Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2007
EditorialSugammadex: an opportunity to change the practice of anesthesiology?
Miller enthusiastically states:
“Sugammadex is likely the most exciting drug in clinical neuromuscular pharmacology since the introduction of atracurium and vecuronium in the middle 1980s.”
...and hints at where benefits may begin:
summary“Will sugammadex’s increased effectiveness, in comparison to neostigmine, lessen the need for or use of monitoring neuromuscular function?”
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Comparative StudySugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.
Time to achieve full reversal (TOFR > 0.9) was significantly faster with sugammadex (107s ± 61) than neostigmine (1044 ±590s) or edrophonium (331s ± 27).
All sugammadex-reversed patients were completely reversed within 5 minutes, compared with no patients receiving neostigmine.
Reversal with sugammadex lead to less increase in heart-rate than when neostigmine-glycopyrrolate or edrophonium-atropine and almost total avoidance of the dry-mouth associated with the later (5% vs 85-95%)
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Anesthesia and analgesia · Mar 2007
Case ReportsA temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex.
We present a case in which a temporary decrease in train-of-four (TOF) response was observed after reversal of muscle relaxation with a small dose (0.5 mg/kg) of sugammadex administered 42 min after 0.9 mg/kg of rocuronium. At the end of the operation, the TOF ratio was >0.9, and the patient woke normally, without signs of muscle weakness. We describe this temporary decrease in muscle response during muscle relaxation reversal as muscle relaxation rebound and hypothesize that it occurs when the dose of sugammadex is sufficient for complex formation with rocuronium in the central compartment, but insufficient for redistribution of rocuronium from peripheral to central compartments. ⋯ Sufficiently large doses of sugammadex eliminate the possibility for muscle relaxation rebound, which does not require dissociation of the sugammadex/ rocuronium complex.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled TrialBilateral ilioinguinal nerve block decreases morphine consumption in female patients undergoing nonlaparoscopic gynecologic surgery.
Bilateral ilioinguinal nerve block may be useful to control postoperative pain in gynecologic surgery, especially hysterectomy. ⋯ The use of bilateral ilioinguinal nerve block for postoperative analgesia after hysterectomy decreased morphine consumption by one-half during the first two postoperative days without differences in side effects from morphine between groups.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Comparative StudyA comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor.
The use of parturient-controlled epidural analgesia (PCEA) with a basal infusion is commonly used in laboring women. We compared a novel approach of providing basal intermittent boluses concurrently with PCEA: PCEA plus automated mandatory boluses (PCEA+AMB) versus PCEA plus basal continuous infusion (PCEA+BCI). We hypothesized that epidural local anesthetic consumption would be lower if basal intermittent boluses were used instead of a basal infusion. ⋯ Our study showed that PCEA+AMB reduced analgesic consumption and could be useful as the mode of maintenance for epidural analgesia.