advantages of giving d-tubocurarine before succinylcholine.
        Anesthesiology. 1972; 37: 568
        • Miller R.D.
        • Way W.L.
        • Katzung B.G.
        The potentiation of neuromuscular blocking agents by quinidine.
        Anesthesiology. 1980; 28: 1104
        • Miller-Jones C.M.HWilliams JH.
        • Miller-Jones C.M.H.
        • Williams J.H.
        Sedation for ventilation: A retrospective study of fifty patients.
        Anaesthesia. 1980; 35: 1104
        • Mummaneni N.
        • Rao T.L.K.
        • Montoya A.
        Awareness and recall with high-dose fentanyl-oxygen anesthesia.
        Anesth Analg. 1980; 59: 948
        • Nakamura K.
        • Koide M.
        • Imanaga T.
        • et al.
        Prolonged neuromuscular blockade following trimethaphan infusion.
        Anaesthesia. 1980; 35: 1202
        • Newman L.H.
        • McDonald J.C.
        • Wallace P.G.M.
        • et al.
        Propofol infusion for sedation in intensive care.
        Anaesthesia. 1987; 42: 929
        • Nigrovic V.
        • McCullough L.S.
        • Wajskol A.
        • et al.
        Succinylcholine-induced increases in plasma catecholamine levels in humans.
        Anesth Analg. 1983; 62: 627
        • Orko R.
        • Rosenberg P.H.
        • Himberg J-J.
        Intravenous infusion of midazolam, propofol and vecuronium in a patient with severe tetanus.
        Acta Anaesthesiol Scand. 1988; 32: 590
        • Park G.R.
        • Manara A.R.
        • Mendel L.
        • et al.
        Ketamine infusion: Its use as a sedative, inotrope and bronchodilator in a critically ill patient.
        Anaesthesia. 1987; 42: 980
        • Parker M.M.
        • Schubert W.
        • Shelhamer J.H.
        • et al.
        Perceptions of a critically ill patient experiencing therapeutic paralysis in an ICU.
        Crit Care Med. 1984; 12: 69
        • Powell D.R.
        • Miller R.
        The effect of repeated doses of succinylcholine on serum potassium in patients with renal failure.
        Anesth Analg. 1975; 54: 746
        • Powles A.B.
        • Ganta R.
        Use of vecuronium in the management of tetanus.
        Anaesthesia. 1985; 40: 879
        • Ropper A.H.
        • Kofke W.A.
        • Bromield E.B.
        • et al.
        Comparison of isoffurane, halothane, and nitrous oxide in status epilepticus.
        Ann Neurol. 1986; 19: 98
        • Rosenberg H.
        • Fletcher J.E.
        Masseter muscle rigidity and malignant hyperthermia susceptibility.
        Anesth Analg. 1986; 65: 161
        • Russell I.F.
        Comparison of wakefulness with two anesthetic regimens. Total I.V. v. balanced anesthesia.
        Br J Anaesth. 1986; 58: 965
        • Ryan J.F.
        • Kagan L.J.
        • Hyman A.l.
        Myoglobinemia after a single dose of succinylcholine.
        N Engl J Med. 1971; 285: 824
        • Saulnier F.F.
        • Durocher A.V.
        • Deturck R.A.
        • et al.
        Respiratory and hemodynamic effects of halothane in status asthmaticus.
        Intensive Care Medicine. 1990; 16: 104
        • Saxena P.R.
        • Bonta I.L.
        Mechanism of selective cardiac vagolytic action of pancuronium bromide. Specific blockade of cardiac muscarinic receptors.
        Eur J Pharmacol. 1970; 11: 332
        • Scappaticci K.A.
        • Ham J.A.
        • Sohn Y.J.
        • et al.
        Effects of furosemide on the neuromuscular junction.
        Anesthesiology. 1982; 57: 381
        • Schaner P.J.
        • Brown R.L.
        • Kirksey T.D.
        • et al.
        Succinylcholine-induced hyperkalemia in burned patients—I.
        Anesth Analg. 1969; 48: 764
        • Segredo V.
        • Matthay M.A.
        • Sharma M.L.
        • et al.
        Prolonged neuromuscular blockade after long-term administration of vecuronium in two critically ill patients.
        Anesthesiology. 1990; 72: 566
        • Shelly M.P.
        • Mendel L.
        • Park G.R.
        Failure of critically ill patients to metabolize midazolam.
        Anaesthesia. 1987; 42: 619
        • Simons F.E.R.
        • Simons K.L.
        • Frith E.M.
        The pharmacokinetics and antihistaminic of the HI receptor antagonist hydroxyzine.
        J Allergy Clin Immunol. 1984; 73: 69
        • Singh Y.N.
        • Marshall I.G.
        • Harvey A.L.
        Pre- and postjunctional blocking effects of aminoglycoside, polymyxin, tetracycline and lincosamide antibiotics.
        Br J Anaesth. 1982; 54: 1295
        • Slater R.M.
        • Pollard B.J.
        • Doran B.R.H.
        Prolonged neuromuscular blockade with vecuronium in renal failure.
        Anaesthesia. 1988; 43: 250
        • Smith C.L.
        • Hunter J.M.
        • Jones R.S.
        Vecuronium infusions in patients with renal failure in an ICU.
        Anaesthesia. 1987; 42: 387
        • Sokol M.D.
        • Gergis S.D.
        Antibiotics and neuromuscular function.
        Anesthesiology. 1981; 55: 148
        • Stevenson P.H.
        • Birch A.A.
        Succinylcholine-induced hyperkalemia in a patient with a closed head injury.
        Anesthesiology. 1979; 51: 89
        • Stoelting R.K.
        • Peterson C.
        Heart rate slowing and junctional rhythm following intravenous succinylcholine with and without intramuscular atropine preanesthctic medication.
        Anesth Analg. 1975; 54: 705
        • Strube P.J.
        • Hallam P.L.
        Ketamine by continuous infusion in status asthmaticus.
        Anaesthesia. 1986; 41: 1017
        • Sunew K.Y.
        • Hicks R.G.
        Effects of neostigmine and pyridostigmine on duration of succinylcholine action and pseudocholinesterase activity.
        Anesthesiology. 1978; 49: 188
        • Van Der Spek A.F.L.
        • Fang W.B.
        • Ashton-Miller J.A.
        • et al.
        The effects of succinylcholine on mouth opening.
        Anesthesiology. 1987; 67: 459
        • Walton J.D.
        • Farman J.V.
        Suxamethonium hyperkalemia in uremic neuropathy.
        Anaesthesia. 1973; 28: 666
        • Waud B.E.
        • Farrel L.
        • Waud D.R.
        Lithium and neuromuscular transmission.
        Anesth Analg. 1982; 61: 399
        • Whittaker M.
        Plasma cholinesterase variants and the anesthetist.
        Anaesthesia. 1980; 35: 174
        • Wilson S.L.
        • Vaughan R.W.
        • Stephen C.R.
        Awareness, dreams, and hallucinations associated with general anesthesia.
        Anesth Analg. 1975; 54: 609
        • Winokur A.
        • Rickels K.
        • Greenblatt D.J.
        • et al.
        Withdrawal reaction from long-term, low-dosage administration of diazepam: A double-blind, placebo-controlled case study.
        Arch Gen Psychiatry. 1980; 37: 101
        • Zalman F.
        • Perloff J.K.
        • Durant N.N.
        • et al.
        Acute respiratory failure following intravenous verapamil in Duchenne’s muscular dystrophy.
        Am Heart J. 1983; 105: 510

      Article info

      Identification

      DOI: https://doi.org/10.1016/S0749-0704(18)30292-6

      Copyright

      © 1991 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX