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confirmed, and IV succinylcholine (200 mg) was administered for paralysis, facilitating easy mask ventilation. Directly after administration of succinylcholine, his heart rate began to decline to 45 to 49 bpm. Additional glycopyrrolate (100 μg) was administered while atropine was prepared; however, before the atropine could be administered, the recycled blood pressure produced a systolic of 76 mm Hg. At that point, the decision to use atropine was aborted, IV epinephrine (10 μg) was administered, and IV fluids were fully opened. The heart rate continued to decline to 40

% respectively), and occur less frequently than with neostigmine (8%) and succinylcholine (Sch; 9%). 5 Several case reports of bradycardia immediately following administration of sugammadex have been reported. 6 The FDA safety trials found a lower incidence of sugammadex-induced bradycardia (0.5%) when compared to neostigmine with glycopyrrolate (4.8%). Bradycardia resulting from sugammadex responds well to classical treatment with atropine. 5 The cause of bradycardia associated with sugammadex is unknown. Sugammadex is chemically inert and has no direct effects on

into the operating room, and standard monitors were applied, including a noninvasive blood pressure cuff, pulse oximeter, capnography, volatile agent analysis, 5-lead electrocardiogram, and axial temperature probe. The patient was then preoxygenated via face mask until her end-tidal oxygen level was greater than 90%. General anesthesia was induced with fentanyl (50 μg), propofol (150 mg), a defasciculating dose of rocuronium (5 mg), followed by succinylcholine (SCh; 100 mg). An atraumatic nasotracheal intubation was performed with a 6.5-mm nasal RAE Parker Flex

controversy regarding the use of cholinesterase inhibitors, as antagonism of acetylcholinesterase has been postulated as a potential mechanism of rhabdomyolysis. 3 Succinylcholine is absolutely contraindicated. 3 Alternatively, suitable intubation conditions often can be attained via propofol and remifentanil, barring any hemodynamic contraindications. Meticulous attention to cardiac function is imperative as the change from spontaneous to positive pressure ventilation can result in significant fluctuations in hemodynamics, specifically decreases in preload. Positioning

Myotonic dystrophy (dystrophia myotonica; DM) is the most common form of muscular dystrophy that usually begins in adulthood. It primarily affects muscles but can also involve other systems. The severity of this disease varies greatly, even among members of the same family. 1 – 3 DM patients, particularly type 1 (DM1), are extremely sensitive to the respiratory depressant effects of anesthetic drugs, including benzodiazepines, propofol, and opioids. 2 – 4 Furthermore, the effects of succinylcholine administration can be unpredictable. DM

in anesthetic practice before remifentanil such as esmolol, succinylcholine, and mivacurium (since discontinued). Now, there is current research into a new esterase metabolized benzodiazepine: remimazolam. This drug combines the pharmacodynamics of midazolam with the esterase metabolism pharmacokinetics of remifentanil. Phase 3 Food and Drug Administration trials are soon to be completed, so approval may be a short number of years away. The medication will need to be administered by continuous intravenous infusion. One of the benefits of this drug is that

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment. Larach MG, Klumpner TT, Brandon BW, Vaughn MT, et al. on behalf of the Multicenter Perioperative Outcomes Group. Anesthesiol . 2019;130:41–54. Dantrolene is an effective treatment for malignant hyperthermia (MH). Succinylcholine and volatile anesthetic agents are potential triggers for inducing MH; however, discrepant recommendations for emergency preparedness exist regarding the availability of dantrolene during general anesthesia. The Malignant