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Nursing Considerations When Using Neuromuscular Blocking Agents to Assist With Intubation

A Review of Literature

Blauvelt, Grant, BSN, RN; Burdick, Kailee, DNP, RN; Cannon, Emily J., DNP, RN

doi: 10.1097/CNQ.0000000000000234
Original Articles

The use of neuromuscular blocking agents (NMBAs) in acute care settings during intubation is vitally important. The NMBAs increase first pass success rates significantly while protecting patients from gastric aspiration, tracheal injury, and death. During emergent intubations, succinylcholine and rocuronium are commonly used, but each comes with specific risks and individualized interventions. First pass success can be increased by ensuring correct dosing for overweight patients and employing the use of video laryngoscope. For planned, nonemergent intubations with sustained paralysis, the chosen NMBA can be individualized to fit the patient's needs. This includes dosages based on upregulation or downregulation of acetylcholine as well as speed of administration to prevent histamine release. Nurses must provide specific care when managing the treatment in high-risk patient populations (coronary artery disease, hyperkalemia, renal failure, liver failure, and traumatic brain injuries) who may receive certain types of NMBAs. Finally, because of the wide range of adverse effects with these drugs, close assessments are essential to prevent complications.

Department of Baccalaureate Nursing, Indiana State University, Monroeville (Mr Blauvelt); and School of Nursing, Indiana State University, Terre Haute (Drs Burdick and Cannon).

Correspondence: Grant Blauvelt, BSN, RN, Department of Baccalaureate Nursing, Indiana State University, 13306 Houk Rd, Monroeville, IN 46773 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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