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Neuromuscular block

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9 papers 0 to 25 followers
By Scott Bentley Rural GP Anaesthetist & Medical Officer in Aeromedical Retrieval Medicine
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...
January 2017: Anesthesiology
P J Schuller, S Newell, P A Strickland, J J Barry
BACKGROUND: The bispectral index (BIS) monitor is a quantitative electroencephalographic (EEG) device that is widely used to assess the hypnotic component of anaesthesia, especially when neuromuscular blocking drugs are used. It has been shown that the BIS is sensitive to changes in electromyogram (EMG) activity in anaesthetized patients. A single study using an earlier version of the BIS showed that decreased EMG activity caused the BIS to decrease even in awake subjects, to levels that suggested deep sedation and anaesthesia...
July 2015: British Journal of Anaesthesia
Petr Stourac, Milan Adamus, Dagmar Seidlova, Tomas Pavlik, Petr Janku, Ivo Krikava, Zdenek Mrozek, Martin Prochazka, Jozef Klucka, Roman Stoudek, Ivana Bartikova, Martina Kosinova, Hana Harazim, Hana Robotkova, Karel Hejduk, Zuzana Hodicka, Martina Kirchnerova, Jana Francakova, Lenka Obare Pyszkova, Jarmila Hlozkova, Pavel Sevcik
BACKGROUND: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery...
May 2016: Anesthesia and Analgesia
Hooman Mirzakhani, Henk-Jan Guchelaar, Charles A Welch, Cristina Cusin, Mary E Doran, Teresa O MacDonald, Edward A Bittner, Matthias Eikermann, Ala Nozari
BACKGROUND: Neuromuscular blockade is required to control excessive muscle contractions during electroconvulsive therapy (ECT). In a crossover, assessor-blinded, prospective randomized study, we studied the minimum effective dose (MED) of succinylcholine and rocuronium for ECT. The MED was the lowest dose to provide a predefined qualitative measure of acceptable control of muscle strength during induced convulsions. METHODS: Succinylcholine (0.8 mg kg) or rocuronium (0...
September 2016: Anesthesia and Analgesia
Sayaka Ishigaki, Kenichi Masui, Tomiei Kazama
BACKGROUND: Circulatory factors modify the onset time of neuromuscular-blocking drugs. Therefore, we hypothesized that infusion of a saline flush immediately after rocuronium administration would shorten the onset time without influencing the duration of the rocuronium effect. METHODS: Forty-eight patients were randomly allocated to the control or saline flush group. Anesthesia was induced and maintained with propofol and remifentanil, and all patients received 0...
March 2016: Anesthesia and Analgesia
M V Madsen, A K Staehr-Rye, M R G├Ątke, C Claudius
BACKGROUND: The level of neuromuscular blockade (NMB) that provides optimal surgical conditions during abdominal surgery has not been well established. The aim of this systematic review was to evaluate current evidence on the use of neuromuscular blocking agents in order to optimise surgical conditions during laparoscopic procedures and open abdominal surgery. METHODS: A wide search was performed in PubMed, Cochrane library and Embase with systematic approach including PRISMA recommendations...
January 2015: Acta Anaesthesiologica Scandinavica
P H M Sadleir, R C Clarke, D L Bunning, P R Platt
BACKGROUND: Neuromuscular blocking drugs (NMBDs) are the most common cause of intraoperative anaphylaxis in Western Australia. Differences in the rates of anaphylaxis between individual agents have been surmised in the past, but not proven, and are an important consideration if agents are otherwise equivalent. METHODS: We estimated a rate of anaphylaxis to NMBDs by analysing cases of NMBD anaphylaxis referred to the only specialized diagnostic centre in Western Australia over a 10 yr period...
June 2013: British Journal of Anaesthesia
Sorin J Brull, Glenn S Murphy
The aim of the second part of this review is to examine optimal neuromuscular management strategies that can be used by clinicians to reduce the risk of residual paralysis in the early postoperative period. Current evidence has demonstrated that frequently used clinical tests of neuromuscular function (such as head lift or hand grip) cannot reliably exclude the presence of residual paralysis. When qualitative (visual or tactile) neuromuscular monitoring is used (train-of-four [TOF], double-burst, or tetanic stimulation patterns), clinicians often are unable to detect fade when TOF ratios are between 0...
July 2010: Anesthesia and Analgesia
Glenn S Murphy, Sorin J Brull
In this review, we summarize the clinical implications of residual neuromuscular block. Data suggest that residual neuromuscular block is a common complication in the postanesthesia care unit, with approximately 40% of patients exhibiting a train-of-four ratio <0.9. Volunteer studies have demonstrated that small degrees of residual paralysis (train-of-four ratios 0.7-0.9) are associated with impaired pharyngeal function and increased risk of aspiration, weakness of upper airway muscles and airway obstruction, attenuation of the hypoxic ventilatory response (approximately 30%), and unpleasant symptoms of muscle weakness...
July 2010: Anesthesia and Analgesia
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