This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Murray, M. J. Articles by Bolton, C. F. Search for Related Content PubMed PubMed Citation Articles by Murray, M. J. Articles by Bolton, C. F.

Brief review: Nondepolarizing neuromuscular blocking drugs and critical illness myopathy

[Revue sommaire : les myorelaxants non dépolarisants et la myopathie de réanimation]

Michael J. Murray, MD PhD^*, Sorin J. Brull, MD^* and Charles F. Bolton, MD

^* From the Departments of Anesthesiology, Mayo Clinic Jacksonville, Jacksonville; and
Neurology, Mayo Clinic Rochester, Minnesota, USA.

Address correspondence to: Dr. Michael J. Murray, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA. Phone: 904-296-5688; Fax: 904-296-3877; E-mail : murray.michael{at}mayo.edu

Purpose: Critically-ill patients who receive nondepolarizing neuromuscular blocking drugs (NMBDs) may be at risk of developing profound muscle weakness that may last for months after the NMBD is discontinued, especially when large cumulative doses of NMBDs and corticosteroids are co-administered to septic, mechanically ventilated patients. This review focuses on the etiology and clinical features of critical illness myopathy (CIM), summarizes specific risk factors for its development, and discusses strategies that might be used to attenuate or even prevent the development of this potentially devastating syndrome.

Clinical features: The etiology of CIM is unknown. Whether it can develop in at-risk patients who undergo lengthy operations during which they receive NMBDs is also unknown. In some patients following exposure to NMBDs their motor systems are impaired secondary to loss of thick (myosin) filaments that render the muscle unexcitable to direct electrical stimulation, while the sensory system is spared. Management of patients who develop NMBD myopathy is supportive, consisting of nutritional support, physical therapy, and daily trials of decreased ventilatory support.

Conclusion: Recent guidelines recommend that NMBDs be used in critically ill patients only when absolutely necessary, that the depth of muscle paralysis be monitored to avoid overdosing and metabolite accumulation, and that drug administration be curtailed periodically to allow interruption of sustained NMBD effect.