When should we not use muscle relaxants?which is best and side effect of each one?

I must say that my experience is very small in this regard.

We would give some sedation if needed, but not relaxants, to babies on a ventilator.

(for "non-emergency" intubation we sometimes give celocurin, 2 (-3) mg/kg as a single dose.)

We never use muscle relaxants in ventilated cases except in Meconium Aspiration cases on HFOV where we have difficulty maintaining oxygenation....but that too for a short duration and as a last resort....

Hi

This is an interesting topic of discussion . The cochrane review by philips cool and Martin Offringa , reviewed in 2009 indicates that there is no conclusive evidence for benefit of using muscle relaxants in ventilated babies . There are a few perceived benefits like reduced risk of intraventricular hemorrhage as well as less serious forms of IVH and reduced airleaks . Studies by Greenough in 1984 , has shown that air leaks were more frequent in struggling babies , and that muscle relaxation reduced the risk ( 1985 ) . Perlman in 1985 demonstrated that there was wide fluctuation in anterior cerebral artery blood flow predisposing to IVH in struggling babies . So far , on some benefits related to muscle relaxation

However , when comparing multiple randomized and quasi randomized trials , there is no difference in morbidity , mortality or outcome in babies who were administered muscle relaxants and who were not . There was also no much difference in incidence of CLD or oxygen requirement . Hence , it is hard to recommend routine muscle relaxants as there is no definite evidence towards same . I couldnt find any recent studies on it . Other complications related to muscle relaxants included risk for hypotension , hypoxemia , deafness , prolongation of ventilation ( controversial ) etc ..

I would basically try for selective paralysis , as in babies with risk for air leaks or who are struggling a lot . But , It seems that babies calm down well with sedatives like Fentanyl , which would suffice in most cases . Hence , In my opinion , muscle relaxation is best used judiciously ; and sedatives tried initially in struggling baby before considering relaxants .. Hope this makes sense

Bye

Gopan

Thanks for the valuble inputs.

We use Arduan during hfv

We have noticed recently the number of term infants that we paralyse that sucumb to migratory consolidation. Regardless of regular position changes and physio, whilst they remain paralysed you can almost guarantee changes in lung fields throughout. Has anyone else seen this in their infants.

Best wishes

Al