3,111 results on '"Vecuronium bromide"'
Search Results
2. Emergency department usage of sugammadex in a large regional health system.
- Author
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Jansson, Paul S., Pimentel, Marc P. T., and Seethala, Raghu R.
- Subjects
NEUROLOGIC examination ,ACADEMIC medical centers ,RESPIRATORY insufficiency ,HOSPITAL emergency services ,HOSPITALS ,ROCURONIUM bromide ,TRACHEA intubation ,SUGAMMADEX ,MEDICAL records ,ACQUISITION of data ,RESEARCH ,PHYSICIAN practice patterns ,VECURONIUM bromide ,CRITICAL care medicine - Abstract
The article focuses on the usage of sugammadex in emergency departments (EDs) within a large regional health system. Topics include the demographic and clinical characteristics of patients receiving sugammadex, the primary indications for its use (especially for neurological examination post-intubation), and the variation in administration practices between academic and community hospitals.
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- 2024
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3. Platform Adaptive Embedded Trial for Acute Respiratory Distress Syndrome (PETARDS)
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Renmin Hospital of Wuhan University, The Second Affiliated Hospital of Harbin Medical University, West China Hospital, The First Affiliated Hospital of Zhengzhou University, Peking Union Medical College Hospital, Wuhan Union Hospital, China, Fudan University, Guangdong Provincial People's Hospital, Ningbo No. 1 Hospital, and Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University
- Published
- 2022
4. Ketamine infusion for sedation in a patient on extracorporeal membrane oxygenation (ECMO).
- Author
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Farrokh, Salia, Kim, Bo Soo, and Cho, Sung-Min
- Subjects
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DRUG efficacy , *PROPOFOL , *INTRAVENOUS therapy , *ANESTHESIA , *RESPIRATORY insufficiency , *CRITICALLY ill , *EXTRACORPOREAL membrane oxygenation , *AGITATION (Psychology) , *PATIENTS , *SURGERY , *LUNG tumors , *THORACOTOMY , *SURGICAL complications , *FENTANYL , *IMIDAZOLES , *KETAMINE , *DRUG therapy , *TERMINATION of treatment , *VECURONIUM bromide , *EVALUATION - Abstract
Introduction: we sought to explore the efficacy of ketamine in a patient on extracorporeal membrane oxygenation (ECMO) receiving ketamine for sedation by investigating the utility of plasma ketamine concentrations. Case report: retrospective chart review of one critically ill patient on ECMO Discussion: This was a descriptive review of serial plasma ketamine concentrations in an ECMO patient. Although no reference plasma concentrations exist in ECMO patients, ketamine levels appeared to be lower than those seen in surgical patients not on ECMO. Conclusion: At this point, no reference plasma concentrations exist for ketamine in ECMO patients, further research may help understand the effects of ECMO on ketamine disposition and that lower ketamine concentrations may be used for effective analgesia or sedation. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
5. Dexmedetomidine and Fentanyl in Endotracheal Intubation: A Comparative Analysis of Hemodynamic and Intubation Responses.
- Author
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Goktas, Aysegul Torun, Temizel, Feriha, Arslan, Gulten, Ozseker, Metin, Suslu, Husnu, and Saitoglu, Leyla
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DRUG efficacy ,PROPOFOL ,ANESTHESIA ,ANESTHESIOLOGISTS ,FENTANYL ,TERTIARY care ,SURGERY ,PATIENTS ,ACQUISITION of data ,MANN Whitney U Test ,IMIDAZOLES ,COMPARATIVE studies ,T-test (Statistics) ,MEDICAL records ,DESCRIPTIVE statistics ,CHI-squared test ,HEMODYNAMICS ,DATA analysis software ,TRACHEA intubation ,VECURONIUM bromide ,PATIENT safety ,EVALUATION - Abstract
Aim: Endotracheal intubation, a critical procedure in anaesthesia, can induce significant hemodynamic fluctuations, posing risks, especially to patients with cardiovascular concerns. This study compares the effects of dexmedetomidine and fentanyl, two agents commonly used to mitigate these responses, on endotracheal intubation conditions and associated hemodynamic changes. Material and Method: Conducted at tertiary care training and research hospital, this study involved 60 patients aged 40-60, all classified American Society of Anesthesiologists (ASA) I-II, undergoing elective upper and lower extremity surgeries. Excluding patients with contraindicating conditions, the subjects were divided into two groups to receive either dexmedetomidine or fentanyl, along with propofol and vecuronium, for induction. Hemodynamic parameters were continuously monitored, and intubation conditions were assessed using the Cooper scoring system. Results: The study found that both dexmedetomidine and fentanyl effectively stabilised hemodynamic parameters during intubation. However, the fentanyl group displayed significantly higher total scores on the Cooper intubation conditions scale, indicating more favourable conditions for endotracheal intubation in terms of ease and patient comfort. Conclusion: While both dexmedetomidine and fentanyl are effective in maintaining hemodynamic stability during endotracheal intubation, fentanyl demonstrates a slight advantage in optimising intubation conditions. This distinction offers valuable insight for anesthesiologists in tailoring anaesthetic strategies and balancing patient safety with procedural efficiency in surgical settings. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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6. Neuromuscular Blocking Agents and Cancer: A Narrative Review.
- Author
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Chen, Rui, Sun, Yan, Li, Yufan, Dou, Xiaoke, Dai, Maosha, Sun, Shujun, and Lin, Yun
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ONLINE information services , *MEDICAL databases , *ROCURONIUM bromide , *STOMACH tumors , *LUNG cancer , *GENERAL anesthesia , *ANESTHESIA , *ANALGESIA , *MUSCLE contraction , *MEDICAL information storage & retrieval systems , *INTUBATION , *SYSTEMATIC reviews , *OPERATIVE surgery , *RESEARCH funding , *MEDLINE , *TUMORS , *NEUROMUSCULAR blocking agents , *BREAST tumors , *VECURONIUM bromide ,TUMOR surgery - Abstract
Objective. Neuromuscular blocking agents (NMBAs) are part of the three elements of general anaesthesia (sedation, analgesia, and muscle relaxation), which can relax muscles and facilitate intubation and surgery. It has been reported that cancer cells are prone to invasion or metastasis during surgery, but various anaesthetics are currently used in cancer resection, particularly NMBA, and the effects on cancer cell behavior are poorly understood. Guidelines for the correct application of NMBA in cancer surgery have not been reported; therefore, the aim of this paper is to explore the relationship between NMBA and cancer. Methods. Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, and CBM for articles of NMBA and cancer. Results. The available evidence suggests that cisatracurium may be more appropriate for use in anaesthesia for cancer surgery, while rocuronium deserves further attention, particularly for breast and gastric cancer surgery, and vecuronium is suitable for breast cancer and non-small-cell lung cancer, while it is used with caution in gastric cancer. Also, the relationship between NMBA (mivacurium, succinylcholine, gantacurium, and decamethonium bromide) and cancer is unclear and deserves further study. Conclusion. The effect of different NMBAs on cancer cells varies, and the effect of some NMBAs on cancer cells is unclear, and most of the current findings are only from in vitro studies, which need to be validated by further clinical studies in the future to better guide the clinical application of NMBAs. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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7. Nasogastric Tube Insertion in Intubated Patients: Comparison of Three Different Positions; Standard Sniffing Position, Additional Flexion of the Neck, and Standard Sniffing Position with Lateral Neck Pressure .
- Author
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Mohanan, Shyam, Gupta, Madhu, and Dabas, Manisha
- Subjects
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GASTRIC intubation , *ENDOTRACHEAL tubes , *ANESTHESIA , *OXYMETAZOLINE , *VECURONIUM bromide - Abstract
Objective: Our study aimed to evaluate two modified nasogastric tube (NGT) insertion techniques in intubated patients compared to the conventional method in respect of first attempt success rate, time taken for insertion, and complications. Methods: In this prospective interventional study, patients with orotracheal intubation requiring NGT insertion were randomly allocated into three groups by SNOS Group A (control group- standard sniffing position, n = 40), Group B (additional flexion of the neck, n = 40), Group C (standard sniffing position with lateral neck pressure, n = 40). The number of attempts for successful NGT insertion, time for insertion, and complications were compared. Results: Modified positions showed a high first-attempt success rate in Group B (55%) and Group C (85%) as compared to conventional Group A (32.50%) (P < 0.001). On intergroup analysis of modified groups (B and C), Group C was superior to Group B in 1st attempt success rate with a significant P value of 0.003. Conclusion: In intubated patients, NGT insertion in standard sniffing position with lateral neck pressure has the highest first attempt success rate followed by additional flexion of neck position. Both the modified positions are better positions for NGT insertion in intubated patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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8. Vecuronium Bromide
- Author
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Pant, AB
- Published
- 2024
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9. Airway Ultrasound Findings in a Rare Case of Parry--Romberg Syndrome.
- Author
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Gupta, Bhavna, Jain, Gaurav, Chaudhary, Ravi, and Shrestha, Kajal
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NECK physiology ,RARE diseases ,FACIAL hemiatrophy ,TREATMENT effectiveness ,SURGICAL blood loss ,DISCHARGE planning ,THYROID gland ,PROPOFOL ,LARYNGOSCOPY ,AIRWAY (Anatomy) ,GENERAL anesthesia ,VECURONIUM bromide ,POSTOPERATIVE period ,FENTANYL - Abstract
Parry--Romberg syndrome (PRS) is a rare disorder characterised by progressive hemifacial atrophy, along with various neurological and ophthalmological manifestations. Patients with PRS may undergo reconstructive procedures such as fat grafting to address the facial contour deformities. Anaesthesiologists may face significant challenges due to the asymmetric craniofacial structures and the potential presence of neurological deficits, including hemiparesis. We report a case of an 18-year-old male with left-sided hemifacial atrophy and PRS with wasting of one side of the lobe of the thyroid gland who underwent fat grafting under general anaesthesia. The challenges faced during the anaesthetic management of this patient are airway management, positioning and monitoring of neurological deficits. PRS has been reported to coexist with other autoimmune diseases, including thyroid disorders. However, thyroid involvement in PRS is rare. This case used ultrasound to evaluate the airway and assess PRS impact. This case highlights the importance of ultrasound airway, which can serve as an effective tool for identifying associated conditions (like thyroid atrophy) in patients with PRS and can assist in the diagnosis and management of this rare and complex disease. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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10. Efficacy and Safety of Sugammadex Dosed According to Actual Body Weight (ABW) or Ideal Body Weight (IBW) in Reversal of Neuromuscular Blockade (NMB) in Morbidly Obese Participants (MK-8616-146)
- Published
- 2021
11. Opioid-Free Shoulder Arthroplasty
- Published
- 2020
12. Safety of Sugammadex for the Reversal of Neuromuscular Blockade in American Society of Anesthesiologists (ASA) Class 3 or 4 Participants (MK-8616-145)
- Published
- 2020
13. A Bridging Trial Comparing Sugammadex (Org 25969) at Reappearance of T2 in Japanese and Caucasian Participants. Part B: Caucasian Participants (P05971)
- Published
- 2019
14. Physical compatibility of remimazolam with opioid analgesics, sedatives, and muscle relaxants during simulated Y-site administration.
- Author
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Kondo, Masayoshi, Yoshida, Naoki, Yoshida, Mariko, Tanaka, Chie, Tagami, Takashi, Horikawa, Kazumi, Sugaya, Kazutoshi, and Takase, Hisamitsu
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BENZODIAZEPINE analysis , *ROCURONIUM bromide , *MUSCLE relaxants , *COMBINATION drug therapy , *HYDROGEN-ion concentration , *INCOMPATIBLES (Pharmacy) , *AUTOANALYZERS , *FENTANYL , *IMIDAZOLES , *COMPARATIVE studies , *DRUG interactions , *DESCRIPTIVE statistics , *REMIFENTANIL , *MIDAZOLAM , *HYPERTONIC saline solutions , *TRANQUILIZING drugs , *VECURONIUM bromide , *DOSAGE forms of drugs - Abstract
Purpose There is a lack of information on the compatibility of remimazolam with opioid analgesics, muscle relaxants, and other sedatives. This study aimed to evaluate the physical compatibility of remimazolam with these drug classes. Methods Remimazolam was combined with 1 or 2 target drugs (remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam). Ten physical compatibility tests were conducted, including four 3-drug compatibility tests. Remimazolam was dissolved in 0.9% sodium chloride injection to a final concentration of 5 mg/mL. Other medications were diluted in 0.9% sodium chloride injection to obtain clinically relevant concentrations. Compatibility tests were conducted with 3 test solutions, wherein remimazolam and the target drugs were compounded at equal volume ratios (1:1 or 1:1:1). Visual appearance was assessed and testing of Tyndall effect, turbidity, and pH was performed immediately after mixing and then again 1 hour and 4 hours after mixing. Appearance and turbidity were evaluated by comparison with the control solution of each target drug diluted with 0.9% sodium chloride injection to the same concentration as the test solution. Results All drugs tested were determined to be compatible with remimazolam. The drug combination with the highest change of turbidity was remimazolam and vecuronium (a mean increase of 0.16 NTU relative to the remimazolam control solution), 4 hours after mixing. The combination with the highest pH was remimazolam, fentanyl, and vecuronium (mean [SD], 3.76 [0.01]), 4 hours after mixing. The combination of remimazolam and fentanyl showed a larger change in pH at 4 hours after mixing (a mean increase of 2.6%) than immediately after mixing. Conclusion Remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam are physically compatible with remimazolam during simulated Y-site administration. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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15. Intraoperative Central Diabetes Insipidus during Aneurysmal Clipping Surgery: An Unusual Phenomenon.
- Author
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Kutum, Chayanika, Khurana, Priyanka, Singh, Karandeep, Ganjoo, Pragati, and Singh, Daljit
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CENTRAL nervous system diseases ,PITUITARY diseases ,GENERAL anesthesia ,THIOPENTAL ,BLOOD gases analysis ,DIABETES insipidus ,INTRAOPERATIVE care ,OPERATIVE surgery ,SURGICAL complications ,FENTANYL ,ARTERIAL pressure ,SUBARACHNOID hemorrhage ,HYPOTHALAMUS ,POSTOPERATIVE period ,CRANIOTOMY ,COMPUTED tomography ,MIDAZOLAM ,INTRACRANIAL aneurysms ,VECURONIUM bromide ,DISEASE complications - Abstract
Central diabetes insipidus (DI) is a known complication associated with pituitary surgeries occurring in postoperative period. However, development of DI following aneurysmal subarachnoid hemorrhage (SAH) is rarely reported. We describe here a case of intraoperative DI in a patient undergoing aneurysmal clipping surgery that posed a challenge for both diagnosis and management. Intraoperative development of central DI was attributed to the evolving ischemic injury to the hypothalamus at the time of rebleeding that was not apparent in the preoperative scan. DI resolved postoperatively after 18 hours of medical management. A careful observation of preoperative scans and vigilant monitoring may help in early diagnosis and management of such complication in the perioperative period. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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16. Does Deep Neuromuscular Blockade Improve Operating Conditions During Total Hip Replacements?
- Author
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MaineHealth, Spectrum Medical Group Anesthesiology, and Craig Curry, Anesthesiologist
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- 2019
17. Comparison of Sugammadex (MK-8616/Org 25969) With Neostigmine Administered at 1-2 Post-tetanic Counts (PTCs) After Administration of Rocuronium or Vecuronium (19.4.302/P05945/MK-8616-025)
- Published
- 2019
18. Intraoperative Lidocaine Infusion vs. Esmolol Infusion for Postoperative Analgesia in Laparoscopic Cholecystectomy
- Author
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Joshan Lal Bajracharya, Junior resident
- Published
- 2018
19. Evaluation of Atracurium-vecuronium Combination in Laparosocpic Surgery
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Amitabh Dutta, Senior Consultant & Professor
- Published
- 2017
20. Effects of tizanidine premedication on the duration of perioperative maintenance dose of vecuronium bromide
- Author
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Ceyhan Oflezer
- Subjects
Alpha 2 agonist ,inguinal hernie ,premedication ,tizanidine ,vecuronium bromide ,Medicine - Abstract
Aim. The aim of this study was to evaluate the effects of preoperative administration of tizanidine on the maintenance dose duration of the nondepolarizing muscle relaxant, i.e. vecuronium bromide. Material and Methods. This prospective clinical study was conducted in 30 adult male patients scheduled for elective inguinal hernia surgery. Patients were categorised into two randomised groups based on the premedication use. Group 1 included patients (n = 15) who received oral diazepam (Diazem) in the evening prior to the surgery, as well as meperidine (Dolantin) 1 mg/kg-1 (max. 50 mg) i.m. with 50 ml water by mouth 1 hour before the procedure. Group 2 comprised patients (n = 15) who were given oral tizanidine 4 mg in the evening before the surgery, as well as oral tizanidine 4 mg with 50 ml water 1 hour prior to the operation. The following parameters were recorded in both groups: pre-operative and perioperative diastolic arterial blood pressure, systolic arterial blood pressure, mean arterial blood pressure, heart rate, respiratory rate, pre-operative vecuronium bromide maintenance doses, procedure time and postoperative score according to the Ramsay scale in 1st, 2nd and 3rd hour. Results. No significant difference was observed between the two groups with regard to the pre-operative and perioperative haemodynamic variables and the respiratory rate (P > 0.05), although it was found that vecuronium maintenance dose duration was significantly higher in the tizanidine premedicated group (P = 0.015). In addition, the operative time (P = 0.128) and the postoperative patients’ Ramsay scores did not differ statistically between the two groups (P > 0.05). Conclusions. The prolonged duration of vecuronium maintenance dose, the increased nondepolarizing block time, as well as haemodynamic stability preservation in patients undergoing inguinal hernia surgery following preoperative oral administration of tizanidine support the view that tizanidine can be used as an effective and safe myotonolytic premedication agent.
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- 2022
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21. Effects of tizanidine premedication on the duration of perioperative maintenance dose of vecuronium bromide.
- Author
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Oflezer, Ceyhan
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PREMEDICATION , *DIASTOLIC blood pressure , *SYSTOLIC blood pressure , *INGUINAL hernia , *HERNIA surgery , *HEART beat - Abstract
Aim. The aim of this study was to evaluate the effects of preoperative administration of tizanidine on the maintenance dose duration of the nondepolarizing muscle relaxant, i.e. vecuronium bromide. Material and Methods. This prospective clinical study was conducted in 30 adult male patients scheduled for elective inguinal hernia surgery. Patients were categorised into two randomised groups based on the premedication use. Group 1 included patients (n = 15) who received oral diazepam (Diazem) in the evening prior to the surgery, as well as meperidine (Dolantin) 1 mg/kg-1 (max. 50 mg) i.m. with 50 ml water by mouth 1 hour before the procedure. Group 2 comprised patients (n = 15) who were given oral tizanidine 4 mg in the evening before the surgery, as well as oral tizanidine 4 mg with 50 ml water 1 hour prior to the operation. The following parameters were recorded in both groups: pre-operative and perioperative diastolic arterial blood pressure, systolic arterial blood pressure, mean arterial blood pressure, heart rate, respiratory rate, pre-operative vecuronium bromide maintenance doses, procedure time and postoperative score according to the Ramsay scale in 1st, 2nd and 3rd hour. Results. No significant difference was observed between the two groups with regard to the pre-operative and perioperative haemodynamic variables and the respiratory rate (P > 0.05), although it was found that vecuronium maintenance dose duration was significantly higher in the tizanidine premedicated group (P = 0.015). In addition, the operative time (P = 0.128) and the postoperative patients' Ramsay scores did not differ statistically between the two groups (P > 0.05). Conclusions. The prolonged duration of vecuronium maintenance dose, the increased nondepolarizing block time, as well as haemodynamic stability preservation in patients undergoing inguinal hernia surgery following preoperative oral administration of tizanidine support the view that tizanidine can be used as an effective and safe myotonolytic premedication agent. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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22. Superselective Anesthesia Functional Examination of the Diaphragm during Endovascular Embolization of Spinal Cord Arteriovenous Malformation.
- Author
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Bharadwaj, Suparna and Muthuchellappan, Radhakrishnan
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SPINAL cord surgery , *PROPOFOL , *LIDOCAINE , *ELECTRODES , *EVOKED potentials (Electrophysiology) , *ANESTHESIA , *ELECTROENCEPHALOGRAPHY , *DIAPHRAGM (Anatomy) , *THERAPEUTIC embolization , *FENTANYL , *FLUOROSCOPY , *ENDOVASCULAR surgery , *ANGIOGRAPHY , *ARTERIOVENOUS malformation , *VECURONIUM bromide - Abstract
Superselective anesthesia functional evaluation (SAFE) is an adjunct to the Wada test. It is performed to rule out unintentional positioning of the tip of the embolization catheter proximal to the origin of a normal artery supplying eloquent region of spinal cord. We report a case of a 36-year-old male with cervical intramedullary spinal cord arteriovenous malformation (SCAVM) at C3 level. In this patient, we monitored motor-evoked potentials (MEPs) of bilateral upper and lower limbs along with diaphragm. Electrodes for compound muscle action potential of diaphragm were placed under fluoroscopy guidance. Through this case, we want to emphasize that intraprocedural diaphragmatic MEPs enhance the safety margin during endovascular embolization of cervical intramedullary SCAVMs. Placement of electrodes under fluoroscopy guidance ensures proper positioning into the diaphragm muscle. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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23. Neuromuscular Blocking Agents and Reversal Agents Among Hospitalized Children: A Cerner Database Study.
- Author
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Zhong, Wenjun, Liu, Xinyue, Bash, Lori D., Bortnichak, Ed, Horrow, Jay, and Koro, Carol
- Subjects
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ROCURONIUM bromide , *PARASYMPATHOMIMETIC agents , *CONFIDENCE intervals , *CROSS-sectional method , *MULTIVARIATE analysis , *CHOLINESTERASE inhibitors , *RACE , *DESCRIPTIVE statistics , *ELECTRONIC health records , *LOGISTIC regression analysis , *ETHNIC groups , *DATA analysis software , *ODDS ratio , *HOSPITAL care of children , *NEUROMUSCULAR blocking agents , *SUGAMMADEX , *VECURONIUM bromide , *CHILDREN - Abstract
Background: Sugammadex (Bridion) was approved by the US Food and Drug Administration (FDA) in December 2015 for the reversal of neuromuscular block (NMB) induced by rocuronium and vecuronium bromide in adults undergoing surgery and approved for use in both adults and children in the European Union in 2008. Sugammadex use in children has been reported in the United States, but to what extent is not clear. Aims: The aim was to describe the utilization pattern of NMB agents and factors associated with the use of reversal agents (neostigmine and sugammadex) in US children. Methods: Cross-sectional study of children with exposure to NMB agents between 2015 and 2017 in the Cerner Health Facts® database, which is an electronic health record (EHR) database across 600 facilities in the United States. Logistic regression estimated factors associated with the use of sugammadex vs neostigmine. Results: A total of 27 094 pediatric clinical encounters were exposed to neuromuscular blocking agents (NMBAs), in which 21 845 were exposed to rocuronium (76%), vecuronium (18%), or both (6%). Among children with exposure to rocuronium and vecuronium, the use of sugammadex was 1.7% in 2016 and 7.6% in 2017. The multivariable logistic model suggested that children who were older (age 12-17 years vs 0-1 year; odds ratio [OR] 1.96; 95% confidence interval [CI], 1.36-2.83), Hispanic or Latino ethnicity and other ethnicities (vs non-Hispanic or Latino; OR 2.03 and 1.56; 95% CI, 1.55-2.67 and 1.15-2.13, respectively), in teaching facilities (OR 1.26; 95% CI, 1.00-1.59), or admitted through emergency departments (OR 1.65; 95% CI, 1.06-2.58) were independently more likely to receive sugammadex than neostigmine after controlling for other covariates. Conclusions: In Cerner Health Facts database 2015 to 2017, among children, rocuronium was more commonly used than vecuronium, and sugammadex use was observed since 2016. Sugammadex and neostigmine users varied by demographic, clinical, and site-level characteristics. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
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24. Carboxymethyl-γ-cyclodextrin, a novel selective relaxant binding agent for the reversal of neuromuscular block induced by aminosteroid neuromuscular blockers: an ex vivo laboratory study.
- Author
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Fábián, Ákos I., Tassonyi, Edömér, Csernoch, Vera, Fedor, Marianna, Sohajda, Tamás, Szente, Lajos, and Fülesdi, Béla
- Subjects
- *
ROCURONIUM bromide , *MUSCLE contraction , *CONFIDENCE intervals , *GLUCANS , *ANIMAL experimentation , *NEUROMUSCULAR blockade , *RATS , *ELECTRIC stimulation , *CURARE-like agents , *NEUROMUSCULAR blocking agents , *SUGAMMADEX , *VECURONIUM bromide , *PHARMACODYNAMICS - Abstract
Background: Residual neuromuscular block at the end of surgery may compromise the patient's safety. The risk of airway complications can be minimized through monitoring of neuromuscular function and reversal of neuromuscular block if needed. Effective reversal can be achieved with selective relaxant binding agents, however, sugammadex is the only clinically approved drug in this group. We investigated the concentration–response properties of a novel selective relaxant binding agent, carboxymethyl-γ-cyclodextrin for the reversal of neuromuscular block. We evaluated the hypothesis that it is equally potent for reversing neuromuscular block as sugammadex. Methods: Phrenic nerve – hemidiaphragm tissue preparations were isolated from male Wistar rats and suspended in a tissue holder allowing electrical stimulation of the nerve and monitoring of muscle contraction force. Concentration–response relationships were constructed for the neuromuscular blocking agents rocuronium, pipecuronium, and vecuronium. The half-effective concentrations of sugammadex and carboxymethyl-γ-cyclodextrin for reversal of neuromuscular block were determined. Results: The half effective concentrations (95% confidence interval, CI) were 7.50 (6.93–8.12) μM for rocuronium, 1.38 (1.33–1.42) μM for pipecuronium, and 3.69 (3.59–3.80) μM for vecuronium. The half effective concentrations (95% CI) of carboxymethyl-γ-cyclodextrin and sugammadex were 35.89 (32.67–39.41) μM and 3.67 (3.43–3.92) μM, respectively, for the reversal of rocuronium-induced block; 10.14 (9.61–10.70) μM and 0.67 (0.62–0.74) μM, respectively, for the reversal of pipecuronium-induced block; and 376.1 (341.9–413.8) μM and 1.45 (1.35–1.56) μM, respectively, for the reversal of vecuronium-induced block. Conclusions: Carboxymethyl-γ-cyclodextrin is an effective, but less potent agent for reversal of neuromuscular block than sugammadex. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
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25. The Effect of TEAS on the Quality of Early Recovery
- Published
- 2015
26. New Tools for Old Problems: Magnetic Stimulation to Study (and Help) the Brain
- Author
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Rivadulla, Casto, Aguilá-Macías, Jordi, Prieto-Soler, Sandra, Aguilar, Juan, Cudeiro, Javier, Guglielmelli, Eugenio, Series editor, Ibáñez, Jaime, editor, González-Vargas, José, editor, Azorín, José María, editor, Akay, Metin, editor, and Pons, José Luis, editor
- Published
- 2017
- Full Text
- View/download PDF
27. Actual versus ideal body weight dosing of sugammadex in morbidly obese patients offers faster reversal of rocuronium- or vecuronium-induced deep or moderate neuromuscular block: a randomized clinical trial.
- Author
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Horrow, Jay C., Li, Wen, Blobner, Manfred, Lombard, John, Speek, Marcel, DeAngelis, Matthew, and Herring, W. Joseph
- Subjects
- *
ROCURONIUM bromide , *BODY weight , *PARASYMPATHOMIMETIC agents , *CONFIDENCE intervals , *MORBID obesity , *GLYCOPYRROLATE , *CHOLINESTERASE inhibitors , *NEUROMUSCULAR blockade , *TREATMENT effectiveness , *RANDOMIZED controlled trials , *BLIND experiment , *ULNAR nerve , *DESCRIPTIVE statistics , *STATISTICAL sampling , *SUGAMMADEX , *VECURONIUM bromide - Abstract
Background: This randomized, double-blind trial evaluated sugammadex-mediated recovery time from rocuronium- or vecuronium-induced moderate (M-) or deep (D-) neuromuscular block in morbidly obese adults dosed by actual (ABW) or ideal body weight (IBW). Methods: Adults with BMI ≥40 kg/m2 were randomized to 1 of 5 groups: M-neuromuscular block, sugammadex 2 mg/kg ABW; M-neuromuscular block, sugammadex 2 mg/kg IBW; M-neuromuscular block, neostigmine 5 mg, and glycopyrrolate 1 mg; D-neuromuscular block, sugammadex 4 mg/kg ABW; or D-neuromuscular block, sugammadex 4 mg/kg IBW. Supramaximal train of four (TOF) stimulation of the ulnar nerve (TOF-watch SX®) monitored recovery. Primary endpoint was time to TOF ratio ≥ 0.9 for ABW and IBW groups pooled across neuromuscular blocking agent (NMBA)/blocking depth, analyzed by log-rank test stratified for agent and depth. Prespecified safety outcomes included treatment-emergent bradycardia, tachycardia, and other arrhythmias, and adjudicated hypersensitivity and anaphylaxis. Results: Of 207 patients randomized, 188 received treatment (28% male, BMI 47 ± 5.1 kg/m2, age 48 ± 13 years). Recovery was 1.5 min faster with ABW vs IBW dosing. The sugammadex 2 mg/kg groups recovered 9-fold faster [time 0.11-fold, 95% CI 0.08 to 0.14] than the neostigmine group. ABW (5.3%) and IBW (2.7%) groups had similar incidences of recovery time > 10 min (95% CI of difference: − 4.8 to 11.0%); 84% for neostigmine group. Re-curarization occurred in one patient each in the 2 mg/kg IBW and neostigmine groups. Prespecified safety outcomes occurred with similar incidences. Conclusions: ABW-based sugammadex dosing yields faster reversal without re-curarization, supporting ABW-based sugammadex dosing in the morbidly obese, irrespective of the depth of neuromuscular block or NMBA used. Trial registration: Registered on November 17, 2017, at ClinicalTrials.gov under number NCT03346070. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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28. Comparative Study of Rocuronium With Vecuronium (Study 71101)(COMPLETED)
- Published
- 2015
29. Mask Ventilation Before and After Neuromuscular Blockade
- Author
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Aaron Joffe, Assistant Professor, Anesthesiology & Pain Medicine
- Published
- 2015
30. Under-dosing and over-dosing of neuromuscular blocking drugs and reversal agents: beware of the risks.
- Author
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Hunter JM and Blobner M
- Subjects
- Humans, Androstanols adverse effects, Rocuronium, Vecuronium Bromide, Neuromuscular Blockade, Neuromuscular Nondepolarizing Agents adverse effects, Neuromuscular Blocking Agents
- Abstract
The phenomena of residual curarisation and recurarisation after the use of long-acting non-depolarising neuromuscular blocking drugs such as tubocurarine and pancuronium were well recognised 60 years ago. But the incidence seemed to decline with the introduction of atracurium and vecuronium. However, recently there have been an increasing number of reports of residual and recurrent neuromuscular block. Some of these reports are a result of inappropriate doses of rocuronium, sugammadex or both, together with inadequate neuromuscular monitoring. We urge clinicians to review their practice to ensure the highest standards of clinical care when using neuromuscular blocking drugs and reversal agents. This includes the use of quantitative neuromuscular monitoring whenever neuromuscular blocking drugs are administered., (Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2024
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31. Reversal of neuromuscular block.
- Author
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Hunter, J.M.
- Subjects
- *
ANAPHYLAXIS , *ANESTHESIA , *BRADYCARDIA , *CARDIAC arrest , *CHOLINESTERASE inhibitors , *CONVALESCENCE , *CURARE-like agents , *LAPAROSCOPIC surgery , *LUNG diseases , *NEUROMUSCULAR blocking agents , *PARASYMPATHOMIMETIC agents , *SURGICAL complications , *VECURONIUM bromide , *DRUG development , *CONTINUING education units , *EXTUBATION , *SUGAMMADEX , *CYSTEINE , *ROCURONIUM bromide , *PHARMACODYNAMICS - Abstract
In this article the author talks about the use of anticholinesterases to reverse residual neuromuscular block which is efficacious only if recovery is already established, and it was originally advised that at least the second twitch (T2) of train-of-four response should be detectable before neostigmine is administered. It mentions the ideal reversal agent which could be given at any time after administration of a neuromuscular blocking agent (NMBA), and should have no muscarinic side-effects.
- Published
- 2020
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32. Effects of Dexmedetomidine on Postoperative Cognitive Dysfunction During One-lung Ventilation in Elder Patients
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YangLu, physician
- Published
- 2014
33. The Effect of Dexmedetomidine to Cognition of Geriatrics in Prolonged Surgery
- Author
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Chinese Medical Association and Yang Li, Anesthesiologist
- Published
- 2014
34. Comparison of the Effects of Vecuronium and Cisatracurium on Electrophysiologic Monitoring During Neurosurgery
- Author
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Jeong Jin Lee, Professor
- Published
- 2013
35. Postoperative airway morbidities in pediatric patients.
- Author
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Zhongpeng, Sun and Dong, Yang
- Subjects
- *
RESPIRATORY disease diagnosis , *RESPIRATORY diseases , *ANESTHESIOLOGISTS , *AIRWAY (Anatomy) , *ANESTHETICS , *SURGICAL complications , *DISEASES , *TREATMENT effectiveness , *EXTUBATION , *LARYNGOSCOPY , *PHARYNGITIS , *ISOFLURANE , *VECURONIUM bromide , *CHILDREN - Abstract
Pediatric airway management is a huge challenge for anaesthetists, and airway-related complications should be actively addressed and focused on. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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- View/download PDF
36. Clinicophysiological, haemodynamic and haematological evaluation of different doses of vecuronium bromide in buffaloes
- Author
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Kumar, Rohit, Kinjavdekar, P., Gautam, Deepesh, Amarpal, Aithal, H.P., Pawde, A.M., Sivanarayanan, T.B., Madhu, D.N., and Patra, S.K.
- Published
- 2018
37. A Study of Residual Curarization Incidence in China
- Author
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Ruijin Hospital, RenJi Hospital, Shanghai Zhongshan Hospital, The First Affiliated Hospital of Guangzhou Medical University, West China Hospital, Eastern Hepatobiliary Surgery Hospital, Wuhan Union Hospital, China, Zhujiang Hospital, Chinese PLA General Hospital, First Affiliated Hospital, Sun Yat-Sen University, The First Affiliated Hospital of Zhengzhou University, Tianjin Medical University General Hospital, Xiangya Hospital of Central South University, Central South University, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, First Affiliated Hospital of Xinjiang Medical University, Peking Union Medical College Hospital, First Affiliated Hospital of Zhejiang University, China Medical University Hospital, Hebei Medical University Fourth Hospital, Tongji Hospital, and Xinmin Wu, Clinical Professor
- Published
- 2013
38. Dose-reversal effect relationship of three different doses of neostigmine in obese patients: A randomised clinical trial
- Author
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Satyen Parida, Venkatesan Kausalya, Sandeep Kumar Mishra, and Sethuramachandran Adinarayanan
- Subjects
Neostigmine ,obesity ,vecuronium bromide ,Anesthesiology ,RD78.3-87.3 - Abstract
Background and Aims: Previous studies suggest that administration of vecuronium based on total body weight rather than ideal body weight (IBW) in obesity results in overdosing with prolonged recovery times. We hypothesised that larger doses of neostigmine could result in faster recovery in obese patients administered vecuronium based on total body weight. Methods: Forty-five obese American Society of Anesthesiologists' II patients undergoing elective surgery under general anaesthesia were randomised into 3 groups to receive neostigmine 30, 40 and 50 μg/kg. Following induction, patients were paralysed with vecuronium 0.1 mg/kg based on total body weight. Reversal was achieved with neostigmine based on the patient's group, and time to train-of-four (TOF) ratios of 0.5, 0.7 and 0.9 measured. The primary outcome variable was time to achieve TOF ratio >0.9. Results: Neostigmine 50 μg/kg achieved faster recovery to TOF 0.7 than neostigmine 30 and 40 μg/kg. There was no significant difference in recovery times to TOF 0.7 in patients receiving either 30 or 40 μg/kg of neostigmine. However, neostigmine 40 μg/kg attained TOF ratio 0.9 faster than 30 μg/kg. We did not note a significant difference between the 40 and 50 μg/kg dose with regard to recovery of TOF to 0.9. Conclusion: Facilitated recovery from neuromuscular blockade to TOF of 0.7 was faster with neostigmine 50 μg/kg compared to 40 or 30 μg/kg. Recovery to TOF ratio of 0.9 was not significantly different with 40 or 50 μg/kg doses although such time was faster as compared to 30 μg/kg dose.
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- 2017
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39. Analysis of the factors contributing to residual weakness after sugammadex administration in pediatric patients under 2 years of age.
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Cates AC, Freundlich RE, Clifton JC, and Lorinc AN
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- Infant, Humans, Child, Child, Preschool, Sugammadex, Rocuronium, Vecuronium Bromide, Retrospective Studies, Androstanols, Time Factors, gamma-Cyclodextrins adverse effects, Neuromuscular Nondepolarizing Agents adverse effects, Neuromuscular Blockade adverse effects, Neuromuscular Blockade methods
- Abstract
Background: Sugammadex reverses the neuromuscular blockade induced by rocuronium and vecuronium and is approved by the U.S. Food and Drug Administration for use in patients aged over 2 years. There is, however, a paucity of data regarding its dosing profile in infants and children younger than 2 years., Aims: The aim of this study was to assess the risk of recurarization, or re-paralysis, in children under 2 years of age to increase awareness on the importance of appropriate neuromuscular blocked monitoring and reversal., Methods: All patients aged ≤24 months who underwent an operative procedure at a tertiary medical center between January 1, 2018, and December 31, 2021, and received both rocuronium for neuromuscular blockade and sugammadex for neuromuscular blockade reversal, were identified in the electronic medical record. Patients were excluded from analysis if they (1) received vecuronium, cisatracurium, atracurium, or succinylcholine for neuromuscular blockade, (2) received neostigmine for reversal, or (3) underwent more than one operation within 24 h. We performed a survival analysis of sugammadex redose using a Cox proportional hazards model., Results: We reviewed 2923 records. Sugammadex was redosed in 123 (4.2%) cases. The median [IQR] time to redose was 7 [4-17] min, and the median [IQR] amount of redose administered was 2.74 [1.96-3.99] mg/kg. Increasing patient age (p < .01) and weight (p < .01) were associated with reduced hazard rate of sugammadex redose. For a patient of median weight, increasing age from 3 to 13 months was associated with a 53% risk reduction (HR: 0.47; 95% CI: 0.24-0.91). For a patient of median age, increasing weight from 4.7 to 9.2 kg was associated with 41% risk reduction (HR: 0.59; 95% CI: 0.32-1.07). We failed to detect any other associations., Conclusions: In this single-center, retrospective cohort study of pediatric surgery patients, there was an association between the hazard of sugammadex redose with both increased age and weight., (© 2023 John Wiley & Sons Ltd.)
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- 2024
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40. Most Hemodynamically Stable Method for Change From High to Low Anesthesia Flow: A Randomized Controlled Trial Comparing State Entropy, High Fresh Gas Flow for 10 Minutes, and 0.8 Ratio of End-Expired Agent Concentration to Inspired Agent Concentration.
- Author
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Punj, Jyotsna, Pandey, R., and Darlong, V.
- Subjects
- *
EPHEDRINE , *HYPOTENSION , *ATROPINE , *BLOOD pressure , *BRADYCARDIA , *FENTANYL , *HEART beat , *HEMODYNAMICS , *INHALATION anesthesia , *ISOFLURANE , *STATISTICAL sampling , *VECURONIUM bromide , *RANDOMIZED controlled trials , *PROPOFOL , *DESCRIPTIVE statistics , *INHALATION anesthetics , *DISEASE risk factors , *THERAPEUTICS - Abstract
This study was undertaken to determine the most hemodynamically stable method to low-flow anesthesia (LFA) between 10-minute administration of high fresh gas flow, 0.8 equilibration ratio (Fe/Fi), and state entropy (SE) between 40 and 60, a marker for adequate depth of anesthesia. Change from high fresh gas flow to LFA was done in 3 groups of 30 patients each: group T (time): 10 minutes; group R (ratio): Fe/Fi = 0.8, and group SE: SE = 40 to 50. A decrease in mean blood pressure or heart rate was treated with ephedrine or atropine, with study termination at more than 2 boluses of either. In group SE, no patient required ephedrine or atropine. The requirement for ephedrine was statistically higher in groups R and T than group SE. Atropine requirement was statistically higher in group R vs groups T and SE. In group R, the mean (SD) time to LFA was 43.9 (20.37) minutes, and in group SE was 151.9 (74.4) seconds. Hypotension or bradycardia did not occur when LFA was started at SE of 40 to 50 after anesthesia induction compared with LFA at 10 minutes, which caused hypotension, and Fe/Fi of 0.8, which caused hypotension and bradycardia. [ABSTRACT FROM AUTHOR]
- Published
- 2019
41. Myocardial protection and clinical outcomes in Tetralogy of Fallot patients undergoing intracardiac repair: a randomized study of two cardioplegic techniques.
- Author
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Negi, Sunder Lal, Mandal, Banashree, Singh, Rana Sandeep, and Puri, Goverdhan Dutt
- Subjects
- *
ANALYSIS of variance , *CARDIOVASCULAR surgery , *COMPARATIVE studies , *CREATINE kinase , *ECHOCARDIOGRAPHY , *FENTANYL , *HEART physiology , *RIGHT heart ventricle , *HEPARIN , *INTENSIVE care units , *ISOENZYMES , *ISOFLURANE , *MIDAZOLAM , *MORPHINE , *MULTIVARIATE analysis , *MYOCARDIUM , *CARDIOMYOPATHIES , *STATISTICAL sampling , *STATISTICS , *T-test (Statistics) , *TETRALOGY of Fallot , *VECURONIUM bromide , *DATA analysis , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *CARDIOPLEGIC solutions , *DATA analysis software , *DESCRIPTIVE statistics , *HOSPITAL mortality , *SEVOFLURANE - Abstract
Background: Myocardial protection in Tetralogy of Fallot patients undergoing intracardiac repair is suboptimal due to hypertrophied right ventricle. Hypertrophied myocardium is more susceptible to poor myocardial preservation because of inadequate capillary density as compared to the myocytes. There is a capillary to myocyte ratio mismatch. But del Nido Cardioplegia owing to its less viscosity is able to get more evenly distributed under hypothermic cardiopulmonary bypass as opposed to blood Cardioplegia. We hypothesized that the del Nido Cardioplegia technique, would be beneficial in myocardial protection because of its composition and method of delivery, leading into better early and late clinical outcomes in patients undergoing Tetralogy of Fallot repair as compared to blood cardioplegia reconstituted using St Thomas Cardioplegia solution. The objective of the study was to identify a better technique of myocardial preservation in Tetralogy of Fallot patient. Methods: In total, 56 Tetralogy of Fallot patients undergoing intracardiac repair under mild hypothermic cardiopulmonary bypass were randomly allocated to receive antegrade Cardioplegia with either standard blood Cardioplegia (Group I) or del Nido Cardioplegia (Group II). Preoperative as well as postoperative data including echocardiographic parameters for right ventricle functions, creatine kinase MB level, inotropic requirement, mechanical ventilation duration, intensive care unit stay and hospital mortality were evaluated. Results: Inotropic score in the first 24 hours postoperatively was significantly lower in Group II compared to Group I (13.4 ± 7.2 vs. 21.2 ± 9.6, p = 0.003). Creatine kinase MB level (ng/mL) was comparable between the groups. Echocardiographic parameters for right ventricle functions were also comparable between the groups during early as well as after 3 to 6 months postoperatively. Conclusion: Del Nido Cardioplegia is equally efficacious in providing myocardial protection during intracardiac repair under mild hypothermic cardiopulmonary bypass in Tetralogy of Fallot patients as compared to blood Cardioplegia solution with the added benefit of reducing inotropic requirement in first 24 hours postoperative period. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
42. Resistance towards nondepolarising muscle relaxants: prolonged onset time: A systematic review.
- Author
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Mørk, Emilie L., Kristensen, Mette L., Stokholm, Janne B., Söderström, Carl M., Madsen, Matias V., and Gätke, Mona R.
- Subjects
MUSCLE relaxants ,SURGICAL diseases ,VECURONIUM bromide ,PANCURONIUM (Drug) ,ROCURONIUM bromide - Abstract
Background: Nondepolarising muscle relaxants (NDMRs) provide optimal conditions for tracheal intubation and improve surgical conditions. Several clinical conditions, diseases and pharmacological interactions have been suggested to cause resistance towards NDMRs that may translate into difficult intubation or inadequate operating conditions during surgery.Objective: The aim of this study was to evaluate the current evidence of patient groups with resistance towards NDMRs. A prolonged onset time was defined as a difference that exceeded 25% compared with controls.Design: A systematic review of randomised controlled trials and cohort studies.Data Sources: A comprehensive search was performed in 2016 in PubMed and EMBASE.Eligibility Criteria: Patients with conditions or diseases, or patients taking medication, which lead to resistance towards current NDMRs (rocuronium, vecuronium, cisatracurium, atracurium, mivacurium and pancuronium). Included outcomes were onset time defined as the time between administration of NDMR to maximal (90, 95 or 100%) depression of baseline twitch height of the first twitch in a train-of-four.Results: Twenty-five studies were included. Strong evidence supports a prolonged onset time of rocuronium in patients with thermal injury and Duchenne muscular dystrophy. Moderate evidence supports a prolonged onset time of NDMRs during hypothermia and in patients with infection, oculopharyngeal muscular dystrophy, liver cirrhosis treated with ulinastatin, when remifentanil is administered prior to administration of an NDMR, in fasting patients being rehydrated intravenously prior to administration of NDMR, in children with end-stage renal failure and in patients with atrial or ventricular septal defects.Conclusion: A prolonged onset time should be suspected in patients with thermal injury and Duchenne's muscular dystrophy. Further, evidence supports a prolonged onset time in patients with infection, oculopharyngeal muscular dystrophy, congenital heart defects, kidney failure, liver cirrhosis treated with ulinastatin along with remifentanil or intravenous fluids administered prior to NDMR. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
43. Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review
- Author
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Qi Wang, Yun Lin, Yan Sun, Zhilin Wu, Shujun Sun, and Rui Chen
- Subjects
Laparoscopic surgery ,medicine.medical_treatment ,Pharmaceutical Science ,Review ,Sugammadex ,Robotic Surgical Procedures ,Pneumoperitoneum ,Drug Discovery ,medicine ,Humans ,Rocuronium ,Pharmacology ,Neuromuscular Blockade ,Vecuronium Bromide ,muscle relaxation remnants ,business.industry ,medicine.disease ,laparoscopic surgery ,deep neuromuscular blockade ,Muscle relaxation ,Anesthesia ,sugammadex ,Robot-Assisted Laparoscopic Surgery ,Laparoscopy ,Narrative review ,business ,Neuromuscular Nondepolarizing Agents ,medicine.drug - Abstract
High intra-abdominal pressure induced by artificial pneumoperitoneum can obviously impair respiratory and circulatory functions and has a negative effect on the prognosis of patients undergoing conventional and robot-assisted laparoscopic surgery. The application of deep neuromuscular blockade during the operation is reported to lower the intra-abdominal pressure and improve patients’ outcome. However, concern lies in the risks of postoperative residual muscular paralysis with the use of deep neuromuscular blockade. Sugammadex, a specific antagonist for aminosteroids muscle relaxants, can effectively and rapidly reverse rocuronium and vecuronium induced neuromuscular blockade of different depths. Thus, sugammadex allows the ability to safeguard the application of deep neuromuscular blockade in laparoscopic operations and helps to alleviate the adverse complications associated with pneumoperitoneum. Here, we review the application of deep neuromuscular blockade in different laparoscopic surgeries and discuss the benefits and possible risks of sugammadex administration in the reversal of deep neuromuscular blockade in these operations.
- Published
- 2021
44. Comparison of neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients
- Author
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Shilpa Bhimasen Joshi, K S Vasudeva Upadhyaya, and M Manjuladevi
- Subjects
Neostigmine ,neuromuscular monitoring ,obesity ,vecuronium bromide ,Anesthesiology ,RD78.3-87.3 - Abstract
Background and Aims: Obese patients are more vulnerable to residual neuromuscular block (NMB) and its associated complications in the post-operative period. This study was carried out to compare neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients, objectively using neuromuscular (NM) monitoring. Methods: Twenty female patients each belonging to normal weight, overweight and obese, based on body mass index, requiring general anaesthesia were recruited for this prospective cross sectional study. NMB was induced with vecuronium (0.1 mg/kg) dose based on patient′s real body weight (RBW) and monitored using acceleromyographic train of four (TOF). All patients received neostigmine 40 μg/kg and glycopyrrolate 10 μg/kg at 25% of spontaneous recovery of first twitch height (T1) of TOF (DUR 25%) and were allowed to recover to TOF ratio of 0.9. Statistical analysis was done using analysis of variance test. Results: Recovery of TOF ratio to 0.5 was comparable in all three groups. Recovery of TOF ratio to 0.7 was delayed in obese (9.82 ± 3.21 min) compared with normal weight group (7.50 ± 2.52 min). Recovery of TOF to 0.9 was significantly delayed in both overweight (12.18 ± 4.29 min) and obese patients (13.78 ± 4.30 min). DUR 25% was significantly longer in overweight (mean, standard deviation [range]; 30.10 [19-40 min]) and obese (28.8 [12-45 min]) compared with normal weight patients (22.75 [16-30 min]). Conclusion: In overweight and obese patients, when vecuronium induction dose is based on RBW, neostigmine induced recovery of NMB is delayed in late phases (TOF 0.7-0.9), which may result in vulnerability for associated complications of incomplete recovery. Ensuring safe recovery thus requires objective NM monitoring.
- Published
- 2015
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45. Physical compatibility of remimazolam with opioid analgesics, sedatives, and muscle relaxants during simulated Y-site administration
- Author
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Masayoshi Kondo, Naoki Yoshida, Mariko Yoshida, Chie Tanaka, Takashi Tagami, Kazumi Horikawa, Kazutoshi Sugaya, and Hisamitsu Takase
- Subjects
Pharmacology ,Vecuronium Bromide ,Health Policy ,Midazolam ,Muscles ,Sodium Chloride ,Anti-Bacterial Agents ,Analgesics, Opioid ,Drug Incompatibility ,Remifentanil ,Fentanyl ,Humans ,Hypnotics and Sedatives ,Rocuronium ,Infusions, Intravenous ,Dexmedetomidine - Abstract
Purpose There is a lack of information on the compatibility of remimazolam with opioid analgesics, muscle relaxants, and other sedatives. This study aimed to evaluate the physical compatibility of remimazolam with these drug classes. Methods Remimazolam was combined with 1 or 2 target drugs (remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam). Ten physical compatibility tests were conducted, including four 3-drug compatibility tests. Remimazolam was dissolved in 0.9% sodium chloride injection to a final concentration of 5 mg/mL. Other medications were diluted in 0.9% sodium chloride injection to obtain clinically relevant concentrations. Compatibility tests were conducted with 3 test solutions, wherein remimazolam and the target drugs were compounded at equal volume ratios (1:1 or 1:1:1). Visual appearance was assessed and testing of Tyndall effect, turbidity, and pH was performed immediately after mixing and then again 1 hour and 4 hours after mixing. Appearance and turbidity were evaluated by comparison with the control solution of each target drug diluted with 0.9% sodium chloride injection to the same concentration as the test solution. Results All drugs tested were determined to be compatible with remimazolam. The drug combination with the highest change of turbidity was remimazolam and vecuronium (a mean increase of 0.16 NTU relative to the remimazolam control solution), 4 hours after mixing. The combination with the highest pH was remimazolam, fentanyl, and vecuronium (mean [SD], 3.76 [0.01]), 4 hours after mixing. The combination of remimazolam and fentanyl showed a larger change in pH at 4 hours after mixing (a mean increase of 2.6%) than immediately after mixing. Conclusion Remifentanil, fentanyl, rocuronium, vecuronium, dexmedetomidine, and midazolam are physically compatible with remimazolam during simulated Y-site administration.
- Published
- 2022
46. Appropriate dosing of sugammadex for reversal of rocuronium-/vecuronium-induced muscle relaxation in morbidly obese patients: a meta-analysis of randomized controlled trials
- Author
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Jian-Qiang Liao, Darrell Shih, Tzu-Yu Lin, Meng Lee, and Cheng-Wei Lu
- Subjects
Vecuronium Bromide ,Muscle Relaxation ,Biochemistry (medical) ,Body Weight ,Cell Biology ,General Medicine ,Biochemistry ,Sugammadex ,Neuromuscular Blockade ,Humans ,Androstanols ,Obesity ,Rocuronium ,Neuromuscular Nondepolarizing Agents ,Randomized Controlled Trials as Topic ,gamma-Cyclodextrins - Abstract
Objective To conduct a meta-analysis to compare different dosing scalars of sugammadex in a morbidly obese population for reversal of neuromuscular blockade (NMB). Methods PubMed®, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar were searched for relevant randomized controlled trials (RCTs) comparing lower-dose sugammadex using ideal body weight (IBW) or corrected body weight (CBW) as dosing scalars with standard-dose sugammadex based on total body weight (TBW) among morbidly obese people after NMB. Mean difference with SD was used to estimate the results. Results The analysis included five RCT with a total of 444 morbidly obese patients. The reversal time was significantly longer in patients receiving sugammadex with dosing scalar based on IBW than in patients receiving sugammadex with dosing scalar based on TBW (mean difference 55.77 s, 95% confidence interval [CI] 32.01, 79.53 s), but it was not significantly different between patients receiving sugammadex with dosing scalars based on CBW versus TBW (mean difference 2.28 s, 95% CI –10.34, 14.89 s). Conclusion Compared with standard-dose sugammadex based on TBW, lower-dose sugammadex based on IBW had 56 s longer reversal time whereas lower-dose sugammadex based on CBW had a comparable reversal time.
- Published
- 2022
47. Laudanosine has No Effects on Respiratory Activity but Induces Non-Respiratory Excitement Activity in Isolated Brainstem-Spinal Cord Preparation of Neonatal Rats
- Author
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Sakuraba, Shigeki, Hosokawa, Yuki, Kaku, Yuki, Takeda, Junzo, Kuwana, Shun-ichi, Homma, Ikuo, editor, Onimaru, Hiroshi, editor, and Fukuchi, Yoshinosuke, editor
- Published
- 2010
- Full Text
- View/download PDF
48. Theoretical studies on the mechanism of sugammadex for the reversal of aminosteroid-induced neuromuscular blockade.
- Author
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Li, Linwei, Zhou, Yanan, Wang, Zhengjun, Wu, Chengjun, Li, Zhen, Sun, Changshan, and Sun, Tiemin
- Subjects
- *
SUGAMMADEX , *STEROIDS , *NEUROMUSCULAR system , *MOLECULAR dynamics , *QUANTUM mechanics , *VECURONIUM bromide - Abstract
The mechanism of action of sugammadex in reversing neuromuscular blockers (NMBs) was theoretically studied by extensive molecular modeling (molecular docking, molecular dynamic and molecular mechanics-quantum mechanics). The NMBs-sugammadex inclusion complex was established by an enthalpy-driven process, which stabilized by hydrophobic interaction, hydrogen bonding and electrostatic interaction between NMBs and sugammadex. Furthermore, the binding energy of NMBs-sugammadex indicated that vecuronium (∆ E = −25.29 kJ mol −1 ) had lower binding affinity to sugammadex than rocuronium (∆ E = −34.61 kJ mol −1 ), thus the former one would be more difficult to be reversed which was consist with the phenotype of clinical trials. Molecular electrostatic potential, natural bond orbital and frontier molecular orbitals were also utilized to give explanation for the discrepancy of interaction strength between rocuronium-sugammadex and vecuronium-sugammadex inclusion complexes. In summary, the molecular modeling study made it possible to explain the different reversal efficiency of NMBs by sugammadex, which could be used to predict the drug-receptor interactions during the design phase of novel compounds development and also provide great opportunity to design novel γ-cyclodextrin-based muscle relaxant antagonists. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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49. The Effect of 5-Hydroxytryptamine Receptor Antagonist in Preventing Pain/Limb Shrinkage Reaction Associated with Rocuronium Injection.
- Author
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He, Qixiong, Zhou, Chengmao, and Zhu, Yu
- Subjects
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MUSCULOSKELETAL system diseases , *ANALGESIA , *CELL receptors , *CONFIDENCE intervals , *EXTREMITIES (Anatomy) , *META-analysis , *PAIN , *VECURONIUM bromide , *SYSTEMATIC reviews , *RELATIVE medical risk , *TREATMENT effectiveness , *DISEASE incidence , *GENERAL anesthesia , *PREVENTION - Abstract
Objectives. To evaluate the effect and safety of 5-hydroxytryptamine (5-HT) receptor antagonist in alleviating the pain of patients under general anesthesia induced by rocuronium injection and preemptive analgesia. Methods. Meta-analysis was conducted with RevMan 5.1 software by electronically retrieving the databases of PubMed, Embase, the Cochrane Library, WanFang Data, and CNKI and collecting the published random control tests (RCTs) where 5-hydroxytryptamine receptor antagonist was used to alleviate the pain/limb shrinkage reaction associated with rocuronium injection. Results. Seven RTCs, including 556 patients, were included. The results of meta-analysis showed the following. (1) Compared to the control group, 5-HT receptor antagonist could prevent the total pain/limb shrinkage reaction associated with rocuronium injection [RR=0.62, 95% CI (0.54, 0.71), P<0.00001] and reduce the incidence rate of mild and moderate pain/limb shrinkage reaction associated with rocuronium injection [RR=0.46, 95% CI (0.33, 0.63), P<0.00001; RR=0.18, 95% CI (0.11, 0.31), P<0.000 01]. (2) Compared to the lidocaine group, the incidence rate was higher in preventing the pain/limb shrinkage reaction associated with rocuronium injection by 5-HT receptor antagonist, which was statistically significant [RR=1.33, 95% CI (1.05, 1.68), P=0.02]. Conclusion. 5-hydroxytryptamine receptor antagonist may be effective in preventing the pain/limb shrinkage reaction associated with rocuronium injection. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
50. Entamoeba histolytica L220 induces the in vitro activation of macrophages and neutrophils and is modulated by neurotransmitters.
- Author
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Del Rocío Villalobos-Gómez, Fabiola, García-Lorenzana, Mario, Escobedo, Galileo, Talamás-Rohana, Patricia, Salinas-Gutiérrez, Rogelio, Hernández-Ramírez, Verónica-Ivonne, Sánchez-Alemán, Esperanza, Del Rosario Campos-Esparza, María, Muñoz-Ortega, Martín Humberto, and Ventura-Juárez, Javier
- Subjects
ENTAMOEBA histolytica ,NEUTROPHILS ,MACROPHAGES ,EPINEPHRINE autoinjectors ,VECURONIUM bromide - Abstract
The neuroimmunoregulation of inflammation has been well characterized. Entamoeba histolytica provokes an inflammatory response in the host in which macrophages and neutrophils are the first line of defense. The aim of this study was to analyze the effect of the 220 kDa lectin of Entamoeba histolytica on stimulation of human macrophages and neutrophils, especially the secretion of cytokines and the relation of these to neurotransmitters. Human cells were interacted with L220, epinephrine, nicotine, esmolol and vecuronium bromide. The concentrations of IL-1β, IFN-γ, TNF-α and IL-10 were determined by ELISA at, 4 h of interaction. L220 has a cytokine stimulating function of macrophages and neutrophils for secretion of IL-1β, and IL-10 only by macrophages, which was modulated by the effect of vecuronium on cholinergic receptors in this immune cells. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
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