Search

Objective: To explore T cell‐intrinsic mechanisms underpinning the mal‐differentiation of tissue‐resident memory T (Trm) cells in patients with rheumatoid arthritis (RA). Methods: Circulating T cells from patient with RA and healthy individuals were used for Trm cell differentiation. The role of Hobit in Trm differentiation was investigated through targeted silencing experiments. Psmb5 expression regulation was explored by identifying BRD2 as a key transcription factor, with the interaction validated through chromatin immunoprecipitation‐quantitative polymerase chain reaction. The impact of BRD2 succinylation on Trm differentiation was examined by manipulating succinyl‐CoA levels in T cells. Humanized NSG chimeras representing synovitis provided insights into Trm infiltration in RA synovitis and were used for translational experiments. Results: In patients with RA, a notable predisposition of CD4+ T cells toward differentiation into Trm cells was observed, demonstrating a positive correlation with the disease activity score 28. Remarkably, Hobit was a pivotal facilitator in the formation of RA CD4+ Trm cells. Mechanistic studies unveiled the dysregulation of proteasomal Psmb5 in T cells of patients with RA as the key factor contributing to elevated Hobit protein levels. The deficiency of proteasomal Psmb5 was intricately linked to BRD2, with succinylation exerting a significant impact on Psmb5 transcription and Trm cell differentiation. This heightened BRD2 succinylation was attributed to elevated levels of mitochondrial succinyl‐CoA in RA T cells. Consequently, targeting succinyl‐CoA within CD4+ T cells controlled the inflammation of synovial tissues in humanized chimeras. Conclusion: Mitochondrial succinyl‐CoA fosters the succinylation of BRD2, resulting in compromised transcription of proteasomal Psmb5 and the differentiation of Trm cells in RA. [ABSTRACT FROM AUTHOR]

Background Succinylcholine is commonly used as a neuromuscular blocker during electroconvulsive therapy (ECT), but it can induce myalgia in patients. Dexmedetomidine, an alpha-2 adrenergic agonist, may mitigate this side effect. This study investigates the efficacy of dexmedetomidine in reducing succinylcholine-induced myalgia in ECT patients. Materials and Methods We conducted a randomized, double-blind clinical trial involving 100 patients scheduled for ECT. Participants were divided into two groups: the dexmedetomidine group (n=50) received 1 µg/kg dexmedetomidine prior to succinylcholine administration, while the control group (n=50) received a placebo. Myalgia was assessed using a numerical rating scale (0-10) 24 hours post-ECT. Results The dexmedetomidine group reported a significantly lower incidence of myalgia (20%) compared to the control group (48%) (p < 0.01). The mean myalgia score in the dexmedetomidine group was 2.1 ± 1.3, while the control group had a mean score of 4.8 ± 2.5 (p < 0.01). No significant adverse effects were noted in either group. Conclusion Dexmedetomidine significantly reduces the incidence and severity of succinylcholine-induced myalgia in patients undergoing ECT. This finding supports the use of dexmedetomidine as a premedication option in this population. [ABSTRACT FROM AUTHOR]

Copyright of Caspian Journal of Neurological Sciences is the property of Negah Institute for Social Research & Scientific Communication and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prevalence of morbid obesity in today's population around the world is alarming. Morbid obesity involves substantial changes in body composition and function, which can affect the pharmacodynamics and pharmacokinetics of many drugs. This paper aims to discuss the application of muscle relaxants and their reversing agents in patients with morbid obesity. This work is based both on the available literature and the author's personal experience. Dosage recommendations for muscle relaxants in morbidly obese patients are as follows: non-depolarizing relaxants like rocuronium, vecuronium, atracurium, and cisatracurium should be based on ideal body weight. Succinylcholine dosage should be adjusted to total body weight with a 200 mg maximum, while mivacurium should also be based on total body weight. Pancuronium is not used due to its long duration. Neostigmine dosing remains uncertain, but some suggest using total body weight. When it comes to Sugammadex opinions of the authors are divided, some indicate that it should be dosed based on ideal body weight, but more recent studies show that it should be based on 40% of corrected body weight. [ABSTRACT FROM AUTHOR]

The dose–response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3–12 years (American Society of Anesthesiologists grade I–II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg−1], B [1 mg kg−1], C [1.5 mg kg−1], and D [2 mg kg−1]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events. Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006. [ABSTRACT FROM AUTHOR]

Background. Succinylcholine and rocuronium are the predominant neuromuscular blocking agents (NMBAs) used for rapid sequence intubation (RSI) in the emergency department (ED). Prior studies have found reduced first‐attempt intubation success (FAIS) with rocuronium compared to succinylcholine. Recent large registry data have shown no difference in intubating conditions or FAIS. Objectives. The objective of this study was to compare FAIS rates for rocuronium and succinylcholine when used for RSI in a high‐acuity academic ED. Methods. This was a single‐center retrospective study. Patients were included if they received either succinylcholine or rocuronium for RSI in the ED from January 2016 to August 2020. The primary endpoint was FAIS. Subgroup analyses were performed evaluating the impact of weight‐based dosing on FAIS for each agent, and multivariate analysis was conducted to evaluate the impact of baseline characteristics on the primary outcome. Results. There were 448 patients who received rocuronium and 183 patients who received succinylcholine. No difference was observed in unadjusted FAIS between patients receiving rocuronium (median weight‐based dose: 1.22 mg/kg) or succinylcholine (median weight‐based dose: 1.43 mg/kg) (361 (80.6%) vs. 150 (82.0%), p = 0.69). There were no differences in FAIS between the weight‐based dose categories for rocuronium and for succinylcholine. Conclusions. These findings were consistent with those from recent studies indicating no difference in FAIS between rocuronium and succinylcholine, although the median dose of rocuronium used in this study was higher than traditionally recommended. Larger prospective studies are warranted to further evaluate the effect of weight‐based paralytic dosing on FAIS. [ABSTRACT FROM AUTHOR]

Background: Suxamethonium is hydrolysed by butyrylcholinesterase (BChE) and a low BChE activity can result in a prolonged duration of action of suxamethonium. The BChE activity is reduced during pregnancy and postpartum period by up to 33%. However, it can also be reduced by mutations in the BChE gene. In this study, we assessed BChE activity and mutations in the BChE gene in pregnant and postpartum patients with prolonged duration of action of suxamethonium. It was hypothesised that at least 30% of patients with a low BChE activity did not have a mutation in the BChE gene. Methods: In this registry study we focused on pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium referred to the Danish Cholinesterase Research Unit (DCRU) between March 2007 and January 2023. Primary outcome was the proportion of patients without a mutation among patients with a low BChE activity. Secondary outcomes were the proportion of patients with a low BChE activity and the proportion of patients with a mutation out of the total number of patients. Results: A total of 40 patients were included and among patients with a low BChE activity, 6% (95% CI: 1%–21%) did not have a mutation. Out of the total number of included patients referred to the DCRU, 90% (95% CI: 76%–97%) had a mutation and 94% (95% CI: 80%–99%) had a low BChE activity. Conclusion: Among pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium and a low BChE activity, 6% did not have a mutation in the BChE gene. Our findings suggest that during pregnancy and postpartum clinically relevant prolonged duration of action of suxamethonium rarely occurs in genotypically normal patients. [ABSTRACT FROM AUTHOR]

Aim & Objective: The aim of this study was designed to compare the effect on Intraocular Pressure of Rocuronium with that of Succinylcholine during Rapid Sequence Induction of anaesthesia using Propofol and Fentanyl. Methodology: This was a sequential controlled study. The study was conducted at Apollo Institute of Medical Sciences & Research, Hyderabad, Telangana. Patients were allocated sequentially to one of two groups (n20 in each group) to receive Succinylcholine (group S) and Rocuronium (group R). All patients were medicated with Tab Alprazolam 0.5 mg orally night before surgery. Preoxygenation was done for 3 min, Anaesthesia was induced with Inj Fentanyl 2 mcg/kg and a sleep dose of Propofol given at a rate of 100 mg /min until loss of verbal response. Results: There was no significant difference between groups in Age, Sex, Weight, Propofol dose, Baseline IOP, Baseline MAP or Baseline HR. The difference in the changes in IOP between the Succinylcholine and Rocuronium groups was highly significant (P=0.001). Conclusion: To conclude Rocuronium bromide in a dose of 1 mg/kg Provides Good to Excellent intubating conditions comparable to that of Succinylcholine. It is a suitable agent for tracheal intubation in patients undergoing elective and emergency ophthalmic surgery where raise in intraocular pressure is undesirable. [ABSTRACT FROM AUTHOR]

Rapid sequence intubation (RSI) is frequently performed by emergency medical services (EMS). We investigated the relationship between succinylcholine and rocuronium use and time until first laryngoscopy attempt, first-pass success, and Cormack-Lehane (CL) grades. We included adult patients for whom prehospital RSI was attempted from July 2015 through June 2022 in a retrospective, observational study with pre-post analysis. Timing was verified using recorded defibrillator audio in addition to review of continuous ECG, pulse oximetry, and end-tidal carbon dioxide waveforms. Our primary exposure was neuromuscular blocking agent (NMBA) used, either rocuronium or succinylcholine. Our prespecified primary outcome was the first attempt Cormack-Lehane view. Key secondary outcomes were first laryngoscopy attempt success rate, timing from NMBA administration to first attempt, number of attempts, and hypoxemic events. Of 5,179 patients in the EMS airway registry, 1,475 adults received an NMBA while not in cardiac arrest. Cormack-Lehane grades for succinylcholine and rocuronium were similar: grade I (64%, 59% [95% CI 0.64–1.09]), grade II (16%, 21%), grade III (18%, 16%), grade IV (3%, 3%). The median interval from NMBA administration to start of the first attempt was 57 s for succinylcholine and 83 s for rocuronium (mean difference 28 [95% CI 20–36] seconds). First attempt success was 84% for succinylcholine and 83% for rocuronium. Hypoxemic events were present in 25% of succinylcholine cases and 23% of rocuronium cases. Prehospital use of either rocuronium or succinylcholine is associated with similar Cormack-Lehane grades, first-pass success rates, and rates of peri-intubation hypoxemia. [ABSTRACT FROM AUTHOR]

Background and Aim: Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective a-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT. Methods: This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's t-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test. Results: There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (P < 0.001). MBP and HR changes were comparable (P > 0.05). Conclusion: A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

This study investigated whether abnormal peak inversion spontaneous potentials (PISPs) recorded at resting myofascial trigger points (MTrPs) stem from the discharge of muscle spindles. Forty-eight male Sprague-Dawley rats were randomly divided into six groups. Five groups underwent MTrP modeling intervention, whereas one group did not receive intervention and was duly designated as the blank control. After model construction, five rat models were randomly subjected to ramp-and-hold stretch tests, succinylcholine injection, eperisone hydrochloride injection, saline injection, and blank drug intervention. By contrast, the rats in the blank control group were subjected to ramp-and-hold stretch tests as a control. Frequencies and amplitudes of PISPs were recorded pre- and post-interventions and compared with those of the blank group. Stretch tests showed that the depolarization time and amplitude of PISPs ranged from 0.4 ms to 0.9 ms and from 80 uV to 140 μV, respectively. However, no PISPs were observed in the control rats. The frequency of PISPs in the ramp and hold phases and the first second after the hold phase was higher than that before stretching (p < 0.01). Succinylcholine and eperisone exerted excitatory and inhibitory effects on PISPs, respectively. In the group injected with 0.9% saline, no considerable differences of the PISPs were observed during the entire observation period. In conclusion, PISPs recorded at resting MTrPs are closely related to muscle spindles. The formation of MTrPs may be an important factor that regulate dysfunctional muscle spindles. [ABSTRACT FROM AUTHOR]

Pediatric difficult airway management is more challenging for an anesthesiologist due to anatomical and physiological differences as compared to adults. Moreover, the familiarity with the use of difficult airway equipment in adults does not equate to proficiency for the same in children. So, here we are presenting the management of a unique case of a difficult airway due to postburn neck contracture in a 4-year-old child, which was managed successfully with the help of a video laryngoscope after the failure attempt with a flexible fiberoptic bronchoscope. [ABSTRACT FROM AUTHOR]

INTRODUCTION The goal of rapid sequence intubation is to secure the patients airway smoothly and quickly, minimizing the chances of regurgitation and aspiration of gastric contents. Traditionally succinylcholine chloride has been the neuromuscular blocking drug of choice for use in rapid sequence intubation because of its rapid onset of action and profound relaxation. Succinylcholine chloride remains unsurpassed in providing ideal intubating conditions. However the use of succinylcholine chloride is associated with many side effects like muscle pain, bradycardia, hyperkalaemia and rise in intragastric and intraocular pressure. Rocuronium bromide is the only drug currently available which has the rapidity of onset of action like succinylcholine chloride. Hence the present study was undertaken to compare rocuronium bromide with succinylcholine chloride for use during rapid sequence intubation in adult patients METHODOLOGY The study population consisted of 90 patients aged between 18-60 years posted for various elective surgeries requiring general anaesthesia at Sri Venkateswara Medical College, Tirupati study population was randomly divided into 2 groups with 30 patients in each sub group. 1. Group I: Intubated with succinylcholine chloride 1 mg kg-1 (n = 30) 2. Group II: Intubated with rocuronium bromide 0.9 mg kg-1 (n = 30) Intubating conditions were assessed at 60 seconds based on the scale adopted by Toni Magorian et al. 1993. The haemodynamic parameters in the present study were compared using p-value obtained from student t-test. RESULTS It was noted that succinylcholine chloride 1 mg kg-1 body weight produced excellent intubating conditions in all patients. Rocuronium bromide 0.9 mg kg-1 body weight produced excellent intubating conditions in 96.67% of patients, which was comparable to that of succinylcholine chloride. INTERPETATION AND CONCLUSION Thus, from the present study, it is clear that succinylcholine chloride is the drug of choice for rapid sequence intubation. Rocuronium bromide is a safe alternative to succinylcholine chloride in conditions where succinylcholine chloride is contraindicated and in whom there no anticipated difficult airway. [ABSTRACT FROM AUTHOR]

Background: Rocuronium bromide is a new amino steroidal neuromuscular blocking agent which is structurally related to vecuronium and its onset time and intubating conditions are comparable with succinylcholine and without the undesirable side effects. Aims and Objectives: This study was planned to evaluate the ideal intubating dose of rocuronium bromide by comparing intubating conditions achieved by its different doses of rocuronium bromide and to consider rocuronium as an ideal intubating muscle relaxing agent, in place of succinylcholine chloride for elective long surgeries. Materials and Methods: This study was conducted on 120 patients who fulfilled the eligibility criteria. These patients were randomized into four groups of 30 each by block randomization technique. Each group received rocuronium bromide 0.6 mg/kg, 0.9 mg/kg, 1.2 mg/kg, and succinylcholine chloride 1 mg/kg, respectively. Results: Out of all the three doses of rocuronium bromide 0.9 mg/kg produced a similar intubating condition as succinylcholine chloride in the dose of 1 mg/kg without undue prolongation of the neuromuscular blockade. Conclusion: Rocuronium bromide can be used as an alternative to succinylcholine as an ideal intubating muscle relaxing agent. [ABSTRACT FROM AUTHOR]

Introduction and purpose Muscle relaxants have been integral to medical practice for decades, benefiting both anesthesiologists for smooth patient intubation and surgeons requiring deep muscle relaxation. This article focuses on succinylcholine, a prominent muscle relaxant, exploring its historical context, efficacy, and the accumulated data on potential life-threatening side effects. The manuscript analyzes the available knowledge regarding the adverse effects of succinylcholine in clinical practice, presenting literature-identified methods aimed at risk mitigation. Summarizing the current understanding of succinylcholine's risks seeks to enhance its effective use, decrease adverse incidents in patients, and contribute to the overall safety of both patients and healthcare providers. Material and methods The following review of studies was based on articles obtained from the PubMed and Google Scholar databases. Key search terms included suxamethonium, succinylcholine, suxamethonium hyperkalemia, suxamethonium myalgia, suxamethonium anaphylaxis, suxamethonium cholinesterase deficiency, and suxamethonium malignant hyperthermia. Conclusions Suxamethonium's adverse effects range from muscle pain-related discomfort to rare, potentially lethal multi-organ complications, impacting patients' health diversely. Despite its drawbacks, succinylcholine remains crucial in anesthesiology. Ongoing research offers avenues to counteract or mitigate side effects. However, these methods necessitate further research to develop universal, widely available protocols in clinical settings. [ABSTRACT FROM AUTHOR]

Background: When used in cases with penetrating eye injuries, succinylcholine can lead to the disastrous complication of vision loss by increasing intraocular pressure and increasing the risk of globe rupture. The goal of this research was to determine if pre-treatment with intravenous dexmedetomidine could mitigate the effects of succinylcholine and intubation on intraocular pressure. Methods: The study was prospective and randomized. After discussing the technique in detail, the study was done on 50 eligible patients with the agreement of an ethical committee and the patients' signed informed consent. Research for this study was carried out at Lifecare Hospital, Baniyas, Abu Dhabi between January 2016 to December 2017. Results: The intraocular pressure of the study group decreased after receiving premedication. After succinylcholine and intubation, IOP rose in all three groups, but in the study groups, it never went beyond pre-treatment levels. The sympathetic response to laryngoscopy and intubation was successfully suppressed at both doses of dexmedetomidine, but hemodynamic stability was better at 0.4 mcg/kg than at 0.6mcg/kg. Conclusion: When it comes to preventing an increase in intraocular pressure (IOP) and dampening the sympathetic response, both dosages of dexmedetomidine i.e. 0.4 mcg/kg and 0.6 mcg/kg are equally effective. Nevertheless, the dose of 0.4 mcg/kg is associated with greater hemodynamic stability. Hence, preventing an increase in intraocular pressure with dexmedetomidine 0.4 mcg/kg may be useful. [ABSTRACT FROM AUTHOR]

Background: One of the most important preconditions for any anesthetic operation is perioperative hemodynamic stability during laryngoscopy and intubation, which has been the subject of extensive research and documentation. Numerous approaches have been proposed to protect the patient from the sympathetic reaction, intraocular pressure (IOP) response, and catecholamine response during laryngoscopy and intubation. Aims and Objectives: To study the efficacy of two doses of intravenous dexmedetomidine premedication given as a single bolus dose over 10 min, 0.4 µg/kg and 0.6 µg/kg, 10 min before induction in preventing the rise of intraocular pressure following succinylcholine administration and endotracheal intubation. Materials and Methods: A retrospective randomized study was conducted. Ethical committee permission and signed informed consent were obtained from 60 eligible patients before the trial began. Results: Premedication with either 0.4 mcg/kg I.V. or 0.6 mcg/kg I.V. of dexmedetomidine diluted in normal saline at a 2 mcg/mL concentration administered over 10 min before induction resulted in significant obtundation of the rise in IOP associated with succinylcholine administration and intubation. Sympathetic response to laryngoscopy and intubation was also significantly diminished. The dose of 0.4 mcg/kg I.V. produced the best hemodynamic stability. Conclusion: Therefore, from the above research it can be concluded that, before succinylcholine delivery and intubation, dexmedetomidine 0.4 mcg/kg I.V. can be used as a premedication in situations where an increase in IOP could be hazardous. [ABSTRACT FROM AUTHOR]

Background: Pyloric distensibility has been reported as a predictive measure in gastroparesis. Measures can be obtained either during endoscopy under anesthesia or in unsedated patients. However, the impact of anesthetic drugs on the results of pyloric characteristics remains unknown. The objective of the present study was to determine the impact of anesthetics on pyloric characteristics measured using EndoFLIP® in patients with gastroparesis. Methods: Consecutive patients with gastroparesis from three French tertiary centers were retrospectively analyzed. Patients with a previous history of pyloric intervention were not considered for analysis. Medical records were reviewed for the potential use of anesthetic drugs during EndoFLIP® measurement. Key Results: One hundred twenty‐five patients were included in the present study [median age: 55.0 years (43.0–66.0)]. Thirty‐four patients (27.2%) had pyloric assessment without general anesthesia and 91 patients (72.8%) with general anesthesia. Pyloric pressure at 40 mL of distension was higher in patients with general anesthesia in comparison with patients without general anesthesia [18.7 (13.0–25.6) mmHg vs. 15.4 (11.9–20.7) mmHg; p = 0.044)]. In multivariate analysis, suxamethonium chloride administration was associated with decreased pyloric distensibility (OR: 3.9; 95% CI: 1.3–11.4; p = 0.013) while ephedrine was rather associated with increased pyloric distensibility (OR: 0.3; 95% CI: 0.1–0.9; p = 0.036). Conclusions and Inferences: This study is the first to have found an impact of general anesthesia on pyloric measurement using the EndoFLIP®. Therefore, further studies are needed to confirm these findings, if possible, prospective studies. [ABSTRACT FROM AUTHOR]

Copyright of Die Anaesthesiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. Group-R9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed. [ABSTRACT FROM AUTHOR]

Background: The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery. Methods: A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample t-test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant. Results: This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride. Conclusion: Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation. [ABSTRACT FROM AUTHOR]

Tracheal tumours are rare and often present as asthma or chronic obstructive airway disease. These tumours can cause partial or complete airway obstruction, especially after giving anaesthesia. Here, we present a case of tracheal tumour posted for bronchoscopic excision. These tumours present as a real challenge to anaesthesiologists as the airway is shared with the surgeons and maintaining a patent airway can be difficult. [ABSTRACT FROM AUTHOR]

Aim and Objective: The purpose of this study was to compare the duration of action of Rocuronium and Suxamethonium during elective thyroidectomy. Methodology : This double-blind experimental study included 60 patients ranging in age from 18 to 60 years old who underwent elective thyroidectomy under general anaesthesia after approval from the Institutional Ethics Committee and written patient consent Result: The Duration of action was comparable between the groups with statistically significant difference (p value is less than 0.05). For analysis of difference in duration of action "t" test was used. P value is less than 0.05, (p=0.000) indicating that highly significant difference between the groups in the duration of action. Conclusion: The study found that Rocuronium has a significantly longer duration of action than Suxamethonium. [ABSTRACT FROM AUTHOR]

Succinylcholine (SUX) is a clinical anesthetic that induces temporary paralysis and is degraded by endogenous enzymes within the body. In high doses and without respiratory support, it results in rapid and untraceable death by asphyxiation. A potentiometric thread-based method was developed for the in-field and rapid detection of SUX for forensic use. We fabricated the first solid-contact SUX ion-selective electrodes from cotton yarn, a carbon black ink, and a polymeric ion-selective membrane. The electrodes could selectively measure SUX in a linear range of 1 mM to 4.3 μ M in urine, with a Nernstian slope of 27.6 mV/decade. Our compact and portable yarn-based SUX sensors achieved 94.1% recovery at low concentrations, demonstrating feasibility in real-world applications. While other challenges remain, the development of a thread-based ion-selective electrode for SUX detection shows that it is possible to detect this poison in urine and paves the way for other low-cost, rapid forensic diagnostic devices. [ABSTRACT FROM AUTHOR]

A 21-year-old woman developed an acute myotonic reaction while undergoing anaesthesia using succinylcholine. Examination later showed she had shoulder, neck and calf hypertrophy, bilateral symmetrical ptosis and eyelid, handgrip and percussion myotonia. Peripheral neurophysiology studies identified significant, continuous myotonic discharges in both upper and lower limbs. Genetic analysis identified a c.3917G>A (p.Gly1306Glu) mutation in the SCN4A gene, confirming a diagnosis of sodium channel myotonia. Succinylcholine and other depolarising agents can precipitate lifethreatening acute myotonic reactions when given to patients with myotonia. Patients with neuromuscular disorders are at an increased risk of perioperative anaesthetic complications. We report a woman who developed an acute myotonic reaction whilst undergoing anaesthesia, in the context of an unrecognised myotonic disorder. We then discuss an approach to the diagnosis of myotonic disorders. [ABSTRACT FROM AUTHOR]

Copyright of Revista Mexicana de Anestesiología is the property of Colegio Mexicano de Anestesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Suxamethonium, a depolarizing neuromuscular agent, was introduced in 1952 and since then has been used for tracheal intubation. It was favoured for its rapid onset and ultra-short duration of action but has numerous side effects, especially cardiovascular. So agents with low potency and shorter duration of action were developed, and in 1995, Rocuronium was introduced, which is a non-depolarizing agent and has the fastest onset of action. Aim and objective: The aim of the study was to compare the intubating conditions at 60 seconds after giving Rocuronium 0.6 mg/kg and Suxamethonium 1 mg/kg intravenously. Methods: In this clinical trial, a total of 60 patients were enrolled. Patients were divided into groups A and B. Group A received Rocuronium 0.6 mg/kg intravenously, and Group B received suxamethonium 1 mg/kg, and all were intubated after 1 minute. Intubation conditions were noted and scored according to a modification of the Kreig et al.,. method. Results: It was observed that intubation conditions were excellent in both groups; there was tachycardia associated with the Rocuronium group, and blood pressure was higher in the Suxamethonium group. Conclusion: Rocuronium can be acceptable for intubation instead of Suxamethonium, except in conditions anticipating difficult intubation. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the frequency at which postintubation sedation is administered following use of long-acting paralytic agents compared to short-acting paralytic agents during rapid sequence intubation performed in the emergency department. Methods: This retrospective, single-center study of intubated patients in the emergency department analyzed the difference in time to administration of additional sedation following use of a short-acting paralytic (succinylcholine) compared to use of a long-acting paralytic (rocuronium or vecuronium). A total of 387 patients were available for analysis. The primary outcome was additional sedation given within 15 minutes following administration of a paralytic agent. The secondary outcome sought to evaluate the incidence of hyperkalemia due to paralytic agents by comparing potassium level before and after paralytic administration. Results: 46.9% of patients who received a short-acting paralytic agent received additional sedation within 15 minutes, compared to 40.9% of patients who received a long-acting paralytic agent. The Chi-square analysis comparing the short and long-acting paralytic groups showed no statistically significant difference (χ² [1, N = 387] = 1.24, P =.266) in the frequency of additional sedation administered. Excluding patients who did not receive any additional sedation, the mean time from paralytic administration to additional sedation in all patients was 20.03 ± 18 minutes. No statistically significant difference was detected between groups regarding changes in potassium level. Conclusion: The use of long-acting paralytic agents was not associated with increased time to administration of sedation compared to shortacting paralytic agents. There is an opportunity to reduce the time to sedation administration for intubated patients receiving both short- and long-acting paralytic agents. [ABSTRACT FROM AUTHOR]

Malignant Hyperthermia (MH) is a rare, hereditary, life-threatening disease triggered by volatile anesthetics and succinylcholine. Rarely, MH can occur after non-pharmacological triggers too. MH was detected more often in children and young adults, which makes this topic very important for every pediatric specialist, both anesthesiologists and intensivists. MH crisis is a life-threatening severe hypermetabolic whole-body reaction. Triggers of MH are used in pediatric intensive care unit (PICU) as well, volatile anesthetics in difficult sedation, status asthmaticus or epilepticus, and succinylcholine still sometimes in airway management. Recrudescence or delayed onset of MH crisis hours after anesthesia was previously described. MH can also be a cause of rhabdomyolysis and hyperpyrexia in the PICU. In addition, patients with neuromuscular diseases are often admitted to PICU and they might be at risk for MH. The most typical symptoms of MH are hypercapnia, tachycardia, hyperthermia, and muscle rigidity. Thinking of the MH as the possible cause of deterioration of a patient's clinical condition is the key to early diagnosis and treatment. The sooner the correct treatment is commenced, the better patient´s outcome. This narrative review article aims to summarize current knowledge and guidelines about recognition, treatment, and further management of MH in PICU. [ABSTRACT FROM AUTHOR]

Background: There is conflict in the literature addressing the role of paramedics in the outcomes and potential complications of rapid sequence induction (RSI) in pre-hospital settings. Objective: This review aims to describe the common indications, complications, anesthetic agents, and success rate of RSI, as performed by paramedics at a pre-hospital setting. Method: This scoping review utilized the PRISMA® flow diagram to guide the literature searching process across multiple resources. MEDLINE, Google Scholar, and PubMed search engines were accessed and searched for related articles using different combinations of keywords. The quality of the selected articles was assessed via the critical appraisal skills program. Results: Twenty-seven articles were included in this review. The main indication of RSI was the loss of consciousness due to different physical disorders. Potential complications include hypoxia, hypotension, and hypo-/hypercapnia. Anesthetic agents ketamine and succinylcholine were extensively used. Success rates of RSI, if performed by paramedics, ranged from 45% to 92%. Conclusion: Endotracheal intubation (ETI) with RSI has various indications and sedative agents that, if used appropriately, increase the victim's survival rates. Also, ETI with RSI is associated with several complications and challenges that affect the success rate, especially for the first intubation attempt. [ABSTRACT FROM AUTHOR]

Background: Anesthesia-associated rhabdomyolysis is a rare complication of surgery that causes postoperative myalgia, weakness, and potential renal failure if not managed promptly. Predisposing conditions that may lead to this complication include muscular dystrophies and myopathies.Case Presentation: This rare case describes a pediatric non-Indigenous Australian patient developing this complication, with no known predisposing risk factors, and no clear etiology. A 9-year-old child with a background of asthma underwent an elective removal of keloid scar on her chest wall. The procedure was brief and uncomplicated, with an uneventful induction of anesthesia. During the emergence period, she developed acutely raised airway pressures with bronchospasm and laryngospasm requiring the use of salbutamol and suxamethonium with good effect. In the initial postoperative period, the patient complained of generalized myalgia and muscle weakness and was unable to mobilize independently. There was transient recovery to normal function; however, a recurrence of symptoms the following day with associated myalgias warranted admission to hospital. She was found to have rhabdomyolysis that was managed conservatively with a full recovery of several weeks. She was thoroughly investigated for any underlying cause, including genetic testing for malignant hyperthermia susceptibility (she had a variant of unknown significance but was negative for the known genetic abnormalities that cause malignant hyperthermia).Conclusion: This case report demonstrates the importance of considering anesthesia-associated rhabdomyolysis as a differential for acute postoperative weakness, and outlines an investigative approach. To the best of our knowledge, it is the first case described in the pediatric literature to report biphasic progression of symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The feasibility of implementing a revised Montpellier intubation bundle incorporating recent evidences was tested in a quality-improvement project. It was hypothesized that this "Care Bundle" implementation would reduce intubation-related complications. Materials and methods: The project was conducted in an 18-bedded multidisciplinary intensive care unit (ICU). Baseline data for intubations were collected over 3-month "Control Period". During the 2-month "Interphase", a revised intubation bundle was developed, and staff members involved in the intubation process were extensively trained on different aspects of intubation with emphasis on bundle components. Various components of the bundle were pre-intubation fluid loading, pre-oxygenation with NIV plus PS, positive-pressure ventilation post-induction, succinylcholine as a first-line induction agent, routine use of stylet, and lung recruitment within 2 minutes of intubation. Intubation data were collected again in the 3-month "Intervention Period". Results: Data were collected for 61 and 64 intubations, respectively, during control and intervention periods. There was significant improvement in compliance to five of six-bundle components; improvement in pre-intubation fluid loading during the intervention period did not reach statistical significance. Overall, at least 3 components of the bundle were compiled within over 92% of intubations in the intervention period. However, whole-bundle compliance was limited to 14.3%. Incidences of major complications were reduced significantly in the intervention period (23.8% vs 45.9%, p = 0.01). There was significant reduction in profound hypotension (21.77% vs 29.51%, p = 0.04) and a nonsignificant 11.89% reduction in profound hypoxemia. There were no differences in minor complications. Conclusion: Implementation of an evidence-based revised Montpellier intubation bundle is feasible and it reduces major complications related to endotracheal intubation. [ABSTRACT FROM AUTHOR]

Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6x ED95) versus 1.2 mg/kg rocuronium (4x ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4x ED95) or 0.3 mg/kg cisatracurium (6x ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ² test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50 ±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects. [ABSTRACT FROM AUTHOR]

Background: Intravenous dantrolene is often prescribed for hypermetabolic syndromes other than the approved indication of malignant hyperthermia (MH). To clarify the extent of and indications for dantrolene use in conditions other than MH, we sought to document current practices in the frequency, diagnoses, clinical characteristics and outcomes associated with dantrolene treatment in critical care settings. Methods: Inpatients receiving intravenous dantrolene from October 1, 2004 to September 30, 2014 were identified retrospectively in the U.S. Veterans Health Administration national database. Extracted data included; diagnoses of hypermetabolic syndromes; triggering drugs; dantrolene dosages; demographics; vital signs; laboratory values; in-hospital mortality; complications; and lengths of stay. Frequency and mortality of patients who did not receive dantrolene were obtained in selected diagnoses for exploratory comparisons. Results: Dantrolene was administered to 304 inpatients. The most frequent diagnoses associated with dantrolene treatment were neuroleptic malignant syndrome (NMS; N = 108, 35.53%) and sepsis (N = 47, 15.46%), with MH accounting for only 13 (4.28%) cases. Over half the patients had psychiatric comorbidities and received psychotropic drugs before dantrolene treatment. Common clinical findings in patients receiving dantrolene included elevated temperature (mean ± SD; 38.7 ± 1.3 °C), pulse (116.33 ± 22.80/bpm), respirations (27.75 ± 9.58/min), creatine kinase levels (2,859.37 ± 6,646.88 IU/L) and low pO2 (74.93 ± 40.16 mmHg). Respiratory, renal or cardiac failure were common complications. Mortality rates in-hospital were 24.01% overall, 7.69% in MH, 20.37% in NMS and 42.55% in sepsis, compared with mortality rates in larger and possibly less severe groups of unmatched patients with MH (5.26%), NMS (6.66%), or sepsis (41.91%) who did not receive dantrolene. Conclusions: In over 95% of cases, dantrolene administration was associated with diagnoses other than MH in critically-ill patients with hypermetabolic symptoms and medical and psychiatric comorbidities. Exploratory survey data suggested that the efficacy and safety of dantrolene in preventing mortality in hypermetabolic syndromes other than MH remain uncertain. However, randomized and controlled studies using standardized criteria between groups matched for severity are essential to guide practice in using dantrolene. [ABSTRACT FROM AUTHOR]

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospital-based, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and Group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection were observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Post Anesthesia Care Unit (PACU) on postoperative day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in Group 2 (mean 0.2187±0.4200) than Group 1 (mean 1.125±0.833, p<0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than Group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia. [ABSTRACT FROM AUTHOR]

Flexible videobronchoscopy-guided awake intubation is the standard of care in adult patients with negligible mouth opening presenting for corrective surgeries. Although paediatric and neonatal flexible bronchoscopes are available, they are seldom used for awake intubation due to a lack of cooperation from children. A highly sensitive airway coupled with an increased risk for bronchospasm in children precludes attempts in performing bronchoscopy without any sedation. As a result, elective tracheostomy is often performed in such children with anticipated difficult airways. Our report describes the rationale, procedure and implications of videobronchoscopy-guided nasotracheal intubation under conscious sedation in a 5-year-old child with Treacher Collins syndrome or mandibulofacial dysostosis complicated by obstructive sleep apnoea. [ABSTRACT FROM AUTHOR]

Background: Succinylcholine has been extensively used for endotracheal intubation because of its ultrashort duration of action, quick onset with complete and predictable paralysis. However, the occurrence of some side effects like post injection fasciculations, postoperative myalgia, and increase in serum potassium levels limits its use in some situations like burns, myopathies, and myoglobinuria. For attenuation of these effects, many drugs have been studied but with limited success. Aims and objectives: To evaluate the role of vitamin C on attenuation of post-suxamethonium myalgia and increase in serum potassium levels. Materials and methods: Seventy-five females of American Society of Anaesthesiologists grade I and II and aged 20 to 50 years undergoing general anesthesia for various short surgical procedures were randomly allocated into three groups. Induction of anesthesia was performed with injection thiopentone 5 mg/kg body weight and suxamethonium 50 mg in all three groups. In group I, no drug was administered before induction of anesthesia. In group II, 500 mg tablet of vitamin C was administered twice orally a day before and on the day of surgery half an hour before induction of anesthesia. In group III, vitamin C 500 mg was administered intravenously in 50 ml saline half an hour before induction of anesthesia. The absence or presence of muscle pains and fasciculations were noted and if present, then their severity was also estimated. Serum potassium levels were measured in the venous samples collected just before induction and at 5-minute interval after the administration of suxamethonium. Patients were observed for myalgia on postoperative days 1, 2, and 3. Results: The patients receiving vitamin C had a little reduction in the incidents but marked reduction in severity of muscle pains and fasciculation. Furthermore, the administration of vitamin C markedly delayed the onset of muscle pains. There was no effect of vitamin C pretreatment on serum potassium levels. Conclusion: Pretreatment with vitamin C 500 mg may be useful in reduction of severity of post-suxamethonium myalgia. [ABSTRACT FROM AUTHOR]

Introduction: due to the wide indications for the use of rapid sequencing induction with succinylcholine and the high prevalence of fasciculation and myalgia, as well as increasing the dose of succinylcholine by up to 50% when using atracurium and long-term relaxation of atracurium, this plan Studies were performed Evaluation of experiences of using Atracurium and lidocaine on succinylcholine-induced fasciculation in anesthesia surgeries: a study from clinical experience. Material And Methods: This study is a clinical experience that was performed in gold in 2019 in Imam Reza Hospital [Tabriz University of Medical Sciences] with the participation of patients undergoing general anesthesia [requiring rapid sequencing anesthesia and succinylcholine injection]. One group received 0.05 mg/kg tracorium with a volume of 5 cc three minutes before induction of anesthesia and the other group received 1.5 mg/kg lidocaine with a volume of 5 cc 30 seconds before induction of anesthesia. The fasciculation status caused by succinylcholine injection was compared between the two groups. Results: The number and severity of fasciculation between the two groups of atracurium and lidocaine to prevent fasciculation were not statistically significant [p> 0.05]. Conclusion: Atracurium and lidocaine administration to prevent saccharin-induced fasciculation had similar effects in patients undergoing general anesthesia. [ABSTRACT FROM AUTHOR]

Intraocular pressure (IOP) is crucial to the well-being of eyes. During anesthesia, the administration of succinylcholine and endotracheal intubation are associated with an increase in IOP, which may be attenuated by short-acting opioids. However, the drug of choice among the commonly used short-acting opioids is unclear. This study aimed to evaluate the effects of fentanyl, sufentanil, alfentanil, and remifentanil on IOP measured after the administration of succinylcholine and after endotracheal intubation in patients undergoing general anesthesia. Five databases were searched. Randomized controlled trials (RCTs) that compared short-acting opioids and reported at least one of the clinical outcomes of interest were included. Nine RCTs with 357 patients were included. Remifentanil (1 μg kg−1) more effectively alleviated the increase in IOP than the placebo after the administration of succinylcholine [mean difference (MD) of IOP, −3.64; confidence interval (CI), −5.47 to −1.81 and after endotracheal intubation (MD, −9.71; CI, −11.91 to −7.51). Remifentanil (1 μg kg−1) ranked the best in terms of both attenuating the increase in IOP after the administration of succinylcholine [surface under the cumulative ranking curve (SUCRA), 0.91; normalized entropy (NE), 0.47; and after endotracheal intubation (SUCRA, 0.89; NE, 0.54) among all of the treatments. Remifentanil (1 μg kg−1) should be considered the drug of choice in the circumstances where increased IOP is a great concern. [ABSTRACT FROM AUTHOR]

Endotracheal tube (ETT) cuff leaks can be encountered in the operating room with variable consequences ranging from a mere annoying bubbling sound to life-threatening respiratory compromise requiring immediate intervention. This scenario becomes more challenging if there is a difficult airway with limited mouth opening and oromaxillofacial surgery where nasal intubation is required with a north pole tube. ETT replacement can expose the patient to airway loss or life-threatening hypoxemia during the ETT exchange. There are no recommended guidelines on how to deal with an ETT cuff leak and no published step-by-step safe management strategy. With the lack of defined protocols and guidelines to manage intraoperative cuff leaks, the presence of mind and ability to make critical decisions by the anesthesiologist cannot be overemphasized. We present a case report of a 40-year-old patient weighing 70 kg diagnosed with carcinoma retromolar trigone posted for wide local excision and posterior segmental mandibulectomy. On airway examination, he had a limited mouth opening of <1 cm, with both nostrils of equal and adequate size. As mask ventilation was not difficult after induction of general anesthesia, we did fiberoptic-guided right nasal intubation with North Pole tube. We were unable to inflate the cuff of ETT and there was a significant leak. Here, we discuss how we exchanged the ETT in this difficult airway scenario. [ABSTRACT FROM AUTHOR]

Introduction: Laryngeal mask airway (LMA) is used more often in today's anaesthesia practice. Smooth and successful insertion needs proper mouth opening and minimal or no airway reflexes such as gagging, coughing, or laryngospasm. Induction agents like propofol and etomidate are known to blunt the laryngeal reflexes but often patient movement, coughing, and gagging create an unpleasant situation. Aim: To assess the effects of Suxamethonium 0.25 mg/kg, and 0.5 mg/kg, and placebo (normal saline) on the facilitation of laryngeal mask airway insertion along with Etomidate as an induction agent in order to achieve hemodynamic stability and fewer complications Materials and Methods: A total of 90 adult patients, American Society of Anaesthesiologists (ASA) class I-II, scheduled for minor surgery under general anaesthesia were included in double-blind randomised controlled study, conducted from December 2021 to February 2022. The total participants were randomly allocated into three groups (Normal Saline (NS), S1 and S2). The group NS (placebo) received normal saline, and Group S1 and S2 received injections of Suxamethonium 0.25 mg/kg, or 0.5 mg/kg, respectively. Induction of anaesthesia was performed with a bolus dose of etomidate 0.3 mg/kg. Study drugs were administered when the patient had lost consciousness. Laryngeal mask airway size 3 or 4 (as appropriate) was inserted. Relaxation of the jaw, coughing, gagging, laryngospasm, and any patient movements was observed during the insertion of LMA. The overall insertion conditions were graded according to modified scheme of Lund and Stovner. The statistical analysis was carried out by using chi-square test, Fisher's exact test and Bonferroni's t-test. Results: A total of 89 patients were analysed (Group NS: n=29, group S1: n=30, Group S2: n=30). Good jaw relaxation (absolutely relaxed with no muscle tone) was noted in 16 patients of Group S2, 12 in Group S1, and 2 in Group NS (p<0.001). There was significant difference in coughing and gagging among the three groups (p=0.041). However, in the group NS, eight patients had mild movement and six had moderate movement during the insertion of LMA (p=0.002). Overall insertion conditions were better in suxamethonium groups (p=0.0001). Conclusion: Etomidate as the sole induction agent for LMA insertion is not ideal. Concurrent use of a low dose of suxamethonium (0.5 mg/kg) might significantly obtund the airway reflexes in response to LMA insertion. [ABSTRACT FROM AUTHOR]

Background: Succinylcholine with quick onset, ultra short duration of action, and complete predictable paralysis has been the best drug for endotracheal intubation but the occurrence of side effects such as muscle fasciculations, postoperative myalgia, rise in serum potassium levels and myoglobinuria limits its use in the full stomach, burns, massive trauma, metabolic acidosis, and few myopathies. For attenuation of these effects, many drugs have been studied but pre-treatment with non-depolarizing muscle relaxant found to be successful. Aims and Objectives: This study was designed to assess the effect of Rocuronium and Vecuronium pre-treatment on post-succinylcholine fasciculations, rise in serum potassium levels, and postoperative myalgia. Materials and Methods: 100 patients between the age of 20–50 years of either sex (American Society of Anaesthesiologists grade I and II) undergoing general anesthesia for various surgical procedures were randomly allocated into two groups according to pre-treatment with Rocuronium (Group R) and Vecuronium (Group V) before Succinylcholine administration. After Succinylcholine administration severity of fasciculations, rise in serum potassium after 5 min and myalgia on postoperative days 1, 2, and 3 were recorded. Results: About 74% patients had no fasciculation in Group R as compared to 36% in group V. Statistically insignificant (P>0.05) rise in serum potassium level was observed in both groups. Higher number of patients had mild-to-moderate degree of myalgia with Vecuronium on postoperative days 2 and 3. Conclusion: Pre-treatment with Rocuronium before Succinylcholine provided better attenuation of post-succinylcholine muscle fasciculations, postoperative myalgia with statistically insignificant rise in serum potassium levels. [ABSTRACT FROM AUTHOR]

Background: Neuromuscular monitoring should be applied routinely to avoid residual neuromuscular block. However, anaesthetists often refrain from applying it, even when the equipment is available. We aimed to increase neuromuscular monitoring in six Danish anaesthesia departments via e‐learning. Methods: Interrupted time series study, with baseline data from a previous study and prospective data collection after implementation of the module, which was available for 2 weeks from 21 November 2016. We included all patients receiving general anaesthesia with muscle relaxants until 30 April 2017. Main outcome was application of acceleromyography, grouped as succinylcholine only and non‐depolarising relaxants. Secondary outcomes were last recorded train‐of‐four ratio (non‐depolarising) relaxants and score on a ten‐question pre‐ and post‐course multiple‐choice test. Results: The post‐intervention data consisted of 6525 cases (3099 (48%) succinylcholine only, 3426 (52%) non‐depolarising relaxants). Analysing all departments, we found a positive pre‐intervention trend in application of acceleromyography for both groups, of estimated 7.5% and 4.8% per year, respectively (p <.001). The monitoring rate increased significantly for succinylcholine in two departments post‐intervention (p =.045 and.010), and for non‐depolarising relaxants in one department (p =.041), but followed by a negative trend of −37.0% per year (p =.041). The rate was already close to 90% at the time of the intervention and the mean last recorded train‐of‐four ratio was 0.97 (SD 0.21), also without a significant change. The median score on the post‐course test increased from 7 (IQR 5–8) to 9 (IQR 8–10) (p <.001, Wilcoxon Signed‐Ranks Test). Conclusion: We found no overall effect of the e‐learning module on application of neuromuscular monitoring, although the post‐course test indicated an effect on anaesthetists' knowledge in this field. Trial registration: Trial registration: Clinicaltrials.gov identifier: NCT02925143. https://clinicaltrials.gov/ct2/show/NCT02925143 [ABSTRACT FROM AUTHOR]

Introduction: Magnesium Sulphate (MgSO4) pre-administration is effective in reducing Succinylcholine (Sch) induced fasciculations due to its effect at presynaptic end plate. Magnesium competes with calcium at the pre-synaptic end plate of neuromuscular junction and inhibits the release of acetylcholine (Ach) from the motor nerve terminal and to a lesser extent, decreases the sensitivity of the postjunctional membrane and reduces the excitability of the muscle fibre. Aim: To evaluate three doses of MgSO4 in reducing the incidence and severity of fasciculations and correlate with the serum magnesium levels. Materials and Methods: This prospective, randomised clinical trial was at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India. Ninety consenting adult patients aged 20-50 years scheduled for elective surgeries with endotracheal intubation under general anaesthesia were randomly allocated to three groups-Group 1, Group 2 and Group 3, to receive Injection (Inj.) MgSO4 20 mg/kg, 30 mg/kg and 40 mg/kg, respectively, before induction. Induction with Inj. propofol (2 mg/kg) was followed by administration of Inj. Sch (1.5 mg/kg). The main outcome parameters were the incidence of fasciculations and grading of the severity. Haemodynamic responses from the basal levels and after intubation, and adverse effects to the study drugs were noted. Chi-square test was used to find the significance of study parameters on categorical scale among the groups. Probability values at <0.05 were considered as significant. Results: The incidence of fasciculations was 90%, 53.4% and 43.4% in groups 1, 2 & 3, respectively. Greater number of patients had grade 3 fasciculations in group 1 (20%), compared to group 2 and group 3 (3.4% and nil) respectively. The fall in blood pressure after MgSO4 was comparable among the three groups. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) increased by 23.5% and 18.5%, 7.9% and 4.1% and 2.8% and 2.7% in groups 1, 2 and 3, respectively at one minute. The SBP and DBP at 3rd and 5th minute stayed at statistically significant greater levels in group 1 as compared to groups 2 and 3, but were similar in groups 2 and 3 overall. The Heart Rate (HR) changes followed similar trend in all 3 groups. Incidence of feeling of warmth was highest in group three as compared to other groups. Conclusion: MgSO4 at 40 mg/kg can be the optimal dose to suppress Sch-induced fasciculations, with better attenuation of intubation associated haemodynamic changes. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to evaluate first attempt intubation failure rate, its associated factors, and its related complications in out-of-hospital emergency setting, when emergency physicians perform standardized airway management using rapid sequence intubation in adult patients. Material and methods: The present study was a substudy of the Succinylcholine versus Rocuronium for out-of-hospital Emergency Intubation (CURASMUR) Trial, which compared Succinylcholine and Rocuronium used for Rapid sequence intubation. First attempt Intubation failure rate and early intubation related complications were recorded. We used multivariable logistic regression analysis to determine first intubation failure associated factors. Results: A total of 1230 patients were included with mean age of 55.9 +/- 19 years. First attempt intubation failure was recorded in 285 (23.2%) patients. The occurrence of a first attempt intubation failure was independently associated with history of ear, nose, and throat neoplasia (OR 2.20, CI 95% 1.06–4.60). Early intubation related complications were more frequent in case of first attempt intubation failure: 80 of 285 (28.4%) in patients with first attempt intubation failure and 185 of 945 (19.6%) in patients with successful first attempt intubation [OR 1.44; CI 95%, 1.11–1.87]. Conclusion: Based on a large multicenter study on out-of-hospital tracheal intubation of adult patients, we found that first attempt intubation failure rate was high and that history of ear, nose, and throat (ENT) neoplasia was an independent associated factor. Failure in first intubation attempt was associated with significantly more intubation related complications. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)