Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
9 - Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
Published online by Cambridge University Press: 18 January 2010
Edited by
Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
Summary
Objectives
Understand the role of neuromuscular blocking agents for tracheal intubation and maintenance of relaxation in trauma patients
Review the pharmacology of depolarizing and nondepolarizing neuromuscular agents and their antagonists used in trauma patients
Formulate recommendations and define indications and contraindications for the use of neuromuscular blocking agents in different trauma settings
INTRODUCTION
Neuromuscular blocking agents are given to trauma patients in two specific circumstances. They may be needed to facilitate tracheal intubation in the emergency department or prior to arrival in the hospital to provide oxygenation and ventilation to the unstable patient. Also, neuromuscular blocking agents may be needed in an otherwise stable patient as an adjunct to other anesthetic drugs for emergency surgery. In both cases, the major challenge is to choose the right drug for tracheal intubation. Neuromuscular blocking agents for maintenance of relaxation during surgery or mechanical ventilation are similar to those used in nontrauma cases. Finally, the indications for reversal in trauma and nontrauma patients do not differ significantly.
Patients with recent trauma are likely to have hemodynamic instability. Thus, they may have an exaggerated response to sedative and hypnotic drugs. Ideally, these drugs should be titrated. However, trauma patients should be presumed to have a full stomach, and measures to prevent pulmonary aspiration of gastric contents should be applied. The management of tracheal intubation in the presence of a full stomach relies on the rapid sequence induction (RSI) technique, which involves the rapid administration of hypnotic drugs and a neuromuscular blocking agent.
- Type
- Chapter
- Information
- Trauma Anesthesia , pp. 142 - 154Publisher: Cambridge University PressPrint publication year: 2008
References
, , , Optimal oxygen concentration during induction of general anesthesia. Anesthesiology 2003; 98: 28–33.CrossRefGoogle ScholarPubMed
, , Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 1993; 78: 56–62.CrossRefGoogle ScholarPubMed
, , , , , , , Acute airway management in the emergency department by non-anesthesiologists. Can J Anaesth 2004; 51: 174–80.CrossRefGoogle ScholarPubMed
, What determines anesthetic induction dose?It's the front-end kinetics, doctor! Anesth Analg 1999; 89: 541–4.Google ScholarPubMed
, , , , Recirculatory pharmacokinetics and pharmacodynamics of rocuronium in patients: The influence of cardiac output. Anesthesiology 2001; 94: 47–55.CrossRefGoogle ScholarPubMed
, Succinylcholine-induced hyperkalemia in acquired pathologic states: Etiologic factors and molecular mechanisms. Anesthesiology 2006; 104: 158–69.CrossRefGoogle ScholarPubMed
Cardiac arrest after succinylcholine: Mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology 2001; 94: 523–9.CrossRefGoogle ScholarPubMed
, , Cholinesterase. Its significance in anaesthetic practice. Anaesthesia 1997; 52: 244–60.CrossRefGoogle ScholarPubMed
Neuromuscular blocking drugs for the new millennium: Current practice, future trends–comparative pharmacology of neuromuscular blocking drugs. Anesth Analg 2000; 90: S2–S6.CrossRefGoogle ScholarPubMed
, , Dose-response curves for succinylcholine: Single versus cumulative techniques. Anesthesiology 1988; 69: 338–42.CrossRefGoogle ScholarPubMed
, , Potency of succinylcholine at the diaphragm and at the adductor pollicis muscle. Anesth Analg 1988; 67: 625–30.CrossRefGoogle ScholarPubMed
, , , Optimal dose of succinylcholine revisited. Anesthesiology 2003; 99: 1045–9.CrossRefGoogle ScholarPubMed
, , , , , The dose of succinylcholine required for excellent endotracheal intubating conditions. Anesth Analg 2006; 102: 151–5.CrossRefGoogle ScholarPubMed
, , , , Succinylcholine dosage and apnea-induced hemoglobin desaturation in patients. Anesthesiology 2005; 102: 35–40.CrossRefGoogle ScholarPubMed
, , , , Frequency of haemoglobin desaturation with the use of succinylcholine during rapid sequence induction of anaesthesia. Acta Anaesthesiol Scand 2001; 45: 746–9.CrossRefGoogle ScholarPubMed
, , , , Hemoglobin desaturation after succinylcholine-induced apnea: A study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology 2001; 94: 754–9.CrossRefGoogle ScholarPubMed
, , Pharmacokinetics of mivacurium isomers and their metabolites in healthy volunteers after intravenous bolus administration. Anesthesiology 1997; 86: 322–30.CrossRefGoogle ScholarPubMed
, , , Rapacuronium augments acetylcholine-induced bronchoconstriction via positive allosteric interactions at the M3 muscarinic receptor. Anesthesiology 2005; 103: 1195–203.CrossRefGoogle ScholarPubMed
, , , , , , Cumulation and reversal with prolonged infusions of atracurium and vecuronium. Can J Anaesth 1992; 39: 670–6.CrossRefGoogle ScholarPubMed
, Laudanosine, an atracurium and cisatracurium metabolite. Eur J Anaesthesiol 2002; 19: 466–73.CrossRefGoogle ScholarPubMed
, , , , , Clinical pharmacology of vecuronium and atracurium. Anesthesiology 1984; 61: 444–53.CrossRefGoogle ScholarPubMed
, Clinical pharmacokinetics of cisatracurium besilate. Clin Pharmacokinet 1999; 36: 27–40.CrossRefGoogle ScholarPubMed
, Cisatracurium besilate. A review of its pharmacology and clinical potential in anaesthetic practice. Drugs 1997; 53: 848–66.CrossRefGoogle ScholarPubMed
, , , , Cumulation characteristics of cisatracurium and rocuronium during continuous infusion. Can J Anaesth 2000; 47: 943–9.CrossRefGoogle ScholarPubMed
, Clinical pharmacokinetics of rocuronium bromide. Clin Pharmacokinet 1996; 31: 174–83.CrossRefGoogle ScholarPubMed
, , , , , A large simple randomized trial of rocuronium versus succinylcholine in rapid-sequence induction of anaesthesia along with propofol. Acta Anaesthesiol Scand 1999; 43: 4–8.CrossRefGoogle ScholarPubMed
, , Reversal of neuromuscular blockade. Anesthesiology 1992; 77: 785–805.CrossRefGoogle ScholarPubMed
, , , , , Postanesthesia care unit recovery times and neuromuscular blocking drugs: A prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium. Anesth Analg 2004; 98: 193–200.CrossRefGoogle ScholarPubMed
, , , , , , Recovery of neuromuscular function after cardiac surgery: Pancuronium versus rocuronium. Anesth Analg 2003; 96: 1301–7.CrossRefGoogle ScholarPubMed
, , Differential sensitivity of abdominal muscles and the diaphragm to mivacurium: An electromyographic study. Anesthesiology 2001; 95: 1323–8.CrossRefGoogle ScholarPubMed
, , , , Comparison of the neuromuscular blocking effect of atracurium and vecuronium on the adductor pollicis and the geniohyoid muscle in humans. Anesthesiology 1995; 82: 649–54.CrossRefGoogle ScholarPubMed
Evidence-based practice and neuromuscular monitoring: It's time for routine quantitative assessment. Anesthesiology 2003; 98: 1037–9.CrossRefGoogle ScholarPubMed
, , Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block. Anesthesiology 2002; 96: 45–50.CrossRefGoogle ScholarPubMed
, , , , , , Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: A dose-finding and safety study. Anesthesiology 2006; 104: 667–74.CrossRefGoogle ScholarPubMed
, , , Prevention of succinylcholine-induced fasciculation and myalgia: A meta-analysis of randomized trials. Anesthesiology 2005; 103: 877–84.CrossRefGoogle ScholarPubMed
, , Succinylcholine and the open globe. Tracing the teaching. Anesthesiology 2003; 99: 220–3.CrossRefGoogle ScholarPubMed
, Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg 2001; 93: 494–513.Google ScholarPubMed
, , , Tactile fade detection with hand or wrist stimulation using train-of-four, double-burst stimulation, 50-hertz tetanus, 100-hertz tetanus, and acceleromyography. Anesth Analg 2006; 102: 1578–84.CrossRefGoogle ScholarPubMed
, , , 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.CrossRefGoogle ScholarPubMed