Pulmonary Disorders I
Reversal of nondepolarizing NMBAs with a failed airway
An acetylcholinesterase inhibitor (neostigmine or pyridostigmine) in combination with an
anticholinergic (atropine or glycopyrrolate)
Sugammadex binds the aminosteroid class of nondepolarizing NMBAs (vecuronium and
rocuronium).
Agent
Dose
Onset
Duration
Cautions
Succinylcholine
IV: 1–2 mg/kg
IM: 3–4 mg/
kg (max 150
mg)
IV: 1 min
IM: 2–3 min
IV: 3–5 min
IM: 10–30
min
| • | Prolonged effects in pseudocholinesterase |
|---|
deficiency
| • | Hyperkalemia or patients at risk of |
|---|
hyperkalemia (prolonged immobilization,
crush injuries, myopathies, burns, muscular
dystrophy, stroke, and spinal cord injuries)
| • | Malignant hyperthermia |
|---|---|
| • | Bradycardia/hypotension with repeated doses |
| • | Mild increase in ICP |
Rocuronium
IV: 0.6–1.2
mg/kg
1–2 min
30–60 min
| • | Moderate increase in duration with liver |
|---|
dysfunction, minimal increase in duration
with renal dysfunction
Vecuronium
IV: 0.08–0.1
mg/kg
2–3 min
20–60 min
| • | Prolonged duration in renal and liver |
|---|
dysfunction
Provide continued sedation/analgesia as needed if an intermediate-acting NMBA was used and assists
in adequate oxygenation and ventilation
Maintain head-of-bed elevation at 30–45 degrees
Mouth and eye care
Bowel regimen
Stress ulcer and deep vein thrombosis prophylaxis