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Pharmacy Hot Topics: Clinical Conversations on Neuromuscular Blockade and Reversal Strategies


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In this interprofessional conversation, expert faculty discuss the clinical effects of neuromuscular blocking and reversal agents, including key components of NMB and reversal strategies during the intraoperative phase of care and neuromuscular monitoring. Patient risk factors and mitigation of post-operative complications will also be discussed.

To learn more about neuromuscular blockade and reversal visit


Rachel WolfeRachel C. Wolfe, Pharm.D., M.H.A., BCCCP, is Clinical Pharmacy Specialist of Perioperative and Surgical Critical Care at Barnes-Jewish Hospital and Washington University Medical Center in St. Louis, Missouri. She is also Adjunct Clinical Instructor for the Barnes-Jewish Hospital Goldfarb School of Nursing and St. Louis College of Pharmacy.

Dr. Wolfe earned her Doctor of Pharmacy degree from St. Louis College of Pharmacy and Master of Health Administration degree from Webster University, also in St. Louis. She completed her residency training at University of Kentucky HealthCare, and she is board certified in critical care.

At Barnes-Jewish Hospital, Dr. Wolfe is responsible for the provision of clinical pharmacy services in the perioperative and periprocedural environment and for the coordination of clinical services provided by four operating room pharmacy satellites. She also serves as a preceptor for Doctor of Pharmacy students and pharmacy residents and is co-chair of the Enhanced Surgical Recovery Pharmacy & Documentation committee and the Analgesia subcommittee of the Pharmacy & Therapeutics committee.

Dr. Wolfe collaborates closely with the Department of Anesthesiology to develop and implement evidenced-based protocols and plays an integral role in the enhanced surgical recovery initiatives that span several surgical services. She actively participates in clinical research and quality improvement initiatives within the Departments of Anesthesiology, Surgery, Perioperative Services, and Pharmacy. She has led several medication safety and standardization initiatives in addition to initiatives that focus on quality of perioperative care and postoperative patient outcomes.

Dr. Wolfe is a member of the American College of Clinical Pharmacy, American Society of Enhanced Recovery, and Society of Critical Care Medicine. In 2011 she received Barnes-Jewish Hospital’s David A. Gee Meritorious Service Award and Team Award for Quality Improvement for Anesthesia Medication Management.

Deborah WagonerDeborah Wagner, Pharm.D., FASHP, is Clinical Professor at the University of Michigan College of Pharmacy and Clinical Professor of Anesthesiology at Michigan Medicine in Ann Arbor.

Dr. Wagner earned her Doctor of Pharmacy degree from the University of Michigan College of Pharmacy. She is a fellow of ASHP.

Dr. Wagner precepts Doctor of Pharmacy students and residents and also teaches for the College of Pharmacy, School of Medicine, and Graduate Nurse Practitioner program at the University. She provides pain management consultation for the pediatric acute pain service and has developed standardized pain management strategies for intravenous acetaminophen, elastomeric pain pumps, and low dose lidocaine and ketamine infusions to enhance multimodal analgesia. Currently she is part of the University of Michigan Injury Prevention network collaborating to address the opioid epidemic regarding misuse and abuse across the state. Dr. Wagner also participates in the medication safety taskforce within the Department of Anesthesiology to address standardization of medications throughout the perioperative area, and she chairs the Pediatric Medication Safety Committee.

Dr. Wagner is widely recognized for promoting medication safety. She and colleagues at the University of Michigan Hospitals and Health System were a finalist for the 2011 ASHP Foundation Award for Excellence in Medication Use Safety for their advancements in pain management therapy and safe practice. In 2015 she received the Medication Safety Cheers Award from the Institute for Safe Medication Practices, and she was the runner up for the Anesthesia Patient Safety Foundation’s Medication Safety Award in 2018.

Glenn MurphyGlenn Murphy, M.D., is an anesthesiologist at Advocate Illinois Masonic Medical Center in Chicago, Illinois. Previously, he was the Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine.

Dr. Murphy received his Doctor of Medicine from Hahnemann University and completed an anesthesiology residency at Northwestern University Medical School in Chicago, Illinois. He is Diplomate, American Board of Anesthesiology and Board Certified in intraoperative transesophageal echocardiography.

Dr. Murphy has several areas of research interest, with a particular focus on issues related to management of neuromuscular blockade. Previous topics examined in his research include the incidence of residual neuromuscular blockade, the clinical complications related to incomplete neuromuscular recovery, and the effects of neuromuscular monitoring on clinical outcomes. Ongoing research studies includes investigations designed to identify patients at risk for residual blockade, examinations of new quantitative neuromuscular monitoring technologies, and studies designed to identify the impact of reversal agents on muscle strength following surgery.

This podcast is provided by ASHP and supported by Merck.

The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.