scholarly journals Masseter Muscle Rigidity After Initiating Monitored Anaesthesia Care of Propofol and Remifentanil

2020 ◽  
pp. 1-3
Author(s):  
Kyu Nam Kim ◽  
Dong Won Kim ◽  
Kyu Nam Kim ◽  
Jung Eun Sun ◽  
Ji Hee Chang ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Airway Management ◽  
Masseter Muscle ◽  
Muscle Relaxants ◽  
Muscle Rigidity ◽  
Nondepolarizing Muscle Relaxants ◽  
Target Controlled Infusion ◽  
Effect Site Concentration ◽  
Rapid Effect ◽  
Anaesthesia Care

Masseter muscle rigidity can be seen following administration of opioids, succinylcholine, and nondepolarizing muscle relaxants. We report a case of a 56-year-old male patient in a “Cannot Intubate Cannot Ventilate Situation” due to masseter muscle rigidity after initiating monitored anaesthesia care (MAC) with remifentanil and propofol using target-controlled infusion in procedural cardiology. For rapid effect and equilibrium between plasma-concentration and effect site-concentration using target-controlled infusion, remifentanil overdose is possible during the induction period of MAC. Moreover, the presence of propofol could result in a significantly greater remifentanil concentration. To manage masseter muscle rigidity, muscle relaxants and emergent ventilation systems should be prepared to secure airway maintenance. In addition, alternative airway management devices and techniques should be on hand even if no airway difficulties are expected.

A Pharmacodynamic Explanation for the Rapid Onset/Offset of Rapacuronium Bromide 

1999 ◽  
Vol 90 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Peter M. C. Wright ◽  
Ronald Brown ◽  
Marie Lau ◽  
Dennis M. Fisher
Keyword(s):  
Plasma Concentration ◽  
Time Course ◽  
Plasma Concentrations ◽  
Rapid Onset ◽  
Muscle Relaxants ◽  
Adductor Pollicis ◽  
Effect Compartment ◽  
Nondepolarizing Muscle Relaxants ◽  
Effect Site ◽  
The Hill

Background Nondepolarizing muscle relaxants differ in their time course at the laryngeal adductors and the adductor pollicis, a result of differences in equilibration delays between plasma and effect sites, the sensitivity of each muscle to the relaxant, and the steepness of the concentration-effect relation at each muscle (the Hill factor). To determine whether similar differences exist for rapacuronium, a muscle relaxant with rapid onset and offset, the authors determined its pharmacodynamic characteristics. Methods The twitch tensions of the adductor pollicis and the laryngeal adductors (via a tracheal tube cuff positioned at the vocal cords) were measured in 10 volunteers who were anesthetized with propofoL Rapacuronium, 1.5 mg/kg, was given and blood samples were collected. A semiparametric effect compartment pharmacodynamic model was fit to values for rapacuronium plasma concentrations and twitch tension of the adductor pollicis and laryngeal adductors. Results Equilibration between the rapacuronium plasma concentration and both effect sites was rapid (typical values for the rate constant for equilibration between plasma and the effect site are 0.405 per min for the adductor pollicis and 0.630 per min for the laryngeal adductors) and was more rapid at the laryngeal adductors than at the adductor pollicis (ratio, 1.59+/-0.16; mean +/- SD). The steady state rapacuronium plasma concentration that depressed twitch tension by 50% and the Hill factor were similar for the two muscles. Conclusions The rapid onset and offset of rapacuronium can be explained by the rapid equilibration between concentrations in plasma and at the effect site. Unlike the finding for other nondepolarizing muscle relaxants, the laryngeal muscles are not resistant to rapacuronium.

scholarly journals Pretreatment with sedative-hypnotics, but not with nondepolarizing muscle relaxants, attenuates alfentanil-induced muscle rigidity

1994 ◽  
Vol 6 (6) ◽  
pp. 473-480 ◽  
Author(s):  
Theodore J. Sanford ◽  
Matthew B. Weinger ◽  
N.Ty Smith ◽  
James L. Benthuysen ◽  
Norman Head ◽  
...  
Keyword(s):  
Muscle Relaxants ◽  
Muscle Rigidity ◽  
Nondepolarizing Muscle Relaxants ◽  
Sedative Hypnotics

The Changing Pharmacodynamics of Metocurine Identify the Onset and Offset of Canine Gastrocnemius Disuse Atrophy

1995 ◽  
Vol 83 (1) ◽  
pp. 134-140. ◽  
Author(s):  
D. L. Fung ◽  
D. A. White ◽  
G. A. Gronert ◽  
E. Disbrow
Keyword(s):  
Acetylcholine Receptors ◽  
Muscle Relaxants ◽  
Disuse Atrophy ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Cast Immobilization ◽  
Nondepolarizing Muscle Relaxants ◽  
Effect Site ◽  
Muscle Disuse ◽  
Effect Site Concentration

Background Immobilization of skeletal muscle results in disuse atrophy and resistance to nondepolarizing muscle relaxants. We studied the pharmacodynamics of metocurine (MTC) to identify the development and recovery of disuse-related resistance to MTC. Methods Nineteen dogs underwent cast immobilization of a hind limb for as long as 3 weeks. Before, during, and after casting, dogs were intermittently anesthetized with thiamylal-N2O-fentanyl. The blood concentration of MTC and the corresponding degree of paralysis after a brief infusion were recorded and were used to characterize the pharmacokinetics and pharmacodynamics of MTC. Results Pharmacodynamic study of the response to MTC demonstrated resistance by the 4th day of casting. The effect-site concentration associated with 50% paralysis of twitch increased after 3 weeks from approximately 250 to 750 ng/ml. After cast removal, resistance persisted for 2 more weeks. Six weeks after cast removal, the effect-site concentration associated with 50% paralysis of twitch was normal in every dog. Conclusions Within the context of this study of immobilization disuse atrophy, pharmacokinetic and pharmacodynamic characterization of antagonist responses can be used to infer muscle disuse-related changes in acetylcholine receptors.

scholarly journals Pretreatment with Sedative-Hypnotics, but Not with Nondepolarizing Muscle Relaxants, Attenuates Alfentanil-Induced Muscle Rigidity

1995 ◽  
Vol 39 (4) ◽  
pp. 246
Author(s):  
THEODORE J. SANFORD ◽  
MATTHEW B. WEINGER ◽  
N. TY SMITH ◽  
JAMES L. BENTHUYSEN ◽  
NORMAN HEAD ◽  
...  
Keyword(s):  
Muscle Relaxants ◽  
Muscle Rigidity ◽  
Nondepolarizing Muscle Relaxants ◽  
Sedative Hypnotics

Nondepolarizing muscle relaxants for surgery in myasthenic patients

2009 ◽  
Author(s):  
Idoris Cordero Escobar ◽  
Javier Espinaco Vald��s ◽  
Angela R Gutierrez Rojas ◽  
Nicolas Parisi L��pez ◽  
Rosa E Jimenez
Keyword(s):  
Muscle Relaxants ◽  
Nondepolarizing Muscle Relaxants

Nondepolarizing muscle relaxants for surgery in myasthenic patients

2007 ◽  
Author(s):  
I Cordero Escobar ◽  
J Espinaco Vald��s ◽  
AR Gutierrez Rojas ◽  
RE Jimenez Paneca ◽  
N Parisi L��pez
Keyword(s):  
Muscle Relaxants ◽  
Nondepolarizing Muscle Relaxants

Rapid Infusion of Hydroxyethyl Starch 70/0.5 but not Acetate Ringer’s Solution Decreases the Plasma Concentration of Propofol during Target-controlled Infusion

2016 ◽  
Vol 125 (2) ◽  
pp. 304-312 ◽  
Author(s):  
Sayako Itakura ◽  
Kenichi Masui ◽  
Tomiei Kazama
Keyword(s):  
Blood Flow ◽  
Plasma Concentration ◽  
Indocyanine Green ◽  
Blood Volume ◽  
Hydroxyethyl Starch ◽  
Hepatic Blood Flow ◽  
Disappearance Rate ◽  
Rapid Infusion ◽  
Ringer’S Solution ◽  
Target Controlled Infusion

Abstract Background Rapid fluid infusion resulting in increased hepatic blood flow may decrease the propofol plasma concentration (Cp) because propofol is a high hepatic extraction drug. The authors investigated the effects of rapid colloid and crystalloid infusions on the propofol Cp during target-controlled infusion. Methods Thirty-six patients were randomly assigned to 1 of 3 interventions (12 patients per group). At least 30 min after the start of propofol infusion, patients received either a 6% hydroxyethyl starch (HES) solution at 24 ml·kg−1·h−1 or acetated Ringer’s solution at 24 or 2 ml·kg−1·h−1 during the first 20 min. In all groups, acetated Ringer’s solution was infused at 2 ml·kg−1·h−1 during the next 20 min. The propofol Cp was measured every 2.5 min as the primary outcome. Cardiac output, blood volume, and indocyanine green disappearance rate were determined using a pulse dye densitogram analyzer before and after the start of fluid administration. Effective hepatic blood flow was calculated as the blood volume multiplied by the indocyanine green disappearance rate. Results The rapid HES infusion significantly decreased the propofol Cp by 22 to 37%, compared to the Cp at 0 min, whereas the rapid or maintenance infusion of acetate Ringer’s solution did not decrease the propofol Cp. Rapid HES infusion, but not acetate Ringer’s solution infusion, increased the effective hepatic blood flow. Conclusions Rapid HES infusion increased the effective hepatic blood flow, resulting in a decreased propofol Cp during target-controlled infusion. Rapid HES infusion should be used cautiously as it may decrease the depth of anesthesia.

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