Table 2.
Studies of NMBAs related to prolonged weakness, CIP, and CIM
| NMBA | Author | Subjects | Study design | Motor | Sensory | EMG | Muscle biopsy | Prolonged weakness, CIP, and CIM |
|---|---|---|---|---|---|---|---|---|
|
Benzylisoquinolinium | ||||||||
| Cisatracurium | ||||||||
| Human studies | ||||||||
| |
Fodale et al. [36] |
1 |
Case report |
Y |
N |
Y |
N |
NMBA and CS for 7 days in patient with chest wall trauma led to quadriplegia consistent with CIM. |
| |
Davis et al. [35] |
1 |
Case report |
Y |
N |
N |
N |
NMBA and CS for 6 days with 6 additional days of NMBA in 45-year-old with ARDS led to CIM. |
| Atracurium | ||||||||
| Human studies | ||||||||
| |
Tousignant et. al. [38] |
1 |
Case report |
Y |
N |
Y |
N |
18-year-old asthmatic with 7 days of NMBA and CS develops acute quadriparesis 3 days after cessation of NMBA consistent with CIM. |
| |
Meyer et al. [37] |
2 |
Case report |
Y |
N |
Y |
N |
38-year-old receiving CS and 8 days of NMBA developed CIM. 25-year-old with good pastures receiving CS and NMBA for 6 days develop CIM. |
|
Aminosteriods | ||||||||
| Pancuronium | ||||||||
| Human studies | ||||||||
| |
Behbehani et al. [26] |
86 |
Retrospective Cohort |
Y |
N |
Y |
N |
Asthmatics receiving NMBA and CS. Pancuronium, vecuronium used in 30 with 9 developing CIM. All nine received pancuronium. |
| |
de Lemos et al. [39] |
30 |
Prospective Observational Cohort |
Y |
N |
Y |
N |
Study of recovery time in continuous infusion versus bolus groups. Six patients with CIM, five of which received continuous infusion. No statistical difference in total dose between groups. |
| |
Giostra et al. [30] |
9 |
Prospective Cohort |
Y |
Y |
Y |
Y |
Over 2 years, nine patients with respiratory failure requiring mechanical ventilation and NMBA developed CIP. Eight of nine received concomitant NMBA and CS. |
| Rocuronium | ||||||||
| Animal Studies | ||||||||
| |
Maes et al.[40] |
Rat / 27 |
Prospective Randomize |
N/A |
N/A |
Y |
Y |
1 dose of CS added to 24 hours of NMBA results in decreased CIM of diaphragm than NMBA alone. |
| |
Testelmans et al.[33] |
Rat / 24 |
Prospective Randomize |
N/A |
N/A |
Y |
Y |
24 hours of rocuronium associated with worse CIM than cisatracurium. |
| |
Testelmans et al.[32] |
Rat / 34 |
Prospective Randomize |
N/A |
N/A |
Y |
Y |
24 hours of NMBA associated with increased CIM than mechanical ventilation alone. |
| Vecuronium | ||||||||
| Human Studies | ||||||||
| |
Garnacho- Montero et al.[25] |
73 |
Prospective Cohort |
Y |
Y |
Y |
N |
In septic cohort with more than 2 organ failure, 9 of 10 patients who got NMBA developed CIP. 6 received vecuronium and 3 received atracurium |
| |
Rudis et al.[34] |
77 |
Prospective Randomized Single-Blind |
Y |
N |
Y |
N |
Use of peripheral nerve stimulator resulted in half dose of NMBA given. 16 patients with prolonged blockade and 4 with CIP. More prolonged blockade and CIP in group with more NMBA. |
| |
Prielipp et al.[41] |
58 |
Prospective Randomized Double-Blind |
Y |
Y |
Y |
Y |
Prolonged recovery in 13 patients with vecuronuim versus 2 with cisatracurium (p=0.002). CIP in 1 vecuronuim patient. |
| |
Douglass et al.[27] |
25 |
Prospective Cohort |
Y |
N |
N |
N |
22 patients received NMBA and CS. 9 developed CIM. CIM associated with time ventilated and dose of NMBA received. |
| |
Kupfer et al.[31] |
28 |
Prospective Cohort |
Y |
1/5 |
Y |
N |
50% of patient without sepsis or multi-organ failure with more than 6 hours of NMBA infusion developed weakness. 1 CIPM, 4 CIM. CIPM and CIM ssociate with increase dose. |
| Danon et al.[42] | 1 | Case report | Y | N | N | Y | 20 year old asthmatic who received CS and NMBA for 10 days developed CIM. | |