Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists

Aytaç, İsmail; Postacı, Aysun; Aytaç, Betül Güven; Saçan, Özlem; Alay, Gülçin Hilal; Çelik, Bülent; Kahveci, Kadriye; Dikmen, Bayazıt

doi:10.1016/j.bjane.2012.06.011

Cited by 29 publications

(35 citation statements)

References 15 publications

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“…Many clinical trials keep demonstrating that postoperative residual neuromuscular blockade is very frequent when objNMM is not used . Knowledge about residual neuromuscular blockade and correct monitoring is important because postoperative residual neuromuscular blockade increases the risks of hypoxemic episodes, airway obstruction and postoperative pulmonary complications by decreasing the sensitivity of our chemoreceptors for hypoxia, weakening of the pharyngeal muscles and impairing the upper oesophageal sphincter muscle .…”

Section: Discussionmentioning

confidence: 99%

Objective neuromuscular monitoring of neuromuscular blockade in Denmark: an online‐based survey of current practice

Söderström

Eskildsen

Gätke

et al. 2017

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

Objective neuromuscular monitoring of neuromuscular blockade in Denmark: an online‐based survey of current practice

Söderström

Eskildsen

Gätke

et al. 2017

Acta Anaesthesiol Scand

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“…2 For this reason, as well as the need for continuous and prolonged TEE, LAA closure is mainly performed under general anesthesia, which itself is burdened by an increased risk of pulmonary complications. 4,9 The possibility of substituting general anesthesia with sedation while keeping the patient spontaneously breathing is debatable. Deep sedation is associated with an increased risk of upper airway collapse, 10 and assisting the patient's breathing with is recommended.…”

Section: Discussionmentioning

confidence: 99%

“…2 To keep patients immobile and allow a prolonged three-dimensional transesophageal echocardiography (3D-TEE) examination, percutaneous LAA is usually performed under general anesthesia. The risk of general anesthesia in the elderly is associated not only with challenges of airway control, potential for residual neuromuscular block, and an increased risk of perioperative pulmonary complications 3,4 but also with the risk of cognitive decline. 5 Furthermore, general anesthesia may increase costs and reduce the number of procedures that can be performed daily.…”

Section: Résumémentioning

confidence: 99%

Prolonged transesophageal echocardiography during percutaneous closure of the left atrial appendage without general anesthesia: the utility of the Janus mask

Zangrillo

Mazzone

Votta

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Left atrial appendage (LAA) closure is an interventional procedure increasingly used to prevent stroke in patients with permanent atrial fibrillation and contraindications to anticoagulation therapy. As this procedure requires a relatively immobile patient and performance of continuous and prolonged transesophageal echocardiography (TEE), it is usually performed under general anesthesia. In this case series, we describe the feasibility of prolonged TEE for percutaneous LAA closure using a new noninvasive ventilation device that can avoid the need for endotracheal intubation and general anesthesia. Clinical features Percutaneous LAA closure was performed under deep sedation in three elderly patients with permanent atrial fibrillation. Sedation was obtained with a combination of midazolam, propofol, and remifentanil. Continuous intraoperative TEE was performed through the port of the newly available Janus mask (Biomedical Srl; Florence, Italy), allowing for noninvasive ventilation (pressure support = 12-16 cm H 2 O; positive end-expiratory pressure = 7 cm H 2 O; FIO 2 = 0.3) in these spontaneously breathing patients. The total procedure times ranged from 75-90 min. The patients reported excellent satisfaction with the sedation received in terms of discomfort experienced during the procedure, capacity to recall the procedure, and comfort with the mask. The operators also rated the procedural conditions as excellent. ConclusionDeep sedation with noninvasive ventilation may be a reasonable and safe alternative to general endotracheal anesthesia in patients requiring prolonged TEE for noninvasive cardiac procedures, including LAA closure. RésuméObjectif La fermeture de l'appendice auriculaire gauche (AAG) est une procédure interventionnelle de plus en plus utilisée pour prévenir les accidents vasculaires cérébraux chez les patients souffrant de fibrillation auriculaire chronique ou présentant des contre-indications à l'anticoagulothérapie. Comme cette intervention requiert que le patient soit relativement immobile et une échocardiographie transoesophagienne (ETO) continue et prolongée, elle est habituellement réalisée sous anesthésie générale. Dans cette série de cas, nous décrivons la faisabilité d'une ETO prolongée pour la fermeture Electronic supplementary material The online version of this article

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“…PORC significantly increases the risk of severe postoperative respiratory complications including airway collapse, hypoxia, the need for reintubation, as well as pneumonia [7,40,41].…”

Section: Residual Neuromuscular Block As a Significant Clinical Problmentioning

confidence: 99%

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

Stankiewicz-Rudnicki

2016

Anaesthesiol Intensive Ther

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The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.Key words: elderly patients; neuromuscular block, muscle relaxants; neuromuscular block, reversal; postoperative residual curarization Anaesthesiology Intensive Therapy 2016, vol. 48, no 4, 257-260 Anaesthesiologists are regularly involved in the treatment of elderly patients due to the increasing life expectancy and rising number of surgeries in the aging population [1]. General anaesthesia comprises four crucial components: unconsciousness, analgesia, immobilization and haemodynamic stability [2]. Neuromuscular block serves the two latter purposes. As it maintains good surgical conditions as well as facilitating airway management, doses of both volatile and intravenous anaesthetics can be considerably reduced. This is of importance in patients over 65 years of age, particularly those older than 75. This group of patients is most susceptible to the adverse effects of anaesthetics [3], including decreased heart muscle contractility and hypotension, which pose a risk of cardiac and central nervous system ischaemia [4].Unfortunately, advanced age is accompanied by an increasing risk of postoperative residual curarization (PORC) [5] which, along with intraoperative awareness [6], is one of the most clinically significant complications of the use of muscle relaxants. Residual blockade is currently defined by the train of four ratio (TOFR) < 0.9, although previous reports mentioned TOFR < 0.7. It may lead to severe respiratory complications in the post-operative period [7], and thus prolong hospitalization. Awareness of the specific issues of neuromuscular blocking agents use in the elderly is therefore crucial in daily anaesthesiological practice. CliniCal aspeCts of the pharmaCokinetiCs of neuromusCular bloCking agents in the elderlyDoses of both steroid and benzylisoquinoline-derived non-depolarising muscle relaxants necessary to reach maximal block, i.e. 95% reduction of muscle response to a stimulus (effective dose 95 , ED 95 ), do not vary significantly between elderly persons and younger subjects [8,9]. This suggests that the physiology of the neuromuscular junction and the pharmacodynamics of neuromuscular blocking agents are not markedly altered in advanced age. It is the pharmacokinetics of these agents that is responsible for their altered clinical effects in the elderly.Decreased cardiac output is accompanied by reduced skeletal muscle perfusion [3] and, consequently, one should expect a prolonged time to maximum blockade following drug administration [10,11]. However, doses of muscle relaxants used for intubation are two to three, or ...

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Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists

Abstract: When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.

Cited by 29 publications

References 15 publications

Objective neuromuscular monitoring of neuromuscular blockade in Denmark: an online‐based survey of current practice

Objective neuromuscular monitoring of neuromuscular blockade in Denmark: an online‐based survey of current practice

Prolonged transesophageal echocardiography during percutaneous closure of the left atrial appendage without general anesthesia: the utility of the Janus mask

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

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