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Neuromuscular blockade in the elderly patient

Authors Lee L, Athanassoglou V, Pandit J

Received 30 October 2015

Accepted for publication 1 April 2016

Published 17 June 2016 Volume 2016:9 Pages 437—444

DOI https://doi.org/10.2147/JPR.S85183

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Michael E Schatman


Luis A Lee, Vassilis Athanassoglou, Jaideep J Pandit

Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Abstract: Neuromuscular blockade is a desirable or even essential component of general anesthesia for major surgical operations. As the population continues to age, and more operations are conducted in the elderly, due consideration must be given to neuromuscular blockade in these patients to avoid possible complications. This review considers the pharmacokinetics and pharmacodynamics of neuromuscular blockade that may be altered in the elderly. Compartment distribution, metabolism, and excretion of drugs may vary due to age-related changes in physiology, altering the duration of action with a need for reduced dosage (eg, aminosteroids). Other drugs (atracurium, cisatracurium) have more reliable duration of action and should perhaps be considered for use in the elderly. The range of interpatient variability that neuromuscular blocking drugs may exhibit is then considered and drugs with a narrower range, such as cisatracurium, may produce more predictable, and inherently safer, outcomes. Ultimately, appropriate neuromuscular monitoring should be used to guide the administration of muscle relaxants so that the risk of residual neuromuscular blockade postoperatively can be minimized. The reliability of various monitoring is considered. This paper concludes with a review of the various reversal agents, namely, anticholinesterase drugs and sugammadex, and the alterations in dosing of these that should be considered for the elderly patient.

Keywords: anesthesia, elderly, drugs, pharmacokinetics, pharmacodynamics
 

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