RESUMO
We report two cases in which moderate and intense rocuronium-induced neuromuscular block was reversed intraoperatively with low sugammadex doses in order to facilitate electromyographic evaluation of facial nerve function during surgery of the parotid gland and the middle ear. Acceleromyography was used to assess reversal of neuromuscular block before starting electromyography monitoring. Rocuronium-induced neuromuscular block was reversed with sugammadex 0.22mgkg(-1) when the TOF ratio was 0.14 in the first patient, and with sugammadex 2mgkg(-1) during intense block (PTC 0) in the second patient. In each case, appropriate neuromuscular function (TOF ratio≥0.9) was established soon after sugammadex administration, and electromyographic evaluation of facial nerve was successfully conducted. The use of rocuronium and sugammadex, coupled with objective neuromuscular monitoring with acceleromyography, assured complete restoration of neuromuscular function and created the optimal conditions for the surgical team.
Assuntos
Androstanóis/uso terapêutico , Nervo Facial/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , gama-Ciclodextrinas/administração & dosagem , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Rocurônio , SugammadexRESUMO
Following hemi-glossectomy and right neck dissection a 63-year-old female patient presented as an emergency with a large neck hematoma. There were significant concerns over difficulty in intubation and mask ventilation leading to deterioration into a cannot intubate cannot ventilate (CICV) situation. After careful discussion and planning with the surgical team, who planned a tracheostomy, the situation was salvaged using a ProSealTM Laryngeal Mask Airway (PLMA). The PLMA enabled rapid establishment of a clear airway early in anesthetic induction, controlled ventilation and safe airway maintenance during a difficult tracheostomy.
Assuntos
Obstrução das Vias Respiratórias/terapia , Tratamento de Emergência , Máscaras Laríngeas , Traqueostomia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Neostigmina/uso terapêutico , Bloqueio Neuromuscular , Idoso , Eletromiografia , Humanos , MasculinoRESUMO
Neuromuscular monitoring is not a routine practice in clinical settings worldwide. The little interest expressed is mainly because clinicians lack information and documentation, even though the literature on the subject is vast and experts agree that routine monitoring reduces morbidity related to the use of neuromuscular blockers. We report a case of an unusual phase II neuromuscular block from a subclinical dose of succinylcholine. The blockade lasted longer than expected in a patient with diminished plasma cholinesterase activity. We emphasize that monitoring neuromuscular function aided diagnosis and observation of the block during emergency surgery.
Assuntos
Monitoramento de Medicamentos , Fármacos Neuromusculares Despolarizantes/administração & dosagem , Succinilcolina/administração & dosagem , Idoso , Humanos , MasculinoAssuntos
Adjuvantes Anestésicos/efeitos adversos , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Analgésicos Opioides/efeitos adversos , Anestésicos/efeitos adversos , Frequência Cardíaca Fetal/efeitos dos fármacos , Adulto , Pressão Sanguínea/fisiologia , Ecocardiografia , Feminino , Humanos , GravidezRESUMO
Many recent studies have underlined the importance of quantitative neuromuscular monitoring and the high incidence of residual block in clinical practice in spite of the use of nondepolarizing neuromuscular blockers of intermediate duration. Neuromuscular monitoring facilitates the tailoring of the muscular paralysis and appropriate patient recovery at the end of surgery. Monitoring also controls or prevents residual block and serves to guide the use of reversing agents. This review describes the physiology of neuromuscular junctions as well as the principles and patterns of nerve stimulation and clinical monitoring. In addition to drawing on their own experience, the authors have reviewed the literature available through evidence-based indexes and other databases up to December 2008. Most references found were case series and reviews. Quantitative monitoring is an evidence-based practice that should be applied in all situations in which a neuromuscular block is established.
Assuntos
Bloqueio Neuromuscular , Estimulação Elétrica/métodos , Eletrodiagnóstico/instrumentação , Eletrodiagnóstico/métodos , Medicina Baseada em Evidências , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Monitorização Intraoperatória , Bloqueio Neuromuscular/efeitos adversos , Bloqueadores Neuromusculares/administração & dosagem , Bloqueadores Neuromusculares/efeitos adversos , Bloqueadores Neuromusculares/farmacologia , Junção Neuromuscular/efeitos dos fármacos , Junção Neuromuscular/fisiologia , Nervos Periféricos/efeitos dos fármacos , Nervos Periféricos/fisiologia , Guias de Prática Clínica como Assunto , Período Refratário Eletrofisiológico/fisiologiaAssuntos
Monitorização Intraoperatória , Bloqueio Neuromuscular , Estimulação Elétrica/métodos , Eletrodiagnóstico/instrumentação , Eletrodiagnóstico/métodos , Desenho de Equipamento , Medicina Baseada em Evidências , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Bloqueio Neuromuscular/efeitos adversos , Bloqueadores Neuromusculares/administração & dosagem , Bloqueadores Neuromusculares/efeitos adversos , Bloqueadores Neuromusculares/farmacologia , Nervos Periféricos/fisiologia , Guias de Prática Clínica como AssuntoAssuntos
Bloqueio Neuromuscular/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Complicações Pós-Operatórias/induzido quimicamente , Desmame do Respirador , Período de Recuperação da Anestesia , Administração de Caso , Confusão/induzido quimicamente , Confusão/prevenção & controle , Eletromiografia , Humanos , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores , Paralisia/induzido quimicamente , Paralisia/prevenção & controle , Pneumonia Aspirativa/induzido quimicamente , Pneumonia Aspirativa/fisiopatologia , Pneumonia Aspirativa/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Recuperação de Função Fisiológica , Sugammadex , Desmame do Respirador/efeitos adversos , Desmame do Respirador/psicologia , gama-Ciclodextrinas/uso terapêuticoRESUMO
The ProSeal laryngeal mask airway (PLMA) has been used routinely for anaesthesia and for difficult airway management including airway rescue in non-fasted patients. Compared with the classic laryngeal mask airway the PLMA increases protection against gastric inflation and pulmonary aspiration, by separating the respiratory and gastro-intestinal tracts. The PLMA has potential advantages over use of the tracheal tube including smoother recovery, reduced pharyngolaryngeal morbidity and even reduced postoperative pain. We report a series of patients scheduled for emergency appendicectomy, without other risk factors for regurgitation, managed with the PLMA. Anaesthesia was induced and maintained with remifentanil, target controlled propofol and rocuronium. A series of 102 cases were managed without complications and high rates of first time placement of the PLMA (inserted over a suction tube placed in the oesophagus). With careful patient selection the PLMA may offer an alternative airway for use by experienced anaesthetists in patients undergoing minor lower abdominal surgery.