Interaction of magnesium sulphate with vecuronium-induced neuromuscular blockt

We have investigated the interaction between magnesium sulphate 40 mg kg−1 i.v. and vecuronium. First, we determined the effect of pretreatment with magnesium on the potency of vecuronium using a single bolus dose-response technique. In addition, we compared the time course of vecuronium-induced neuromuscular block (vecuronium 100 μg kg−1) with and without magnesium pretreatment. For both parts, neuromuscular block was assessed by electromyography. In addition, the effect of magnesium pretreatment on vecuronium-induced neuromuscular block was investigated in the context of rapid sequence induction of anaesthesia. We found that the neuromuscular potency of vecuronium was increased by pretreatment with magnesium sul phate. The ED50 and ED90 of vecuronium with MgSO4 were 25% lower than without MgSO4 (ED50 21.3 vs 26.9 μg kg−1 ED90 34.2 vs 45.7 μg kg−1 P < 0.05 for both). Mean onset time was 147.3 (SD 22.2) s in the MgSO4 group vs 297.3 (122) s for controls (P < 0.05). Clinical duration was prolonged (MgSO4-vecuronium 43.3 (9) min vs 25.2 (5.1) min for controls; P < 0.05). This was also true for the recovery index (20.1 (6.6) mm vs 10.6 (3.4) min; P < 0.05) and duration to 75% recovery (63.4 (9.9) min vs 35.8 (6.9) min; < 0.05). In the context of rapid sequence induction, pretreatment with MgSO4 improved the intubating score of vecuronium compared with vecuronium without MgSO4 reach ing the same quality as that with suxamethonium 1 mg kg−1. We conclude that magnesium pretreat ment increased the neuromuscular potency of vecuronium, in addition to modifying the time course of its neuromuscular bloc

EMA recommendation to suspend HES is hazardous

Peer reviewe

A survey on the availability, usage and perception of neuromuscular monitors in Europe

Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research was funded by the Flanders Innovation and Entrepreneurship Fund (VLAIO), the Willy Gepts Fund for Scientific Research, the Society for Anesthesia and Resuscitation of Belgium (BeSARPP), and the Vrije Universiteit Brussel (VUB).Peer reviewedPostprin

Dermal reaction and bigeminal premature ventricular contractions due to neostigmine: a case report

<p>Abstract</p> <p>Introduction</p> <p>Neostigmine is a frequently used acetylcholinesterase inhibitor administered to reverse muscular relaxation caused by nondepolarizing neuromuscular relaxants in patients recovering from general anesthesia. Severe allergic reactions and urticaria are rarely reported following the use of neostigmine bromide, and never with methylsulfate-containing drugs. In this case, bigeminal premature ventricular contractions added to urticaria provides a warning about the possibility of a life-threatening situation.</p> <p>Case presentation</p> <p>We report the case of a 23-year-old Persian woman who presented with bigeminal premature ventricular contractions along with urticarial lesions on her arm and trunk as soon as she was administered neostigmine methylsulfate after undergoing a laparoscopy for ectopic pregnancy.</p> <p>Conclusion</p> <p>This case report could be of value not only for anesthesiologists who routinely use neostigmine but also for others who administer the pharmaceutical preparation in other situations. The report presents a rare case of drug reaction following neostigmine use. As a result, one should consider any drug a probable cause of drug reaction. The preparation of resuscitative facilities, therefore, is necessary prior to the prescription of the medication.</p

A comparison of the accuracy of ulnar versus median nerve stimulation for neuromuscular monitoring

BACKGROUND: Inexperienced anesthesiologists are frequently unclear as to whether to stimulate the ulnar or median nerve to monitor the adductor pollicis. The primary purpose of this study was to determine whether monitoring the adductor pollicis by positioning the stimulating electrodes over the median nerve is an acceptable alternative to applying electrodes over the ulnar nerve.0aMETHODS: In 20 patients anesthetized with propofol and remifentanil, one pair of stimulating electrodes was positioned over the ulnar nerve. A second pair was placed over the median nerve on the other hand. The acceleromyographic response was monitored on both hands. Rocuronium 0.6 mg/kg was administered. Single twitch (ST) and train-of-four (TOF) stimulations were applied alternatively to both sites.0aRESULTS: None of the patients showed a twitch response at either site after injection of rocuronium. There were no differences in the mean supramaximal threshold, mean initial TOF ratio, or mean initial ST ratio between the two sites. Bland-Altman analysis revealed a bias (limit of agreement) in the TOF and ST ratios over the median nerve of 7% (with that of the ulnar nerve value, and the median nerve ST ratio was overestimated by 72.9%, as compared to that of the ulnar nerve.0aCONCLUSIONS: The ulnar and median nerves cannot be used interchangeably for accurate neuromuscular monitoring

The construction and evaluation of a device for mechanomyography in anaesthetized Göttingen minipigs

OBJECTIVE: To devise a method for assessing evoked muscle strength on nerve stimulation [mechanomyography (MMG)] in the anaesthetized minipig. STUDY DESIGN: Prospective observational. ANIMALS: Sixty male Göttingen minipigs weighing 10.5–26.0 kg. METHODS: After cadaveric studies, a limb fixation device was constructed which allowed the twitch responses of the pelvic limb digital extensor muscles to be measured by force-displacement transduction in response to supramaximal train-of-four (TOF) stimulation of the common peroneal nerve. The device was tested in 60 minipigs weighing 10.5–26.0 kg positioned in dorsal recumbency. RESULTS: The technique recorded the MMG of the common peroneal-pelvic limb digital extensor nerve-muscle unit for up to 12 hours during which twitch height remained constant in 18 animals in which single twitch duration was <300–500 ms. In 42, in which twitch duration was >300–500 ms, 2 Hz nerve stimulation caused progressive baseline elevation (reverse fade) necessitating a modified signal capture method for TOF ratio (TOFR) computation. However, T1 was unaffected. The mean (range) of the TOFR in pigs with reverse fade was 1.2 (1.1–1.3). CONCLUSIONS AND CLINICAL RELEVANCE: The technique allowed MMG recording in unparalysed pigs in response to TOF nerve stimulation and revealed a hitherto unreported complication of MMG monitoring using TOF in animals: reverse fade. This complicated TOFR calculation