scholarly journals Sugammadex versus neostigmine in pediatric cancer patients undergoing outpatient surgical procedures

2020 ◽  
Vol 11 (2) ◽  
pp. 2741-2746
Author(s):  
AbdelfattahAbdelsattar Hussein ◽  
Mohamed Mostafa Hegazy ◽  
Mohamed Adly Elramely ◽  
Amani Gaber Mohamed
Keyword(s):  
Surgical Procedures ◽  
Neuromuscular Block ◽  
Pediatric Population ◽  
Good Alternative ◽  
Primary Outcome Measure ◽  
Early Postoperative Period ◽  
Neuromuscular Blocking ◽  
Extubation Time ◽  
Pediatric Cancer Patients ◽  
Residual Curarization

Neuromuscular blocking agents (NMBAs) are still required for the pediatric population. Residual neuromuscular block is a common complication in the early postoperative period. The objective of this study is to compare the efϑicacy of sugammadex versus neostigmine for reversing NMB in pediatric patients with cancer who undergo outpatient surgical procedures. This double-blinded study included 80 children with different oncological diagnoses, aged 2-18 years, scheduled for outpatient surgical procedures. They were randomly divided into two equal groups; Group N received neostigmine 0.03 mg/kg with atropine 0.02 mg/kg and Group S received sugammadex 2 mg/kg at the end of surgery. The patients were clinically assessed for NMB recovery and extubated. The primary outcome measure was the time from NMB reversal to recovery of the TOF ratio to 0.9% (recovery time). The secondary outcomes included the time between reversal injection and extubation (extubation time) and possible adverse events. The time to recovery of the TOF ratio to 0.9 and the time between reversal injection and extubation were signiϑicantly shorter in S Group (p< 0.001). The time to reach TOF ratio of 0.9 was not correlated with age, anesthesia time, or the dose of the neuromuscular blocker. None of the children developed respiratory depression or postoperative residual curarization. Relatively few patients developed arrhythmia, hypotension, and nausea and vomiting with no signiϑicant difference between the two groups. Sugammadex is a good alternative to neostigmine for reversal of neuromuscular block in outpatient surgical procedures in children with cancer; it safely provides faster NMB reversal and extubation time.

scholarly journals A Miracle That Accelerates Operating Room Functionality: Sugammadex

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Erdal Dogan ◽  
Mehmet Salim Akdemir ◽  
Abdulmenap Guzel ◽  
Mehmet Besir Yildirim ◽  
Zeynep Baysal Yildirim ◽  
...  
Keyword(s):  
Cholinesterase Inhibitors ◽  
Neuromuscular Block ◽  
Good Alternative ◽  
Cylindrical Shape ◽  
Hemodynamic Parameters ◽  
Time Period ◽  
Extubation Time ◽  
Before And After ◽  
Residual Block ◽  
Time Of Administration

Background.Sugammadex offers a good alternative to the conventional decurarisation process currently performed with cholinesterase inhibitors. Sugammadex, which was developed specifically for the aminosteroid-structured rocuronium and vecuronium neuromuscular blockers, is a modified cyclodextrin made up of 8 glucose monomers arranged in a cylindrical shape.Methods.In this study, the goal was to investigate the efficacy of sugammadex. Sugammadex was used when there was insufficient decurarisation following neostigmine. This study was performed on 14 patients who experienced insufficient decurarisation (TOF<0.9) with neostigmine after general anaesthesia in the operating rooms of a university and a state hospital between June, 2012, and January, 2014. A dose of 2 mg/kg of sugammadex was administered.Results.Time elapsed until sugammadex administration following neostigmine37 ± 6min, following sugammadex it took2.1 ± 0.9min to reach TOF≥ 0.9, and the extubation time was3.2 ± 1.4min. No statistically significant differences were detected in the hemodynamic parameters before and after sugammadex application. From the time of administration of sugammadex to the second postoperative hour, no side effects or complications occurred. None of the patients experienced acute respiratory failure or residual block during this time period.Conclusion.Sugammadex was successfully used to reverse rocuronium-induced neuromuscular block in patients where neostigmine was insufficient.

scholarly journals Sugammadex in antagonism of neuromuscular block in anesthesia: a clinical and economic profile

2009 ◽  
Vol 10 (3) ◽  
pp. 103-114
Author(s):  
Viola Sacchi ◽  
Sergio Iannazzo ◽  
Francesco Giunta
Keyword(s):  
Impact Analysis ◽  
Neuromuscular Block ◽  
Dose Range ◽  
Cost Savings ◽  
Neuromuscular Blocking ◽  
Phase Iii ◽  
Pivotal Phase ◽  
Residual Curarization ◽  
Deep Neuromuscular Block ◽  
Anaesthesia Care

Sugammadex is a modified cyclodextrin which acts by encapsulating and inactivating the neuromuscular blocking agents (NMBAs) rocuronium and vecuronium, used to induce relaxation of skeletal muscles during surgery and to facilitate endotracheal intubation. The procedure of reversal of the block at the end of surgery can influence the time to discharge from the operating room and post-operative residual curarization (PORC) incidence, which is related to an increased rate of adverse respiratory events in the post-anaesthesia care unit. Cholinesterase inhibitors are frequently used to reverse neuromuscular block, but their use is associated with potential cardiovascular and respiratory side-effects. The recommended dose-range for sugammadex is 2-16 mg/kg, depending on the level of block: the dose is approximately 2 mg/kg for reversal of moderate blockade, 4 mg/kg for deep blockade and 16 mg/kg for the immediate reversal of a neuromuscular blockade as early as 3 minutes after 1-1.2 mg/kg of rocuronium. Four pivotal, phase III trials studied sugammadex in routine reversal of moderate, deep neuromuscular block and in the immediate reversal of rocuronium-induced block. In all the cases the drug demonstrated of being significantly more efficient than other reversal strategies, providing a faster reversal than the most used anticholinesterase comparator neostigmine. Sugammadex also appeared to have an acceptable safety profile. Acquisition cost of sugammadex is greater than that of neostigmine, but cost-savings related to the reduced theatre time and to the reduced incidence of PORC episodes can offset it. A Budget Impact analysis in the perspective of the hospital has been conducted for the Italian setting resulting in a total cost-save of 7,420 € for one year of activity. In conclusion, sugammadex appears to be a valuable innovation in anesthesiology. This drug represents a safe and effective alternative to anticholinesterase agents.

scholarly journals Postoperative residual curarization as a complication after general anesthesia

2021 ◽  
Author(s):  
Paweł Radkowski ◽  
Justyna Dawidowska-Fidrych ◽  
Radosław Fidrych ◽  
Iwona Podlińska ◽  
Oliwia Mandziuk-Radkowska ◽  
...  
Keyword(s):  
Neuromuscular Block ◽  
Muscle Relaxation ◽  
Complete Recovery ◽  
Small Degree ◽  
Neuromuscular Blocking ◽  
Striated Muscles ◽  
Upper Respiratory Tract ◽  
Increased Risk ◽  
Residual Curarization ◽  
Postoperative Residual

Introduction: Postoperative residual curarization (PORC) is a common complication but rarely taken into account during the postoperative period. PORC is associated with an increased risk of morbidity and mortality in anesthetized patients. Even small degrees of residual muscle relaxation of the transverse striated muscles can have serious clinical consequences for patients including a decline of upper respiratory tract function or swallowing disorders. Aim: The aim of the work is to discuss the problem of PORC, its risk factors and diagnosis, as well as to identify the most common errors, which can be made even by experienced anesthesiologists and can lead to an increased risk of developing this life-threatening complication. Material and methods: This work is based on the available literature and the authors’ experience. Results and discussion: PORC caused by non-depolarizing neuromuscular blocking agents is a known problem in daily clinical practice. The effects of PORC significantly increase the risk of respiratory complications (hypoxia, pulmonary edema, atelectasis and pneumonia). Patients can report discomfort even with a small degree of residual muscle block above a train of four (TOF) ratio of 0.8. Complete recovery of neuromuscular function does not occur until the TOF ratio is greater or equal to 0.9. Conclusions: The primary strategy to avoid residual neuromuscular block and to improve the safety precautions of patients undergoing anesthesia is not by means of clinical evaluation but consistent monitoring of neuromuscular conduction and extubating the patient when the TOF ratio more than 0.9.

The Clinical Neuromuscular Pharmacology of 51W89 in Patients Receiving Nitrous Oxide/Opioid/Barbiturate Anesthesia 

1995 ◽  
Vol 82 (5) ◽  
pp. 1139-1145 ◽  
Author(s):  
Matthew R. Belmont ◽  
Cynthia A. Lien ◽  
Steve Quessy ◽  
Martha M. Abou-Donia ◽  
Amy Abalos ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Surgical Procedures ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Blocking Effect ◽  
Preclinical Studies ◽  
Physical Status ◽  
Elective Surgical Procedures ◽  
Recovery Index

Background Atracurium is a mixture of ten stereoisomers. 51W89, one of these isomers, is a potent nondepolarizing intermediate-duration neuromuscular blocking agent. Preclinical studies have shown 51W89 to be significantly more potent than atracurium but with a similar neuromuscular blocking profile. This study was undertaken to establish the neuromuscular blocking potency and pharmacodynamics of 51W89 in patients undergoing elective surgical procedures. Methods Ninety-nine ASA physical status 1 or 2 patients undergoing elective surgical procedures under nitrous oxide/opioid/barbiturate anesthesia were studied. The neuromuscular blocking effect of 51W89 was assessed after administration of bolus doses from 0.015 to 0.4 mg/kg, as well as during and after continuous infusions from 11 to 249 min in length. Results The calculated ED95 for inhibition of adductor pollicis twitch evoked at 0.15 Hz was 0.048 mg/kg. At 0.10 mg/kg, maximum block developed within 5.2 +/- 0.3 min, and recovery to 95% twitch height occurred 64.4 +/- 3.9 min after injection. At 0.4 mg/kg, onset was 1.9 +/- 0.1 min, and 95% recovery developed within 121.0 +/- 5.9 min. Comparative recovery indexes from 5% to 95% or from 25% to 75% twitch heights did not differ significantly among all dosage groups from 0.1 to 0.4 mg/kg (means ranged from 29.6 to 32.3 min and from 12.6 to 14.3 min, respectively). The average infusion rate necessary to maintain approximately 95% twitch suppression was 1.35 micrograms/kg/min. Recovery indexes from infusions were 5-95% 33.2 +/- 1.8 min and 25-75% 15.0 +/- 0.6 min, not differing significantly from recovery indexes from single bolus doses. Twenty-five patients received neostigmine (0.06 mg/kg) with atropine (0.03 mg/kg) at twitch height recovery of between 6% and 21%. Antagonism to 95% control twitch height developed within 6.8 +/- 0.3 min, and the neostigmine-accelerated 25-75% recovery index was 2.8 +/- 0.2 min. Conclusions 51W89 is a potent nondepolarizing neuromuscular blocking agent that shows noncumulative intermediate-duration neuromuscular blocking pharmacodynamics.

Dual action of maltoxin, a neuromuscular blocking agent from malt rootlet

1960 ◽  
Vol 198 (5) ◽  
pp. 939-942 ◽  
Author(s):  
Norimoto Urakawa ◽  
Toshio Narahashi ◽  
Takehiko Deguchi ◽  
Yoshio Ohkubo
Keyword(s):  
Mode Of Action ◽  
Neuromuscular Block ◽  
Previous Treatment ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Sartorius Muscle ◽  
Direct Stimulation ◽  
End Plate ◽  
Muscle Action Potential ◽  
Dual Action

Maltoxin, an amine obtained from brew malt rootlet, causes a neuromuscular block in the frog. Its mode of action on the frog's sartorius muscle has been studied mainly with the aid of intracellular microelectrodes. Maltoxin of 10–5 concentration caused an over-all depolarization of the muscle fibers; therefore, direct and indirect stimulations of the muscle were ineffective in producing muscle action potential. Progressive repolarization took place thereafter and the muscle became excitable by direct stimulation, though indirect stimulation remained ineffective for a long period of time. Small end-plate potentials observed could not be explained in terms of depolarization. It was found that the sensitivity of the end-plate membrane to acetylcholine was effectively depressed by maltoxin, and that this is responsible for the persistent neuromuscular block. The initial over-all depolarization caused by maltoxin was fairly antagonized by a previous treatment with d-tubocurarine. It is concluded that maltoxin has a dual mode of action, having some resemblance to acetylcholine, decamethonium, succinylcholine and nicotine.

Residual Block after Mivacurium with or without Edrophonium Reversal in Adults and Children

1996 ◽  
Vol 84 (2) ◽  
pp. 362-367. ◽  
Author(s):  
David R. Bevan ◽  
Raymond Kahwaji ◽  
John M. Ansermino ◽  
Eleanor Reimer ◽  
Michael F. Smith ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Neuromuscular Block ◽  
Saline Group ◽  
Neuromuscular Blocking ◽  
Postanesthesia Care Unit ◽  
Random Allocation ◽  
Train Of Four ◽  
Residual Neuromuscular Block ◽  
Residual Block ◽  
Stimulation Of

Background The rapid recovery from mivacurium- induced neuromuscular block has encouraged omission of its reversal. The purpose of this study was to determine, in children and in adults, whether failure to reverse mivacurium neuromuscular block was associated with residual neuromuscular block on arrival in the postanesthesia care unit. Methods In 50 children, aged 2-12 yr, and 50 adults, aged 20-60 yr, anesthesia was induced and maintained with propofol and fentanyl, and neuromuscular block was achieved by an infusion of mivacurium, to maintain one or two visible responses to train-of-four (TOF) stimulation of the ulnar nerve. At the end of surgery, mivacurium infusion was stopped, and 10 min later, reversal was attempted with saline or 0.5 mg x kg(-1) edrophonium by random allocation. On arrival in the postanesthesia care unit, a blinded observer assessed patients clinically and by stimulation of the ulnar nerve with a Datex electromyogram in the uncalibrated TOF mode. Results Children arrived in the postanesthesia care unit 8.2 +/- 3-4 min after reversal of neuromuscular block and showed no sign of weakness, either clinically or by TOF stimulation. Although TOF ratio was greater in children who had received edrophonium (1.00 +/- 0.05 vs. 0.93 +/- 0.01, P&lt;0.01), TOF was &gt;0.7 in all children. Adults arrived in the postanesthesia care unit 12.9 +/- 5.3 min after reversal of neuromuscular block(P&lt;0.01 vs. children). Six in the saline group demonstrated weakness (two required immediate reversal of neuromuscular block, and TOF was &lt;0.7 in four others), compared with TOF &lt;0.7 in only one of the edrophonium group (P&lt;0.05). Conclusions This study demonstrated that, in adults, failure to reverse mivacurium neuromuscular block was associated with an increased incidence of residual block. Such weakness was not observed in children receiving similar anesthetic and neuromuscular blocking regimens.

scholarly journals The tof-guard neuromuscular transmission monitor and its use in horses

1999 ◽  
Vol 29 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Juliana Noda Bechara ◽  
Denise Tabacchi Fantoni ◽  
Paulo Sergio de Moraes Barros ◽  
Elton Rodrigues Migliati ◽  
Marcio Augusto Ferreira ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Neuromuscular Transmission ◽  
Medical Literature ◽  
Neuromuscular Block ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Neuromuscular Transmission Monitor ◽  
To Receive ◽  
Neuromuscular Transmission Monitoring

It has been emphasized in the human medical literature, that when using a neuromuscular blocking agent, it is of vital importance the monitoring of the neuromuscular block and that these agents should never be used without it. The purpose of this study was to evaluate the use of the neuromuscular transmission monitor TOF-Guard in horses. Twelve horses were randomly assigned whether to receive pancuronium or atracurium as the neuromuscular blocking agent. All horses were pre-medicated with romifidine, anaesthesia induced with diazepam and ketamine and maintenance with halothane. Abolition of spontaneous ventilation was accomplished by the administration of atracurium or pancuronium. The time from injection of the muscle relaxant agent to the onset of maximum block (T1=0), recovery of T1 to 25% and the recovery of TOF ratio to 0.7 were recorded, as was the time for recovery of T1 from 25 to 75%. It was concluded that it is very important the neuromuscular transmission monitoring during the use of a nondepolarizing neuromuscular blocking agent, since it provides a safer anaesthetic and surgical procedure with the use of adequate dosages and due to the impossibility of a superficialization of the neuromuscular blockade during a surgical procedure. The TOF-Guard showed to be a good option for neuromuscular monitoring in horses.

The regional anesthesia for surgical correction of the malformation of upper extremities in pediatric

2017 ◽  
Vol 8 (5) ◽  
pp. 83-90
Author(s):  
Julia A. Manokhina
Keyword(s):  
Young Children ◽  
Upper Extremity ◽  
Regional Anesthesia ◽  
Surgical Procedures ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Negative Impact ◽  
Early Postoperative Period ◽  
Surgical Correction ◽  
Nerve Blocks

The article presents an analysis of the publications devoted to the problems of anesthesia to surgical procedures at the malformations of the upper extremity in children. The article reviews the questions of epidemiology, classification of upper extremity malformation, safety of anesthesia and the role of regional blockades in the structure of intraoperative and postoperative analgesia to surgical procedures at the malformations of the upper extremity in children. Children are more likely than adults to experience stress in the operating room and early postoperative period. Children are almost impossible to prepare psychologically for the upcoming anesthesia, surgical intervention, a sense of pain after it. Surgical correction of malformations of the upper limbs in children is characterized by multistage and high traumatism, which requires the search for adequate methods of anesthesia, capable of ensuring not only the absence of pain, but also the negative impact on the nervous system of little patients. The key to the application of regional anesthesia in young children is the need for sedation or general anesthesia. The use of ultrasound navigation and electrostimulation of peripheral nerves significantly increases the level of safety and success of their realization. At present, the questions about the duration of postoperative analgesia with the use of peripheral nerve blocks and the need for additional anesthesia in the early postoperative period have been little studied. The influence of the applied anesthesia technique on the state of young children in the postoperative period are requires further investigation.

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