Nondepolarizing neuromuscular blocking drugs in the intensive care unit: a clinical review.
BACKGROUND
The use of nondepolarizing neuromuscular blocking drugs (NDNMBDs) via continuous infusion in the intensive care unit (ICU) is gaining in popularity. Several new NDNMBDs have been developed recently; these drugs vary in their elimination, metabolism, and half-lives.


METHODS
A review of the recent English language literature was done, with those articles relevant to the ICU being incorporated into this paper.


RESULTS
The six most frequently used NDNMBDs, consisting of atracurium, cisatracurium, doxacurlum, pancuronium, rocuronium, and vecuronium, were reviewed. The neuromuscular junction and impulse transmission, clinical monitoring, clinical pharmacology, the elimination and metabolism, the adverse reactions, and the drug interactions of these NDNMBDs are reviewed.


CONCLUSIONS
The use of NDNMBDs is progressively increasing in ICUs. Proper understanding of normal neuromuscular physiology, clinical pharmacology, and drug interactions is essential to optimize patient care and to minimize the risk of adverse reactions.
Reeves
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ST
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston 29425-2207, USA.
Turcasso
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NM
D000732:Androstanols / Q000627:therapeutic use; D001279:Atracurium / Q000031:analogs & derivatives / Q000627:therapeutic use; D003422:Critical Care; D004347:Drug Interactions; D006801:Humans; D007262:Infusions, Intravenous; D007546:Isoquinolines / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010197:Pancuronium / Q000627:therapeutic use; D000077123:Rocuronium; D014673:Vecuronium Bromide / Q000627:therapeutic use
D000732:Androstanols; D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D014673:Vecuronium Bromide; D010197:Pancuronium; C049429:doxacurium; C101584:cisatracurium; D000077123:Rocuronium