Atracurium is associated with postoperative residual curarization

McCaul, Conán; Tobin, Elizabeth; Boylan, John F.; McShane, A. J.

doi:10.1093/bja/89.5.766

Cited by 47 publications

(36 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our patient required 30 mg atracurium for surgical duration of 90mins.Reversal of residual neuromuscular blockade at the end of surgery with anticholinesterases is controversial, as it may be difficult to differentiate from weakness resulting from cholinergic crisis, in the recovery room. However, atracurium has been found to be associated with residual curarization postoperatively (6). Hence, we reversed our patient after adequate recovery of NM function(TOF -99%) and extubated him after confirming full consciousness and hemodynamic stability.…”

Section: Discussionmentioning

confidence: 91%

Myaesthenia Gravis: An Anaesthetic Challenge

Malliwal¹,

Bakhshi²,

Agarwal³

2015

jmscr

View full text Add to dashboard Cite

Myaesthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by fluctuating skeletal muscle weakness that worsens with exertion and improves after a period of rest Keywords: myasthenia gravis, respiratory muscle weakness, anticholinesterase medicationCase Report A 78year old male, weighing 65kgs, known case of myasthenia gravis (Osserman IIa) presented for cholecystectomy with CBD exploration. He was on tablet. Pyridostigmine 60 mg twice daily. He had been treated conservatively for cholangitis and had undergone endoscopic retrograde cholangio pancreaticography (ERCP) with biliary stenting ten days prior. Other complaints included urinary incontinence (for which he was on tab. Urimax-D once daily) and dyspnoea on exertion (NYHA grade II). General and systemic examination were unremarkable except for pallor and decreased breath-holding time(~12-13seconds).Airway examination revealed anticipated difficult intubation due to heavy jaw, Mallampatti grade III and multiple artificial fixed dentures in both jaws. Routine haematological investigations were within normal limits except haemoglobin 8.0gm%.He had left anterior hemiblock on ECG and moderate obstruction on pulmonary function test (PFT). Chest radiograph revealed increased broncho-vascular markings with few calcific granulomas. Echocardiography showed ejection fraction 55% with diastolic dysfunction and concentric left ventricular hypertrophy. The patient was taken up for surgery after correcting anaemia and optimizing with nebulisations. High risk consent was taken and ICU bed and ventilator were kept available.

show abstract

Section: Discussionmentioning

confidence: 91%

Myaesthenia Gravis: An Anaesthetic Challenge

Malliwal¹,

Bakhshi²,

Agarwal³

2015

jmscr

View full text Add to dashboard Cite

show abstract

“…3, 19 In the pre sent study, ne u ro mus cu lar bloc k was not mo nito red from ro cu ro ni um ad mi nis tra ti on in the opera ting ro om un til TOF me a su re ment in the PA CU, and this co uld ha ve con tri bu ted to the high in ciden ce of PORC. The pro to col of this study was desig ned to ref lect stan dard cli ni cal prac ti ce in our cli nic.…”

Section: Discussionmentioning

confidence: 95%

“…PORC has be en fo und as an im por tant con tri bu ting fac tor in the de ve lop ment of cri ti cal res pi ra tory events inc lu ding up per air way obs truc ti on and hypo xe mi a du ring this im me di a te pos to pe ra ti ve pe ri od re sulting in pul mo nary comp li ca ti ons. 8,19 Re co very of ne u ro mus cu lar func ti on sho uld be ac hi e ved pri or to trac he al ex tu ba ti on to en su re ac cep tab le re co very of phary nge al and res pi ra tory musc le strength and to re du ce the risk of res pi ra tory comp li ca ti ons. Reco very of ne u ro mus cu lar func ti on inc lu ding norTurkiye Klinikleri J Med Sci 2010;30 (4) Data are mean ± SD, median (range), or number of patients (%).…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that the in ci den ce of PORC may be re du ced if an ta go nism of ne u romus cu lar bloc ka de is ini ti a ted 20-30 min be fo re trac he al ex tu ba ti on. 19 The ba se li ne AMG-TOF ra ti os va ri ed wi dely [110.8 (91-149)] in the cur rent study, si mi lar to pre vi o us stu di es. 11,16,17,20 Even tho ugh the ba se li ne TOF ra ti os we re >1 in 71 (58.1%) pa ti ents, they were <1 in 29 (23.7%) pa ti ents.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

High Incidence of Residual Curarization After Rocuronium Despite Administration of Neostigmine

Baykara¹,

Hoşten²,

Özdamar³

et al. 2010

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of the study was to in ves ti ga te the in ci den ce of pos to pe ra ti ve re sidu al curarization (PORC) af ter ro cu ro ni um ad mi nis tra ti on using nor ma li zed ac ce le rom yog rap hic (AMG) tra in-of-fo ur (TOF) ra ti os. M Ma at te er ri ia al l a an nd d M Me et t h ho od ds s: : Du ring pro po fol-fen tanyl-nit ro us oxi de anest he si a, ne u ro mus cu lar block was mo ni to red using ac ce le rom yog raphy met hod in 130 pa ti ents. A TOF ra ti o me a su red at the end of con trol sti mu la ti on was re cor ded as a ba se li ne TOF va lu e. Neu ro mus cu lar block was in du ced with ro cu ro ni um 0.6 mg.kg -1 and an ta go ni zed with ne os tig mi ne 40 μg.kg -1 at the end of anest he si a. Im me di a tely af ter the pa ti ents' ar ri val in the pos ta nest he tic ca re unit (PA CU), TOF ra ti os we re me a su red and nor ma li zed (i.e., di vi ding the raw TOF ra ti o by the ba seli ne TOF va lu e). The in ci den ces of PORC we re de ter mi ned ac cor ding to thre e dif fe rent TOF threshold va lu es: Nor ma li zed AMG-TOF ra ti o <1; raw AMG-TOF ra ti o <1; and raw AMG-TOF ra ti o < 0.9. R Re e s su ul lt ts s: : The ba se li ne AMG TOF ra ti os va ri ed wi dely 110.8 (91-149) among pa ti ents. Con si dering nor ma li zed AMG-TOF ra ti os <1 as PORC, 77 (63.1%) pa ti ents had PORC on ar ri val to the PA -CU. Sig ni fi cantly fe wer pa ti ents had raw TOF ra ti os < 0.9 (39 sub jects, 31.9%), and <1 (67 sub jects, 54.9%) than who se nor ma li zed TOF ra ti os <1 (77 sub jects, 63.1 %) (p< 0.05). Although not statistically significant, the when it was determined using normalized AMG-TOF ratios rather than using raw AMG-TOF ratios (18.3% and 10%, respectively). C Co on nc c l lu u s si i o on n: : Des pi te re ver sal of ne u ro muscu lar block with ne os tig mi ne, the in ci den ce of PORC is very high af ter ro cu ro ni um ad mi nis tra tion.K Ke ey y W Wo or rd ds s: : Mo ni to ring, physi o lo gic; ro cu ro ni um; comp li ca ti ons; ne u ro mus cu lar bloc ka de Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma da ro ku ron yum son ra sı pos to pe ra tif re zi dü el kü ra ri zas yon (PORK) sık lı ğı -nın nor mal leş ti ril miş ak se le rom yog ra fik (AMG) tra in-of-fo ur (TOF) oran la rı kul la nı la rak be lir lenme si amaç lan mış tır. G Ge e r re eç ç v ve e Y Yö ön n t te em ml le er r: : Pro po fol-fen ta nil-nit roz ok sit anes te zi si sı ra sın da, 130 has ta da nö ro müs kü ler blok ak se le rom yog ra fi yön te miy le mo ni to ri ze edil di. Kon trol sti mü lasyo nu son ra sın da öl çü len TOF ora nı ba zal TOF de ğe ri ola rak ka bul edil di. Nö ro müs kü ler blok 0.6 mg.kg -1 ro ku ron yum la sağ lan dı ve anes te zi nin so nun da 40 μg.kg -1 ne os tig min le an ta go ni ze edil di. Has ta lar pos to pe ra tif der len me oda sı na gel dik ten he men son ra TOF oran la rı öl çül dü ve nor mal leş -ti ril di (ham TOF ora nı nın ba zal TOF de ğe ri ne bö lün me siy le). PORK sık lı ğı üç fark lı TOF eşik değe ri ne gö re be lir l...

show abstract

“…La incidencia de BNMR presenta una gran variabilidad con porcentajes que oscilan entre el 2% y el 64% 87,93,94,95,96,97,98,99,100,101,102,103,104,105 .…”

Section: Incidencia De Bnmrunclassified