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April 1, 1992

Sedating Drugs and Neuromuscular Blockade During Mechanical Ventilation

Author Affiliations

Children's Hospital Medical Center Cincinnati, Ohio

JAMA. 1992;267(13):1775. doi:10.1001/jama.1992.03480130087015

To the Editor.  —In a recent report, Hansen-Flaschen et al1 discussed the results of their survey of 164 hospitals regarding the "Use of Sedating Drugs and Neuromuscular Blocking Agents in Patients Requiring Mechanical Ventilation for Respiratory Failure." They reported that neuromuscular blocking agents were used in the treatment of respiratory failure in 98% of the hospitals surveyed. The authors expressed concerns about "how little guidance" can be found in the current literature.We and others have described2,3 terminal motor axonal neuropathy, motor end-plate changes, and muscle atrophy following prolonged use of neuromuscular-blocking agents. We observed a prolonged myasthenic syndrome after 1 week of neuromuscular blockade in a 28-month-old boy. He required brief additional respirator support because of muscular weakness. Electrodiagnostic studies showed a presynaptic disorder similar to what is seen in myasthenic syndromes. Ultrastructural study of an intercostal muscle biopsy specimen obtained 17 days after the onset of weakness