Strategies to Reduce the Most Frequent Adverse Events of Neuromuscular Blocking Agents

Abstract

Neuromuscular blocking agents are without doubt the drugs most frequently associated with perioperative adverse events in anesthesia. Acknowledging and treating those patients at high risk of developing unexpected events caused by the administration of these agents should become a routine for the perioperative medicine specialist. This article is a reflection on simple pharmacokinetics and pharmacodynamics for improved safety in the administration of NMBs by the anesthesiologist. Preserving internal homeostasis, thermoprotection and securing microcirculation are key strategies for reducing events such as postoperative residual curarization. Furthermore, a right clinical approach to patients at high risk of developing NMBrelated hypersensitivity reactions enables a safe and comprehensive management of the patient, avoiding subsequent and more severe or even fatal events.