The use of neuromuscular blocking drugs in the intensive care unit: A US perspective

1993 ◽  
Vol 19 (S2) ◽  
pp. S40-S44 ◽  
Author(s):  
M. J. Murray ◽  
R. A. Strickland ◽  
C. Weiler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Drugs

Do Shorter-acting Neuromuscular Blocking Drugs or Opioids Associate with Reduced Intensive Care Unit or Hospital Lengths of Stay after Coronary Artery Bypass Grafting? 

1998 ◽  
Vol 88 (6) ◽  
pp. 1437-1446 ◽  
Author(s):  
John Butterworth ◽  
Robert James ◽  
Richard C. Prielipp ◽  
Julie Cerese ◽  
Jean Livingston ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Coronary Artery ◽  
Tracheal Intubation ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Tracheal Extubation ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Drugs

Background The authors hypothesized that shorter-acting opioid and neuromuscular blocking drugs would be associated with reductions in duration of intubation, length of stay (LOS) in the intensive care unit (ICU) after tracheal extubation, or postoperative (exclusive of ICU) LOS, and that shorter durations of intubation would be associated with reduced ICU LOS after extubation and postoperative (exclusive of ICU) LOS. Methods One-thousand ninety-four patients undergoing primary coronary artery bypass graft surgery at 40 academic health centers were studied. Multiple patient-related factors were included in multivariate models for hypothesis testing. Results The duration of tracheal intubation, ICU LOS after extubation, and postoperative (exclusive of ICU) LOS all varied significantly by site. There was no difference between vecuronium and pancuronium in duration of intubation, ICU LOS after extubation, or postoperative (exclusive of ICU) LOS. Use of sufentanil rather than fentanyl was associated with a significant (P=0.045) reduction of 1.9 h (95% CI, 0.04 to 4.1 h) in duration of tracheal intubation but had no significant effect on ICU LOS after extubation, total ICU LOS, postoperative (exclusive of ICU) LOS, or total postoperative LOS. The authors' best model predicts a complex association between increasing duration of intubation and both ICU LOS after tracheal extubation and postoperative (exclusive of ICU) LOS, which was associated with an increase in those measures when duration of intubation exceeded 7.3 or 3 h, respectively. Conclusions The LOS measures varied considerably among the institutions. Use of shorter-acting opioid and neuromuscular blocking drugs had no association with ICU LOS after tracheal extubation or with postoperative (exclusive of ICU) LOS. Only when the duration of intubation exceeded threshold values was it associated with increased LOS measures.

scholarly journals Evaluation of the antimicrobial effects of atracurium, rocuronium and mivacurium. Antimicrobial effects of muscle relaxants

2010 ◽  
Vol 1 (1) ◽  
pp. 2 ◽  
Author(s):  
Volkan Hanci ◽  
Fusun Cömert ◽  
Hilal Ayoğlu ◽  
Canan Kulah ◽  
Serhan Yurtlu ◽  
...  
Keyword(s):  
Intensive Care ◽  
Antibacterial Effect ◽  
Neuromuscular Blocking ◽  
Antibacterial Effects ◽  
Minimum Concentration ◽  
Neuromuscular Blocking Drugs ◽  
Antimicrobial Effects ◽  
Anaesthetic Agents ◽  
Broth Microdilution Method

Some anaesthetic agents may be contaminated with microorganisms during the process of preparing an infusion. For this reason, it is important to understand the antimicrobial effects of various anaesthetic agents, which have been investigated to some degree in previous studies. However, studies specifically focusing on antibacterial effects of neuromuscular blocking drugs (anaesthetic agents) are very rare. Herein, we analysed the antimicrobial effects of atracurium, rocuronium, and mivacurium, on four different microorganisms. The in vitro antimicrobial activities of atracurium, rocuronium and mivacurium were investigated using the broth microdilution method. The pH of the test solutions was determined using a pH meter. The test microorganisms included Staphylococcus aureus ATCC 29213, Enterococcus fecalis ATCC 29212, Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. The pH of the test solutions ranged between 7.20 and 7.32. The minimum inhibitory concentrations of atracurium, rocuronium and mivacurium for S. auereus, E. fecalis, E. coli and P. Aeruginosa were all found to be 512 µg/mL. Atracurium, rocuronium and mivacurium inhibit the growth of common intensive care unit pathogens at the same concentration (512 µg.mL–1). Thus, the neuromuscular blocking drugs, atracurium, rocuronium and mivacurium should be administered at a minimum concentration of 512 µg/mL in intensive care units to achieve this antibacterial effect. In our opinion, when used systemically, atracurium, rocuronium and mivacurium do not cause a systemic antibacterial effect. However, their antibacterial effects may be advantageous for inhibiting the spread of bacterial contamination during the preparation of the infusion solutions.

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