Now, which route do we give neuromuscular blockers? Well, there are no oral forms of
neuromuscular blockers. They have to be given IV. Why? Because neuromuscular blockers
can't pass over that blood-brain barrier. That's why it has no impact on the central nervous
system. So, you have paralysis but not sedation when a patient gets a neuromuscular blocker.
Now, as far as the placenta, it has minimal effects on the fetus. We're not going to go into that
a lot of detail here, but we just wanted you to have that piece of information. So, we have to
give it, what route? Right, IV. Now, what can't it cross? What can't it pass through?
Blood-brain barrier. That's why somebody on a neuromuscular blocker is still wide awake.
They have paralysis but no sedation. So, let's give that one more review and what we know
so far. We know that neuromuscular blockers compete with the acetylcholine for the nicotinic
M receptors. We know that it blocks receptor's activation of acetylcholine. That's why it gets
its name blocker. So, that is the mechanism of action of a neuromuscular blocker. Now, what
are the pharmacological effects? Severe muscle relaxation which we call flaccid paralysis, and
lastly, no impact on the central nervous system. They're paralyzed but fully conscious because
that drug can't cross the blood-brain barrier. Okay, so can you think of one more possible
pharmacological effect of neuromuscular blockers? Think what would cause us to have to do
additional monitoring. Okay. The answer is low blood pressure or hypotension. Now, the risk of
this adverse effects requires really proactive monitoring and intervention. So, it takes a
nurse who understands how neuromuscular blockers work and how to monitor their patients
safely. You already know that you're going to monitor for respiratory problems. Right? So,
we're going to have them on mechanical ventilation, particularly for these competitive
neuromuscular blockers. Now, the cardiovascular effects are not as significant, but it can
cause hypotension. So, when I'm thinking about neuromuscular blockers, what am I watching
my patient for? Breathing and beating. Right? Breathing and blood pressure.