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profound neuromuscular blockade and surgery

Moira H D Bruintjes, Piet Krijtenburg, Chris H Martini, Paul P Poyck, Frank C H d'Ancona, Volkert A L Huurman, Michel van der Jagt, Johan F Langenhuijsen, Willemijn N Nijboer, Cornelis J H M van Laarhoven, Albert Dahan, Michiel C Warlé
BACKGROUND: Profound neuromuscular blockade (NMB) during anaesthesia has been shown to reduce postoperative pain scores, when compared with a moderate block. We hypothesised that profound NMB during laparoscopic donor nephrectomy (LDN) could also improve the early quality of recovery after surgery. OBJECTIVES: To compare the effectiveness of profound versus moderate NMB during LDN in enhancing postoperative recovery. DESIGN: A phase IV, double-blinded, randomised controlled trial...
March 27, 2019: European Journal of Anaesthesiology
Ozlem Ozmete, Cagla Bali, Oya Yalcin Cok, Hatice Evren Eker Turk, Nesrın Bozdogan Ozyilkan, Soner Civi, Anıs Aribogan
STUDY OBJECTIVE: To evaluate the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in infant patients. DESIGN: Retrospective observational study. SETTING: University teaching hospital. PATIENTS: Twenty-six infants (2-12 months of age; 3-11 kg) with an American Society of Anesthesiologists classification I, II, or III who were scheduled to undergo neurosurgical procedures were included in the study...
December 2016: Journal of Clinical Anesthesia
Vinit K Srivastava, Sanjay Agrawal, Vikrant K Nimbhorkar, Abhishek Mishra, Sunil Sharma, Prasanta K Panda
BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups...
March 2016: Brazilian Journal of Anesthesiology
Vinit K Srivastava, Sanjay Agrawal, Vikrant K Nimbhorkar, Abhishek Mishra, Sunil Sharma, Prasanta K Panda
BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups...
March 2016: Revista Brasileira de Anestesiologia
Rachel Eshima McKay, Kathryn T Hall, Nancy Hills
BACKGROUND: Nonintubated patients receiving sevoflurane have slower protective airway reflex recovery after anesthesia compared with patients receiving desflurane. We asked whether this difference would remain significant among intubated patients receiving rocuronium or whether the impact of variable neuromuscular recovery would predominate and thus minimize differences between anesthetics. METHODS: After obtaining written informed consent, patients were randomly assigned to receive sevoflurane (n = 41) or desflurane (n = 40), with neuromuscular monitoring by quantitative train-of-four (TOF) method using accelerometry...
February 2016: Anesthesia and Analgesia
Camila M de Souza, Maria A Tardelli, Helio Tedesco, Natalia N Garcia, Mario P Caparros, Jose A Alvarez-Gomez, Itamar S de Oliveira Junior
BACKGROUND: Renal failure affects the pharmacology of nondepolarizing neuromuscular blockers making recovery of neuromuscular function unpredictable. Sugammadex antagonises rocuronium-induced neuromuscular blockade by encapsulating rocuronium, creating a stable complex molecule that is mainly excreted by the kidneys. Previous studies suggest that sugammadex is effective in reversing moderate neuromuscular block in the presence of renal failure, but no data are available regarding reversal of profound neuromuscular block in patients with renal failure...
October 2015: European Journal of Anaesthesiology
Ramasamy Govindarajan, Ajay Shah, Vemuru Sunil Reddy, Vellore Parithivel, Saiganesh Ravikumar, Dave Livingstone
Intra-operative nerve monitoring (IONM) is rapidly becoming a standard of care in many institutions across the country. In the absence of neuromuscular blocking agents to facilitate the IONM, the depth of anesthesia required to abolish the laryngo tracheal reflexes often results in profound hemodynamic instability during surgery, necessitating the use of large doses of sympathomimetic amines. The excessive alpha and beta adrenergic effects exhibited by these agents are undesirable in the presence of cardiovascular co-morbidities...
April 2015: Journal of Clinical Medicine Research
Yasuyoshi Sakurai, Michiko Uchida, Junko Aiba, Fumiaki Mimura, Midori Yamaguchi, Masaya Kakumoto
BACKGROUND: We investigated whether sugammadex could reverse neuromuscular blockade induced by rocuronium in patients for cesarean delivery treated with magnesium sulfate preoperatively. METHODS: Twenty-three pregnant women received general anesthesia induced with thiopental and rocuronium. They were maintained by nitrous oxide, oxygen and sevoflurane (GOS) before delivery and after delivery by GOS, midazolam, and propofol. After the surgery, the patients with two or more counts of train-of-four (TOF), the moderate block group were classified into Mg (-) M and Mg (+) M, depending whether magnesium sulfate had been injected or not, and sugammadex 2 mg x kg(-1) was administered to both groups...
March 2014: Masui. the Japanese Journal of Anesthesiology
Michele Carron, Stefano Veronese, Mirto Foletto, Carlo Ori
BACKGROUND: Morbidly obese (MO) patients are at increased risk for postoperative anesthesia-related complications. We evaluated the role of sugammadex versus neostigmine in the quality of recovery from profound rocuronium-induced neuromuscular blockade (NMB) in patients with morbid obesity. METHODS: We studied 40 female MO patients who received desflurane and remifentanil anesthesia for laparoscopic removal of adjustable gastric banding. NMB was achieved with rocuronium...
October 2013: Obesity Surgery
Masakazu Shibusawa, Yutaka Ejima, Ryou Nishino, Hiroaki Toyama, Shin Kurosawa
Recently, rocuronium is being used in patients for caesarean section undergoing general anesthesia instead of suxamethonium. An increased dose of rocuronium improves intubating conditions but prolongs neuromuscular blockade. Sugammadex reverses rapidly and predictably even profound rocuronium-induced neuromuscular blockade. We experienced 13 cases of caesarean section patients undergoing general anesthesia with thiopental (3.5 mg x kg(-1)) and rocuronium (0.9 mg x kg(-1)). At the end of surgery, sugammadex (2 mg x kg(-1)) was administered every 3 minutes repeatedly until TOF>0...
August 2012: Masui. the Japanese Journal of Anesthesiology
V Pavoni, L Gianesello, G De Scisciolo, E Provvedi, D Horton, R Barbagli, P Conti, R Conti, F Giunta
BACKGROUND: Sugammadex is the first of a new class of selective relaxant binding drugs developed for the rapid and complete reversal of neuromuscular blockade (NMB) induced by the aminosteroid neuromuscular blocking drugs rocuronium and vecuronium. Neuromuscular blocking drugs block the transmission from the peripheral nerve to the muscle units, with reduction and disappearance of the evoked electromyographic activity. Usually, neuromuscular monitoring for the investigational reversal drug is performed by calibrated acceleromyography...
May 2012: Minerva Anestesiologica
P Van Lancker, B Dillemans, T Bogaert, J P Mulier, M De Kock, M Haspeslagh
To date, the dosing of sugammadex is based on real body weight without taking fat content into account. We compared the reversal of profound rocuronium-induced neuromuscular blockade in morbidly obese patients using doses of sugammadex based on four different weight corrections. One hundred morbidly obese patients, scheduled for laparoscopic bariatric surgery under propofol-sufentanil anaesthesia, were randomly assigned four groups: ideal body weight; ideal body weight + 20%; ideal body weight + 40%; and real body weight...
August 2011: Anaesthesia
Ira Makri, Artemisia Papadima, Aimilia Lafioniati, Apostolos B Pappas, Karanikas George, Koronakis E Nikolaos, Chrysikos D Ioannis, Seretis Charalambos, Lagoudianakis E Emmanuel, Theodoros Xanthos, Lila Papadimitriou
According to published data, sugammadex, rapidly reverses (2-5 min) shallow and profound NM block induced by rocuronium and vecuronium, without being connected with serious adverse events. It is accepted that in order to reverse shallow block, the suggested dose of sugammadex comes up to 2 mg/kg. Profound level of NM block demands 4 mg/kg in order to defy few responses at the post titanic count. Doses of sugammadex lower than 1 mg/kg may lead to rebound of rocuronium's effect. Higher doses of sugammadex (12 16 mg/g) are used in rescue reversal...
September 2011: Reviews on Recent Clinical Trials
T Suzuki, O Kitajima, K Ueda, Y Kondo, J Kato, S Ogawa
BACKGROUND: This study compared the reversibility of rocuronium-induced profound neuromuscular block with sugammadex in younger and older patients. METHODS: Fifteen younger (20-50 yr) and 15 older (≥70 yr) patients were sequentially enrolled in this study. After induction of anaesthesia and laryngeal mask insertion, contraction of the adductor pollicis muscle in response to ulnar nerve stimulation was quantified using acceleromyography during 1.0-1.5% end-tidal sevoflurane and remifentanil anaesthesia...
June 2011: British Journal of Anaesthesia
R M Williamson, S Mallaiah, P Barclay
BACKGROUND: Many anaesthetists use rocuronium in place of suxamethonium for rapid sequence induction (RSI). This is less common in obstetric anaesthesia as the duration of action of an effective dose of rocuronium exceeds most obstetric procedures. Sugammadex offers the possibility of rapidly reversing profound rocuronium neuromuscular blockade at the end of surgery. We aimed to determine whether rocuronium 1.2 mg/kg used for RSI in the obstetric population would provide good intubating conditions at 60 s and would be effectively reversed by sugammadex at the end of surgery...
July 2011: Acta Anaesthesiologica Scandinavica
Arezou Sadighi Akha, Joseph Rosa, Jonathan S Jahr, Alvin Li, Kianusch Kiai
Neuromuscular blocking agents are widely used in perioperative medicine to aid in endotracheal intubation, facilitate surgery, and in critical care/emergency medicine settings. Muscle relaxants have profound clinical uses in current surgical and intensive care and emergency medical therapy. This article reviews cyclodextrins, development of selective binding agents, clinical development, and future directions of sugammadex.
December 2010: Anesthesiology Clinics
Vincent Bonhomme, Pol Hans
PURPOSE OF REVIEW: The present review focuses on similarities and discrepancies in the management of emergent and elective unstable cervical spine (C-spine) patients. RECENT FINDINGS: During mobilization, lifting is superior to rolling in limiting spine movements. Before prone position surgery, the transfer of the patient on a rotating table is preferable to rolling. In trauma patients, helical computed tomography (CT) with sagittal reconstruction is the first choice for clearing the C-spine...
October 2009: Current Opinion in Anaesthesiology
Farshid Sarrafzadeh-Rezaei, R Eddie Clutton
OBJECTIVE: To evaluate the post-tetanic count (PTC) for predicting the return of reversible neuromuscular blockade at the n. facialis-m. nasolabialis (nF-mNL) and n. ulnaris-mm. carpi flexorii (nU-mCF) nerve-muscle units (NMUs) during profound vecuronium neuromuscular blockade in halothane-anaesthetized dogs. STUDY DESIGN: Randomized, prospective, experimental study. ANIMALS: Twenty-five dogs (seven male 18 female) undergoing surgery; mean age: 4...
May 2009: Veterinary Anaesthesia and Analgesia
Chingmuh Lee, Ronald L Katz
Although antiquated and long targeted for obsolescence, neostigmine and succinylcholine still serve the anesthesia community, decades after their inferior pharmacological profiles have been recognized. The need to quickly establish a good intubation condition with a relaxant that will recover rapidly is fundamental to safe anesthesia practice. So is the need to restore muscle power safely and quickly at the end of surgery, by reversing a residual neuromuscular block. Recent data have shown that sugammadex can safely and rapidly reverse profound neuromuscular block established by rocuronium and vecuronium...
March 2009: Journal of Critical Care
Farshid Sarrafzadeh-Rezaei, R Eddie Clutton
OBJECTIVE: To compare n. facialis-m. nasolabialis (nF-mNL) and n. ulnar-mm. carpi flexorii (nU-mCF) sensitivity to vecuronium during halothane or isoflurane anaesthesia. STUDY DESIGN: Randomized, prospective, experimental study. ANIMALS: Forty-four client-owned dogs (19 male, 25 female) undergoing surgery; mean age: 5.0 years; mean body mass: 24.7 kg. METHODS: Thirty minutes after acepromazine (0.05 mg kg(-1)) and morphine (0...
January 2009: Veterinary Anaesthesia and Analgesia
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