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Pharmacology · Chapter 7

Paralyzed Two Ways

Two drug classes both leave a patient limp and apneic — but they do it by opposite mechanisms, and that difference decides which reversal agent saves your patient and which one makes things worse. Pick an agent, read the twitch monitor, then try to reverse it.

The neuromuscular junction

Train-of-four · ulnar nerve, thumb
The neuromuscular junctionpick an agent to block it
Onset—
Duration—
Cleared by—
Reversal bench — give one
Nothing given yetChoose an agent above, then pick a reversal. The right answer changes with the class — that is the whole lesson.
True of every drug on this page. Neuromuscular blockers paralyze only. They give no sedation, no analgesia, no amnesia — a paralyzed patient can be fully awake, in pain, and unable to signal it. Sedation and analgesia go on first and stay on. Paralysis means apnea: never give one without a secured airway, a ventilator, and suction at the bedside. Monitor train-of-four at the ulnar nerve (goal 1–2 of 4 twitches on an ICU drip; T4/T1 ≥ 0.9 before extubation). The pharyngeal muscles recover last, so residual weakness shows up as aspiration and airway obstruction — a sustained 5-second head lift is your bedside check. And because the patient cannot blink: lubricate and tape the eyes, reposition, and give DVT prophylaxis.