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International Journal of Medical... 2017Rocuronium (ROC) and Vecuronium (VEC) are the most currently used steroidal non-depolarizing neuromuscular blocking (MNB) agents. Sugammadex (SUG) rapidly reverses...
Rocuronium (ROC) and Vecuronium (VEC) are the most currently used steroidal non-depolarizing neuromuscular blocking (MNB) agents. Sugammadex (SUG) rapidly reverses steroidal NMB agents after anaesthesia. The present study was conducted in order to evaluate neuronal effects of SUG alone and in combination with both ROC and VEC. Using MTT, CASP-3 activity and Western-blot we determined the toxicity of SUG, ROC or VEC in neurons in primary culture. SUG induces apoptosis/necrosis in neurons in primary culture and increases cytochrome C (CytC), apoptosis-inducing factor (AIF), Smac/Diablo and Caspase 3 (CASP-3) protein expression. Our results also demonstrated that both ROC and VEC prevent these SUG effects. The protective role of both ROC and VEC could be explained by the fact that SUG encapsulates NMB drugs. In BBB impaired conditions it would be desirable to control SUG doses to prevent the excess of free SUG in plasma that may induce neuronal damage. A balance between SUG, ROC or VEC would be necessary to prevent the risk of cell damage.
Topics: Androstanols; Animals; Apoptosis Inducing Factor; Caspase 3; Cytochromes c; Dose-Response Relationship, Drug; Drug Combinations; Gene Expression Regulation; Humans; Neuromuscular Blocking Agents; Neurons; Primary Cell Culture; Rats; Rocuronium; Sugammadex; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 28367082
DOI: 10.7150/ijms.17545 -
Journal of the American Veterinary... Jan 2017CASE DESCRIPTION 4 dogs were examined because of pleural effusion and ventricular tachycardia, coughing and supraventricular tachycardia, appendicular osteosarcoma, and...
CASE DESCRIPTION 4 dogs were examined because of pleural effusion and ventricular tachycardia, coughing and supraventricular tachycardia, appendicular osteosarcoma, and syncopal episodes. CLINICAL FINDINGS In all 4 dogs, a heart base tumor was identified by means of thoracic CT. TREATMENT AND OUTCOME In all 4 dogs, the heart base tumors were treated by means of stereotactic body radiation therapy. Dogs were anesthetized, and neuromuscular blockade was achieved with atracurium or vecuronium. A circle rebreathing system with 15 m (50 feet) of anesthetic tubing coursing through the vault wall was used to connect the patient to the anesthesia machine, which was located in the control room. After a brief period of hyperventilation, an inspiratory breath was held at 20 cm HO for the duration of beam delivery. Each beam delivery lasted between 30 and 100 seconds. Immediately following the breath hold, assisted ventilation was resumed. Mean treatment delivery time for each patient was 26 minutes; mean total anesthesia time was 89 minutes. All patients recovered without complications. There was no evidence of hemoglobin desaturation or hypercapnia during the anesthetic procedure. CLINICAL RELEVANCE The technique allowed for control of the respiration cycle from outside the radiation vault and a short overall treatment time. No adverse effects were encountered. This procedure should be considered when delivering radiation to structures within the thoracic cavity.
Topics: Animals; Atracurium; Breath Holding; Dog Diseases; Dogs; Female; Heart Neoplasms; Male; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Stereotaxic Techniques; Vecuronium Bromide
PubMed: 28058956
DOI: 10.2460/javma.250.2.199 -
Journal of Biomedical Optics Jan 2017The purpose of this study is to evaluate the suitability of five different anesthetic protocols (isoflurane, isoflurane–xylazine, pentobarbital, ketamine–xylazine,...
The purpose of this study is to evaluate the suitability of five different anesthetic protocols (isoflurane, isoflurane–xylazine, pentobarbital, ketamine–xylazine, and ketamine–xylazine–vecuronium) for functional blood flow imaging in the rat eye. Total retinal blood flow was measured at a series of time points using an ultrahigh-speed Doppler OCT system. Additionally, each anesthetic protocol was qualitatively evaluated according to the following criteria: (1) time-stability of blood flow, (2) overall rate of blood flow, (3) ocular immobilization, and (4) simplicity. We observed that different anesthetic protocols produced markedly different blood flows. Different anesthetic protocols also varied with respect to the four evaluated criteria. These findings suggest that the choice of anesthetic protocol should be carefully considered when designing and interpreting functional blood flow studies in the rat eye.
Topics: Anesthesia; Anesthetics; Animals; Eye; Isoflurane; Ketamine; Pentobarbital; Rats; Regional Blood Flow; Retina; Vecuronium Bromide; Xylazine
PubMed: 28056146
DOI: 10.1117/1.JBO.22.1.016005 -
Anaesthesiology Intensive Therapy 2016The purpose of this study was to compare cardiac sympathetic and parasympathetic balance using heart rate variability (HRV) during induction of anaesthesia between... (Comparative Study)
Comparative Study
BACKGROUND
The purpose of this study was to compare cardiac sympathetic and parasympathetic balance using heart rate variability (HRV) during induction of anaesthesia between sevoflurane and isoflurane in combination with nitrous oxide.
METHODS
40 individuals aged from 30 to 60 years, scheduled for general anaesthesia were equally divided into sevoflurane or isoflurane groups. After 100% oxygen inhalation for a few minutes, anaesthesia was induced with nitrous oxide 3 L min-1, oxygen 3 L min-1 and sevoflurane or isoflurane. Sevoflurane or isoflurane concentration was increased by 0.5% every 2 to 3 breaths until 5% was attained for sevoflurane, or 3% for isoflurane. Vecuronium was administered to facilitate tracheal intubation. After intubation, sevoflurane was set to 2% while isoflurane was set to 1% with nitrous oxide with oxygen (1:1) for 5 min.
RESULTS
Both sevoflurane and isoflurane provoked a decrease in blood pressure, total power, the low frequency component (LF), and high frequency component (HF) of HRV. Although the heart rate increased during isoflurane anaesthesia, it decreased under sevoflurane. The power of LF and HF also decreased in both groups. LF was higher in the isoflurane group while HF was higher in the sevoflurane group. The LF/HF ratio increased transiently in the isoflurane group, but decreased in the sevoflurane group.
CONCLUSION
Anaesthesia induction with isoflurane-nitrous oxide transiently increased cardiac sympathetic activity, while sevoflurane-nitrous oxide decreased both cardiac sympathetic and parasympathetic activities. The balance of cardiac parasympathetic/sympathetic activity was higher in sevoflurane anaesthesia.
Topics: Adult; Anesthesia, Inhalation; Anesthetics, Inhalation; Female; Heart; Heart Rate; Humans; Intubation, Intratracheal; Isoflurane; Male; Methyl Ethers; Middle Aged; Monitoring, Intraoperative; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Parasympathetic Nervous System; Sevoflurane; Sympathetic Nervous System; Vecuronium Bromide
PubMed: 27689429
DOI: 10.5603/AIT.a2016.0041 -
American Journal of Physiology.... Nov 2016The aim of this study was to clarify the effect of vagal afferent activation on salivation and swallowing-like events. Salivation is part of a reflex induced by...
The aim of this study was to clarify the effect of vagal afferent activation on salivation and swallowing-like events. Salivation is part of a reflex induced by stimulation of the oral area during feeding or chewing. Recently, we reported that nausea induced by gastroesophageal reflux (GER) activation produced salivation and swallowing in humans. Here, we investigated the ability of visceral sensation to enhance salivation and swallowing in rodents in order to inform the mechanism of GER-mediated stomatognathic activation. First, we administered LiCl to anesthetized male rats to induce nausea. LiCl significantly increased salivation and increased the activity of the vagal afferent nerve. Next, we simultaneously recorded salivation and swallowing using an electrode attached to the mylohyoid muscle during vagal afferent stimulation in a physiological range of frequencies. Vagal afferent stimulation significantly increased salivation and swallowing-like events in a frequency-dependent manner. A muscle relaxant, vecuronium bromide, diminished the swallowing-like response but did not affect salivation. These results indicate that visceral sensation induces salivation and swallowing-like events in anesthetized rodents through vagal afferent activation.
Topics: Afferent Pathways; Anesthesia; Animals; Deglutition; Electric Stimulation; Male; Rats; Rats, Wistar; Reflex; Salivation; Vagus Nerve
PubMed: 27707722
DOI: 10.1152/ajpregu.00292.2016 -
Anesthesia, Essays and Researches 2016Here, we present the case of a 42 year old female patient, ASA1 and donor for renal transplant surgery of her husband. The pre-anesthesia visit did not reveal any...
Here, we present the case of a 42 year old female patient, ASA1 and donor for renal transplant surgery of her husband. The pre-anesthesia visit did not reveal any co-morbidity on history and the physical examination was also within normal limits. The patient was taken to the operating room and routine monitoring in the form of non-invasive blood pressure (NIBP), SpO2 probe and five lead electrocardiogram were applied. Anesthesia was induced with midazolam 1mg intravenous (i/v), fentanyl 100 μg i.v, propofol 100mg i/v and vecuronium bromide 5 mg. i/v. At the end of surgery, anesthesia was reversed and breathing attempts were observed. Suddenly the monitor displayed a drop in the ETCO2 to 5-6 mmHg. Immediately the ventilator circuit was checked which was found to be in place and on chest auscultation, bilateral equal air entry was heard. Sudden bradycardia with heart beat dropping to 32 beats per minute and a blood pressure reading of 90/50 mmHg was displayed on the monitor. Surgeons were informed about the possibility of an intra-abdominal bleed. On surgical exploration, the renal artery pedicle ligature was found to have slipped away resulting in torrential amount of bleeding. The bleeder having been identified was secured and a complete inspection of other possible bleeding sites was done. Post operatively, the patient was shifted to the intensive care unit with inotropic support. It was decided to keep the patient mechanically ventilated on volume control mode of ventilation. The patient remained stable on post-operative day 5, the patient was shifted to the ward.
PubMed: 26957714
DOI: 10.4103/0259-1162.167834 -
Anesthesia, Essays and Researches 2016The present study is undertaken to compare the hemodynamic effects using vecuronium versus rocuronium for maintenance in patients undergoing general surgical procedures.
AIMS
The present study is undertaken to compare the hemodynamic effects using vecuronium versus rocuronium for maintenance in patients undergoing general surgical procedures.
SETTINGS AND DESIGN
It is a prospective, randomized, and cohort study.
SUBJECTS AND METHODS
100 patients were randomly divided into two groups. All patients were induced with 5 mg/kg of thiopentone sodium, and intubation conditions were achieved with 1.5 mg/kg of suxamethonium, using a well-lubricated cuffed endotracheal tube of appropriate size. When the patient started to breathe spontaneously, they were administered either 0.6 mg/kg of rocuronium (Group A) or 0.1 mg/kg of vecuronium (Group B). Hemodynamic parameters (heart rate and mean arterial pressure [MAP]) were monitored before administering the drug; at 1, 5, 10, 15, and 20 min after the drug and at the end of the surgery.
STATISTICAL ANALYSIS USED
Data were compiled, analyzed and presented as frequency, proportions, mean, standard deviation, percentages, and t-test using SPSS (version 16). A P < 0.05 was considered as significant.
RESULTS
The heart rate increased significantly at 1-min and 5-min after administration of rocuronium (83.76 ± 10.37 and 86.8 ± 9.98), unlike vecuronium. However, it gradually declined towards normal, and change in heart rate with either drug was not significant beyond 10 min. The MAP decreased significantly at 1-min after administration of rocuronium (96.68 ± 7.57) which later showed a gradual increasing trend when compared to vecuronium which had no statistically significant change at any time.
CONCLUSIONS
For short surgical procedures rocuronium is a good alternative to vecuronium, as the drug is reasonably cardio stable, produces excellent intubation conditions, has a shorter duration of action, and shows minimal cumulative effect.
PubMed: 26957692
DOI: 10.4103/0259-1162.164740 -
Annual International Conference of the... 2015Cardiac arrest (CA) results in global brain ischemia. To explore the role of cerebral blood flow (CBF) during ischemia, laser speckle contrast imaging (LSCI), a...
Cardiac arrest (CA) results in global brain ischemia. To explore the role of cerebral blood flow (CBF) during ischemia, laser speckle contrast imaging (LSCI), a full-field high-resolution optical imaging technique, was used for real-time monitoring of the fluctuations of CBF in a rat model of asphyxial-CA. The temporal changes of CBF were characterized and the relationship between CBF and mean arterial pressure (MAP) was evaluated. Asphyxial-CA led to transient CBF dysregulation, manifested by changes in CBF velocity were significantly impacted by MAP. Hyperemia is aligned with a bolus injection of vecuronium, the first two minutes of asphyxia, the time of epinephrine injection and cardiopulmonary resuscitation, and then lasted for 13 min after the return of spontaneous respiratory (ROSC), followed by hypoperfusion about 55-70% of baseline level no later than 40 min after ROSC. Interestingly, we found that the velocity of venule blood flow increased more than that of the arteriole blood flow during the hyperemia (176% vs 120%). Our study, for the first time, shows real-time CBF changes during and immediately after asphyxial-CA, with high spatial and temporal resolution images. The quantified cerebro-vascular response during the different phases of recovery after CA may underlie the mechanism of injury and recovery after brain ischemia. The study provides a new technique to study the neurovascular coupling and metabolic regulation of CBF after CA.
Topics: Animals; Arterial Pressure; Asphyxia; Brain Ischemia; Cardiopulmonary Resuscitation; Cerebrovascular Circulation; Disease Models, Animal; Epinephrine; Heart Arrest; Hemodynamics; Hyperemia; Image Processing, Computer-Assisted; Neuromuscular Nondepolarizing Agents; Rats; Rats, Wistar; Vasoconstrictor Agents; Vecuronium Bromide
PubMed: 26737896
DOI: 10.1109/EMBC.2015.7319996 -
Journal of Anesthesia Apr 2016Perioperative anaphylaxis is a life-threatening clinical condition that is typically the result of drugs or substances used for anesthesia or surgery. The most common... (Review)
Review
Perioperative anaphylaxis is a life-threatening clinical condition that is typically the result of drugs or substances used for anesthesia or surgery. The most common cause of anaphylaxis during anesthesia is reportedly neuromuscular blocking agents. Of the many muscle relaxants that are clinically available, rocuronium is becoming popular in many countries. Recent studies have demonstrated that succinylcholine (but also rocuronium use) is associated with a relatively high rate of IgE-mediated anaphylaxis compared with other muscle relaxant agents. Sugammadex is widely used for reversal of the effects of steroidal neuromuscular blocking agents, such as rocuronium and vecuronium. Confirmed cases of allergic reactions to clinical doses of sugammadex have also been recently reported. Given these circumstances, the number of cases of hypersensitivity to either sugammadex or rocuronium is likely to increase. Thus, anesthesiologists should be familiar with the epidemiology, mechanisms, and clinical presentations of anaphylaxis induced by these drugs. In this review, we focus on the diagnosis and treatment of anaphylaxis to sugammadex and neuromuscular blocking agents. Moreover, we discuss recent studies in this field, including the diagnostic utility of flow cytometry and improvement of rocuronium-induced anaphylaxis with the use of sugammadex.
Topics: Anaphylaxis; Androstanols; Anesthesia; Humans; Neuromuscular Nondepolarizing Agents; Rocuronium; Succinylcholine; Sugammadex; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 26646837
DOI: 10.1007/s00540-015-2105-x -
Anesthesiology Dec 2015The authors evaluated the comparative effectiveness of calabadion 2 to reverse non-depolarizing neuromuscular-blocking agents (NMBAs) by binding and inactivation. (Comparative Study)
Comparative Study
BACKGROUND
The authors evaluated the comparative effectiveness of calabadion 2 to reverse non-depolarizing neuromuscular-blocking agents (NMBAs) by binding and inactivation.
METHODS
The dose-response relationship of drugs to reverse vecuronium-, rocuronium-, and cisatracurium-induced neuromuscular block (NMB) was evaluated in vitro (competition binding assays and urine analysis), ex vivo (n = 34; phrenic nerve hemidiaphragm preparation), and in vivo (n = 108; quadriceps femoris muscle of the rat). Cumulative dose-response curves of calabadions, neostigmine, or sugammadex were created ex vivo at a steady-state deep NMB. In living rats, the authors studied the dose-response relationship of the test drugs to reverse deep block under physiologic conditions, and they measured the amount of calabadion 2 excreted in the urine.
RESULTS
In vitro experiments showed that calabadion 2 binds rocuronium with 89 times the affinity of sugammadex (Ka = 3.4 × 10 M and Ka = 3.8 × 10 M-). The results of urine analysis (proton nuclear magnetic resonance), competition binding assays, and ex vivo study obtained in the absence of metabolic deactivation are in accordance with an 1:1 binding ratio of sugammadex and calabadion 2 toward rocuronium. In living rats, calabadion 2 dose-dependently and rapidly reversed all NMBAs tested. The molar potency of calabadion 2 to reverse vecuronium and rocuronium was higher compared with that of sugammadex. Calabadion 2 was eliminated renally and did not affect blood pressure or heart rate.
CONCLUSIONS
Calabadion 2 reverses NMB induced by benzylisoquinolines and steroidal NMBAs in rats more effectively, i.e., faster than sugammadex. Calabadion 2 is eliminated in the urine and well tolerated in rats.
Topics: Androstanols; Animals; Atracurium; Dose-Response Relationship, Drug; Heterocyclic Compounds, 4 or More Rings; Male; Neostigmine; Neuromuscular Nondepolarizing Agents; Rats; Rocuronium; Sugammadex; Sulfonic Acids; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 26418697
DOI: 10.1097/ALN.0000000000000868