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Neuromuscular blocking agents

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https://www.readbyqxmd.com/read/28924110/bloody-bronchial-cast-formation-due-to-alveolar-hemorrhage-associated-with-h1n1-influenza-infection
#1
Yohei Okada, Asami Okada, Hiromichi Narumiya, Ryoji Iiduka, Kanade Katsura
A previously healthy 55-year-old man with H1N1 influenza A presented with severe respiratory failure and cardiac arrest. Following the return of spontaneous circulation, venovenous extracorporeal membrane oxygenation was required to maintain oxygenation. On day 2, bronchoscopy revealed a bloody bronchial cast obstructing the right main bronchus. A pathological examination revealed that it was composed of intrabronchial and intra-alveolar hemorrhagic tissue. Unfortunately, the patient died due to severe brain ischemia; a subsequent autopsy revealed marked alveolar hemorrhage...
September 15, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28913862/the-effect-of-neuromuscular-blockade-on-the-efficiency-of-facemask-ventilation-in-patients-difficult-to-facemask-ventilate-a-prospective-trial
#2
S Soltész, P Alm, A Mathes, M Hellmich, J Hinkelbein
Facemask ventilation of the lungs can be an important rescue intervention in a 'cannot intubate' scenario. We assessed the effect of neuromuscular blockade on expiratory tidal volumes in patients with expected difficulty in mask ventilation. The lungs of patients with at least three predictors of difficulty in mask ventilation were ventilated using a facemask held with two hands, with mechanical ventilation set in a pressure-controlled mode. Tidal volumes were recorded before and after the establishment of complete neuromuscular block...
September 14, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28911283/australian-and-new-zealand-anaesthetic-allergy-group-perioperative-anaphylaxis-investigation-guidelines
#3
R J Scolaro, H M Crilly, E J Maycock, P T McAleer, K A Nicholls, M A Rose, Rih The
These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed...
September 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28905252/human-and-equipment-resources-for-difficult-airway-management-airway-education-programs-and-capnometry-use-in-japanese-emergency-departments-a-nationwide-cross-sectional-study
#4
Yuko Ono, Koichi Tanigawa, Kazuaki Shinohara, Tetsuhiro Yano, Kotaro Sorimachi, Ryota Inokuchi, Jiro Shimada
BACKGROUND: Although human and equipment resources, proper training, and the verification of endotracheal intubation are vital elements of difficult airway management (DAM), their availability in Japanese emergency departments (EDs) has not been determined. How ED type and patient volume affect DAM preparation is also unclear. We conducted the present survey to address this knowledge gaps. METHODS: This nationwide cross-sectional study was conducted from April to September 2016...
September 13, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28893450/emergency-medicine-evaluation-and-management-of-the-end-stage-renal-disease-patient
#5
REVIEW
Brit Long, Alex Koyfman, Courtney M Lee
BACKGROUND: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population...
September 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28868303/adjuvants-to-local-anesthetics-current-understanding-and-future-trends
#6
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
#7
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...
August 30, 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28862524/effect-of-anaesthetic-and-choice-of-neuromuscular-blocker-on-vagal-control-of-heart-rate-under-laboratory-animal-experimental-conditions
#8
Divya Sarma Kandukuri, Jacqueline K Phillips, Mark Tahmindjis, Cara M Hildreth
Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensitivity) under two different types of anaesthesia in Lewis rats...
January 1, 2017: Laboratory Animals
https://www.readbyqxmd.com/read/28840256/-neurophysiological-monitoring-during-surgical-procedures
#9
REVIEW
P Michels, A Bräuer, M Bauer, M Söhle
The application of intraoperative neurophysiological monitoring (IONM) is gaining more and more importance in daily clinical practice. The use of IONM allows the localization of neural structures and to control functioning of the peripheral and central nervous systems in anesthetized patients. This enables surgeons to identify and to protect neural structures and cerebral areas. The use of IONM also enables anesthesiologists to adjust anesthesia and cardiopulmonary therapy to the individual needs of the patient...
August 24, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28834856/review-of-continuous-infusion-neuromuscular-blocking-agents-in-the-adult-intensive-care-unit
#10
Keaton S Smetana, Neil A Roe, Bruce A Doepker, G Morgan Jones
The use of continuous infusion neuromuscular blocking agents remains controversial. The clinical benefit of these medications may be overshadowed by concerns of propagating intensive care unit-acquired weakness, which may prolong mechanical ventilation and impair the inability to assess neurologic function or pain. Despite these risks, the use of neuromuscular blocking agents in the intensive care unit is indicated in numerous clinical situations. Understanding pharmacologic nuances and clinical roles of these agents will aid in facilitating safe use in a variety of acute disease processes...
October 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/28830363/recovery-and-prediction-of-postoperative-muscle-power-is-it-still-a-problem
#11
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/28828366/sedation-and-neuromuscular-blocking-agents-in-acute-respiratory-distress-syndrome
#12
REVIEW
Jeremy Bourenne, Sami Hraiech, Antoine Roch, Marc Gainnier, Laurent Papazian, Jean-Marie Forel
Mechanical ventilation (MV) is the cornerstone of acute respiratory distress syndrome (ARDS) management. The use of protective ventilation is a priority in this acute phase of lung inflammation. Neuromuscular blocking agents (NMBAs) induce reversible muscle paralysis. Their use in patients with ARDS remains controversial but occurs frequently. NMBAs are used in 25-45% of ARDS patients for a mean period of 1±2 days. The main indications of NMBAs are hypoxemia and facilitation of MV. For ethical reasons, NMBA use is inseparable from sedation in the management of early ARDS...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828364/prone-positioning-acute-respiratory-distress-syndrome-patients
#13
REVIEW
Claude Guérin
Prone position has been used in acute respiratory distress syndrome (ARDS) patients for more than 40 years in ICU. After having demonstrated its capability to significantly improve oxygenation in a large number of patients, sometimes dramatically, this procedure has been found to prevent ventilator-induced lung injury, the primary concern for the intensivists managing ARDS patients. Over the time, several trials have been done, which regularly improved and refined from each other. At the end, significant improvement in survival has been demonstrated in the most severe ARDS patients, at a threshold of 100-150 mmHg PaO2/FiO2 ratio...
July 2017: Annals of Translational Medicine
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
#14
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/28815798/infant-spinal-anesthesia-do-girls-need-a-larger-dose-of-local-anesthetic
#15
Geoff Frawley, Md Hamidul Huque
BACKGROUND: Gender differences in absorption, distribution, and metabolism of a number of anesthetic agents have been identified in adults. Clinically, adult studies suggest women demonstrate slower onset of opioid analgesic effects, lower spinal and epidural dose requirements, and greater sensitivity to neuromuscular blocking agents. Sex-related differences in the pharmacokinetics and pharmacodynamics of local anesthetics in neonates and infants, however, have not been well documented...
October 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28814478/effect-of-patient-weight-on-first-pass-success-and-neuromuscular-blocking-agent-dosing-for-rapid-sequence-intubation-in-the-emergency-department
#16
Asad E Patanwala, John C Sakles
OBJECTIVES: The primary objective of this study was to determine the association between patient weight and first pass success (FPS) during rapid sequence intubation (RSI) in the ED. The secondary objective was to evaluate the association between patient weight and neuromuscular blocking agent (NMBA) dosing. METHODS: This was a retrospective cohort study conducted in a tertiary care academic ED. Consecutive adult patients who underwent RSI in the ED between January 2014 and June 2016 were included...
August 16, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28811009/the-feasibility-of-sugammadex-for-general-anesthesia-and-facial-nerve-monitoring-in-patients-undergoing-parotid-surgery
#17
I-Cheng Lu, Pi-Ying Chang, Miao-Pei Su, Po-Nien Chen, Hsiu-Ya Chen, Feng-Yu Chiang, Che-Wei Wu
The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery. Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25)...
August 2017: Kaohsiung Journal of Medical Sciences
https://www.readbyqxmd.com/read/28806470/efficacy-and-safety-of-sugammadex-versus-neostigmine-in-reversing-neuromuscular-blockade-in-adults
#18
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
#19
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
https://www.readbyqxmd.com/read/28795964/neuromuscular-monitoring-in-the-perioperative-period
#20
Glenn S Murphy
Neuromuscular monitoring devices were introduced into clinical practice in the 1970s. Qualitative neuromuscular monitors, or peripheral nerve stimulators, provide an electrical stimulus to a motor nerve and the response of corresponding muscle subjectively evaluated. A standard peripheral nerve stimulator provides several patterns of nerve stimulation, including train-of-four (TOF), double-burst, tetanic, and post-tetanic count. Qualitative (and quantitative) monitors are needed to determine onset of neuromuscular blockade, maintain the required depth of muscle relaxation during the surgical procedure, and assess an appropriate dose of reversal agent...
August 8, 2017: Anesthesia and Analgesia
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