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Neuromuscular blockers

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https://www.readbyqxmd.com/read/29200077/consensus-statement-on-perioperative-use-of-neuromuscular-monitoring
#1
Mohamed Naguib, Sorin J Brull, Aaron F Kopman, Jennifer M Hunter, Béla Fülesdi, Hal R Arkes, Arthur Elstein, Michael M Todd, Ken B Johnson
A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29153297/pain-management-practice-and-guidelines-in-jordanian-pediatric-intensive-care-units
#2
Ahmad Ismail, Paula Forgeron, Viola Polomeno, Huda Gharaibeh, Denise Harrison
Limited knowledge exists of current pain management practices and supporting guidelines in Jordanian pediatric intensive care units. To determine the current pain management practices and the availability and content of practice guidelines in Jordanian pediatric intensive care units, we conducted a cross-sectional and multisite survey of four pediatric intensive care units in Jordan. A questionnaire was developed and orally administered over the phone or in person to head nurses or their nominees to capture pain management practices and the existence and content of guidelines...
November 15, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29125190/lambert-eaton-myasthenic-syndrome-mouse-passive-transfer-model-illuminates-disease-pathology-and-facilitates-testing-therapeutic-leads
#3
REVIEW
Stephen D Meriney, Tyler B Tarr, Kristine S Ojala, Man Wu, Yizhi Li, David Lacomis, Adolfo Garcia-Ocaña, Mary Liang, Guillermo Valdomir, Peter Wipf
Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder caused by antibodies directed against the voltage-gated calcium channels that provide the calcium ion flux that triggers acetylcholine release at the neuromuscular junction. To study the pathophysiology of LEMS and test candidate therapeutic strategies, a passive-transfer animal model has been developed in mice, which can be created by daily intraperitoneal injections of LEMS patient serum or IgG into mice for 2-4 weeks. Results from studies of the mouse neuromuscular junction have revealed that each synapse has hundreds of transmitter release sites but that the probability for release at each one is likely to be low...
November 10, 2017: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29095176/sugammadex-for-neuromuscular-blockade-reversal
#4
Michelle R Papathanas, Alley Killian
Postoperative residual neuromuscular blockade is associated with an increased risk of respiratory insufficiency, aspiration, and potential pulmonary complications. The standard of care for reversal of residual block centers on anticholinesterases such as neostigmine. However, these medications provide inconsistent or inadequate effect while being associated with potentially severe adverse effects. Sugammadex, a modified γ-cyclodextrine compound, is a recently approved agent for the reversal of blockade with aminosterodial neuromuscular blockers...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29079016/the-8-year-experience-of-the-florence-referral-ecmo-center-and-retrieval-team-for-acute-respiratory-failure
#5
Giovanni Cianchi, Chiara Lazzeri, Manuela Bonizzoli, Stefano Batacchi, Morena Cozzolino, Marco Ciapetti, Pasquale Bernardo, Andrea Franci, Marco Chiostri, Adriano Peris
OBJECTIVE: Many extracorporeal membrane oxygenation (ECMO) centers for respiratory failure and ECMO mobile teams were instituted during the H1N1 pandemic. Data on transportation are scarce and heterogeneous. The authors therefore described the experience of their referral ECMO center for severe respiratory failure from 2009 to 2016 and gave a comprehensive report of transfers performed by their mobile ECMO team. DESIGN: Observational retrospective study. SETTING: An intensive care unit (ECMO referral center) in a teaching hospital...
June 8, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29050397/the-antimyotonic-effect-of-lamotrigine-in-non-dystrophic-myotonias-a-double-blind-randomized-study
#6
RANDOMIZED CONTROLLED TRIAL
Grete Andersen, Gitte Hedermann, Nanna Witting, Morten Duno, Henning Andersen, John Vissing
Mexiletine is the only drug with proven effect for treatment of non-dystrophic myotonia, but mexiletine is expensive, has limited availability and several side effects. There is therefore a need to identify other pharmacological compounds that can alleviate myotonia in non-dystrophic myotonias. Like mexiletine, lamotrigine is a sodium channel blocker, but unlike mexiletine, lamotrigine is available, inexpensive, and well tolerated. We investigated the potential of using lamotrigine for treatment of myotonia in patients with non-dystrophic myotonias...
September 1, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28987399/review-of-difficult-airway-management-in-thoracic-surgery
#7
M Granell, M J Parra, M J Jiménez, L Gallart, A Villalonga, O Valencia, M C Unzueta, A Planas, J M Calvo
The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers...
October 4, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28977098/what-every-intensivist-should-know-about-acute-respiratory-distress-syndrome-and-diffuse-alveolar-damage
#8
Fernando Rios, Teresa Iscar, Pablo Cardinal-Fernández
Acute respiratory distress syndrome is a challenging entity for the intensivist. The pathological hallmark of the acute phase is diffuse alveolar damage, which is present in approximately half of living patients with acute respiratory distress syndrome. It is clear that respiratory support for acute respiratory distress syndrome has gradually been improving over recent decades. However, it is also evident that these procedures are beneficial, as they reduce lung injury and keep the patient alive. This could be interpreted as a time-gaining strategy until the trigger or causal or risk factor improves, the inflammatory storm decreases and the lung heals...
September 28, 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28913813/pharmacotherapy-pearls-for-emergency-neurological-life-support
#9
Gretchen M Brophy, Theresa Human
The appropriate use of medications during Emergency Neurological Life Support (ENLS) is essential to optimize patient care. Important considerations when choosing the appropriate agent include the patient's organ function and medication allergies, potential adverse drug effects, drug interactions and critical illness and aging pathophysiologic changes. Critical medications used during ENLS include hyperosmolar therapy, anticonvulsants, antithrombotics, anticoagulant reversal and hemostatic agents, anti-shivering agents, neuromuscular blockers, antihypertensive agents, sedatives, vasopressors and inotropes, and antimicrobials...
September 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28910146/management-of-ards-and-refractory-hypoxemia-a-multicenter-observational-study
#10
Erick H Duan, Neill Kj Adhikari, Frederick D'Aragon, Deborah J Cook, Sangeeta Mehta, Waleed Alhazzani, Ewan Goligher, Emmanuel Charbonney, Yaseen M Arabi, Tim Karachi, Alexis F Turgeon, Lori Hand, Qi Zhou, Peggy Austin, Jan Friedrich, Francois Lamontagne, François Lauzier, Rakesh Patel, John Muscedere, Richard Hall, Pierre Aslanian, Thomas Piraino, Martin Albert, Sean M Bagshaw, Mike Jacka, Gordon Wood, William Henderson, Delbert Dorscheid, Niall D Ferguson, Maureen O Meade
RATIONALE: Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described. OBJECTIVES: To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS including refractory hypoxemia. METHODS: Prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring FiO2 ≥0.50 in 24 ICUs...
September 14, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28873075/intraoperative-magnesium-sulphate-decreases-agitation-and-pain-in-patients-undergoing-functional-endoscopic-surgery-a-randomised-double-blind-study
#11
Hazem E Elsersy, Magdy Ch Metyas, Hana A Elfeky, Ahmed A Hassan
BACKGROUND: Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff. OBJECTIVE: The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery. DESIGN: A randomised, double-blinded, placebo-controlled trial. SETTING: ENT operating room, Menofia University Hospitals, Egypt...
October 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28868303/adjuvants-to-local-anesthetics-current-understanding-and-future-trends
#12
EDITORIAL
Amlan Swain, Deb Sanjay Nag, Seelora Sahu, Devi Prasad Samaddar
Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action...
August 16, 2017: World Journal of Clinical Cases
https://www.readbyqxmd.com/read/28862524/effect-of-anaesthetic-and-choice-of-neuromuscular-blocker-on-vagal-control-of-heart-rate-under-laboratory-animal-experimental-conditions
#13
Divya Sarma Kandukuri, Jacqueline K Phillips, Mark Tahmindjis, Cara M Hildreth
Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensitivity) under two different types of anaesthesia in Lewis rats...
January 1, 2017: Laboratory Animals
https://www.readbyqxmd.com/read/28743332/-clinical-significance-of-early-immunological-paralysis-in-patients-with-severe-h1n1-influenza-a
#14
Yongbing Qian, Hui Xie, Rui Tian, Jian Lu, Wei Jin, Ruilan Wang
OBJECTIVE: To analysis the immunological characteristics of patients with severe H1N1 influenza A, and to provide theoretical basis for predicting the prognosis of the disease. METHODS: A retrospective analysis was conducted. The clinical data of 15 patients diagnosed with severe H1N1 influenza A and admitted to Shanghai General Hospital of Nanjing Medical University from October 2015 to December 2016 were collected. All the patients were divided into survival and death groups according to 28-day survival...
July 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28701350/effectiveness-of-interventions-to-improve-medication-use-during-rapid-sequence-intubation-in-a-pediatric-emergency-department
#15
Michelle C Caruso, Jenna R Dyas, Matthew R Mittiga, Andrea S Rinderknecht, Benjamin T Kerrey
PURPOSE: Results of a study to determine whether checklist-based interventions improved the selection and administration of rapid-sequence intubation (RSI) medications in a pediatric emergency department (ED) are reported. METHODS: A retrospective study of data collected during a quality-improvement project was conducted. Data sources included the electronic health record and video review. The central intervention was use of a 21-item RSI checklist, which included guidance for the physician team leader on medication selection and timing...
September 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28668906/a-current-approach-to-heart-failure-in-duchenne-muscular-dystrophy
#16
REVIEW
Domenico D'Amario, Antonio Amodeo, Rachele Adorisio, Francesco Danilo Tiziano, Antonio Maria Leone, Gianluigi Perri, Piergiorgio Bruno, Massimo Massetti, Alessandra Ferlini, Marika Pane, Giampaolo Niccoli, Italo Porto, Gianluca A D'Angelo, Josip Anđelo Borovac, Eugenio Mercuri, Filippo Crea
Duchenne muscular dystrophy (DMD) is a genetic, progressive neuromuscular condition that is marked by the long-term muscle deterioration with significant implications of pulmonary and cardiac dysfunction. As such, end-stage heart failure (HF) in DMD is increasingly becoming the main cause of death in this population. The early detection of cardiomyopathy is often challenging, due to a long subclinical phase of ventricular dysfunction and difficulties in assessment of cardiovascular symptomatology in these patients who usually loose ambulation during the early adolescence...
November 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28660165/the-incidence-of-hypotension-with-continuous-infusion-atracurium-compared-to-cisatracurium-in-the-intensive-care-unit
#17
Luke A VanderWeide, Mahmoud Abdel-Rasoul, Anthony Thomas Gerlach
BACKGROUND: A drug shortage of cisatracurium led to use of atracurium as an alternative neuromuscular blocker (NMB). Cisatracurium may be preferred due to less histamine release and potentially less hypotension. The study purpose is to compare the incidence of hypotension with continuous infusion atracurium to continuous infusion cisatracurium in ICU patients. MATERIALS AND METHODS: This retrospective cohort analysis reviewed 119 ICU patients who received either continuous infusion atracurium (56) or cisatracurium (63)...
April 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28658142/use-of-neuromuscular-blockers-and-neostigmine-for-general-anesthesia-and-its-association-with-neuraxial-blockade-a-retrospective-study
#18
Filipe Nadir Caparica Santos, Angélica de Fátima de Assunção Braga, Fernando Eduardo Feres Junqueira, Rafaela Menezes Bezerra, Felipe Ferreira de Almeida, Franklin Sarmento da Silva Braga, Vanessa Henriques Carvalho
This research aimed to assess the use of neuromuscular blockers (NMB) and its reversal, associated or not with neuraxial blockade, after general anesthesia.This retrospective study analyzed 1295 patients that underwent surgery with general anesthesia at Prof. Dr. José Aristodemo Pinotti Hospital in 2013. The study included patients aged >1 year, with complete, readable medical charts and anesthetic records.Rocuronium (ROC) was the most used NMB (96.7%), with an initial dose of 0.60 (0.52-0.74) mg/kg and total dose of 0...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28658119/is-neuromuscular-blocker-needed-in-children-undergoing-inguinal-herniorrhaphy-a-prospective-randomized-and-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Bon-Wook Koo, Kyu-Whan Jung, Ah-Young Oh, Eun-Young Kim, Hyo-Seok Na, Eun-Su Choi, Kwang-Suk Seo
BACKGROUND: Intraoperative neuromuscular blocker is widely used, but is known to be associated with postoperative residual paralysis, which is known to be associated with increased risk of pulmonary complications. Hence, its use should be individualized and restricted to procedures where it is mandatory. We examined whether not using a neuromuscular blocker affects the surgical conditions in children undergoing inguinal herniorrhaphy. METHODS: Anesthesia was induced and maintained with sevoflurane in 60% nitrous oxide, and the airway was maintained using an I-gel...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28608304/lambert-eaton-myasthenic-syndrome-lems-a-rare-autoimmune-presynaptic-disorder-often-associated-with-cancer
#20
REVIEW
Benedikt Schoser, Bruno Eymard, Joe Datt, Renato Mantegazza
Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune neuromuscular junction disorder that is related to the loss of functional P/Q-type voltage-gated calcium channels (VGCCs) on presynaptic nerve terminals. Up to 60% of cases occur as a paraneoplastic disorder (SCLC-LEMS), most commonly in association with small cell lung cancer. The remaining cases have an idiopathic non-tumor etiology but are associated with underlying autoimmune disease (NT-LEMS). Patients with LEMS invariably experience progressive proximal muscle weakness, often accompanied by general fatigue and autonomic symptoms...
September 2017: Journal of Neurology
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