Strategies to Reduce the Most Frequent Adverse Events of Neuromuscular Blocking Agents
Keywords:
Neuromuscular blocking agents, Pharmacokinetics, Neuromuscular blockade, Ambulatory surgical procedures
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 NMB related hypersensitivity reactions enables a safe and comprehensive management of the patient, avoiding subsequent and more severe or even fatal events.
References
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11. Alfille PH, Merritt C, Chamberlin NL, Eikermann M. Control of perioperative muscle strength during ambulatory surgery. Curr Opin Anaesthesiol. 2009;22:730-7.
12. McDonnell NJ, Pavy TJ, Green LK, Platt PR. Sugammadex in the management of rocuronium-induced anaphylaxis. Br J Anaesth. 2011;106:199-201.
13. Baldo BA, McDonnell NJ, Pham NH. Drug-specific cyclodextrins with emphasis on sugammadex, the neuromuscular blocker rocuronium and perioperative anaphylaxis: implications for drug allergy. Clin Exp Allergy. 2011;7. DOI: 10.1111/j.1365-2222.2011.03805.x.
14. Mertes PM, Laxenaire MC. Allergic reactions occurring during anaesthesia. Eur J Anaesthesiol. 2002;19:240-62.
15. Mertes PM, Laxenaire MC. Adverse reactions to neuromuscular blocking agents. Curr Allergy Asthma Rep. 2004;4:7-16.
16. Mertes PM; EAACI interest group on drug hypersensitivity. Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Invest Allergol Clin Immunol. 2005;15:91-101.
2. Raghavendra T. Neuromuscular blocking drugs: discovery and development. J R Soc Med. 2002;95:363-7.
3. Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: A focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35:2196-204.
4. Kocabas S, Yedicocuklu D, Askar FZ. The neuromuscular effects of 0.6 mg kg21 rocuronium in elderly and young adults with or without renal failure. Eur J Anaesth. 2008;25:940-6.
5. Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98:1042-8.
6. Butterly A, Bittner EA, George E, Sandberg WS, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010;105:304-9.
7. Di Marco P, Della Rocca G, Iannuccelli F, Pompei L, Reale C, Pietropaoli P. Knowledge of residual curarization: an Italian survey. Acta Anaesthesiol Scand. 2010;54:307-12.
8. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110-9.
9. Tramèr MR, Fuchs-Buder T. Omitting antagonism of neuromuscular block: efect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review. Br J Anaesth. 1999;82:302-16.
10. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarization: a meta-analysis.
11. Alfille PH, Merritt C, Chamberlin NL, Eikermann M. Control of perioperative muscle strength during ambulatory surgery. Curr Opin Anaesthesiol. 2009;22:730-7.
12. McDonnell NJ, Pavy TJ, Green LK, Platt PR. Sugammadex in the management of rocuronium-induced anaphylaxis. Br J Anaesth. 2011;106:199-201.
13. Baldo BA, McDonnell NJ, Pham NH. Drug-specific cyclodextrins with emphasis on sugammadex, the neuromuscular blocker rocuronium and perioperative anaphylaxis: implications for drug allergy. Clin Exp Allergy. 2011;7. DOI: 10.1111/j.1365-2222.2011.03805.x.
14. Mertes PM, Laxenaire MC. Allergic reactions occurring during anaesthesia. Eur J Anaesthesiol. 2002;19:240-62.
15. Mertes PM, Laxenaire MC. Adverse reactions to neuromuscular blocking agents. Curr Allergy Asthma Rep. 2004;4:7-16.
16. Mertes PM; EAACI interest group on drug hypersensitivity. Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Invest Allergol Clin Immunol. 2005;15:91-101.
How to Cite
1.
Ariza Cadena F. Strategies to Reduce the Most Frequent Adverse Events of Neuromuscular Blocking Agents. Colomb. J. Anesthesiol. [Internet]. 2012 Apr. 1 [cited 2024 Jul. 22];40(2):127-30. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/822
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Published
2012-04-01
How to Cite
1.
Ariza Cadena F. Strategies to Reduce the Most Frequent Adverse Events of Neuromuscular Blocking Agents. Colomb. J. Anesthesiol. [Internet]. 2012 Apr. 1 [cited 2024 Jul. 22];40(2):127-30. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/822
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