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Neuromuscular Blocking and Reversal Agents

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Geriatric Anesthesiology

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Abstract

Although age-related changes in hepatic, renal, and cardiac function slow the onset and clearance of many nondepolarizing neuromuscular blocking agents (NMBAs) in geriatric patients, extensive changes at the neuromuscular junction do not increase sensitivity to these compounds. Decreased clearance mandates that neuromuscular block be maintained and subsequent doses administered only after documentation of return of muscle strength with a monitor of neuromuscular blockade. Except in rare cases, antagonism of residual NMB will be required. Dosing of reversal agents, whether anticholinesterases or the selective relaxant binding agent, sugammadex, should, as it is with NMBAs, be based on the results of monitoring of neuromuscular function.

As the surgical population ages and surgical trends and practices evolve, neuromuscular blocking agents, like anesthetics, must be specifically chosen based not only on their pharmacokinetic and pharmacodynamic properties but also on the basis of patient age.

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Abbreviations

BChE:

Butyrylcholinesterase

ED95 :

The dose that will cause, on average, 95% of neuromuscular blockade

NMB:

Neuromuscular blockade

NMBAs:

Neuromuscular blocking agents

PACU:

Postanesthesia care unit

TOFR:

Train-of-four ratio

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Authors and Affiliations

  1. Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA

    Cynthia A. Lien

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Correspondence to Cynthia A. Lien .

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Editors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

    J. G. Reves

  2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Sheila Ryan Barnett

  3. Department of Anesthesia and Perioperative Medicine, Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA

    Julie R. McSwain

  4. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA

    G. Alec Rooke

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Lien, C.A. (2018). Neuromuscular Blocking and Reversal Agents. In: Reves, J., Barnett, S., McSwain, J., Rooke, G. (eds) Geriatric Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-66878-9_20

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