Approach to Muscle Relaxants in Intensive Care


Muscle relaxant use in the intensive care setting is to be discouraged unless specifically indicated.

The indications for using muscle relaxants in intensive care are limited to:

  • Endotracheal intubation (suxamethonium unless contra-indicated)
  • Acute control of ventilation post intubation
  • Patient transport
  • Selected patients with complicated ventilatory parameters
  • Facilitate acute procedure:  tracheostomy, bronchoscopy
  • In selected patients with severe head injury and uncontrolled intra-cranial pressure



  • Hyperkalaemia (suxamethonium)
  • Polyneuropathy and myopathy
  • Sympathetic overdrive where accompanying sedation is adequate


Commonly Used Muscle Relaxants in the Intensive Care


100-200 mg



Consider pre-treatment with atropine (0.6-1.2 mg) if potential bradycardia

Contraindicated in burns (> 3 days post burn), chronic spinal and neuromuscular syndromes, hyperkalaemic states (K+ > 5.5)

Pancuronium2-4 mg IV prnTachycardia rarely a problem in IC patients
Rocuronium0.6 mg/kg

Rapid onset (60 secs) non depolarizer

Duration of action: 30-40 minutes

Used as alternative to suxamethonium for emergency intubation


Pancuronium should be used for ongoing paralysis unless contraindicated‚Äč

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Page last reviewed: 14 May 2014