View source for Neuromuscular Blockade

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NMBA
NMBD


<b>Standards/Guidelines</b>

[https://pubmed.ncbi.nlm.nih.gov/36520073/ 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade]

[https://pubmed.ncbi.nlm.nih.gov/10983014/ Neuromuscular blockade in children]

[https://pubmed.ncbi.nlm.nih.gov/30594097/ Incidence, risk factors, and consequences of residual neuromuscular block in the United States: The prospective, observational, multicenter RECITE-US study]

[https://pubmed.ncbi.nlm.nih.gov/36377554/ Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care]



<b>Physiology</b>

[https://pubmed.ncbi.nlm.nih.gov/40905255/ Development of the neuromuscular junction and neuromuscular blocking agents in neonates, infants and children: A narrative review]

[https://pubmed.ncbi.nlm.nih.gov/7114542/ Pharmacokinetics and pharmacodynamics of d-tubocurarine in infants, children, and adults.]

[[Pseudocholinesterase Deficiency]]

[https://link.springer.com/article/10.2165/00003088-200443020-00001 Antiepileptic-Induced Resistance to Neuromuscular Blockers: Mechanisms and Clinical Significance]




<b>Monitoring</b>

[https://www.bjaed.org/article/S2058-5349(23)00143-9/fulltext Neuromuscular block management: evidence-based principles and practice]

[https://pubmed.ncbi.nlm.nih.gov/34813652/ Quantitative Neuromuscular Monitoring and Postoperative Outcomes: A Narrative Review]

[https://pubmed.ncbi.nlm.nih.gov/28795964/ Neuromuscular Monitoring in the Perioperative Period]

[https://pubmed.ncbi.nlm.nih.gov/6990835/ Leg lift and maximum inspiratory force, clinical signs of neuromuscular blockade reversal in neonates and infants]

[https://pubmed.ncbi.nlm.nih.gov/31607388/ Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data]

[https://pubmed.ncbi.nlm.nih.gov/23001053/ Intraoperative neuromuscular monitoring site and residual paralysis]

[https://pubmed.ncbi.nlm.nih.gov/35188958/ Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative]

[https://journals.lww.com/anesthesia-analgesia/fulltext/2024/07000/pediatric_intraoperative_electromyographic.7.aspx Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis]

[https://pubs.asahq.org/anesthesiology/article/141/2/262/141383/Accuracy-and-Precision-of-Three-Acceleromyographs Accuracy and Precision of Three Acceleromyographs, Three Electromyographs, and a Mechanomyograph Measuring the Train-of-four Ratio in the Absence of Neuromuscular Blocking Drugs]

[https://journals.lww.com/anesthesiology/fulltext/2025/08000/skin_injury_after_removal_of_electrode_used_for.26.aspx Skin Injury after Removal of Electrode Used for Quantitative Monitoring of Neuromuscular Transmission]

<b>Agents</b>

''Depolarizing''


Succinylcholine

[https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2009.03032.x The place of suxamethonium in pediatric anesthesia]

[https://pubmed.ncbi.nlm.nih.gov/3946815/ Failure of succinylcholine to alter plasma potassium in children with myelomeningocoele]

 

''Non-Depolarizing''


Rocuronium

[https://pubmed.ncbi.nlm.nih.gov/9054273/ Intramuscular rocuronium]

[https://pubmed.ncbi.nlm.nih.gov/9366462/ Bioavailability of intramuscular rocuronium in infants and children]

[https://pubs.asahq.org/anesthesiology/article/139/1/A16/138250/Goldilocks-and-the-Three-Rocuronium-Reversals-A Goldilocks and the Three Rocuronium Reversals: A Sugammadex Dose-finding Study]

[https://pubmed.ncbi.nlm.nih.gov/12378667/ Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children]

[https://pubmed.ncbi.nlm.nih.gov/10485771/ Intramuscular rocuronium in infants and children: a multicenter study to evaluate tracheal intubating conditions, onset, and duration of action]

[[TYK6 |Test Your Knowledge]]: unique advantage of rocuronium

Elkhateb R, Campbell DL, Zhao X, et al. Neuromuscular blockade and antagonism in patients with renal impairment: a multicenter retrospective cross-sectional study. Anesthesiology. 2025 Jun; 142(6): 1009-1024. PMID: 39928534

Vecuronium


Cis-atracurium


<b>Antagonism/Reversal</b>

[https://pubmed.ncbi.nlm.nih.gov/21474022/ Assessment of neuromuscular blockade in children at the time of block reversal and the removal of the endotracheal tube]

[https://pubmed.ncbi.nlm.nih.gov/33543867/ A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade]

[https://pubmed.ncbi.nlm.nih.gov/36520074/ Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade]

[https://pubs.asahq.org/anesthesiology/article/139/1/6/138070/A-Dose-finding-Study-of-Sugammadex-for-Reversal-of A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]


Sugammadex

[https://www.statpearls.com/ArticleLibrary/viewarticle/29661 StatPearls: Sugammadex]

[https://pubmed.ncbi.nlm.nih.gov/31584918/ Retrospective Analysis of the Safety and Efficacy of Sugammadex Versus Neostigmine for the Reversal of Neuromuscular Blockade in Children]

[https://pubs.asahq.org/anesthesiology/article/doi/10.1097/ALN.0000000000004442/137334/Encapsulation-dynamics-of-neuromuscular-blocking Encapsulation dynamics of neuromuscular blocking drugs by sugammadex]

[https://pubmed.ncbi.nlm.nih.gov/28806470/ Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults]

[https://pubmed.ncbi.nlm.nih.gov/29280475/ The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta-analysis and trial sequential analysis]

[https://pubmed.ncbi.nlm.nih.gov/34878707/ Sugammadex for reversal of neuromuscular blockade in pediatric patients: Results from a phase IV randomized study]

[https://www.bjanaesthesia.org/article/S0007-0912(19)30835-9/fulltext Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study]

[https://www.bjaopen.org/article/S2772-6096(22)00091-0/fulltext Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study]

[https://pubmed.ncbi.nlm.nih.gov/33329823/ Advantages and pitfalls of clinical application of sugammadex]

[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1002/anr3.12233 Cardiac arrest following sugammadex administration]

[https://pubs.asahq.org/anesthesiology/article/138/2/152/137334/Encapsulation-Dynamics-of-Neuromuscular-Blocking Encapsulation Dynamics of Neuromuscular Blocking Drugs by Sugammadex]

[https://pubs.asahq.org/anesthesiology/article/139/1/6/138070/A-Dose-finding-Study-of-Sugammadex-for-Reversal-of A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]

[https://www.bjanaesthesia.org/article/S0007-0912(23)00385-9/fulltext A retrospective observational cross-sectional study of intraoperative neuromuscular blocking agent choice and dosing in a US paediatric referral hospital before and after introduction of sugammadex]

[https://pubs.asahq.org/anesthesiology/article/139/1/108/138037/Sugammadex-Vial-Wastage-Implications-for-the-Cost Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter]

[https://www.bjanaesthesia.org/article/S0007-0912(23)00548-2/fulltext Recurarisation after sugammadex in children: review of case reports and recommendations]

[https://journals.lww.com/anesthesia-analgesia/fulltext/2025/01000/factors_associated_with_decision_to_use_and_dosing.14.aspx Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study]

[https://pubmed.ncbi.nlm.nih.gov/39058621/ Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study]

[https://x.com/apsforg/status/1898792243835883675?s=46&t=X_9iaGrsYZbY5PJKh6nAPQ X tweet about sugammadex]

[https://pubmed.ncbi.nlm.nih.gov/39976619/ Unintended Consequences: Is Sugammadex Changing the Way We Deliver Anesthesia?]

[https://pubmed.ncbi.nlm.nih.gov/31980926/ Heart rate changes following the administration of sugammadex in children: a prospective, observational study]

[https://journals.lww.com/anesthesiology/abstract/9900/sugammadex_for_reversal_of_neuromuscular_blockade.682.aspx Sugammadex for reversal of neuromuscular blockade in neonates and infants <2 years old: results from a phase IV randomized clinical trial]

[https://pubmed.ncbi.nlm.nih.gov/32324657/ Sugammadex and neuromuscular reversal: Special focus on neonatal and infant populations]

[https://pubmed.ncbi.nlm.nih.gov/31584918/ Retrospective analysis of the safety and efficacy of sugammadex versus neostigmine for the reversal of neuromuscular blockade in children]

[https://pubmed.ncbi.nlm.nih.gov/27859917/ Current evidence for the use of sugammadex in children]

[https://pubmed.ncbi.nlm.nih.gov/37792601/ Analysis of the factors contributing to residual weakness after sugammadex administration in pediatric patients under 2 years of age]

[https://pubmed.ncbi.nlm.nih.gov/37279102/ Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal]

[https://pubmed.ncbi.nlm.nih.gov/37027807/ A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]


Sugammadexand Women, Hormonal Regulation, and Contraceptives, 

[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15902 A prospective observational study of the effects of sugammadex on peri-operative oestrogen and progesterone levels in women who take hormonal contraception]

[https://anesth-pain-med.org/m/journal/view.php?doi=10.17085/apm.23041 What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives]

[https://www.apsf.org/article/safety-of-sugammadex-in-pregnancy-pediatrics-and-renal-failure/ Safety of Sugammadex in Pregnancy, Pediatrics, and Renal Failure]



Neostigmine

[https://journals.lww.com/anesthesia-analgesia/fulltext/2025/05000/rocuronium_sugammadex_versus.1.aspx Rocuronium-Sugammadex Versus Cisatracurium-Neostigmine in Kidney Disease: Making Sense of Surprising Results]

[https://pubmed.ncbi.nlm.nih.gov/37171989/ Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring]

'''Anaphylaxis'''

[https://pubmed.ncbi.nlm.nih.gov/26646837/ Sugammadex and rocuronium-induced anaphylaxis]

[https://pubmed.ncbi.nlm.nih.gov/21149287/ Sugammadex in the management of rocuronium-induced anaphylaxis]

[https://pubmed.ncbi.nlm.nih.gov/35212434/ Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports]

[https://pubmed.ncbi.nlm.nih.gov/22512555/ The cyclodextrin sugammadex and anaphylaxis to rocuronium: is rocuronium still potentially allergenic in the inclusion complex form?]

[https://www.bjanaesthesia.org/article/S0007-0912(23)00104-6/fulltext Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study]

[https://www.bjanaesthesia.org/article/S0007-0912(24)00560-9/fulltext Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort]

[https://www.bjanaesthesia.org/article/S0007-0912(24)00716-5/fulltext Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity]

[https://www.bjanaesthesia.org/article/S0007-0912(25)00284-3/fulltext Incidence of immediate hypersensitivity to sugammadex in Aotearoa New Zealand: a retrospective cohort study]



<b>Historic</b>

Gallamine


Micacurium

[https://pubmed.ncbi.nlm.nih.gov/10638896/ Neuromuscular effects of mivacurium in 2- to 12-yr-old children with burn injury]


Curare