The Danger With Neuromuscular Blocking Agents

Abstract

It is not uncommon to find a variety of neuromuscular blocking agents (NMBs) (eg, succinylcholine chloride, atracurium besylate [Tracium], vecuronium bromide, and pancuronium bromide) in the emergency department because of the urgent need for these medications during unplanned endotracheal intubations. Used primarily to support skeletal muscle relaxation prior to intubation procedures,1 these medications are commonly found in trauma/resuscitation rooms, medication stock cabinets and refrigerators, rapid sequence intubation boxes, and even in the pockets of responding anesthesia personnel. Although these medications frequently are used for intubation, they must be used with extreme caution. Although no more errors occur with NMBs than with other medications, these “high-alert” drugs have the propensity to cause serious harm when an error occurs.2 Unfortunately, a variety of reports of serious errors have been associated with these medications, commonly related to look-alike packaging and storage issues. Consider the following scenarios below and whether they could actually happen in your emergency department.