Selection and Monitoring of Muscle Relaxants During Mechanical Ventilation
Bibliographic record
Abstract
ABSTRACT Traditionally, intensive care patients on mechanical ventilation who require muscle relaxant therapy have been treated with bolus doses of pancuronium, a non-depolarizing neuromuscular blocker. Although this drug produces effective paralysis, its use is limited by adverse effects including accumulation with prolonged use, dosage adjustment requirements in the elderly and those with renal or hepatic failure, and cardiovascular toxicity. Vecuronium and atracurium are two newer non-depolarizing muscle relaxants which can be administered by continuous infusion. These agents are more expensive than pancuronium, however, they offer several advantages for critically ill patients requiring continuous paralysis. There is less potential for accumulation, even in patients with renal dysfunction, allowing rapid reversal of paralysis upon discontinuation. In addition, both agents have a higher cardiovascular safety margin. Finally, infusions provide continuous, titratable paralysis as opposed to bolus doses which are re-administered only after signs of recovery. While many patients do not need to be continually paralysed and are well maintained on as required pancuronium bolus doses, atracurium and vecuronium are advantageous in the severely agitated, ventilator-dependent patient. For any patient receiving neuromuscular blocking agents, appropriate monitoring should minimize adverse effects and limit the potential for prolonged recovery. RESUME Habituellement, les patients des soins intensifs sur respirateur qui ont besoin d'un traitement myorelaxant recoivent des doses intermittentes de pancuronium, agent bloquant neuromusculaire non depolarisant. Bien que ce medicament produise une paralysie efficace, son emploi est limite par des effets secondaires, tels que son accumulation lors d'un usage prolonge, par la necessite d'ajuster la posologie chez les personnes âgees ou souffrant d'insuffisance renale ou hepatique, et par sa toxicite cardiovasculaire. Le vecuronium et l'atracurium sont deux relaxants musculaires non depolarisants plus recents administres par perfusion continue. Ces agents coutent plus cher que le pancuronium, mais offrent plusieurs avantages au patient dont l'etat exige une paralysie continue. Le risque d'accumulation etant moindre, meme chez le patient presentant une insuffisance renale, le renversement de la paralysie est rapide lorsqu'on interrompt le traitement. De plus, ces deux medicaments offrent une plus grande marge de securite au niveau cardiovasculaire. Finalement, la perfusion induit une paralysie continue titrable contrairement aux doses intermittentes qui ne sont readministree qu'a l'apparition de signes de recuperation. Bien que bon nombre de patients n'aient pas besoin d'une paralysie continue et chez qui l’administration de doses intermittentes de pancuronium est suffisante, l'atracurium et le vecuronium presentent des avantages chez le patient tres agite sur respirateur. Dans tous les cas, les patients recevant des agents bloquants neuromusculaires doivent faire l'objet d'une surveillance adequate afin de minimiser les effets secondaires et diminuer le risque de recuperation Prolongee.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".