Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Apr 2013
Observational StudyResidual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium.
Incomplete recovery of neuromuscular function following the administration of medium-acting, non- -depolarising agents is one of the most feared complications in anaesthesia. We assessed the incidence of postoperative residual curarisation (PORC) after general anaesthesia with rocuronium in elderly and young patients, and we evaluated possible complications of postoperative residual curarisation. ⋯ Residual paralysis remains a major problem in geriatric clinical anaesthesia. Neuromuscular function monitoring is obligatory, and pharmacological reversal of relaxation should be advised in geriatric patients after using relaxants for general anaesthesia.
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Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. ⋯ This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.
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Neuromuscular blocking agents are a substantial element of anaesthesia in almost every surgical field. Nevertheless, their use has been associated with rises in mortality and morbidity. Of importance are: the general health state of the patient, liver and renal function, metabolism and excretion, active metabolites, side effects of muscle relaxants and, above all, residual paralysis. ⋯ In contrast to anticholinergic agents, which enhance the acetylcholine amount in the postsynaptic part of the neuromuscular junction, sugammadex encapsulates myorelaxing agent removing it from the junction. Sugammadex binds specifically only muscle relaxants of aminosteroid structure. In this paper, we present the current understanding of the characteristics, dosing, indications and side effects of sugammadex.
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Anaesthesiol Intensive Ther · Apr 2013
Theorethical principles of fluid managment according to physicochemical Stewart approach.
Interpreting acid base disturbances according to the physicochemical Stewart approach allows the cause of such abnormalities to be discovered. This method is based on three independent variables: SID (strong ion difference), mainly sodium and chloride; weak acids concentration - Atot, mainly albumins and phosphate; and carbon dioxide tension - pCO₂. These three independent variables are responsible for the change of water dissociation and for the change in H+ concentration and, consequently, the change in serum pH value. ⋯ Administering a fluid with a SID greater than the HCO₃ concentration causes a pH increase towards alkalosis. Likewise, administering a a fluid with a SID lower than the HCO₃ concentration causes a pH decrease towards acidosis. It seems that knowledge of the electrolyte concentration and the SID value of an administered fluid is an important factor regarding acid base disturbances.