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Neuromuscular Monitoring in Anesthesia

Neuromuscular Block Monitoring

By Ilkka S. Kalli MD, PhD, MBA

The whole article available in PDF: 2504 KB

Ilkka Kalli, 2001 © Copyright, Imprint (WB Saunders)

Neuromuscular blocking agents (NBAs) were brought into clinical practice over 50 years ago as adjuvants to inhalation anesthesia and to facilitate surgery. Initially, after a few years, they were abandoned as unsafe; these drugs paralyze voluntary muscles and hence also weaken spontaneous breathing. Later, when intubation and control of ventilation were developed, use of NBAs became a safe routine in anesthesia. However, their history was repeated in the postanesthesia care unit (PACU), where residual neuromuscular block may increase the patient’s risk.
Modern NBAs have an excellent toxicity profile, and their site of action at the neuromuscular junction is quite specific. Barring allergic reactions, an overdose does not lead to toxic manifestations. Yet, an overdose does delay the return of neuromuscular integrity and increases the need for antagonists. Therefore, it is important to monitor the degree of blockade. Nerve stimulators, when used appropriately, allow optimal dosing according to patients' needs and ensure well-timed and safe recovery. In today's managed care, the anesthetist may also face new requirements or constraints. Selection of drugs based on their cost is one consideration, as is the requirement of "fast tracking" or early discharge of the patient. Use of the nerve stimulator to optimize drug administration can be of significant help to the anesthetist who must balance different obligation.

 

Further information from the publisher's website (click the book below):

By Robert R. Kirby, MD, Professor of Anesthesiology,
University of Florida College of Medicine, System Chief,
Anesthesiology, North Florida/South Georgia Veterans Health
System, Malcom Randall Veterans Affairs Medical Center,
Gainesville, FL.

Nikolaus Gravenstein, MD, Professor and Executive
Associate Chairman, Department of Anesthesiology, and
Professor of Neurosurgery, University of Florida College of
Medicine, Gainesville, FL.

Emilio B. Lobato, MD, Professor of Anesthesiology, University of Florida College
of Medicine, Gainesville, FL.

J.S. Gravenstein, MD, Graduate Research Professor Emeritus, Department of
Anesthesiology, University of Florida College of Medicine, Gainesville, FL.

With 108 additional contributors.


ISBN 0-7216-8566-8


Last updated: 1 July 2003Created
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Olli A. Meretoja:
Muscle relaxants in pediatric patients
ppt presentation

See also our first issue Relaxation, June 2000.



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