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: December 4, 2023

Table of contents

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 paralysisRapidRapid
PeakPeak effects persist 20–45 minutes and then decline.Peaks after 1 minute, fades after 4–10 minutes
RecoveryComplete recovery in 1 hourUltrashort-acting
Used for longer procedures?YesNo
Reversed byAcetylcholineAcetylcholine inhibitors
Classification of neuromuscular blockers

What are drug examples of neuromuscular blockers? 


  • Atracurium
  • Pancuronium
  • Vecuronium
  • Cisatracurium
  • Rocuronium


  • Succinylcholine

What are adverse effects of neuromuscular blockers? 


  • Tachycardia
  • Respiratory arrest
  • Hypotension
  • Hemodynamic instability
  • Seizures
  • Bronchospasm


  • 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


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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