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[PMID]:28448393
[Au] Autor:Boon M; Martini CH; Aarts LP; Torensma B; Dahan A
[Ad] Endereço:Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands, m.boon@lumc.nl.
[Ti] Título:Deep Neuromuscular Block and Surgical Conditions During Bariatric Surgery.
[So] Source:Anesth Analg;124(6):2094-2095, 2017 06.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Androstanóis
Bloqueio Neuromuscular
[Mh] Termos MeSH secundário: Cirurgia Bariátrica
Seres Humanos
Fármacos Neuromusculares não Despolarizantes
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Androstanols); 0 (Neuromuscular Nondepolarizing Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180110
[Lr] Data última revisão:
180110
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002101


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[PMID]:27770778
[Au] Autor:Dubovoy T; Housey M; Devine S; Kheterpal S
[Ad] Endereço:Department of Anaesthesiology, University of Michigan Medical School, CVC 4172, 1500 East Medical Centre Drive, Ann Arbour, MI, 48109, USA. tdubovoy@med.umich.edu.
[Ti] Título:Observational study on patterns of neuromuscular blockade reversal.
[So] Source:BMC Anesthesiol;16(1):103, 2016 10 22.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Using electronic health record data, we hypothesized that larger reversal doses are used for patients with deeper levels of neuromuscular blockade (NMB) as evidenced by the last recorded TOF measurement. We also examined if dosing regimens reflect current practice guidelines of using ideal body weight (IBW) for NMB agents and total body weight (TBW) for neostigmine. METHODS: This is a retrospective observational study of adult, ASA 1-4 patients who underwent general anaesthesia and received non-depolarizing NMB agents between 01/01/2004 and 12/31/2013. For the primary outcome, percentages of cases receiving neostigmine and median doses administered for each subjective train-of-four (TOF) category were calculated. Secondary analyses evaluated associations between NMB dosing and neostigmine administration based on Body Mass Index (BMI) categories. RESULTS: A total of 135,633 cases met inclusion criteria for the study. There was no clinically significant difference in median neostigmine dosing based on last TOF count prior to reversal administration: 37.5 mcg/kg for TOF of 4/4 vs. 37.9 mcg/kg for TOF of 0/4 for the total neostigmine dose. Significantly higher number of patients with lower TOF counts received additional neostigmine administration: 5.7 % for 0/4 vs. 1.5 % for 4/4 TOF counts. The median times to extubation following neostigmine administration were clinically similar across TOF count categories. The median doses for neostigmine based on TBW decreased with higher BMI categories and were significantly different between the lowest and highest categories: 42.8 mcg/kg vs 30.8 mcg/kg for total doses (p < .0001) respectively. The percentages of cases requiring reversal in addition to the initial dose increased with increasing BMI categories and were 2.1 % for BMI < 18 vs. 3.3 % for BMI ≥ 40. The total median dose of NMB agents in ED95 equivalents per IBW increased from 2.9 in the Underweight category to 4.2 in the Class III Obese category. The majority of patients in the pancuronium subgroup received very low ED95 equivalent dose of 0.1 and did not require reversal. Patients receiving cisatracurium were given significantly higher median ED95 equivalent dose of 5.6 vs 2.8-3.9 compared to other intermediate acting NMB agents, while receiving clinically similar doses of neostigmine. CONCLUSIONS: Neither neostigmine dosing nor times to extubation were affected by the depth of the neuromuscular blockade prior to reversal. The need for additional reversal, or rescue, correlated strongly with the depth of NMB. There was significant variability in neostigmine dosing across the BMI categories. Underweight patients received relatively lower NMB doses while simultaneously receiving relatively higher reversal doses, and the opposite was true for patients with BMI >40.
[Mh] Termos MeSH primário: Neostigmina/farmacologia
Bloqueio Neuromuscular/estatística & dados numéricos
Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores
[Mh] Termos MeSH secundário: Extubação/estatística & dados numéricos
Peso Corporal
Inibidores da Colinesterase/administração & dosagem
Inibidores da Colinesterase/farmacologia
Relação Dose-Resposta a Droga
Feminino
Fidelidade a Diretrizes
Seres Humanos
Masculino
Meia-Idade
Neostigmina/administração & dosagem
Fármacos Neuromusculares não Despolarizantes/administração & dosagem
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Cholinesterase Inhibitors); 0 (Neuromuscular Nondepolarizing Agents); 3982TWQ96G (Neostigmine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28953616
[Au] Autor:Geng W; Nie Y; Huang S
[Ad] Endereço:Department of Anesthesia, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
[Ti] Título:Effects of methylprednisolone on the duration of rocuronium-induced neuromuscular block: A randomized double-blind trial.
[So] Source:Medicine (Baltimore);96(39):e7947, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We aim to investigate whether intraoperative use of methylprednisolone could affect the duration of rocuronium-induced neuromuscular blockade. METHODS: A double blind, randomized, placebo-controlled trial was conducted. A total of 136 patients underwent gynecologic laparoscopic surgery were randomly divided into 3 groups: pregroup, receiving intravenous injection of methylprednisolone (40 mg) 30 minutes before induction of anesthesia; postgroup, receiving intravenous injection of methylprednisolone (40 mg) immediately after induction of anesthesia and intubation; and control group, receiving intravenous injection of normal saline. Patients were intravenously administrated with rocuronium 0.6 mg/kg, and changes in adductor policies evoked twitch responses were measured by ulnar nerve stimulator. RESULTS: We found that all patients achieved maximum blockade effects, and there was no difference in onset time among the 2 groups. For time required to achieve train-of-four ratio (TOFR) 90%, pregroup (64.50 ±â€Š10.52 minutes) and postgroup (65.29 ±â€Š11.64 minutes) were significantly shorter than that of the control group (71.04 ±â€Š10.55 minutes, P = .027), whereas clinical duration and total duration were significantly shorter in the 2 groups received methylprednisolone than the control group. However, there was no significant difference between the 2 treatment groups either in clinical duration and total duration of muscle relaxants, or time required to achieve TOFR 90%. No significant difference was found in recovery index among the 3 groups. CONCLUSION: Our findings suggest that a single intravenous injection of methylprednisolone, no matter preoperatively or intraoperatively, could shorten the duration of rocuronium-induced neuromuscular blockade.
[Mh] Termos MeSH primário: Androstanóis/farmacologia
Glucocorticoides/farmacologia
Procedimentos Cirúrgicos em Ginecologia
Metilprednisolona/farmacologia
Bloqueio Neuromuscular
Fármacos Neuromusculares não Despolarizantes/farmacologia
[Mh] Termos MeSH secundário: Adulto
Método Duplo-Cego
Interações Medicamentosas
Feminino
Glucocorticoides/administração & dosagem
Seres Humanos
Injeções Intravenosas
Metilprednisolona/administração & dosagem
Monitoração Neuromuscular
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Androstanols); 0 (Glucocorticoids); 0 (Neuromuscular Nondepolarizing Agents); WRE554RFEZ (rocuronium); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007947


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[PMID]:28941538
[Au] Autor:Zuppa AF; Curley MAQ
[Ad] Endereço:Department of Pediatric Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Center for Clinical Pharmacology, Colket Translational Research, Room 4008, 3614 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA. Electronic address: zuppa@email.chop.edu.
[Ti] Título:Sedation Analgesia and Neuromuscular Blockade in Pediatric Critical Care: Overview and Current Landscape.
[So] Source:Pediatr Clin North Am;64(5):1103-1116, 2017 Oct.
[Is] ISSN:1557-8240
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Sedation is a mainstay of therapy for critically ill children. Although necessary in the care of the critically ill child, sedative drugs are associated with adverse effects, such as disruption of circadian rhythm, altered sleep, delirium, potential neurotoxicity, and immunosuppression. Optimal approaches to the sedation of the critically ill child should include identification of sedation targets and sedation interruptions, allowing for a more individualized approach to sedation. Further research is needed to better understand the relationship between critical illness and sedation pharmacokinetics and pharmacodynamics, the impact of sedation on immune function, and the genetic implications on drug disposition and response.
[Mh] Termos MeSH primário: Analgesia/métodos
Analgésicos
Anestésicos
Cuidados Críticos/métodos
Hipnóticos e Sedativos
Bloqueio Neuromuscular/métodos
Bloqueadores Neuromusculares
[Mh] Termos MeSH secundário: Analgésicos/administração & dosagem
Analgésicos/farmacocinética
Anestésicos/administração & dosagem
Anestésicos/farmacocinética
Criança
Seres Humanos
Hipnóticos e Sedativos/administração & dosagem
Hipnóticos e Sedativos/farmacocinética
Bloqueadores Neuromusculares/administração & dosagem
Pediatria
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 0 (Anesthetics); 0 (Hypnotics and Sedatives); 0 (Neuromuscular Blocking Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170925
[St] Status:MEDLINE


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[PMID]:28867438
[Au] Autor:Cavalcante WLG; Noronha-Matos JB; Timóteo MA; Fontes MRM; Gallacci M; Correia-de-Sá P
[Ad] Endereço:Departamento de Farmacologia, Instituto de Ciências Biológicas, UFMG, Av. Antônio Carlos, 6627 Belo Horizonte, Brazil; Laboratório de Farmacologia e Neurobiologia, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto (ICBAS-UP), R. Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portug
[Ti] Título:Neuromuscular paralysis by the basic phospholipase A subunit of crotoxin from Crotalus durissus terrificus snake venom needs its acid chaperone to concurrently inhibit acetylcholine release and produce muscle blockage.
[So] Source:Toxicol Appl Pharmacol;334:8-17, 2017 Nov 01.
[Is] ISSN:1096-0333
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Crotoxin (CTX), a heterodimeric phospholipase A (PLA ) neurotoxin from Crotalus durissus terrificus snake venom, promotes irreversible blockade of neuromuscular transmission. Indirect electrophysiological evidence suggests that CTX exerts a primary inhibitory action on transmitter exocytosis, yet contribution of a postsynaptic action of the toxin resulting from nicotinic receptor desensitization cannot be excluded. Here, we examined the blocking effect of CTX on nerve-evoked transmitter release measured directly using radioisotope neurochemistry and video microscopy with the FM4-64 fluorescent dye. EXPERIMENTAL APPROACH: Experiments were conducted using mice phrenic-diaphragm preparations. Real-time fluorescence video microscopy and liquid scintillation spectrometry techniques were used to detect transmitter exocytosis and nerve-evoked [ H]-acetylcholine ([ H]ACh) release, respectively. Nerve-evoked myographic recordings were also carried out for comparison purposes. KEY RESULTS: Both CTX (5µg/mL) and its basic PLA subunit (CB, 20µg/mL) had biphasic effects on nerve-evoked transmitter exocytosis characterized by a transient initial facilitation followed by a sustained decay. CTX and CB reduced nerve-evoked [ H]ACh release by 60% and 69%, respectively, but only the heterodimer, CTX, decreased the amplitude of nerve-evoked muscle twitches. CONCLUSION AND IMPLICATIONS: Data show that CTX exerts a presynaptic inhibitory action on ACh release that is highly dependent on its intrinsic PLA activity. Given the high safety margin of the neuromuscular transmission, one may argue that the presynaptic block caused by the toxin is not enough to produce muscle paralysis unless a concurrent postsynaptic inhibitory action is also exerted by the CTX heterodimer.
[Mh] Termos MeSH primário: Acetilcolina/antagonistas & inibidores
Venenos de Crotalídeos/toxicidade
Crotalus/fisiologia
Crotoxina/toxicidade
Chaperonas Moleculares/metabolismo
Bloqueio Neuromuscular
[Mh] Termos MeSH secundário: Acetilcolina/metabolismo
Animais
Venenos de Crotalídeos/química
Crotoxina/química
Feminino
Masculino
Camundongos
Chaperonas Moleculares/química
Músculos/efeitos dos fármacos
Neurotoxinas/toxicidade
Fosfolipases A2
Subunidades Proteicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Crotalid Venoms); 0 (Molecular Chaperones); 0 (Neurotoxins); 0 (Protein Subunits); 9007-40-3 (Crotoxin); EC 3.1.1.4 (Phospholipases A2); N9YNS0M02X (Acetylcholine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28834856
[Au] Autor:Smetana KS; Roe NA; Doepker BA; Jones GM
[Ad] Endereço:Department of Clinical Pharmacy, The Ohio State University Wexner Medical Center, Columbus (Drs Smetana and Doepker); Department of Pharmacy, Baptist Health Medical Center, Little Rock, Arkansas (Dr Roe); Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee (Dr Jones); and Department of Clinical Pharmacy, Neurology, and Neurosurgery, The University of Tennessee Health Science Center, Memphis (Dr Jones).
[Ti] Título:Review of Continuous Infusion Neuromuscular Blocking Agents in the Adult Intensive Care Unit.
[So] Source:Crit Care Nurs Q;40(4):323-343, 2017 Oct/Dec.
[Is] ISSN:1550-5111
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The use of continuous infusion neuromuscular blocking agents remains controversial. The clinical benefit of these medications may be overshadowed by concerns of propagating intensive care unit-acquired weakness, which may prolong mechanical ventilation and impair the inability to assess neurologic function or pain. Despite these risks, the use of neuromuscular blocking agents in the intensive care unit is indicated in numerous clinical situations. Understanding pharmacologic nuances and clinical roles of these agents will aid in facilitating safe use in a variety of acute disease processes. This article provides clinicians with information regarding pharmacologic differences, indication for use, adverse effects, recommended doses, ancillary care, and monitoring among agents used for continuous neuromuscular blockade.
[Mh] Termos MeSH primário: Bombas de Infusão
Unidades de Terapia Intensiva
Bloqueio Neuromuscular
Bloqueadores Neuromusculares/uso terapêutico
[Mh] Termos MeSH secundário: Cuidados Críticos
Seres Humanos
Bloqueadores Neuromusculares/farmacologia
Dor/tratamento farmacológico
Respiração Artificial
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Neuromuscular Blocking Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/CNQ.0000000000000171


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[PMID]:28806470
[Au] Autor:Hristovska AM; Duch P; Allingstrup M; Afshari A
[Ad] Endereço:Juliane Marie Centre - Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, 2100.
[Ti] Título:Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults.
[So] Source:Cochrane Database Syst Rev;8:CD012763, 2017 Aug 14.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Acetylcholinesterase inhibitors, such as neostigmine, have traditionally been used for reversal of non-depolarizing neuromuscular blocking agents. However, these drugs have significant limitations, such as indirect mechanisms of reversal, limited and unpredictable efficacy, and undesirable autonomic responses. Sugammadex is a selective relaxant-binding agent specifically developed for rapid reversal of non-depolarizing neuromuscular blockade induced by rocuronium. Its potential clinical benefits include fast and predictable reversal of any degree of block, increased patient safety, reduced incidence of residual block on recovery, and more efficient use of healthcare resources. OBJECTIVES: The main objective of this review was to compare the efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade caused by non-depolarizing neuromuscular agents in adults. SEARCH METHODS: We searched the following databases on 2 May 2016: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (WebSPIRS Ovid SP), Embase (WebSPIRS Ovid SP), and the clinical trials registries www.controlled-trials.com, clinicaltrials.gov, and www.centerwatch.com. We re-ran the search on 10 May 2017. SELECTION CRITERIA: We included randomized controlled trials (RCTs) irrespective of publication status, date of publication, blinding status, outcomes published, or language. We included adults, classified as American Society of Anesthesiologists (ASA) I to IV, who received non-depolarizing neuromuscular blocking agents for an elective in-patient or day-case surgical procedure. We included all trials comparing sugammadex versus neostigmine that reported recovery times or adverse events. We included any dose of sugammadex and neostigmine and any time point of study drug administration. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts to identify trials for eligibility, examined articles for eligibility, abstracted data, assessed the articles, and excluded obviously irrelevant reports. We resolved disagreements by discussion between review authors and further disagreements through consultation with the last review author. We assessed risk of bias in 10 methodological domains using the Cochrane risk of bias tool and examined risk of random error through trial sequential analysis. We used the principles of the GRADE approach to prepare an overall assessment of the quality of evidence. For our primary outcomes (recovery times to train-of-four ratio (TOFR) > 0.9), we presented data as mean differences (MDs) with 95 % confidence intervals (CIs), and for our secondary outcomes (risk of adverse events and risk of serious adverse events), we calculated risk ratios (RRs) with CIs. MAIN RESULTS: We included 41 studies (4206 participants) in this updated review, 38 of which were new studies. Twelve trials were eligible for meta-analysis of primary outcomes (n = 949), 28 trials were eligible for meta-analysis of secondary outcomes (n = 2298), and 10 trials (n = 1647) were ineligible for meta-analysis.We compared sugammadex 2 mg/kg and neostigmine 0.05 mg/kg for reversal of rocuronium-induced moderate neuromuscular blockade (NMB). Sugammadex 2 mg/kg was 10.22 minutes (6.6 times) faster then neostigmine 0.05 mg/kg (1.96 vs 12.87 minutes) in reversing NMB from the second twitch (T2) to TOFR > 0.9 (MD 10.22 minutes, 95% CI 8.48 to 11.96; I = 84%; 10 studies, n = 835; GRADE: moderate quality).We compared sugammadex 4 mg/kg and neostigmine 0.07 mg/kg for reversal of rocuronium-induced deep NMB. Sugammadex 4 mg/kg was 45.78 minutes (16.8 times) faster then neostigmine 0.07 mg/kg (2.9 vs 48.8 minutes) in reversing NMB from post-tetanic count (PTC) 1 to 5 to TOFR > 0.9 (MD 45.78 minutes, 95% CI 39.41 to 52.15; I = 0%; two studies, n = 114; GRADE: low quality).For our secondary outcomes, we compared sugammadex, any dose, and neostigmine, any dose, looking at risk of adverse and serious adverse events. We found significantly fewer composite adverse events in the sugammadex group compared with the neostigmine group (RR 0.60, 95% CI 0.49 to 0.74; I = 40%; 28 studies, n = 2298; GRADE: moderate quality). Risk of adverse events was 28% in the neostigmine group and 16% in the sugammadex group, resulting in a number needed to treat for an additional beneficial outcome (NNTB) of 8. When looking at specific adverse events, we noted significantly less risk of bradycardia (RR 0.16, 95% CI 0.07 to 0.34; I = 0%; 11 studies, n = 1218; NNTB 14; GRADE: moderate quality), postoperative nausea and vomiting (PONV) (RR 0.52, 95% CI 0.28 to 0.97; I = 0%; six studies, n = 389; NNTB 16; GRADE: low quality) and overall signs of postoperative residual paralysis (RR 0.40, 95% CI 0.28 to 0.57; I = 0%; 15 studies, n = 1474; NNTB 13; GRADE: moderate quality) in the sugammadex group when compared with the neostigmine group. Finally, we found no significant differences between sugammadex and neostigmine regarding risk of serious adverse events (RR 0.54, 95% CI 0.13 to 2.25; I = 0%; 10 studies, n = 959; GRADE: low quality).Application of trial sequential analysis (TSA) indicates superiority of sugammadex for outcomes such as recovery time from T2 to TOFR > 0.9, adverse events, and overall signs of postoperative residual paralysis. AUTHORS' CONCLUSIONS: Review results suggest that in comparison with neostigmine, sugammadex can more rapidly reverse rocuronium-induced neuromuscular block regardless of the depth of the block. Sugammadex 2 mg/kg is 10.22 minutes (˜ 6.6 times) faster in reversing moderate neuromuscular blockade (T2) than neostigmine 0.05 mg/kg (GRADE: moderate quality), and sugammadex 4 mg/kg is 45.78 minutes (˜ 16.8 times) faster in reversing deep neuromuscular blockade (PTC 1 to 5) than neostigmine 0.07 mg/kg (GRADE: low quality). With an NNTB of 8 to avoid an adverse event, sugammadex appears to have a better safety profile than neostigmine. Patients receiving sugammadex had 40% fewer adverse events compared with those given neostigmine. Specifically, risks of bradycardia (RR 0.16, NNTB 14; GRADE: moderate quality), PONV (RR 0.52, NNTB 16; GRADE: low quality), and overall signs of postoperative residual paralysis (RR 0.40, NNTB 13; GRADE: moderate quality) were reduced. Both sugammadex and neostigmine were associated with serious adverse events in less than 1% of patients, and data showed no differences in risk of serious adverse events between groups (RR 0.54; GRADE: low quality).
[Mh] Termos MeSH primário: Inibidores da Colinesterase/farmacologia
Neostigmina/farmacologia
Bloqueio Neuromuscular
Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores
gama-Ciclodextrinas/farmacologia
[Mh] Termos MeSH secundário: Adulto
Androstanóis/antagonistas & inibidores
Atracúrio/análogos & derivados
Atracúrio/antagonistas & inibidores
Inibidores da Colinesterase/administração & dosagem
Inibidores da Colinesterase/efeitos adversos
Seres Humanos
Neostigmina/administração & dosagem
Neostigmina/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Fatores de Tempo
Brometo de Vecurônio/antagonistas & inibidores
gama-Ciclodextrinas/administração & dosagem
gama-Ciclodextrinas/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Androstanols); 0 (Cholinesterase Inhibitors); 0 (Neuromuscular Nondepolarizing Agents); 0 (gamma-Cyclodextrins); 2GQ1IRY63P (Atracurium); 361LPM2T56 (Sugammadex); 3982TWQ96G (Neostigmine); 7E4PHP5N1D (Vecuronium Bromide); QX62KLI41N (cisatracurium); WRE554RFEZ (rocuronium)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012763


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[PMID]:28679468
[Au] Autor:Min KC; Lasseter KC; Marbury TC; Wrishko RE; Hanley WD; Wolford DG; Udo de Haes J; Reitmann C; Gutstein DE
[Ti] Título:Pharmacokinetics of sugammadex in subjects with moderate and severe renal impairment
.
[So] Source:Int J Clin Pharmacol Ther;55(9):746-752, 2017 Sep.
[Is] ISSN:0946-1965
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:AIMS: Sugammadex rapidly reverses moderate and deep rocuronium- or vecuronium-induced neuromuscular blockade at doses of 4 mg/kg and 2 mg/kg, respectively. Sugammadex is renally eliminated. This study evaluated the pharmacokinetics of sugammadex in subjects with renal impairment versus those with normal renal function. METHODS: This open-label, two-part, phase 1 study included adults with moderate (creatinine clearance (CLcr) 30 - < 50 mL/min) and severe (CLcr < 30 mL/min) renal impairment and healthy controls (CLcr ≥ 80 mL/min). A single intravenous (IV) bolus injection of sugammadex 4 mg/kg was administered into a peripheral vein over 10 seconds directly by straight needle in part 1 (n = 24; 8/group), and via an IV catheter followed by a saline flush in part 2 (n = 18; 6/group). Plasma concentrations of sugammadex were collected after drug administration. Due to dosing issues in part 1, pharmacokinetic parameters were determined for part 2 only. Safety was assessed throughout the study. RESULTS: Pharmacokinetic data were obtained from 18 subjects. Mean sugammadex exposure (AUC0-∞) in subjects with moderate and severe renal impairment was 2.42- and 5.42-times, respectively, that of healthy controls. Clearance decreased and apparent terminal half-life was prolonged with increasing renal dysfunction. Similar Cmax values were observed in subjects with renal impairment and healthy controls. There were no serious adverse events. CONCLUSIONS: Sugammadex exposure is increased in subjects with moderate and severe renal insufficiency due to progressively decreased clearance as a function of worsening renal function. Sugammadex 4 mg/kg was well tolerated in subjects with renal impairment, with a safety profile similar to that of healthy subjects. These results indicate that dose adjustment of sugammadex is not required in patients with moderate renal impairment; however, current safety experience is insufficient to support the use of sugammadex in patients with CLcr < 30 mL/min.
.
[Mh] Termos MeSH primário: Rim/metabolismo
Insuficiência Renal/metabolismo
gama-Ciclodextrinas/farmacocinética
[Mh] Termos MeSH secundário: Idoso
Estudos de Casos e Controles
Feminino
Meia-Vida
Seres Humanos
Masculino
Meia-Idade
Bloqueio Neuromuscular/métodos
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE I; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (gamma-Cyclodextrins); 361LPM2T56 (Sugammadex)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.5414/CP203025


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[PMID]:28658119
[Au] Autor:Koo BW; Jung KW; Oh AY; Kim EY; Na HS; Choi ES; Seo KS
[Ad] Endereço:aDepartment of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam bDepartment of Surgery, Jeju National University Hospital, Jeju cDepartment of Anesthesiology and Pain Medicine, Seoul National University School of Medicine dDepartment of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University eDepartment of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea.
[Ti] Título:Is neuromuscular blocker needed in children undergoing inguinal herniorrhaphy?: A prospective, randomized, and controlled trial.
[So] Source:Medicine (Baltimore);96(26):e7259, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intraoperative neuromuscular blocker is widely used, but is known to be associated with postoperative residual paralysis, which is known to be associated with increased risk of pulmonary complications. Hence, its use should be individualized and restricted to procedures where it is mandatory. We examined whether not using a neuromuscular blocker affects the surgical conditions in children undergoing inguinal herniorrhaphy. METHODS: Anesthesia was induced and maintained with sevoflurane in 60% nitrous oxide, and the airway was maintained using an I-gel. In total, 66 children aged 1 to 6 years were randomized to receive rocuronium (rocuronium group, n = 33) or saline (control group, n = 33); 61 children of them finished the study. A single surgeon who performed the operation rated the surgical condition of each patient on a 4-point scale (1 = poor, 2 = acceptable, 3 = good, and 4 = excellent). Intraoperative patient movement, recovery time, emergence agitation, and postoperative pain scores were evaluated. RESULTS: One patient in control group and no patient in rocuronium group showed intraoperative movement. When noninferiority test was done for intraoperative patient movement, with the noninferiority margin of 20%, the difference of absolute risk was 3.3% (95% confidence interval -8.0% to 16.7%) and saline group was noninferior to rocuronium group. All of the patients showed good to excellent surgical conditions, and no difference was found between the 2 groups. The recovery time was shorter in the control group than in the rocuronium group (4.5 ±â€Š1.8 vs 5.6 ±â€Š2.2 minutes, respectively; P = .028). CONCLUSION: In children aged 1 to 6 years undergoing inguinal herniorhaphy under sevoflurane anesthesia using an I-gel, not using neuromuscular blocker showed similar intraoperative condition and shortened recovery time compared with using neuromouscular blocker.
[Mh] Termos MeSH primário: Androstanóis/uso terapêutico
Hérnia Inguinal/cirurgia
Herniorrafia
Bloqueadores Neuromusculares/uso terapêutico
[Mh] Termos MeSH secundário: Androstanóis/efeitos adversos
Anestésicos Inalatórios/uso terapêutico
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Masculino
Éteres Metílicos/uso terapêutico
Movimento/efeitos dos fármacos
Bloqueio Neuromuscular/efeitos adversos
Bloqueadores Neuromusculares/efeitos adversos
Dor Pós-Operatória
Recuperação de Função Fisiológica/efeitos dos fármacos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Androstanols); 0 (Anesthetics, Inhalation); 0 (Methyl Ethers); 0 (Neuromuscular Blocking Agents); 38LVP0K73A (sevoflurane); WRE554RFEZ (rocuronium)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007259


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[PMID]:28640017
[Au] Autor:Asztalos L; Szabó-Maák Z; Gajdos A; Nemes R; Pongrácz A; Lengyel S; Fülesdi B; Tassonyi E
[Ad] Endereço:From the Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary (L.A., Z.S.-M., A.G., R.N., A.P., B.F., E.T.); Outcomes Research Consortium, Cleveland, Ohio (B.F.); and Department of Ecology, Danube Research Institute, Centre for Ecological Research, Hungarian Academy of Sciences, Debrecen, Hungary (S.L.).
[Ti] Título:Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four: A Randomized Controlled Trial.
[So] Source:Anesthesiology;127(3):441-449, 2017 Sep.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Rocuronium-induced neuromuscular block that spontaneously recovered to a train-of-four count of four can be reversed with sugammadex 0.5 or 1.0 mg/kg. We investigated whether these doses of sugammadex can also reverse vecuronium at a similar level of block. METHODS: Sixty-five patients were randomly assigned, and 64 were analyzed in this controlled, superiority study. Participants received general anesthesia with propofol, sevoflurane, fentanyl, and vecuronium. Measurement of neuromuscular function was performed with acceleromyography (TOF-Watch-SX, Organon Teknika B.V., The Netherlands ). Once the block recovered spontaneously to four twitches in response to train-of-four stimulation, patients were randomly assigned to receive sugammadex 0.5, 1.0, or 2.0 mg/kg; neostigmine 0.05 mg/kg; or placebo. Time from study drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30 min were the primary outcome variables. Secondary outcome was the incidence of reparalysis (normalized train-of-four ratio less than 0.9). RESULTS: Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed a threshold train-of-four count of four to normalized train-of-four ratio of 0.9 or higher in all patients in 4.4 ± 2.3 min (mean ± SD) and 2.6 ± 1.6 min, respectively. Sugammadex 0.5 mg/kg reversed the block in 6.8 ± 4.1 min in 70% of patients (P < 0.0001 vs. 1.0 and 2.0 mg/kg), whereas neostigmine produced reversal in 11.3 ± 9.7 min in 77% of patients (P > 0.05 vs. sugammadex 0.5 mg/kg). The overall frequency of reparalysis was 18.7%, but this incidence varied from group to group. CONCLUSIONS: Sugammadex 1.0 mg/kg, unlike 0.5 mg/kg, properly reversed a threshold train-of-four count of four vecuronium-induced block but did not prevent reparalysis.
[Mh] Termos MeSH primário: Bloqueio Neuromuscular
Junção Neuromuscular/efeitos dos fármacos
Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores
Brometo de Vecurônio/antagonistas & inibidores
gama-Ciclodextrinas/farmacologia
[Mh] Termos MeSH secundário: Adulto
Relação Dose-Resposta a Droga
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Neuromuscular Nondepolarizing Agents); 0 (gamma-Cyclodextrins); 361LPM2T56 (Sugammadex); 7E4PHP5N1D (Vecuronium Bromide)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.1097/ALN.0000000000001744



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