The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: a study with vecuronium and atracurium

Werba, A.; Klezl, M.; Schramm, W.; Langenecker, Sibylle A.; Müller, C.; Gosch, M.; Spiss, C. K.

doi:10.1111/j.1365-2044.1993.tb06947.x

Cited by 47 publications

(24 citation statements)

References 16 publications

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“…Diaphragmatic movement can also endanger patients during certain procedures, such as tracheal suction, by increasing intracranial pressure. 64 Increasing depth of anesthesia decreases the occurrence of spontaneous diaphragmatic movements, but it may be problematic. The fear of allergic reactions with the use of muscle relaxants, 65,66 the need for rapid recovery especially in day surgery, the problems of residual paralysis even with muscle relaxants of short duration, 67 and economic considerations 68 have led some to question the need for neuromuscular blockade.…”

Section: Importance Of Neuromuscular Block At the Diaphragmmentioning

confidence: 99%

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Hemmerling

Donati

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To review recent findings concerning neuromuscular blockade and monitoring at the larynx, the diaphragm, and the corrugator supercilii muscle.S So ou ur rc ce e: : This narrative review is based on recent publications. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Neuromuscular blockade at the larynx and the diaphragm is less intense than at the adductor pollicis muscle; the onset and offset of neuromuscular blockade is more rapid. The corrugator supercilii muscle reflects better the time course of neuromuscular blockade of the larynx than the adductor pollicis muscle, is better suited to monitor the onset of neuromuscular blockade for intubation, and should give a better reflection of the time course and degree of neuromuscular blockade of the larynx or the diaphragm. Recovery of neuromuscular function at the end of any procedure is best reflected at the adductor pollicis muscle where neuromuscular transmission is last restored. Clinical monitoring of the larynx or the diaphragm is still limited by the absence of a simple method. Acceleromyography of the corrugator supercilii muscle is prone to artifacts that do not occur during monitoring of the adductor pollicis muscle. Phonomyography, a new method of monitoring that is currently being tested, is based on the phenomenon that muscle contraction creates low-frequency sound waves, which can be detected using special microphones to quantify neuromuscular blockade. This method seems promising because it can be easily used on all muscles of interest.C Co on nc cl lu us si io on n: : Research during the last 15 years has greatly enhanced our knowledge about how muscles react differently to muscle relaxants and has enabled us to achieve better surgical conditions with safer use of muscle relaxants. Interesting technologies have been developed to reliably monitor neuromuscular blockade at the larynx and the diaphragm, but are currently restricted to research settings. Our increased understanding should help us in ongoing efforts to develop the "ideal" muscle relaxant and the "ideal" method of neuromuscular monitoring. Objectif

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Section: Importance Of Neuromuscular Block At the Diaphragmmentioning

confidence: 99%

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Hemmerling

Donati

2003

Can J Anesth/J Can Anesth

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“…Grundlage für die Annahme, dass eine tiefe Blockade möglicherweise die Operationsbedingungen verbessern könnte, ist die Resistenz des Diaphragmas gegenüber der Wirkung von Muskelrelaxanzien; das Diaphragma ist bereits zu einem Zeitpunkt wieder vollständig neuromuskulär erholt, an dem der M. adductor pollicis noch eine ausreichende neuromuskuläre Blockade aufweist [13]. Erst bei Vollrelaxierung entsprechend einer bis 2 Antworten nach Stimulation im PTC-Modus ist mit keinerlei Reaktionen des Diaphragmas zu rechnen [14,15] …”

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Vollrelaxation: „magic bullet“ oder Marketing-Gag?

Fuchs-Buder

2018

Anaesthesist

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“…The studies included patients who had severe brain injury with decreased levels of consciousness requiring ventilatory support. The interventions assessed were neuromuscular blocking agents (93,94), topical and parenteral anesthetic agents (94)(95)(96), barbiturates (94) and narcotics (94,97). One study assessed the effect of hyperventilation as a co-intervention (96).…”

Section: Practice Guidelines For Suctioningmentioning

confidence: 99%

“…One RCT (93) and four randomized crossover trials (94)(95)(96)(97) were designed to assess the effectiveness of a variety of pharmacological agents on ICP and CPP in patients with acute head injury. The studies included patients who had severe brain injury with decreased levels of consciousness requiring ventilatory support.…”

Section: Practice Guidelines For Suctioningmentioning

confidence: 99%

Clinical Practice Guideline for Suctioning the Airway of the Intubated and Non-Intubated Patient

Brooks

Anderson²,

Carter³

et al. 2001

Canadian Respiratory Journal

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OBJECTIVE: To provide physicians, physiotherapists, nurses and respiratory therapists with guidelines for the application of airway suctioning. DESIGN: This clinical practice guideline was developed using the model by Browman and colleagues. A working group of representatives from four professional colleges (nurses, physicians and surgeons, physiotherapists and respiratory therapists) and research experts was formed to conduct a systematic review, develop evidence-based recommendations and generate clinical practice guidelines. MEDLINE (1966 to 1998), CINAHL (1982) and EMBASE (1974 as well as the reference lists of identified articles were searched. Inclusion of articles was determined by at least two group members, and studies were classified according to type. Randomized, controlled; randomized; and nonrandomized crossover and comparative cohort trials were grouped by type of intervention and population for use in the development of recommendations. Other observational and animal studies dealing with adverse effects of suctioning were included in the review but were not used in the development of recommendations. Input on the evidencebased recommendations was sought and incorporated from members of all four professions and from experts on content and methodology. SETTING: Any setting (hospital or home) where suctioning is performed. POPULATION: Intubated and nonintubated adults, infants and children. RESULTS AND CONCLUSIONS: An attempt was made to develop recommendations in each of the subcategories of suctioning techniques addressed by at least one study. In some subcategories, definite recommendations were made (13 in adults, and three in children and infants); in other subcategories, insufficient evidence precluded recommendations. The recommendations addressed the following aspects of suctioning: preoxygenation, hyperinflation, insufflation, hyperoxygenation, hyperventilation, saline instillation, adaptor use, medication use, open and closed systems, and various types of catheters.

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The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: a study with vecuronium and atracurium

Abstract: SummaryThe eflects of tracheobronchial suction before and after neuromuscular blockade with vecuronium (0.12

Cited by 47 publications

References 16 publications

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Vollrelaxation: „magic bullet“ oder Marketing-Gag?

Clinical Practice Guideline for Suctioning the Airway of the Intubated and Non-Intubated Patient

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