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https://www.readbyqxmd.com/read/27922561/a-pharmacologic-review-of-anaphylaxis
#1
Nancy S Yunker, Bradley J Wagner
Anaphylaxis occurs in the surgical population and may have devastating consequences. Anaphylaxis and anaphylactoid reactions are immediate hypersensitivity reactions that are most commonly precipitated by medications, insect stings, and foods. In the surgical population, 47.4% of immediate hypersensitivity reactions were precipitated by neuromuscular blocking agents, followed by latex and antibiotics in 20% and 18.1% of cases, respectively. Initial treatment consists of removing the precipitating trigger, administering epinephrine, and correct patient positioning...
October 2016: Plastic Surgical Nursing
https://www.readbyqxmd.com/read/27909595/effect-of-smoking-on-reversing-neuromuscular-block
#2
Ömür Öztürk, Gülbin Yalçın Sezen, Handan Ankaralı, Onur Özlü, Yavuz Demiraran, Hakan Ateş, Burhan Dost
OBJECTIVE: Rocuronium is a non-depolarising, intermediate-acting, monoquaternary amino steroid and was brought into clinical use as a potentially ideal muscle relaxant. Post-operative residual curarisation (PORC) results from the prolonged effects of non-depolarising neuromuscular blocking agents. This is a common problem and seriously affects patient safety. No recent study has investigated the effects of sugammadex on smokers, which is often used to restore neuromuscular block and avoid PORC...
August 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27872771/tranexamic-acid-an-exceedingly-rare-cause-of-anaphylaxis-during-anaesthesia
#3
R A Bansal, A Nicholas, A S Bansal
Tranexamic acid (TXA) allergy is extremely rare. An 80-year-old woman without prior exposure to TXA underwent elective knee replacement. Shortly after induction of anaesthesia and intravenous TXA, she developed hypotension, tachycardia, and facial erythema accompanied by a raised serum tryptase. Later, skin prick and intradermal testing confirmed positive responses to TXA in high dilution and with negative results to the other drugs used. While neuromuscular blocking agents, opiates, and antibiotics remain the most frequent cause of anaphylaxis during anaesthesia, allergy to TXA should always be borne in mind and requires skin testing for confirmation as there are presently no blood tests available...
2016: Case Reports in Immunology
https://www.readbyqxmd.com/read/27871583/sugammadex-given-for-rocuronium-induced-neuromuscular-blockade-in-infants-a-retrospect%C3%A4-ve-study
#4
Ozlem Ozmete, Cagla Bali, Oya Yalcin Cok, Hatice Evren Eker Turk, Nesrın Bozdogan Ozyilkan, Soner Civi, Anıs Aribogan
STUDY OBJECTIVE: To evaluate the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in infant patients. DESIGN: Retrospective observational study. SETTING: University teaching hospital. PATIENTS: Twenty-six infants (2-12 months of age; 3-11 kg) with an American Society of Anesthesiologists classification I, II, or III who were scheduled to undergo neurosurgical procedures were included in the study...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27859358/six-years-without-pholcodine-norwegians-are-significantly-less-ige-sensitized-and-clinically-more-tolerant-to-neuromuscular-blocking-agents
#5
G H de Pater, E Florvaag, S G O Johansson, Å Irgens, M N H Petersen, A B Guttormsen
BACKGROUND: As a strong inducer of IgE-antibodies to substituted ammonium ion epitopes (QAI), pholcodine (PHO) is a postulated cause of allergic anaphylaxis to neuromuscular blocking agents (NMBAs). Three years after withdrawal of PHO in Norway, a significant reduction in IgE-sensitization and anaphylaxis reporting was seen. OBJECTIVE: Six year follow-up study on the effects of PHO withdrawal on IgE-sensitization and anaphylaxis reporting. METHODS: From 650 acute consecutive reports (2005-2013) to the Norwegian Network for Anaphylaxis under Anaesthesia (NARA), total number of reports on suspected anaphylactic reactions, number of reactions where NMBAs were administered, number of reactions where serum IgE-antibodies (≥0...
November 9, 2016: Allergy
https://www.readbyqxmd.com/read/27850841/1205-evaluation-of-a-neuromuscular-blocking-agent-order-set-in-the-intensive-care-unit
#6
Chelsea Tasaka, Kendall Gross, Ashley Thompson, Deanna Horner, Cindy Burg, John Turnbull, Matthew Aldrich, Fanny Li
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27828786/the-effect-of-prior-tetanic-stimulation-on-train-of-four-monitoring-in-paediatric-patients-a-randomised-open-label-controlled-trial
#7
Ricardo V Carlos, Hans Donald de Boer, Marcelo Luis Abramides Torres, Maria José Carvalho Carmona
BACKGROUND: In clinical research, neuromuscular monitoring must present a stable response for a period of 2 to 5 min before administration of a neuromuscular blocking agent. The time required to reach this stable response may be shortened by applying a 5-s tetanic stimulus. OBJECTIVES: The aim of this study was to test whether tetanic stimulation interferes with onset and recovery times after a single dose of rocuronium 0.6 mg kg followed by spontaneous recovery...
November 8, 2016: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/27820709/current-status-of-neuromuscular-reversal-and-monitoring-challenges-and-opportunities
#8
Sorin J Brull, Aaron F Kopman
Postoperative residual neuromuscular block has been recognized as a potential problem for decades, and it remains so today. Traditional pharmacologic antagonists (anticholinesterases) are ineffective in reversing profound and deep levels of neuromuscular block; at the opposite end of the recovery curve close to full recovery, anticholinesterases may induce paradoxical muscle weakness. The new selective relaxant-binding agent sugammadex can reverse any depth of block from aminosteroid (but not benzylisoquinolinium) relaxants; however, the effective dose to be administered should be chosen based on objective monitoring of the depth of neuromuscular block...
November 7, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#9
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27798767/practical-management-of-anaesthesia-in-the-elderly
#10
Camilla Strøm, Lars Simon Rasmussen, Jacob Steinmetz
The elderly population is rapidly growing and particularly diverse. Ageing leads to reduced organ function and a decline in physiologic reserve. Elderly patients are characterised by great inter-individual variability in physiological function with a high prevalence of chronic disease. In general, older patients have a higher risk of postoperative adverse outcomes, and frailty is a very important risk factor. This review article aims to provide a practical guide to anaesthetic management of the elderly surgical patient...
October 31, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27797097/neuromuscular-blockade-in-the-elderly
#11
Michał Stankiewicz-Rudnicki
The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27796041/optimal-anesthetic-regimen-for-ambulatory-laser-microlaryngeal-surgery
#12
Hyub Huh, Seol Ju Park, Hyong Hwan Lim, Kwang Yoon Jung, Seung-Kuk Baek, Seung Zhoo Yoon, Hye Won Lee, Hye Ja Lim, Jang Eun Cho
OBJECTIVES/HYPOTHESIS: Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant-binding agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade...
October 31, 2016: Laryngoscope
https://www.readbyqxmd.com/read/27765010/dexamethasone-does-not-diminish-sugammadex-reversal-of-neuromuscular-block-clinical-study-in-surgical-patients-undergoing-general-anesthesia
#13
Katja Rezonja, Tomaz Mars, Ales Jerin, Gordana Kozelj, Neva Pozar-Lukanovic, Maja Sostaric
BACKGROUND: Sugammadex reverses neuromuscular block (NMB) through binding aminosteroid neuromuscular blocking agents. Although sugammadex appears to be highly selective, it can interact with other drugs, like corticosteroids. A prospective single-blinded randomized clinical trial was designed to explore the significance of interactions between dexamethasone and sugammadex. METHODS: Sixty-five patients who were anesthetized for elective abdominal or urological surgery were included...
October 21, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27755068/clinical-practice-guidelines-for-sustained-neuromuscular-blockade-in-the-adult-critically-ill-patient
#14
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27746543/ease-of-intubation-a-randomized-double-blind-study-to-compare-two-doses-of-rocuronium-bromide-for-endotracheal-intubation
#15
Aparna Shukla, Shilpi Misra
CONTEXT: Clinical need for a nondepolarizing agent with a rapid onset time and a brief duration of action has led to the development of rocuronium bromide. AIMS: The aim of this study was to evaluate optimal dose of rocuronium bromide for intubation and to compare the onset time, duration of action, intubating conditions, and hemodynamic effects of two doses of rocuronium bromide. SETTINGS AND DESIGN: A prospective, randomized, double-blind study...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27744183/thiadiazolodiazepine-analogues-as-a-new-class-of-neuromuscular-blocking-agents-synthesis-biological-evaluation-and-molecular-modeling-study
#16
Hussein I El-Subbagh, Adel S El-Azab, Ghada S Hassan, Shahenda M El-Messery, Alaa A-M Abdel-Aziz, Kamal E H El-Taher
The synthesis, biological evaluation and molecular modeling study of 6,7-dihydro-[1,3,4] thiadiazolo[3,2-a][1,3]diazepine analogues as new class of neuromuscular blocking agents are described. The new compounds act via competitive mechanism with ACh which could be reversed by the anticholinesterase - Physostigmine. Compounds GS-53 (30) and AAH1 (33) induced dose-dependent neuromuscular blockade with onset time of 3 and 10 min, ED50 0.15 and 0.36 mmol/kg i.p., respectively, in rats. Compound 30 proved to be as twice as potent as 33 with rapid onset and shorter duration (P < 0...
September 30, 2016: European Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/27737558/adjuvants-to-mechanical-ventilation-for-acute-respiratory-failure-adoption-de-adoption-and-factors-associated-with-selection
#17
Laveena Munshi, Hayley B Gershengorn, Eddy Fan, Hannah Wunsch, Niall D Ferguson, Therese A Stukel, Gordon D Rubenfeld
RATIONALE: Adoption and de-adoption of adjuvant strategies to mechanical ventilation for acute respiratory failure (ARF), and factors associated with their selection, have not been extensively evaluated. OBJECTIVES: To evaluate change in use of adjuvants to mechanical ventilation for ARF (2008-2013), the impact of landmark publications on adoption and de-adoption, and factors associated with use. METHODS: Changes in use of four adjuvants for ARF from 2008-2013, the impact of landmark publications on use, and factors associated with use were evaluated using the Premier Database...
October 13, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27723018/the-effect-of-general-anaesthesia-and-neuromuscular-blockade-on-eustachian-tube-compliance-a-prospective-study
#18
Akeelesh Mungur, Guy Cochard, Yves Ozier, Pierre Lafère
OBJECTIVE: The most common complications of hyperbaric oxygen treatment (HBOT) are related to pressure changes on gas-containing cavities. Therefore, inability to auto-inflate the middle ear may result in transient or permanent hearing loss. However, it seems that middle ear barotrauma (MEBt) does not develop more often in mechanically ventilated patients than in ambulatory patients. This might be explained by deep sedation of these patients. Therefore, the aim of this study was to determine whether anaesthesia and/or neuromuscular blockade can influence Eustachian tube (ET) function...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/27713677/intraoperative-anaphylactic-reaction-is-it-the-floseal
#19
Brianne Bordes, David Martin, Brian Schloss, Allan Beebe, Walter Samora, Jan Klamar, David Stukus, Joseph D Tobias
When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/27712572/old-new-and-hidden-causes-of-perioperative-hypersensitivity
#20
Lene H Garvey
Perioperative hypersensitivity reactions are rare, often life-threatening events, and subsequent investigations to identify the culprit are important to avoid re-exposure. All exposures in the perioperative setting may potentially be the cause of a hypersensitivity reaction, but drugs administered intravenously such as neuromuscular blocking agents (NMBA), induction agents and antibiotics have traditionally been reported to be implicated most commonly. It has recently become apparent that there are geographical differences in sensitization patterns related to variation in exposures, referral patterns and performance and interpretation of investigations...
October 4, 2016: Current Pharmaceutical Design
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