Neuromuscular blocking drug toxicity?
I need to find out why it is a major concern for this drug's toxic side effects after surgery? What would the nurse be looking for and are the side effects more dangerous after surgery?
Answers:
NMBAs don't really own a lot of side effects. Pancuronium can cause tachycardia, and curare was renowned for histamine release (it's no longer used). Succinylcholine has its own issues, but they're going to be intraoperative, not post-op, unless it's the rare case of pseudocholinesterase deficiency/atypia. (Repeated doses of sux can basis asystole - that's exciting - and infusions can lead to a phase 2 block)
The main thing that one wants to watch out for is not a SIDE effect, but residual blockade. We monitor NM blockade with a peripheral backbone stimulator, and it's not particularly sensitive. Patients can still be weak after surgery. Some of the reversal drugs are shorter acting than some of the NMBAs, so recurarization is a possiblity (yeah, we call it that even though we don't use curare any more)
Look for impediment and difficulty breathing. A quick and dirty test for NM function is if the patient can hold his team leader up off the pillow for 5 seconds.
Residual blockade is going to be more dangerous after surgery because the forgiving isn't monitored as closely, the airway is not usually controlled, and there's not a ventilator sitting 3 feet away. Source(s): I play with these drugs a lot.
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Answers:
NMBAs don't really own a lot of side effects. Pancuronium can cause tachycardia, and curare was renowned for histamine release (it's no longer used). Succinylcholine has its own issues, but they're going to be intraoperative, not post-op, unless it's the rare case of pseudocholinesterase deficiency/atypia. (Repeated doses of sux can basis asystole - that's exciting - and infusions can lead to a phase 2 block)
The main thing that one wants to watch out for is not a SIDE effect, but residual blockade. We monitor NM blockade with a peripheral backbone stimulator, and it's not particularly sensitive. Patients can still be weak after surgery. Some of the reversal drugs are shorter acting than some of the NMBAs, so recurarization is a possiblity (yeah, we call it that even though we don't use curare any more)
Look for impediment and difficulty breathing. A quick and dirty test for NM function is if the patient can hold his team leader up off the pillow for 5 seconds.
Residual blockade is going to be more dangerous after surgery because the forgiving isn't monitored as closely, the airway is not usually controlled, and there's not a ventilator sitting 3 feet away. Source(s): I play with these drugs a lot.
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