PROLONGED MUSCLE WEAKNESS AFTER NEUROMUSCULAR BLOCKADE IN THE INTENSIVE-CARE UNIT

Recent reports from around the world have demonstrated that some critically ill patients remain profoundly weak for days to weeks after receiving a neuromuscular blocking agent in the intensive care unit. Because muscle weakness can be caused by several different conditions in the ICU, management should begin with a systematic evaluation, including neurologic examination and electrodiagnostic studies. Central nervous system dysfunction should be considered first. Prolonged muscle weakness can be caused by persistent neuromuscular blockade resulting from delayed elimination of a parent drug or an active metabolite. An acute, necrotizing myopathy sometimes develops after prolonged administration of a neuromuscular blocking drug, especially when used in combination with a glucocorticoid. Critical care polyneuropathy should also be considered in these patients. The rate of recovery from prolonged muscle weakness varies according to the cause but is often complete following appropriate rehabilitation.