MUSCLE RELAXANTS IN THE ICU.

Muscle relaxants are used in icu to facilitate mechanical ventilation of  the critically ill patients.The drugs commonly used  are pancuronium, vecuronium, atra curium, cisatra curium, and rocuronium.  Muscle relaxants are essential in the management of tetanus, status epilepticus, to provide hyper ventilation in head injury, or after  precise surgical intervention like tracheal anastomosis and vascular anastomosis.These agents are also used to reduce oxygen consumption or to reduce work of breathing in COPD and ARDS(where inflation pressures are high) patients.

Apart from the beneficial effects  the complications of these agents are also of concern and are investigated. These can be classified as  complications due to short term use and long term use

Short term use   

• Side effects atracurium causing histamine release or hyperkalemia due to suxamethonium
• Inadequate analgesia or sedation as these components are under estimated when relaxants are used

Long term use

• Immobility : DVT decubitus ulcers, peripheral nerve injuries.
• Inability to cough:  retained secretions,  atelectasis and infection
• Persistent paralysis on stoppage of the drugs "Critical Illness Neuropathy and Critical Illness Myopathy", Steroid induced myopathy.
• CNS effects of drugs eg: laudanosine causing convulsions

The end result of these complications  are failure to wean from mechanical ventilator, other ventilator associated complications,  residual weakness for life, and health care costs.