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Neuromuscular Blockers

Nursing Knowledge

Neuromuscular Blockers

Neuromuscular blockers (NMBs) are a class of medications that are commonly used in clinical practice to facilitate endotracheal intubation, mechanical ventilation, and surgical procedures. NMBs work by blocking the transmission of nerve impulses to skeletal muscles, resulting in temporary paralysis. For nurses, it is essential to have a thorough understanding of NMBs, including their mechanism of action, classifications, drug names, onset and duration of action, and adverse effects.

Last updated: January 20, 2026

What are neuromuscular blockers?

Neuromuscular blockers are a class of medications that block the transmission of nerve impulses to skeletal muscles, resulting in temporary paralysis.

What is the mechanism of action of neuromuscular blockers?

Neuromuscular blockers prevent acetylcholine from activating the nicotinic M receptors post-synaptically at the skeletal neuromuscular junction.

They paralyze all skeletal muscles, including those used for breathing (the diaphragm). Mechanical ventilation is required.

They do not affect the CNS. The client is completely paralyzed, but fully conscious. Sedatives should always be given before NMBs.

What are neuromuscular blockers used for?

Surgery
Endotracheal intubation
Mechanical ventilation

Neuromuscular blockers classification

	Competitive neuromuscular blockers (antagonists)	Depolarizing neuromuscular blockers (agonists)
Onset of paralysis	Rapid	Rapid
Peak	Peak effects persist 20–45 minutes and then decline.	Peaks after 1 minute, fades after 4–10 minutes
Recovery	Complete recovery in 1 hour	Ultrashort-acting
Used for longer procedures?	Yes	No
Reversed by	Acetylcholine	Acetylcholine inhibitors

Classification of neuromuscular blockers

Related videos

Neuromuscular Blocking Drugs

Competitive vs. Depolarizing NMBs

What are drug examples of neuromuscular blockers?

Competitive:

Atracurium
Pancuronium
Vecuronium
Cisatracurium
Rocuronium

Depolarizing:

Succinylcholine

What are adverse effects of neuromuscular blockers?

Competitive:

Tachycardia
Respiratory arrest
Hypotension
Hemodynamic instability
Seizures
Bronchospasm

Depolarizing:

Bradycardia
Respiratory arrest
Post-op muscle pain
Hyperkalemia
Malignant hyperthermia

Nursing tips around neuromuscular blockers

All neuromuscular blockers are given IV, there are no oral forms.
Neuromuscular blockers cannot cross the blood-brain barrier. There is no impact on the CNS and minimal effects on a fetus.
Dantrolene is used to treat malignant hyperthermia:
- Reduces heat production and rigidity within minutes
- Has a risk of hepatotoxicity

RELATED TOPIC:

5 Rights of Medication Administration

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Neuromuscular Blockers

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Comparison of competitive and non-competitive neuromuscular blockers includes how they work, when they’re used, and side effects.

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