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Neuromuscular Blockade

Updated : August 28, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

succinylcholine

0.6

mg/kg

Intravenous (IV)

for small procedures
Or 0.3-1.1 mg/kg IV
Or 3-4 mg/kg IM, max 150mg
0.04-0.07 mg/kg IV to maintain adequate muscle relaxation



edrophonium/atropine 

Administer dose of 0.05 to 0.1 ml/kg intravenously given over 45 to 60 seconds
Dosing modification
Renal impairment
No dose modification required
Hepatic Impairment
No dose modification required



neostigmine 

Dose of 0.03 to 0.07 mg/kg intravenous will typically result in a train-of-four twitch ratio of 90% within 10 to 20 minutes of administration
Dose not more than 0.07 mg/kg or a cumulative total of 5 mg whichever dose is smaller from these is to be injected by slow intravenous for minimum 1 minute



glycopyrrolate 

Intravenous (IV)

0.2mg i.v./1 mg neostigmine or 0.2 mg i.v. per 5 mg of pyridostigmine



 

succinylcholine

Initial: 2 mg/kg IV or 3-4 mg/kg deep IM
Maintenance: 0.3-0.6 mg/kg IV every 5-10min



neostigmine 

Dose of 0.03 to 0.07 mg/kg intravenous will typically result in a train-of-four twitch ratio of 90% within 10 to 20 minutes of administration
Dose not more than 0.07 mg/kg or a cumulative total of 5 mg whichever dose is smaller from these is to be injected by slow intravenous for minimum 1 minute
Administration
Intravenous train-of-four monitoring for Neuromuscular Blockade reversal:
Peripheral nerve stimulation devices capable of producing a train-of-four stimulus are required to effectively and safely regulate intravenous dose



glycopyrrolate 

0.2mg/neostigmine or per each 5mg of pyridostigmine



 

Media Gallary

References

Neuromuscular Blockade

Updated : August 28, 2022




succinylcholine

0.6

mg/kg

Intravenous (IV)

for small procedures
Or 0.3-1.1 mg/kg IV
Or 3-4 mg/kg IM, max 150mg
0.04-0.07 mg/kg IV to maintain adequate muscle relaxation



edrophonium/atropine 

Administer dose of 0.05 to 0.1 ml/kg intravenously given over 45 to 60 seconds
Dosing modification
Renal impairment
No dose modification required
Hepatic Impairment
No dose modification required



neostigmine 

Dose of 0.03 to 0.07 mg/kg intravenous will typically result in a train-of-four twitch ratio of 90% within 10 to 20 minutes of administration
Dose not more than 0.07 mg/kg or a cumulative total of 5 mg whichever dose is smaller from these is to be injected by slow intravenous for minimum 1 minute



glycopyrrolate 

Intravenous (IV)

0.2mg i.v./1 mg neostigmine or 0.2 mg i.v. per 5 mg of pyridostigmine



succinylcholine

Initial: 2 mg/kg IV or 3-4 mg/kg deep IM
Maintenance: 0.3-0.6 mg/kg IV every 5-10min



neostigmine 

Dose of 0.03 to 0.07 mg/kg intravenous will typically result in a train-of-four twitch ratio of 90% within 10 to 20 minutes of administration
Dose not more than 0.07 mg/kg or a cumulative total of 5 mg whichever dose is smaller from these is to be injected by slow intravenous for minimum 1 minute
Administration
Intravenous train-of-four monitoring for Neuromuscular Blockade reversal:
Peripheral nerve stimulation devices capable of producing a train-of-four stimulus are required to effectively and safely regulate intravenous dose



glycopyrrolate 

0.2mg/neostigmine or per each 5mg of pyridostigmine



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