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Paolo Feltracco, Tommaso Tonetti, Stefania Barbieri, Anna Chiara Frigo, Carlo Ori
BACKGROUND: Postoperative residual neuromuscular blockade (RNMB) is a common complication in the postanesthesia care unit (PACU), but also one of the most controversial issues. Many studies and trials demonstrated that some methods and techniques can reduce the incidence and the extent of the phenomenon. STUDY OBJECTIVE: To determine the incidence of RNMB in the PACU at standardized times after extubation with the implementation of a protocol of careful neuromuscular blockade management...
December 2016: Journal of Clinical Anesthesia
Ralph P Insinga, Cédric Joyal, Alexandra Goyette, André Galarneau
BACKGROUND: The objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada. METHODS: A discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use...
November 16, 2016: BMC Anesthesiology
C Khandkar, S Liang, S Phillips, C Y Lee, P A Stewart
This study compared two commercially available quantitative neuromuscular function monitoring techniques, kinemyography (KMG) and electromyography (EMG), to assess whether KMG could be used interchangeably with EMG to exclude residual neuromuscular blockade (RNMB). Train-of-four (TOF) ratios were recorded every 20 seconds using KMG at the adductor pollicis and EMG at the first dorsal interosseous of the same hand during spontaneous recovery from shallow neuromuscular blockade. TOF ratios were compared using Bland-Altman analysis for repeated measurements...
November 2016: Anaesthesia and Intensive Care
Wendy H Teoh, Thomas Ledowski, Phillip S Tseng
Introduction. This survey aimed to investigate the attitudes/practice pertaining the use, management, and monitoring of neuromuscular blockade amongst Singaporean anaesthetists. Methods. All specialist accredited anaesthetists registered with the Singapore Medical Council were invited to complete an anonymous online survey. Results. The response rate was 39.5%. Neuromuscular monitoring (NM) was used routinely by only 13.1% despite the widespread availability of monitors. 82% stated residual NMB (RNMB) was a significant risk factor for patient outcome, but only 24% believed NMB monitoring should be compulsory in all paralyzed patients...
2016: Anesthesiology Research and Practice
Paul A Stewart, Sophie S Liang, Qiushuang Susan Li, Min Li Huang, Ayse B Bilgin, Dukyeon Kim, Stephanie Phillips
BACKGROUND: Residual neuromuscular blockade (RNMB) has been linked to adverse respiratory events (AREs) in the postanesthetic care unit (PACU). However, these events are often not attributed to RNMB by anesthesiologists because they may also be precipitated by other factors including obstructive sleep apnea, opioids, or hypnotic agents. Many anesthesiologists believe RNMB occurs infrequently and is rarely associated with adverse outcomes. This study evaluated the prevalence and predictors of RNMB and AREs...
October 2016: Anesthesia and Analgesia
Buwei Yu, Baoyi Ouyang, Shengjin Ge, Yan Luo, Jun Li, Dongmei Ni, Shuangfei Hu, Hui Xu, Jin Liu, Su Min, Longyun Li, Zhengliang Ma, Kangjie Xie, Changhong Miao, Xinmin Wu
OBJECTIVE: Evidences demonstrate that postoperative residual neuromuscular blockade (rNMB) is a primary and frequent anesthetic risk factor for postoperative complications. This study was designed to mitigate the paucity of data regarding the occurrence and degree of rNMB in a real-life setting. METHODS: This prospective, multicenter, anesthetist-blind, observational study enrolled 1571 Chinese adults undergoing elective open or laparoscopic abdominal surgery lasting ≤4 hours from 32 hospitals across China...
2016: Current Medical Research and Opinion
Chrysanthi Batistaki, Panagiotis Tentes, Paraskevi Deligiannidi, Agathi Karakosta, Panagiota Florou, Georgia Kostopanagiotou
BACKGROUND: The aim of this study was to identify the frequency of residual neuromuscular blockade (RNMB) in the postanesthesia care unit (PACU) of a tertiary university hospital in Greece, and its correlation with reversal agents. The influence of other perioperative factors was assessed secondarily. METHODS: Patients >18 years old, undergoing surgery with general anesthesia were prospectively studied during a 6-month period. Immediately after arrival at the PACU, the train-of-four ratio (TOF) was assessed by independent investigators, using accelerometry 3 consecutive times, and the mean value was calculated...
May 2016: Minerva Anestesiologica
Thomas Ledowski, Brendan O'Dea, Luke Meyerkort, Mary Hegarty, Britta S von Ungern-Sternberg
Purpose. Residual neuromuscular blockade (RNMB) is known to be a significant but frequently overlooked complication after the use of neuromuscular blocking agents (NMBA). Aim of this prospective audit was to investigate the incidence and severity of RNMB at our Australian tertiary pediatric center. Methods. All children receiving NMBA during anesthesia were included over a 5-week period at the end of 2011 (Mondays to Fridays; 8 a.m.-6 p.m.). At the end of surgery, directly prior to tracheal extubation, the train-of-four (TOF) ratio was assessed quantitatively...
2015: Anesthesiology Research and Practice
Thomas Ledowski, Laura Falke, Faye Johnston, Emily Gillies, Matt Greenaway, Ayala De Mel, Wuen S Tiong, Michael Phillips
BACKGROUND: Postoperative residual neuromuscular blockade (RNMB) is associated with significant morbidity. OBJECTIVE: The aim of this retrospective data analysis was to investigate the influence of the method of RNMB reversal on postoperative outcome. SETTING: Tertiary teaching hospital in Western Australia. PATIENTS: With Ethics Committee approval, data from 1444 patients who received at least one dose of a non-depolarising muscle relaxant intraoperatively during 2011 were analysed...
August 2014: European Journal of Anaesthesiology
Ignacio Armendáriz-Buil, Félix Lobato-Solores, Luciano Aguilera-Celorrio, Emilio Morros-Díaz, Enrique Fraile-Jiménez, Jorge Vera-Bella
BACKGROUND: Diabetes mellitus causes motor nerve dysfunction and degeneration that may alter the response to neuromuscular blocking drugs. OBJECTIVE: To analyse the risk of residual neuromuscular block (RNMB) induced by rocuronium given in standard doses to patients with type 2 diabetes mellitus (T2DM). DESIGN: A prospective, observational study. SETTINGS: Hospital San Jorge, Huesca and Hospital San Pedro, Logroño, Spain, from December 2011 to June 2012...
August 2014: European Journal of Anaesthesiology
Gopalaiah Venkatesh Kumar, Anita Pramod Nair, Hanuman Srinivasa Murthy, Koppa Ramegowda Jalaja, Karnate Ramachandra, Gundappa Parameshwara
BACKGROUND: Residual neuromuscular blockade (RNMB) is known to be associated with respiratory complications in the postoperative period after muscle relaxant usage. The authors hypothesized that RNMB causes reductions in pulmonary function test (PFT) parameters in the immediate postoperative period. METHODS: An open-label prospective randomized cohort study was conducted comparing reductions in PFT parameters due to RNMB among different neuromuscular blocking agents...
December 2012: Anesthesiology
P C Yip, J A Hannam, A J D Cameron, D Campbell
We conducted a prospective observational study to assess the incidence of residual neuromuscular blockade (RNMB) in a post-anaesthetic care unit (PACU) of a tertiary hospital. The subjects were 102 patients undergoing general anaesthesia with neuromuscular blockade (NMB). The procedural anaesthetists were unaware of their patients' inclusion in the study, and the choice of muscle relaxant and use of reversal agents were at the anaesthetists' discretion. On arrival to the PACU, the train-of-four ratio was assessed using electromyography, repeated every five minutes until the train-of-four ratio exceeded 0...
January 2010: Anaesthesia and Intensive Care
J R Ortíz-Gómez, J Pérez-Cajaraville
OBJECTIVES: To assess the effectiveness of low doses of neostigmine in the reversion of residual non-polarising neuromuscular blockade (RNMB). MATERIAL AND METHODS: The work involved one hundred and nineteen adult patients, ASA I-III, anaesthetised with fentanyl, thiopental, O2-N2O-isoflurane and atracurium (n=62) or vecuronium (n=57). RNMB was monitored with continuous electromyography of adductor pollicis with TOF stimulation. When TOF-Ratio (TR) < 75%, neostigmine 0...
May 2006: Anales del Sistema Sanitario de Navarra
W Hou, T Tsuda, R T Jensen
The actions of neuromedin B (NMB), a recently discovered mammalian bombesin-related peptide, are mediated by interacting with a distinct receptor; however, little is known about its cellular basis of action. Recent studies show activation of phospholipase D (PLD) is an important transduction cascade for a number of GI hormones, especially for stimulation of growth and protein sorting. The purpose of the present study was to determine whether activation of the NMB receptor causes activation of PLD and to explore whether this activation was coupled to PLC activation...
April 22, 1998: Biochimica et Biophysica Acta
T Tsuda, T Kusui, R T Jensen
Recent studies show that tyrosine phosphorylation by a number of neuropeptides may be an important intracellular pathway in mediating changes in cell function, particularly related to growth. Neuromedin B (NMB), a mammalian bombesin related peptide, functions through a distinct receptor, the neuromedin B receptor (NMB-R), of which little is known about its cellular basis of action. In the present study we explored the ability of NMB-R activation to cause tyrosine phosphorylation of focal adhesion kinase (p125(FAK)), an important substrate for tyrosine phosphorylation by other neuropeptides...
December 23, 1997: Biochemistry
M R Volkert, L J Margossian, A J Clark
rnmB281 leads to high constitutive levels of recA protein such that no increase after UV-inducing treatment occurs. The mutation maps in or near the portion of recA corresponding to the NH2-terminal end of the protein. Examination of the recA proteins from rnmB+ recA-/rnmB281 recA+ heterozygotes suggests that both rnmB alleles are cis-acting and codominant. This is the behavior expected from alleles of a regulatory gene such as an operator or promoter of recA. The possibility that rnmB mutations occur in the promoter of recA...
March 1981: Proceedings of the National Academy of Sciences of the United States of America
M R Volkert, D F Spencer, A J Clark
In Escherichia coli B/r the expression of UV inducible (SOS) functions is under the control of the recA and lexA genes. In this study we have characterized mutants which are altered in their ability to express SOS functions. These mutants were isolated as UV resistant UV nonmutable (Rnm) derivatives of the lexA102 uvrA155 mutant strain WP51. The UV resistance of these Rnm strains is a result of the suppression of lexA102 mediated UV sensitivity. Genetic mapping of rnm mutations shows that the two predominant classes, rnmA and rnmB, map in or very near the lexA and recA genes respectively...
1979: Molecular & General Genetics: MGG
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