Clinical Use of Neuromuscular Blocking Agents
Course #35111 - $60 -
- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
Neuromuscular blocking agents (drugs that paralyze skeletal muscle) have been used in anesthesia since the 1930s. Their use in the intensive care unit, emergency department, and prehospital care (e.g., ground and air ambulances) is somewhat more recent, though still well-established. Despite the fact that these drugs are commonly administered to critically ill patients, many practitioners have only the most rudimentary knowledge regarding the proper selection of these agents, their broad classifications, their dosages, the monitoring technique necessary for their use, and other crucial aspects of this class of drugs. Indeed, a number of potentially lethal side effects from the acute or chronic administration of these agents may occur, resulting in significantly increased morbidity and mortality among patients receiving them.
- INTRODUCTION
- A BRIEF HISTORY OF NEUROMUSCULAR BLOCKERS
- THE NEUROMUSCULAR JUNCTION
- NEUROMUSCULAR BLOCKING AGENTS
- MONITORING NEUROMUSCULAR BLOCKADE
- REVERSAL OF NEUROMUSCULAR BLOCKADE
- COMMON USES OF NEURO-MUSCULAR BLOCKING AGENTS AND AREAS OF CONCERN FOR THE PRACTITIONER
- CONCLUSION
- Works Cited
- Evidence-Based Practice Recommendations Citations
This course is designed for nurses, nurse practitioners, and other allied health professionals in a variety of settings, including the intensive care unit, emergency department, acute care, prehospital settings, critical care, and post-anesthesia care.
The purpose of this course is to provide intensive care, emergency, and prehospital providers with the clinical knowledge to administer neuromuscular blocking agents in a safe and effective fashion, as well as to know how such agents can be effectively monitored and, ultimately, safely and efficiently reversed.
Upon completion of this course, you should be able to:
- Review the pertinent history surrounding the discovery and early administration of neuromuscular blocking agents.
- Outline the anatomy and physiology of the neuromuscular junction.
- Identify commonly used neuromuscular blockers.
- Discuss the use and effects of benzylisoquinolinium nondepolarizing neuromuscular blocking agents.
- Describe the use and effects of amino steroid nondepolarizing neuromuscular blockers.
- Identify the crucial effects and side effects of succinylcholine, listing both relative and absolute contraindications to its use.
- Analyze approaches to monitoring neuromuscular blockade.
- Evaluate the effects and use of traditional agents used to reverse neuromuscular blockade.
- Discuss the reversal agent sugammadex.
- Analyze the role of neuromuscular blockers in various patient populations.
Richard E. Haas, BSN, MSN, EdM, PhD, CRNA, LTC US Army Nurse Corps (Retired), is a retired nurse anesthetist and prehospital registered nurse (instructor) who has published extensively in various areas of healthcare research while providing clinical care in arenas ranging from academic medical centers to austere environments in the third world during both wartime and peacetime. He has a bachelor’s degree in nursing from Georgetown University, Master’s degrees in education (Boston University) and nursing specializing in anesthesia (State University of New York in Buffalo and U.S. Army), and a PhD from the University of South Carolina. He is a retired lieutenant colonel in the U.S. Army Nurse Corps. He has taught nursing anesthesia, pharmacology, and physiology; mentored students in doctoral programs; and used advanced patient simulation to train students. Dr. Haas has worked in clinical, administrative, education, and research roles. He continues to work as an independent consultant, while taking more time to enjoy life with his wife of nearly 50 years and their children and grandchildren.
Contributing faculty, Richard E. Haas, BSN, MSN, EdM, PhD, CRNA, LTC US Army Nurse Corps (Retired), has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Margo A. Halm, RN, PhD, NEA-BC, FAAN
The division planner has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Sarah Campbell
The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
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The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.
Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.