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Zhang Y, Ge G, Xu X, Wu J. Ensemble-Based Virtual Screening Led to the Discovery of Novel Lead Molecules as Potential NMBAs. Molecules 2024; 29:1955. [PMID: 38731447 PMCID: PMC11085220 DOI: 10.3390/molecules29091955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Neuromuscular blocking agents (NMBAs) are routinely used during anesthesia to relax skeletal muscle. Nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels; NMBAs can induce muscle paralysis by preventing the neurotransmitter acetylcholine (ACh) from binding to nAChRs situated on the postsynaptic membranes. Despite widespread efforts, it is still a great challenge to find new NMBAs since the introduction of cisatracurium in 1995. In this work, an effective ensemble-based virtual screening method, including molecular property filters, 3D pharmacophore model, and molecular docking, was applied to discover potential NMBAs from the ZINC15 database. The results showed that screened hit compounds had better docking scores than the reference compound d-tubocurarine. In order to further investigate the binding modes between the hit compounds and nAChRs at simulated physiological conditions, the molecular dynamics simulation was performed. Deep analysis of the simulation results revealed that ZINC257459695 can stably bind to nAChRs' active sites and interact with the key residue Asp165. The binding free energies were also calculated for the obtained hits using the MM/GBSA method. In silico ADMET calculations were performed to assess the pharmacokinetic properties of hit compounds in the human body. Overall, the identified ZINC257459695 may be a promising lead compound for developing new NMBAs as an adjunct to general anesthesia, necessitating further investigations.
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Affiliation(s)
- Yi Zhang
- School of Medicine, Nanjing University, Nanjing 210093, China
- Jiangsu Key Laboratory of Central Nervous System Drug Research and Development, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou 221116, China
| | - Gonghui Ge
- School of Pharmacy, China Medical University, Shenyang 110122, China
| | - Xiangyang Xu
- Jiangsu Key Laboratory of Central Nervous System Drug Research and Development, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou 221116, China
| | - Jinhui Wu
- School of Medicine, Nanjing University, Nanjing 210093, China
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Grillot N, Roquilly A. Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation Among Patients at Risk of Aspiration-Reply. JAMA 2023; 329:1518-1519. [PMID: 37129657 DOI: 10.1001/jama.2023.3497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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3
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Römer T, Büttner C, Ossowski R, Mutlak H, Muellenbach RM. Atemwegsmanagement in der Intensivmedizin – Schritt für Schritt. Pneumologie 2023; 77:37-46. [PMID: 36716795 DOI: 10.1055/a-1906-6984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Cvachovec K. Suxamethonium - is it still needed? ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Rapid Sequence Intubation Experiences in the Pediatric Emergency Department. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.1137449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Patient selection and management of rapid sequence intubation application in the emergency department can be challenging for clinicians. In this study, we aimed to describe the demographic information, clinical characteristics and medical conditions of the patients who underwent rapid sequence intubation in the children's emergency department of our hospital and to present patient management strategies.
Methods: Cases under the age of 18 who underwent rapid sequence intubation in the emergency department between January 2021 and January 2022 were retrospectively analyzed.
Results: 11 patients were included in the study. The median age of the patients was 6 years (min-max 2-15), 7 of them were girls (63,6%). The median time from symptom onset to presentation was 120 minutes (min-max 15 minutes-2 weeks). RSI indications were trauma (n=5), mass (n=4), ventriculoperitoneal shunt dysfunction (n=1), refractory status epilepticus (n=1). All patients had focal neurological deficits on examination. The median value of Glasgow coma scale scores of the patients was 8 (min-max 4-15). The first neuroimaging method was cranial tomography in ten (90.9%) patients. Intracranial hemorrhage was present in 45.4% (5 patients) of the patients. No complications were observed in any of the patients during rapid sequence intubation application. One patient each died due to intracranial hemorrhage and shunt dysfunction. Neurological deficits (dysarthria, gait disturbance, hemiparesis, visual impairment) were detected in five patients during their first month follow-up.
Conclusion: This retrospective study identified critically ill children who were admitted to the emergency department with acute neurological symptoms and underwent RSI to prevent increased intracranial pressure and further brain damage.
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Reinert LF, Herdtle S, Hohenstein C, Behringer W, Arrich J. Prähospitales Atemwegsmanagement in zwei deutschen Städten. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Zusammenfassung
Hintergrund und Fragestellung
In der prähospitalen Notfallmedizin ist ein erweitertes Atemwegsmanagement eine wichtige Fähigkeit für Notärzte und Notärztinnen . Sein Erfolg bestimmt die Komplikationen und die Sterblichkeit der Patient(inn)en. Ziel der Studie war es, das prähospitale erweiterte Atemwegsmanagement der bodengebundenen Rettungsdienste in zwei vergleichbaren deutschen Städten zu charakterisieren.
Material und Methoden
Retrospektive Analyse eines prähospitalen Atemwegsmanagementregisters (intubationsregister.de) im Jahr 2018, mit einem Vergleich der Patientenfaktoren, der Intubationssituation, der Charakteristika des Rettungsteams und des Rettungsdiensts in zwei mittelgroßen Städten in Deutschland.
Ergebnisse
Trotz ähnlicher Demografien und vergleichbarer Strukturen der Rettungsdienste fanden sich relevante Unterschiede in der Intubationssituation, dem Ausbildungsgrad der Notärzte und Notärztinnen, der Art der verwendeten Muskelrelaxanzien, der Verfügbarkeit der Videolaryngoskopie, dem Erfolg des ersten Intubationsversuchs und Komplikationen.
Diskussion
Eine strukturierte Erhebung des prähospitalen Atemwegsmanagements und ein Vergleich zwischen den Rettungsdiensten unterschiedlicher Städte können relevante Unterschiede aufzeigen und neue Ansatzpunkte für eine verbesserte Patientenversorgung bieten. Weitere Untersuchungen sind notwendig, um die Ergebnisse zu bestätigen und weitere Fragestellungen anschließen zu können.
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Ghosh S, Salhotra R, Arora G, Lyall A, Singh A, Kumar N, Chawla A, Gupta M. Implementation of a Revised Montpellier Bundle on the Outcome of Intubation in Critically Ill Patients: A Quality Improvement Project. Indian J Crit Care Med 2022; 26:1106-1114. [PMID: 36876213 PMCID: PMC9983673 DOI: 10.5005/jp-journals-10071-24332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
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 complied 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. How to cite this article Ghosh S, Salhotra R, Arora G, Lyall A, Singh A, Kumar N, et al. Implementation of a Revised Montpellier Bundle on the Outcome of Intubation in Critically Ill Patients: A Quality Improvement Project. Indian J Crit Care Med 2022;26(10):1106-1114.
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Affiliation(s)
- Supradip Ghosh
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Ripenmeet Salhotra
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Garima Arora
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Aditya Lyall
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Amandeep Singh
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Niranjan Kumar
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Aayush Chawla
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Meenakshi Gupta
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
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Tsolaki V, Zakynthinos GE, Papadonta ME, Bardaka F, Fotakopoulos G, Pantazopoulos I, Makris D, Zakynthinos E. Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients. J Pers Med 2022; 12:jpm12091538. [PMID: 36143323 PMCID: PMC9504585 DOI: 10.3390/jpm12091538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients’ self-inflicted lung injury. Moreover, NMBAs can harmonize the patient–ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the “war” conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS.
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Affiliation(s)
- Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
- Correspondence: ; Tel.: +30-2413502964
| | - George E. Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
- Third Department of Cardiology, Sotiria General Hospital, 11527 Athens, Greece
| | - Maria-Eirini Papadonta
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Fotini Bardaka
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - George Fotakopoulos
- Neurosurgical Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Ioannis Pantazopoulos
- Emergency Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Demosthenes Makris
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
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Tang L, Zhao X, Li S, Huang L, Li J, Chen L, Huang S. Impact of Succinylcholine vs. Rocuronium on Apnea Duration for Rapid Sequence Induction: A Prospective Cohort Study. Front Med (Lausanne) 2022; 9:717477. [PMID: 35223887 PMCID: PMC8864070 DOI: 10.3389/fmed.2022.717477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate the impact of 1.5 mg/kg succinylcholine or 1.2 mg/kg rocuronium, vs. 1.0 mg/kg succinylcholine on apnea duration in patients underwent rapid sequence induction (RSI). METHODS This prospective cohort study was conducted in the Department of Anesthesiology in Shanghai General Hospital from July 2020 to November 2020. Apnea duration was defined as the time from apnea prompted by the PETCO2 waveform to the time the point of oxygen saturation declined to 90% (T90) and 95% (T95) after succinylcholine or rocuronium administration. The primary outcome included T90 and T95 changes in 1.5 mg/kg vs. 1.0 mg/kg succinylcholine groups and 1.5 mg/kg succinylcholine vs. 1.2 mg/kg rocuronium groups. RESULTS A total of 265 participants were subjected for analysis. The succinylcholine (1.0 mg/kg) group had a significantly longer T90 (50.72, 95% confidence interval [CI, 7.60, 94.38], P = 0.015) and T95 (48.09, 95% CI [7.11, 89.07], P = 0.012) than the succinylcholine (1.5 mg/kg) group. In addition, significantly longer T90 (56.84, 95% CI [16.24, 97.44], P = 0.003) and T95 (50.57, 95% CI [12.58, 88.57], P = 0.003) were observed in the rocuronium (1.2 mg/kg) group than those in the succinylcholine (1.5 mg/kg) group. No severe side events were observed during the operation. CONCLUSION Rocuronium and the lower dose of succinylcholine may be recommended to patients underwent RSI.
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Affiliation(s)
- Lijun Tang
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Xiao Zhao
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shitong Li
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lina Huang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinbao Li
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lianhua Chen
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Shiwei Huang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Rutt AL, Torp KD, Zimmermann T, Warner P, Hofer R, Charnin JE, Ekbom D. Apneic Technique in Laryngotracheal Surgery. Cureus 2022; 14:e21584. [PMID: 35228942 PMCID: PMC8873441 DOI: 10.7759/cureus.21584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/05/2022] Open
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Almeida CEDD, Carvalho LRD, Andrade CVC, Nascimento PD, Barros GAMD, Modolo NSP. Effects of magnesium sulphate on the onset time of rocuronium at different doses: a randomized clinical trial. Braz J Anesthesiol 2021; 71:482-488. [PMID: 34403648 PMCID: PMC9373264 DOI: 10.1016/j.bjane.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/11/2022] Open
Abstract
Background and aims Rocuronium may provide excellent onset time, but high doses are required for effective action. Several strategies have managed to shorten rocuronium onset time, including the use of Magnesium Sulphate (MgSO4). Methods One hundred and eighty patients were randomized into six groups according to rocuronium dose received (0.3, 0.6 or 1.2 mg.kg-1) and the administration of saline or MgSO4 (60 mg.kg-1). Correlations between tissue perfusion and rocuronium onset time was determined by variations in perfusion index. Results Median (quartiles) rocuronium onset times were 85.5 (74.0–92.0); 76.0 (52.0–87.0) and 50.0 (41.0–59.5) seconds for 0.3, 0.6 mg.kg-1 and 1.2 mg.kg-1 doses, respectively. MgSO4 decreased rocuronium onset at doses of 0.3 mg.kg-1 (60.0 [48.0–74.3] seconds) and 0.6 mg.kg-1 (44.0 [39.0–49.0] seconds) but not at 1.2 mg.kg-1 (38.0 [33.5–56.3] seconds) (p < 0.001). Perfusion index variations in groups that received MgSO4 were greater than in controls. A negative correlation between shorten onset and increased perfusion index was observed in rocuronium doses of 0.3 mg.kg-1 (r = -0.50; p < 0.001) and 0.6 mg.kg-1 (r = -0.424; p < 0.001), but not for 1.2 mg.kg-1 dose (r = -0.25; p = 0.07). Conclusion MgSO4 reduces rocuronium onset time at doses of 0.3 mg.kg-1 and 0.6 mg.kg-1 being that the latter has a similar effect when compared to the dose of 1.2 mg.kg-1, with or without the use of MgSO4. Trial registry at http://www.ensaiosclinicos.gov.br/ Registry Number RBR-96CY3K
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Affiliation(s)
- Carlos Eduardo David de Almeida
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Programa de Pós-Graduação em Anestesiologia, Botucatu, SP, Brazil
| | | | - Carla Vasconcelos Caspar Andrade
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Programa de Pós-Graduação em Anestesiologia, Botucatu, SP, Brazil
| | - Paulo do Nascimento
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Divisão de Anestesiologia, Botucatu, SP, Brazil
| | | | - Norma Sueli Pinheiro Modolo
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Divisão de Anestesiologia, Botucatu, SP, Brazil
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Ruiz VR, Grande-Ratti MF, Martínez B, Midley A, Sylvestre V, Mayer GF. In-hospital mortality associated factors in elderly patients with invasive mechanical ventilation in the emergency department. ENFERMERIA INTENSIVA 2021; 32:145-152. [PMID: 34340950 DOI: 10.1016/j.enfie.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/04/2020] [Indexed: 10/20/2022]
Abstract
AIMS To identify factors associated with in-hospital mortality, to estimate the intubation rate and to describe in-hospital mortality in patients over 65 years old with invasive mechanical ventilation (IMV) in the emergency department (ED). METHODS Retrospective cohort study of patients over 65 years old, who were intubated in an ED of a high complexity hospital between 2016 and 2018. Demographic data, comorbidities, and severity scores on admission were described. Bivariate and multivariate analyses were performed with logistic regression according to mortality and possible confounders. RESULTS A total of 285 patients with a mean age of 80 years required IMV in the emergency department, for a median of 3 days, and with a mean APACHE II score of 20 points of severity. The IMV rate was .48% (95% CI .43-.54), and 55.44% (158) died. Mortality-associated factors after age and sex adjustment were stroke (OR 2.13; 95% CI 1.21-3.76), chronic kidney failure, (OR 4.,38; 95% CI 1.91-10.04), Charlson index (OR 1.19; 95% CI 1.02-1.38), APACHE II score (OR 1.07; 95% CI 1.02-1.12), and SOFA score (OR 1.14; 95% CI 1.03-1.27). DISCUSSION Our IMV rate was lower than that stated by Johnson et al. in the United States in 2018 (.59%). In-hospital mortality in our study exceeded that predicted by the APACHE II score (40%) and SOFA (33%). However it was consistent with that reported by Lieberman et al. in Israel and Esteban et al. in the United States. CONCLUSIONS Although the IMV rate was low in the ED, more than half the patients died during hospitalization. Pre-existing cerebrovascular and renal diseases and high results in the comorbidities index and severity scores on admission were independent factors associated with in-hospital mortality.
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Affiliation(s)
- V R Ruiz
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M F Grande-Ratti
- Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - B Martínez
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Midley
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Sylvestre
- Central de Emergencias del Adulto, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G F Mayer
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Sun H, Jin T, Wu X, Yang L, Zuo Y, Liao R. Efficacy of magnesium sulfate as an adjuvant to rocuronium in general anaesthesia: a meta-analysis. J Int Med Res 2021; 49:3000605211027736. [PMID: 34311594 PMCID: PMC8320568 DOI: 10.1177/03000605211027736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective Magnesium sulfate is considered to be an effective adjuvant to rocuronium in general anaesthesia. We conducted a meta-analysis to clarify its efficacy. Methods We searched the PubMed, Embase, Web of Science, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) of magnesium sulfate as an adjuvant to rocuronium from the start of the database establishment until May 2020. Results Eleven RCTs were analysed. The pooled meta-analysis showed that using magnesium sulfate as an adjuvant significantly shortened the onset time and prolonged the clinical duration of neuromuscular blockade by rocuronium compared with the control group without magnesium sulfate. However, there was no significant difference in recovery index of neuromuscular block between the magnesium and control groups. Furthermore, magnesium sulfate significantly increased the rates of excellent and clinically acceptable intubation conditions. Conclusion Adding magnesium sulfate to rocuronium during general anaesthesia can alter the neuromuscular parameters, including shortening the anaesthesia-onset time and prolonging the clinical duration, without significantly increasing the recovery time. Pretreatment with magnesium sulfate may also improve intubation conditions during general anaesthesia.
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Affiliation(s)
- Haiyan Sun
- Department of Anaesthesiology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Tao Jin
- Department of Anaesthesiology, Cangzhou Integrated Traditional Chinese and Western Medicine Hospital, Cangzhou, Hebei, China
| | - Xiping Wu
- Department of Anaesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lei Yang
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Zuo
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ren Liao
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Levin NM, Fix ML, April MD, Arana AA, Brown CA. The association of rocuronium dosing and first-attempt intubation success in adult emergency department patients. CAN J EMERG MED 2021; 23:518-527. [PMID: 33837951 DOI: 10.1007/s43678-021-00119-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The recommended rocuronium dose for rapid sequence intubation is 1.0 mg/kg; however, the optimal dose for emergency airway management is not clear. We assessed the relationship between rocuronium dose and first-attempt success among emergency department (ED) patients undergoing rapid sequence intubation. METHODS This is a secondary analysis of the National Emergency Airway Registry (NEAR), an observational 25-center registry of ED intubations. Ninety percent recording compliance was required from each site for data inclusion. We included all patients > 14 years of age who received rocuronium for rapid sequence intubation from 1 Jan 2016 to 31 Dec 2018. We compared first-attempt success between encounters using alternative rocuronium doses (< 1.0, 1.0-1.1, 1.2-1.3 and ≥1.4 mg/kg). We performed logistic regressions to control for predictors of difficult airways, indication, pre-intubation hemodynamics, operator, body habitus and device. We also performed subgroup analyses stratified by device (direct vs. video laryngoscopy). We calculated univariate descriptive statistics and odds ratios (OR) from multivariable logistic regressions with cluster-adjusted 95% confidence intervals (CI). RESULTS 19,071 encounters were recorded during the 3-year period. Of these, 8,034 utilized rocuronium for rapid sequence intubation. Overall, first attempt success was 88.4% for < 1.0 mg/kg, 88.1% for 1.0-1.1 mg/kg, 89.7% for 1.2-1.3 mg/kg, and 92.2% for ≥1.4 mg/kg. Logistic regression demonstrated that when direct laryngoscopy was used and when compared to the standard dosing range of 1.0-1.1 mg/kg, the adjusted odds of a first attempt success was significantly higher in ≥1.4 mg/kg group at 1.9 (95% CI 1.3-2.7) relative to the other dosing ranges, OR 0.9 (95% CI 0.7-1.2) for < 1.0 mg/kg and OR 1.2 (95% CI 0.9-1.7) for the 1.2-1.3 mg/kg group. First-attempt success was similar across all rocuronium doses among patients utilizing video laryngoscopy. Patients who were hypotensive (SBP < 100 mmHg) prior to intubation had higher first-attempt success 94.9% versus 88.6% when higher doses of rocuronium were used. The rates of all peri-intubation adverse events and desaturation were similar between dosing groups, laryngoscope type utilized and varying pre-intubation hemodynamics. CONCLUSIONS Rocuronium dosed ≥1.4 mg/kg was associated with higher first attempt success when using direct laryngoscopy and among patients with pre-intubation hypotension with no increase in adverse events. We recommend further prospective evaluation of the dosing of rocuronium prior to offering definitive clinical guidance.
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Affiliation(s)
- Nicholas M Levin
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
| | - Megan L Fix
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael D April
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Allyson A Arana
- The United Stated Army Institute of Surgical Research, San Antonio, TX, USA
| | - Calvin A Brown
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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West JR, O'Keefe BP, Russell JT. Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation. Trauma Surg Acute Care Open 2021; 6:e000588. [PMID: 34263062 PMCID: PMC8246356 DOI: 10.1136/tsaco-2020-000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The predictors of first pass success (FPS) without hypoxemia among trauma patients requiring rapid sequence intubation (RSI) in the emergent setting are unknown. Methods Retrospective study of adult trauma patients requiring RSI during a 5-year period comparing the trauma patients achieving FPS without hypoxemia to those who did not. The primary outcome was FPS without hypoxemia evaluated by multivariate logistic regression adjusting for the neuromuscular blocking agent used (succinylcholine or rocuronium), hypoxemia prior to RSI, Glasgow Coma Scale (GCS) scores, the presence of head or facial trauma, and intubating operator level of training. Results 246 patients met our inclusion criteria. The overall FPS rate was 89%, and there was no statistical difference between those receiving either paralytic agent. 167 (69%) patients achieved FPS without hypoxemia. The two groups (those achieving FPS without hypoxemia and those who did not) had similar mean GCS, mean Injury Severity Scores, presence of head or facial trauma, the presence of penetrating trauma, intubating operator-level training, use of direct laryngoscopy, hypoxemia prior to RSI, heart rate per minute, mean systolic blood pressure, and respiratory rate. In the multivariate regression analysis, the use of succinylcholine and GCS score of 13–15 were found to have adjusted ORs of 2.1 (95% CI 1.2 to 3.8) and 2.0 (95% CI 1.0 to 3.3) for FPS without hypoxemia, respectively. Conclusion Trauma patients requiring emergency department RSI with high GCS score and those who received succinylcholine had higher odds of achieving FPS without hypoxemia, a patient safety goal requiring more study. Level of evidence IV. Study type Prognostic.
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Affiliation(s)
- Jason Randall West
- Emergency Medicine, NYC Health + Hospitals / Lincoln, Bronx, New York, USA
| | - Brandon P O'Keefe
- Emergency Medicine, NYC Health + Hospitals / Lincoln, Bronx, New York, USA.,Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - James T Russell
- Emergency Medicine, NYC Health + Hospitals / Lincoln, Bronx, New York, USA
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16
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Avery P, Morton S, Raitt J, Lossius HM, Lockey D. Rapid sequence induction: where did the consensus go? Scand J Trauma Resusc Emerg Med 2021; 29:64. [PMID: 33985541 PMCID: PMC8116824 DOI: 10.1186/s13049-021-00883-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.
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Affiliation(s)
- Pascale Avery
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Sarah Morton
- Essex & Herts Air Ambulance, Flight House, Earls Colne, Colchester, Essex, CO6 2NS, UK
| | - James Raitt
- Thames Valley Air Ambulance Stokenchurch House, Oxford Rd, Stokenchurch, High Wycombe, HP14 3SX, UK
| | | | - David Lockey
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.,Blizard Institute, Queen Mary University, Whitechapel, London, E1 2AT, UK
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17
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Grillot N, Garot M, Lasocki S, Huet O, Bouzat P, Le Moal C, Oudot M, Chatel-Josse N, El Amine Y, Danguy des Déserts M, Bruneau N, Cinotti R, David JS, Langeron O, Minville V, Tching-Sin M, Faurel-Paul E, Lerebourg C, Flattres-Duchaussoy D, Jobert A, Asehnoune K, Feuillet F, Roquilly A. Assessment of remifentanil for rapid sequence induction and intubation in patients at risk of pulmonary aspiration of gastric contents compared to rapid-onset paralytic agents: study protocol for a non-inferiority simple blind randomized controlled trial (the REMICRUSH study). Trials 2021; 22:237. [PMID: 33785069 PMCID: PMC8009075 DOI: 10.1186/s13063-021-05192-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background Rapid-onset paralytic agents are recommended to achieve muscle relaxation and facilitate tracheal intubation during rapid sequence induction in patients at risk of pulmonary aspiration of gastric contents. However, opioids are frequently used in this setting. The study’s objective is to demonstrate the non-inferiority of remifentanil compared to rapid-onset paralytic agents, in association with an hypnotic drug, for tracheal intubation in patients undergoing procedure under general anesthesia and at risk of pulmonary aspiration of gastric contents. Methods The REMICRUSH (Remifentanil for Rapid Sequence Induction of Anaesthesia) study is a multicenter, single-blinded, non-inferiority randomized controlled trial comparing remifentanil (3 to 4 μg/kg) with rapid-onset paralytic agents (succinylcholine or rocuronium 1 mg/kg) for rapid sequence induction in 1150 adult surgical patients requiring tracheal intubation during general anesthesia. Enrolment started in October 2019 in 15 French anesthesia units. The expected date of the final follow-up is October 2021. The primary outcome is the proportion of successful tracheal intubation without major complications. A non-inferiority margin of 7% was chosen. Analyses of the intent-to-treat and per-protocol populations are planned. Discussion The REMICRUSH trial protocol has been approved by the ethics committee of The Comité de Protection des Personnes Sud-Ouest et Outre-Mer II and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals. The REMICRUSH trial is the first randomized controlled trial powered to investigate whether remifentanil with hypnotics is non-inferior to rapid-onset paralytic agents with hypnotic in rapid sequence induction of anesthesia for full stomach patients considering successful tracheal intubation without major complication. Trial registration ClinicalTrials.gov NCT03960801. Registered on May 23, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05192-x.
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Affiliation(s)
- Nicolas Grillot
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France.
| | - Matthias Garot
- CHU de Lille, Pole Anesthésie Réanimation, Hôpital Claude Huriez, Lille, France
| | - Sigismond Lasocki
- Université d'Angers, CHU d'Angers, Département Anesthésie Réanimation, Angers, F-49933, France
| | - Olivier Huet
- Anaesthesia, and Intensive Care Unit, Brest Regional University Hospital, Brest, France
| | - Pierre Bouzat
- Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France
| | - Charlène Le Moal
- Anaesthesia and Intensive Care Unit, Le Mans Public Hospital, Le Mans, France
| | - Mathieu Oudot
- Anaesthesia Unit, Vendée District Hospital Center, La Roche-sur-Yon, France
| | | | - Younes El Amine
- Anaesthesia Unit, Valenciennes Public Hospital, Valenciennes, France
| | | | - Nathalie Bruneau
- Anaesthesia and Intensive Care Unit, Lille Regional University Hospital, Lille, France
| | - Raphael Cinotti
- CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Guillaume et René Laennec, Université de Nantes, Saint-Herblain, 44800, France
| | - Jean-Stéphane David
- Hospices Civils de Lyon, Lyon Sud Regional University Hospital, Anaesthesia and Intensive Care Unit, Lyon, France
| | - Olivier Langeron
- Anaesthesia and Intensive Care Unit, Henri-Mondor University Hospital (AP-HP), Créteil, France
| | - Vincent Minville
- Anaesthesia and Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | | | - Elodie Faurel-Paul
- Department of Clinical Research, Nantes University Hospital, Nantes, France
| | - Céline Lerebourg
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
| | - Delphine Flattres-Duchaussoy
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
| | - Alexandra Jobert
- Department of Clinical Research, Nantes University Hospital, Nantes, France
| | - Karim Asehnoune
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
| | - Fanny Feuillet
- Nantes University Hospital, Methodology and Biostatistics Platform, Department of Clinical Research, Nantes, France.,Nantes University, INSERM, SPHERE U1246, Nantes, France
| | - Antoine Roquilly
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
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18
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Li G, Cheng L, Wang J. Comparison of Rocuronium with Succinylcholine for Rapid Sequence Induction Intubation in the Emergency Department: A Retrospective Study at a Single Center in China. Med Sci Monit 2021; 27:e928462. [PMID: 33441534 PMCID: PMC7814511 DOI: 10.12659/msm.928462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This retrospective study was conducted at a single center in China and aimed to compare rocuronium with succinylcholine for rapid sequence induction intubation in the Emergency Department of a hospital. MATERIAL AND METHODS An orotracheal intubation procedure was performed in a total of 267 patients by direct laryngoscopy using an intravenous bolus injection of 1 mg/kg of succinylcholine (n=141; SY group) or 1.2 mg/kg of rocuronium (n=126; RM group) for a rapid sequence induction in the emergency department. The success of orotracheal intubation was evaluated by a capnography curve. The modified Cormack-Lehane score was used to grade the direct laryngoscopy. RESULTS There was no statistically significant difference in numbers of patients with successful first-attempt orotracheal intubation between the groups (112 vs. 87, P=0.067). Fewer intubation failures under direct laryngoscopy were reported in the SY group than in the RM group (23 [16%] vs. 34 [27%], P=0.037). The number of intubation attempts was higher in the RM group than in the SY group (1.52±0.87 per patient vs. 1.27±0.60 per patient, P=0.032). CONCLUSIONS The findings from this study support results from previous studies, showing that even in the Emergency Department setting, rocuronium was equivalent to succinylcholine in achieving rapid sequence induction intubation, when the dose was appropriate. However, as current clinical guidelines highlight, succinylcholine has more contraindications and adverse effects, including hyperkalemia, which should be monitored, and rocuronium has a longer duration of action.
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Affiliation(s)
- Gui Li
- Department of Anesthesiology, Dangyang People's Hospital, Dangyang, Hubei, China (mainland)
| | - Lin Cheng
- Department of Anesthesiology, Yichang Central People's Hospital and The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China (mainland)
| | - Jianke Wang
- Department of Anesthesiology, Dangyang People's Hospital, Dangyang, Hubei, China (mainland)
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19
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Fiorelli S, Menna C, Piccioni F, Ibrahim M, Rendina EA, Rocco M, Massullo D. The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak. J Cardiothorac Vasc Anesth 2020; 34:3203-3210. [PMID: 32631666 PMCID: PMC7276138 DOI: 10.1053/j.jvca.2020.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Piccioni
- Department of Critical Care and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
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20
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Patel S, Wali A. Airway Management of the Obstetric Patient. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Kunhahamed MO, Thomas VK, Abraham SV, Palatty BU, Kallivalappil SC. Survival following intentional succinylcholine injection for self-harm. Turk J Emerg Med 2020; 20:193-195. [PMID: 33089028 PMCID: PMC7549520 DOI: 10.4103/2452-2473.297468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022] Open
Abstract
Succinylcholine is a short-acting depolarizing neuromuscular blocking agent. We describe a case where the above drug was employed for self-harm by a health-care worker. The patient, a 28-year-old female, was brought to the emergency department (ED) in impending respiratory arrest and altered mental status. On arrival, she had hypoxia, bradycardia, and hypotension. Although the cause for rapid deterioration in this patient was unknown, the ED physician still went ahead by resuscitating the patient's airway, breathing, and circulation. During the course of resuscitation, information was received that an empty ampoule of succinylcholine was recovered from her bathroom. Further clinical examination and laboratory investigations led the treating physicians to suspect deliberate intravenous injection of succinylcholine. She was mechanically ventilated and monitored in the critical care unit. Targeted temperature management was initiated in the ED and was continued for 24 h. The patient was discharged from the hospital without any neurological deficits after 4 days. Patients with acute poisoning are one of the major encounters in ED, and this case highlights the possibility of anesthetic drug misuse in any health-care workers coming to the ED with sudden cardiac arrest, altered sensorium, or abnormal vitals. This is the first report describing the survival of a patient following intentional succinylcholine injection for self-harm.
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Affiliation(s)
- Meenhas Oravil Kunhahamed
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Vimal Koshy Thomas
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Siju Varghese Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Babu Urumese Palatty
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Shibu C Kallivalappil
- Department of Anaesthesiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
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22
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Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F, Hirshberg EL, Slonim A, Dezfulian C. Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists. Pediatr Crit Care Med 2020; 21:607-619. [PMID: 32420720 PMCID: PMC7331597 DOI: 10.1097/pcc.0000000000002429] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN Narrative review/perspective. SETTING Not applicable. PATIENTS Not applicable. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.
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Affiliation(s)
- Kenneth E Remy
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Philip A Verhoef
- Department of Internal Medicine, University of Hawaii-Manoa, Manoa, HI
- Kaiser Permanente Hawaii, Honolulu, HI
| | - Jay R Malone
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Michael D Ruppe
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Norton Healthcare, University of Louisville, Louisville, KY
| | - Timothy B Kaselitz
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Frank Lodeserto
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, PA
- Department of Pediatrics, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Eliotte L Hirshberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine and Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Anthony Slonim
- University of Nevada, Reno School of Medicine, Renown Health System, Reno, NV
| | - Cameron Dezfulian
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
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23
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Turhanoğlu S, Tunç M, Okşar M, Temiz M. Perioperative Effects of Induction with High-dose Rocuronium during Laparoscopic Cholecystectomy. Turk J Anaesthesiol Reanim 2020; 48:188-195. [PMID: 32551445 PMCID: PMC7279866 DOI: 10.5152/tjar.2019.31855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/20/2019] [Indexed: 12/02/2022] Open
Abstract
Objective We aimed to investigate the effects of high-dose rocuronium administration on intra-abdominal pressure (IAP) and surgical conditions during anaesthesia induction and laparoscopic cholecystectomy anaesthesia induction, respectively. Further, we aimed to determine postoperative nausea and vomiting (PONV) and pain scores following the laparoscopic cholecystectomy. Methods Patients with American Society of Anesthesiologists (ASA) score of I–III, aged 18 to 75 years and who were scheduled for surgery under general anaesthesia were included in the study. Patients were randomised and a high-dose of 1.2 mg kg−1 rocuronium was given to Group A and 0.6 mg kg−1 rocuronium to Group B. The intraoperative train of four (TOF) ratio and post-tetanic count (PTC) were measured. Surgery was initiated with a low IAP of 7 mmHg. The surgeon evaluated surgical conditions with a 4-step surgical field scale and increased the IAP when necessary. PONV at 4, 12 and 24 hours and postoperative pain at 2 and 24 hours and 3 days were evaluated. Results There were no significant differences in the demographic and haemodynamic parameters between the groups. In high-dose rocuronium Group A, IAP values were significantly lower in the first 20 minutes compared to Group B. The duration of operations was significantly shorter in Group A (29.00±7.39 minute vs. 34.63±12.00 minute, p=0.044). PONV in the first 12 hours was significantly lower in Group A (p<0.05). Conclusion High-dose rocuronium-induced deep neuromuscular block helped perform laparoscopic cholecystectomy operations with lower values of IAP compared to a normal dose rocuronium. It also shortened duration of operation and reduced PONV and pain.
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Affiliation(s)
- Selim Turhanoğlu
- Department of Anaesthesiology and Intensive Care, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Mehmet Tunç
- Department of Anaesthesiology and Intensive Care, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Menekşe Okşar
- Department of Anaesthesiology and Intensive Care, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Muhyittin Temiz
- Department of General Surgery, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey
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24
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Renew JR, Ratzlaff R, Hernandez-Torres V, Brull SJ, Prielipp RC. Neuromuscular blockade management in the critically Ill patient. J Intensive Care 2020; 8:37. [PMID: 32483489 PMCID: PMC7245849 DOI: 10.1186/s40560-020-00455-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022] Open
Abstract
Neuromuscular blocking agents (NMBAs) can be an effective modality to address challenges that arise daily in the intensive care unit (ICU). These medications are often used to optimize mechanical ventilation, facilitate endotracheal intubation, stop overt shivering during therapeutic hypothermia following cardiac arrest, and may have a role in the management of life-threatening conditions such as elevated intracranial pressure and status asthmaticus (when deep sedation fails or is not tolerated). However, current NMBA use has decreased during the last decade due to concerns of potential adverse effects such as venous thrombosis, patient awareness during paralysis, development of critical illness myopathy, autonomic interactions, and even residual paralysis following cessation of NMBA use. It is therefore essential for clinicians to be familiar with evidence-based practices regarding appropriate NMBA use in order to select appropriate indications for their use and avoid complications. We believe that selecting the right NMBA, administering concomitant sedation and analgesic therapy, and using appropriate monitoring techniques mitigate these risks for critically ill patients. Therefore, we review the indications of NMBA use in the critical care setting and discuss the most appropriate use of NMBAs in the intensive care setting based on their structure, mechanism of action, side effects, and recognized clinical indications. Lastly, we highlight the available pharmacologic antagonists, strategies for sedation, newer neuromuscular monitoring techniques, and potential complications related to the use of NMBAs in the ICU setting.
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Affiliation(s)
- J Ross Renew
- 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Robert Ratzlaff
- 2Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL USA
| | - Vivian Hernandez-Torres
- 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Sorin J Brull
- 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA.,3Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN USA
| | - Richard C Prielipp
- 3Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN USA
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Sorbello M, Di Giacinto I, Corso RM, Cataldo R. Prevention is better than the cure, but the cure cannot be worse than the disease: fibreoptic tracheal intubation in COVID-19 patients. Br J Anaesth 2020; 125:e187-e188. [PMID: 32386832 PMCID: PMC7183937 DOI: 10.1016/j.bja.2020.04.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022] Open
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Chalermkitpanit P, Rodanant O, Thaveepunsan W, Assavanop S. Determination of dose and efficacy of atracurium for rapid sequence induction of anesthesia: A randomised prospective study. J Anaesthesiol Clin Pharmacol 2020; 36:37-42. [PMID: 32174655 PMCID: PMC7047700 DOI: 10.4103/joacp.joacp_36_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 08/28/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Succinylcholine and high dose rocuronium are neuromuscular blocking agents commonly used for rapid sequence induction of anesthesia. Their usage is limited or contraindicated in some circumstances. The aim of this study is to determine the dosage and efficacy of atracurium without priming for rapid sequence induction of anesthesia. Material and Methods: One hundred fifteen surgical patients under general anesthesia were randomised into three groups. All patients were given 2-3 mg/kg propofol and 1 μg/kg fentanyl intravenously for the induction of anesthesia followed by different doses of atracurium (0.6 mg/kg, 0.75 mg/kg or 1 mg/kg) without a priming dose. Tracheal intubation was performed within one minute after the administration of the study drugs. The intubating conditions, vocal cord movement and diaphragm movement were graded as the primary endpoints. Statistical analysis was done using one-way analysis of variance (ANOVA) and Post Hoc tests. Results: Atracurium doses of 1 mg/kg, 0.75 mg/kg, and 0.6 mg/kg provided 51.4%, 43.6% and 26.3% success rates of intubation without coughing or bucking, respectively (P = 0.03). The intubating conditions were graded as excellent or good in 86.5% of the 1 mg/kg atracurium group patients and in 84.6% of the 0.75 mg/kg group patients (P < 0.05). An atracurium dose of 1 mg/kg facilitated significant differences in vocal cord and diaphragm paralysis compared with the dose of 0.6 mg/kg (P = 0.03). Conclusion: The administration of a relatively high dose of atracurium without priming can be used as an alternative neuromuscular blocking agent for rapid sequence induction of anesthesia in some circumstances.
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Affiliation(s)
- Pornpan Chalermkitpanit
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Oraluxna Rodanant
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Winnie Thaveepunsan
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sireedhorn Assavanop
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Guihard B, Chollet-Xémard C, Lakhnati P, Vivien B, Broche C, Savary D, Ricard-Hibon A, Marianne dit Cassou PJ, Adnet F, Wiel E, Deutsch J, Tissier C, Loeb T, Bounes V, Rousseau E, Jabre P, Huiart L, Ferdynus C, Combes X. Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation: A Randomized Clinical Trial. JAMA 2019; 322:2303-2312. [PMID: 31846014 PMCID: PMC6990819 DOI: 10.1001/jama.2019.18254] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Rocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Succinylcholine use has been associated with several adverse events not reported with rocuronium. OBJECTIVE To assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations. DESIGN, SETTING AND PARTICIPANTS Multicenter, single-blind, noninferiority randomized clinical trial comparing rocuronium (1.2 mg/kg) with succinylcholine (1 mg/kg) for rapid sequence intubation in 1248 adult patients needing out-of-hospital tracheal intubation. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. The date of final follow-up was August 31, 2016. INTERVENTIONS Patients were randomly assigned to undergo tracheal intubation facilitated by rocuronium (n = 624) or succinylcholine (n = 624). MAIN OUTCOMES AND MEASURES The primary outcome was the intubation success rate on first attempt. A noninferiority margin of 7% was chosen. A per-protocol analysis was prespecified as the primary analysis. RESULTS Among 1248 patients who were randomized (mean age, 56 years; 501 [40.1%] women), 1230 (98.6%) completed the trial and 1226 (98.2%) were included in the per-protocol analysis. The number of patients with successful first-attempt intubation was 455 of 610 (74.6%) in the rocuronium group vs 489 of 616 (79.4%) in the succinylcholine group, with a between-group difference of -4.8% (1-sided 97.5% CI, -9% to ∞), which did not meet criteria for noninferiority. The most common intubation-related adverse events were hypoxemia (55 of 610 patients [9.0%]) and hypotension (39 of 610 patients [6.4%]) in the rocuronium group and hypoxemia (61 of 616 [9.9%]) and hypotension (62 of 616 patients [10.1%]) in the succinylcholine group. CONCLUSIONS AND RELEVANCE Among patients undergoing endotracheal intubation in an out-of-hospital emergency setting, rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02000674.
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Affiliation(s)
- Bertrand Guihard
- Department of Emergency, CHU de la Réunion, Allée des Topazes, Saint Denis, Réunion, France
| | - Charlotte Chollet-Xémard
- Groupe Hospitalo-Universitaire Henri Mondor, SAMU 94, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - Benoit Vivien
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - Claire Broche
- Département d'Anesthésie-Réanimation-SMUR, Hôpital Universitaire Lariboisière, AP-HP, Paris, France
| | - Dominique Savary
- Emergency Department, General Hospital of Annecy, Annecy, France
| | | | | | - Frédéric Adnet
- AP-HP, Urgences-SAMU 93, Unité Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, France
| | - Eric Wiel
- Univ Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
- French National Out-of-Hospital Cardiac Arrest Registry Research Group - Registre électronique des Arrêts Cardiaques, Lille, France
- Emergency Medicine Department and SAMU 59, Lille University Hospital, Lille, France
| | - Juliette Deutsch
- Department of Emergency Medicine, Groupe Hospitalier Broca Cochin Hôtel-Dieu, Paris, France
| | - Cindy Tissier
- Department of Emergency Medicine, University Hospital Dijon, Dijon, France
| | - Thomas Loeb
- Raymond Poincaré Hospital (APHP), SAMU 92, Paris, France
| | - Vincent Bounes
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse, France
- INSERM UMR 1027, Université Paul Sabatier, Toulouse, France
| | - Emmanuel Rousseau
- Services de Médecine d’Urgence et de Réanimation, Pôle Urgence Réanimation, SAMU 77, Melun, France
| | - Patricia Jabre
- AP-HP, Service d'Aide Médicale d'Urgence (SAMU) de Paris and Paris Sudden Death Expertise Center, Université Paris Descartes, Paris, France
| | - Laetitia Huiart
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Cyril Ferdynus
- Departement d'Informatique Clinique, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Xavier Combes
- Department of Emergency, CHU de la Réunion, Université de la Réunion, Réunion, France
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Birenbaum A, Hajage D, Roche S, Ntouba A, Eurin M, Cuvillon P, Rohn A, Compere V, Benhamou D, Biais M, Menut R, Benachi S, Lenfant F, Riou B. Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. JAMA Surg 2019; 154:9-17. [PMID: 30347104 DOI: 10.1001/jamasurg.2018.3577] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The use of cricoid pressure (Sellick maneuver) during rapid sequence induction (RSI) of anesthesia remains controversial in the absence of a large randomized trial. Objective To test the hypothesis that the incidence of pulmonary aspiration is not increased when cricoid pressure is not performed. Design, Setting, and Participants Randomized, double-blind, noninferiority trial conducted in 10 academic centers. Patients undergoing anesthesia with RSI were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge (last follow-up, February 8, 2017). Interventions Patients were assigned to a cricoid pressure (Sellick group) or a sham procedure group. Main Outcomes and Measures Primary end point was the incidence of pulmonary aspiration (at the glottis level during laryngoscopy or by tracheal aspiration after intubation). It was hypothesized that the sham procedure would not be inferior to the cricoid pressure. The secondary end points were related to pulmonary aspiration, difficult tracheal intubation, and traumatic complications owing to the tracheal intubation or cricoid pressure. Results Of 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9 patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI of relative risk was 2.00, exceeding 1.50, failing to demonstrate noninferiority (P = .14). The risk difference was -0.06% (2-sided 95% CI, -0.57 to 0.42) in the intent-to-treat population and -0.06% (2-sided 95% CI, -0.56 to 0.43) in the per protocol population. Secondary end points were not significantly different among the 2 groups (pneumonia, length of stay, and mortality), although the comparison of the Cormack and Lehane grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time (Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased difficulty of tracheal intubation in the Sellick group. Conclusions and Relevance This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. Trial Registration ClinicalTrials.gov Identifier: NCT02080754.
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Affiliation(s)
- Aurélie Birenbaum
- Department of Anesthesiology and Critical Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Hajage
- Sorbonne Université, Department of Biostatistics Public Health and Medical Information, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Roche
- Department of Anesthesiology and Critical Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Ntouba
- Université Jules Verne, Department of Anesthesiology and Critical Care, CHI Amiens-Picardie, Amiens, France
| | - Mathilde Eurin
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Philippe Cuvillon
- Université de Montpellier, Department of Anesthesiology and Critical Care, Hôpital Carémeau, Nîmes, France
| | - Aurélien Rohn
- Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Regional de Lille, Lille, France
| | - Vincent Compere
- Université de Haute-Normandie, Department of Anesthesiology and Critical Care, Hôpital, Rouen, France
| | - Dan Benhamou
- Université Paris-Sud, Department of Anesthesiology and Critical Care, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Matthieu Biais
- Université Victor Segalen, Department of Anesthesiology and Critical Care, Hôpital Pellegrin, Bordeaux, France
| | - Remi Menut
- Université Toulouse 3-Paul Sabatier, Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Sabiha Benachi
- Department of Anesthesiology and Critical Care, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - François Lenfant
- Department of Anesthesiology, Centre Hospitalier Simone Veil, Cannes, France
| | - Bruno Riou
- Sorbonne Université, UMR Inserm, Institut hospitalo-universitaire ICAN, Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Bang YS, Park C. Anesthetic Consideration for Peroral Endoscopic Myotomy. Clin Endosc 2019; 52:549-555. [PMID: 31288505 PMCID: PMC6900293 DOI: 10.5946/ce.2019.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.
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Affiliation(s)
- Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chunghyun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Zhang X, Cheng Q, Li L, Shangguan L, Li C, Li S, Huang F, Zhang J, Wang R. Supramolecular therapeutics to treat the side effects induced by a depolarizing neuromuscular blocking agent. Theranostics 2019; 9:3107-3121. [PMID: 31244944 PMCID: PMC6567959 DOI: 10.7150/thno.34947] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Succinylcholine (Sch) is the only depolarizing neuromuscular blocking agent widely used for rapid sequence induction in emergency rooms. Unfortunately, a variety of (sometimes lethal) adverse effects, such as hyperkalemia and cardiac arrest, are associated with its use, and currently there are no specific antidotes to reverse Sch or to treat these side-effects. Methods: The binding behaviors of Sch and several synthetic receptors, including cucurbit[7]uril, sulfo-calix[4]arene and water-soluble carboxylatopillar[6]arene (WP[6]), were first investigated. With a mouse model, a leathal dose of Sch was selected for evaluation of the antidotal effects of these synthetic receptors on Sch induced mortality. The antidotal effects of a selected synthetic receptor, WP[6], on Sch induced cardiac arrhythmias, hyperkalemia, rhabdomyolysis and paralysis were subsequently evaluated with rat and mouse models. The reversal mechanism was also investigated at a cellular level. Results: All of these macrocyclic molecules exhibited relatively high binding affinities with Sch in vitro. In a Sch-overdosed mouse model, immediate injection of these synthetic receptors right after Sch administration increased the overall survival rate, with WP[6] standing out with the most effective antidotal effects. In addition, administration of WP[6] also reversed the paralysis induced by Sch in a mouse model. Moreover, infusion of WP[6] to Sch-overdosed rats reduced the incidence of cardiac arrhythmia, inhibited the otherwise abnormally high serum potassium levels, and relieved the muscular damage. At the cellular level, WP[6] reversed the Sch induced depolarization and reduced the efflux of intracellular potassium. Conclusion: Synthetic receptors, particularly WP[6], exhibited high binding affinities towards Sch, and presented a significant potential as supramolecular therapeutics to treat the various side effects of Sch by specifically sequestering Sch in vivo.
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Affiliation(s)
- Xiangjun Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Qian Cheng
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Lanlan Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China
| | - Liqing Shangguan
- State Key Laboratory of Chemical Engineering, Center for Chemistry of High-Performance & Novel Materials, Department of Chemistry, Zhejiang University, Hangzhou 310027, P. R. China
| | - Chenwen Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China
| | - Shengke Li
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
- School of Materials Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Feihe Huang
- State Key Laboratory of Chemical Engineering, Center for Chemistry of High-Performance & Novel Materials, Department of Chemistry, Zhejiang University, Hangzhou 310027, P. R. China
| | - Jianxiang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China
| | - Ruibing Wang
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
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Wahlen BM, El-Menyar A, Asim M, Al-Thani H. Rapid sequence induction (RSI) in trauma patients: Insights from healthcare providers. World J Emerg Med 2019; 10:19-26. [PMID: 30598714 PMCID: PMC6264984 DOI: 10.5847/wjem.j.1920-8642.2019.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/20/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction (RSI) among trauma patients. METHODS A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating specialties. RESULTS A total of 102 participants were included; 47 were anaesthetists and 55 were emergency physicians. Propofol (74.5%) and Etomidate (50.0%) were the most frequently used induction agents. Significantly higher proportion of anesthesiologist used Propofol whereas, Etomidate was commonly used by emergency physicians in stable patients (P=0.001). Emergency physicians preferred Etomidate (63.6%) and Ketamine (20.0%) in unstable patients. The two groups were comparable for opioid use for stable patients. In unstable patients, use of opioid differed significantly by intubating specialties. The relation between rocuronium and suxamethonium use did change among the anaesthetists. Emergency physicians used more suxamethonium (55.6% vs. 27.7%, P=0.01) in stable as well as unstable (43.4 % vs. 27.7%, P=0.08) patients. CONCLUSION There is variability in the use of drugs for RSI in trauma patients amongst emergency physicians and anaesthesiologists. There is a need to develop an RSI protocol using standardized types and dose of these agents to deliver an effective airway management for trauma patients.
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Affiliation(s)
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Yang C, Cai W, Li Z, Page AT, Fang Y. The current status and effects of emergency drug shortages in China: Perceptions of emergency department physicians. PLoS One 2018; 13:e0205238. [PMID: 30300412 PMCID: PMC6177176 DOI: 10.1371/journal.pone.0205238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/22/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The shortage of emergency drugs in China is severe. This study aimed to characterize emergency drug shortages in China and to measure their effects. METHODS An online questionnaire based on a literature review was sent to emergency department physicians in Chinese secondary and tertiary hospitals from November 2016 to February 2017. The survey asked physicians questions about their experiences with emergency drug shortages. RESULTS In total, 236 physicians from 29 provinces participated in the survey. According to their responses, 90.7% of the respondents experienced drug shortages during the last year. More than half of the physicians (65.7%) reported that drug shortages occurred at least once a month. Hospitals in the eastern and western regions of China had more emergency drugs in shortage than hospitals in central China, especially those with many inpatient beds (≥800). In addition, the shortage situation was more serious in secondary hospitals than in tertiary hospitals. More respondents agreed that original medicines, injections, essential medicines, medicines without alternative agents and cheap medicines were more susceptible to shortages than generics, oral medicines, nonessential medicines, medicines with alternative agents and expensive medicines, respectively. Most respondents thought that drug shortages always, often or sometimes affected patients [delayed therapy (62.6%), longer rescue and recovery times (58.9%) and higher costs (58.7%)] and physicians [inconvenience (81.0%), higher pressure (76.5%) and harm to patient-doctor relationships (72%)] and compromised hospital reputations (55.1%). CONCLUSIONS The shortage of emergency drugs in China is serious, especially in secondary hospitals located in eastern and western China. Emergency drug shortages have significant effects on patients and physicians.
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Affiliation(s)
- Caijun Yang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Wenfang Cai
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Zongjie Li
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
| | - Amy Theresa Page
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Australia
- Centre for Medicine Use and Safety, Monash University, Perth, Australia
| | - Yu Fang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi’an, China
- * E-mail:
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Airway management and neuromuscular block: What are we waiting for? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Deciding on proper medication administration for the traumatic brain injury (TBI) patient undergoing intubation can be daunting and confusing. Pretreatment with lidocaine and/or vecuronium is no longer recommended; however, high-dose fentanyl can be utilized to help blunt the sympathetic stimulation of intubation. Induction with etomidate is recommended; however, ketamine can be considered in the proper patient population, such as those with hypotension. Paralysis can be performed with either succinylcholine or rocuronium, with the caveat that rocuronium can lead to delays in proper neurological examinations due to prolonged paralysis. Recommendations for post-intubation continuous sedation medications include a combination propofol and fentanyl in the normotensive/hypertensive patient population. A combination midazolam and fentanyl or ketamine alone can be considered in the hypotensive patient.
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Affiliation(s)
- Nicholas Kramer
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - David Lebowitz
- Office of Faculty and Academic Affairs, University of Central Florida College of Medicine, Orlando, USA
| | - Michael Walsh
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Latha Ganti
- Clinical Sciences, University of Central Florida College of Medicine, Orlando, USA
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35
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Abstract
Rocuronium is commonly used in preference to suxamethonium for rapid sequence induction in the Intensive Care Unit (ICU). We describe a patient who suffered significant neck trauma following a suicide attempt. On initial presentation to accident and emergency, he was an easy intubation with a Grade 1 view obtained at laryngoscopy. After surgery to repair his neck laceration, he was extubated and discharged from ICU. He later developed a severe aspiration pneumonia and required reintubation. After induction and paralysis with suxamethonium, the best view at laryngoscopy was a Grade 3 despite the use of different laryngoscopes. As the muscle paralysis wore off the patient began breathing. This produced bubbles in the back of the patient's pharynx which directed the clinician to the laryngeal inlet to allow successful intubation. In this case, the short duration of action of suxamethonium significantly aided intubation due to the return of spontaneous breathing by the patient.
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Affiliation(s)
- David Howe
- Anaesthetic Department, Princess Royal Hospital, Apley, Telford TF1 6TF, UK
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Lin SH, Chi CH, Chuang CC, Chan TY. Tips to Improve Success Rate of Intubation: A Standardized Rapid Sequence Intubation Protocol Attached to the Resuscitation Cart. J Acute Med 2017; 7:67-74. [PMID: 32995174 PMCID: PMC7517902 DOI: 10.6705/j.jacme.2017.0702.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/13/2016] [Accepted: 11/21/2016] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether the implementation of a standardized rapid sequence intubation (RSI) protocol easily accessed on the resuscitation cart increased the success rate of intubation and reduced intubation-related complications in the emergency department (ED). METHODS This work was a retrospective study of patients who were intubated in the ED between February 2006 and June 2007. The RSI protocol and a dosage cross-table were attached to the resuscitation cart beginning in January 2007. Intubated patients before and after application of the protocol were sorted into two groups: pre-intervention and post-intervention. RESULTS A total of 147 patients were enrolled in the study, including 72 patients in the pre-intervention group and 75 patients in the post-intervention group. After application of the standardized protocol prompted on the resuscitation cart. The adherence rates to pre-treatment agents (69% vs. 90%; p < 0.01) and neuromuscular blocking agents (NMBA) (72% vs. 90%; p < 0.01) significantly improved. The first-attempt success rate was 57 of 72 (79%) in the pre-intervention group versus 70 of 75 (93%) in the post-intervention group (p = 0.016). The time to intubation did not differ signifi cantly, but the preintervention group had a higher percentage of prolonged time to intubation (13% vs. 3%; p = 0.029). The implementation of a standardized RSI protocol did not induce signifi cant adverse effects. CONCLUSIONS Our study demonstrated implementation of a standardized RSI protocol, improved clinician adherence to the RSI, increased success of first-attempt ED intubation and led to a decline in the rate of prolonged time to intubation.
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Affiliation(s)
- Shih-Hao Lin
- National Cheng Kung University Hospital Department of Emergency Medicine Tainan Taiwan
| | - Chih-Hsien Chi
- National Cheng Kung University Hospital Department of Emergency Medicine Tainan Taiwan
| | - Chia-Chang Chuang
- National Cheng Kung University Hospital Department of Emergency Medicine Tainan Taiwan
| | - Tsung-Yu Chan
- National Cheng Kung University Hospital Department of Emergency Medicine Tainan Taiwan
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37
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Park SK, Kang JG, Wie HW, Shin EY. A case involving anesthesia for cesarean section followed by resection of ruptured cavernous malformation of pons −A case report−. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Soo Kyoung Park
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jin Gu Kang
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Hee Wook Wie
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Eui-yong Shin
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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38
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Yassin HM, Abdel Moneim AT, Mostafa Bayoumy AS, Bayoumy HM, Taher SG. The Influence of Two Different Doses of Magnesium Sulfate on Intraocular Pressure Variations after Injection of Succinylcholine and Endotracheal Intubation: A Prospective, Randomized, Parallel Three-Arm, Double-blind, Placebo-controlled Clinical Trial. Anesth Essays Res 2017; 11:969-975. [PMID: 29284858 PMCID: PMC5735497 DOI: 10.4103/aer.aer_35_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The use of succinylcholine for rapid sequence induction in patients with open globe injuries may be detrimental to the eye. Aim: The aim of this study is to determine if the premedication with magnesium sulfate (MgSO4) could attenuate the increase in intraocular pressure (IOP) associated with succinylcholine injection and intubation. Setting: Operation theaters in a tertiary care University Hospital between December 2014 and July 215. Design: This was a prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial. Participants: One hundred and thirteen patients’ physical status ASA Classes I and II underwent elective cataract surgery under general anesthesia. Patients and Methods: These patients allocated into three groups: Group C (control group) received 100 ml normal saline, Group M1 received 30 mg/kg MgSO4 in 100 ml normal saline, and Group M2 received 50 mg/kg MgSO4 in 100 ml normal saline. IOP, mean arterial pressure (MAP), and heart rate (HR) reported at 5-time points related to study drug administration. In addition, any adverse effects related to MgSO4 were recorded. Intragroup and between-groups differences were examined by analysis of variance test. Results: We noticed a significant decrease in IOP in M1 (n = 38) and M2 (n = 37) groups as compared with C group (n = 38) after study drugs infusion, 2 and 5 min after intubation, P < 0.001. While the difference between M1 and M2 groups was insignificant, P = 0.296 and P = 0.647, respectively. There was a significant decrease in MAP and HR in M1 and M2 groups as compared with C group 2 and 5 min after intubation, P = 0.01. While the difference between M1 and M2 groups was insignificant, P = 1. Conclusion: MgSO4 30 mg/kg as well as 50 mg/kg effectively prevented the rise in IOP, MAP, and HR associated with rapid sequence induction by succinylcholine and endotracheal intubation.
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Affiliation(s)
- Hany Mahmoud Yassin
- Department of Anaesthesiology, Faculty of Medicine, Fayoum University, Fayuom, Egypt
| | | | | | | | - Sameh Galal Taher
- Department of Ophthalmology, Research Institute of Ophthalmology, Cairo, Egypt
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Myatra SN, Shah A, Kundra P, Patwa A, Ramkumar V, Divatia JV, Raveendra US, Shetty SR, Ahmed SM, Doctor JR, Pawar DK, Ramesh S, Das S, Garg R. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults. Indian J Anaesth 2016; 60:885-898. [PMID: 28003690 PMCID: PMC5168891 DOI: 10.4103/0019-5049.195481] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes 'complete ventilation failure', and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a 'difficult airway alert form' must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart.
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Affiliation(s)
- Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Address for correspondence: Prof. Sheila Nainan Myatra, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Dr. Ernest Borges Road, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Amit Shah
- Kailash Cancer Hospital and Research Centre, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
| | - Apeksh Patwa
- Kailash Cancer Hospital and Research Centre, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
| | | | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ubaradka S Raveendra
- Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Sumalatha Radhakrishna Shetty
- Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
| | - Jeson Rajan Doctor
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dilip K Pawar
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Singaravelu Ramesh
- Department of Anaesthesiology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
| | - Sabyasachi Das
- Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
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40
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Shukla A, Misra S. Ease of intubation: A randomized, double-blind study to compare two doses of rocuronium bromide for endotracheal intubation. Anesth Essays Res 2016; 10:512-515. [PMID: 27746543 PMCID: PMC5062231 DOI: 10.4103/0259-1162.179308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Clinical need for a nondepolarizing agent with a rapid onset time and a brief duration of action has led to the development of rocuronium bromide. AIMS The aim of this study was to evaluate optimal dose of rocuronium bromide for intubation and to compare the onset time, duration of action, intubating conditions, and hemodynamic effects of two doses of rocuronium bromide. SETTINGS AND DESIGN A prospective, randomized, double-blind study. MATERIALS AND METHODS All the patients were divided in a randomized, double-blind fashion into two groups of twenty patients each. Group I patients received rocuronium bromide 0.6 mg/kg intravenously and intubated at 60 s, Group II patients received rocuronium bromide 0.9 mg/kg and intubated at 60 s. The neuromuscular block was assessed using single twitch stimulation of 0.1 Hz at adductor pollicis muscle of hand at every 10 s. STATISTICAL ANALYSIS USED The results were compiled and analyzed statistically using Chi-square test for qualitative data and Student's t-test for quantitative data. RESULTS Time of onset was significantly shorter (P < 0.01) and duration of action was prolonged (P < 0.001) for Group II as compared to Group I. The intubating conditions were (excellent + good) in 100% patients of Group II and (excellent + good) in 80% of Group I. There was no significant change in pulse rate and mean arterial pressure from the baseline value after the administration of muscle relaxants in either of the two groups. CONCLUSIONS Rocuronium bromide 0.9 mg/kg is a safer alternative to rocuronium bromide 0.6 mg/kg for endotracheal intubation with shorter time of onset and better intubating conditions.
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Affiliation(s)
- Aparna Shukla
- Department of Anesthesia, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India
| | - Shilpi Misra
- Department of Anesthesia, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India
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42
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Komorowski M, Fleming S, Kirkpatrick AW. Fundamentals of Anesthesiology for Spaceflight. J Cardiothorac Vasc Anesth 2016; 30:781-90. [DOI: 10.1053/j.jvca.2016.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Indexed: 01/06/2023]
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43
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Hung O, McKeen D, Huitink J. Our love-hate relationship with succinylcholine: Is sugammadex any better? Can J Anaesth 2016; 63:905-10. [PMID: 27142003 DOI: 10.1007/s12630-016-0664-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/30/2016] [Accepted: 04/20/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Orlando Hung
- Department of Anesthesia, Pain Management and Perioperative Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, 1278 South Park St, Halifax, NS, B3H 2Y9, Canada.
| | - Dolores McKeen
- Department of Anesthesia, Pain Management and Perioperative Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, 1278 South Park St, Halifax, NS, B3H 2Y9, Canada
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