| Abstrakt: |
There are many reasons for monitoring the neuromuscular function, including1.There is a wide variability in onset and recovery times with various relaxant regimens. 2.When clinical means of assessment are used exclusively, the incidence of residual curazidation remains unacceptably high. 3.Infusion techniques of both depolarizing and nondepolarizing agents are notoriously difficult to titrate accurately in the clinical setting 4.The development of phase 2 block after succinylcholine requires the use of a nerve stimulator for its diagnosis. 5.The newer nondepolarizing agents with short half-lives (especially mivacurium) may have such rapid offset that minitoring is needed to assure adequate intraoperative relaxation. 6.Patient response to muscle relaxants is difficult to predict accurately in certain disease states (myasthenia gravis, Eaton-Lambert syndrome, hypothermia, and hypokalemia). 7.The pharmacokinetic parameters of relaxants are altered in the elderly, those with renal or hepatic impairment, and in patients with atypical or reduced pseudocholinesterase levels. 8.Drug interactions between neuromuscular agents and inhalational anesthetics, nitrous oxide, local anesthetics, antiarrhythmics, aminoglycosides, and calcium channel blockers can modify the response to both relaxants and reversal agents. 9.In the ICU setting or when patients require prolonged neuromuscular relaxation, monitoring and titration of NMBs based on evoked responses prevents NMB overdosing and reduces the incidence of persistent paralysis/myopathy. |
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