Train-of-four results and observed muscle movement in children during continuous neuromuscular blockade.

http://ccn.aacnjournals.org to continue traveling through the muscle fibers and create a muscle contraction. Once each receptor has been activated, the acetylcholine is released and inactivated by acetylcholinesterase. Nondepolarizing NMBAs also bind temporarily to nicotinic receptors, blocking binding of acetylcholine there. Once 70% of the nicotinic receptors are filled by NMBAs, the receptors can no longer generate a contraction of the muscle fibers. NMBA infusion is often monitored by using peripheral nerve stimulation to determine the percentage of receptors at the neuromuscular junction blocked by NMBAs. In a study by Foster et al, 75% of ICU nurses reported caring for patients who required continuous infusions of NMBAs. Common indications for NMBA infusion include facilitating mechanical ventilation and decreasing intracranial pressure after head injury (Table 1). It has been estimated that up to 10% of patients who receive an NMBA infusion for more than 24 hours may have residual muscle weakness. Vecuronium and pancuronium have active metabolites that build up Lisa Corso, RN, BSN, CCRN