Abstract
Neuromuscular blocking agents are essential for patient safety during surgical procedures because they facilitate laryngoscopy, surgical exposure, and safe use of laparoscopic equipment. Paralysis is accomplished by the medications' capacity to block or mimic acetylcholine at neuromuscular junctions (NMJs), preventing depolarization or repolarization. Intermittent neuromuscular monitoring during surgical procedures assesses the medications' effectiveness. A substance that disrupts the flow of acetylcholine to the NMJ is botulinum toxin A, which is injected intradermally to produce local paralysis for aesthetic purposes. Therefore, botulinum toxin A injections may interfere with proper neuromuscular monitoring and dosing of paralytics or reversal agents during surgical procedures. A 37-year-old patient presented for rhinoplasty and during the procedure, she displayed a decreased response to neuromuscular monitoring in the orbicularis oculi muscle. The patient received botulinum toxin A injections in this location, leading to the question: in adult patients undergoing surgical procedures requiring paralysis, does the administration of intradermal botulinum toxin A in the past 6 months cause a decrease in response to neuromuscular monitoring during surgical procedures compared to patients without a history of botulinum toxin A administration? A correlation between decreased twitch response and botulinum toxin A injection is possible due to the effects of the neurotoxin on the NMJ. It is recommended to inquire about intradermal injections during the preoperative interview and to utilize alternative neuromuscular monitoring sites if needed.
Sigma Membership
Non-member
Type
DNP Capstone Project
Format Type
Text-based Document
Study Design/Type
Case Study/Series
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Botulinum Toxin, Neuromuscular Junction, Neuromuscular Monitoring
Advisor
Terri M. Cahoon
Second Advisor
Ellen Buckner
Degree
DNP
Degree Grantor
Samford University
Degree Year
2025
Recommended Citation
Nguyen, Haley Harrison and Greenway, Mary Beth, "The Effect of Botulinum Toxin A on Neuromuscular Monitoring" (2025). Group: Samford University Moffett & Sanders School of Nursing. 187.
https://www.sigmarepository.org/samford/187
Rights Holder
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Review Type
None: Degree-based Submission
Acquisition
Proxy-submission
Full Text of Presentation
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