Rational Use of Muscle Relaxants During Intensive Care Treatment

Abstract

Muscle relaxants are clinically used to facilitate endotracheal intubation and artificial ventilation, to relax hypertone muscles, to decrease oxygen consumption and to make surgical operations possible. For these indications depolarizing and non-depolarizing muscle relaxants are routinely used in both the operation suite and the intensive care unit. Besides for the facilitation of endotracheal intubation is nowadays such a routine administration of relaxants during intensive care treatment controversial. The occurrence of immobilization atrophy and the subsequent muscle weakness resulting in problems with weaning of the patients from the ventilator and with mobilization, have led to a more selective use of the compounds. Complete paralysis with insufficient sedation may in many patients have contributed to the post-intensive care psychological problems. Therefore a more rational use depending on the needs of the patients and the characteristics of the available agents are requested. The various muscle relaxants do have different pharmacological properties that make it possible to select the drug to be administered in relation to the need and the pathological condition of the patient. For example some muscle relaxants cause a considerable increase in heart rate and should therefore be avoided in patients with tachycardia [1]. Other relaxants cause histamine release [2, 3] leading to hypotension, tachycardia and bronchoconstriction.