- The Knowledge Profile, Competence and Pending Problems of Chinese Anesthesiologists in Dealing with Malignant Hyperthermia: A Cross-Sectional Survey. [Journal Article]
- CONCLUSIONS: The study indicated that difficulty in obtaining dantrolene, lack of competency in management of MH, difficulty in obtaining professional help, and poor teamwork were the main problems of most anesthesiologists in face of MH.
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- Sugammadex in Emergency Situations. [Journal Article]
- Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequ…
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- Comparison of different doses of atracurium for quality of muscle relaxation during modified rapid sequence induction in emergency laparotomy: A prospective randomised double blind study. [Journal Article]
- CONCLUSIONS: Acceptable intubating conditions can be achieved in a minute with the use of a high dose of atracurium (1 mg/kg) during RSI. Hence, atracurium can be used as an alternative drug for RSI.
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- Application of Continuous Sacral Block Guided by Ultrasound After Comprehensive Sacral Canal Scanning in Children Undergoing Laparoscopic Surgery: A Prospective, Randomized, Double-Blind Study. [Clinical Trial]
- CONCLUSIONS: Based on the modified protocol, continuous sacral block provides reliable and safety analgesia for children undergoing laparoscopic surgery, thereby improving the satisfaction of PACU nurses.
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- Modulation of Cerebral Function by Muscle Afferent Activity, with Reference to Intravenous Succinylcholine. [Journal Article]Anesthesiology. 2023 Feb 01; 138(2):209-215.A
- Cerebral Function and Muscle Afferent Activity Following Intravenous Succinylcholine in Dogs Anesthetized with Halothane: The Effects of Pretreatment with a Defasciculating Dose of Pancuronium. By WL Lanier, PA Iaizzo, and JH Milde. Anesthesiology 1989; 71:87-95. Reprinted with permission. By the mid-1980s, it was widely assumed that if the depolarizing muscle relaxant, succinylcholine, given IV,…
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- Clinical Features of Suspected Malignant Hyperthermia in China from 2015 to 2020: A Retrospective Study from China Malignant Hyperthermia Emergency Assistance Group. [Journal Article]
- CONCLUSIONS: The current main diagnostic methods of suspected MH in China are still clinical diagnosis. Hence, it is critical to keep dantrolene for immediate accessibility with the introduction of domestic dantrolene to China. The WeChat group model has played an important but limited role in quick diagnosis and treatment of MH.
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- A Case Report of an Incidental Ultrasound Finding in a Suspected Malignant Hyperthermia Patient. [Case Reports]A A Pract. 2022 Dec 01; 16(12):e01651.P
- Malignant hyperthermia (MH) is a rare but life-threatening genetic disorder of the skeletal muscles triggered by inhalation anesthetics or succinylcholine. A 49-year-old female developed symptoms of MH shortly after a lumbar surgery. Despite being insidious, MH was diagnosed based on the clinical grading scale. We incidentally discovered fine fasciculations in extremities while inserting an ultra…
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- Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. [Randomized Controlled Trial]JAMA. 2023 01 03; 329(1):28-38.JAMA
- CONCLUSIONS: Among adults at risk of aspiration during rapid sequence intubation in the operating room, remifentanil, compared with neuromuscular blockers, did not meet the criterion for noninferiority with regard to successful intubation on first attempt without major complications. Although remifentanil was statistically inferior to neuromuscular blockers, the wide confidence interval around the effect estimate remains compatible with noninferiority and limits conclusions about the clinical relevance of the difference.
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- Stable Gastric Pentadecapeptide BPC 157 and Striated, Smooth, and Heart Muscle. [Review]
- First, we review the definitively severed myotendinous junction and recovery by the cytoprotective stable gastric pentadecapeptide BPC 157 therapy, its healing that might combine both transected and detached tendon and transected muscle, ligament and bone injuries, applied alone, as native peptide therapy, effective in rat injury, given intraperitoneally or in drinking water or topically, at the …
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- Complications After Dental Sedation: A Myotonic Mystery Case Report. [Case Reports]
- Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-…
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- GeneReviews®: Calpainopathy [BOOK]GeneReviews®. University of Washington, Seattle: Seattle (WA)BOOK
- Calpainopathy is characterized by symmetric and progressive weakness of proximal limb-girdle muscles. The age at onset of muscle weakness ranges from two to 40 years. The phenotype shows intra- and interfamilial variability ranging from severe to mild. Three autosomal recessive calpainopathy phenotypes have been identified based on the distribution of muscle weakness and age at onset: Pelvifemora…
- Trismus during tracheal extubation as a complication of general anaesthesia - A case report. [Case Reports]
- Tracheal extubation is a risky phase of anaesthesia. Most complications that occur when an endotracheal tube is removed are of minor nature, but those that require critical action can end in serious complications or even death. Patient - A 55-year-old woman was admitted for elective transabdominal hysterectomy and adnexal procedures. Anaesthesia - Standard monitoring. For induction, we used fenta…
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- Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. [Journal Article]
- Recent data indicated a high incidence of inappropriate management of neuromuscular block, with a high rate of residual paralysis and relaxant-associated postoperative complications. These data are alarming in that the available neuromuscular monitoring, as well as myorelaxants and their antagonists basically allow well tolerated management of neuromuscular blockade. In this first European Societ…
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- Malignant Hyperthermia in PICU-From Diagnosis to Treatment in the Light of Up-to-Date Knowledge. [Review]
- Malignant Hyperthermia (MH) is a rare, hereditary, life-threatening disease triggered by volatile anesthetics and succinylcholine. Rarely, MH can occur after non-pharmacological triggers too. MH was detected more often in children and young adults, which makes this topic very important for every pediatric specialist, both anesthesiologists and intensivists. MH crisis is a life-threatening severe …
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- Effect of Paralytic Agents on Post-Intubation Sedation in the Emergency Department. [Journal Article]
- Purpose: This study aimed to evaluate the frequency at which postintubation sedation is administered following use of long-acting paralytic agents compared to short-acting paralytic agents during rapid sequence intubation performed in the emergency department. Methods: This retrospective, single-center study of intubated patients in the emergency department analyzed the difference in time to admi…
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- Does the Use of Rocuronium-Sugammadex Instead of Succinylcholine in Electroconvulsive Therapy Affect Seizure Duration? [Journal Article]
- CONCLUSIONS: The results of this study show that the use of rocuronium-sugammadex as a neuromuscular blocker instead of succinylcholine during ECT with propofol anesthesia produces similar results in terms of seizure variables and clinical outcomes.
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- Should rocuronium and sugammadex replace succinylcholine for airway emergencies in class B ambulatory anesthesia settings? A systematic review. [Journal Article]Minerva Anestesiol. 2022 Nov 03 [Online ahead of print]MA
- CONCLUSIONS: The use of succinylcholine in isolation without volatile agents has a low incidence of triggering MH. Laryngospasm is a common airway emergency that requires immediate treatment to avoid morbidity and mortality. Both succinylcholine and rocuronium-sugammadex provide adequate treatment of airway emergencies and rapid return of spontaneous ventilation, but succinylcholine has a superior economic and clinical profile.
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- Succinylcholine Induced Rhabdomyolysis in a Heavy Marijuana Smoker: A Case Report. [Case Reports]Isr Med Assoc J. 2022 10; 24(10):687-688.IM
- Postoperative weakness and anesthetic-associated rhabdomyolysis in a pediatric patient: a case report and review of the literature. [Case Reports]
- CONCLUSIONS: This case report demonstrates the importance of considering anesthesia-associated rhabdomyolysis as a differential for acute postoperative weakness, and outlines an investigative approach. To the best of our knowledge, it is the first case described in the pediatric literature to report biphasic progression of symptoms.
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- Premedication with Diclofenac and Precurarization with Atracurium on Succinylcholine-Induced Myalgia in Laparoscopic Cholecystectomy: A Double-Blinded Randomized Study. [Journal Article]
- CONCLUSIONS: Succinylcholine-induced myalgia has a complex pathophysiology. However, the preemptive use of diclofenac in combination with precurarization can alleviate the incidence and severity of succinylcholine-induced myalgia. Therefore, its use may be considered in routine cases for induction of anesthesia for facilitating laryngoscopy and endotracheal intubation.
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- Alfentanil Pretreatment for Electroconvulsive Therapy-Associated Hemodynamic Lability: A Prospective Randomized Crossover Trial. [Journal Article]J ECT. 2022 Oct 01 [Online ahead of print]JE
- CONCLUSIONS: Premedication with alfentanil reduces poststimulus hypertension and increased HR in patients receiving ECT and therefore, may reduce morbidity related to this in susceptible patients.
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- Acute myotonic reaction during succinylcholine anaesthesia. [Case Reports]Pract Neurol. 2023 Feb; 23(1):74-77.PN
- A 21-year-old woman developed an acute myotonic reaction while undergoing anaesthesia using succinylcholine. Examination later showed she had shoulder, neck and calf hypertrophy, bilateral symmetrical ptosis and eyelid, handgrip and percussion myotonia. Peripheral neurophysiology studies identified significant, continuous myotonic discharges in both upper and lower limbs. Genetic analysis identif…
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- StatPearls: Biochemistry, Pseudocholinesterase [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Pseudocholinesterase is a serine hydrolase enzyme, primarily produced in the liver that catalyzes the hydrolysis of choline esters, most prominently succinylcholine and mivacurium.[1] It is imperative to differentiate this from “true” cholinesterase, also known as acetylcholinesterase, which occurs in higher concentrations within conducting tissues such as the central/peripheral nervous systems a…
- StatPearls: Neuromuscular Blockade [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Neuromuscular blockade is frequently used in anesthesia to facilitate endotracheal intubation, optimize surgical conditions, and assist with mechanical ventilation in patients who have reduced lung compliance. Neuromuscular blocking agents (NMBAs) come in two forms: depolarizing neuromuscular blocking agents (e.g., succinylcholine) and nondepolarizing neuromuscular blocking agents (e.g., rocuroni…
- Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia. [Case Reports]
- Malignant hyperthermia (MH) is an acute hypermetabolic crisis, triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When providing anesthetic care for MH-susceptible patients, a total intravenous anesthetic technique with propofol or other sedative hypnotic is frequently chosen. Remimazolam is a novel benzodiazepine which, like midazolam, has …
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- Intravenous dantrolene in hypermetabolic syndromes: a survey of the U.S. Veterans Health Administration database. [Journal Article]
- CONCLUSIONS: In over 95% of cases, dantrolene administration was associated with diagnoses other than MH in critically-ill patients with hypermetabolic symptoms and medical and psychiatric comorbidities. Exploratory survey data suggested that the efficacy and safety of dantrolene in preventing mortality in hypermetabolic syndromes other than MH remain uncertain. However, randomized and controlled studies using standardized criteria between groups matched for severity are essential to guide practice in using dantrolene.
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- StatPearls: Pseudocholinesterase Deficiency [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, refers to a rare acquired or inherited defect in the pseudocholinesterase enzyme produced by the liver.[1] In clinical anesthesia practice, the muscle relaxants succinylcholine and mivacurium are drugs used to optimize intubating conditions and surgical exposure.[2] The drugs succinylcholine and mivacurium are both m…
- The Nonirritating Concentrations of Neuromuscular Blocking Agents and Related Compounds. [Journal Article]J Allergy Clin Immunol Pract. 2022 Sep 13 [Online ahead of print]JA
- CONCLUSIONS: Our results suggest that SPT may be performed with undiluted stock concentrations. We confirm maximal IDT NICs for cisatracurium and rocuronium. We also propose that currently recommended maximal IDT NICs of succinylcholine, neostigmine, sugammadex, and S-R-Cx could be increased, whereas the maximal IDT NIC of vecuronium could be decreased compared with current guidelines and prior reports.
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- Oxygen desaturation in a transgender man: initial concerns and recommendations regarding the practice of chest binding: a case report. [Case Reports]
- CONCLUSIONS: In the clinical narrative, a healthy patient was observed to have prolonged oxygen desaturation after induction of anesthesia. Laryngospasm was suspected clinically owing to the sudden absence of end-tidal carbon dioxide. Prolonged oxygen desaturation despite appropriate interventions suggests the contribution of additional factors. We speculate that the presence of a chest binder intraoperatively predisposed the patient to more rapid oxygen desaturation less responsive to typical therapy. A chest binder would introduce mechanical restriction to the patient's breathing owing to its inherent design to compress. Although the patient was asked to remove all clothing, specific instructions were not provided regarding the removal of a chest binder. The presence of chest binding was also absent in the electronic health record, despite the documented presence of the patient's preferred gender, hormonal therapy regimen, and medical history. Ultimately, this case reflects the gap between practitioner knowledge and hospital guidelines and the practices of transgender patients. In reviewing existing literature and the potential for atelectasis with external compression, we would consider that patients refrain from chest binding for 12-24 hours before surgical procedures, resume no sooner than 24 hours after ambulation, and participate in diagnostic incentive spirometry pre- and postoperatively.
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