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A neuromuscular blockade is an administration of paralytic drugs which act on the neuromuscular junction to facilitate temporary paralysis. A number of drugs can have neuromuscular effects, including pancuronium, atracurium, and gallamine. These drugs must be administered in a clinical setting because they can have dangerous side effects and in some patients they may have lingering effects which need to be monitored.
Historically, neuromuscular blockade was first used as an anesthesia technique in surgery. With the use of paralytic drugs, surgeons can operate in a very still field. These drugs have to be combined with pain relief and other medication as it is still possible for people to feel pain in an area which has been rendered motionless with the use of a neuromuscular blockade. These drugs are usually administered by a qualified anesthesiologist who has studied their action in the body and who is aware of safety issues related to neuromuscular blockade.
One of the biggest safety concerns is that it is possible for a patient to stop breathing, in which case prompt intervention is needed to secure the airway and attach a mechanical ventilator to breathe for the patient until the effects of the drugs wear off. Patients can also develop an irregular heart rate and high blood pressure, both of which can be dangerous in general but especially during surgery. For these reasons, careful monitoring is needed while a neuromuscular blockade is used, and it is important to perform a thorough followup exam to check for any lingering ill effects.
Today, this technique is also used in intensive care, where it is sometimes necessary to use paralytic agents so that patients can remain on ventilators or to address other issues, such as fighting intravenous lines. Some patients in intensive care enter a state of delirium as a result of advanced disease processes and side effects from medications, and they may not be aware of what they are doing. Neuromuscular blockades need to be used with care in these cases because long-term use of paralytic drugs can cause permanent muscle damage and weakness.
Another area of medical practice in which induced paralysis can be useful is for medical procedures in which the patient must be still. Patients usually cannot hold totally still for procedures, especially if they are sick or confused, and they can put themselves or their care providers at risk by moving. With the assistance of an anesthesiologist, a neuromuscular blockade can be used during procedures where absolute stillness is required.
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