Articles: neuromuscular-blocking-agents-adverse-effects.
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Acta Anaesthesiol Scand · Oct 1997
Randomized Controlled Trial Multicenter Study Clinical TrialResidual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium.
After anaesthesia involving pancuronium a high incidence of both residual neuromuscular block and postoperative pulmonary complications (POPC) has been reported. The aim of this study was to compare the incidence of POPC following the use of pancuronium, atracurium, and vecuronium, and to examine the effect of residual neuromuscular block on the incidence of POPC. ⋯ Postoperative residual block caused by pancuronium is a significant risk factor for development of POPC.
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Annals of neurology · Oct 1996
Acute myopathy of intensive care: clinical, electromyographic, and pathological aspects.
An acute myopathy of intensive care occurs in critically ill patients treated with intravenous corticosteroids and neuromuscular junction-blocking agents. The full clinicopathological spectrum is uncertain. We evaluated the clinical, electrodiagnostic, and histopathological features of 14 patients who developed acute myopathy of intensive care after organ transplantation or during treatment of severe pulmonary disorders and sepsis. ⋯ Loss of thick filaments was identified in muscle biopsy specimens obtained 30 +/- 11 days (mean +/- standard deviation) after intravenous corticosteroid treatment but not in those obtained earlier (12 +/- 2 days). Critically ill patients, including those receiving organ transplants, may develop acute myopathy of intensive care after exposure to intravenous corticosteroids and neuromuscular junction-blocking agents, although the exposure to the latter drugs may be minimal. Selective loss of thick filaments is common in acute myopathy of intensive care, especially if the muscle biopsy specimen is obtained 2 weeks or more after intravenous corticosteroid exposure.
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The purpose of this article is to report the case of a patient who developed prolonged neuromuscular block after a large dose of clindamycin (2400 mg). A 58-yr-old, 65 kg woman with severe rheumatoid arthritis was admitted for wrist arthrodesis. After d-tubocurarine (3 mg) and fentanyl (1.5 micrograms.kg-1), anaesthesia was induced with thiopentone (4 mg.kg-1) followed by succinylcholine (1.5 mg.kg-1) and was maintained with N2O in O2 and isoflurane (0.75-1.0% end tidal) and ventilation was controlled. ⋯ Controlled ventilation was continued in the Recovery Room where neuromuscular testing showed a train-of-four ratio of 0.27 which improved to only 0.47 five minutes after calcium chloride (1.5 mg.kg-1 i.v.), and to 0.62 after edrophonium (20 mg) and neostigmine (2 mg). Nine hours later the patient began to cough, the TOF had returned to 1.0 and two hours later the trachea was extubated and spontaneous ventilation was resumed. Large doses of clindamycin can induce profound, long-lasting neuromuscular blockade in the absence of non-depolarizing relaxants and after full recovery from succinylcholine has been demonstrated.
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Many anaesthetic drugs and adjuvants can cause the release of histamine by chemical (anaphylactoid) or immunologic (anaphylactic) mechanisms. While both types of reactions can be clinically indistinguishable, they are mechanistically different. In anaphylactoid reactions, only preformed mediators are released, of which histamine may be the most clinically important. ⋯ Anaphylactoid reactions may occur commonly under anaesthesia in response to many drugs, including induction agents, some opiates, plasma expanders, and curariform relaxants. Anaphylactic reactions are far less common than anaphylactoid reactions, but they nevertheless represent more than half of the life-threatening reactions that occur in anaesthetic practice. Muscle relaxants are the most frequently implicated class of drugs; suxamethonium is the most common agent implicated in anaphylactic reactions during anaesthesia, but even drugs without apparent chemical histamine release (i.e., vecuronium) are frequently implicated in anaphylactic reactions.
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This study was done to determine the safety and success of orotracheal intubation with planned neuromuscular blockade in patients who are severely injured. The study was performed at Carle Foundation Hospital, designated Level I trauma center located in east central Illinois. ⋯ Orotracheal intubation with planned neuromuscular blockade and in-line cervical traction is a safe, effective method for airway control in patients who are severely injured. This technique is also indicated to expedite therapy in combative, uncooperative patients because of the high incidence of significant life-threatening injuries to the brain and other organs.