Adducted vocal cords relieved by neuromuscular blocking drug: a cause of impaired mechanical ventilation when using a Laryngeal Mask Airway: two photographically documented cases

Purpose: To determine whether etomidate use before intubation increased development of hospital-acquired pneumonia (HAP) in critically ill, nontrauma patients. Materials and Methods: A single-center, retrospective, cohort study of critically ill, nontrauma patients admitted to the medical intensive care unit (ICU) from 2012 to 2015 and intubated with or without etomidate was conducted. Demographics, comorbidities, primary diagnosis, critical illness scores, concomitant medications, and outcomes were obtained from medical records. Student t, chi-square, and Fisher exact tests were performed as appropriate. Relevant characteristics were modeled using logistic regression techniques to determine whether any predicted HAP independently. Results: Of the 174 patients, 94 (54%) received etomidate and 80 (46%) did not. There was no difference in HAP between etomidate and no etomidate groups (13.8% vs 23.7%, P = .092). Duration of mechanical ventilation (4.4 vs 4.6 days, P = .845), ICU length of stay (7.4 vs 6.9 days, P = .547), ICU mortality (14.9% vs 12.5%, P = .648), and hospital mortality (17% vs 16.2%, P = .892) were similar between the groups. For each 1-day increase in mechanical ventilation duration, the likelihood of HAP development increased by 21%. Patients who received etomidate but no neuromuscular-blocking drug were 80% less likely to develop HAP than those who did not receive etomidate or a neuromuscular-blocking drug (odds ratio: 0.202, 95% confidence interval: 0.045-0.908). Conclusion: Etomidate use was not associated with a difference in HAP development in critically ill, nontrauma patients.

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▾ Vecuronium - another intermediate duration neuromuscular blocking drug

Drug and Therapeutics Bulletin ◽

10.1136/dtb.25.5.19 ◽

1987 ◽

Vol 25 (5) ◽

pp. 19-20

Keyword(s):

Histamine Release ◽

Cardiovascular Effects ◽

Neuromuscular Blocking ◽

Vecuronium Bromide ◽

Renal Elimination ◽

Blocking Drug ◽

Neuromuscular Blocking Drug ◽

The Uk

Vecuronium bromide (Norcuron - Organon) is a neuromuscular blocking drug introduced in the UK shortly after atracurium besylate. The manufacturer claims it is free from significant unwanted cardiovascular effects, causes minimal histamine release and has low renal elimination and so does not cumulate.

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Cardiopulmonary Effects of the Novel Neuromuscular Blocking Drug GW280430A (AV430A) in Dogs

Anesthesiology ◽

10.1097/00000542-200404000-00014 ◽

2004 ◽

Vol 100 (4) ◽

pp. 846-851 ◽

Cited By ~ 18

Author(s):

Paul M. Heerdt ◽

Richard Kang ◽

Andrew The’ ◽

Mir Hashim ◽

Robert J. Mook ◽

...

Keyword(s):

Cardiovascular Effects ◽

Neuromuscular Blocking ◽

Blocking Drug ◽

Histamine Concentration ◽

Duration Of Action ◽

Neuromuscular Blocking Drug ◽

Pulmonary Vasoconstriction ◽

Arterial Blood ◽

Before And After ◽

Plasma Histamine Concentration

Background This investigation determined the cardiopulmonary side effects of a novel nondepolarizing neuromuscular blocking drug with an ultrashort duration of action in anesthetized male beagles. Methods The ED95 for GW280430A was first determined in four animals. These data were then used to guide bolus dosing in multiples of ED95 in six dogs instrumented for hemodynamic measurements as well as inspiratory pressure and pulmonary compliance. Cardiopulmonary data were compared before and after the conclusion of a 60- to 90-min GW280430A infusion and in response to subsequent incremental bolus dosing starting with 3.125 x ED95. An adverse response was regarded as an alteration of 10% or greater in any variable. Arterial blood was obtained for histamine analysis before and 1 min after each dose. Results The ED95 of GW280430A was 0.064 +/- 0.01 mg/kg, and stable neuromuscular blockade was maintained with infusion of 0.012 +/- 0.002 mg.kg(-1).min(-1). With the exception of a late 14% increase in heart rate, there were no cardiopulmonary changes during infusion. Bolus dosing produced no cardiopulmonary change until a decrease in mean arterial pressure was elicited in four of six dogs at 25 x ED95. This response was modest, transient, and associated with a concomitant increase in plasma histamine concentration. There were no accompanying changes indicative of direct myocardial depression, pulmonary vasoconstriction, or bronchospasm. Conclusions These data indicate that GW280430 does not produce demonstrable cardiovascular effects in the anesthetized dog until doses far in excess of the ED95 are administered as a bolus.

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Pipecuronium Bromide (Arduan)—A New Long-acting Non-depolarizing Neuromuscular Blocking Drug

Clinics in Anaesthesiology ◽

10.1016/s0261-9881(21)00079-3 ◽

1985 ◽

Vol 3 (2) ◽

pp. 361-369 ◽

Cited By ~ 1

Author(s):

S. Agoston ◽

F.J. Richardson

Keyword(s):

Neuromuscular Blocking ◽

Blocking Drug ◽

Neuromuscular Blocking Drug ◽

Long Acting

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Cysteine Reversal of the Novel Neuromuscular Blocking Drug CW002 in Dogs

Anesthesiology ◽

10.1097/aln.0b013e3181d31f8c ◽

2010 ◽

Vol 112 (4) ◽

pp. 900-909 ◽

Cited By ~ 15

Author(s):

Hiroshi Sunaga ◽

Jaideep K. Malhotra ◽

Edward Yoon ◽

John J. Savarese ◽

Paul M. Heerdt

Keyword(s):

Heart Rate ◽

Dose Range ◽

Cardiovascular Effects ◽

Neuromuscular Blocking ◽

Dependent Manner ◽

Blocking Drug ◽

Muscle Twitch ◽

Organ Toxicity ◽

Neuromuscular Blocking Drug ◽

Additional Group

Background CW002 is a neuromuscular blocking drug that is inactivated by endogenous L-cysteine. This study determined the exogenous L-cysteine dose-response relationship for CW002 reversal along with acute cardiovascular effects and organ toxicity in dogs. Methods Six dogs were each studied four times during isoflurane-nitrous oxide anesthesia and recording of muscle twitch, arterial pressure, and heart rate. CW002 (0.08 mg/kg or 9 x ED95) was injected, and the time to spontaneous muscle recovery was determined. CW002 was then administered again followed 1 min later by 10, 20, 50, or 100 mg/kg L-cysteine (1 dose/experiment). After twitch recovery, CW002 was given a third time to determine whether residual L-cysteine influenced duration. Preliminary toxicology was performed in an additional group of dogs that received CW002 followed by vehicle (n = 8) or 200 mg/kg L-cysteine (n = 8). Animals were awakened and observed for 2 or 14 days before sacrificing and anatomic, biochemical, and histopathologic analyses. Results L-cysteine at all doses accelerated recovery from CW002, with both 50 and 100 mg/kg decreasing median duration from more than 70 min to less than 5 min. After reversal, duration of a subsequent CW002 dose was also decreased in a dose-dependent manner. Over the studied dose range, L-cysteine had less than 10% effect on blood pressure and heart rate. Animals receiving a single 200-mg/kg dose of L-cysteine showed no clinical, anatomic, biochemical, or histologic evidence of organ toxicity. Conclusion The optimal L-cysteine dose for rapidly reversing the neuromuscular blockade produced by a large dose of CW002 in dogs is approximately 50 mg/kg, which has no concomitant hemodynamic effect. A dose of 200 mg/kg had no evident organ toxicity.

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