Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2014
Case ReportsIntraoperative anaphylaxis to sugammadex and a protocol for intradermal skin testing.
Sugammadex is a selective binding agent for aminosteroid neuromuscular blockers whose use is increasing in anaesthetic practice. We present three cases of severe anaphylaxis coincident with sugammadex administration. ⋯ As all patients were administered sugammadex to reverse neuromuscular blockade with rocuronium, we considered that sugammadex-rocuronium complexes were a potential unique allergen. In the two patients who were additionally tested with a rocuronium-sugammadex (3.6:1 molecular ratio) mixture, the wheal-and-flare response was significantly attenuated.
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We describe a case of a patient undergoing open abdominal aneurysm surgery who developed a severe, life-threatening allergic reaction immediately after administration of sugammadex. The manifestation was purely a cardiovascular collapse. ⋯ Sugammadex was confirmed as the cause of the anaphylaxis by a positive intradermal allergy test (25 mm diameter response to 1:100 dilution), with a normal saline control and a negative response to the other drugs used during the event. This case report is a reminder that the use of sugammadex is associated with rare but serious risks.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialA randomised controlled trial of parecoxib, celecoxib and paracetamol as adjuncts to patient-controlled epidural analgesia after caesarean delivery.
The benefit of combining non-opioid analgesics with neuraxial opioids for analgesia after caesarean delivery has not been clearly established. Larger doses of paracetamol or cyclooxygenase-2 inhibitors have not been evaluated. A randomised, double blind, double-dummy, parallel group placebo-controlled clinical trial was conducted among women having elective caesarean delivery under spinal anaesthesia, followed by pethidine patient-controlled epidural analgesia. ⋯ There were no differences between groups for pethidine consumption, based on either intention-to-treat (median 365, 365, 405 and 360 mg in groups C, PC, PA and PCPA respectively, P=0.84) or per protocol analysis (17 major violations). Dynamic pain scores did not differ between groups but requirement for, and dose of, supplementary oral tramadol was least in group PCPA (incidence 23% versus 48%, 70% and 58% in groups C, PC and PA respectively, P=0.004). The addition of regular paracetamol, cyclooxygenase-2 inhibitors or both to pethidine patient-controlled epidural post-caesarean analgesia did not provide a pethidine dose-sparing effect during the first 24 hours.
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Anaesth Intensive Care · Jan 2014
Observational StudyObservational study of dexmedetomidine for hysteroscopy, cystoscopy and transrectal ultrasound biopsy.
Dexmedetomidine shows promise of being an airway-stable drug. It is approved in Australia for procedural sedation. However, it is important to note that in the study on which this indication is based, all the subjects received a local anaesthetic block before their procedure or surgery. ⋯ As described in the dexmedetomidine product information, the Observer's Assessment of Alertness/Sedation Scale grades sedation from 5 (alert) down to 1 (deepest level of sedation). In the study on which dexmedetomidine's indication for procedural sedation is based, patients needed only to achieve a score of 4 and, thus, the approved product information recommends a loading dose of 1.0 µg/kg followed by a maintenance infusion of 0.2 to 1.0 µg/kg/hour. This current study aims to add to the literature regarding the safety of dexmedetomidine when used at higher than recommended doses.