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Calabadion is a new heterocyclic molecule that offers rapid and complete reversal of both aminosteroids, such as rocuronium, and benzylisoquinoline NMBDS, such as cisatracurium.
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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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Meta Analysis Comparative Study
Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials.
Intrathecal morphine prolongs post-operative analgesia, but at the expense of increasing nausea, vomiting, pruritus, urinary retention and risk of respiratory depression.
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Excellent anaesthetists were identified by anaesthesia nurses as being:
- Organised & focused: structured, responsible, and focused approach to work tasks.
- Good communicators: clear and informative, briefing of team about the plan before induction.
- Respectful of complexity: humble to the complexity of anaesthesia, admitting own fallibility.
- Patient-centred: personal contact with the patient before induction.
- Good situational awareness: fluent in practical work without losing overview.
- Calm and clear in critical situations, being able to change to a strong leading style.
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Randomized Controlled Trial Multicenter Study
Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial.
The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. ⋯ Our results were largely consistent with previous much smaller studies. Compared with sevoflurane GA with opioid analgesia, the combination of paravertebral analgesia with propofol GA provides an early clinical analgesic benefit in females having breast cancer surgery. This analysis is a substudy of an ongoing multicentre double-blinded randomized trial ( www.clinicaltrials.gov , NCT00418457) of cancer recurrence.