Use of neuromuscular blockers in Brazil.

The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers, focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of neuromuscular blockers. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main neuromuscular blockers used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to neuromuscular blockers were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to neuromuscular blockers. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.

Myasthenia gravis: two case reports and review of the literature.

BACKGROUND AND OBJECTIVES: Myasthenia gravis (MG) is an autoimmune neurologic disease that affects the postsynaptic portion of the neuromuscular junction. It represents a challenge for anesthesiologists due to the diversity of disease manifestations and possibility of postoperative respiratory complications. The objective of this study was to demonstrate the importance of adequate monitoring of the neuromuscular blockade (NMB) due to the multiple presentations of MG. CONTENTS: In this paper we report two cases of patients with MG. The first patient presented with the classical sensitivity to the neuromuscular blocker (NMB) and the second had a similar response to that of a normal patient. The literature review will be restricted to disease characteristics, while the description of its pathophysiology will focus on its reactions to NMB. CONCLUSIONS: We suggest that, due to the multiple presentation and treatment of MG, neuromuscular transmission monitors are fundamental when using NMB.

Conscious sedation for upper digestive endoscopy performed by endoscopists.

BACKGROUND AND OBJECTIVES: Conscious sedation in the ambulatory setting albeit common is not risk-free. The present study aimed at evaluating the blood pressure, heart rate and peripheral oxygen saturation in patients submitted to conscious sedation for upper digestive endoscopy performed by endoscopists. METHODS: A total of 105 patients of both sexes were selected, aged 18 and older, physical status ASA I to III, submitted to upper digestive endoscopy under conscious sedation. The patients were monitored through noninvasive blood pressure measurements, pulse oximetry and heart rate recorded before, during and after the examination. The sedation was carried out with midazolam or meperidine. RESULTS: The variations in oxygen saturation, blood pressure and heart rate throughout time were not statistically significant. However, an incidence of hypoxia of 41.9% was observed; 53.3% of the cases presented arterial hypotension and 25.6% presented tachycardia. Obese patients were more prone to hypoxia and hypotension than those non obese. CONCLUSIONS: The occurrence of hypoxia and arterial hypotension is common in upper digestive endoscopic examinations under conscious sedation when midazolam and meperidine are associated. Obese patients demonstrated to be more susceptible to hypoxemia and arterial hypotension.