Anesthesia and analgesia
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The most useful qualities of a NMBD for pediatric anesthesia are: rapid, reliable onset of laryngeal muscle block after IV or IM administration, duration of < or =20 min, and lack of side effects. Until recently, no nondepolarizer met all these criteria. However, 2 mg/kg rapacuronium produces rapid laryngeal block that can be easily reversed to restore neuromuscular function within 20 min in most pediatric patients.
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Anesthesia and analgesia · May 2000
Meta AnalysisNovel analgesic adjuncts for brachial plexus block: a systematic review.
This article reviews current evidence for the efficacy of adding novel analgesic adjuncts to brachial plexus block, the goal of which is to prolong analgesic effect without the disadvantage of systemic side effects or prolonged motor block. It may also allow for a reduction in the total dose of local anesthetic used. Novel adjuncts studied to date include opioids, clonidine, neostigmine, and tramadol. ⋯ Evidence regarding the analgesic benefit of opioid adjuncts remains equivocal and more evidence is required before their routine use can be recommended. Clonidine appears to have significant analgesic benefit and to cause minimal adverse effects when used in doses up to 150 microg. Data regarding other drugs, such as tramadol and neostigmine, are not sufficient to allow for any recommendations, and further studies are required.
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The elective use of succinylcholine in anesthesia has largely been abandoned because of unwanted side effects. Alternatives now exist for short, intermediate, or long elective surgical procedures. NMBDs are frequently used only to facilitate tracheal intubation; rapacuronium fills an important niche particularly for a short elective case (e.g., same-day surgery). ⋯ Figure 1 shows such a plot for mivacurium (13). There is less variability in the maximum block at the larger dose of rapacuronium but still variability in onset time. Further studies will be important in defining the role of rapacuronium for rapid sequence induction in various clinical settings.