NEUROMUSCULAR BLOCKING AGENTS-Clinical Pearls

1. NMBA (Neuro muscular Blocking Agents) are used to improve conditions for TRACHEAL INTUBATION, to provide IMMOBILITY during surgery and to facilitate MECHANICAL VENTILATION.
2. The introduction of NMBA in 1942 was one of the most important MILESTONES in the history of Anesthesia. However, in1954, in a paper on anesthetic mortality, Beecher and Todd claimed that mortality increased by six folds when NMBA were used. This situation was probably because of suboptimal use of mechanical ventilation and reversal drugs
3. Incidence of awareness is greater when NMBA are used. However, anesthetics act at spinal cord level to produce immobility, and movement in response to a noxious stimulus indicates INADEQUATE ANALGESIA and not insufficient unconsciousness. THEREFORE, AWARENESS DOES NOT OCCUR BECAUSE TOO MUCH NMBA HAS BEEN GIVEN, BUT BECAUSE TOO LITTLE ANESTHETIC IS ADMINISTERED.
4. NMBA make a difference in lower abdominal surgery and surgical conditions are better in patients receiving these agents
5. By providing optimal intubating conditions, NMBA decrease the incidence of voice hoarseness and vocal cord damage
6. It is very essential to make sure that the effects of NMBA have worn off or are reversed before the patient regains consciousness