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monitoring neuromuscular block

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https://www.readbyqxmd.com/read/29629201/anesthesia-and-fast-track-in-video-assisted-thoracic-surgery-vats-from-evidence-to-practice
#1
REVIEW
Marzia Umari, Stefano Falini, Matteo Segat, Michele Zuliani, Marco Crisman, Lucia Comuzzi, Francesco Pagos, Stefano Lovadina, Umberto Lucangelo
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29609909/-why-is-the-morbidly-obese-patient-at-high-risk-of-anesthetic-complications
#2
Audrey De Jong, Daniel Verzilli, Marie Geniez, Gérald Chanques, David Nocca, Samir Jaber
Obesity is often associated with obstructive sleep apnea (OSA), which increases the risk of intraoperative and postoperative complications. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications...
March 30, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29557601/sedation-and-analgesia-in-patients-on-mechanical-ventilation-in-pediatric-intensive-care-units-in-argentina
#3
Pedro Taffarel, German Bonetto, Facundo Jorro Barón, Claudia Meregalli
INTRODUCTION: Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV). OBJECTIVE: To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina. MATERIAL AND METHODS: Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys...
April 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29497496/recent-advances-in-neuromuscular-block-during-anesthesia
#4
REVIEW
Martijn Boon, Christian Martini, Albert Dahan
Muscle relaxation is a routine part of anesthesia and has important advantages. However, the lingering effects of muscle relaxants in the postoperative period have historically been associated with postoperative adverse events. Neuromuscular reversal, together with neuromuscular monitoring, is a recognized strategy to reduce the rate of postoperative residual relaxation but has only marginally improved outcome in the past few decades. Sugammadex, a novel reversal agent with unique encapsulating properties, has changed the landscape of neuromuscular reversal and opened up new opportunities to improve patient care...
2018: F1000Research
https://www.readbyqxmd.com/read/29496709/residual-neuromuscular-blockade-in-the-critical-care-setting
#5
Nicole Stawicki, Patty Gessner
Residual neuromuscular blockade is a widespread challenge for providers in the acute care setting that, if left unrecognized or untreated, places patients at higher risk for morbidity and mortality. The condition is estimated to occur in 26% to 88% of patients undergoing general anesthesia. The role of the advanced practice nurse in the acute care setting is to facilitate a safe recovery process by identifying early signs of deterioration and supporting the patient until full muscular strength has returned...
2018: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/29494403/pharmacokinetic-pharmacodynamic-model-of-cw002-an-investigational-intermediate-neuromuscular-blocking-agent-in-healthy-volunteers
#6
Josh D Kaullen, Joel S Owen, Kim L R Brouwer, Paul M Heerdt, Cynthia A Lien, John J Savarese, Virginia D Schmith
BACKGROUND: CW002 is an investigational nondepolarizing, neuromuscular blocking agent with a rapid onset and intermediate duration of action in animals. This is a single ascending dose, healthy subject study exploring tolerability, pharmacokinetics, and potency. METHODS: Population pharmacokinetic and pharmacokinetic/pharmacodynamic models were developed using plasma drug concentration data from a previously published dose-response study in 28 healthy subjects receiving single doses of CW002 during sevoflurane anesthesia...
March 1, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29491207/method-for-prediction-of-efficacy-of-sugammadex-administered-to-recover-from-rocuronium-induced-neuromuscular-blockade-in-gynecological-laparoscopic-surgery-cases
#7
Koji Kimura, Kazuya Omura, Tetsuya Hoshino, Hiroyuki Takahashi, Masaharu Imaura, Yasuhiko Yamada
Sugammadex (SDX), a neuromuscular blocking-reversal agent, quickly reverses neuromuscular blockade induced by rocuronium (RCR). SDX dosage is set according to the state of neuromuscular blockade determined with a neuromuscular monitoring device. However, in clinical situations, such a devise is not frequently used. Here, we report construction of a method for theoretically setting SDX dose by which the optimum reverse time (RT) can be obtained for individual patients even when the device is not available. The subjects were 42 adult female patients who underwent laparoscopic surgery from 1 August 2015 to 31 March 2016, during which RCR and SDX were administered...
2018: Biological & Pharmaceutical Bulletin
https://www.readbyqxmd.com/read/29486876/bias-limits-of-agreement-and-percent-errors-between-acceleromyography-and-mechanomyography-in-anesthetized-dogs
#8
D M Sakai, M Romano, C T Tseng, A Flanders, M Martin-Flores
This study compared measurements of neuromuscular function with mechanomyography (MMG) and acceleromyography (AMG) in nine anesthetized dogs receiving 0.1mg/kg vecuronium intravenously. Train-of-four (TOF) stimulation was applied to each ulnar nerve every 15s. The resulting amplitude of the first twitch (T1) and the TOF ratio were measured with both monitors. The baseline TOF ratio (prior to vecuronium), onset time (time of injection to T1<5%), recovery index (time between T1 values of 25% and 75%) and duration of neuromuscular block (injection to TOF 0...
March 2018: Veterinary Journal
https://www.readbyqxmd.com/read/29467022/recovery-of-muscle-function-after-deep-neuromuscular-block-by-means-of-diaphragm-ultrasonography-and-adductor-of-pollicis-acceleromyography-with-comparison-of-neostigmine-vs-sugammadex-as-reversal-drugs-study-protocol-for-a-randomized-controlled-trial
#9
Iacopo Cappellini, Fabio Picciafuochi, Daniele Ostento, Ginevra Danti, Angelo Raffaele De Gaudio, Chiara Adembri
BACKGROUND: The extensive use of neuromuscular blocking agents (NMBAs) during surgical procedures still leads to potential residual paralyzing effects in the postoperative period. Indeed, neuromuscular monitoring in an intra-operative setting is strongly advocated. Acetylcholinesterase inhibitors can reverse muscle block, but their short half-life may lead to residual curarization in the ward, especially when intermediate or long-acting NMBAs have been administered. Sugammadex is the first selective reversal drug for steroidal NMBAs; it has been shown to give full and rapid recovery of muscle strength, thus minimizing the occurrence of residual curarization...
February 21, 2018: Trials
https://www.readbyqxmd.com/read/29465045/sugammadex-improves-neuromuscular-function-in-patients-receiving-perioperative-steroids
#10
A B Ozer, E Bolat, O L Erhan, M Kilinc, I Demirel, G Caglar Toprak
Context: Sugammadex has steroid-encapsulating effect. Aim: This study was undertaken to assess whether the clinical efficacy of sugammadex was altered by the administration of steroids. Setting and Design: Sixty patients between 18 and 60 years of age with the American Society of Anesthesiologists I-IV and undergoing elective direct laryngoscopy/biopsy were included in this study. Materials and Methods: Patients were assigned to two groups based on the intraoperative steroid use: those who received steroid (Group S) and who did not (Group C)...
February 2018: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/29378987/incidence-of-postoperative-residual-paralysis-in-a-nigerian-teaching-hospital
#11
A A Majekodunmi, O A Ikotun, O D Oladokun
BACKGROUND: Postoperative residual paralysis (PORP) is a known risk factor after general anesthesia (GA) for critical respiratory events and increased postoperative morbidity. PORP is defined as a train-of-four ratio (TOFR) of <0.9 using acceleromyography (AMG). TOFR <0.9 has been associated with increased risk of aspiration, obstruction of the upper airway and an impaired hypoxic ventilatory response. AIM: The aim of this study was to determine the incidence of PORP, associated factors related with its occurrence and critical respiratory events in the postanesthesia recovery room (PAR) at our institution...
December 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/29317806/profile-of-sugammadex-for-reversal-of-neuromuscular-blockade-in-the-elderly-current-perspectives
#12
REVIEW
Michele Carron, Francesco Bertoncello, Giovanna Ieppariello
The number of elderly patients is increasing worldwide. This will have a significant impact on the practice of anesthesia in future decades. Anesthesiologists must provide care for an increasing number of elderly patients, who have an elevated risk of perioperative morbidity and mortality. Complications related to postoperative residual neuromuscular blockade, such as muscle weakness, airway obstruction, hypoxemia, atelectasis, pneumonia, and acute respiratory failure, are more frequent in older than in younger patients...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29217857/a-comparison-of-haemodynamic-responses-between-clinical-assessment-guided-tracheal-intubation-and-neuromuscular-block-monitoring-guided-tracheal-intubation-a-prospective-randomised-study
#13
Rudranil Nandi, Shekhar Ranjan Basu, Susanta Sarkar, Rakesh Garg
Background and Aims: Haemodynamic responses to laryngoscopy and endotracheal intubation and their hazards are well documented. The purpose of the study was to compare the effects of laryngoscopy and intubation on cardiovascular responses when the appropriate moment for intubation was directed by either clinical judgment or train-of-four assessment. Methods: A total of 68 patients, posted for laparoscopic cholecystectomy, were randomised into two groups. In Group M patients, the trachea was intubated after train of four counts became zero in adductor pollicis muscle, whereas in Group C patients, the trachea was intubated after the clinical judgment of jaw muscle relaxation...
November 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29216820/comparison-of-the-effect-of-different-infusion-rates-of-sufentanil-on-surgical-stress-index-during-cranial-pinning-in-children-under-general-anaesthesia-a-randomized-controlled-study
#14
In-Kyung Song, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim
BACKGROUND: Surgical stress index (SSI) is an established indicator for intraoperative nociception. Opioids are used to block stimulus of cranial pinning in neurosurgery. We investigated the effect of different infusion rates of sufentanil on SSI during cranial pinning in children under general anaesthesia. METHODS: Forty-nine children (2-12 years of age) underwent neurosurgery with pinning. The children were randomized into three groups based on the rate of sufentanil infusion: 0...
December 8, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29200077/consensus-statement-on-perioperative-use-of-neuromuscular-monitoring
#15
Mohamed Naguib, Sorin J Brull, Aaron F Kopman, Jennifer M Hunter, Béla Fülesdi, Hal R Arkes, Arthur Elstein, Michael M Todd, Ken B Johnson
A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29189420/neostigmine-based-reversal-of-intermediate-acting-neuromuscular-blocking-agents-to-prevent-postoperative-residual-paralysis-a-systematic-review
#16
Najat Tajaate, Jan-Uwe Schreiber, Thomas Fuchs-Buder, Yvonne Jelting, Peter Kranke
BACKGROUND: Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S): The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN: We performed a systematic search of the literature from January 1992 to December 2015...
March 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29178460/the-adequate-rocuronium-dose-required-for-complete-block-of-the-adductor-muscles-of-the-thigh
#17
M Fujimoto, K Kawano, T Yamamoto
BACKGROUND: Rocuronium can prevent the obturator jerk during transurethral resection of bladder tumors. We investigated the adequate rocuronium dose required for complete block of the thigh adductor muscles, and its correlation with individual responses of the adductor pollicis muscle to rocuronium. METHODS: Eleven patients scheduled for transurethral resection of bladder tumors under general anesthesia were investigated. After general anesthesia induction, neuromuscular monitoring of the adductor pollicis muscle and ultrasonography-guided stimulation of the obturator nerve was commenced...
March 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29161387/reversal-of-residual-neuromuscular-block-complications-associated-with-perioperative-management-of-muscle-relaxation
#18
J M Hunter
The use of anticholinesterases to reverse residual neuromuscular block at the end of surgery became routine practice in the 1950s. These drugs could only be used when recovery from block was established [two twitches of the train-of-four (TOF) count detectable] and concern was expressed about their cholinergic side-effects. By the 1990s, it was recognized that failure to reverse residual block adequately to a TOF ratio (TOFR) >0.7 was associated with increased risk of postoperative pulmonary complications (POPCs) following the long-acting non-depolarizing neuromuscular blocking drug (NDNMBD) pancuronium...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29159065/train-of-four-stimulation-artifact-mimicking-a-seizure-during-computerized-automated-icu-eeg-monitoring
#19
Laxmi P Dhakal, William O Tatum, William D Freeman
A 54-year-old man was admitted to the intensive care unit with an aneurysmal subarachnoid hemorrhage and subsequently underwent mechanical ventilation and received neuromuscular blocking drugs to control refractory elevated intracranial pressure. During quantitative EEG monitoring, an automated alert was triggered by the train of four peripheral nerve stimulation artifacts. Real-time feedback was made possible due to remote monitoring. This case illustrates how computerized, automated artificial intelligence algorithms can be used beyond typical seizure detection in the intensive care unit for remote monitoring to benefit patient care...
2017: Epilepsy & Behavior Case Reports
https://www.readbyqxmd.com/read/29077827/postoperative-conditions-after-antagonism-of-neuromuscular-blocking-agent-and-extubation-without-use-of-a-neuromuscular-monitor
#20
A Dahan, M Boon, C Martini
No abstract text is available yet for this article.
November 1, 2017: British Journal of Anaesthesia
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