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Braun G. [Nutrition (therapy) in gastrointestinal failure]. Med Klin Intensivmed Notfmed 2024; 119:296-301. [PMID: 37985511 DOI: 10.1007/s00063-023-01082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/29/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The presence of gastrointestinal dysfunction is an outcome-relevant complication in critically ill ICU patients. AIMS, MATERIALS AND METHODS The following review aims to show the importance of gastrointestinal dysfunction. Multimodal therapy for gastroparesis and paralytic ileus is discussed. CONCLUSION Erythromycin and metoclopramide are options for gastroparesis, while neostigmine is commonly used for paralytic ileus.
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Affiliation(s)
- Georg Braun
- Internistisches Intensivzentrum, Medizinische Klinik 3 am Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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Cao M, Huang H, Tong J, Ou Y, Liao Y. Optimal dose of neostigmine antagonizing cisatracurium-induced shallow neuromuscular block in elderly patients: a randomized control study. BMC Anesthesiol 2023; 23:269. [PMID: 37563623 PMCID: PMC10413529 DOI: 10.1186/s12871-023-02233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Residual neuromuscular block after using neuromuscular blocking agents is a common and potentially harmful complication of general anesthesia. Neostigmine is a widely used antagonist, but its optimal dose for elderly patients is unclear. OBJECTIVES To compare the optimal dosage and safety of neostigmine for reversing shallow residual block in elderly patients after cisatracurium-induced neuromuscular block. METHODS A randomized controlled trial was conducted in 196 elderly patients undergoing non-cardiac surgery under general anesthesia with cisatracurium. Patients were assigned to receive either no neostigmine (control group) or neostigmine at 20 µg/kg, 40 µg/kg or 50 µg/kg when train-of-four (TOF) ratio reached 0.2 at the end of surgery. The primary outcome was the time to reach TOF ratio of 0.9 after administration. Secondary outcomes included TOF ratio at 10 min after administration, postoperative nausea and vomiting, postoperative cognitive impairment and post-anesthesia care unit (PACU) stay time. RESULTS The time to reach TOF ratio of 0.9 in the 20 µg/kg, 40 µg/kg and 50 µg/kg groups was significantly shorter than the control group (H = 104.257, P < 0.01), and the time of 40 µg/kg group and 50 µg/kg group was significantly shorter than the 20 µg/kg group (P < 0.001). There was no significant difference between 40 µg/kg and 50 µg/kg groups (P = 0.249). The TOF ratio at 10 min after administration showed similar results. There were no significant differences among groups in postoperative nausea and vomiting, postoperative cognitive impairment or post-operation hospital stay. CONCLUSIONS Timely use of neostigmine after general anesthesia in elderly patients can significantly shorten time of TOF value reaching 0.9, among which 40 µg/kg dosage may be a more optimized choice. TRIAL REGISTRATION this study was registered on chictr.org.cn (ChiCTR2100054685, 24/12/2021).
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Affiliation(s)
- Mengya Cao
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Huifan Huang
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, P.R. China
| | - Jianbin Tong
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
- Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Yangwen Ou
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Yan Liao
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China.
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Hashimoto K, Tashima K, Imai T, Matsumoto K, Horie S. The rodent model of impaired gastric motility induced by allyl isothiocyanate, a pungent ingredient of wasabi, to evaluate therapeutic agents for functional dyspepsia. J Pharmacol Sci 2021; 145:122-129. [PMID: 33357770 DOI: 10.1016/j.jphs.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/03/2020] [Accepted: 10/26/2020] [Indexed: 01/19/2023] Open
Abstract
Functional dyspepsia (FD) is thought to be mainly based on gastric motility dysfunction and chronic hypersensitivity, yet FD animal models has been reported a few. We studied to establish the mouse model of impaired gastric motility induced by a pungent ingredient of wasabi allyl isothiocyanate (AITC), which is reliable to evaluate prokinetic agents. Male ddY mice were used. Gastric motility was measured by 13C-acetic acid breath test in conscious mice. AITC (80 mM) was given 60 min before the measurement of motility. Prokinetic agents including itopride (30, 100 mg/kg), mosapride (0.1-1 mg/kg), neostigmine (30 μg/kg), acotiamide (10-100 mg/kg), and daikenchuto (100-1000 mg/kg) were given 40 min before the measurement. AITC impaired gastric motility without mucosal damages, which reverted 24 h after AITC treatment. The decreased motility induced by AITC was restored by prokinetic agents such as itopride, mosapride, neostigmine, and acotiamide. In separate experiment, daikenchuto recovered the decreased motility induced by AITC, although daikenchuto had no effect on motility in normal condition. In conclusion, it is considered that the AITC-induced impaired gastric motility mouse model is useful to develop new prokinetic agents for treatment of FD, and to re-evaluate traditional Japanese herbal medicines.
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Affiliation(s)
- Kazuki Hashimoto
- Laboratory of Pharmacology, Faculty of Pharmaceutical Sciences, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555, Japan
| | - Kimihito Tashima
- Laboratory of Pharmacology, Faculty of Pharmaceutical Sciences, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555, Japan; Center of Pharmacological Kampo Research, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555, Japan.
| | - Taku Imai
- Laboratory of Pharmacology, Faculty of Pharmaceutical Sciences, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555, Japan
| | - Kenjiro Matsumoto
- Division of Pathological Sciences, Department of Pharmacology and Experimental Therapeutics, Kyoto Pharmaceutical University, Yamashina, Kyoto, 607-8414, Japan
| | - Syunji Horie
- Laboratory of Pharmacology, Faculty of Pharmaceutical Sciences, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555, Japan; Center of Pharmacological Kampo Research, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555, Japan
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4
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Arroyo-Fernández FJ, Calderón Seoane JE, Torres Morera LM. Strategies of analgesic treatment after cesarean delivery. Current state and new alternatives. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:167-175. [PMID: 32085919 DOI: 10.1016/j.redar.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
The number of caesarean sections performed worldwide is increasing, and with it, the need for the optimal analgesia strategies. Deficient postoperative analgesia increases the need for opioids, delays recovery, and is associated with chronic pain and postpartum depression. It is essential to find good postoperative pain control strategies that facilitate early mobility, early recovery, and early hospital discharge with minimal side effects on the mother and infant. Multimodal analgesia based on neuroaxial anaesthesia with morphine in combination with non-opioids such as non-steroidal anti-inflammatory drugs and paracetamol, gives the best post-caesarean analgesia outcome, and allows anaesthesiologists to reserve opioids, corticoids, gabapentin, magnesium or ketamine for situations where neuroaxial anaesthesia cannot be performed, for high-risk patients, or when pain is difficult to control. Peripheral nerve block techniques can also be added, such as transverse abdominis plane block, erector spinae block, or continuous wound infiltration.
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Menon SMR, Mokkath NR. Myasthenia gravis masquerading as acute stroke: a case report. Pan Afr Med J 2020; 37:305. [PMID: 33654524 PMCID: PMC7896516 DOI: 10.11604/pamj.2020.37.305.27032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 11/11/2022] Open
Abstract
Among non-iatrogenic neuromuscular disorders, myasthenia gravis remains the most prevalent. Diagnosing this disorder may become challenging in certain cases such as in patients with coexisting comorbid illnesses and non-specific clinical symptoms. This is a case of atypical myasthenia gravis in a middle-aged hypertensive male, who initially presented symptoms suggestive of an acute ischemic stroke. Upon later investigation, prompted by persistent symptoms, the patient was found to have AchR antibodies and had the rare finding of a fissured and atrophied tongue (reversible on treatment). It is a well-known fact that brainstem strokes can present with bulbar weakness resulting in aspiration pneumonitis, as was with the clinical presentation in the below mentioned report. Due to the initial misdiagnosis, he had received medical therapy aimed towards stroke management and prevention. Further investigation leading to a definitive diagnosis, was followed by medical therapy with neostigmine, pyridostigmine and oral prednisolone, leading to significant improvement in symptoms. Hence as a mandatory measure, while dealing with a case of a new onset of weakness, especially in cranial musculature, myasthenia gravis must not be excluded from the list of differential diagnosis. Myasthenia gravis (MG) is a potential “stroke mimic” especially in the elderly. However, due to recent change in trends of stroke statistics, this disease should be considered a possibility even in younger patients.
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Affiliation(s)
- Sarath Menon Ramachandra Menon
- Department of Neurology, Sree Narayana Institute of Medical Sciences (SNIMS), Kunnukara, India
- Corresponding author: Sarath Menon Ramachandra Menon, Department of Neurology, Sree Narayana Institute of Medical Sciences (SNIMS), Kunnukara, India.
| | - Namith Ranjith Mokkath
- Department of Neurology, Sree Narayana Institute of Medical Sciences (SNIMS), Kunnukara, India
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Bedsworth MB, Harris EM, Vacchiano CA, Thompson JA, Grant SA, Goode VM. Evaluating a Quality Improvement Initiative to Increase Anesthesia Providers' Use of and Understanding of Quantitative Neuromuscular Monitors. AANA J 2019; 87:357-363. [PMID: 31612840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Improved understanding of the monitoring and dosing practices of anesthesia providers regarding neuromuscular blockade is necessary. The use of subjective methods such as peripheral nerve stimulation and clinical assessment tests can increase the risk of residual neuromuscular blockade and adverse postoperative outcomes. Quantitative monitoring of neuromuscular blockade is an alternative tool to peripheral nerve stimulation to guide neuromuscular blockade; however, it is rarely used by providers. We developed an initiative to improve anesthesia providers' knowledge of neuromuscular blockade pharmacology, physiology, monitoring, and management. After the initiative, an analysis assessed for practice change regarding the use of quantitative monitoring and dosing of neuromuscular blocking agents and neostigmine. The use of quantitative monitoring increased significantly from 14.0% in the preinitiative group to 48.0% after the initiative (P < .001). The least squares mean 95% effective dose (ED95) neuromuscular blocking agents dose was compared between pre-initiative and postinitiative groups, and case length was a significant predictor for patients receiving the highest neuromuscular blocking agents doses. Neostigmine doses were compared between preinitiative and postinitiative groups, and body mass index was a significant predictor of the least squares mean neostigmine dose (P = .002) and the likelihood of receiving a high neostigmine dose (odds ratio = 0.911, 95% CI = 0.870-0.955).
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Affiliation(s)
- Meredith B Bedsworth
- is a graduate from the Duke University School of Nursing in Durham, North Carolina
| | - Erica M Harris
- is in the Duke University Hospital Department of Anesthesiology, Durham, North Carolina
| | | | | | - Stuart A Grant
- is in the Department of Anesthesiology, Duke University Hospital, Durham, North Carolina
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Freundlich A, Badeaux J, Adorno M. Sugammadex versus neostigmine for postoperative nausea and vomiting in adult patients undergoing laparoscopic surgery paralyzed with rocuronium bromide: a systematic review protocol. JBI Database System Rev Implement Rep 2019; 17:2187-2192. [PMID: 31453838 DOI: 10.11124/jbisrir-2017-003997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this review is to determine if the occurrence of post-operative nausea and vomiting (PONV) is affected by using sugammadex or neostigmine, in adult patients undergoing laparoscopic procedures paralyzed by rocuronium bromide. INTRODUCTION Laparoscopic procedures significantly increase the occurrence of PONV in patients. The focus should be on preventing the occurrence of PONV. Laparoscopic procedures use neo-muscular blocking agents to assist with creation of a pneumoperitoneum. After the procedure is complete, reversal of these agents is critical for patient recovery. Understanding the effects for each of the reversal medications is important for future decisions for peri-operative care. INCLUSION CRITERIA This review will consider studies with patients aged 18 and older, undergoing laparoscopic procedures, paralyzed with rocuronium. METHODS A search for relevant published and unpublished literature will be conducted in MEDLINE, CINAHL, Embase, Scopus, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials (CENTRAL), in addition to gray literature sources. Articles that meet the inclusion criteria will be further assessed for methodological validity by two independent reviewers using standardized critical appraisal instruments. Data will be extracted from papers included in the review using a standardized data extraction tool. Quantitative data will be pooled for statistical meta-analysis to evaluate the occurrence of PONV with both sugammadex and neostigmine.
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Affiliation(s)
- Angela Freundlich
- Louisiana State University Health Sciences Center, School of Nursing, New Orleans, United States of America
- The Louisiana Centre for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Centre of Excellence
| | - Jennifer Badeaux
- Louisiana State University Health Sciences Center, School of Nursing, New Orleans, United States of America
- The Louisiana Centre for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Centre of Excellence
| | - Marie Adorno
- Louisiana State University Health Sciences Center, School of Nursing, New Orleans, United States of America
- The Louisiana Centre for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Centre of Excellence
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Herman AP, Skipor J, Krawczyńska A, Bochenek J, Wojtulewicz K, Pawlina B, Antushevich H, Herman A, Tomaszewska-Zaremba D. Effect of Central Injection of Neostigmine on the Bacterial Endotoxin Induced Suppression of GnRH/LH Secretion in Ewes during the Follicular Phase of the Estrous Cycle. Int J Mol Sci 2019; 20:ijms20184598. [PMID: 31533319 PMCID: PMC6769544 DOI: 10.3390/ijms20184598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022] Open
Abstract
Induced by a bacterial infection, an immune/inflammatory challenge is a potent negative regulator of the reproduction process in females. The reduction of the synthesis of pro-inflammatory cytokine is considered as an effective strategy in the treatment of inflammatory induced neuroendocrine disorders. Therefore, the effect of direct administration of acetylcholinesterase inhibitor—neostigmine—into the third ventricle of the brain on the gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) secretions under basal and immune stress conditions was evaluated in this study. In the study, 24 adult, 2-years-old Blackhead ewes during the follicular phase of their estrous cycle were used. Immune stress was induced by the intravenous injection of LPS Escherichia coli in a dose of 400 ng/kg. Animals received an intracerebroventricular injection of neostigmine (1 mg/animal) 0.5 h before LPS/saline treatment. It was shown that central administration of neostigmine might prevent the inflammatory-dependent decrease of GnRH/LH secretion in ewes and it had a stimulatory effect on LH release. This central action of neostigmine is connected with its inhibitory action on local pro-inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)α synthesis in the hypothalamus, which indicates the importance of this mediator in the inhibition of GnRH secretion during acute inflammation.
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Affiliation(s)
- Andrzej Przemysław Herman
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
- Correspondence: ; Tel.: +48-22-765-33-02; Fax: +48-22-765-33-03
| | - Janina Skipor
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10-748 Olsztyn, Poland;
| | - Agata Krawczyńska
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
| | - Joanna Bochenek
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
| | - Karolina Wojtulewicz
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
| | - Bartosz Pawlina
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
| | - Hanna Antushevich
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
| | - Anna Herman
- Faculty of Health Sciences, Warsaw School of Engineering and Health, 02-366 Warsaw, Poland;
| | - Dorota Tomaszewska-Zaremba
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-100 Jabłonna, Poland; (A.K.); (J.B.); (K.W.); (B.P.); (H.A.); (D.T.-Z.)
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Alday E, Muñoz M, Planas A, Mata E, Alvarez C. Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery: a randomized-controlled trial. Can J Anaesth 2019; 66:1328-1337. [PMID: 31165457 DOI: 10.1007/s12630-019-01419-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Postoperative pulmonary complications may be better reduced by reversal of neuromuscular block with sugammadex than by reversal with neostigmine because the incidence of residual block after sugammadex application is lower and diaphragm function is less impaired than after neostigmine administration. The aim of the study was to compare the effect of reversal of neuromuscular block with sugammadex or neostigmine on lung function after major abdominal surgery. METHODS One hundred and thirty adults scheduled for major abdominal surgery under combined general and epidural anesthesia were randomly allocated to receive 40 µg of neostigmine or 4 mg·kg-1 of sugammadex to reverse neuromuscular block. Two blinded researchers performed spirometry and lung ultrasound before the surgery, as well as 1 hr and 24 hr postoperatively. Differences in mean changes from baseline were analyzed with repeated measures analysis of variance. Forced vital capacity (FVC) loss one hour after surgery was the main outcome. Secondary outcomes were differences in rate and size of atelectasis one hour and 24 hr after surgery. RESULTS One hundred twenty-six patients were included in the main analysis. In the neostigmine group (n = 64), mean (95% confidence interval [95% CI]) reduction in FVC after one hour was 0.5 (0.4 to 0.6) L. In the sugammadex group (n = 62), the mean (95% CI) reduction in FVC during the first hour was 0.5 (95% CI, 0.3 to 0.6) L. Thirty-nine percent of patients in the neostigmine group and 29% in the sugammadex group had visible atelectasis. Median [interquartile range (IQR)] atelectasis area was 9.7 [4.7-13.1] cm2 and 6.8 [3.6-12.5] cm2, respectively. CONCLUSION We found no differences in pulmonary function in patients reversed with sugammadex or neostigmine in a high-risk population. TRIAL REGISTRATION EudraCT 2014-005156-26; registered 27 May, 2015.
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Affiliation(s)
- Enrique Alday
- Hospital Universitario La Princesa, C/Diego de León 62, 28006, Madrid, Spain.
| | - Manolo Muñoz
- Hospital Universitario La Princesa, C/Diego de León 62, 28006, Madrid, Spain
| | - Antonio Planas
- Hospital Universitario La Princesa, C/Diego de León 62, 28006, Madrid, Spain
| | - Esperanza Mata
- Hospital Universitario La Princesa, C/Diego de León 62, 28006, Madrid, Spain
| | - Carlos Alvarez
- Hospital Universitario La Princesa, C/Diego de León 62, 28006, Madrid, Spain
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Silver JR, Weiner MF. The history of the use of intrathecal prostigmine to achieve fertility in men with spinal cord injuries. Spinal Cord Ser Cases 2019; 5:37. [PMID: 31632698 PMCID: PMC6786382 DOI: 10.1038/s41394-019-0183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/04/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- J. R. Silver
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
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Chandra A, Pant B. Hypophonia as only presenting symptom in myasthenia gravis - a diagnostic dilemma in poor countries: a case report. J Med Case Rep 2019; 13:48. [PMID: 30823884 PMCID: PMC6397472 DOI: 10.1186/s13256-019-1970-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/02/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The autoimmune disease myasthenia gravis can mimic a variety of neurological disorders leading to a delay in diagnosis and treatment. In the older population, due to confusion with signs of the ageing process or comorbidities due to ageing, there are many underdiagnosed or misdiagnosed cases of myasthenia gravis. A majority of myasthenia gravis symptoms appear as ocular or motor symptoms and there are very few cases of bulbar symptoms. We present a case of myasthenia gravis with only hypophonia as a clinical feature. CASE PRESENTATION We present a case of a 51-year-old Madheshi woman whose only complaint was sudden onset of hypophonia which later showed a fluctuating nature throughout the daytime. There was only reduced pitch in her voice with no nasal tone or dysarthria (so-called dysphonia), which created a diagnostic dilemma. Later, a neurological examination and other relevant investigations suggested myasthenia gravis. CONCLUSIONS Sudden onset and focal neurological deficit can raise the diagnostic dilemma of myasthenia gravis. Relevant laboratory tests and clinical examinations are important to diagnose this disease properly. In resources-deprived nations like Nepal, where several investigations are expensive and access to them is difficult, it becomes very difficult to achieve a solid diagnosis for rare presentations of diseases.
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Affiliation(s)
- Avinash Chandra
- Deptartment of Neurology, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, 44600 Nepal
| | - Basant Pant
- Deptartment of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
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Yellott E, Badeaux J, Martin J, Schiavo JH. Effectiveness of sugammadex versus neostigmine on restoration of neuromuscular function in surgical patients with myasthenia gravis undergoing rocuronium-induced neuromuscular blockade: a systematic review protocol. JBI Database System Rev Implement Rep 2018; 16:1922-1928. [PMID: 30335038 DOI: 10.11124/jbisrir-2017-003624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this systematic review is to identify the effectiveness of sugammadex versus neostigmine on the reversal of rocuronium-induced neuromuscular blockade in surgical patients with myasthenia gravis undergoing general anesthesia.
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Affiliation(s)
- Elizabeth Yellott
- Louisiana State University Health Sciences Center, New Orleans, USA
- The Louisiana Center for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Center of Excellence
| | - Jennifer Badeaux
- Louisiana State University Health Sciences Center, New Orleans, USA
- The Louisiana Center for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Center of Excellence
| | - Jennifer Martin
- Louisiana State University Health Sciences Center, New Orleans, USA
- The Louisiana Center for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Center of Excellence
| | - Julie H Schiavo
- Louisiana State University Health Sciences Center, New Orleans, USA
- The Louisiana Center for Promotion of Optimal Health Outcomes: a Joanna Briggs Institute Center of Excellence
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Abstract
Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, refers to pathologic dilation of the colon without underlying mechanical obstruction, occurring primarily in patients with serious comorbidities. Diagnosis of Ogilvie's syndrome is based on clinical and radiologic grounds, and can be treated conservatively or with interventions such as acetylcholinesterase inhibitors (such as neostigmine), decompressive procedures including colonoscopy, and even surgery. Based on our clinical experience we hypothesized that conservative management yields similar, if not superior, results to interventional management. Therefore, we retrospectively examined all patients over the age of 18 with Ogilvie's syndrome who presented to the Medical University of South Carolina (MUSC). The diagnosis of Ogilvie's syndrome was confirmed by clinical criteria, including imaging evidence of colonic dilation ≥9 cm. Patients were divided and analyzed in 2 groups based on management: conservative (observation, rectal tube, nasogastric tube, fluid resuscitation, and correction of electrolytes) and interventional (neostigmine, colonoscopy, and surgery). Use of narcotics in relation to maximal bowel size was also analyzed. Over the 11-year study period (2005-2015), 37 patients with Ogilvie's syndrome were identified. The average age was 67 years and the average maximal bowel diameter was 12.5 cm. Overall, 19 patients (51%) were managed conservatively and 18 (49%) underwent interventional management. There was no significant difference in bowel dilation (12.0 cm vs 13.0 cm; P = .21), comorbidities (based on the Charlson Comorbidity Index (CCI), 3.2 vs 3.4; P = .74), or narcotic use (P = .79) between the conservative and interventional management groups, respectively. Of the 18 patients undergoing interventional management, 11 (61%) had Ogilvie's-syndrome-related complications compared to 4 (21%) of the 19 patients in the conservative management group (P < .01). There was no difference in overall length of stay in the 2 groups. Two patients, one in each group, died from complications unrelated to their Ogilvie's syndrome. We conclude that Ogilvie's syndrome, although uncommon, and typically associated with severe underlying disease, is currently associated with a low inpatient mortality. While interventional management is often alluded to in the literature, we found no evidence that aggressive measures lead to improved outcomes.
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Affiliation(s)
- Magda Haj
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Mona Haj
- Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC
| | - Don C. Rockey
- Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC
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Zhang X, Jiang H, Li S, Luo A, Zhao Y. Use of low-dose neostigmine intravenously in the treatment of thyroid storm-induced severe tachycardia in patient during huge pelvic mass resection: A case report and review of literature. Medicine (Baltimore) 2018; 97:e0300. [PMID: 29620652 PMCID: PMC5902261 DOI: 10.1097/md.0000000000010300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Thyroid storm is a rare and life-threatening metabolic crisis because of an emergent release of excess thyroid hormone. Sinus tachycardia induced by excess thyroid hormone may result in congestive heart failure due to decreased diastolic filling time. PATIENT CONCERNS A controlled hyperthyroidism patient with severe sinus tachycardia. DIAGNOSES A controlled hyperthyroidism patient was induced thyroid storm during huge pelvic mass resection. INTERVENTIONS Application of low-dose neostigmine and β-antagonist esmolol to control the heart rate (HR) avoided hemodynamic collapse. OUTCOMES The patient improved dramatically following application of low-dose neostigmine instead of esmolol to control the HR avoided hemodynamic collapse. LESSONS Our case suggests that neostigmine, an acetylcholinesterase inhibitor, may warrant further investigation in patients with thyroid storm-induced severe sinus tachycardia.
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Korsten MA, Lyons BL, Radulovic M, Cummings TM, Sikka G, Singh K, Hobson JC, Sabiev A, Spungen AM, Bauman WA. Delivery of neostigmine and glycopyrrolate by iontophoresis: a nonrandomized study in individuals with spinal cord injury. Spinal Cord 2018; 56:212-217. [PMID: 29116244 PMCID: PMC5839930 DOI: 10.1038/s41393-017-0018-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 01/11/2023]
Abstract
STUDY DESIGN Phase I Clinical Trial. OBJECTIVES In this proof-of-principle study, the effectiveness and safety of transdermal administration of neostigmine/glycopyrrolate to elicit a bowel movement was compared to intravenous administration in patients with spinal cord injury. SETTING James J. Peters Veterans Affairs Medical Center (Bronx, NY). METHODS Individuals were screened for responsiveness (Physical Response) to intravenous neostigmine (0.03 mg/kg)/glycopyrrolate (0.006 mg/kg). Intravenous neostigmine/glycopyrrolate responders (Therapeutic Response) were administered low-dose transdermal neostigmine/glycopyrrolate [(0.05 mg/kg)/(0.01 mg/kg)] by iontophoresis. Non-responders to low-dose transdermal neostigmine/glycopyrrolate were administered high-dose transdermal neostigmine/glycopyrrolate [(0.07 mg/kg)/(0.014 mg/kg)] by iontophoresis. Bowel movement, bowel evacuation time, and cholinergic side effects were recorded. Visits were separated by 2 to 14 days. RESULTS Eighteen of 25 individuals (72.0%) had a bowel movement (20 ± 22 min) after intravenous neostigmine/glycopyrrolate. Of these 18 individuals, 5 individuals experienced a bowel movement with low-dose transdermal neostigmine/glycopyrrolate. Another five individuals had a bowel movement after high-dose transdermal neostigmine/glycopyrrolate administration. Fewer side effects were observed in individuals who received neostigmine/glycopyrrolate transdermally compared to those who were administered intravenous neostigmine/glycopyrrolate. CONCLUSIONS Transdermal administration of neostigmine/glycopyrrolate by iontophoresis appears to be a practical, safe, and effective approach to induce bowel evacuation in individuals with spinal cord injury.
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Affiliation(s)
- Mark A Korsten
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA.
- Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA.
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Brian L Lyons
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - Miroslav Radulovic
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
- Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Tradd M Cummings
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - Gautam Sikka
- Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kamaldeep Singh
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
- Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Joshua C Hobson
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - Anton Sabiev
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - Ann M Spungen
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
- Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Batistaki C, Riga M, Zafeiropoulou F, Lyrakos G, Kostopanagiotou G, Matsota P. Effect of sugammadex versus neostigmine/atropine combination on postoperative cognitive dysfunction after elective surgery. Anaesth Intensive Care 2017; 45:581-588. [PMID: 28911287 DOI: 10.1177/0310057x1704500508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were >40 years. The Mini-Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge. The anaesthetic protocol was the same for all patients, except for the neuromuscular block reversal, which was administered by random allocation using either sugammadex or neostigmine/atropine after the reappearance of T2 in the train-of-four sequence. POCD was defined as a decline ≥1 standard deviation in ≥2 cognitive tests. The incidence of POCD was similar in both groups at one hour postoperatively and at discharge (28% and 10%, in the neostigmine group, 23% and 5.4% in the sugammadex group, P=0.55 and 0.27 respectively). In relation to individual tests, a significant decline of clock-drawing test in the neostigmine group was observed at one hour postoperatively and at discharge. For the Isaacs Set test, a greater decline was found in the sugammadex group. These findings suggest that there are no clinically important differences in the incidence of POCD after neostigmine or sugammadex administration.
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Abstract
BACKGROUND Acetylcholinesterase inhibitors, such as neostigmine, have traditionally been used for reversal of non-depolarizing neuromuscular blocking agents. However, these drugs have significant limitations, such as indirect mechanisms of reversal, limited and unpredictable efficacy, and undesirable autonomic responses. Sugammadex is a selective relaxant-binding agent specifically developed for rapid reversal of non-depolarizing neuromuscular blockade induced by rocuronium. Its potential clinical benefits include fast and predictable reversal of any degree of block, increased patient safety, reduced incidence of residual block on recovery, and more efficient use of healthcare resources. OBJECTIVES The main objective of this review was to compare the efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade caused by non-depolarizing neuromuscular agents in adults. SEARCH METHODS We searched the following databases on 2 May 2016: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (WebSPIRS Ovid SP), Embase (WebSPIRS Ovid SP), and the clinical trials registries www.controlled-trials.com, clinicaltrials.gov, and www.centerwatch.com. We re-ran the search on 10 May 2017. SELECTION CRITERIA We included randomized controlled trials (RCTs) irrespective of publication status, date of publication, blinding status, outcomes published, or language. We included adults, classified as American Society of Anesthesiologists (ASA) I to IV, who received non-depolarizing neuromuscular blocking agents for an elective in-patient or day-case surgical procedure. We included all trials comparing sugammadex versus neostigmine that reported recovery times or adverse events. We included any dose of sugammadex and neostigmine and any time point of study drug administration. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts to identify trials for eligibility, examined articles for eligibility, abstracted data, assessed the articles, and excluded obviously irrelevant reports. We resolved disagreements by discussion between review authors and further disagreements through consultation with the last review author. We assessed risk of bias in 10 methodological domains using the Cochrane risk of bias tool and examined risk of random error through trial sequential analysis. We used the principles of the GRADE approach to prepare an overall assessment of the quality of evidence. For our primary outcomes (recovery times to train-of-four ratio (TOFR) > 0.9), we presented data as mean differences (MDs) with 95 % confidence intervals (CIs), and for our secondary outcomes (risk of adverse events and risk of serious adverse events), we calculated risk ratios (RRs) with CIs. MAIN RESULTS We included 41 studies (4206 participants) in this updated review, 38 of which were new studies. Twelve trials were eligible for meta-analysis of primary outcomes (n = 949), 28 trials were eligible for meta-analysis of secondary outcomes (n = 2298), and 10 trials (n = 1647) were ineligible for meta-analysis.We compared sugammadex 2 mg/kg and neostigmine 0.05 mg/kg for reversal of rocuronium-induced moderate neuromuscular blockade (NMB). Sugammadex 2 mg/kg was 10.22 minutes (6.6 times) faster then neostigmine 0.05 mg/kg (1.96 vs 12.87 minutes) in reversing NMB from the second twitch (T2) to TOFR > 0.9 (MD 10.22 minutes, 95% CI 8.48 to 11.96; I2 = 84%; 10 studies, n = 835; GRADE: moderate quality).We compared sugammadex 4 mg/kg and neostigmine 0.07 mg/kg for reversal of rocuronium-induced deep NMB. Sugammadex 4 mg/kg was 45.78 minutes (16.8 times) faster then neostigmine 0.07 mg/kg (2.9 vs 48.8 minutes) in reversing NMB from post-tetanic count (PTC) 1 to 5 to TOFR > 0.9 (MD 45.78 minutes, 95% CI 39.41 to 52.15; I2 = 0%; two studies, n = 114; GRADE: low quality).For our secondary outcomes, we compared sugammadex, any dose, and neostigmine, any dose, looking at risk of adverse and serious adverse events. We found significantly fewer composite adverse events in the sugammadex group compared with the neostigmine group (RR 0.60, 95% CI 0.49 to 0.74; I2 = 40%; 28 studies, n = 2298; GRADE: moderate quality). Risk of adverse events was 28% in the neostigmine group and 16% in the sugammadex group, resulting in a number needed to treat for an additional beneficial outcome (NNTB) of 8. When looking at specific adverse events, we noted significantly less risk of bradycardia (RR 0.16, 95% CI 0.07 to 0.34; I2= 0%; 11 studies, n = 1218; NNTB 14; GRADE: moderate quality), postoperative nausea and vomiting (PONV) (RR 0.52, 95% CI 0.28 to 0.97; I2 = 0%; six studies, n = 389; NNTB 16; GRADE: low quality) and overall signs of postoperative residual paralysis (RR 0.40, 95% CI 0.28 to 0.57; I2 = 0%; 15 studies, n = 1474; NNTB 13; GRADE: moderate quality) in the sugammadex group when compared with the neostigmine group. Finally, we found no significant differences between sugammadex and neostigmine regarding risk of serious adverse events (RR 0.54, 95% CI 0.13 to 2.25; I2= 0%; 10 studies, n = 959; GRADE: low quality).Application of trial sequential analysis (TSA) indicates superiority of sugammadex for outcomes such as recovery time from T2 to TOFR > 0.9, adverse events, and overall signs of postoperative residual paralysis. AUTHORS' CONCLUSIONS Review results suggest that in comparison with neostigmine, sugammadex can more rapidly reverse rocuronium-induced neuromuscular block regardless of the depth of the block. Sugammadex 2 mg/kg is 10.22 minutes (˜ 6.6 times) faster in reversing moderate neuromuscular blockade (T2) than neostigmine 0.05 mg/kg (GRADE: moderate quality), and sugammadex 4 mg/kg is 45.78 minutes (˜ 16.8 times) faster in reversing deep neuromuscular blockade (PTC 1 to 5) than neostigmine 0.07 mg/kg (GRADE: low quality). With an NNTB of 8 to avoid an adverse event, sugammadex appears to have a better safety profile than neostigmine. Patients receiving sugammadex had 40% fewer adverse events compared with those given neostigmine. Specifically, risks of bradycardia (RR 0.16, NNTB 14; GRADE: moderate quality), PONV (RR 0.52, NNTB 16; GRADE: low quality), and overall signs of postoperative residual paralysis (RR 0.40, NNTB 13; GRADE: moderate quality) were reduced. Both sugammadex and neostigmine were associated with serious adverse events in less than 1% of patients, and data showed no differences in risk of serious adverse events between groups (RR 0.54; GRADE: low quality).
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Affiliation(s)
- Ana‐Marija Hristovska
- Rigshospitalet, Copenhagen University HospitalJuliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013Blegdamsvej 9CopenhagenDenmark2100
| | - Patricia Duch
- Copenhagen University Hospital HvidovreDepartment of Anaesthesiology and Intensive Care MedicineKettegård Alle 39HvidovreDenmark2650
| | - Mikkel Allingstrup
- Rigshospitalet, Copenhagen University HospitalJuliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013Blegdamsvej 9CopenhagenDenmark2100
| | - Arash Afshari
- Rigshospitalet, Copenhagen University HospitalJuliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013Blegdamsvej 9CopenhagenDenmark2100
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Liu G, Wang R, Yan Y, Fan L, Xue J, Wang T. The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: A systematic review. Sci Rep 2017; 7:5724. [PMID: 28720838 PMCID: PMC5515941 DOI: 10.1038/s41598-017-06159-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 05/24/2017] [Indexed: 12/17/2022] Open
Abstract
The aim of this study is to evaluate the efficacy and safety of sugammadex for reversing neuromuscular blockade in pediatric patients. MEDLINE and other three Databases were searched. Randomized clinical trials were included if they compared sugammadex with neostigmine or placebo in pediatric patients undergoing surgery involving the use of rocuronium or vecuronium. The primary outcome was the time interval from administration of reversal agents to train-of-four ratio (TOFr, T4/T1) > 0.9. Incidences of any drug-related adverse events were secondary outcomes. Trial inclusion, data extraction, and risk of bias assessment were performed independently. Mean difference and relative risk were used as summary statistics with random effects models. Statistical heterogeneity was assessed by the I2 statistic. Funnel plot was used to detect publication bias. Ten studies with 580 participants were included. Although considerable heterogeneity (I2 = 98.5%) was detected in primary outcome, the results suggested that, compared with placebo or neostigmine, sugammadex can reverse rocuronium-induced neuromuscular blockade more rapidly with lower incidence of bradycardia. No significant differences were found in the incidences of other adverse events. Compared with neostigmine or placebo, sugammadex may reverse rocuronium-induced neuromuscular blockade in pediatric patients rapidly and safely.
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Affiliation(s)
- Guangyu Liu
- Department of Anesthesiology, Peking University First Hospital, Beijing, 100035, China
| | - Rui Wang
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yanhong Yan
- Department of Anesthesiology, Beijing Tong Ren Hospital, Capital Medical University, Beijing, 100730, China
| | - Long Fan
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jixiu Xue
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China.
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Khan MW, Ghauri SK, Shamim S. Ogilvie's Syndrome. J Coll Physicians Surg Pak 2016; 26:989-991. [PMID: 28043313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 04/08/2016] [Indexed: 06/06/2023]
Abstract
Ogilvie's syndrome, also known as 'paralytic ileus of the colon', is characterised by pseudo-obstruction of the large intestine in the absence of any mechanical obstructing component; and presents as a massively distended abdomen. If left untreated, it may lead to bowel perforation or ischemia. Ogilvie's syndrome usually presents as a postsurgical complication, mainly due to the lack and/or restriction of movement coupled with a possible electrolyte imbalance. Here, we present a case of a pre-surgical 63-year lady, having a right hip fracture, who came with complaints of severe abdominal pain and distension for 4 days. Abdominal X-rays showed massively dilated bowel loops. Patient was successfully managed with neostigmine administration and was discharged home.
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Affiliation(s)
| | | | - Sara Shamim
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi
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Putz L, Dransart C, Jamart J, Marotta ML, Delnooz G, Dubois PE. Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial. J Clin Anesth 2016; 35:107-113. [PMID: 27871505 DOI: 10.1016/j.jclinane.2016.07.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/07/2016] [Accepted: 07/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit. DESIGN A randomized controlled trial. SETTING Monocentric study performed from February 2011 until May 2012. PATIENTS One hundred consenting women with American Society of Anesthesiologists grade I or II were randomized into 2 groups. INTERVENTION Laparoscopic hysterectomy was performed under desflurane general anesthesia. For the neostigmine (N) group, 0.45 mg · kg-1 rocuronium was followed by spontaneous recovery. A 5-mg rescue bolus was administered only if surgical evaluation was unacceptable. At the end of surgery, 50 μg · kg-1 neostigmine with glycopyrrolate was administered. For the sugammadex (S) group, a higher intubating rocuronium dose (0.6 mg · kg-1) was followed by 5-mg boluses each time the train-of-four count exceeded 2. Sugammadex (2-4 mg · kg-1) was administered to reverse the block. All patients were extubated after obtaining a train-of-four ratio of 0.9. MEASUREMENTS The duration between the end of surgery and operating room discharge and the time spent in the postanesthesia care unit. MAIN RESULTS The time till operating room discharge was shorter and more predictable in group S (9.15±4.28 minutes vs 13.87±11.43 minutes in group N; P=.005). The maximal duration in group S was 22 minutes, compared with 72 minutes in group N. The time spent in the postanesthesia care unit was not significantly different (group S: 47.75±31.77 minutes and group N: 53.43±40.57 minutes; P=.543). CONCLUSION Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine.
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Affiliation(s)
- Laurie Putz
- Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.
| | - Christophe Dransart
- Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium
| | - Jacques Jamart
- Scientific Support Unit, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium
| | - Maria-Laura Marotta
- Gynecology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium
| | - Geraldine Delnooz
- Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium
| | - Philippe E Dubois
- Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium
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Welliver M. Shake Up in the Neostig- mine Methylsulfate Cholin- esterase Inhibitor Market for Neuromuscular Block Reversal. AANA J 2015; 83:240-242. [PMID: 26390739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kayalha H, Mousavi Z, Sadat Barikani A, Yaghoobi S, Khezri MB. THE EFFECTS OF INTRATHECAL NEOSTIGMINE ADDED TO BUPIVACAINE ON POSTOPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY. Middle East J Anaesthesiol 2015; 23:199-204. [PMID: 26442397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects of them and increase the degree of satisfaction. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy of the neostigmine added to bupivacaine using spinal anesthesia in patients undergoing lower limb orthopedic surgery. METHODS Sixty patients 18-80 yr old American Society of Anesthesiologists (ASA) physical status I or II, scheduled for femur surgery under spinal anesthesia, were recruited in a prospective, double-blinded, randomized way. The patients were randomly allocated to one of two groups of 30 each. The neostigmine group (group N) received bupivacaine 20 mg combined with 25 µg neostigmine, and the placebo group (group C) received bupivacaine 20 mg combined with 0.5ml distilled water (intrathecally) 5 minutes prior to surgery. The time to the first analgesic request, analgesic requirement in the first 12 hours after surgery, the duration of sensory and motor blockade, the incidence of adverse effects such as nausea,vomiting,hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. RESULTS Patients receiving neostigmine had a significantly prolonged duration of motor block (C95% CI 30.27 to 87.65; P < 0.001) and sensory block (C95% CI 101.04 to 224.64; P < 0.001) compared to the control group. The difference of the mean time to the first analgesic request was also significantly longer in neostigmine group (C95% CI 83.139 to 208.526; P < 0.001). The total analgesic consumption during the first 12 hours after surgery was devoid of any significant difference between groups N and C (p = 0.41).The two groups were not significantly different in terms of intraoperative and postoperative side effects. CONCLUSION Intrathecal neostigmine 25 µg with bupivacaine caused a prolonged time to the first analgesic request and its use was not associated with any side effects.
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Abstract
BACKGROUND In myasthenia gravis, antibody-mediated blockade of acetylcholine receptors at the neuromuscular junction abolishes the naturally occurring 'safety factor' of synaptic transmission. Acetylcholinesterase inhibitors provide temporary symptomatic treatment of muscle weakness but there is controversy about their long-term efficacy, dosage and side effects. This is the second update of a review published in The Cochrane Library Issue 2, 2011. OBJECTIVES To evaluate the efficacy of acetylcholinesterase inhibitors in all forms of myasthenia gravis. SEARCH METHODS On 8 July 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE for randomised controlled trials and quasi-randomised controlled trials regarding usage of acetylcholinesterase inhibitors in myasthenia gravis. Two authors scanned the articles for any study eligible for inclusion. We also contacted the authors and known experts in the field to identify additional published or unpublished data and searched clinical trials registries for ongoing trials. SELECTION CRITERIA The types of studies were randomised or quasi-randomised trials. Participants were myasthenia gravis patients diagnosed by an internationally accepted definition. The intervention was treatment with any form of acetylcholinesterase inhibitor. Types of outcome measures Primary outcome measureImprovement in the presenting symptoms within one to 14 days of the start of treatment. Secondary outcome measures(1) Improvement in the presenting symptoms more than 14 days after the start of treatment.(2) Change in impairment measured by a recognised and preferably validated scale, such as the quantitative myasthenia gravis score, within one to 14 days and more than 14 days after the start of treatment.(3) Myasthenia Gravis Association of America post-intervention status more than 14 days after start of treatment.(4) Adverse events including muscarinic side effects. DATA COLLECTION AND ANALYSIS One author (MMM) extracted the data, which were checked by a second author. We contacted study authors for extra information and collected data on adverse effects from the trials. MAIN RESULTS We did not find any large randomised or quasi-randomised trials of acetylcholinesterase inhibitors in generalised myasthenia gravis either for the first version of this review or this update. One cross-over randomised trial using intranasal neostigmine in a total of 10 participants was only available as an abstract. It included three participants with ocular myasthenia gravis and seven with generalised myasthenia gravis. Symptoms of myasthenia gravis (measured as improvement in at least one muscle function) improved in nine of the 10 participants after the two-week neostigmine treatment phase. No participant improved after the placebo phase. Lack of detail in the report meant that the risk of bias was unclear. Adverse events were minor. AUTHORS' CONCLUSIONS Except for one small and inconclusive trial of intranasal neostigmine, no other randomised controlled trials have been conducted on the use of acetylcholinesterase inhibitors in myasthenia gravis. The response to acetylcholinesterase inhibitors in observational studies is so clear that a randomised controlled trial depriving participants in a placebo arm of treatment would be difficult to justify.
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Affiliation(s)
| | - Sanjay Pandey
- G.B. Pant HospitalDepartment of Neurology#502, Academic BlockNew DelhiIndia110002
| | - Thierry Kuntzer
- CHU Vaudois and University of LausanneNerve‐Muscle Unit, Service of NeurologyLausanneSwitzerland1011
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Fyneface-Ogan S, Mato CN, Tobin M. A comparative study between caudal bupivacaine and bupivacaine co-administered with neostigmine for postoperative analgesia in children. Niger Postgrad Med J 2014; 21:51-56. [PMID: 24887252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to compare the duration of postoperative analgesia and possible adverse effects produced by caudal bupivacaine 0.25% at 1 ml/kg with or without 1.5 ug/kg of neostigmine in children undergoing unilateral herniotomy. PATIENTS AND METHODS Sixty-six children aged 1-6 years, of ASA physical status classes I or II for elective unilateral herniotomy under general anaesthesia without premedication were studied. The patients were randomly allocated into two groups of 33 each. Group B received caudal analgesia with plain bupivacaine 0.25% at 1 ml/kg alone, while group BN received caudal analgesia using a mixture of plain bupivacaine 0.25% at 1 ml/kg and neostigmine 1.5 ug/ kg. Postoperatively, monitoring of pain scores and time to first analgesic request and, total dose of analgesics administered in the first 24 hours were recorded. RESULTS All the patients participated throughout the study. There were no differences in the demographic characteristics (age, weight, ASA status)between the two groups. The mean duration of effective analgesia was significantly longer in group BN, 460 ± 60.2 min. compared to group B, 286.4 ± 47.8 mins, (p < 0.001). The analgesic requirement within the first 24 hours postoperatively was also significantly reduced in group BN, p < 0.001. CONCLUSION The study shows that the addition of low dose neostigmine to caudal isobaric bupivacaine significantly prolonged the time to first analgesic request and hence significantly reduced postoperative analgesic requirement.
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Ertberg P, Vilandt J, Bødker B. [Diagnosis and treatment of acute colonic pseudo-obstruction]. Ugeskr Laeger 2013; 175:1176-1180. [PMID: 23651781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a clinical condition with acute dilatation of the colon without a provable mechanical cause. Early recognition and treatment of the condition is important in order to improve the outcome. The diagnosis is based on clinical and radiographic findings. Supportive therapy should be the initial management. If no improvement occurs after 24 hours, medical treatment with neostigmine administered i.v. is instituted and repeated if necessary. Colonoscopic decompression is the next step, but if ischaemia or perforation appear surgery should be performed.
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Affiliation(s)
- Pia Ertberg
- Gynækologisk-obstetrisk Afdeling G, Hillerød Hospital, Denmark.
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Lang CL, Haveman MC, Achiam M. [Successful conservative treatment of coecal perforation in a patient with Ogilvie's syndrome]. Ugeskr Laeger 2013; 175:1120-1121. [PMID: 23651754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The case report describes a 37-year-old woman who was diagnosed with Ogilvie's syndrome after caesarean section. Conservative treatment was initiated with minimal effect, and the patient was subsequently treated with IV neostigmine. A computed tomography of the abdomen revealed enlarged peritoneal cavity. However the patient was clinically unaffected without fever or signs of peritonitis. The perforation was managed with a conservative approach including antibiotics and close observation of the patient. After nine days the patient was discharged with normal gastrointestinal function and without further reported complications.
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Affiliation(s)
- Christian Lyngsaa Lang
- Gastroenheden - Kirurgisk Sektion, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
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Jain A, Sahni N, Banik S, Solanki SL. Accidental intra-arterial injection of neostigmine with glycopyrrolate or atropine for reversal of residual neuromuscular blockade: a report of two cases. Anesth Analg 2012; 115:210-1. [PMID: 22723211 DOI: 10.1213/ane.0b013e3182572919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Xiong HR, Tan QY, Liu BL, Luo W, Zhang JQ. [Pharmacokinetics and relative bioavailability of neostigmine bromide sustained-release tablets]. Sichuan Da Xue Xue Bao Yi Xue Ban 2011; 42:657-660. [PMID: 22007493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To study the pharmacokinetics and relative bioavailability of neostigmine bromide conventional tablets and sustained-release tablets in rabbits. METHODS Six healthy rabbits were randomly divided into two groups for a cross self-contrast trial. RP-HPLC was used to detect plasma concentrations of neostigmine bromide. The pharmacokinetic parameters were calculated with the aid of DAS 2.0 software. RESULTS The main pharmacokinetics parameters of the sustained-release tablets and conventional tablets were as follows, respectively: T(max)(3.67 +/- 1.51) hand (1.58 +/- 0.38) h; C(max) (5.04 +/- 1.19) mg/L and (4.56 +/- 1.70) mg/L; AUC(0 --> infinity) (32.82 +/- 9.88) mg/L x h and (29.84 +/- 14.27) mg/L x h. The relative bioavailability of the neostigmine bromide sustained-release tablets was 115.4%. CONCLUSION The pharmacokinetics of neostigmine bromide accords with two compartments model, showing constant plasma concentration and relatively high bioavailability.
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Affiliation(s)
- Hua-Rong Xiong
- Medicine Engineering Research Center, Chongqing Key Laboratory of Biochemical & Molecular Pharmacology, Chongqing Medical University, Chongqing 400016, China
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Dadu S, Mishra LS, Agrawal M, Chandola HC. Comparative clinical study of effect of neostigmine and ketamine for postoperative analgesia. J Indian Med Assoc 2011; 109:308-311. [PMID: 22187762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of the study was to evaluate and compare the role of neostigmine and ketamine as an additive to epidural bupivacaine to prolong the duration of postoperative analgesia. A double-blind randomised study was done on 60 adult patients, of both sexes, between 18 and 50 years, belonging to ASA grades I and II, undergoing below umbilical surgeries under epidural anaesthesia. All the patients were divided into three groups of 20 each to receive 20 ml of 0.5% bupivacaine with either 1 ml of normal saline, 100 mg of neostigmine or 50 mg of ketamine (both diluted with 1 ml normal saline). The mean (+/- SD) time to the first rescue analgesic administration was significantly prolonged by neostigmine [543.30 (+/- 133.40) minutes] and ketamine [292.00 (+/- 71.93) minutes] compared to the control group with saline [212.80 (+/- 62.49) minutes]. Postoperative 24-hour pain score was also less in neostigmine group. When compared to ketamine group neostigmine showed superior postoperative pain relief. Both neostigmine and ketamine demonstrated better haemodynamic stability with less incidence of hypotension. There was no increased incidence of nausea and vomiting or any other side-effects. In conclusion, it can be said neostigmine is a good adjuvant to epidural block to produce adequate pain relief without increased incidence of adverse effects.
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Affiliation(s)
- Shalini Dadu
- Department of Anaesthesiology, Moti Lal Nehru Medical College, Allahabad 211001
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Lederer W, Reiner T, Khuenl-Brady KS. Neostigmine injected 5 minutes after low-dose rocuronium accelerates the recovery of neuromuscular function. J Clin Anesth 2011; 22:420-4. [PMID: 20868962 DOI: 10.1016/j.jclinane.2009.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 10/22/2009] [Accepted: 10/29/2009] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE To determine whether neostigmine 5 minutes after 0.4 mg/kg rocuronium accelerates reversal. DESIGN Prospective, randomized, comparative open-label study. SETTING Operating room. PATIENTS 60 ASA physical status I and II patients, aged 18 to 65 years. INTERVENTIONS Patients received 0.4 mg/kg rocuronium during nitrous oxide (N(2)O)-propofol-opioid anesthesia. Reversal of neuromuscular blockade was achieved with neostigmine, either at 0.03 mg/kg or 0.05 mg/kg intravenously (IV), together with glycopyrrolate administered 5 minutes after relaxant and compared with spontaneous recovery. Onset, depth, and duration of neuromuscular block, as well as recovery of train-of-four (TOF) to 0.8 and 0.9 were evaluated. MAIN RESULTS Times to achieve TOF ratios of 0.8 and 0.9 were significantly shorter when 0.03 mg/kg or 0.05 mg/kg neostigmine was administered 5 minutes after administration of rocuronium (20.2 ± 5 min and 22.6 ± 5.9 min or 17.8 ± 4.8 min and 19.4 ± 5.1 min, respectively) compared with controls (36.2 ± 8.5 min and 39.0 ± 8.7 min; P < 0.01). Duration to spontaneous T1 25% recovery after rocuronium was 15.5 ± 6.5 min versus 9.3 ± 2.3 min and 7.7 ± 1.6 min in the treatment groups (P < 0.01). Recovery index (T1 from 25% to 75%) was significantly shorter after neostigmine (7.1 ± 2.4 min and 5.7 ± 4.0 min) versus controls (13.3 ± 8.3 min; P < 0.01). Speed of reversal did not differ significantly between IV neostigmine doses of 0.03 mg/kg or 0.05 mg/kg. CONCLUSION Neostigmine accelerates recovery when administered 5 minutes after injection of IV rocuronium 0.4 mg/kg.
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Affiliation(s)
- Wolfgang Lederer
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria.
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Xiao E, Xiong H, Zhao YH, Deng XK, Mei ZN. [Study on acute toxicity and animal gastrointestinal activity of crude and processed products of Entada phaseoloides]. Zhong Yao Cai 2010; 33:1704-1707. [PMID: 21434429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the acute toxicity of the crude and processed products of Entada phaseoloides and their effects on gastrointestinal movement in mice. METHODS Using the method of intragastric administration, to observe the acute toxicity of the crude and processed products of Entada phaseoloides in mice and determine their LD50. With the methods of charcoal propulsion of small intestine and methyl orange colorimetry of gastric emptying, to study the impact of the crude and processed products of Entada on gastrointestinal movement in mice. RESULTS The oral LD50 of crude Entada phaseoloides, No. 1 and No. 2 processed products of Entada phaseoloides in mice were 27.17, 35.13, 42.18 g/kg body weight. Crude and processed products of Entada phaseoloides can significantly promote the enteric propulsion of normal mice, and can significantly counteract the depressing status induced by atropine, but have no influence on the overactive status induced by neostigmine. The high, middle and low-dose of groups showed significant inhibition of the gastric emptying in normal mice. CONCLUSION Processed Entada phaseoloides showed effects on the enteric propulsion of normal and depressing mice, can restrain the gastric emptying under normal mice, but its safety is better than crude Entada phaseoloides.
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Affiliation(s)
- Er Xiao
- College of Pharmacy, South-central University for Nationalities, Wuhan 430074, China.
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Kasaba T. [Some adjuvants added to local anesthetics improve the duration and quality of epidural anesthesia]. Masui 2010; 59 Suppl:S157-S165. [PMID: 21702102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Hye MA, Masud KM, Banik D, Banik D, Haque MF, Akhtaruzzaman KM. Intrathecal neostigmine for postoperatrive analgesia in caesarean section. Mymensingh Med J 2010; 19:586-593. [PMID: 20956904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study was done for intrathecal adjuncts often are used to enhance small dose spinal bupivacaine anaesthesia. We designed this study to evaluate the postoperative analgesic efficacy and safety of intrathecal neostigmine. A randomized, double-blind prospective study was conducted in 90 healthy term pregnant patients scheduled to undergoing elective caesarean section using spinal anaesthesia. Women were administered 12.5 mg bupivacaine alone or with 75 microgram and 150 microgram of neostigmine as intrathecal drug. Parametric data were analyzed using ANOVA. Chi-square test was used to analyze the incidence data. Neostigmine significantly increased the duration sensory and motor block (p<0.05) and the time until for achieving discharge criteria. The addition of neostigmine produced dose-dependent nausea and vomiting and had no significant effect on haemodynamic or respiratory parameters. Addition of neostigmine to intrathecal bupivacaine extends the duration of postoperative analgesia with fewer side-effects without adverse effects on fetus following caesarean section.
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Affiliation(s)
- M A Hye
- Department of Anaesthesia, Intensive Care and Pain Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka, Bangladesh.
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de Boer HD. Sugammadex and cholinesterase inhibitors. Anaesth Intensive Care 2010; 38:955-956. [PMID: 20865891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Mizikov VM, Stamov VI, Deshko IV, Ialich AI. [Problem of neuromuscular block reversion: neostigmine and sugammadex]. Anesteziol Reanimatol 2010:40-43. [PMID: 20524330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The review covers the history of neuromuscular block reversal. It states that indications for decurarization have been changed due to the extremely high rate of residual curarization even after the use of average-acting myorelaxants. The paper provides the pharmacological characteristics of sugammadex, a new selective relaxant-binding agent for aminosteroids (rocuronium and vecuronium) with the unique mechanism of action. It also gives data on the efficacy and safety of sugammadex versus anticholinesterase agents and estimates the prospects for its clinical application.
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Nowak A, Łata S. [Datura intoxication--report of three cases]. Przegl Lek 2010; 67:438-439. [PMID: 20684356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In recent months, more and more reports have appeared about datura seed poisoning. Datura is widespread and has hallucinogenic properties. It is part of the increase in drug use among the younger generation that is experimenting with intoxicants. The hallucinogenic and poisonous effects of datura involve the presence of tropine alkaloids: atropine and scopolamine. They both have similar effects, suppressing the parasympathetic peripheral nervous system. In large doses they lead to death as a result of respiratory paralysis. Treatment addresses the symptoms. In order to eliminate toxic effects of atropine, an antagonistic medication such as neostigmine is given.
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Affiliation(s)
- Agnieszka Nowak
- Szpital Wojewódzki im. Sw.Łukasza, Tarnów II Oddział Chorób Wewnetrznych i Ostrych Zatruć
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Shen LP, Guan J, Ding KY. [Clinical observation on electroacupuncture combined with acupoint injection for treatment of early postoperative inflammatory intestinal obstruction]. Zhongguo Zhen Jiu 2010; 30:27-30. [PMID: 20353110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To search for a better therapy for early postoperative inflammatory small bowel obstruction (EPISBO). METHODS Two hundred and forty cases were divided into four groups according to admitting order, 60 cases in each group. Routine treatments in western medicine were used in group A including gastrointestinal decompression, parenteral nutrition, anti-infection, supportive therapy and so on. Group B was treated with electroacupuncture in Zusanli (ST 36), Shangjuxu (ST 37) etc. in addition to those given in group A. Group C was treated with acupoint injection with Neostigmine in Dachangshu (BL 25), Zusanli (ST 36) etc. in addition to the treatment used in group A. Group D was treated with all of the treatments used in group A, B and C. RESULTS The total effective rate was 93. 3% in group A, 96. 7% in group B, 100.0% in group C and group D. There was no significant difference among the four groups (P>0. 05). The average recovery time of bowel sound was (11. 512. 9) days in group A, (9. 3 +/- 2.5) days in group B, (5.6 +/- 3.5) days in group C and (2. 2 +/- 1.7) days in group D. The average anal exsufflation time was (12. 5 +/- 3. 1) days in group A, (10. 7 +/- 3.6) days in group B, (7. 2 +/- 3. 1) days in group C and (2. 5 +/- 1. 5) days in group D. Group D was superior to those of other three groups obviously, and there were significant differences between them (all P<0. 01). CONCLUSION Electroacupuncture combined with acupoint injection has a satisfied therapeutic effect for treatment of EPISBO.
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Affiliation(s)
- Li-ping Shen
- Acupuncture Department, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, China.
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Suzuki T, Mizutani H, Miyake E, Fukano N, Saeki S, Ogawa S. Infusion requirements and reversibility of rocuronium at the corrugator supercilii and adductor pollicis muscles. Acta Anaesthesiol Scand 2009; 53:1336-40. [PMID: 19650798 DOI: 10.1111/j.1399-6576.2009.02073.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM). METHODS We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0-1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced and maintained at T1 of 10% of the control at the CSM or APM for 120 min. Immediately after rocuronium infusion was discontinued, the time required for 0.04 mg/kg neostigmine-facilitated recovery to a TOF ratio of 0.9 was recorded. RESULTS Rocuronium infusion dose after a lapse of 120 min was significantly larger in the CSM than in the APM [7.1 (2.3) vs. 4.7 (2.6) microg/kg/min; P=0.001]. The time for facilitated recovery was shorter in the CSM than in the APM [11.4 (3.8) vs. 16.2 (6.0) min; P=0.016]. CONCLUSION A larger rocuronium infusion dose was required to maintain a constant neuromuscular block at the CSM. Neostigmine-mediated reversal was faster at the CSM.
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Affiliation(s)
- T Suzuki
- Department of Anesthesiology, Surugadai Nihon University Hospital, 1-8-13, Kanda-Surugadai, Chiyoda-Ku, Tokyo, Japan.
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Cao BL, Jiao L, Liu XM. [Application of Dachengqi Granule in the perioperative period of total laparoscopic hysterectomy]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2009; 29:441-443. [PMID: 19673338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To observe the effects of Dachengqi Granule (DCG) in the recovery of gastrointestinal function and the condition of patients in the perioperative period of total laparoscopic hysterectomy. METHODS Two hundred and one patients received total laparoscopic hysterectomy were assigned to 2 groups, the treated group (103 cases) was orally administered DCG twice, 9 g at 4:00 pm, one day before operation and 6 g at 16 h after operation, while to the control group, enema with 400 mL of soap solution at 8:00 pm one day before operation and acupoint ST 36 injection with 1 mL neostigmine at 16 h after operation were given. RESULTS Total laparoscopic hysterectomy was accomplished successfully in all patients, no need to receive open abdominal operation, and with no post-operational complications. In the treated group, the operation time was (116.8 +/- 29.7) min, the operative blood loss was (141.6 +/- 25.1) mL, the post-operative temperature was (37.38 +/- 1.39) degrees C, while those in the control group were (119.6 +/- 28.4) min, (150.6 +/- 22.1) mL, and (37.55 +/- 0.43) degrees C, correspondingly, showing insignificant difference between the two groups (P > 0.05). The white blood cell count on the 1st day after operation was (11.18 +/- 2.93) x 10(9)/L in the treated group, and (12.57 +/- 3.55) x 10(9)/L in the control group (P < 0.01); time for post-operative aerofluxus in them was (35.66 +/- 5.72) h, and (41.77 +/- 6.06) h; time for post-operative defecation (48.47 +/- 18.97) h, and (54.81 +/- 21.30) h, respectively, all showed statistical difference between the two groups (P < 0.01 or P < 0.05). CONCLUSION Administering DCG before and early after operation can effect better than pre-operational enema in ensuring the gynecological operation progression smoothly, and it could also promote the recovery of post-operational gastrointestinal function and improve patients' condition in the perioperative period.
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Dubois PE. Delayed reversal of a potentiated rocuronium neuromuscular block. Eur J Anaesthesiol 2009; 26:350-352. [PMID: 19401670 DOI: 10.1097/eja.0b013e32831bc6d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Batra YK, Rajeev S, Panda NB, Lokesh VC, Rao KLN. Intrathecal neostigmine with bupivacaine for infants undergoing lower abdominal and urogenital procedures: dose response. Acta Anaesthesiol Scand 2009; 53:470-5. [PMID: 19317863 DOI: 10.1111/j.1399-6576.2008.01837.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intrathecal (IT) neostigmine produces dose-dependent analgesia in adults. However, the dose of spinal neostigmine has not been investigated in infants. The purpose of this study was to assess spinal anesthesia (SA) duration provided by four doses of spinal neostigmine added to bupivacaine for lower abdominal and urogenital procedures in infants. METHODS Seventy-five infants were randomized into five groups. The control group B received IT plain 0.5% hyperbaric bupivacaine. Groups BN.25, BN.50, BN.75, and BN1.0 received bupivacaine with 0.25, 0.5, 0.75, and 1 microg/kg of neostigmine, respectively. The primary variable was the duration of anesthesia assessed by recovery of hip flexion. Postoperative pain with facial expression, leg activity, arm activity, crying and consolability scale score, and rescue analgesic requirements were the secondary variables measured, and the side effects were noted. RESULTS Seventy-three infants completed the study. There was a significant linear increase in SA duration with IT neostigmine to 65.2 (4.3) min with 0.5 microg/kg (P<0.01), 88.2 (5.1) with 0.75 microg/kg (P<0.001) and 92 (4.3) with 1 microg/kg (P<0.001) from 52.4 (4.3) min with bupivacaine alone. SA duration showed no significant difference between plain bupivacaine and BN.25 (P=0.100) or between groups BN.75 and BN1.0 (P=0.451). Groups BN.75 and BN1.0 had significantly reduced pain scores, and the median duration before the first dose rescue analgesic was requested prolonged significantly (P<0.001) compared with the other three groups. CONCLUSIONS IT neostigmine at a dose of 0.75 microg/kg added to bupivacaine significantly prolonged SA duration with reduced postoperative pain scores and rescue analgesic requirements in infants undergoing lower abdominal and urogenital procedures. No additional benefits were provided on increasing it to 1 microg/kg.
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Affiliation(s)
- Y K Batra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Beccaria P, Cabrini L, Garancini MP, Colombo S. Recurarisation in a surgical ward. Anaesth Intensive Care 2008; 36:917. [PMID: 19115668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Rosman AS, Chaparala G, Monga A, Spungen AM, Bauman WA, Korsten MA. Intramuscular neostigmine and glycopyrrolate safely accelerated bowel evacuation in patients with spinal cord injury and defecatory disorders. Dig Dis Sci 2008; 53:2710-3. [PMID: 18338263 DOI: 10.1007/s10620-008-0216-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 02/12/2008] [Indexed: 12/13/2022]
Abstract
Difficulty with evacuation after spinal cord injury (SCI) may be due to a lack of parasympathetic stimulation of the colon. Prior studies in persons with spinal cord injury have suggested that intravenous administration of neostigmine stimulates colonic motility while glycopyrrolate attenuates some of the cholinergic side effects of neostigmine. We thus performed a double-blind, cross-over study to evaluate the effect of neostigmine/glycopyrrolate injections in patients with SCI and defecatory difficulties. Seven subjects received active treatment (neostigmine 2 mg and glycopyrrolate 0.4 mg intramuscularly) during three consecutive bowel evacuation sessions and were crossed-over to placebo injections for three consecutive sessions. Compared with placebo, neostigmine/glycopyrrolate reduced the total bowel evacuation time from 98.1 +/- 7.2 to 74.8 min +/- 5.8 (p < 0.05). The lowest heart rate or blood pressure was not significantly different between the treatment and placebo groups. In conclusion, neostigmine/glycopyrrolate may improve bowel evacuation in patients with SCI-related defecatory disorders.
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Affiliation(s)
- Alan S Rosman
- Gastroenterology Practice and the Spinal Cord Center of Excellence, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
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Polenceusz W, Kupisiak J, Goch R, Ryznar T, Leksowski K. [Comparison of two methods of pre-emptive infiltration anaesthesia for inguinal hernia repair]. Anestezjol Intens Ter 2008; 40:227-231. [PMID: 19517661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Intraarticular injection of neostigmine has been reported to create long-lasting analgesia due to the blockade of muscarinic receptors and neuronociceptive transmitters. The aim of the study was to determine if similar effects could be achieved after adding neostigmine to bupivacaine during infiltration of the surgical area before inguinal hernia surgery. METHODS Ninety patients (82 males and 8 females), aged 20-88 (mean 54.8) years, scheduled for Lichtenstein hernia surgery under spinal anaesthesia, were randomly allocated to three groups. The surgical area was infiltrated with 10 mL of 0.5% bupivacaine in group 1, or 10 mL of 0.5% bupivacaine with 0.5 mg neostigmine in group 2. Patients in the control group did not receive local infiltration. Postoperative pain was assessed using a numerical rating scale (NRS), and adjective rating scale (ARS) and the need for rescue analgesia (ketoprofen or pethidine) was recorded. RESULTS The patients of group 1 required rescue analgesia significantly later, compared to the other two groups. Intense pain occurred less frequently in group 1 and the most frequently in group 3. The need for rescue analgesia was also least in group 1 and greatest in group 3. CONCLUSIONS Neostigmine added to bupivacaine had no effect on analgesia after pre-emptive local wound infiltration.
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Takeda J. [Muscle relaxants in ambulatory anesthesia]. Masui 2008; 57:845-852. [PMID: 18649639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Neuromuscular blocking agents are used to facilitate tracheal intubation and surgical procedure in ambulatory anesthesia. However, the ideal neuromuscular blocking agents for ambulatory anesthesia are not yet available. The only depolarizing neuromuscular blocking agent, suxamethonium, is still widely used by its rapid onset and short duration of action producing excellent intubating conditions, in spite of its numerous adverse effects. Nondepolarizing neuromuscular agents have proved to be associated with postoperative residual block more frequently than it was thought before. The use of neostigmine for reversal and the measurement of the TOF ratio during recovery are recommended after intermediate-acting neuromuscular blocking agents. Some studies have shown that tracheal intubation without neuromuscular agents may be associated with postoperative hoarseness and vocal cord injuries. Sugammadex will resolve many issues in using nondepolarizing neuromuscular agents in ambulatory anesthesia.
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Affiliation(s)
- Junzo Takeda
- Department of Anesthesiology, School of Medicine, Keio University, Tokyo 160-8582
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Ohsone J, Yamakage M, Murouchi T. [Reversal of neuromuscular blockade and complications of remaining blocking effect]. Masui 2008; 57:838-844. [PMID: 18649638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We Japanese anesthesiologists can now use rocuronium as well as vecuronium. Although the onset of rocuronium is more rapid, the non-depolarizing neuromuscular blocking (NMB) agent has similar characteristics of duration and recovery compared to vecuronium. Reversal of NMB is therefore essential to recover patients safely. Conventional standard of reversal of NMB [train of four (TOF) >0.7] is not enough to have sufficient vital capacity and inspiratory force, resulting in pulmonary regurgitation or atelectasis. Even though the reversal of NMB cannot sufficiently be completed by anti-cholinesterase (ChE) agents such as neostigmine, it is needed to reverse the NMB because of their late spontaneous recovery. We also have to take care of patients with neuromusclar diseases such as Duchenne-type muscle dystrophy, when we use anti-ChE agents. Sugammadex is a novel and unique compound designed as an antagonist of rocuronium and possibly other steroid NMB agents. Sugammadex exerts its effect by forming very tight water-soluble complexes at a 1 : 1 ratio with steroid NMB agents (rocuronium>vecuronium>>pancuronium). PhaseIII trials in Japan as well as Europe and the US have just been finished, and it is expected to be used clinically in the near future.
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Affiliation(s)
- Junpei Ohsone
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543
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Bhardwaj N, Yaddanapudi S, Ghai B, Wig J. Neostigmine does not prolong the duration of analgesia produced by caudal bupivacaine in children undergoing urethroplasty. J Postgrad Med 2008; 53:161-5. [PMID: 17699988 DOI: 10.4103/0022-3859.33856] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Neostigmine extends the duration of analgesia produced by caudal bupivacaine in children. AIMS To study the effect of different doses of caudal neostigmine on the duration of postoperative analgesia. SETTINGS AND DESIGN A randomized, double-blind study was conducted in 120 boys aged 1-12 years undergoing urethroplasty under combined general and caudal anesthesia. MATERIALS AND METHODS Children were administered 1.875 mg/kg bupivacaine alone (Group B) or with 2, 3 or 4 microg/kg of neostigmine (groups BN 2, BN 3 or BN 4 respectively) as caudal drug (0.75 ml/kg). Children with a pain score of 4 or more (OPS and NRS) postoperatively were administered rescue analgesic. Time to first analgesic and the number of analgesic doses administered in the 24h were recorded. STATISTICAL ANALYSIS Parametric data were analyzed using ANOVA. Kaplan-Meier survival curves for the time to first analgesic administration were plotted and compared using log rank analysis. Chi-square test was used to analyze the incidence data. RESULTS The median [IQR] time to first analgesic in Group B (540 [240-1441] min) was similar to that in Groups BN 2 (450 [240-720]), BN 3 (600 [360-1020]) and BN 4 (990 [420-1441]). Significantly more patients in Groups B (9 [34.6%]) and BN 4 (13 [44.8%]) required no supplemental analgesic for 24h than those in Groups BN 2 and BN 3 (4 [13.8%] and 4 [13.3%]). The number of analgesic doses required in 24h in the four groups was similar. CONCLUSION Addition of neostigmine to 1.875 mg/kg of caudal bupivacaine did not prolong the analgesia following urethroplasty in children.
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Affiliation(s)
- N Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India.
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