Anesthesia Progress Volume 70: Issue 2

Objective:

Scientific evidence has rarely, if at all, been reported in the literature demonstrating analytical confirmation of the physical compatibility and stability of glycopyrrolate and rocuronium combined. The purpose of this experiment was to determine if glycopyrrolate and rocuronium are physically compatible.

Methods:

Glycopyrrolate and rocuronium were combined in various containers, observed over a 60-minute period, and compared against positive and negative controls. Measured metrics included color change, precipitate formation, Tyndall beam test, turbidity, and pH. Statistical analyses were used to assess significance of data trends.

Results:

The combination of glycopyrrolate and rocuronium did not result in any color change, precipitate formation, a positive Tyndall beam test, or a significantly positive turbidity and did not result in any significant change in pH, regardless of container.

Conclusion:

Per the protocol used in this study, glycopyrrolate and rocuronium were determined to be physically compatible.

Objective:

This study investigated the involvement of α₁- and β₂-adrenergic receptors in skeletal muscle blood flow changes during variations in ETCO₂.

Methods:

Forty Japanese White rabbits anesthetized with isoflurane were randomly allocated to 1 of 5 groups: phentolamine, metaproterenol, phenylephrine, butoxamine, and atropine. Heart rate (HR), systolic blood pressure (SBP), common carotid artery blood flow (CCBF), masseter muscle tissue blood flow (MBF), and quadriceps muscle tissue blood flow (QBF) were recorded and analyzed at 3 periods: (1) baseline, (2) during hypercapnia (phentolamine and metaproterenol groups) or hypocapnia (phenylephrine, butoxamine, and atropine groups), and (3) during or after receiving vasoactive agents.

Results:

MBF and QBF decreased during hypercapnia. The decrease in MBF was smaller than that in QBF. SBP and CCBF increased, while HR decreased. Both MBF and QBF recovered to their baseline levels after phentolamine administration. MBF became greater than its baseline level, while QBF did not fully recover after metaproterenol administration. MBF and QBF increased during hypocapnia. The increase rate in MBF was larger than that in QBF. HR, SBP, and CCBF did not change. Both MBF and QBF decreased to ∼90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Atropine showed no effects on MBF and QBF.

Conclusion:

These results suggest the skeletal muscle blood flow changes observed during hypercapnia and hypocapnia may mainly involve α₁-adrenergic but not β₂-adrenergic receptor activity.

Remimazolam, an ultra-short-acting benzodiazepine, is a new intravenous anesthetic used for sedation and general anesthesia. Because remimazolam is primarily metabolized by carboxylesterases in the liver and other tissues including the lung and has metabolites with little or no bioactivity, its anesthetic effect is not significantly influenced by renal dysfunction. Therefore, remimazolam may be considered an appropriate agent for hemodialysis patients and may have added benefits beyond midazolam and propofol. Remimazolam has also been suggested to cause less cardiac depression than propofol. This case report presents an 82-year-old female hemodialysis patient with chronic heart failure who underwent partial glossectomy for squamous cell carcinoma of the tongue under general anesthesia with remimazolam and remifentanil. Hemodynamic control was stable during the anesthetic, which was safely completed without any adverse events and resulted in a rapid, clear emergence without flumazenil. Remimazolam and remifentanil may be appropriate as first-line general anesthetic agents for hemodialysis patients with heart failure.

We experienced a case of accidental pilsicainide poisoning suspected as the cause of pacing failure leading to cardiac arrest. The patient was a 36-year-old woman with a history of refractory multifocal supraventricular tachycardia who had previously undergone multiple cardiac ablations requiring placement of a pacemaker. Upon her arrival on the day of dental treatment, the patient's condition deteriorated rapidly, with a heart rate of approximately 30 beats/min, pacing failure, and an idioventricular rhythm upon electrocardiographic examination. During transportation for emergency medical care, the patient experienced clonic convulsions, and ventricular tachycardia was observed. Cardiopulmonary resuscitation, large-volume infusion, and percutaneous cardiopulmonary support

In 2020, the World Allergy Organization Anaphylaxis (WAOA) Guidance document was published that updated the definition of and amended the criteria for diagnosing anaphylaxis (Table). The WAOA definition now reads as follows: “Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. Severe anaphylaxis is characterized by potentially life-threatening compromise in airway, breathing and/or the circulation, and may occur without typical skin features or circulatory shock being present.”¹

Anaphylaxis is one of the medical emergencies (systemic contingencies)

A New Dental Specialty in Canada

The Physical Compatibility of Glycopyrrolate and Rocuronium

Objective:

Methods:

Results:

Conclusion:

Involvement of α- and β-Adrenergic Receptors in Skeletal Muscle Blood Flow Changes During Hyper-/Hypocapnia in Anesthetized Rabbits

Objective:

Methods:

Results:

Conclusion:

Anesthetic Management Using Remimazolam in a Hemodialysis Patient

Cardiac Arrest Due to Pacing Failure From Pilsicainide Poisoning

Postoperative Epistaxis Following Dental Treatment With Nitrous Oxide/Oxygen Sedation

Successful Premedication With Sublingual Midazolam Using a Suction Toothbrush

Evaluation of Sedation Levels Using SedLine During Intravenous Sedation for Dental Procedures: A Case-Series Study

Ultrasound-Guided Maxillary Nerve Block and Superficial Cervical Plexus Block During Surgery for Maxillary Malignancy: A Case Report

Hypotension Without Skin Symptoms at Local Anesthesia in Dental Treatment: Anaphylaxis? Or Vasovagal Reaction?

Management of Anaphylaxis in Dental Practice

Literature Review for Office-Based Anesthesia

Aziz M, Berkow L. Pro-con debate: videolaryngoscopy should be standard of care for tracheal intubation. Anesth Analg. 2023;136(4):683-688. doi: 10.1213/ANE.0000000000006252.

Literature Review for Office-Based Anesthesia

A New Dental Specialty in Canada

The Physical Compatibility of Glycopyrrolate and Rocuronium

Involvement of α- and β-Adrenergic Receptors in Skeletal Muscle Blood Flow Changes During Hyper-/Hypocapnia in Anesthetized Rabbits

Anesthetic Management Using Remimazolam in a Hemodialysis Patient