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.

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.

Neuromuscular Monitoring at the Orbicularis Oculi May Overestimate the Blockade in Myasthenic Patients

2000 ◽  
Vol 93 (5) ◽  
pp. 1194-1197 ◽  
Author(s):  
Hironori Itoh ◽  
Keizo Shibata ◽  
Masahiro Yoshida ◽  
Ken Yamamoto
Keyword(s):  
Nitrous Oxide ◽  
Facial Nerve ◽  
Myasthenia Gravis ◽  
Neuromuscular Blockade ◽  
Ulnar Nerve ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Neuromuscular Monitoring ◽  
Adductor Pollicis ◽  
Orbicularis Oculi

Background In most publications about myasthenia, monitoring neuromuscular blockade during anesthesia is recommended. In healthy patients, the relation of blockade between muscles has been established, but there is little information about the relation in myasthenic patients. Our objective was to investigate whether the relation between the orbicularis oculi and adductor pollicis muscles is the same in healthy patients and myasthenic patients. Methods After anesthesia was induced with 4-6 mg/kg thiopental and 2 microg/kg fentanyl, followed by 2% sevoflurane and 60% nitrous oxide in oxygen, 10 healthy patients and 10 myasthenic patients received 0. 025 and 0.01 mg/kg vecuronium, respectively. Neuromuscular monitoring was performed with use of accelerometry at the orbicularis oculi and the adductor pollicis muscles by stimulating the temporal branch of the facial nerve and the ulnar nerve. Results The relation of blockade between these two muscles was not the same in healthy patients and myasthenic patients: in healthy patients, the maximum neuromuscular blockade with 0.025 mg/kg vecuronium was less in the orbicularis oculi than in the adductor pollicis (median 72% vs. 91%; P < 0.05); in contrast, in myasthenic patients, the blockade with 0.01 mg/kg vecuronium was greater in the orbicularis oculi than in the adductor pollicis (median 96% vs. 62%; P < 0.05). Conclusion Neuromuscular monitoring at the orbicularis oculi may overestimate blockade in myasthenic patients. Extubation must be performed when the muscle most sensitive to neuromuscular blocking agents is recovered. Therefore, neuromuscular monitoring at the orbicularis oculi is recommended to avoid persistent neuromuscular blockade in patients with myasthenia gravis.

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

2020 ◽  
Vol 30 (4) ◽  
pp. 401-414 ◽  
Author(s):  
Luc E. Vanlinthout ◽  
Bénédicte Geniets ◽  
Jacques J. Driessen ◽  
Vera Saldien ◽  
Raphaël Lapré ◽  
...  
Keyword(s):  
Systematic Review ◽  
Tracheal Intubation ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Blocking Agents
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