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Methods of Testing Neuromuscular Transmission in the Intensive Care Unit

Published online by Cambridge University Press:  18 September 2015

François Grand'Maison
François Grand'Maison*
Affiliation:
Service de Neurologie, Hôpital Charles-LeMoyne, Geenfield Park, Québec
*
Hôpital Charles-LeMoyne, Service de Neurologie, 3120 boul., Geenfield Park, Québec, Canada J4V 2H1
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Abstract

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All disorders of neuromuscular transmission (NMT) may cause ventilatory failure, albeit rarely. Respiratory muscle weakness is occasionally the presenting feature of myasthenia gravis (MG), the Lambert-Eaton myasthenic syndrome (LEMS), hypermagnesemia and botulism. Chronic MG, congenital myasthenic syndromes and LEMS may be acutely exacerbated by various intercurrent conditions and by drugs which interfere with NMT. Finally, in the ICU, difficulty in weaning from the ventilator may be caused by prolonged use of neuromuscular blocking agents. Electrophysiological studies of NMT disorders in the intensive care unit have rarely been reported. Nevertheless, the available data indicates that the electrodiagnosis of severe NMT disorders can be misleading. With severe NMT defects, the electrophysiological distinction between post-synaptic and pre-synaptic disorders is blurred and the differential diagnosis with myopathies may be difficult. A clinically suspected NMT disorder should therefore not be ruled out when electrodiagnosis fails to demonstrate the expected abnormalities.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue S1 , February 1998 , pp. S36 - S39
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

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