Neuromuscular Blocking Agents: an Argument for Their Adequate Use

Abstract

Introduction. The debate regarding the use of muscle relaxants is still ongoing, with arguments against such as their adverse effects and published risks, and arguments in favor such as the need to ensure rapid and adequate intubation in emergency cases, the benefit of an easy surgical field for the surgeon, and other reported benefits.

Objective. To review aspects associated with the adequate use of neuromuscular blocking agents in anesthesia.

Materials and methods. Narrative review of the scientific literature available on the subject that focused on indications, risks, benefits and monitoring.

Results. The absolute indication of muscle relaxants is rapid-sequence intubation, but there are other situations where they are recommended: Intubation in elective surgery, certain types of special surgical procedures and situations (ARDS, electroconvulsive therapy, intra-abdominal hypertension, intracranial hypertension), and they may be avoided in many general anesthesia cases. Most important is to be aware of their indications, risks and adequate use.

Conclusion. In conclusion, there are situations where the use of muscle relaxants may be avoided, but there are also instances were they are a requirement and it is in those cases where they are recommended. Therefore, if they are to be used, they must be the ideal choice for the individual patient at the right time and the right dose, and always under appropriate monitoring.