International anesthesiology clinics
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Intelligent, safe use of muscle relaxants dictates that the clinician monitor neuromuscular function in all patients to determine each patient's sensitivity to relaxants. Restoration of muscle strength is a function of pharmacological antagonism of residual NMB, spontaneous recovery as the concentration of relaxant declines at the neuromuscular junction, or both. ⋯ As new relaxants with very short half-lives become available, it is likely that steady states of relaxation will increasingly be maintained with continuous infusions. In this setting, the rapid rate of spontaneous recovery of both clinical neuromuscular function and an adequate margin of safety may vastly reduce the need for pharmacological antagonism.
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Kidney transplantation in adults, infants, and children is a safe and effective treatment of ESRD. In 1990, for all patients with irreversible ESRD, transplantation is the preferred treatment over dialysis. ⋯ Thus increased use of grafts from living donors appears warranted. Continued refinements and advances in immunosuppression should result in even better long-term graft and patient survival.