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https://www.readbyqxmd.com/read/28663656/dilemmas-in-anesthetic-management-of-a-patient-with-history-of-anaphylaxis-to-vecuronium
#1
Nidhi Agrawal, A R Gogia, Madhu Dayal
Anaphylaxis during anesthesia is a life-threatening situation that occurs uncommonly. A 60-year-old woman with a history of anaphylaxis during previous anesthesia is scheduled to undergo elective open cholecystectomy. Her skin tests revealed sensitivity to vecuronium and nonsensitivity to injections of midazolam, fentanyl, and propofol. Due to high incidence of cross sensitivity among neuromuscular drugs, it was thought best to avoid general anesthesia. Spinal anesthesia was planned for the patient. The patient refused to give consent for spinal anesthesia, and she had to be taken up for surgery under general anesthesia...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28663611/financial-implications-of-intravenous-anesthetic-drug-wastage-in-operation-room
#2
Suvarna Kaniyil, A Krishnadas, Arun Kumar Parathody, K T Ramadas
BACKGROUND AND OBJECTIVES: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. METHODS: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28660165/the-incidence-of-hypotension-with-continuous-infusion-atracurium-compared-to-cisatracurium-in-the-intensive-care-unit
#3
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/28598915/anesthetic-and-obstetric-management-of-syringomyelia-during-labor-and-delivery-a-case-series-and-systematic-review
#4
Gráinne Patricia Garvey, Vibhangini S Wasade, Kellie E Murphy, Mrinalini Balki
BACKGROUND: Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. METHODS: A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken...
June 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28580612/utility-of-basophil-activation-testing-to-assess-perioperative-anaphylactic-reactions-in-real-world-practice
#5
Bernadette Eberlein, Sibylle Wigand, Heidrun Lewald, Eberhard Kochs, Johannes Ring, Tilo Biedermann, Ulf Darsow
INTRODUCTION: Perioperative anaphylactic reactions due to drugs and substances associated with general anesthesia can potentially be life-threatening. The objective of this study was to investigate the significance of the basophil activation test (BAT) for allergy diagnosis work up. METHODS: A total of 14 patients (5 men, 9 women; mean age: 57.8 years) with clinical records of anaphylactic reactions under general anesthesia were studied by means of anesthesia records, skin and serological tests...
June 5, 2017: Immunity, Inflammation and Disease
https://www.readbyqxmd.com/read/28573344/-residual-neuromuscular-blockade
#6
T Fuchs-Buder, D Schmartz
Even small degrees of residual neuromuscular blockade, i. e. a train-of-four (TOF) ratio >0.6, may lead to clinically relevant consequences for the patient. Especially upper airway integrity and the ability to swallow may still be markedly impaired. Moreover, increasing evidence suggests that residual neuromuscular blockade may affect postoperative outcome of patients. The incidence of these small degrees of residual blockade is relatively high and may persist for more than 90 min after a single intubating dose of an intermediately acting neuromuscular blocking agent, such as rocuronium and atracurium...
June 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28516057/comparison-of-atracurium-and-methocarbamol-for-preventing-succinylcholine-induced-muscle-fasciculation-a-randomized-controlled-trial
#7
Gholamreza Shabanian, Mohammadreza Shabanian, Alireza Shabanian, Saeid Heidari-Soureshjani
Fasciculation is a minor adverse effect of succinylcholine and may be an unpleasant experience for patient. The aim of this study was to compare the use of atracurium and methocarbamol to decrease the occurrence and severity of succinylcholine-induced muscle fasciculation. Fifty-nine adults with American Society of Anesthesiologists I or II hospitalized for elective surgery were randomly assigned to two groups: Group A (n = 29) who received succinylcholine 1 mg/kg body weight (BW) intravenously followed by 0...
April 2017: Journal of Advanced Pharmaceutical Technology & Research
https://www.readbyqxmd.com/read/28498889/uk-anaesthetists-perspectives-and-experiences-of-severe-perioperative-anaphylaxis-nap6-baseline-survey%C3%A2
#8
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/28485777/influences-of-cisatracurium-besylate-and-vecuronium-bromide-on-muscle-relaxant-effects-and-electromyography-of-tracheal-intubation-under-general-anesthesia
#9
D-J Yu, H-Y Gao
OBJECTIVE: To observe the influences of atracurium besylate and vecuronium bromide on muscle relaxant effects and electromyography of patients with tracheal intubation under general anesthesia in thyroid surgery. PATIENTS AND METHODS: 120 patients treated with thyroid surgery were randomly divided into group A and group V. Patients in group A were administered with cisatracurium besylate combined with propofol and fentanyl for induction of tracheal intubation under general anesthesia...
April 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28403018/prophylactic-atropine-administration-attenuates-the-negative-haemodynamic-effects-of-induction-of-anaesthesia-with-propofol-and-high-dose-remifentanil-a-randomised-controlled-trial
#10
Marieke Poterman, Thomas W L Scheeren, Marieke I van der Velde, Pieter L Buisman, Silvie Allaert, Michel M R F Struys, Alain F Kalmar
BACKGROUND: Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine. OBJECTIVE: To investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia. DESIGN: A double-blind, randomised controlled trial...
April 11, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28351905/comparison-of-cisatracurium-versus-atracurium-in-early-ards
#11
Leanne Moore, Charles Joseph Kramer, Sophie Delcoix-Lopes, Ariel M Modrykamien
BACKGROUND: Administration of cisatracurium in severe ARDS decreases in-hospital mortality. Whether clinical outcomes are cisatracurium-specific or related with all neuromuscular blockers is unknown. This study aimed to compare outcomes in severe ARDS patients treated with cisatracurium versus atracurium. METHODS: Patients admitted in ICUs with a diagnosis of severe ARDS and treated with neuromuscular blocking agents within 72 h of diagnosis were included. Subjects treated with cisatracurium versus atracurium were compared...
March 28, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28351497/a-preferential-delivery-method-to-investigate-direct-neuromuscular-blockade-effect-of-inhaled-anesthetics-on-skeletal-muscle
#12
Ling Ye, Pingliang Yang
Inhaled anesthetics can enhance the effect of neuromuscular blocker, but whether inhaled anesthetics such as sevoflurane have a direct effect on skeletal muscle contractility is unknown. Selectively blocking skeletal muscle may prevent the interference effect of central nervous system. So we decided to evaluate a local application of neuromuscular blocker (NMB) atracurium to prevent the general effect on skeletal muscle. In part 1, sevoflurane (a inhaled anesthetic) minimum alveolar concentrations (MAC) of 1...
April 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/28344390/algal-cultivation-in-urban-wastewater-an-efficient-way-to-reduce-pharmaceutical-pollutants
#13
Francesco G Gentili, Jerker Fick
The purpose of this study was to investigate whether pharmaceutical pollutants in urban wastewater can be reduced during algal cultivation. A mixed population of wild freshwater green algal species was grown on urban wastewater influent in a 650 L photobioreactor under natural light and with the addition of flue gases. Removal efficiencies were very high (>90 %), moderate (50-90 %), low (10-50 %), and very low or non-quantifiable (<10 %) for 9, 14, 11, and 18 pharmaceuticals, respectively, over a 7-day period...
2017: Journal of Applied Phycology
https://www.readbyqxmd.com/read/28216703/effects-of-avoiding-neuromuscular-blocking-agents-during-maintenance-of-anaesthesia-on-recovery-characteristics-in-patients-undergoing-craniotomy-for-supratentorial-lesions-a-randomised-controlled-study
#14
Ruchi A Jain, Anita N Shetty, Shrikanta P Oak, Anjana S Wajekar, Madhu B Garasia
BACKGROUND AND AIMS: Neuromuscular blocking agents have been one of the cornerstones of anaesthesia. With the advent of newer surgical, anaesthetic and neurological monitoring techniques, their utility in neuroanaesthesia practice seems dispensable. The aim of this prospective, comparative, randomised study was to determine whether neuromuscular blocking agents are required in patients undergoing supratentorial surgery when balanced anaesthesia with desflurane, dexmedetomidine and scalp block is used...
January 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28198315/beware-of-lookalikes
#15
Matt Griffiths
In 2014, health staff who were vaccinating children in rebel-held northern Syria accidentally administered a muscle relaxant, atracurium, to up to 75 children, killing 15 of them. An investigation found that the drug was given to the children instead of a solution used to mix measles vaccines because the packaging was similar.
February 15, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28102521/clinical-assessment-and-train-of-four-measurements-in-critically-ill-patients-treated-with-recommended-doses-of-cisatracurium-or-atracurium-for-neuromuscular-blockade-a-prospective-descriptive-study
#16
Pierre Bouju, Jean-Marc Tadié, Nicolas Barbarot, Julien Letheulle, Fabrice Uhel, Pierre Fillatre, Guillaume Grillet, Angélique Goepp, Yves Le Tulzo, Arnaud Gacouin
BACKGROUND: Despite few studies, a monitoring of a neuromuscular blockade with a train of four (TOF) is recommended in intensive care unit (ICU). Our objective was to compare the results of ulnar and facial TOF measurements with an overall clinical assessment for neuromuscular blockade in ICU patients treated with recommended doses of atracurium or cisatracurium, including patients with acute respiratory disease syndrome (ARDS). METHODS: We prospectively included in two ICUs 119 patients, 94 with ARDS, who required a neuromuscular blockade for more than 24 h...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28058956/neuromuscular-blockade-and-inspiratory-breath-hold-during-stereotactic-body-radiation-therapy-for-treatment-of-heart-base-tumors-in-four-dogs
#17
Krista L Kelsey, Lyndsay N Kubicek, Nicholas J Bacon, Terry Torres, Sheilah A Robertson
CASE DESCRIPTION 4 dogs were examined because of pleural effusion and ventricular tachycardia, coughing and supraventricular tachycardia, appendicular osteosarcoma, and syncopal episodes. CLINICAL FINDINGS In all 4 dogs, a heart base tumor was identified by means of thoracic CT. TREATMENT AND OUTCOME In all 4 dogs, the heart base tumors were treated by means of stereotactic body radiation therapy. Dogs were anesthetized, and neuromuscular blockade was achieved with atracurium or vecuronium. A circle rebreathing system with 15 m (50 feet) of anesthetic tubing coursing through the vault wall was used to connect the patient to the anesthesia machine, which was located in the control room...
January 15, 2017: Journal of the American Veterinary Medical Association
https://www.readbyqxmd.com/read/27933398/ecmo-for-intractable-status-asthmaticus-following-atracurium
#18
Vittorio Scaravilli, Giacomo Grasselli, Annalisa Benini, Michela Bombino, Daniele Ceriani, Uta Emmig, Alberto Zanella, Nicolò Patroniti, Antonio Pesenti
Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2 > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit...
June 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/27896927/a-retrospective-review-of-anesthesia-and-perioperative-care-in-children-with-medium-chain-acyl-coa-dehydrogenase-deficiency
#19
Claire Allen, Russell Perkins, Bernd Schwahn
BACKGROUND: Medium-chain acyl-CoA dehydrogenase deficiency is the most common genetically determined disorder of mitochondrial fatty acid oxidation. Decompensation can result in hypoglycemia, seizures, coma, and death but may be prevented by ensuring glycogen stores do not become depleted. Perioperative care is of interest as surgery, fasting, and infection may all trigger decompensation and the safety of anesthetic agents has been questioned. Current guidelines from the British Inherited Metabolic Disease Group advise on administering fluid containing 10% glucose during the perioperative period...
January 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27869199/ion-mobility-spectrometry-as-a-simple-and-rapid-method-to-measure-the-plasma-propofol-concentrations-for-intravenous-anaesthesia-monitoring
#20
Xin Wang, Qinghua Zhou, Dandan Jiang, Yulei Gong, Enyou Li, Haiyang Li
The plasma propofol concentration is important information for anaesthetists to monitor and adjust the anaesthesia depth for patients during a surgery operation. In this paper, a stand-alone ion mobility spectrometer (IMS) was constructed for the rapid measurement of the plasma propofol concentrations. Without any sample pre-treatment, the plasma samples were dropped on a piece of glass microfiber paper and then introduced into the IMS cell by the thermal desorption directly. Each individual measurement could be accomplished within 1 min...
November 21, 2016: Scientific Reports
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