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monitoring neuromuscular block

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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
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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...
November 26, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29161387/reversal-of-residual-neuromuscular-block-complications-associated-with-perioperative-management-of-muscle-relaxation
#10
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
#11
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
#12
A Dahan, M Boon, C Martini
No abstract text is available yet for this article.
November 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29054436/in-vitro-and-ex-vivo-screening-of-candidate-therapeutics-to-restore-neurotransmission-in-nerve-terminals-intoxicated-by-botulinum-neurotoxin-serotype-a1
#13
Phillip H Beske, Aaron B Bradford, Katie M Hoffman, Sydney Mason, Patrick M McNutt
Botulinum neurotoxins (BoNTs) are exceedingly potent neurological poisons that block cholinergic release in the peripheral nervous system and cause death by asphyxiation. While post-exposure prophylaxis can effectively eliminate toxin in the bloodstream, there are no clinically effective treatments to prevent or reverse disease once BoNT has entered the neuron. To address the need for post-symptomatic countermeasures, we designed and developed an in vitro assay based on whole-cell, patch-clamp electrophysiological monitoring of miniature excitatory post-synaptic currents in synaptically active murine embryonic stem cell-derived neurons...
October 17, 2017: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/29050397/the-antimyotonic-effect-of-lamotrigine-in-non-dystrophic-myotonias-a-double-blind-randomized-study
#14
RANDOMIZED CONTROLLED TRIAL
Grete Andersen, Gitte Hedermann, Nanna Witting, Morten Duno, Henning Andersen, John Vissing
Mexiletine is the only drug with proven effect for treatment of non-dystrophic myotonia, but mexiletine is expensive, has limited availability and several side effects. There is therefore a need to identify other pharmacological compounds that can alleviate myotonia in non-dystrophic myotonias. Like mexiletine, lamotrigine is a sodium channel blocker, but unlike mexiletine, lamotrigine is available, inexpensive, and well tolerated. We investigated the potential of using lamotrigine for treatment of myotonia in patients with non-dystrophic myotonias...
September 1, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29046769/factors-that-affect-the-onset-of-action-of-non-depolarizing-neuromuscular-blocking-agents
#15
REVIEW
Yong Byum Kim, Tae-Yun Sung, Hong Seuk Yang
Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action...
October 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29046425/carotid-chemoreceptors-tune-breathing-via-multipath-routing-reticular-chain-and-loop-operations-supported-by-parallel-spike-train-correlations
#16
Kendall F Morris, Sarah C Nuding, Lauren S Segers, Kimberly Erin Iceman, Russell O'Connor, Jay B Dean, Mackenzie M Ott, Pierina A Alencar, Dale Shuman, Kofi-Kermit Horton, Thomas E Taylor-Clark, Donald C Bolser, Bruce G Lindsey
We tested the hypothesis that carotid chemoreceptors tune breathing through parallel circuit paths that target distinct elements of an inspiratory neuron chain in the ventral respiratory column (VRC). Microelectrode arrays were used to monitor neuronal spike trains simultaneously in the VRC, peri-nucleus tractus solitarius-medial medulla (p-NTS-MM), the dorsal parafacial region of the lateral tegmental field (FTL-pF), and medullary raphé nuclei together with phrenic nerve activity during selective stimulation of carotid chemoreceptors or transient hypoxia in 19 decerebrate, neuromuscularly-blocked, and artificially ventilated cats...
October 18, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/29041919/preparing-for-the-unexpected-special-considerations-and-complications-after-sugammadex-administration
#17
REVIEW
Hajime Iwasaki, J Ross Renew, Takayuki Kunisawa, Sorin J Brull
Sugammadex, a modified gamma-cyclodextrin, has changed clinical practice of neuromuscular reversal dramatically. With the introduction of this selective relaxant binding agent, rapid and reliable neuromuscular reversal from any depth of block became possible. Sugammadex can reverse neuromuscular blockade without the muscarinic side effects typically associated with the administration of acetylcholinesterase inhibitors. However, what remained unchanged is the incidence of residual neuromuscular blockade. It is known that sugammadex cannot always prevent its occurrence, if appropriate dosing is not chosen based on the level of neuromuscular paralysis prior to administration determined by objective neuromuscular monitoring...
October 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28986337/improving-neuromuscular-monitoring-and-reducing-residual-neuromuscular-blockade-with-e-learning-protocol-for-the-multicenter-interrupted-time-series-invert-study
#18
Jakob Louis Demant Thomsen, Ole Mathiesen, Daniel Hägi-Pedersen, Lene Theil Skovgaard, Doris Østergaard, Jens Engbaek, Mona Ring Gätke
BACKGROUND: Muscle relaxants facilitate endotracheal intubation under general anesthesia and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still partially paralyzed when awakened after surgery. The condition is associated with subjective discomfort and an increased risk of respiratory complications. Use of an objective neuromuscular monitoring device may prevent residual block. Despite this, many anesthetists refrain from using the device. Efforts to increase the use of objective monitoring are time consuming and require the presence of expert personnel...
October 6, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28863931/diabetes-mellitus-does-not-affect-the-neuromuscular-blocking-action-of-atracurium-in-dogs
#19
Elizabeth A Leece, Louise Clark
OBJECTIVE: To compare the duration of action of atracurium in diabetic and nondiabetic dogs. STUDY DESIGN: Prospective, blinded, clinical study. ANIMALS: A total of 26 diabetic and 29 nondiabetic dogs. METHODS: Following preanaesthetic medication and intravenous (IV) propofol induction, anaesthesia was maintained with isoflurane in oxygen. Atracurium 0.2 mg kg(-1) IV was administered to provide neuromuscular blockade (NMB) and the responses (twitches; T) to train-of-four nerve stimulation were recorded by palpation and electromyography (EMG)...
April 25, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28840256/-neurophysiological-monitoring-during-surgical-procedures
#20
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...
September 2017: Der Anaesthesist
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