• Nondepolarizing neuromuscular blockers are used in combination with a sedative as part of the rapid-sequence intubation process. (medscape.com)
  • BACKGROUND: Sugammadex is a reversal agent for non-depolarizing neuromuscular blockers and widely used worldwide on account of its rapid and effective reversal from neuromuscular blockade, despite its advantages, multiple cases. (koreamed.org)
  • There are also possible risks with using anesthetic agents and particularly neuromuscular blockers. (psychiatrist.com)
  • As with other nondepolarizing neuromuscular blockers, the time to onset of paralysis decreases and the duration of maximum effect increases with increasing doses of metocurine iodide. (chembase.cn)
  • Considering these evidences, the use of neuromuscular blockers could be interpreted as a double-edged sword that facilitates anesthesia and surgery, but is simultaneously associated with increased postoperative complications and mortality due to residual neuromuscular blockade. (anesth-pain-med.org)
  • Despite developments such as reduction of the duration of action of neuromuscular blockers and the use of neuromuscular reversal agents, postoperative complications and mortality due to residual neuromuscular blockade remain a problem [ 4 - 6 ]. (anesth-pain-med.org)
  • The development of neuromuscular blockers and reversal agents resulted in that of neuromuscular monitoring methods for the residual neuromuscular blockade. (anesth-pain-med.org)
  • We have reports of residual neuromuscular block (residual "curarization") for over 3 decades (Viby-Mogensen, 1979). (apsf.org)
  • Thus, we investigated which approach, qualitative or quantitative monitoring of neuromuscular blockade, left patients with a degree of residual neuromuscular block that created a greater risk of having critical respiratory events. (bariatrictimes.com)
  • The control group showed a mild degree of residual neuromuscular block relative to the intervention group at the time of extubation (train-of-four ratio: mean 0.86 vs 0.94). (bariatrictimes.com)
  • 1,2 Qualitative relative to quantitative management of neuromuscular blockade predisposes patients to postoperative residual neuromuscular block. (bariatrictimes.com)
  • 3 Postoperative residual neuromuscular block seems to be a risk factor for postoperative pulmonary complications and critical respiratory events. (bariatrictimes.com)
  • The CS is more resistant to the effect of neuromuscular blocking agents, requires higher concentrations/doses, and leaves patients with a considerably high degree of postoperative residual neuromuscular block. (bariatrictimes.com)
  • 6,7 It is recommended to use quantitative monitoring at the adductor pollicis muscle (AP) to avoid postoperative residual neuromuscular block. (bariatrictimes.com)
  • The aim of the study was to determine whether the risk of postoperative residual neuromuscular block and respiratory complications could be decreased by using quantitative neuromuscular monitoring (acceleromyography [AMG]) compared to our current clinical practice, using qualitative (visual) neuromuscular monitoring. (bariatrictimes.com)
  • Residual neuromuscular block: lessons unlearned. (anesthesiaejournal.com)
  • Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. (anesthesiaejournal.com)
  • Myasthenia gravis (MG) is a relatively rare acquired, autoimmune disorder caused by an antibody-mediated blockade of neuromuscular transmission resulting in skeletal muscle weakness and rapid muscle fatigue. (medscape.com)
  • Dihydrochandonium is an aminosteroid non-depolarizing neuromuscular blocking agent. (wikipedia.org)
  • Rocuronium (brand names Zemuron, Esmeron) is an aminosteroid non-depolarizing neuromuscular blocker or muscle relaxant used in modern anesthesia to facilitate endotracheal intubation by providing skeletal muscle relaxation, most commonly required for surgery or mechanical ventilation. (ncats.io)
  • BACKGROUND: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. (anesthesiaexperts.com)
  • for maintenance of anesthesia in pediatric patients following induction with agents other than Desflurane, USP, Liquid for Inhalation and intubation. (nih.gov)
  • Patients with a history of moderate to severe hepatic dysfunction following anesthesia with halogenated agents and not otherwise explained. (nih.gov)
  • If possible, avoidance of nondepolarizing agents during general anesthesia is beneficial. (medscape.com)
  • Sevoflurane should not be used in patients with known or suspected hypersensitivity to sevoflurane or to other halogenated anaesthetics (e. g. history of liver function disorder, fever or leucocytosis of unknown cause after anesthesia with one of these agents). (medicines.org.uk)
  • With this background, APSF sponsored a panel on monitoring neuromuscular blockade at the 2012 New York Society of Anesthesiologists Postgraduate Assembly ( https://www.apsf.org/newsletters/pdf/spring2013.pdf ) and most recently conducted a survey to determine the opinions of anesthesia professionals with respect to "Residual Muscle Relaxant-Induced Weakness in the Postoperative Period: Is it a Patient Safety Issue? (apsf.org)
  • Inhalation anesthetics have advantages over intravenous agents in that the depth of anesthesia can be changed rapidly by altering the inhaled concentration. (lookformedical.com)
  • As with other rapidly acting intravenous anesthetic agents, the half-time of the blood-brain equilibration is approximately 1 minute to 3 minutes, accounting for the rate of induction of anesthesia. (guidelinecentral.com)
  • Comparative clinical studies have shown that the hemodynamic effects of DIPRIVAN during induction of anesthesia are generally more pronounced than with other intravenous (IV) induction agents. (guidelinecentral.com)
  • Rocuronium bromide is a nondepolarizing neuromuscular blocking agent indicated as an adjunct to general anesthesia to facilitate both rapid sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. (ncats.io)
  • Before induction of anesthesia, a train-of-four (TOF) electromyography was installed in order to monitor neuromuscular function during operation. (asahq.org)
  • In humans, administration of the drugs is not without risk and may result in accidental awareness under general anaesthesia and postoperative residual neuromuscular blockade that can lead to serious respiratory complications. (au.dk)
  • 2010. A survey of current management of neuromuscular block in the United States and Europe. . (cornell.edu)
  • The literature suggests that quantitative management of neuromuscular blockade reduces the residual weakness that can lead to critical respiratory events in the postoperative period. (bariatrictimes.com)
  • Neuromuscular disorders encompass a number of different disease processes, including myasthenia gravis (MG), Lambert-Eaton myasthenic syndrome (LEMS), Duchenne muscular dystrophy (DMD), Becker muscular dystrophy (BMD), and hypokalemic periodic paralysis. (medscape.com)
  • Neuromuscular diseases such as myasthenia gravis (small test dose may be used to assess response). (unboundmedicine.com)
  • Therefore, this study investigates the neuromuscular response of two infusion rates of rocuronium, a commonly used non-depolarizing neuromuscular blocking agent. (au.dk)
  • CONCLUSION: The large inter-animal variation in pharmacodynamic profiles emphasizes that individual neuromuscular monitoring and titration to effect should be used routinely in research protocols that include rocuronium. (au.dk)
  • 2003. Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium. . (cornell.edu)
  • Rocuronium bromide is a nondepolarizing neuromuscular blocking agent with a rapid to intermediate onset depending on dose and intermediate duration. (ncats.io)
  • The nondepolarizing NMBA acts as a competitive inhibitor of ACh leading to decreased effect of ACh in the NMJ. (openanesthesia.org)
  • Short-acting neuromuscular blocking agent (NMBA), mivacurium (11 mg), was administered to facilitate tracheal intubation. (asahq.org)
  • NEOSTIGMINE INJ 5MG Neostigmine Methylsulfate Injection, a cholinesterase inhibitor, is indicated for reversal of the effects of nondepolarizing neuromuscular blocking agents (NMBA) after surgery. (be-pharmaceuticals.com)
  • Neuromuscular monitoring was performed with acceleromyography using train-of-four (TOF) stimulation. (au.dk)
  • Acceleromyography (AMG)-based neuromuscular monitoring was regarded as "clinical gold standard" and widely applied. (anesth-pain-med.org)
  • Pretreatment with anticholinergic agents (e.g., atropine) may reduce the occurrence of bradyarrhythmias. (nih.gov)
  • Atropine is usually administered prior to or concurrently with anticholinesterase agents to counteract the muscarinic effects. (unboundmedicine.com)
  • There are two types: depolarizing and nondepolarizing NMBAs. (openanesthesia.org)
  • Neonates and infants require smaller doses of nondepolarizing NMBAs and less frequent redosing. (openanesthesia.org)
  • Nondepolarizing NMBAs are competitive antagonists which means they bind to the ACh receptor and prevent ACh from binding. (openanesthesia.org)
  • Upregulation of ACh Receptor sites results in increased sensitivity to depolarizing NMBAs and resistance to nondepolarizing NMBAs. (openanesthesia.org)
  • Fade occurs with tetanic stimulation in the presence of nondepolarizing NMBAs. (openanesthesia.org)
  • RESISTANCE to nondepolarizing neuromuscular blocking agents (NMBAs) occurs in many clinical diseases and drug interactions. (asahq.org)
  • Neuromuscular blocking drugs act on acetylcholine receptors and fall into two distinct groups: nondepolarizing (competitive) and depolarizing blocking agents. (britannica.com)
  • Competitive neuromuscular blocking drugs act as antagonists at acetylcholine receptors, reducing the effectiveness of acetylcholine in generating an end-plate potential . (britannica.com)
  • Metocurine iodide is a benzylisoquinolinium competitive nondepolarizing neuromuscular blocking agent. (chembase.cn)
  • Mivacurium chloride is a short-acting, non-depolarizing neuromuscular blocking agent. (umaryland.edu)
  • Neostigmine: how much is necessary for patients who receive a nondepolarizing neuromuscular blocking agent? (cornell.edu)
  • 2018. Pharmacokinetic/Pharmacodynamic Model of CW002, an Investigational Intermediate Neuromuscular Blocking Agent, in Healthy Volunteers. . (cornell.edu)
  • 3. Which neuromuscular blocking agent is contraindicated in patients with glaucoma? (remixeducation.in)
  • Risk factors of peri-intubation cardiac arrest (PICA) for inpatients were intubation-related shock index, number of intubation attempts, pre-endotracheal tube intubation vasopressor use, and neuromuscular blocking agent use. (accjournal.org)
  • Among the four independent risk factors for PICA, preintubation hemodynamic stabilization and avoidance of neuromuscular blocking agent were modifiable to decrease the risk of PICA. (accjournal.org)
  • If possible, avoidance of neuromuscular blocking agents is recommended to reduce the patient's risk of requiring postoperative ventilator support. (medscape.com)
  • However, issues related to patient's posture and overestimation of train-of-four ratio associated with AMG-based neuromuscular monitoring have increased. (anesth-pain-med.org)
  • Recently, however, owing to developments in surgical techniques such as laparoscopy and robotic surgery, neuromuscular monitoring has decreased because access to the patient's arm is difficult in such surgical conditions. (anesth-pain-med.org)
  • At the conclusion of the operation the patient's neuromuscular blockade was assessed via train-of-four at the corrugator supercilii and the patient was given neuromuscular blockade reversal agents. (anesthesiaejournal.com)
  • Recently, electromyography (EMG)-based neuromuscular monitoring is receiving renewed attention, since it overcomes AMG's weaknesses. (anesth-pain-med.org)
  • Desflurane, USP, Liquid for Inhalation should not be used as the sole agent for anesthetic induction in patients with coronary artery disease or where increases in heart rate or blood pressure are undesirable. (nih.gov)
  • A blocking of nerve conduction to a specific area by an injection of an anesthetic agent. (lookformedical.com)
  • The vast majority of respondents (85%) agreed there was an association between residual neuromuscular blockade and pulmonary complications in the first 24 hours postoperatively (Figure 5) and that appropriate antagonism of neuromuscular blockade would decrease the 24-hour major postoperative morbidity and mortality. (apsf.org)
  • Its most useful feature as an induction agent is that it produces deep sedation while causing minimal cardiovascular effects. (medscape.com)
  • Like methohexital, it is most commonly used as an induction agent for intubation. (medscape.com)
  • A short acting barbiturate or other intravenous induction agent may be administered followed by inhalation of sevoflurane. (medicines.org.uk)
  • After 317 of the 362 patients were enrolled, sugammadex was added as a reversal agent at the study facility. (bariatrictimes.com)
  • A continuous record from peri-operative evoked electromyographic monitoring (Train-of-four stimulation, a Datex neuromuscular transmission monitor). (asahq.org)
  • Repeated administration of maintenance doses of metocurine iodide has no cumulative effect on the duration of neuromuscular block if recovery is allowed to begin prior to repeat dosing. (chembase.cn)
  • And we have reports that have documented that appropriate antagonism of neuromuscular block decreases 24-hr morbidity and mortality (Arbous, 2005). (apsf.org)
  • 4. Kopman AF, Eikerman M. Antagonism of non-depolarising neuromuscular block: current practice. (anesthesiaejournal.com)
  • Example of a poorly lipid soluble agent with a V d about equal to extracellular fluid volume: nondepolarizing neuromuscular blocking drugs. (pharmacology2000.com)
  • The pharmacology of new short-acting nondepolarizing ester neuromuscular blocking agents: clinical implications. (cornell.edu)
  • The etiology is likely multi-factorial: use of non-depolarizing muscle relaxant agents, lack of intraoperative objective monitoring, and reliance on subjective assessment (visual or tactile means) or clinical tests (head-lift, grip strength, tidal volume, etc) to judge adequacy of pharmacologic reversal prior to tracheal extubation. (apsf.org)
  • In the following decades, AMG-based neuromuscular monitoring equipment was regarded as "clinical gold standard" and widely distributed. (anesth-pain-med.org)
  • Clinical factors such as site and severity of infection, suspected or confirmed infectious agent, underlying disease and concomitant therapies 7 , and the fact that the drug has a narrow therapeutic range all increase the risk of side effects, such as nephritic syndrome and ototoxicity, skin reactions (e.g., erythema), and flushing histamine-like and other anaphylactic reactions, when anaesthetics are given. (bvsalud.org)
  • There is an unprecedented demand and shortage of neuromuscular blocker (NMB) products in Canada as a result of the COVID-19 pandemic. (canada.ca)
  • If such agents are necessary, reversal with sugammadex sodium may make postoperative ventilator support less likely to be required. (medscape.com)
  • If nondepolarizing agents are necessary, reversal with sugammadex may make postoperative ventilation less likely to be needed. (medscape.com)
  • Patients with latent or overt neuromuscular disease, particularly with Duchenne muscular dystrophy, appear to be most vulnerable. (nih.gov)
  • Patients with LEMS are unpredictably sensitive to the effects of both depolarizing and nondepolarizing neuromuscular blocking agents. (medscape.com)
  • Some patients may be on platelet inhibitors, including aspirin or clopidogrel, and it is unlikely that the surgeon would proceed with surgery while a patient is on these agents. (renalandurologynews.com)
  • Neuromuscular monitoring equipment measures the muscle's contractile "force" following electrical nerve stimulation. (anesth-pain-med.org)
  • Comparison of the neuromuscular effects of two infusion r. (au.dk)
  • Dose-response and Cardiopulmonary Side Effects of the Novel Neuromuscular-blocking Drug CW002 in Man. (cornell.edu)
  • Fosaprepitant for injection, in combination with other antiemetic agents, is indicated in adults for the prevention of: Acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin. (be-pharmaceuticals.com)
  • Discontinue triggering agents, administer intravenous dantrolene sodium, and apply supportive therapies. (nih.gov)