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Neuromuscular blocking agents

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https://www.readbyqxmd.com/read/28323670/prevention-of-respiratory-complications-of-the-surgical-patient-actionable-plan-for-continued-process-improvement
#1
Katarina J Ruscic, Stephanie D Grabitz, Maíra I Rudolph, Matthias Eikermann
PURPOSE OF REVIEW: Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. RECENT FINDINGS: Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders...
March 20, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28297684/physical-and-occupational-therapy-utilization-in-a-pediatric-intensive-care-unit
#2
Liang R Cui, Megan LaPorte, Matthew Civitello, Meg Stanger, Maxine Orringer, Frank Casey, Bradley A Kuch, Sue R Beers, Cynthia A Valenta, Patrick M Kochanek, Amy J Houtrow, Ericka L Fink
PURPOSE: To characterize the use of physical therapy (PT) and occupational therapy (OT) consultation in our pediatric intensive care unit (PICU). MATERIALS AND METHODS: We studied children aged 1week-18years admitted to a tertiary care PICU for ≥3days. Patient characteristics, details of PT and OT sessions and adverse events were collected. A multivariable logistic regression was performed to determine factors associated with receipt of PT and OT consultation with propensity analysis followed by a regression for factors associated with outcome...
March 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28291680/epidemiology-of-drug-induced-anaphylaxis-in-a-tertiary-hospital-in-korea
#3
Han-Ki Park, Min-Gyu Kang, Min-Suk Yang, Jae-Woo Jung, Sang-Heon Cho, Hye-Ryun Kang
BACKGROUND: Epidemiology and risk factors of drug-induced anaphylaxis are difficult to estimate due to lack of confirmative diagnosis and under reporting. Here we report the current state of drug-induced anaphylaxis in Korea based on an in-hospital pharmacovigilance database in a tertiary hospital. METHODS: This study is a retrospective analysis of drug-induced anaphylaxis, reported to an in-hospital pharmacovigilance center in Seoul National University Hospital from June 2009 to May 2013...
March 10, 2017: Allergology International: Official Journal of the Japanese Society of Allergology
https://www.readbyqxmd.com/read/28290972/malignant-hyperthermia-susceptibility-and-fitness-for-duty
#4
Michael A Lee, Erin B McGlinch, Maria C McGlinch, John F Capacchione
INTRODUCTION: Malignant hyperthermia (MH) is an inherited hypermetabolic condition characterized by uncontrolled calcium release from the sarcoplasmic reticulum of skeletal muscle, usually from exposure to inhaled general anesthetics and/or the depolarizing neuromuscular blocking agent succinylcholine. Multiple case reports now reveal that crises may be precipitated by environmental factors such as exercise or high ambient temperatures. Common signs of an MH crisis include life-threatening hyperthermia, metabolic acidosis, muscle rigidity, and tachycardia...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28258478/in-vitro-diagnosis-of-immediate-drug-hypersensitivity-anno-2017-potentials-and-limitations
#5
REVIEW
I I Decuyper, E A Mangodt, A L Van Gasse, K Claesen, A Uyttebroek, M Faber, V Sabato, C H Bridts, C Mertens, M M Hagendorens, L S De Clerck, Didier G Ebo
BACKGROUND: For most physicians, quantification of drug-specific immunoglobulin E (drug-sIgE) antibodies constitutes the primary in vitro measure to document immediate drug hypersensitivity reactions (IDHR). Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHR and impossible for non-IgE-mediated IDHR that result from alternative routes of basophil and mast cell activation. In these difficult cases, diagnosis might benefit from cellular tests such as basophil activation tests (BAT)...
March 4, 2017: Drugs in R&D
https://www.readbyqxmd.com/read/28244947/intermediate-acting-nondepolarizing-neuromuscular-blocking-agents-and-risk-of-postoperative-30-day-morbidity-and-mortality-and-long-term-survival
#6
Michael R Bronsert, William G Henderson, Terri G Monk, Joshua S Richman, Jennifer D Nguyen, John T Sum-Ping, Michael P Mangione, Binh Higley, Karl E Hammermeister
BACKGROUND: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality. METHODS: This is a retrospective observational study of 11,355 adult patients undergoing general anesthesia for noncardiac surgery at 5 Veterans Health Administration (VA) hospitals...
February 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28222701/the-effect-of-deep-muscle-relaxation-on-the-force-required-during-latissimus-dorsi-dissection-for-breast-reconstructive-surgery-results-of-a-prospective-double-blinded-observational-pilot-study
#7
T Ledowski, A Goodwin-Walters, P Quinn, M Calvert
BACKGROUND: The use of neuromuscular blocking agents has previously been suggested to facilitate the dissection of the latissimus dorsi muscle during breast reconstructive surgery. The aim of this study was to quantify the influence of deep muscle relaxation on the force required to lift the latissimus dorsi muscle during flap preparation. METHODS: After ethics approval and written informed consent 15 patients scheduled for elective breast reconstruction with a latissimus dorsi pedicled flap (muscle flap, not myocutaneous flap) under general anaesthesia were prospectively included...
February 21, 2017: BMC Anesthesiology
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
#8
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/28212212/neuromuscular-blocking-agents-during-electroconvulsive-therapy-was-the-crossover-design-appropriate-and-valid
#9
Mahmoud Daoud
No abstract text is available yet for this article.
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28194756/chlorhexidine-allergy-in-4-specialist-allergy-centres-in-the-uk-2009-2013-clinical-features-and-diagnostic-tests
#10
William Egner, Matthew Helbert, Ravishankar Sargur, Kirsty Swallow, Nigel Harper, Tomaz Garcez, Sinisa Savic, Louise Savic, Eren Effren
We describe an observational survey of diagnostic pathways in 104 patients attending four specialist allergy clinics in the UK following perioperative hypersensitivity reactions to chlorhexidine reactions. The majority were life threatening. Men undergoing urological or cardiothoracic surgery predominated. Skin prick testing and sIgE testing were the most common tests used for diagnosis. Fifty-three % of diagnoses were made on the basis of a single positive test. Where multiple tests were performed the sensitivity of intradermal, basophil activation and skin prick testing was 68% (50-86%), 50% (10-90%) and 35% (17-55%) respectively...
February 14, 2017: Clinical and Experimental Immunology
https://www.readbyqxmd.com/read/28183558/frequency-of-inadequate-neuromuscular-blockade-during-general-anesthesia
#11
Timur Dubovoy, Amy M Shanks, Scott Devine, Sachin Kheterpal
STUDY OBJECTIVE: We used electronic health record data to define frequency of inadequate intraoperative neuromuscular blockade (NMB). DESIGN: Retrospective observational study using electronic health record data. SETTING: Operating room in a tertiary care academic hospital. PATIENTS: A total of 129,209 adult patients with American Society of Anesthesiologists physical status 1 to 5 undergoing general anesthesia in an outpatient or inpatient setting who received nondepolarizing NMB...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28164272/anaphylaxis-during-general-anaesthesia-experience-from-a-drug-allergy-centre-in-the-uk
#12
J Meng, G Rotiroti, E Burdett, J J Lukawska
BACKGROUND: Anaphylaxis during general anaesthesia is rare but often severe. Identification of the cause of anaphylaxis and recommendation of a range of drugs or agents likely to be safer for future surgery is a collaborative venture between the allergists and the anaesthesiologists, but it often poses a significant challenge. METHODS: A total of 31 patients who attended the Drug Allergy Unit at University College London Hospital with suspected perioperative anaphylaxis between March 2013 and January 2016 were reviewed retrospectively...
March 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28164269/anaesthetic-hypersensitivity-reactions-in-france-between-2011-and-2012-the-10th-gerap-epidemiologic-survey
#13
C Tacquard, O Collange, P Gomis, J-M Malinovsky, N Petitpain, P Demoly, S Nicoll, P M Mertes
BACKGROUND: Immediate hypersensitivity reactions during anaesthesia are rare but potentially life-threatening. The epidemiology changes with time and evolving professional practice, and hence needs to be monitored. Our objective was to follow this epidemiology. METHODS: This was a retrospective, observational study in French hospital clinics, conducted by GERAP members (Groupe d'Étude des Réactions Anaphylactoïdes Périopératoires). Consecutive patients seen in allergo-anaesthesia outpatient clinics, who had experienced a hypersensitivity reaction during anaesthesia between 1 January 2011 and 31 December 2012, were included...
March 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28151766/the-use-of-sugammadex-in-a-patient-with-guillain-barre-syndrome-a-case-report
#14
Büşra Tezcan, Demet Bölükbaş, Dilek Kazanc, Sema Turan, Gülseren Suer Kaya, Ayşegül Özgök
Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation...
February 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28130958/a-definition-of-gentle-ventilation-in-congenital-diaphragmatic-hernia-a-survey-of-neonatologists-and-pediatric-surgeons
#15
Christiana Farkouh-Karoleski, Tasnim Najaf, Julia Wynn, Gudrun Aspelund, Wendy K Chung, Charles J Stolar, George B Mychaliska, Brad W Warner, Amy J Wagner, Robert A Cusick, Foong-Yen Lim, David T Schindel, Douglas Potoka, Kenneth Azarow, C Michael Cotten, Anthony Hesketh, Samuel Soffer, Timothy Crombleholme, Howard Needelman
Ventilation practices have changed significantly since the initial reports in the mid 1980 of successful use of permissive hypercapnia and spontaneous ventilation [often called gentle ventilation (GV)] in infants with congenital diaphragmatic hernia (CDH). However, there has been little standardization of these practices or of the physiologic limits that define GV. We sought to ascertain among Diaphragmatic Hernia Research and Exploration; Advancing Molecular Science (DHREAMS) centers' GV practices in the neonatal management of CDH...
January 28, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28049438/important-modifications-by-sugammadex-a-modified-%C3%AE-cyclodextrin-of-ion-currents-in-differentiated-nsc-34-neuronal-cells
#16
Hung-Te Hsu, Yi-Ching Lo, Yan-Ming Huang, Yu-Ting Tseng, Sheng-Nan Wu
BACKGROUND: Sugammadex (SGX) is a modified γ-cyclodextrin used for reversal of steroidal neuromuscular blocking agents during general anesthesia. Despite its application in clinical use, whether SGX treatment exerts any effects on membrane ion currents in neurons remains largely unclear. In this study, effects of SGX treatment on ion currents, particularly on delayed-rectifier K(+) current [I K(DR)], were extensively investigated in differentiated NSC-34 neuronal cells. RESULTS: After cells were exposed to SGX (30 μM), there was a reduction in the amplitude of I K(DR) followed by an apparent slowing in current activation in response to membrane depolarization...
January 3, 2017: BMC Neuroscience
https://www.readbyqxmd.com/read/28044330/conceptual-and-technical-insights-into-the-basis-of-neuromuscular-monitoring
#17
REVIEW
M Naguib, S J Brull, K B Johnson
Unrecognised postoperative residual neuromuscular block remains a frequent occurrence in recovery rooms. Evidence indicates that current practice continues to perpetuate the status quo, in which 10-40% of patients experience postoperative residual weakness. A departure from the current practice requires small efforts on the clinicians' part. This review addresses several selected core questions regarding neuromuscular blockade monitoring and provides a framework to rationally discuss and develop basic guidelines for the use of neuromuscular blocking agents in patient care...
January 2017: Anaesthesia
https://www.readbyqxmd.com/read/28030444/impact-of-reversal-strategies-on-the-incidence-of-postoperative-residual-paralysis-after-rocuronium-relaxation-without-neuromuscular-monitoring-a-partially-randomised-placebo-controlled-trial
#18
Réka Nemes, Béla Fülesdi, Adrienn Pongrácz, László Asztalos, Zoltán Szabó-Maák, Szabolcs Lengyel, Edömér Tassonyi
BACKGROUND: Electronic neuromuscular monitoring is not widely used to determine either the reversal requirements for neuromuscular block before extubation of the trachea, or to determine if there is any subsequent postoperative residual neuromuscular block (PORNB). OBJECTIVES: To investigate the incidence of PORNB using acceleromyography after spontaneous recovery of rocuronium-induced block and to compare this with the administration of sugammadex, neostigmine or a placebo...
December 26, 2016: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28013329/effects-of-neuromuscular-blockers-on-transpulmonary-pressures-in-moderate-to-severe-acute-respiratory-distress-syndrome
#19
Christophe Guervilly, Magali Bisbal, Jean Marie Forel, Malika Mechati, Samuel Lehingue, Jeremy Bourenne, Gilles Perrin, Romain Rambaud, Melanie Adda, Sami Hraiech, Elisa Marchi, Antoine Roch, Marc Gainnier, Laurent Papazian
PURPOSE: To investigate whether neuromuscular blocking agents (NMBA) exert beneficial effects in acute respiratory distress syndrome (ARDS) by reason of their action on respiratory mechanics, particularly transpulmonary pressures (P L). METHODS: A prospective randomised controlled study in patients with moderate to severe ARDS within 48 h of the onset of ARDS. All patients were monitored by means of an oesophageal catheter and followed up for 48 h. Moderate ARDS patients were randomised into two groups according to whether they were given a 48-h continuous infusion of cisatracurium besylate or not (control group)...
March 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28012426/perceived-safety-and-efficacy-of-neuromuscular-blockers-for-acute-respiratory-distress-syndrome-among-medical-intensive-care-unit-practitioners-a-multicenter-survey
#20
Heather Torbic, Seth R Bauer, Heather A Personett, Amy L Dzierba, Joanna L Stollings, Lindsay P Ryder, Craig E Daniels, Sean M Caples, Erin N Frazee
PURPOSE: Neuromuscular blocking agents (NMBAs) are frequently used in patients with acute respiratory distress syndrome (ARDS). The purpose of this survey is to describe providers' knowledge and perceived efficacy and safety of NMBAs in patients with ARDS. MATERIALS AND METHODS: We performed a prospective, multicenter survey of medical intensive care unit intensivists, fellows, nurse practitioners (NPs), physician's assistants (PAs), and pharmacists at 5 tertiary care centers between July 2012 and May 2013...
April 2017: Journal of Critical Care
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