Title: NMBA Pearls<br/>Author: Michael Winters<br/><a href='http://umem.org/profiles/faculty/141/'>[Click to email author]</a><hr/><p>
        <strong><u>Neuromuscular Blocking Agents in the Critically Ill</u></strong></p>
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                NMBAs are used in critically ill patients for RSI, patient-ventilator asynchrony, reducing intra-abdominal pressure, reducing intracranial pressure, and preventing shivering during therapeutic hypothermia.</li>
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                There are a number of alterations in critical illness that affect the action of NMBAs
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                                Electrolyte abnormalities
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                                                Hypercalcemia: decreases duration of blockade</li>
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                                                Hypermagnesemia: prolongs duration of blockade</li>
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                                Acidosis: can enhance effect of nondepolarizing agents</li>
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                                Hepatic dysfunction: prolongs effects of vecuronium and rocuronium</li>
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                In addition, there are a number of medications that may interact with NMBAs
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                                Increased resistance: phenytoin and carbamazepine</li>
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                                Prolongs effect: clindamycin and vancomycin</li>
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                Key complications of NMBAs in the critically ill include:
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                                ICU-aquired weakness (controversial)</li>
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                                DVT: NMBAs are one of the strongest predictors for ICU-related DVT</li>
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                                Corneal abrasions: prevalence up to 60%</li>
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<fieldset><legend>References</legend>

                <p>
        Greenberg SB, et al. The use of neuromuscular blocking agents in the ICU: Where are we know? <em>Crit Care Med</em> 2013; 41:1332-1344.</p>
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