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Table 4 Neuromuscular blocking agents (adapted from Sturgess, Anaesthesia 2017 [25].)

From: Neuromuscular blockade management in the critically Ill patient

Agent

ED95a (mg/kg)

Onset time

Infusion dose (μg/kg/min)

Clinical duration

Notes

Succinylcholine

0.5–0.6

30–60 s

NR

Dose dependent; 3 × ED95 lasts 12–15 min

Transiently increases serum K levels by 0.5 mEq, can be used for RSII, metabolized by butyrylcholinesterasec

Rocuronium

0.3b

1.5–3 min

5–12

20–70 min

Can be used for RSII, eliminated by the liver (90%) and kidneys (10%)

Vecuronium

0.05

3–4 min

1–2

25–50 min

Active metabolites, associated with ICUAW

Mivacurium

0.08

3–4 min

5–8

15–20

Metabolized by butyrylcholinesterasec, associated with histamine release

Cisatracurium

0.05

4–7 min

1–3

35–50 min

Hofmann elimination

Atracurium

0.25

3–5 min

10–20

30–45 min

Metabolized by plasma esterase and Hofmann elimination, associated with histamine release

Pancuronium

0.07

2–4 min

20–40 (not recommended)

60–120 min

Active metabolites, associated with ICUAW, vagolytic effect causes tachycardia

  1. ED95 effective dose that decreases the twitch by 95% from baseline, ICUAW intensive care unit-acquired weakness, NR not recommended, RSII rapid sequence induction and intubation
  2. aIntubating dose is 2 × ED95
  3. b1.2 mg/kg (4 × ED95) can be used for rapid sequence induction and intubation
  4. cAlso referred to as plasma cholinesterase or pseudocholinesterase