The Influence of Acid-Base Balance on Anesthetic Muscle Relaxants: A Comprehensive Review on Clinical Applications and Mechanisms - Article abstract #944510

Navigating Anesthesia: Muscle Relaxants and Reversal Agents in Patients with Renal Impairment - Article abstract #945141

Neuromuscular blocking agents (NMBAs) are widely used in anesthesiology. However, their use in Intensive Care Units (ICUs) has yet to be fully standardized. Due to numerous conflicting reports or insufficient scientific evidence, there are significant controversies surrounding the use of these drugs, particularly in patients requiring ventilatory support for ARDS, those with increased intracranial pressure, or patients undergoing therapeutic hypothermia (especially after cardiac arrest resuscitation). ICU patients are typically critically ill, often in sepsis, with multiple comorbidities, multi-organ failure, homeostasis disturbances, and requiring multiple medications. These conditions can significantly affect the potency and action of skeletal muscle relaxants. In recent years, the importance of monitoring neuromuscular blockade has been emphasized. Clinical examination, although widely used, has limited applicability in ICU settings. Peripheral nerve stimulation (PNS) and train-of-four (TOF) monitoring are qualitative methods, whereas quantitative techniques, which provide objective measurements, are increasingly recommended for managing neuromuscular blockade. Most guidelines currently focus on perioperative monitoring, and there is a lack of detailed recommendations for using these methods in the ICU. This article discusses existing research on the use of skeletal muscle relaxants, neuromuscular blockade reversal agents, and monitoring methods for neuromuscular blockade in intensive care units.

Skeletal muscle relaxants have found wide application in anesthesiology. They are used during surgeries, to support mechanical ventilation, or as an aid for safe intubation. Their use is associated with the creation of a conduction block at the neuromuscular junction. To terminate the neuromuscular blockade or to prevent residual blockade, another group of drugs called reversal agents is used. These include drugs like neostigmine and sugammadex. Many factors may influence the duration and potency of skeletal muscle relaxants, including dysfunctions of organs such as the kidneys or liver. Liver damage can have various etiologies - it can be toxic drug-induced, or due to the ingestion of toxic substances, viral infections, or alcohol consumption. In recent years, there have been increasing reports on the impact of metabolic disorders on liver steatosis and damage. The liver is responsible for the metabolism of many drugs, the excretion of metabolites into bile, and protein production. Progressive liver damage can lead to its remodeling, and eventually to cirrhosis and failure. Liver dysfunction can be associated with numerous systemic complications. A decrease in protein synthesis causes a decrease in the binding of drugs to plasma proteins, a decrease in the volume of distribution, and an increased amount of free drug forms in the body. Liver failure can affect the metabolism of some skeletal muscle relaxants and neuromuscular blockade reversal agents. This article aims to review the role of muscle relaxants in anesthesia for patents with liver disease.

Use of Muscle Relaxants in Emergency Medicine: A Review - Article abstract #949876

Skeletal Muscle Relaxants and Their Impact on Intracranial Pressure in Neurosurgery - Article abstract #946569