Clinical uses and controversies of neuromuscular blocking agents in infants and children.
OBJECTIVE
To review the pharmacology of neuromuscular blocking drugs (NMBDs), their use in critically ill or injured infants and children, and the relevance of developmental changes in neuromuscular transmission.


METHODS
Computerized search of the medical literature.


METHODS
Studies specifically examining the following were reviewed: a) the developmental changes in neuromuscular transmission; b) the pharmacokinetics and pharmacodynamics of all clinically available NMBDs in neonates, infants, children, and adults; and c) clinical experience with NMBDs in the critical care setting. Particular attention was directed toward studies in the pediatric population.


RESULTS
Neuromuscular transmission undergoes maturational changes during the first 2 months of life. Alterations in body composition and organ function affect the pharmacokinetics and pharmacodynamics of the NMBDs throughout active growth and development. Numerous NMBDs have been developed during the last two decades with unique pharmacologic profiles and potential clinical advantages. The NMBDs are routinely used in critically ill or injured patients of all ages. This widespread use is associated with rare but significant clinical complications, such as prolonged weakness.


CONCLUSIONS
Significant gaps in our knowledge of the pharmacokinetics and pharmacodynamics of NMBDs in infants and children continue to exist. Alterations in electrolyte balance and organ-specific drug metabolism may contribute to complications with the use of NMBDs in the critical care arena.
Martin
L D
LD
Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
Bratton
S L
SL
O'Rourke
P P
PP
D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology / Q000627:therapeutic use*; D009467:Neuromuscular Depolarizing Agents / Q000494:pharmacology / Q000627:therapeutic use; D009469:Neuromuscular Junction / Q000254:growth & development*; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology / Q000627:therapeutic use; D009435:Synaptic Transmission
D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents