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https://www.readbyqxmd.com/read/28542054/quantitative-neuromuscular-blockade-monitoring-two-pictures-of-unexpected-rocuronium-effect-a-case-report
#1
Paul A Leonard, Michael M Todd
Wide variation in responses to neuromuscular blocking agents is well described but typically underappreciated in clinical practice. We present 2 patients with unexpected responses to rocuronium, despite being otherwise unremarkable. Quantitative neuromuscular monitoring provided clear documentation of the events, providing illustrations of these atypical responses.
May 23, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28534702/factors-affecting-recovery-from-anaesthesia-with-propofol-remifentanil-target-controlled-infusion-in-laparoscopic-surgery
#2
Shao-Hua Liu, Ming Tian
Objective This study was performed to analyse factors influencing the effect-site concentration (Ce) of propofol at return of consciousness (ROC) with target-controlled infusion of propofol-remifentanil after laparoscopic surgery. Methods In total, 112 patients who underwent laparoscopic surgery under general anaesthesia were given propofol at the target concentration of 3.5 µg/ml. Remifentanil (Ce: 4.0 ng/ml) and 0.9 mg/kg of rocuronium were administered when the Observer's Assessment of Alertness/Sedation score reached 1...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28526472/-functional-respiratory-imaging-after-neostigmine-or-sugammadex-enhanced-recovery-from-neuromuscular-blockade-in-the-anesthetised-rat-a-randomised-controlled-pilot-study
#3
Tom Schepens, Guy Cammu, Sabine Maes, Benny Desmedt, Wim Vos, Kristof Deseure
OBJECTIVES: Reductions in diaphragm activity are associated with the postoperative development of atelectasis. Neostigmine reversal is also associated with increased atelectasis. We assessed the effects of neostigmine, sugammadex, and spontaneous reversal on regional lung ventilation and airway flow. METHODS: Six Sprague-Dawley rats were paralysed with rocuronium and mechanically ventilated until recovery of the train-of-four ratio to 0.5. We administered neostigmine (0...
May 16, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28515526/fentanyl-or-ketamine-pre-treatment-to-prevent-withdrawal-response-to-rocuronium
#4
Suchita S Kosare, Nandini M Dave, Madhu Garasia
No abstract text is available yet for this article.
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28498889/uk-anaesthetists-perspectives-and-experiences-of-severe-perioperative-anaphylaxis-nap6-baseline-survey%C3%A2
#5
H I Kemp, T M Cook, M Thomas, N J N Harper
Background: There is limited information on UK anaesthetists' perspectives and experiences of perioperative anaphylaxis. This baseline survey of the Sixth National Audit Project (NAP6) aimed to identify relevant departmental preparedness and practices, and individual experiences, perceptions and drug-avoidance patterns. Methods: All anaesthetists in 356 UK NHS hospitals were invited to complete an electronic survey. Results: 11 104 anaesthetists (77% crude response rate) from 341 (96%) hospitals responded...
May 12, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28494905/role-of-sugammadex-in-accelerating-postoperative-discharge-a-meta-analysis
#6
REVIEW
Michele Carron, Francesco Zarantonello, Nadia Lazzarotto, Paola Tellaroli, Carlo Ori
STUDY OBJECTIVE: Sugammadex has been introduced for reversal of neuromuscular blockade (NMB) induced by rocuronium (or vecuronium). Although its efficacy and safety have been established, data are conflicting as to whether it accelerates discharge to the surgical ward compared with neostigmine, which is traditionally used for reversing NMB. The object of this systematic review and meta-analysis was to review the research comparing sugammadex and neostigmine in the context of patient discharge after general anesthesia...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28493510/comparison-of-reversal-with-neostigmine-of-low-dose-rocuronium-vs-reversal-with-sugammadex-of-high-dose-rocuronium-for-a-short-procedure
#7
E S Choi, A Y Oh, B W Koo, J W Hwang, J W Han, K S Seo, S H Ahn, W J Jeong
Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty-four patients undergoing elective laryngeal micro-surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg(-1) with neostigmine (50 μg.kg(-1) with glycopyrrolate 10 μg.kg(-1) ) reversal (moderate block group) vs. rocuronium 0.90 mg.kg(-1) with sugammadex (4 mg.kg(-1) ) reversal (deep block group). The primary outcome was the intubating conditions during laryngoscopy secondary outcomes included recovery of neuromuscular block; conditions for tracheal intubation; satisfaction score as determined by the surgeon; onset of neuromuscular block; and postoperative sore throat...
May 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28489210/sugammadex-ed90-dose-to-reverse-the-rocuronium-neuromuscular-blockade-in-obese-patients
#8
Mauro Prado DA Silva, Christiano Matsui, Daniel Dongiou Kim, Joaquim Edson Vieira, Carlos Alberto Malheiros, Ligia Andrade Silva Telles Mathias
Objective: to determine the ED90 (minimum effective dose in 90% of patients) of sugammadex for the reversal of rocuronium-induced moderate neuromuscular blockade (NMB) in patients with grade III obesity undergoing bariatric surgery. Methods: we conducted a prospective study with the biased coin up-and-down sequential design. We chosen the following doses: 2.0mg/Kg, 2.2mg/Kg, 2.4mg/Kg, 2.6mg/Kg, 2.8mg/Kg. The complete reversal of rocuronium-induced NMB considered a T4/T1 ratio ≥0...
January 2017: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28483312/current-knowledge-and-management-of-hypersensitivity-to-perioperative-drugs-and-radiocontrast-media
#9
Karen S Hsu Blatman, David L Hepner
Perioperative anaphylaxis is an iatrogenic clinical condition, most often after anesthetic induction. Several mechanisms are implicated, including IgE- and non-IgE-mediated mechanisms. Perioperative anaphylaxis tends to be severe and has a higher mortality rate than anaphylaxis in other settings. This is partly due to factors that impair early recognition of anaphylaxis. Neuromuscular blocking agents, latex containing products, and antibiotics are the most common etiology. Chlorhexidine and dyes are increasingly culprits...
May 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28449630/sevoflurane-at-1-0-mac-together-with-remifentanil-and-propofol-produces-clinically-acceptable-intubation-conditions-at-the-vocal-cords-a-prospective-randomized-study
#10
Attila Ovari, Ilona Bicker, Susann Machmueller, Tobias Schuldt, Martin Sauer, Stefan Soltesz, Gabriele Noeldge-Schomburg, Robert Mlynski, Thomas Mencke
Objective The overall intubation conditions after tracheal intubation with remifentanil, propofol, and sevoflurane at 1.0 minimum alveolar concentration (MAC) are worse than with rocuronium at 0.45 mg/kg. Therefore, we compared the intubation conditions and laryngeal morbidity (vocal cord injuries, hoarseness, and sore throat) with sevoflurane at 1.2 and 1.4 MAC versus 1.0 MAC. Methods In this prospective clinical trial, 90 patients were randomized to 3 groups: the sevoflurane 1.0, 1.2, and 1.4 MAC groups...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28442963/sugammadex-to-reverse-neuromuscular-blockade-and-provide-optimal-conditions-for-motor-evoked-potential-monitoring
#11
Mehdi Trifa, Senthil Krishna, Ajay D'Mello, Mumin Hakim, Joseph Drew Tobias
Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade (NMB) via a mechanism that differs completely from acetylcholinesterase inhibitors. By encapsulating rocuronium, sugammadex can provide recovery of neuromuscular function even when there is a profound degree of NMB. We report anecdotal experience with the use of sugammadex to reverse NMB to facilitate intraoperative neurophysiological monitoring (motor evoked potentials) in an adolescent with scoliosis during posterior spinal fusion...
April 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28437264/magnesium-sulphate-improves-pulmonary-function-after-video-assisted-thoracoscopic-surgery-a-randomised-double-blind-placebo-controlled-study
#12
Hye-Min Sohn, Sang-Hoon Jheon, Sunwoo Nam, Sang-Hwan Do
BACKGROUND: Reduced lung volumes are unavoidable after lung resection surgery. Magnesium sulphate (MgSO4) administration has been reported to reduce the requirement for neuromuscular blocking drugs and postoperative analgesics in surgical patients. OBJECTIVE: To investigate the effect of MgSO4 on pulmonary function after video-assisted thoracoscopic surgery (VATS). DESIGN: A randomised, double-blind, placebo-controlled trial. SETTING: A university tertiary care centre...
April 21, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28419660/acute-masseter-dystonia-in-a-pediatric-patient-receiving-aripiprazole-and-methylphenidate-following-induction-of-general-anesthesia
#13
Michelle LeRiger, Jasper Williams, Greta Duncan-Wiebe, Mohanad Shukry
An 11-year-old male receiving aripiprazole, methylphenidate, and clonidine developed acute masseter dystonia inhibiting tracheal intubation after induction of general anesthesia with propofol and rocuronium. Following emergence, he had trismus and jaw discomfort. Psychiatry consultation suspected an acute dystonic reaction, so diphenhydramine was administered intravenously which resolved symptoms. We suspect chronic aripiprazole and methylphenidate usage combined with propofol administration in the short-term absence of methylphenidate made this patient susceptible to dystonic reactions...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28410821/-analgesia-nociception-index-for-perioperative-analgesia-monitoring-in-spinal-surgery
#14
Guldem Turan, Arzu Yıldırım Ar, Yıldız Yigit Kuplay, Oznur Demiroluk, Mustafa Gazi, Nur Akgun, Erhan Celikoglu
BACKGROUND AND OBJECTIVES: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain...
April 11, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28410818/-use-of-protocol-and-evaluation-of-postoperative-residual-curarization-incidence-in-the-absence-of-intraoperative-acceleromyography-randomized-clinical-trial
#15
Filipe Nadir Caparica Santos, Angelica de Fátima de Assunção Braga, Carla Josefine Barbosa de Lima Ribeiro, Franklin Sarmento da Silva Braga, Vanessa Henriques Carvalho, Fernando Eduardo Feres Junqueira
OBJECTIVE: Evaluate the incidence of PORC in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). METHODS: Randomized clinical trial with 122 patients divided into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6mg/kg and 10mg, respectively); the use of rocuronium was avoided in the final 45minutes; blockade reversal with neostigmine (50μg/kg); time ≥ 15minutes between reversion and extubation...
April 12, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28409297/the-slco1a2-189_-188insa-polymorphism-reduces-clearance-of-rocuronium-in-patients-submitted-to-elective-surgeries
#16
A C C Costa, E B Coelho, V L Lanchote, B V Correia, J T Abumansur, G R Lauretti, N V de Moraes
PURPOSE: Rocuronium (ROC) is a neuromuscular blocker mainly eliminated by biliary excretion dependent on organic anion transporting polypeptide 1A2 (OATP1A2) hepatocellular uptake. However, the influence of SLCO1A2 (gene encoding OATP1A2) genetic polymorphism on ROC pharmacokinetics was never described before. The objective of this work was to evaluate the influence of genetic polymorphisms of SLCO1A2 on the pharmacokinetics of rocuronium (ROC). METHODS: Patients undergoing elective surgeries under general anesthesia using rocuronium as a neuromuscular blocker were genotyped for SLCO1A2 polymorphisms in the coding region (41A>G, 382A>T, 404A>T, 502C>T, 516A>C, 559G>A, 830C>A, and 833delA) and in the promoter region (-1105G>A, -1032G>A, -715T>C, -361G>A, and -189_-188insA)...
April 14, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28399799/half-dose-sugammadex-combined-with-neostigmine-is-non-inferior-to-full-dose-sugammadex-for-reversal-of-rocuronium-induced-deep-neuromuscular-blockade-a-cost-saving-strategy
#17
Marie T Aouad, Waseem S Alfahel, Roland N Kaddoum, Sahar M Siddik-Sayyid
BACKGROUND: Sugammadex reverses the effect of rocuronium more rapidly and effectively than neostigmine, at all levels of neuromuscular blockade (NMB). However, its cost is prohibitive. The combination of half dose sugammadex with neostigmine would be non-inferior to full dose sugammadex for the reversal of deep NMB. This approach would reduce the cost of sugammadex while preserving its efficacy. METHODS: Patients were randomly allocated to receive sugammadex 4 mg/kg (Group S) or sugammadex 2 mg/kg with neostigmine 50 μg/kg and glycopyrrolate 10 μg/kg (Group NS) for reversal of rocuronium deep NMB...
April 11, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28394450/effects-of-presynaptic-muscarinic-receptor-blockade-on-neuromuscular-transmission-as-assessed-by-the-train-of-four-and-the-tetanic-fade-response-to-rocuronium
#18
Yong Beom Kim, Sangseok Lee, Kyeong Cheon Lee, Ha Jung Kim, Young Jin Ro, Hong-Seuk Yang
This study investigated the effect of muscarinic M1 and M2 receptor antagonists on the rocuronium-induced train of four (TOF) fade and tetanic fade, respectively. Ex-vivo phrenic nerves/diaphragms were obtained from adult Sprague-Dawley rats and, stabilized in Krebs buffer, and the nerve-stimulated muscle TOF fade was observed at 20 s intervals. For the TOF study, phrenic nerve/diaphragms were incubated with pirenzepine (an M1 blocker) at concentrations of 0 nM (control), 10 nM (PZP10), or 100 nM (PZP100). Rocuronium was then administered incrementally until the first twitch tension (T1) had depressed by >95% during TOF stimulation...
April 10, 2017: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/28372680/the-impact-of-anesthesia-on-hemodynamic-and-volume-changes-in-operative-hysteroscopy-a-bioimpedance-randomized-study
#19
Ehab E Moharram, Ahmed M El Attar, Moustafa A Kamel
BACKGROUND: Operative hysteroscopy is accompanied by the use of distention medium. Its absorption can lead to volume overload and hemodynamic disturbances that can lead to serious complications. We investigated the impact of the type of anesthesia on decreasing these complications with the use of noninvasive thoracic bioimpedance. DESIGN: A prospective, randomized, blind study. METHOD: Sixty women, with American Society of Anesthesiologists classifications I-III, undergoing operative hysteroscopy were randomly allocated into 2 groups...
May 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28367292/reversal-with-sugammadex-for-rocuronium-induced-deep-neuromuscular-block-after-pretreatment-of-magnesium-sulfate-in-rabbits
#20
Woon Seok Kang, Kyo Sang Kim, Shin Mi Song
BACKGROUND: Magnesium sulfate (MgSO4) has been used in the treatment of pre-eclampsia, hypertension and arrhythmia. Magnesium enhances the neuromuscular block of rocuronium. This study has been conducted to evaluate the reversal efficacy of sugammadex from deep rocuronium-induced neuromuscular block (NMB) during consistent pretreatment of MgSO4 in rabbits. METHODS: Twenty-eight rabbits were randomly assigned to four groups, a control group or study groups (50% MgSO4 150-200 mg/kg and 25 mg/kg/h IV), and received rocuronium 0...
April 2017: Korean Journal of Anesthesiology
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