Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pharmacologic administration of sedatives is used routinely in the care of the critically ill to enhance patient comfort and optimize care. Long-term administration of NMB drugs is far less frequent but often occurs in patients with greater organ dysfunction. The experience of several authors using NMB drugs in the ICU is summarized in Table 5. Both classes of drugs have potential untoward effects. Some are readily predictable; others are not. NMB drugs enjoy a long record of safe, effective use during the perioperative period, but certain issues linger in defining appropriate administration to critically ill patients. Major concerns focus on the appropriate drug selection and delivery, monitoring, and neuromuscular recovery of patients who receive NMB drugs for longer than 24 hours. The development of myopathy and paresis has been increasingly recognized after prolonged use of NMB drugs in the ICU. Further investigation needs to fully characterize this process, identify those at risk, and outline a mechanism to prevent or limit the injury. Prolonged weakness may occur secondary to changes in the basic pharmacology and elimination of NMB drugs in ICU patients. Pathophysiologic changes in the nerve, muscle, or neuromuscular junction may also play a role in the development of some cases of prolonged weakness or myopathy after discontinuation of NMB drugs. Concerns about the potential for direct or indirect toxicity of NMB drugs to skeletal muscle and in the CNS remain. Resolution of these issues will improve the selection and optimal administration of sedative and NMB drugs in the ICU setting.
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PMID:Complications associated with sedative and neuromuscular blocking drugs in critically ill patients. 853 89

Muscle weakness, particularly impairment of the respiratory muscles, is a frequent abnormality in ICU patients. This is more relevant in some clinical situations--for example, in weaning patients from mechanical ventilation. Intensive care procedures that are designed to "rest" respiratory muscles, such as mechanical ventilation, may also contribute to impaired muscle function. Pharmacologic administration of glucocorticoids, several antibiotics, NMB agents, and so on has the potential to cause untoward effects. The development of myopathy and prolonged paresis has been increasingly recognized after prolonged use of these drugs in the ICU. Pathophysiologic changes in the nerve, muscle, or neuromuscular junction associated with the patient's underlying condition may also play a role in the development of impaired function. The assessment of muscle function is difficult and inaccurate. The techniques developed have a poor predictive value because of the difficulty in making the measurements in uncooperative patients and the lack of standardization. Furthermore, it is likely that some voluntary maneuvers underestimate muscle strength. Invasive procedures such as phrenic nerve stimulation or EMG recording are also of limited value.
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PMID:Muscle dysfunction in the intensive care unit. 1038 66