Sedativesand Paralytics: Nursing Priorities

Course overview

This course discusses physiology, pharmacology, monitoring, and reversal of neuromuscular blockade (NMB) in both anesthetic and critical care settings. Learners will explore how NMB agents disrupt normal NMB physiology, leading to muscle weakness/paralysis. Without sedation provided with these drugs, there is a high potential for patients experiencing awareness with recall, which can lead to psychological trauma and avoidable injury. Learners will be able to evaluate current evidence-based guidelines for quantitative monitoring of NMJ function using various techniques, such as the Train-of-Four (TOF), Post-Tetanic Count (PTC), and fade recognition, and the choice of muscle to monitor, such as the Adductor Pollicis or Peri-Ocular Muscles. In addition, learners will explore the potential complications associated with Residual Neuromuscular Blockade (RNMB). RNMB can lead to airway obstruction, dysphagia, aspiration, respiratory compromise, and postoperative pulmonary events. Learners will explore the reversal of pharmacologic NMB with neostigmine and sugammadex, including objective monitoring, timing, dosage, safe recovery, and other considerations. Learners will examine sedative and anesthetic agents used with neuromuscular blockade (NMB), including propofol, dexmedetomidine, midazolam, and ketamine. Concepts include mechanisms of action, pharmacokinetics, special populations, adverse effects, and drug interactions. Practical, guideline-driven approaches to the use of paralytic agents, including succinylcholine (Anectine, Quelicin), rocuronium (Zemuron), and cisatracurium (Nimbex). The course will emphasize quality assurance strategies to decrease awareness, residual blockade, and complications related to NMB.