A paralytic, also described as a neuromuscular blocking agent, is a type of potent muscle relaxant that is used to prevent muscle movement during surgical procedures or during intensive care for serious respiratory illnesses.
Your anesthesiologist will inject the paralytic agent into your intravenous (IV, vein) line before and during the procedure and will monitor the effects throughout the operation.
When these drugs are used during intensive care, they are generally used for a longer period of time than when used during surgery.
Why are paralytics used?
Paralytics are used as part of general anesthesia to prevent movement during surgery. General anesthesia includes medications that make you sleepy and prevent pain, such as ketamine, and muscle paralyzes to prevent movement.
Because the surgery uses sharp instruments and affects delicate areas of the body, even involuntary movements, such as sneezing or slight muscle contractions, can cause serious injury. For this reason, muscle movement must be medically suppressed during surgery, except for muscle movement necessary for breathing.
Neuromuscular blockers are sometimes used during acute care for severe respiratory distress syndrome when a person needs intubation (insertion of a breathing tube into the throat) due to breathing problems.
In these situations, muscle paralysis usually persists for 12 to 24 hours or more.
Medications for paralysis are generally used during:
- Insert a breathing tube into the windpipe
- Abdominal surgery
- Throat surgery
- Certain breast surgeries that affect the heart and / or lungs.
- Colunm surgery
- Brain surgery
- Many types of orthopedic (bone) surgeries
- Intensive care for respiratory failure
How Paralytic Drugs Work
Paralytic drugs temporarily interfere with the transmission of nerve impulses to the skeletal muscles of the body. Skeletal muscles are those that control the movements of the face, arms, legs, back and trunk.
These drugs also paralyze the muscles of the diaphragm , which help expand the lungs. While under the influence of a neuromuscular blocking agent, you need mechanical assistance to help you breathe because paralysis of the diaphragmatic muscles prevents you from breathing on your own. To breathe, you need a breathing tube and a ventilator .
Paralytic medications are rapidly distributed throughout the body after injection. They bind quickly and block the neuromuscular junction points of the muscles, preventing their function.
Normally, nerves in the body activate muscles by releasing the neurotransmitter acetylcholine, which binds to and blocks muscle cells. When neurotransmitter binding sites are blocked, the muscles relax completely and cannot move until the drug is depleted or medical treatment is resumed.
These drugs can affect people in different ways. For example, in adults over the age of 80, they may last longer, or they may last longer in people with kidney or liver disease.
The most commonly used paralytic drugs.
Paralytic medications are available in hospitals and surgical facilities. Your dosage will be carefully selected before you start, and you should closely monitor whether you are taking any of these medications.
Succinylcholine, a short-acting, fast-acting depolarizing muscle relaxant, has traditionally been the drug of choice when rapid muscle relaxation is required.
Common paralytics used in surgery include:
When the surgery is complete, medications are prescribed to reverse the effects of the paralyzing drugs. Examples include acetylcholinesterase inhibitors, neostigmine, and edrophonium. As with paralytic medications, the dosage must be carefully selected to avoid negative side effects.
What the paralyzed do not do
General anesthesia involves a combination of medication, observation, and support. Paralytics are part of the whole process of general anesthesia and do not affect pain or memory. Other anesthetic drugs provide sedation (for sleep) and pain relief.
Sedation administered during surgery also makes it difficult for people to remember the surgery, as well as aspects of the immediate preoperative and postoperative period.
Neuromuscular blockers are different from local anesthetics , which are given to prevent pain in a small area of the body. Local anesthetics used for surgery can be administered while awake, for example, during dermatological procedures, certain types of limb surgeries, etc.
Neuromuscular blockers are not used at home. Some milder muscle relaxants, such as Flexeril (cyclobenzaprine), are taken by mouth or injected for problems like muscle cramps or pain, but they are not as strong as neuromuscular blockers used in surgery.
Side effects of paralyzing drugs.
Even when used correctly and carefully controlled, neuromuscular blockers can cause side effects.
Common side effects
Some common side effects of neuromuscular blockers include:
- Muscle spasms
- Altered heart beat
- Fast or slow breathing
- Increased body temperature
- Changes in blood pressure
You will be monitored during surgery so your anesthetist can quickly detect these side effects. Treatment will begin immediately so that your surgery can continue safely.
Serious side effects
Serious side effects of neuromuscular blockers can include:
- Stop breathing
- Myocardial infarction
- Muscle tear
Serious complications are more common in people at high risk for heart disease, lung disease, obesity, or neuromuscular disease. Part of your preoperative testing includes identifying potential predisposing factors that may increase the risk of anesthesia side effects and possibly adjusting the dose of anesthesia in advance to avoid side effects.
After your surgery, your healthcare providers will monitor you in the recovery area to determine if you have any side effects as the medicine wears off. If you experience any side effects, treatment will start immediately. This may include interventions such as oxygen or medications for the heart or lungs.
Frequently asked questions
How long can a patient take paralyzing medications?
Paralyzing medications are usually given during the operation, which can last less than half an hour or up to several hours, depending on the procedure. If you take paralyzing medications during intensive care for a respiratory illness, you may be taking them for a longer period of time, such as 12 to 24 hours or more.
How long does it take to recover from paralytic medication?
Usually after stopping or stopping paralyzing medications, it may take a few minutes to an hour to start moving again because they are short-acting medications. You will be monitored while you recover from all prescription medications for general anesthesia, including sedatives and pain relievers.