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Neuromuscular blocking drugs

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https://www.readbyqxmd.com/read/29241014/an-observational-study-of-the-efficacy-of-cisatracurium-compared-to-vecuronium-in-patients-with-or-at-risk-for-ards
#1
Peter D Sottile, Tyree H Kiser, Ellen L Burnham, P Michael Ho, Richard R Allen, R William Vandivier, Marc Moss
RATIONALE: The neuromuscular blocking agent cisatracurium may improve mortality for patients with moderate-severe ARDS. Other neuromuscular blocking agents, such as vecuronium, are commonly used and have different mechanisms of action, side effects, cost, and availability in the setting of drug shortages. OBJECTIVE: To determine whether cisatracurium is associated with improved outcomes when compared vecuronium in patients at risk for and with ARDS. METHODS: Using a nationally representative database, patients admitted to the intensive care unit (ICU) with a diagnosis of ARDS or an ARDS risk factor, received mechanical ventilation, and were treated with a continuous infusion of neuromuscular blocking agent for at least two days within two days of hospital admission were included...
December 14, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29236668/-claude-bernard-and-nicotinic-receptors-from-the-neuromuscular-junction-to-tobacco-weaning
#2
Laurent Monassier
Claude Bernard (1813-1878) was fascinated by the pharmacological mechanisms of poisons. In particular, using a huge amount of ingenious and robust experiments, he demonstrated the peripheral toxic action of the natural compound curare. His work generated controversies in a period where scientific methodology and technical development followed the progression of concepts and ideas. From his intense debates with Albert Vulpian emerged the location of curare's toxicity at the neuromuscular junction. These two fascinating scientists could not imagine how important were these discoveries which allowed John Langley to propose the concept of receptor early in the 20th century...
2017: Biologie Aujourd'hui
https://www.readbyqxmd.com/read/29200077/consensus-statement-on-perioperative-use-of-neuromuscular-monitoring
#3
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/29161387/reversal-of-residual-neuromuscular-block-complications-associated-with-perioperative-management-of-muscle-relaxation
#4
J M Hunter
The use of anticholinesterases to reverse residual neuromuscular block at the end of surgery became routine practice in the 1950s. These drugs could only be used when recovery from block was established [two twitches of the train-of-four (TOF) count detectable] and concern was expressed about their cholinergic side-effects. By the 1990s, it was recognized that failure to reverse residual block adequately to a TOF ratio (TOFR) >0.7 was associated with increased risk of postoperative pulmonary complications (POPCs) following the long-acting non-depolarizing neuromuscular blocking drug (NDNMBD) pancuronium...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29159065/train-of-four-stimulation-artifact-mimicking-a-seizure-during-computerized-automated-icu-eeg-monitoring
#5
Laxmi P Dhakal, William O Tatum, William D Freeman
A 54-year-old man was admitted to the intensive care unit with an aneurysmal subarachnoid hemorrhage and subsequently underwent mechanical ventilation and received neuromuscular blocking drugs to control refractory elevated intracranial pressure. During quantitative EEG monitoring, an automated alert was triggered by the train of four peripheral nerve stimulation artifacts. Real-time feedback was made possible due to remote monitoring. This case illustrates how computerized, automated artificial intelligence algorithms can be used beyond typical seizure detection in the intensive care unit for remote monitoring to benefit patient care...
2017: Epilepsy & Behavior Case Reports
https://www.readbyqxmd.com/read/29121312/readmission-after-surgery-are-neuromuscular-blocking-drugs-a-cause
#6
M Blobner, K Ulm, J M Hunter
No abstract text is available yet for this article.
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29066245/effects-of-neostigmine-or-edrophonium-on-force-of-contraction-when-administered-at-a-train-of-four-ratio-of-0-9-in-anesthetized-dogs
#7
Marta Romano, Manuel Martin-Flores, Daniel M Sakai, Chia T Tseng, Luis Campoy, Robin D Gleed
OBJECTIVE: Anticholinesterase drugs may produce paradoxical neuromuscular block when administered at shallow levels of neuromuscular block. The objective of this study was to evaluate the effects of neostigmine and edrophonium when administered at near-complete reversal from nondepolarizing block in anesthetized dogs. STUDY DESIGN: Incomplete crossover, randomized, blinded experimental study. ANIMALS: A total of 12 Beagle dogs. METHODS: Each dog was anesthetized twice with propofol and maintained with isoflurane and dexmedetomidine...
August 3, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29054436/in-vitro-and-ex-vivo-screening-of-candidate-therapeutics-to-restore-neurotransmission-in-nerve-terminals-intoxicated-by-botulinum-neurotoxin-serotype-a1
#8
Phillip H Beske, Aaron B Bradford, Katie M Hoffman, Sydney Mason, Patrick M McNutt
Botulinum neurotoxins (BoNTs) are exceedingly potent neurological poisons that block cholinergic release in the peripheral nervous system and cause death by asphyxiation. While post-exposure prophylaxis can effectively eliminate toxin in the bloodstream, there are no clinically effective treatments to prevent or reverse disease once BoNT has entered the neuron. To address the need for post-symptomatic countermeasures, we designed and developed an in vitro assay based on whole-cell, patch-clamp electrophysiological monitoring of miniature excitatory post-synaptic currents in synaptically active murine embryonic stem cell-derived neurons...
October 17, 2017: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/29050397/the-antimyotonic-effect-of-lamotrigine-in-non-dystrophic-myotonias-a-double-blind-randomized-study
#9
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/29046769/factors-that-affect-the-onset-of-action-of-non-depolarizing-neuromuscular-blocking-agents
#10
REVIEW
Yong Byum Kim, Tae-Yun Sung, Hong Seuk Yang
Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action...
October 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29044014/-anaphylaxis-and-allergic-reactions-during-surgery-and-medical-procedures
#11
Blas J Larrauri, María Gabriela Torre, Eloísa Malbrán, María Cecilia Juri, Diego S Fernández Romero, Alejandro Malbrán
Anaphylaxis during anesthesia is an unpredictable, severe, and rare reaction. It has an incidence of 1/10 000 to 1/20 000 surgeries. In most series, the responsible drugs include neuromuscular blocking agents, latex, or antibiotics. The frequency and etiology of systemic allergic reactions in other medical procedures are largely unknown. The identification of responsible drugs of anaphylaxis is a complex task, requiring testing of all medications and substances used during surgery. We describe our experience in a retrospective study of 15 patients...
2017: Medicina
https://www.readbyqxmd.com/read/29034449/nitrous-oxide-based-vs-nitrous-oxide-free-general-anaesthesia-and-accidental-awareness-in-surgical-patients-an-abridged-cochrane-systematic-review
#12
REVIEW
J Hounsome, J Greenhalgh, O J Schofield-Robinson, S R Lewis, T M Cook, A F Smith
Accidental awareness during general anaesthesia can arise from a failure to deliver sufficient anaesthetic agent, or from a patient's resistance to an expected sufficient dose of such an agent. Awareness is 'explicit' if the patient is subsequently able to recall the event. We conducted a systematic review into the effect of nitrous oxide used as part of a general anaesthetic on the risk of accidental awareness in people over the age of five years undergoing general anaesthesia for surgery. We included 15 randomised controlled trials, 14 of which, representing a total of 3439 participants, were included in our primary analysis of the frequency of accidental awareness events...
October 16, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28964314/optimal-dose-of-rocuronium-bromide-undergoing-adenotonsillectomy-under-5-sevoflurane-with-fentanyl
#13
RANDOMIZED CONTROLLED TRIAL
Hyub Huh, Jeong Jun Park, Ji Yeong Kim, Tae Hoon Kim, Seung Zhoo Yoon, Hye Won Shin, Hye-Won Lee, Hye-Ja Lim, Jang Eun Cho
OBJECTIVE: Adenotonsillectomy is a short surgical procedure under general anaesthesia in children. An ideal muscle relaxant for adenotonsillectomy would create an intense neuromuscular block while having a quick recovery time without postoperative morbidity. We compared the effect of different doses of rocuronium for the tracheal intubation in children under 5% sevoflurane and fentanyl. MATERIALS AND METHODS: 75 children (aged 3-10 years, ASA I) scheduled for adenotonsillectomy were enrolled...
October 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28868303/adjuvants-to-local-anesthetics-current-understanding-and-future-trends
#14
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/28866307/evaluation-of-periprocedural-hypersensitivity-reactions
#15
Melissa Iammatteo, Taha Keskin, Elina Jerschow
BACKGROUND: Identifying the cause of periprocedural hypersensitivity reactions (HSRs) remains challenging because of the multitude of medications involved. Antibiotics are the most common cause in the United States, whereas neuromuscular blocking agents are most common in Europe. OBJECTIVE: To identify causative agents for periprocedural HSRs. METHODS: This study was a 7-year retrospective medical record review of patients evaluated between December 2009 and January 2017 at a drug allergy center in Bronx, New York for periprocedural HSRs, defined as occurring soon before, during, or soon after a medical procedure or operation with or without general anesthesia...
October 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28838986/ammonia-modifies-enteric-neuromuscular-transmission-through-glial-gamma-aminobutyric-acid-signaling
#16
David E Fried, Ralph E Watson, Simon C Robson, Brian D Gulbransen
OBJECTIVE: Impaired gut motility may contribute, at least in part, to the development of systemic hyperammonemia and systemic neurological disorders in inherited metabolic disorders, or in severe liver and renal disease. It is not known whether enteric neurotransmission regulates intestinal luminal and hence systemic ammonia levels by induced changes in motility. DESIGN: Here, we propose and test the hypothesis that ammonia acts through specific enteric circuits to influence gut motility...
August 24, 2017: American Journal of Physiology. Gastrointestinal and Liver Physiology
https://www.readbyqxmd.com/read/28830363/recovery-and-prediction-of-postoperative-muscle-power-is-it-still-a-problem
#17
Martin Zoremba, Dennis Kornmann, Benjamin Vojnar, Rene Burchard, Thomas Wiesmann, Hinnerk Wulf, Thomas Kratz
BACKGROUND: In the postoperative period, immediate recovery of muscular power is essential for patient safety, but this can be affected by anaesthetic drugs, opioids and neuromuscular blocking agents (NMBA). In this cohort study, we evaluated anaesthetic and patient-related factors contributing to reduced postoperative muscle power and pulse oximetric saturation. METHODS: We prospectively observed 615 patients scheduled for minor surgery. Premedication, general anaesthesia and respiratory settings were standardized according to standard operating procedures (SOP)...
August 22, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28818054/comparison-of-the-trapezius-and-the-adductor-pollicis-muscle-as-predictor-of-good-intubating-conditions-a-randomized-controlled-trial
#18
Stefan Soltesz, Christian Stark, Karl G Noé, Michael Anapolski, Thomas Mencke
BACKGROUND: Adequate muscle relaxation is important for ensuring optimal conditions for intubation. Although acceleromyography of the adductor pollicis muscle is commonly used to assess conditions for intubation, we hypothesized that acceleromyography of the trapezius is more indicative of optimal intubating conditions. The primary outcome was the difference between both measurement sites with regard to prediction of good or acceptable intubating conditions. METHODS: Neuromuscular blockade after injection of rocuronium 0...
August 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28806470/efficacy-and-safety-of-sugammadex-versus-neostigmine-in-reversing-neuromuscular-blockade-in-adults
#19
REVIEW
Ana-Marija Hristovska, Patricia Duch, Mikkel Allingstrup, Arash Afshari
BACKGROUND: Acetylcholinesterase inhibitors, such as neostigmine, have traditionally been used for reversal of non-depolarizing neuromuscular blocking agents. However, these drugs have significant limitations, such as indirect mechanisms of reversal, limited and unpredictable efficacy, and undesirable autonomic responses. Sugammadex is a selective relaxant-binding agent specifically developed for rapid reversal of non-depolarizing neuromuscular blockade induced by rocuronium. Its potential clinical benefits include fast and predictable reversal of any degree of block, increased patient safety, reduced incidence of residual block on recovery, and more efficient use of healthcare resources...
August 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28798922/practical-approach-to-the-patient-with-acute-neuromuscular-weakness
#20
REVIEW
Rajeev Nayak
Acute neuromuscular paralysis (ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks (less than 4 wk). Bulbar and respiratory muscle weakness may or may not be present. It is a common neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia...
July 16, 2017: World Journal of Clinical Cases
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