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Meghan MacKenzie, Richard Hall
PURPOSE: Knowledge of how alterations in pharmacogenomics and pharmacogenetics may affect drug therapy in the intensive care unit (ICU) has received little study. We review the clinically relevant application of pharmacogenetics and pharmacogenomics to drugs and conditions encountered in the ICU. SOURCE: We selected relevant literature to illustrate the important concepts contained within. PRINCIPAL FINDINGS: Two main approaches have been used to identify genetic abnormalities - the candidate gene approach and the genome-wide approach...
October 17, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Rahul Bhat, Maryann Mazer-Amirshahi, Christie Sun, Janelle Vaughns, Maria Dynin, Eshetu Tefera, Daryn Towle, Munish Goyal
OBJECTIVE: There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients. METHODS: Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011...
September 28, 2016: American Journal of Emergency Medicine
Brian E Driver, Robert F Reardon
Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. A 60-year-old woman presented with acute hypoxic respiratory failure. Despite application of high-flow oxygen (60 L/min) with a nonrebreather face mask, her oxygen saturation remained at 93%...
September 27, 2016: Annals of Emergency Medicine
Leressè Pillay, Timothy Hardcastle
INTRODUCTION: Establishing a definitive airway in order to ensure adequate ventilation and oxygenation is an important aspect of resuscitation of the polytrauma patient . AIM: To review the relevant literature that compares the different drugs used for rapid sequence intubation (RSI) of trauma patients, specifically reviewing: premedication, induction agents and neuromuscular blocking agents across the prehospital, emergency department and operating room setting, and to present the best practices based on the reviewed evidence...
September 19, 2016: World Journal of Surgery
Erin H Li, Ethan O Bryson, Charles H Kellner
No abstract text is available yet for this article.
September 16, 2016: Anesthesia and Analgesia
A Kollmann-Camaiora, E Alsina, A Domínguez, B Del Blanco, M J Yepes, J L Guerrero, A García
Malignant hyperthermia is a hypermetabolic syndrome that appears in susceptible patients after exposure to certain anaesthetic drugs (succinylcholine, inhalation anaesthetics). Its incidence in Spain is 1 in 40,000 adults, with a 10% mortality rate. It is induced by an abnormal regulation of the ryanodine receptors, producing a massive release of calcium from the sarcoplasmic reticulum in the striate muscle. Clinical manifestations include: CO2 increase, tachycardia, haemodynamic instability, metabolic and respiratory acidosis, profuse sweating, hyperpyrexia, CPK increase, myoglobinuria, kidney failure, disseminated intravascular coagulation (DIC), and ending in cardiac arrest...
September 12, 2016: Revista Española de Anestesiología y Reanimación
Reza Safaeian, Valiollah Hassani, Hamid Reza Faiz
BACKGROUND Diaphragmatic rupture can be seen in up to 5% of car accidents, and 80%-100% of diaphragmatic hernias are associated with other vital organ injuries. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic managements. CASE REPORT A 37-year-old male victim of a head-on collision who was suffering diaphragmatic rupture and corneal laceration was prepared for an emergency operation 11 hours after the car accident. Gastric decompression, pre-oxygenation, rapid sequence induction with succinylcholine, immediate use of non-depolarizing muscle relaxant, and mechanical ventilation with low tidal volume after intubation were used in anesthetic management of the patient...
2016: American Journal of Case Reports
Melekşah Pekel, Nadide Aysun Postaci, İsmail Aytaç, Derya Karasu, Hüseyin Keleş, Özlem Şen, Bayazit Dikmen, Erol Göka
BACKGROUND/AIM: In this prospective randomized cross-over study we compare the effects of sevoflurane versus propofol for electroconvulsive therapy (ECT) anesthesia. MATERIALS AND METHODS: Twenty four patients (ASA I-III, 18-65 years old) receiving ECT three times per week were included. Anesthesia was induced with either propofol (0.75 mg/kg iv) or 5% sevoflurane in 100% oxygen. Consecutive ECT sessions followed a 2 × 2 crossover design and a 2-day washout period until the 10th ECT...
2016: Turkish Journal of Medical Sciences
Candace Binkley
Pseudocholinesterase abnormalities are a genetic cause of aberrant metabolism of the depolarizing muscle relaxant succinylcholine. This article examines a case where succinylcholine was chosen to facilitate intubation due to its ultra short duration and the request of the surgeon to monitor motor evoked potentials. Following succinylcholine administration the neurophysiologist was unable to obtain motor evoked potentials. This case study highlights the intraoperative and postoperative management of an elderly patient with an unknown pseudocholinesterase deficiency...
June 2016: AANA Journal
Somchai Amornyotin, Sukanya Jirachaipitak, Surasawadee Wangnamtip
BACKGROUND: Esophageal stent placement is a minimally invasive procedure for treatment of esophageal strictures that cannot be treated with surgical procedure. It requires some forms of anesthesia. This procedure could be performed in the operating room and in the endoscopy unit. OBJECTIVE: The study is aimed to report and evaluate the choices and techniques, drugs used and complications of anesthesia in the patients undergoing esophageal stent placement procedure in an endoscopy unit outside the operating room in a developing country...
May 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Justin L Poklis, Amanda J Mohs, Carl E Wolf, Alphonse Poklis, Michelle R Peace
In healthcare settings drug diversion and impairment of physicians are major concerns requiring a rapid and efficient method for surveillance and detection. A Direct Analysis in Real Time ion source coupled to a JEOL AccuTOF(TM) time-of-flight mass spectrometer (DART-MS) method was developed to screen parenteral pharmaceutical formulations for potential drug diversion. Parenteral pharmaceutical formulations are also known as injectable formulations and are used with intravenous, subcutaneous, intramuscular and intra-articular administration...
October 2016: Journal of Analytical Toxicology
Dimitri A Cozanitis
In 1957, Professor Daniel Bovet received the Nobel Prize in Physiology or Medicine for his studies on various compounds including the muscle relaxants gallamine and succinylcholine that became very useful in anaesthesia. Textbooks credit Professor Bovet for the discovery of these drugs. However, although he indeed did discover their pharmacological character, the actual syntheses were made by Ernest Fourneau and Reid Hunt, respectively; sadly, these two scientists have largely been ignored. In this paper, a brief biography of Bovet is presented along with some of his more notable accomplishments...
July 28, 2016: Wiener Medizinische Wochenschrift
Christopher J LaRocca, Greg J Beilman, Martin Birch
Pseudocholinesterase deficiencies occur because of both genetic and acquired factors. We present the case of a patient with a history of bariatric surgery and severe malnutrition who subsequently developed prolonged neuromuscular blockade after succinylcholine administration. She had markedly decreased pseudocholinesterase levels at the time of the incident, but her motor function returned to normal with supportive care. After aggressive nutritional support over multiple weeks, her pseudocholinesterase levels drastically improved...
September 1, 2016: A & A Case Reports
Stefan Josef Schaller, Heidrun Lewald
INTRODUCTION: Sugammadex is the first clinical representative of a class of drugs called steroidal muscle relaxant encapsulators. Due to its 1:1 binding of rocuronium or vecuronium, sugammadex can reverse any depth of neuromuscular block and has therefore revolutionized the way anesthetists think about drug reversal. AREAS COVERED: This review gives an overview of the clinical pharmacology and efficacy of sugammadex in healthy patients as well as in patients with pre-existing diseases...
September 2016: Expert Opinion on Drug Metabolism & Toxicology
Karim Nasseri, Sanaz Arvien
OBJECTIVE: Despite the many complications of succinylcholine, it is still widely used as a superior muscle relaxant for rapid sequence induction. One of these complications is postoperative myalgia (POM). The aim of this study was to investigate the prophylactic effect of low-dose ketamine on the incidence and severity of POM. MATERIALS AND METHODS: In this double-blind clinical study, a total of 148 patients scheduled for general anesthesia were randomly divided into two equal groups...
2016: Journal of Pain Research
Sabrina De Winter, Koen Bronselaer, Peter Vanbrabant, Bart Blanchaert, Marwa F Mansour, Daniele Brandolisio, Stijn De Jonge, Peter Slaets, Paul Sas, Ann Van Schepdael, Isabel Spriet
OBJECTIVE: Transportation by air exposes drugs used in emergency medical services to vibrations. The aim of the study was to determine whether or not vibrations caused by a helicopter induce the degradation of 5 drugs used in this setting. METHODS: A longitudinal study in an operating medical helicopter along with a worst case was conducted. The studied drugs were 3 drugs labeled for refrigeration (cisatracurium, lorazepam, and succinylcholine) and 2 albumin solutions (human albumin 4% and 20%)...
July 2016: Air Medical Journal
Rubén J Lopez, Susan Byrne, Mirko Vukcevic, Marijana Sekulic-Jablanovic, Lifen Xu, Marijke Brink, Jay Alamelu, Nicol Voermans, Marc Snoeck, Emma Clement, Francesco Muntoni, Haiyan Zhou, Aleksandar Radunovic, Shehla Mohammed, Elizabeth Wraige, Francesco Zorzato, Susan Treves, Heinz Jungbluth
Malignant hyperthermia is a potentially fatal hypermetabolic disorder triggered by halogenated anesthetics and the myorelaxant succinylcholine in genetically predisposed individuals. About 50% of susceptible individuals carry dominant, gain-of-function mutations in RYR1 [which encodes ryanodine receptor type 1 (RyR1)], though they have normal muscle function and no overt clinical symptoms. RyR1 is predominantly found in skeletal muscle but also at lower amounts in immune and smooth muscle cells, suggesting that RYR1 mutations may have a wider range of effects than previously suspected...
2016: Science Signaling
P R Mathur, M Rundla, N Jain, V Mathur
Malignant hyperthermia (MH) is a rare hypermetabolic disorder of skeletal muscles that manifests as a life-threatening crisis in susceptible individuals, after exposure to triggering agents, most commonly halothane and succinylcholine. MH presents with multiple nonspecific signs and laboratory findings such as tachycardia, hyperthermia, hypercarbia, acidosis, and muscle rigidity. Caffeine halothane contracture test is not available at most centers in India. Larach et al. have described a clinical grading scale for determining the MH raw score based on clinical findings and biochemical tests...
July 2016: Saudi Journal of Anaesthesia
Ruslan Abdullayev, Ömer Burak Küçükebe, Recai Kaya, Bülent Çelik, Hatice Kuşderci, Mehmet Duran, Öznur Uludağ, Mesut Öterkuş, Aysel Buyrukcan, Ülkü Sabuncu, Abdullah Arpacı
OBJECTIVE: Pseudocholinesterase (PChE) is an enzyme responsible for the hydrolysis of succinylcholine. In case of its deficiency, the effect of succinylcholine that is approximately 5-10 min is prolonged up to few hours. The use of succinylcholine has been declined recently. However, it is still actively used in some special conditions and in developing countries. In this study, incidence of PChE enzyme deficiency around Adiyaman city was investigated and presented with the literature review...
December 2015: Turkish Journal of Anaesthesiology and Reanimation
Dilek Ömür, Hasan Ali Kiraz, Hasan Şahin, Hüseyin Toman, Berna Uyan, Serpil Ekin, Volkan Hancı
OBJECTIVE: Although succinylcholine (SCh) has side effects, it is among the most commonly used muscle relaxants for rapid induction because of the faster onset of its effects and short effect duration. However, there is no information regarding the frequency of use of SCh by anaesthetists in Turkey. This study aims to investigate the use of SCh by anaesthetists working in Turkey. METHODS: A web-based survey form was sent by e-mail to anaesthetists working in Turkey...
October 2015: Turkish Journal of Anaesthesiology and Reanimation
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