Polyneuropathy in Patients Undergoing a Neuromuscular Junction Blockade

Abstract

Neuromuscular blocking drugs (NMBD) are used extensively in many intensive care units (ICU) in the USA, whereas in Europe they are less frequently used [1, 2]. Often these drugs are used without monitoring the neuromuscular block quantitatively. The NMBD are used in doses which exceed by far those used in the operating room and for a considerably longer period of time in patients who are very different from the healthier patients undergoing general anaesthesia. Most recommendations for the use of NMBD are extrapolated from the short-term use in the operating room and this information is not applicable to the long-term use in critically ill patients. The ICU patients are often haemodynamically unstable: they have reduced organ functions or even organ failure and often receive concomitant medication. Furthermore these patients are immobilised, which might have consequences for the neuromuscular block. The importance of the different structure and pharmacokinetics of the individual NMBD is of special importance in the ICU patients. The long-term use of NMBD is associated with many difficulties and serious complications. Many case reports describe persistent paralysis after long-term use of NMBD to facilitate mechanical ventilation. The incidence of prolonged paralysis is estimated at 20% for the patient receiving NMBD for more than 6 days and 15–40% in patients with asthma receiving NMBD and corticosteroids [1]. It has been suggested that reducing the amount of NMBD administered by monitoring the neuromuscular transmission may decrease the risk of prolonged paralysis.