Guidelines for the Use of Neuromuscular Blocking Agents: A Clinical Update-Guidelines NMB

Video Transcription

Video Summary

The panel discussed the guidelines for the use of neuromuscular blocking agents, specifically focusing on monitoring considerations and the use of Sugammadex for reversal. The panel emphasized the importance of objective monitoring, such as using the ulnar nerve or adductor pollicis muscle, rather than subjective signs of assessment. They highlighted that the standard for readiness for extubation is a train-of-four ratio of at least 0.9. They also discussed the use of Sugammadex as a reversal agent, stating that it is a safer and more effective alternative to neostigmine. The panel recommended that Sugammadex be used for all levels of neuromuscular blockade, as determined by objective monitoring. They addressed concerns about the cost of Sugammadex and suggested working with pharmaceutical organizations to increase its availability. They also mentioned the need for caution in using Sugammadex for end-stage renal disease patients, as there is limited data on its use in this population. The panel emphasized the importance of considering comorbidities and contraindications when determining the appropriate neuromuscular blocking agent to use. Overall, the guidelines aim to improve patient outcomes and promote safety in the administration of neuromuscular blocking agents.

Keywords

neuromuscular blocking agents

monitoring considerations

Sugammadex

reversal

objective monitoring

train-of-four ratio

neostigmine

end-stage renal disease

comorbidities