Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study

Çakmak, Murat; Çağlayan, Fatma; Somuncu, Salih; Leventoğlu, Alev; Ulusoy, Sevgi; Akman, Hülya; Kaya, Murat

doi:10.1016/j.jpedsurg.2005.12.023

Cited by 65 publications

(26 citation statements)

References 12 publications

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“…16 The potential use of BTA as an adjunct for abdominal wall closure was first theorized in 2006 when a study on rats successfully increased intra-abdominal volume and decreased pressure by paralyzing abdominal wall muscles, thus diminishing transverse hernia defect. 17 The attempted use of novel technique involving the application of BTA before abdominal wall hernia reconstruction was first reported in 2009, in a study involving 12 patients. 18 The technique proved useful as the paralysis of lateral muscles and hernia defect reduction (mean of 5.25 ± 2.32 cm) allowed a lower tension closure 4 weeks after BTA application.…”

Section: Discussionmentioning

confidence: 99%

Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19‐year‐old female

Hijji

AlShammari

Alhammad

et al. 2019

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19‐year‐old female

Hijji

AlShammari

Alhammad

et al. 2019

Clinical Case Reports

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“…22 The “chemical component separation” provided by BTX has also been shown to achieve 79% of the tension of a mechanical components separation in pigs. 23 Whether this translates into a beneficial clinical effect in humans, however, is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin A–induced paralysis of the lateral abdominal wall after damage-control laparotomy

Zielinski

Kuntz

Zhang

et al. 2016

Journal of Trauma and Acute Care Surgery

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INTRODUCTION Damage control laparotomy (DCL) is a life-saving operation used in critically ill patients; however, interval primary fascial closure remains a challenge. We hypothesized that flaccid paralysis of the lateral abdominal wall musculature induced by Botulinum Toxin A (BTX), would improve of rates of primary fascial closure, decrease duration of hospital stay (LOS), and enhance pain control. METHODS Consenting adults who had undergone a DCL at two institutions were prospectively randomized to receive ultrasound-guided injections of their external oblique, internal oblique, and transversus abdominus muscles with either BTX (150cc, 2units/cc) or placebo (150cc 0.9%NaCl). Patients were excluded if they had a BMI>50, remained unstable or coagulopathic, were home O2 dependent or had an existing neuromuscular disorder. Outcomes were assessed in a double-blinded manner. Univariate and Kaplan Meier estimates of cumulative probability of abdominal closure were performed. RESULTS We randomized 46 patients (24 BTX, 22 placebo). There were no significant differences in demographics, comorbidities, and physiological status. Injections were performed on average 1.8 ± 2.8 days after DCL (range 0-14). The 10-day cumulative probability of primary fascial closure was similar between groups: 96% for BTX (95% CI 72%-99%) and 93% for placebo (95% CI 61%-99%); HR =1.0 (95% CI 0.5-1.8). No difference between BTX and placebo groups was observed for LOS (37 vs 26 days, p=0.30) or intensive care unit stay (17 vs 11 days, p=0.27). There was no difference in median morphine equivalents following DCL. The overall complication rate was similar (63% vs 68%, p=0.69), with 2 deaths in the placebo group and 0 in the BTX group. No BTX or injection procedure complications were observed. CONCLUSION Use of BTX after DCL was safe but did not appear to affect primary fascial closure, LOS, or pain modulation after DCL. Given higher than expected rates of primary fascial closure, type II error may have occurred.

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“…[11] Although there is no consensus on how NMB ameliorates ACS, it may be that early treatment of IAH/ACS stops the cycle of tissue abdominal organ hypoxia and oedema before it spirals out of control.…”

Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome successfully treated with neuromuscular blockade

Chiles

Feeney

2011

Indian J Anaesth

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A 48 year old male admitted to the intensive care unit after a cardiac arrest complicated by a stroke intra-operatively during automatic implantable cardioverter defibrillator placement. He post-operatively developed a rigid abdomen, elevated peak and plateau pressures, hypoxia and renal insufficiency. He was diagnosed with abdominal compartment syndrome with an intra-abdominal compartment pressure of 40mmHg. The patient was administered 10 mg of intravenous cisatracuriumbesylate in preparation for bedside surgical abdominal decompression. Cisatracurium eliminated the patients need for surgical intervention by reducing his abdominal compartment pressures to normal and improving his hypoxia and renal function. This case illustrates that neuromuscular blockade should be attempted in patients with abdominal compartment syndrome prior to surgical intervention.

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Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study

Cited by 65 publications

References 12 publications

Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19‐year‐old female

Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19‐year‐old female

Botulinum toxin A–induced paralysis of the lateral abdominal wall after damage-control laparotomy

Abdominal compartment syndrome successfully treated with neuromuscular blockade

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