AnatomyDiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPhenomena and ProcessesHealth Care
Neuromuscular Nondepolarizing AgentsNeostigminePancuroniumVecuronium BromideAtracuriumNeuromuscular Blocking AgentsAndrostanolsTubocurarineEdrophoniumSuccinylcholineNeuromuscular BlockadeCholinesterase InhibitorsNeuromuscular JunctionNeuromuscular Depolarizing AgentsIsoquinolinesGallamine TriethiodideCholinesterasesPyridostigmine BromideDimethylphenylpiperazinium IodideThiopentalNitrous Oxidegamma-CyclodextrinsParasympathomimeticsNicotinic AntagonistsAnesthesiaGlycopyrrolateAcetylcholineInjections, SpinalDose-Response Relationship, DrugMuscle ContractionPhysostigmineAnesthesia Recovery PeriodColonic Pseudo-ObstructionReceptors, NicotinicTime FactorsPseudocholinesterase
EdrophoniumInduced neuromuscular blockadeAnesthesiaRisk of PostoperativeManagement of neuromuscularSuccinylcholineMyasthenia gravisBlockade producedParalysisJunctionAnesthesiologyBlockerAtropineRocuroniumAntagonistsReversal AgentPostoperativeBlockersMechanical ventilationIntravenousDoseAcetylcholine receptorsRespiratory complicationsPyridostigmineVecuroniumIntermediateDrugsSkeletal musclePatientsPeripheralAntagonizing residualDosesCholinergicClinical practiceAdministrationMedicationsBlockInjectionIntubationChemicallySevereAssessDepth
Edrophonium3
Induced neuromuscular blockade1
Anesthesia7
  • In clinical use, neuromuscular block is used adjunctively to anesthesia to produce paralysis, firstly to paralyze the vocal cords, and permit endotracheal intubation, and secondly to optimize the surgical field by inhibiting spontaneous ventilation, and causing relaxation of skeletal muscles. (wikipedia.org)
  • BACKGROUND: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. (anesthesiaexperts.com)
  • Patients who were administered an NNMBD followed by neostigmine had no differences in outcomes compared with patients who had general anesthesia without an NNMBD. (anesthesiaexperts.com)
  • 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)
  • 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)
  • If possible, avoidance of nondepolarizing agents during general anesthesia is beneficial. (medscape.com)
  • While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol . (wikidoc.org)
Risk of Postoperative1
  • 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)
Management of neuromuscular3
  • 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)
  • 1,2 Qualitative relative to quantitative management of neuromuscular blockade predisposes patients to postoperative residual neuromuscular block. (bariatrictimes.com)
Succinylcholine7
Myasthenia gravis3
  • 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). (drugguide.com)
  • Myasthenia gravis (MG) is an autoimmune disorder affecting nicotinic acetylcholine receptors at the post-synaptic site in the neuromuscular junction (NMJ). (riajournal.com)
Blockade produced2
Paralysis2
Junction7
  • The motor nerve fibres reach the muscle fibres at sites called motor end plates, which are located roughly in the middle of each muscle fibre and store vesicles of the neurotransmitter acetylcholine (this meeting of nerve and muscle fibres is known as the neuromuscular junction ). (britannica.com)
  • Because this mechanism is relatively insensitive to drug action, the most important group of drugs that affect the neuromuscular junction act on (1) acetylcholine release, (2) acetylcholine receptors, or (3) the enzyme acetylcholinesterase (which normally inactivates acetylcholine to terminate muscle fibre contraction). (britannica.com)
  • Sequence Of Events At Neuromuscular Junction Action potentials arriving at the presynaptic terminal cause voltage-gated Ca 2+ channels to open. (slidetodoc.com)
  • Sequence Of Events At Neuromuscular Junction (continued) n Ach travels across the synaptic cleft to postsynaptic membrane which is also known as motor end plate. (slidetodoc.com)
  • Sequence Of Events At Neuromuscular Junction n (continued) Motor end plate contains nicotinic receptors for Ach , which r ligand gated ion channels Ach binds to the alpha subunits of nicotinic receptors and causes conformational change. (slidetodoc.com)
  • Prevents neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. (drugguide.com)
  • 1 In MG, there is decrease in the numbers of acetylcholine receptors at the neuromuscular junction (NMJ) (postsynaptic site), which decreases the transmission of acetylcholine and nerve signal, hence deficient to trigger a muscle action potential. (riajournal.com)
Anesthesiology1
  • InterviewAnswers by Any resident in Anesthesiology … Ans:b, 64.Which of the following anesthetic agent sensitizes the heart to adrenaline c) Propofur a)1% a)Isoflurane Anesthesiologist : An anesthesiologist is a doctor that completed medical school, a four-year residency program, and often a one-year subspecialty fellowship. (usiad.net)
Blocker2
  • A neuromuscular non-depolarizing agent is a form of neuromuscular blocker that does not depolarize the motor end plate. (wikipedia.org)
  • NIMBEX (cisatracurium besylate) is a nondepolarizing skeletal neuromuscular blocker for intravenous administration. (mdtodate.com)
Atropine2
  • 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)
Rocuronium1
  • Rocuronium bromide is a nondepolarizing neuromuscular blocking agent with a rapid to intermediate onset depending on dose and intermediate duration. (ncats.io)
Antagonists1
Reversal Agent3
  • 4. What is the reversal agent for benzodiazepines? (mcqsadda.online)
  • In the control group, administration of the reversal agent, neostigmine, and tracheal extubation was based on qualitative monitoring of neuromuscular blockade, whereas in the intervention group it was based on quantitative measurements via acceleromyography. (bariatrictimes.com)
  • After 317 of the 362 patients were enrolled, sugammadex was added as a reversal agent at the study facility. (bariatrictimes.com)
Postoperative7
  • This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality. (anesthesiaexperts.com)
  • If such agents are necessary, reversal with sugammadex sodium may make postoperative ventilator support less likely to be required. (medscape.com)
  • If possible, avoidance of neuromuscular blocking agents is recommended to reduce the patient's risk of requiring postoperative ventilator support. (medscape.com)
  • If nondepolarizing agents are necessary, reversal with sugammadex may make postoperative ventilation less likely to be needed. (medscape.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)
Blockers2
  • These drugs fall into two groups: Non-depolarizing blocking agents: These agents constitute the majority of the clinically relevant neuromuscular blockers. (wikipedia.org)
  • Compared to other neuromuscular blockers, it is intermediate in its onset and duration of action. (mdtodate.com)
Mechanical ventilation1
  • Because the appropriate dose of neuromuscular-blocking drug may paralyze muscles required for breathing (i.e., the diaphragm), mechanical ventilation should be available to maintain adequate respiration. (wikipedia.org)
Intravenous2
  • Discontinue triggering agents, administer intravenous dantrolene sodium, and apply supportive therapies. (nih.gov)
  • 1.Which of the following is a commonly used intravenous induction agent? (mcqsadda.online)
Dose4
  • An initial vecuronium bromide dose of 0.08 to 0.1 mg/kg generally produces first depression of twitch in approximately 1 minute, good or excellent intubation conditions within 2.5 to 3 minutes, and maximum neuromuscular blockade within 3 to 5 minutes of injection in most patients. (nih.gov)
  • 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)
  • Despite the administration of 3.5 mg of neostigmine over the following 100 min (last dose, 4:30 P.M.), symptoms of residual weakness persisted throughout the evening. (asahq.org)
Acetylcholine receptors1
  • Neuromuscular blocking drugs act on acetylcholine receptors and fall into two distinct groups: nondepolarizing (competitive) and depolarizing blocking agents. (britannica.com)
Respiratory complications1
  • however, there are certain shared considerations, most notably the concern regarding perioperative respiratory complications associated with the administration of neuromuscular blocking agents. (medscape.com)
Pyridostigmine2
  • n Treatment : it is treated with long acting anticholinesterase inhibitor pyridostigmine or neostigmine. (slidetodoc.com)
  • Administration of anticholinesterase agents (neostigmine, pyridostigmine) may be used to antagonize the action of atracurium once the patient has demonstrated some spontaneous recovery from neuromuscular block. (unboundmedicine.com)
Vecuronium4
  • Vecuronium Bromide for Injection is a nondepolarizing neuromuscular blocking agent of intermediate duration, chemically designated as 1-(3α,17β-Dihydroxy-2β-piperidino-5α-androstan-16β,5α-yl)-1-methylpiperidinium bromide, diacetate. (nih.gov)
  • Vecuronium is a nondepolarizing neuromuscular blocking agent possessing all of the characteristic pharmacological actions of this class of drugs (curariform). (nih.gov)
  • The neuromuscular blocking action of vecuronium is slightly enhanced in the presence of potent inhalation anesthetics. (nih.gov)
  • Repeated administration of maintenance doses of vecuronium has little or no cumulative effect on the duration of neuromuscular blockade. (nih.gov)
Intermediate2
  • 2018. Pharmacokinetic/Pharmacodynamic Model of CW002, an Investigational Intermediate Neuromuscular Blocking Agent, in Healthy Volunteers. . (cornell.edu)
  • By study design, there was no difference in the intraoperative dosing of intermediate neuromuscular blocking agents. (bariatrictimes.com)
Drugs3
  • Neuromuscular blocking drugs are often classified into two broad classes: Pachycurares, which are bulky molecules with nondepolarizing activity Leptocurares, which are thin and flexible molecules that tend to have depolarizing activity. (wikipedia.org)
  • The use of a peripheral nerve stimulator is recommended in assessing the degree of muscular relaxation with all neuromuscular blocking drugs. (nih.gov)
  • The specific actions and uses of drugs related to perianesthesia care are discussed in the physiology chapters within Section II, as are the concepts of anesthetic agents presented in Section III chapters. (nursekey.com)
Skeletal muscle1
  • Depolarizing blocking agents: These agents act by depolarizing the sarcolemma of the skeletal muscle fiber. (wikipedia.org)
Patients10
  • RESULTS: Our primary aim was to assess the adverse outcomes in the patients who had received NNMBDs with and without neostigmine. (anesthesiaexperts.com)
  • CONCLUSIONS: The use of NNMBDs without neostigmine reversal was associated with increased odds of our composite respiratory outcome compared with patients reversed with neostigmine. (anesthesiaexperts.com)
  • Neostigmine: how much is necessary for patients who receive a nondepolarizing neuromuscular blocking agent? (cornell.edu)
  • 3. Which neuromuscular blocking agent is contraindicated in patients with glaucoma? (remixeducation.in)
  • Patients with LEMS are unpredictably sensitive to the effects of both depolarizing and nondepolarizing neuromuscular blocking agents. (medscape.com)
  • because of higher risk of toxicity and proarrhythmic effects, antiarrhythmic agents generally reserved for patients who do not respond to or cannot be treated with AV nodal blocking agents (β-adrenergic blocking agents, verapamil, diltiazem). (drugs.com)
  • Patients received 0.15 mg/kg cisatracurium and were randomized to receive 0.07 mg/kg neostigmine on reappearance of the first (group I), second (group II), third (group III), or fourth (group IV) tactile TOF response (16 patients per group). (silverchair.com)
  • To achieve rapid (within 10 min) reversal to a TOF ratio of 0.7 in more than 87% of patients, three or four tactile responses should be present at the time of neostigmine administration. (silverchair.com)
  • It was not possible within 30 min to achieve a TOF ratio of 0.9 in all patients, regardless of the number of tactile responses present at neostigmine administration. (silverchair.com)
  • 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)
Peripheral3
  • Neuromuscular response should be monitored with a peripheral nerve stimulator intraoperatively. (drugguide.com)
  • If overdose occurs, use peripheral nerve stimulator to determine the degree of neuromuscular blockade. (drugguide.com)
  • Our current clinical practice of monitoring neuromuscular blockade uses a standard peripheral nerve stimulator to stimulate the facial nerve (qualitative) and visually assess the response of the corrugator supercilii muscle (CS). (bariatrictimes.com)
Antagonizing residual1
  • Because tactile evaluation is the most common form of clinical neuromuscular monitoring, this study examines the relative efficacy of antagonizing residual block at different levels of recovery of the tactile train-of-four (TOF) response. (silverchair.com)
Doses1
  • 2 ] We certainly do not want to claim primacy for the observation that vision may be impaired by very small doses of nondepolarizing relaxants. (asahq.org)
Cholinergic1
  • NIMBEX binds competitively to cholinergic receptors on the motor end-plate to antagonize the action of acetylcholine, resulting in blockade of neuromuscular transmission. (mdtodate.com)
Clinical practice1
  • IN clinical practice, tactile evaluation of the adductor pollicis response to train-of-four (TOF) stimulation of the ulnar nerve is the most common method used to evaluate neuromuscular block. (silverchair.com)
Administration2
Medications1
  • Consideration must also be given to a patient's existing medications including herbal agents and other over-the-counter preparations. (nursekey.com)
Block3
  • The TOF count is often used in the guidelines for neostigmine-induced reversal of neuromuscular block. (silverchair.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)
  • The only other sign or subjective symptom of neuromuscular block that he experienced was ocular in nature, and these persisted for 2 h. (asahq.org)
Injection1
Intubation1
  • 5. Which neuromuscular blocking agent is commonly used for rapid sequence intubation? (mcqsadda.online)
Chemically1
  • characterization of substances, such as epinephrine and norepinephrine, that exert their effect in the sympathetic autonomic nervous system and agents that are chemically similar to these substances. (ashp.org)
Severe1
  • Because of procainamide's arrhythmogenic potential, lack of evidence for improved survival for class I antiarrhythmic agents, and risk of serious, potentially fatal adverse hematologic effects (see Boxed Warning), particularly leukopenia or agranulocytosis, use for less severe arrhythmias not recommended. (drugs.com)
Assess1
Depth1