Surgery Paralytic Drugs Explained One of the medications given during surgery for general anesthesia By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FN LinkedIn Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine. Learn about our editorial process Updated on November 28, 2022 Medically reviewed by Lissette Pichardo, MD Medically reviewed by Lissette Pichardo, MD LinkedIn Lissette Pichardo, MD, is a board-certified anesthesiologist. She administers anesthesia for patients at St. Barnabas Hospital in the Bronx, New York. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Uses How They Work Examples Limitations Side Effects Frequently Asked Questions Paralytic drugs, or neuromuscular blocking agents (NMBAs), are powerful muscle relaxants used to prevent muscle movement during surgical procedures. They're also used during critical care, such as when a person is intubated and placed on a ventilator due to severe respiratory illness. Common paralytic drugs include succinylcholine, atracurium, and vecuronium. They're administered by an anesthesiologist directly into a vein via an intravenous (IV) line before and during a procedure, while the effects are closely monitored. This article explains how paralytic drugs work and some common conditions for which they're needed during treatment. It lists several of these medications as well as their side effects. Caiaimage / Sam Edwards / Getty Images Why and When Paralytics Are Used Paralyzing drugs are commonly used during: Placement of a breathing tube into the windpipeAbdominal surgeryThroat surgerySome surgeries in the chest affecting the heart and/or lungsSpine surgeryBrain surgeryMany types of orthopedic (bone) surgeryIntensive care for respiratory distressTherapeutic hypothermia after cardiac arrest Surgery Paralytics are used as part of general anesthesia, to prevent movement during surgery. General anesthesia involves medications that put you to sleep and prevent pain, like ketamine, as well as muscle paralytics to prevent movement. Because surgery uses sharp instruments and affects delicate areas of the body, even involuntary movements, such as a sneeze or a small muscle twitch, could cause a serious injury. For this reason, muscle movement has to be medically suppressed during surgery, with the exception of the muscle movement that's necessary for breathing. Critical Care Sometimes neuromuscular blocking agents are used during intensive care for severe respiratory distress syndrome when a person requires intubation (insertion of a breathing tube in the throat) due to impaired breathing. These medications are also given to stop shivering due to therapeutic hypothermia, a type of treatment used to temporarily lower body temperature in certain situations, such as cardiac arrest. This can help reduce brain damage and long-term problems. When neuromuscular blocking agents are used during critical care, they are usually used for a longer time period than when they are used during surgery. In these situations, muscle paralysis is usually maintained for 12 to 24 hours or longer. How Paralytic Drugs Work Paralytic drugs temporarily interfere with the messages that nerves send to the skeletal muscles of the body. The skeletal muscles are those that control movements of the face, arms, legs, back, and trunk. The muscles of the diaphragm, which help expand the lungs, are also paralyzed by these medications. While under the effect of a neuromuscular blocking agent, you would need mechanical assistance to help you breathe because diaphragmatic muscle paralysis prevents you from breathing on your own. A breathing tube and ventilator will be needed to help you breathe. Paralytic drugs are rapidly distributed throughout the body after they are injected. They quickly bind to and block neuromuscular binding sites on muscles to prevent them from functioning. Normally, nerves in the body activate muscles by releasing the neurotransmitter acetylcholine, which binds to muscle cells, blocking them. When the neurotransmitter binding sites are blocked, the muscles completely relax and can't move until the medication wears off or is medically reversed. These drugs can affect people differently. For example, they may take longer to work in adults over age 80, or their action can last longer for people who have kidney or liver disease. Commonly Used Paralytic Drugs Paralytic drugs are available in hospitals and surgical facilities. Your dose would be carefully selected before it is started, and you need to be closely monitored if you receive any of these medications. Succinylcholine, a rapid-onset, short-acting depolarizing muscle relaxant, has traditionally been the drug of choice when rapid muscle relaxation is needed. Common paralytics used for surgery include: Succinylcholine Rocuronium Vecuronium Mivacurium Atracurium Cisatracurium When surgery is complete, medication is given to reverse the effects of the paralytic drugs. Examples include acetylcholinesterase inhibitors, neostigmine, and edrophonium. As with paralytic drugs, the dosage must be carefully selected to avoid negative side effects. What Paralytics Don't Do General anesthesia involves a combination of medications, monitoring, and support. Paralytics are one part of the whole general anesthesia process, and they do not impact pain or memory. Other anesthetic medications provide sedation (put you to sleep) and pain control. Sedation that's given for surgery also prevents people from remembering the surgery, as well as aspects of the immediate pre-operative and post-operative period. Local Anesthesia Neuromuscular blocking agents are different from local anesthetics that are injected to prevent pain in a small region of your body. Local anesthetics used for surgery might be injected while you are awake—such as during dermatologic procedures, some types of limb surgeries, and more. Home Use Neuromuscular blocking agents are not used at home. Some milder muscle relaxants, like Flexeril (cyclobenzaprine) or Ryanodex (dantrolene), are taken orally or injected for problems like muscle spasms or pain, but they are not as powerful as neuromuscular blocking agents that are used for surgery. Paralytic Drugs Side Effects Even with appropriate use and careful monitoring, common side effects of neuromuscular blocking agents can cause side effects. Common Side Effects Some common side effects of neuromuscular blocking agents include: Muscle twitchingAltered heartbeatRapid or slowed breathingIncreased body temperatureBlood pressure changes During surgery, you would be monitored so that your anesthesiologist would be able to detect these side effects quickly. Treatment would be initiated right away so that your surgery can proceed safely. Severe Side Effects Serious side effects of neuromuscular blocking agents can include: Respiratory arrestHeart attackMuscle breakdown Severe complications are more common among people who are at high risk due to heart disease, lung disease, obesity, or neuromuscular disease. Part of your pre-surgical testing involves identifying potential predisposing factors that could put you at an increased risk of anesthesia side effects, and potentially adjusting your anesthesia dosing in advance to avoid adverse effects. After surgery, your healthcare providers will monitor you in the recovery area to determine whether you are having any side effects as the medication wears off. If you develop any side effects, treatment would be initiated right away. This can include interventions such as oxygen or medication for your heart or lungs. Frequently Asked Questions How long is a paralytic used? Generally, paralytic drugs are administered for the duration of surgery, which can last for less than half an hour or up to several hours, depending on the procedure. If you are having a paralytic drug during critical care for a respiratory condition, you may have it for a longer period of time, such as 12 to 24 hours or longer. How long does it take for a paralytic to wear off? Normally, it can take several minutes to an hour to be able to move again after paralytic drugs are stopped or reversed, because these are short-acting medications. You will be monitored as you recover from all of the medications administered for your general anesthesia—including sedation and pain control medications. Do you need paralytics for intubation? While paralytics are used for intubation, they aren't always—especially if a patient is being treated outside of a medical facility in an emergency, when these drugs may not be readily available. Is propofol a paralytic drug? No. Propofol is a sedative. It is used to put you to sleep during a medical procedure. 7 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hadique S, Badami V, Forte M. The implementation of protocol-based utilization of neuromuscular blocking agent using clinical variables in acute respiratory distress syndrome patients. Crit Care Explor. 2021;3(3):e0371. doi:10.1097/CCE.0000000000000371 Renew JR, Ratzlaff R, Hernandez-Torres V, Brull SJ, Prielipp RC. Neuromuscular blockade management in the critically Ill patient. J Intensive Care. 2020;8(1):37. doi:10.1186/s40560-020-00455-2 Boon M, Martini C, Dahan A. Recent advances in neuromuscular block during anesthesia. F1000Res. 2018;7:167. doi:10.12688/f1000research.13169.1 Bjerring C, Vested M, Arleth T, Eriksen K, Albrechtsen C, Rasmussen LS. 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By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit