ABSTRACT
Neuromuscular blockade (NMB) use in trauma and critical care presents several unique challenges. First and foremost is its interference with the ability to repeatedly evaluate the neurological status of patients, both during initial resuscitation and later in the intensive care unit (ICU). Second, altered renal and hepatic function changes the pharmacokinetic and pharmacodynamic profiles of many NMB drugs. Third, some patients requiring prolonged administration of NMBs during their ICU stay, increase their risk of postparalytic syndrome. Fourth, critical illness polyneuropathy (CIP) and steroid-related myopathy are additional complications that may compound the issue of prolonged weakness. Finally, the emergent nature of severe traumatic injuries further complicate the situation (especially head trauma), as incomplete information about the patient’s preinjury neurological status or other underlying medical conditions, may be unavailable to guide the proper use of sedatives and NMBs (1-8).
