Monitoring neuromuscular blockade in the intensive care unit: The peripheral nerve stimulator

Traditionally, neuromuscular blocking agents (NMBAs) have been administered in the operating room as an adjunct to anesthetics. Recent studies in the United States have indicated that 98% of the anesthesiologists and critical care nurses surveyed use NMBAs at least occasionally. When monitoring the use of NMBAs, a combination of clinical monitoring and peripheral nerve stimulator monitoring has been recommended. However, the most effective techniques have yet to be described. Understanding the complexities of NMBAs and the absolute need for accurate monitoring techniques is imperative for clinicians. The purpose of this literature review is to evaluate current literature regarding monitoring techniques of NMBAs and to guide the advanced practice nurse’s role in critical care. (Heart Lung® 1999;28:352-62)