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Pamela G. Dulin, RN, MSN, CCRN; Lawrence Gilliard, MD; Cheryl J. Williams, RN, BSN
Florida Hospital Medical Center Orlando

JAMA. 1992;267(13):1775.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The recent article by Hansen-Flaschen et al¹ that discussed the use of sedating drugs and neuromuscular blocking agents in the intensive care unit (ICU) is timely.

In September 1990, we instituted a new protocol at Florida Hospital Medical Center in Orlando. This protocol resulted from our unsatisfactory experiences with both pancuronium and vecuronium when used in mechanically ventilated patients; neither agent was predictably reversible.

We have successfully treated more than 60 patients with continuous infusions of atracurium besylate in conjunction with various sedating agents and careful monitoring with a peripheral nerve stimulator. We have experienced no untoward or unexpected effects and have, on every occasion, been able to readily recover these patients within an hour of discontinuing the infusion. Our protocol is based on an initial bolus dose of 0.3 to 0.5 mg/kg, immediately followed by an infusion, usually in the range of 5 to 15 . . . [Full Text PDF of this Article]

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