Myopathy in Status Asthmaticus: Relation to Neuromuscular Blockade and Corticosteroid Administration

1993 ◽  
Vol 8 (3) ◽  
pp. 144-152 ◽  
Author(s):  
Janet M. Shapiro ◽  
Rany Condos ◽  
Randolph P. Cole
Keyword(s):  
Mechanical Ventilation ◽  
Creatine Kinase ◽  
Neuromuscular Blockade ◽  
Muscle Weakness ◽  
Status Asthmaticus ◽  
Rare Complication ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Corticosteroid Administration ◽  
Blocking Agents

Myopathy is a rare complication that arises during management of status asthmaticus that may be related to administration of corticosteroids and neuromuscular blocking agents. We present 4 patients with myopathy and a review of the 31 previously reported patients in the literature. All patients received corticosteroids, and 33 of the 35 patients received neuromuscular blocking agents. Muscle weakness was often diffuse and, in several patients, involved the muscles of respiration. Creatine kinase values ranged from normal to markedly elevated. Diagnosis was obtained by electromyogram and muscle biopsy in most patients. Resolution of the muscle weakness occurred over a period of days to months. Patients in whom myopathy developed required mechanical ventilation for longer periods than patients intubated for status asthmaticus without myopathy.

Sugammadex is changing the paradigm in neuromuscular blockade in patients with myotonic dystrophy

2019 ◽  
Vol 29 (10) ◽  
pp. 337-340 ◽  
Author(s):  
Joana Teixeira ◽  
Bernardo Matias ◽  
Irene Ferreira ◽  
Tiago Taleço ◽  
João S Duarte
Keyword(s):  
General Anaesthesia ◽  
Myotonic Dystrophy ◽  
Neuromuscular Blockade ◽  
Perioperative Complications ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Myotonic Dystrophy Type 1 ◽  
Myotonic Dystrophy Type ◽  
Blocking Agents

Myotonic dystrophy type 1 is a rare neuromuscular disease that represents a challenge to anaesthetic management. Most of the literature does not recommend the usage of neuromuscular blocking agents, if general anaesthesia is needed in these patients. Depolarising neuromuscular blocking agents like suxamethonium are contraindicated, and there might be an increased sensitivity to non-depolarising agents like rocuronium with greater risk of postoperative residual neuromuscular blockade and consequent respiratory failure. Reversing neuromuscular blockade is also problematic as neostigmine can induce myotonic crisis, impairing normal ventilation. We discuss the use of sugammadex for neuromuscular blockade reversal, from a clinical case of a patient with myotonic dystrophy type 1 for laparoscopic cholecystectomy. The patient had a general anaesthesia with neuromuscular blockade with rocuronium. After the surgical procedure, neuromuscular blockade was safely reversed with sugammadex, guided by neuromuscular monitoring without any perioperative complications.

scholarly journals Neuromuscular blockade in children

2000 ◽  
Vol 55 (3) ◽  
pp. 105-110 ◽  
Author(s):  
João Fernando Lourenço de Almeida ◽  
W. Jorge Kalil Filho ◽  
Eduardo J. Troster
Keyword(s):  
Mechanical Ventilation ◽  
Neuromuscular Junction ◽  
Neuromuscular Blockade ◽  
Continuous Improvement ◽  
Pediatric Patients ◽  
Invasive Procedure ◽  
Medical Intervention ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
The Many

Neuromuscular blocking agents (NMBAs) have been widely used to control patients who need to be immobilized for some kind of medical intervention, such as an invasive procedure or synchronism with mechanical ventilation. The purpose of this monograph is to review the pharmacology of the NMBAs, to compare the main differences between the neuromuscular junction in neonates, infants, toddlers and adults, and moreover to discuss their indications in critically ill pediatric patients. Continuous improvement of knowledge about NMBAs pharmacology, adverse effects, and the many other remaining unanswered questions about neuromuscular junction and neuromuscular blockade in children is essential for the correct use of these drugs. Therefore, the indication of these agents in pediatrics is determined with extreme judiciousness. Computorized (Medline 1990-2000) and active search of articles were the mechanisms used in this review.

scholarly journals Residual Neuromuscular Blockade Affects Postoperative Pulmonary Function

2012 ◽  
Vol 117 (6) ◽  
pp. 1234-1244 ◽  
Author(s):  
Gopalaiah Venkatesh Kumar ◽  
Anita Pramod Nair ◽  
Hanuman Srinivasa Murthy ◽  
Koppa Ramegowda Jalaja ◽  
Karnate Ramachandra ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Peak Expiratory Flow ◽  
Postoperative Period ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Blocking Agents ◽  
Train Of Four ◽  
Expiratory Flow

Abstract Background Residual neuromuscular blockade (RNMB) is known to be associated with respiratory complications in the postoperative period after muscle relaxant usage. The authors hypothesized that RNMB causes reductions in pulmonary function test (PFT) parameters in the immediate postoperative period. Methods An open-label prospective randomized cohort study was conducted comparing reductions in PFT parameters due to RNMB among different neuromuscular blocking agents. One hundred and fifty patients were randomized to receive vecuronium, atracurium, or rocuronium. After reversal of neuromuscular blockade and extubation, train-of-four ratio was measured every 5 min until the train-of-four ratio of 0.9 or greater was attained. PFTs were performed preoperatively and postoperatively when the patients were willing and fit. The train-of-four ratio, measured at PFT, was used to classify patients into “RNMB absent” and “RNMB present.” RNMB was defined as a train-of-four ratio less than 0.9. Results Thirty-nine patients had RNMB at the time of performing PFT. There was no statistically significant difference in the postoperative reductions in PFT parameters in patients with RNMB among different neuromuscular blocking agents. Patients were regrouped as RNMB absent and RNMB present, irrespective of neuromuscular blocking agents. Postoperative PFT values for the RNMB-absent and RNMB-present groups were 62% and 49% of baseline forced vital capacity and 47% and 38% of baseline peak expiratory flow of the baseline, respectively. Postoperative forced vital capacity and peak expiratory flow values of RNMB-present patients were lower by 13% and 9% in absolute terms (P < 0.008) and 21% and 19% in relative terms, respectively, compared with RNMB-absent patients. Conclusion RNMB results in reductions in forced vital capacity and peak expiratory flow in the immediate postoperative period indicating impaired respiratory muscle function.

Muscle weakness after administration of neuromuscular blocking agents: Do not immobilize the diaphragm unnecessarily

2007 ◽  
Vol 35 (6) ◽  
pp. 1635
Author(s):  
Dries Testelmans ◽  
Karen Maes ◽  
Patrick Wouters ◽  
Marc Decramer ◽  
Ghislaine Gayan-Ramirez
Keyword(s):  
Muscle Weakness ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Blocking Agents
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