Prolonged neuromuscular blockade following a bolus of succinylcholine and Rett syndrome- a case report

Background: Residual neuromuscular blockade (RNMB) is a frequent event after general anesthesia, which can lead to serious complications, such as upper airway obstruction. Sugammadex is useful in reversing RNMB. However, its use in infants has not yet been approved by the Food and Drug Administration. Therefore, anesthesiologists can be hesitant use it, even in situations where no other choice is available.Case: A two-month-old baby presented to the hospital for umbilical polypectomy. At the end of the surgery, neostigmine was administered. Even after waiting for 30 min and injecting an additional dose of neostigmine, neuromuscular blockade was not adequately reversed. Eventually, sugammadex was administered, and spontaneous breathing returned.Conclusions: If there were no particular causes of delayed return to spontaneous breathing in infants, RNMB should be considered and reversal with sugammadex would be useful.

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Postoperative negative pressure pulmonary edema following repetitive laryngospasm even after reversal of neuromuscular blockade by sugammadex: a case report

Korean Journal of Anesthesiology ◽

10.4097/kjae.2017.70.1.95 ◽

2017 ◽

Vol 70 (1) ◽

pp. 95 ◽

Cited By ~ 10

Author(s):

Ji Hyeon Lee ◽

Jae Ho Lee ◽

Min Hyun Lee ◽

Hyun Oh Cho ◽

Soon Eun Park

Keyword(s):

Case Report ◽

Pulmonary Edema ◽

Neuromuscular Blockade ◽

Negative Pressure ◽

Negative Pressure Pulmonary Edema

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PROLONGED NEUROMUSCULAR BLOCKADE FOLLOWING VECURONIUM

British Journal of Anaesthesia ◽

10.1093/bja/57.8.807 ◽

1985 ◽

Vol 57 (8) ◽

pp. 807-810 ◽

Cited By ~ 9

Author(s):

A.B. SHANKS ◽

T. LONG ◽

A.R. AITKENHEAD

Keyword(s):

Neuromuscular Blockade ◽

Prolonged Neuromuscular Blockade

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A Case Study on Management of Rett Syndrome by Wholistic approach

International Journal of Ayurvedic Medicine ◽

10.47552/ijam.v11i2.1403 ◽

2020 ◽

Vol 11 (2) ◽

pp. 351-357

Author(s):

Renu Rathi ◽

Bharat Rathi ◽

Rakesh Khatana ◽

Suraj Sankh

Keyword(s):

Case Report ◽

Rett Syndrome ◽

Motor Development ◽

Autism Spectrum ◽

Severe Form ◽

Fine Motor ◽

Gross Motor ◽

Gross Motor Development

Background: Rett syndrome-RS comes under Autism spectrum disorder-ASD which is a neurodevelopmental syndrome. It is diagnosed by the main differentiating features of lack of interpersonal and communication skills, poor eye contact, delayed speech with pervasive abnormal body movements. Aim and Objectives: This case report is aimed at dissemination of comprehensive role of Ayurveda in management of ASD, Rett syndrome. Material and Methods: RS is the severe form of ASD. This case study of 2.3 year’s girl presented with RS and global delay, being treated with wholistic approach. It comprises Ayurveda chikitsa and other therapies like Yoga, hydrotherapy, occupational, music, physiotherapy and many more. Observation and Result: Patient has shown promising results in all developmental milestones such as gross motor, fine motor and personal social in 6 months duration except language. Different varieties of massage therapy, diet and Basti, Nasya (Panchkarma) procedures, Omkar mantra chanting, passive Yogasana were done. Conclusion: In this case report, mainly Ayurveda interventions were implemented with wholistic approach as an adjuvant, received good result in gross motor development which is very difficult in RS, hence it is a unique case. It also opened the door of wholistic approach with the hope to deliver the good result in similar disorders.

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Use of peripheral nerve stimulators to monitor patients with neuromuscular blockade in the ICU

American Journal of Critical Care ◽

10.4037/ajcc1996.5.6.449 ◽

1996 ◽

Vol 5 (6) ◽

pp. 449-454 ◽

Cited By ~ 15

Author(s):

R Kleinpell ◽

C Bedrosian ◽

L McCormick ◽

M Kremer ◽

L Bujalski ◽

...

Keyword(s):

Peripheral Nerve ◽

Neuromuscular Blockade ◽

National Sample ◽

Neuromuscular Blocking ◽

Nerve Stimulator ◽

Peripheral Nerve Stimulator ◽

Number Of Patients ◽

Train Of Four ◽

Current Monitoring ◽

Prolonged Neuromuscular Blockade

BACKGROUND: Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care. OBJECTIVE: The purpose of this study was to assess current monitoring practices of nurses who care for patients treated with neuromuscular blockade. METHODS: In January 1995, questionnaires were mailed to a random national sample of 2000 critical care nurses. Of the 2000 questionnaires mailed, 744 were returned. RESULTS: The number of patients per month who were treated with neuromuscular blockade in ICU settings ranged from 0 to 75 (mean = 6.82, SD = 9.15). For each patient, the average number of days of blockade ranged from less than 1 to 63 (mean = 4.12, SD = 3.36). The most common indications for neuromuscular blockade were to assist in mechanical ventilation, reduce oxygen consumption, and treat agitation. Only 41% of respondents (n = 306) reported using train-of-four stimuli and a peripheral nerve stimulator to monitor patients. Depth of neuromuscular blockade was routinely monitored by using clinical assessment (31%), a peripheral nerve stimulator (16%), or both (52%). CONCLUSIONS: Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.

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