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A meta-analysis reported that the incidence of residual neuromuscular paralysis was 41% in patients receiving intermediate neuromuscular blocking agents during anaesthesia. [1] It is possible that > 100,000 patients annually in the USA alone, are at risk of adverse events associated with undetected residual neuromuscular blockade. [5]
It may be used from the induction of to recovery from neuromuscular blockade. Importantly, it is used to confirm adequacy of recovery after the administration of neuromuscular blocking agents. [3] The response of the muscles to electrical stimulation of the nerves can be recorded subjectively (qualitative) or objectively (quantitatively).
Neuromuscular-blocking drugs, or Neuromuscular blocking agents (NMBAs), block transmission at the neuromuscular junction, [1] causing paralysis of the affected skeletal muscles. This is accomplished via their action on the post-synaptic acetylcholine (Nm) receptors.
Effective neuromuscular block by non-depolarizing neuromuscular drugs occurs only when 70-80% of acetylcholine receptors are occupied by the drug. [11] This is because at this occupancy rate, junctional potential cannot reach the threshold value required for muscle contraction. Diagram of nicotinic receptor (Acetylcholine receptor)
The British Journal of Anaesthesia published an article in 2015 in which the incidence of residual neuromuscular blockade could be reduced to zero if sugammadex is used as the reversal agent and the correct dosage is selected with the use of neuromuscular monitoring. [17]
Rapid sequence intubation refers to the pharmacologically induced sedation and neuromuscular paralysis prior to intubation of the trachea. The technique is a quicker form of the process normally used to induce general anesthesia. A useful framework for describing the technique of RSI is the "seven Ps". [27] Prehospital RSI training using a ...
Intraoperative neurophysiological monitoring (IONM) or intraoperative neuromonitoring is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integrity of certain neural structures (e.g., nerves, spinal cord and parts of the brain) during surgery.
Vecuronium is in the aminosteroid neuromuscular-blocker family of medications and is of the non-depolarizing type. [2] It works by competitively blocking the action of acetylcholine on skeletal muscles. [2] The effects may be reversed with sugammadex or a combination of neostigmine and glycopyrrolate. To minimize residual blockade, reversal ...