Revista española de anestesiología y reanimación
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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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Although postoperative behavioral anomalies were first reported more than one hundred years ago, only in the past ten years has the profile for postoperative cognitive dysfunction (POCD) been defined. POCD is reversible and it has been suggested that the disorder has implications for increased mortality and morbidity if it is not diagnosed and treated early. At present the clinical presentation of POCD is thought to be variable and fluctuating, ranging from slight disorientation to coma. ⋯ Once symptoms have developed,whether in the recovery unit or later, it is important to eliminate organic factors and begin treating the cause. The most important drugs for treatment are neuroleptics and benzodiazepines. We review the definition, epidemiology, etiology, pathophysiology and treatment of POCD and include a list of diseases and drugs associated with its development, as well as a description of psychological tests used for diagnosis.
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Sevoflurane is a fluoridated derivative of methyl isopropyl ether. Its administration does not require the use of sophisticated vaporizers and its blood/gas partition coefficient is 0.69. Sevoflurane is the only ethereal anesthesia that does not trigger a reflex response or cause airway irritation during inhaled induction. ⋯ Renal toxicity has not been reported even though fluoride is a metabolic product. Sevoflurane breaks down in the presence of soda lime, producing compound A and giving rise to controversy and investigation although the toxicity of compound A is more theoretical than real. Sevoflurane is not harmful to the ozone layer.