Trending Articles
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Minerva anestesiologica · Apr 2012
ReviewMyths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade.
Fink & Hollman describe and refute several commonly-held myths regarding neuromuscular pharmacology. Their evidence-supported arguments are:
- Intubating patients without muscle relaxants is less safe and sub-optimal.
- Even if you know muscle relaxant pharmacokinetics, it is sufficiently unpredictable that neuromuscular monitoring and reversal is still necessary.
- Post-operative residual curarization (PORC) is clinically significant with real consequences.
- Postoperative residual curarization (PORC) is common.
- Postoperative residual curarisation (PORC) (TOFR < 0.9) can only be diagnosed with a quantitative neuromuscular monitor. Clinical tests are insufficient and poorly sensitive.
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Randomized Controlled Trial Comparative Study
Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children.
Propofol 1 mg/kg reduces emergence delirium in children, without increasing nausea, vomiting or length of PACU stay, unlike fentanyl 1 mcg/kg.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Comparative StudySugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.
Time to achieve full reversal (TOFR > 0.9) was significantly faster with sugammadex (107s ± 61) than neostigmine (1044 ±590s) or edrophonium (331s ± 27).
All sugammadex-reversed patients were completely reversed within 5 minutes, compared with no patients receiving neostigmine.
Reversal with sugammadex lead to less increase in heart-rate than when neostigmine-glycopyrrolate or edrophonium-atropine and almost total avoidance of the dry-mouth associated with the later (5% vs 85-95%)
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Review Meta Analysis
Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: A meta-analysis of randomised controlled trials.
Dexamethasone doubled the duration of postoperative analgesia after brachial plexus block, as well as speeding onset and reducing PONV.
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Anesthesia and analgesia · Jul 2015
Controlled Clinical TrialThe ED90 of Prophylactic Oxytocin Infusion After Delivery of the Placenta During Cesarean Delivery in Laboring Compared with Nonlaboring Women: An Up-Down Sequential Allocation Dose-Response Study.
Labouring women already exposed to oxytocin require a higher dose of oxytocin after cesarean section than non-labouring women to achieve the same uterotonic effect.
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