Critical Illness Clinical Trial
The main objectives of the prolonged resuscitation paralysis are usually adaptation to
mechanical ventilation, lower insufflation pressures and cough suppression.
The use of monitoring during the prolonged neuromuscular blockade is the subject of
recommendations. Its interest is subject to a recommendation grade B and its use in
prevention of overdose is associated with a recommendation of Grade C.
However, many practitioners continue to objectify the depth of neuromuscular blockade and
reversal by simple clinical evaluation. This is a subjective estimate of the depth of
neuromuscular block.
Resuscitation in several pharmacokinetic parameters are taken into account. First, the drug
distribution volume is usually increased in the Intensive Care patient and requires an
increase in initial doses to obtain the same pharmacological effect.
Then, unlike a short-term administration, the administration of neuromuscular blocking agents
on days causes diffusion in peripheral compartments. Their diffusion coefficients are slower
which contributes to the increase of the elimination period after interruption of the
administration of curare. There is therefore a risk of residual paralysis.
Secondarily, the curare needs can be influenced by thermoregulation, water and electrolyte
disorders and acid-base, administration of certain drugs, the inter- and intra-individual
variability and tachyphylaxis (form tolerance of particularly rapid installation during a few
close administration, linked to the proliferation of cholinergic receptors).
The value of monitoring neuromuscular blockade in intensive care is the prevention of
overdose and in finding the lowest effective dose.
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