Revista española de anestesiología y reanimación
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We describe a case of prolonged neuromuscular block (longer than 8 hours) after administration of mivacurium. The patient was shown to be homozygous for the atypical butyrylcholinesterase gene. We discuss our treatment of the patient as well as other cases described in the literature, emphasizing the need for neuromuscular monitoring.
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Rocuronium is a new nondepolarizing neuromuscular blocking agent (NDNMBA) that has recently been introduced for clinical use. Its main advantage over other such agents is its rapid onset of action, which may lead to its use as the relaxant of choice when rapid intubation is required. An additional advantage is that, unlike other amino-steroidal NDNMBAs, rocuronium does not produce active metabolites. ⋯ Hemodynamic stability, along with the absence of histamine release even at doses as high as 4 to 5 ED95, allow it to be used in high risk patients. Successful use has been reported in emergency surgery in patients with full stomachs, in cesarean deliveries, in cardiovascular surgery, and in liver, kidney and other transplants. Rocuronium administered in repeated doses or in continuous infusion provides adequate muscle relaxation over the required period, with predictable reversibility of effects.
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Mivacurium is a short-acting nondepolarizing muscle relaxant (NDPMR) with a benzyl-isoquinoline structure and rapid, spontaneous reversal. It is hydrolyzed by cholinesterase in plasma and its chemical structure favors histamine release, leading to cutaneous or cardiovascular symptoms, particularly when the dose is increased or when the drug is injected rapidly. Both duration of effect and reversal of mivacurium are less dose dependent than they are with intermediate-duration NDPMRs. ⋯ Neuromuscular blockade may be prolonged in patients with low plasma cholinesterase activity, particularly in individuals who are homozygous for the atypical plasma cholinesterase gene. Monitoring is therefore recommended when mivacurium is used. Provided patients have normal plasma cholinesterase activity, mivacurium is indicated for interventions that are short or of unpredictable duration when rapid reversal of neuromuscular blockade is required, or whenever anticholinesterase agents must be avoided.
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Rev Esp Anestesiol Reanim · Oct 1997
Randomized Controlled Trial Clinical Trial[Effects of precurarization on oxygen arterial saturation measure with pulse oximetry and neuromuscular function].
To study changes in arterial oxygen saturation (SpO2) measured by pulse oximetry, and the effect of neuromuscular function after precurarization with different nondepolarizing muscle relaxants. ⋯ SpO2 measured by pulse oximetry is an effective method for monitoring breathing function in the precurarized patient, as it detects early changes in arterial oxygen saturation related to respiratory muscle weakness. The agent d-tubocurarine is recommended for precurarization, because of its scarce effect on neuromuscular function at the dose used in this study.
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Rev Esp Anestesiol Reanim · Oct 1997
Case Reports[Electromyographic characteristics of postanesthetic tremor].
Postanesthetic tremor is a frequent complication during recovery from surgery. Its etiopathogenesis is poorly understood and its electromyographic characteristics have scarcely been studies. ⋯ None of the three patients had electromyographic signs typical of hypothermic patients with tremor. We conclude that the electromyographic signs of postanesthetic tremor should be studied further and consider it noteworthy that the recordings we made could be attributable to high levels of circulating catecholamines, leading to exacerbation of physiologic tremor manifested in the form of postanesthetic shivering.