Approach to Muscle Relaxants in Intensive Care

Introduction

Muscle relaxant use in the intensive care setting is to be discouraged unless specifically indicated.

The indications for using muscle relaxants in intensive care are limited to:

  • Endotracheal intubation (suxamethonium unless contra-indicated)
  • Acute control of ventilation post intubation
  • Patient transport
  • Selected patients with complicated ventilatory parameters
  • Facilitate acute procedure:  tracheostomy, bronchoscopy
  • In selected patients with severe head injury and uncontrolled intra-cranial pressure

 

Complications

  • Hyperkalaemia (suxamethonium)
  • Polyneuropathy and myopathy
  • Sympathetic overdrive where accompanying sedation is adequate

 

Commonly Used Muscle Relaxants in the Intensive Care

RelaxantDoseComment
Suxamethonium

100-200 mg

or

1-2mg/kg

Consider pre-treatment with atropine (0.6-1.2 mg) if potential bradycardia

Contraindicated in burns (> 3 days post burn), chronic spinal and neuromuscular syndromes, hyperkalaemic states (K+ > 5.5)

Pancuronium2-4 mg IV prnTachycardia rarely a problem in IC patients
Rocuronium0.6 mg/kg

Rapid onset (60 secs) non depolarizer

Duration of action: 30-40 minutes

Used as alternative to suxamethonium for emergency intubation

 

Pancuronium should be used for ongoing paralysis unless contraindicated

rounded corners top

Related Documents

rounded corners bottom
Page last reviewed: 14 May 2014
Contact Us
Image of a Phone By Phone
Image of an Email sign By Email

For a full list of the convenient ways that you can contact us, refer to the Contact Us page