Reversal agents in anaesthesia and critical care

Pani, Nibedita; Dongare, Pradeep A; Mishra, Rajeeb Kumar

doi:10.4103/0019-5049.167484

Cited by 19 publications

(25 citation statements)

References 30 publications

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“…Currently, there is no evidence that any long-term medication is useful to treat FNSD and it is generally advised that chronic, long-term pharmacological treatment should be avoided due to associated side effects [43]. Depending on the anesthetic course, it is reasonable to administer naloxone or other opioid reversal agents for suspicion of opioid overdose, flumazenil for benzodiazepine overdose, and physostigmine for the possibility of central anticholinergic syndrome and sleep paralysis [44][45][46][47]. Notable medication-related side effects in our case series included unanticipated tracheal intubation due to sedation and respiratory depression from parenteral diazepam, chlormethiazole, thiopentone, and alfentanil in one patient [17], and unresponsiveness in an another patient with hypercapnia (arterial blood gas pH of 7.15 and pCO 2 of 65 mm Hg) after administration of 2 mg IV midazolam [11].…”

Section: Discussionmentioning

confidence: 99%

Post-operative functional neurological symptom disorder after anesthesia

D’Souza

Vogt

Rho

2020

Bosn J of Basic Med Sci

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A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

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Section: Discussionmentioning

confidence: 99%

Post-operative functional neurological symptom disorder after anesthesia

D’Souza

Vogt

Rho

2020

Bosn J of Basic Med Sci

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“…[ 30 ] These are prevented by adding an anticholinergic agent with it, but the unpleasant side effects of neostigmine can be avoided by the use of objective neuromuscular monitoring and assessing the actual need for anticholinesterases at the time of reversal. [ 31 32 ]…”

Section: Discussionmentioning

confidence: 99%

Reversal agents: do we need to administer with neuromuscular monitoring – an observational study

et al. 2018

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Background and Aims:In clinical practice, in the majority of patients, recovery from the effect of muscle relaxants is assessed using subjective methods such as head lift, eye-opening, or by sustained hand grip after giving anticholinesterases (neostigmine) at the end of surgery. We planned a prospective observational cohort study to test the hypothesis that objective neuromuscular monitoring can help us in avoiding the use of anticholinesterases for reversal.Methods:The patients posted for surgery of <2 h duration were included in the study. The cohort of patients was formed on the basis of those who were exposed to objective neuromuscular monitoring of recovery (train-of-four [TOF] ratio of 0.9 or more; exposed group) and the patients who were not exposed to objective neuromuscular monitoring (non-exposed group) acting as a control. Using objective neuromuscular monitoring, the time required for recovery from muscle relaxation when neostigmine was not given for reversal was noted and it was then compared with that of the control group.Results:A total of 190 patients were enrolled over a period of 3 years. With the use of TOF ratio of 0.9 for extubation, patients safely recovered from neuromuscular blockade, without using neostigmine, with no difference in the mean recovery time (14.48 ± 1.138 min) as compared to the control group (12.14 ± 1.067 min, P = 0.139). There was no incidence of reintubation in post-operative period.Conclusion:With objective neuromuscular monitoring, we can ensure complete recovery from the neuromuscular blockade while avoiding the use of anticholinesterases.

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“…Las reacciones alérgicas a los BNM están casi exclusivamente mediadas por IgE. Hasta 75% de las reacciones se han publicado en el primer contacto conocido con el BNM (13)(14)(15)(16) . Esto sugiere una posible reacción cruzada con los anticuerpos IgE generados por contacto previo con productos químicos aparentemente no relacionadas.…”

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