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https://www.readbyqxmd.com/read/28418788/factors-associated-with-delayed-cooling-in-cardiac-arrest-patients
#1
David A Pearson, Katherine Mayer, Catherine M Wares, Michael S Runyon, Jonathan R Studnek, Shana L Ward, Kathi M Kraft, Alan C Heffner
Therapeutic hypothermia has been shown to improve neurologic outcome in medical cardiac arrest patients, yet little is known about factors that delay target temperature achievement. Our primary aim was to identify factors associated with not achieving our institutional "door-to-cool" (DTC) performance goal (emergency department [ED] arrival to temperature of 34°C) of ≤4 hours. Secondary aims included whether achievement of DTC goal was associated with timing of bolus neuromuscular blockade (NMB), survival, or functional outcome...
April 18, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/28406814/pilot-feasibility-study-of-therapeutic-hypothermia-for-moderate-to-severe-acute-respiratory-distress-syndrome
#2
Donald F Slack, Douglas S Corwin, Nirav G Shah, Carl B Shanholtz, Avelino C Verceles, Giora Netzer, Kevin M Jones, Clayton H Brown, Michael L Terrin, Jeffrey D Hasday
OBJECTIVES: Prior studies suggest hypothermia may be beneficial in acute respiratory distress syndrome, but cooling causes shivering and increases metabolism. The objective of this study was to assess the feasibility of performing a randomized clinical trial of hypothermia in patients with acute respiratory distress syndrome receiving treatment with neuromuscular blockade because they cannot shiver. DESIGN: Retrospective study and pilot, prospective, open-label, feasibility study...
April 12, 2017: Critical Care Medicine
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
#3
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
#4
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/28392946/management-of-residual-neuromuscular-blockade-recovery-age-old-problem-with-a-new-solution
#5
Michael S Green, Archana Gundigi Venkatesh, Ranjani Venkataramani
Neostigmine has been traditionally used as the agent of choice to reverse Neuromuscular Blockade (NMB) after muscle paralysis during general anesthesia. However, the use of neostigmine has not been without untoward events. Sugammadex is a novel drug that selectively binds to aminosteroid nondepolarizing muscle relaxants and reverses even a deep level of NMB. Controversy exists regarding the optimal dose of sugammadex that is effective in reversing the NMB after the incomplete reversal with neostigmine and glycopyrrolate...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28362035/commentary-to-the-article-neuromuscular-blockade-in-the-elderly
#6
Paweł Twardowski, Michał Domżalski
No abstract text is available yet for this article.
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28351497/a-preferential-delivery-method-to-investigate-direct-neuromuscular-blockade-effect-of-inhaled-anesthetics-on-skeletal-muscle
#7
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/28337407/fentanyl-induced-chest-wall-rigidity-syndrome-in-a-routine-bronchoscopy
#8
Chee Kiang Phua, Audrey Wee, Albert Lim, John Abisheganaden, Akash Verma
Combination of sedatives such as fentanyl and midazolam during bronchoscopy is recommended by American College of Chest Physician due to its favourable drug profile. It improves patient comfort and tolerance, and is commonly given unless contraindicated. We describe a rare case of fentanyl-induced chest wall rigidity syndrome during a routine bronchoscopy with endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) in a 55 year old male presenting with a lung mass and mediastinal lymphadenopathy...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28320323/changes-in-duration-of-action-of-rocuronium-following-decrease-in-hepatic-blood-flow-during-pneumoperitoneum-for-laparoscopic-gynaecological-surgery
#9
Yang Liu, Wen Cao, Yu Liu, Yun Wang, Ren Lang, Yun Yue, An-Shi Wu
BACKGROUND: A moderate insufflation pressure and deep neuromuscular blockade (NMB) have been recommended in laparoscopic surgery in consideration of the possible reduction in splanchnic perfusion due to the CO2-pneumoperitoneum. Since the liver is the major organ for rocuronium metabolism, the question of whether NMB of rocuronium would change with the variation of liver perfusion during pneumoperitoneum during laparoscopic surgery merits investigation. METHODS: In this prospective study, a total of sixty female patients scheduled for either selective laparoscopic gynaecological surgery (group laparoscopy) or laparotomy for gynaecological surgery (group control) were analyzed...
March 20, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28289767/-update-on-muscle-relaxation-what-comes-after-succinylcholine-rocuronium-and-sugammadex
#10
N Zoremba, G Schälte, C Bruells, F K Pühringer
Due to the great advantages, it is not possible to imagine current practice in anesthesia without the adminstration of muscle relaxants. For a long time the administration of succinylcholine for rapid sequence induction (RSI) was considered to be the state of the art for patients at risk for aspiration. The favorable characteristics are, however, accompanied by many, sometimes severe side effects. Due to the development of non-depolarizing muscle relaxants, in particular rocuronium in combination with sugammadex, there is the possibility to achieve a profile of action similar to succinylcholine with low side effects...
March 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28284847/a-survey-on-some-biochemical-and-pharmacological-activities-of-venom-from-two-colombian-colubrid-snakes-erythrolamprus-bizona-double-banded-coral-snake-mimic-and-pseudoboa-neuwiedii-neuwied-s-false-boa
#11
Kristian A Torres-Bonilla, Rafael S Floriano, Raphael Schezaro-Ramos, Léa Rodrigues-Simioni, Maria Alice da Cruz-Höfling
Colombian colubrid snake venoms have been poorly studied. They represent a great resource of biological, ecological, toxinological and pharmacological research. We assessed some enzymatic properties and neuromuscular effects of Erythrolamprus bizona and Pseudoboa neuwiedii venoms from Colombia. Proteolytic, amidolytic and phospholipase A2 (PLA2) activities were analyzed using colorimetric assays and the neuromuscular activity was analyzed in chick biventer cervicis (BC) preparations. The venom of both species showed very low PLA2 and amidolytic activities; however, both exhibited high proteolytic activity, which in E...
March 9, 2017: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/28284294/optimal-strategies-for-severe-acute-respiratory-distress-syndrome
#12
REVIEW
Jeremy W Cannon, Jacob T Gutsche, Daniel Brodie
Acute respiratory distress syndrome (ARDS) occurs in more than 10% of intensive care unit admissions and in nearly 25% of ventilated patients. Mortality remains high at 40%, and, for patients who survive, recovery continues for months or even years. Early recognition and minimizing further lung injury remain essential to successful management of severe ARDS. Advanced treatment strategies, which complement lung protective ventilation, include short-term neuromuscular blockade, prone positioning, and extracorporeal membrane oxygenation...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28265685/laparoscopic-partial-nephrectomy-in-a-patient-on-simvastatin-delayed-recovery-from-neuromuscular-blockade
#13
E E Abd El-Hakeem, A M Kaki, S A Almazlom, A J Alsayyad
Delayed recovery from anesthesia remains a very challenging subject for anesthesiologists. This case report describes the clinical course of delayed recovery from neuromuscular blockade after laparoscopic partial nephrectomy in a patient on simvastatin. The patient was hypertensive on regular treatment with oral captopril 25 mg twice daily and amlodipine 5 mg once daily and hypercholesterolemic on regular simvastatin 40 mg once daily with a normal electrocardiogram (ECG). All preoperative laboratory findings were within normal ranges...
March 6, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28265468/the-benefit-of-neuromuscular-blockade-in-patients-with-postanoxic-myoclonus-otherwise-obscuring-continuous-electroencephalography-ceeg
#14
Christopher R Newey, Alejandro Hornik, Meziane Guerch, Anantha Veripuram, Sushma Yerram, Agnieszka Ardelt
Introduction. Myoclonus status epilepticus is independently associated with poor outcome in coma patients after cardiac arrest. Determining if myoclonus is of cortical origin on continuous electroencephalography (CEEG) can be difficult secondary to the muscle artifact obscuring the underlying CEEG. The use of a neuromuscular blocker can be useful in these cases. Methods. Retrospective review of CEEG in patients with postanoxic myoclonus who received cisatracurium while being monitored. Results. Twelve patients (mean age: 53...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/28259181/effectiveness-of-deep-versus-moderate-muscle-relaxation-during-laparoscopic-donor-nephrectomy-in-enhancing-postoperative-recovery-study-protocol-for-a-randomized-controlled-study
#15
Moira H D Bruintjes, Andries E Braat, Albert Dahan, Gert-Jan Scheffer, Luuk B Hilbrands, Frank C H d'Ancona, Rogier A R T Donders, Cornelis J H M van Laarhoven, Michiel C Warlé
BACKGROUND: Postoperative recovery after live donor nephrectomy is largely determined by the consequences of postoperative pain and analgesia consumptions. The use of deep neuromuscular blockade has been shown to reduce postoperative pain scores after laparoscopic surgery. In this study, we will investigate whether deep neuromuscular blockade also improves the early quality of recovery after live donor nephrectomy. METHODS: The RELAX-study is a phase IV, multicenter, double-blinded, randomized controlled trial, in which 96 patients, scheduled for living donor nephrectomy, will be randomized into two groups: one with deep and one with moderate neuromuscular blockade...
March 4, 2017: Trials
https://www.readbyqxmd.com/read/28257153/assessment-of-continuous-pain-in-newborns-admitted-to-nicus-in%C3%A2-18%C3%A2-european-countries
#16
Kanwaljeet J S Anand, Mats Eriksson, Elaine M Boyle, Alejandro Avila-Alvarez, Randi Dovland Andersen, Kosmas Sarafidis, Tarja Polkki, Cristina Matos, Paola Lago, Thalia Papadouri, Simon Attard-Montalto, Mari-Liis Ilmoja, Sinno Simons, Rasa Tameliene, Bart van Overmeire, Angelika Berger, Anna Dobrzanska, Michael Schroth, Lena Bergqvist, Emilie Courtois, Jessica Rousseau, Ricardo Carbajal
AIM: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. METHODS: A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission...
March 3, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28256331/-deep-versus-moderate-neuromuscular-block-during-one-lung-ventilation-in-lung-resection-surgery
#17
Javier Casanova, Patricia Piñeiro, Francisco De La Gala, Luis Olmedilla, Patricia Cruz, Patricia Duque, Ignacio Garutti
BACKGROUND AND OBJECTIVES: Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one-lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one-lung ventilation is not deleterious...
February 27, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28251555/deep-neuromuscular-blockade-improves-laparoscopic-surgical-conditions-a-randomized-controlled-study
#18
Jacob Rosenberg, W Joseph Herring, Manfred Blobner, Jan P Mulier, Niels Rahe-Meyer, Tiffany Woo, Michael K Li, Peter Grobara, Christopher A Assaid, Hein Fennema, Armin Szegedi
INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecystectomy. We further assessed whether use of low insufflation pressure improves patient pain scores after surgery. METHODS: This randomized, controlled, blinded study (NCT01728584) compared use of deep (1-2 post-tetanic-counts) or moderate (train-of-four ratio 10%) NMB, and lower (8 mmHg) or higher (12 mmHg; 'standard') insufflation pressure in a 2 × 2 factorial design...
March 1, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28248887/the-optimal-exhaled-concentration-of-sevoflurane-for-intubation-without-neuromuscular-blockade-using-clinical-bolus-doses-of-remifentanil-a-randomized-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Eui-Kyoung Goo, Jong Seok Lee, Jae Chul Koh
BACKGROUND: The aim of this study was to investigate the optimal exhaled sevoflurane concentration that produces adequate endotracheal intubation conditions when sevoflurane is combined with the different bolus doses of remifentanil used in clinical practice. METHODS: The patients were randomized to 3 groups (groups 1.0, 1.5, and 2.0), receiving remifentanil bolus doses of 1.0, 1.5, and 2.0 μg/kg, respectively. For each group, the concentration of sevoflurane used for each consecutive patient was increased or decreased using the "up-and-down" method based on the success or failure to achieve adequate conditions for intubation in the previous patient...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28246021/influence-of-phospholipasic-inhibition-on-neuromuscular-activity-of-bothrops-fonsecai-snake-venom
#20
Raphael Schezaro-Ramos, Rita de Cássia O Collaço, Priscila Randazzo-Moura, Thalita Rocha, José Carlos Cogo, Léa Rodrigues-Simioni
Bothrops fonsecai (B. fonsecai), a pitviper endemic to southeastern Brazil, has a venom mainly composed by snake venom phospholipases (PLA2) and metalloproteases, compounds that could interfere with neuromuscular junction in vitro. In this work, we investigated the role of PLA2 in the myotoxicity and neuromuscular blockade caused by B. fonsecai venom using different procedures frequently associated with PLA2 activity inhibition: 24 °C bath temperature, Ca(2+) - Sr(2+) replacement and chemical modification with p-bromophenacyl bromide (p-BPB)...
February 27, 2017: Toxicon: Official Journal of the International Society on Toxinology
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