Changes in Cisatracurium Infusion Requirements During Induced Hypothermia to Treat Increased Intracranial Pressure in a Child

1997 ◽  
Vol 12 (5) ◽  
pp. 261-263 ◽  
Author(s):  
Joseph D. Tobias
Keyword(s):  
Intensive Care Unit ◽  
Intracranial Pressure ◽  
Body Temperature ◽  
Core Body Temperature ◽  
Pediatric Intensive Care ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Induced Hypothermia ◽  
Increased Intracranial Pressure ◽  
Core Body

Several factors may affect the dosing requirements of neuromuscular blocking agents in pediatric intensive care unit patients. I present a 4 year, 2 month old child who received neuromuscular blockade with cisatracurium and induced hypothermia to control increased intracranial pressure. Induction of hypothermia led to a reduction in cisatracurium infusion requirements. The infusion requirements promptly returned to baseline once the patient's body temperature was allowed to normalize. Priorto induction of hypothermia, the infusion requirements for cisatracurium averaged 3.2 μg/kg/min. During the 48 hours of deliberate hypothermia (core body temperature, 34°C) to control intracranial pressure, cisatracurium infusion requirements averaged 1.7 μg/kg/min. Infusion requirements promptly increased to 3.4 μg/kg/min once body temperature was allowed to return to normal.

Acute Hyperthermia Syndromes

2021 ◽  
pp. 519-522
Author(s):  
Maximiliano A. Hawkes ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Status Epilepticus ◽  
Intracranial Pressure ◽  
Body Temperature ◽  
Plasma Membranes ◽  
Core Body Temperature ◽  
Sympathetic System ◽  
Medical Emergency ◽  
Injured Brain ◽  
Injury Control ◽  
Core Body

A high core body temperature is a medical emergency. Neuronal mitochondria and plasma membranes are thought to undergo protein changes at temperatures higher than 40°C, which lead to brain damage or dysfunction. In addition, the effects of hyperthermia on an already injured brain cause further injury. Control of fever is one of the important additional interventions necessary to control increased intracranial pressure and status epilepticus and to treat hypertensive surges in patients with sympathetic system overdrive.

Reversible Visual Involvement in Critical Illness Polyneuropathy

2018 ◽  
Vol 17 (04) ◽  
pp. 143-145
Author(s):  
Khalid Mudawi ◽  
Tamer Rizk
Keyword(s):  
Intensive Care Unit ◽  
Critical Illness ◽  
Clinical Presentation ◽  
Pediatric Intensive Care ◽  
Critical Illness Polyneuropathy ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Inotropic Support ◽  
Unique Combination ◽  
Visual Disturbances

AbstractWe hereby describe a 3-year-old boy who developed severe fulminant sepsis with the need of urgent intubation, ventilation, and inotropic support. He was admitted to the pediatric intensive care unit where he was initially ventilated for 10 days. Extubation failed, so he was reventilated for further 10 days. Neuromuscular blocking agents, inotropes, steroids, and broad-spectrum antibiotics, including aminoglycosides, were all used. Weakness of all limbs was noticed on day 7. This was associated with visual disturbances. He was diagnosed as having critical illness polyneuropathy and myopathy (CIP/CIM). His outcome was favorable. This case report highlights the unique combination of CIP/CIM features associated with visual impairment and also suggests that full recovery is possible for this clinical presentation.

scholarly journals Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Aurélien Culver ◽  
Benjamin Coiffard ◽  
François Antonini ◽  
Gary Duclos ◽  
Emmanuelle Hammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Body Temperature ◽  
Mortality Rate ◽  
Head Trauma ◽  
Core Body Temperature ◽  
Trauma Patients ◽  
Single Center ◽  
Independent Risk Factors ◽  
Core Body

Abstract Background Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9 °C (p < 0.001) and an amplitude > 0.6 °C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23–0.70], p = 0.001 and HR = 4.73, 95% CI [1.38–16.22], p = 0.01). Conclusions Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

Sedation and Analgesia

2017 ◽  
Author(s):  
Iskra I. Ivanova ◽  
Lynn D. Martin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care ◽  
Neuromuscular Blocking ◽  
Muscle Relaxants ◽  
Neuromuscular Blocking Agents ◽  
Essential Information ◽  
Sedation And Analgesia ◽  
American Society ◽  
American Society Of Anesthesiologists

This chapter on sedation and analgesia provides essential information on how to achieve and monitor the comfort of patients safely in the pediatric intensive care unit. Included is succinct information about dosing, pharmacodynamics, and pharmacokinetics of benzodiazepines, opiates, and other sedatives (propofol, etomidate, ketamine, dexmedetomidine, and nonsteroidal anti-inflammatory agents), as well as the antagonists naloxone and flumazenil. Information is also provided about the use and dosage of both depolarizing and nondepolarizing neuromuscular blocking agents (muscle relaxants) and American Society of Anesthesiologists guidelines for fasting (i.e., nothing by mouth) times before elective endotracheal intubation. The chapter also includes key information regarding the recognition and treatment of malignant hyperthermia.

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