China
Africa
Explore chapters and articles related to this topic
Candida and parasitic infection: Helminths, trichomoniasis, lice, scabies, and malaria
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Pyrantel pamoate, a pyrimidine derivative, acts by paralyzing nematodes, allowing them to be expelled. Its action is similar to depolarizing neuromuscular blocking agents (41). Pyrantel pamoate is very poorly absorbed, with half remaining in the intestinal tract unabsorbed. This poor absorption is the basis for its recommendation as first-line therapy in pregnancy. Blood levels of pyrantel pamoate are quite low, but it is not known whether it crosses the placenta. Animal teratology studies were negative, and no human malformations have been reported (compatible with pregnancy category B, but never labeled by the FDA). Pyrantel pamoate is considered safe for use while breastfeeding, due to its low absorption. Side effects (gastrointestinal complaints) are generally minimal and are not increased in pregnancy. Pyrantel doses can be calculated from the pamoate form or the free base (1mg base = 2.9mg pamoate form). Anthelmintic doses are 5 to 10 mg/kg pyrantel base or 15 to 30mg/kg pyrantel pamoate (maximum daily dose, 1-g pyrantel base) (41).
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The incidence of these complications can be reduced by restricting the use of neuromuscular blocking agents to circumstances where their benefits clearly outweigh the risks associated with their administration. If these agents are to be used, then their use should be kept to a minimum; they should either be given by intermittent dosing schedules or, when given by continuous infusion, these should be routinely discontinued to allow for recovery of neuromuscular function and assessment of the underlying degree of sedation. Monitoring of the depth of neuromuscular blockade using train-of-four transcutaneous stimulation of the ulnar nerve, can allow for the titration of doses of neuromuscular blocking agents when given by continuous infusion and allow for the minimisation of the total doses received.
Surgical Management of Vestibular Schwannoma
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Shakeel R. Saeed, Christopher J. Skilbeck
The patient is placed on the operating table in the supine position with the head turned 30 degrees away from the surgeon and supported either in a soft head ring or fixed in the Mayfield clamp. Two-channel neuromonitoring for the facial nerve is usually sufficient, but with very large tumours it may be necessary to monitor the lower cranial nerves as well. The anaesthetist should be reminded that neuromuscular blocking agents must not be used after intubation.
Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS?
Published in Expert Review of Respiratory Medicine, 2023
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin
Two major trials have assessed the impact of neuromuscular blocking agents (NMBA) during ARDS [33,67]. The ACURASIS trial randomized moderate-to-severe ARDS patients to receive 48 hours of cisatracurium or a placebo [33]. Cisatracurium was associated with an improved 90-day survival rate, increased ventilator-free and ICU-free days, and decreased barotrauma. Nine years later, the ROSE trial randomized moderate-to-severe ARDS patients to receive 48 hours of either Cisatracurium or a placebo [67]. The trial was stopped early for futility with no difference in mortality or ventilator-free conditions. Multiple differences between the trials may explain these divergent results, including earlier randomization, lighter sedation, and a lower incidence of reverse-triggering dyssynchrony [68,69]. A recent meta-analysis combining these two trials with three others demonstrated no benefit in mortality or ventilator-free days, but showed an improvement of oxygenation for 72 hours and a lower risk of barotrauma [70]. Similar results were found in the COVID-19 cohort and pediatric patients with ARDS [71,72]. Guidelines proposed to limit the use of NMBA in cases of deep sedation in order to facilitate lung protective ventilation or prone positioning [73]. Yet some experts suggest that NMBA can be used when ‘physiologically and clinically indicated’ [68].
Comparison of vecuronium or rocuronium for rapid sequence induction in morbidly obese patients: a randomized study
Published in Egyptian Journal of Anaesthesia, 2020
Mohamed M. Abu Yazed, Sameh Abdelkhalik Ahmed
Nondepolarizing neuromuscular blocking agents, such as pancuronium, vecuronium, atracurium, and cisatracurium, may be alternative agents to succinylcholine. However, these blocking agents have a delayed onset and a prolonged duration of action when used in the standard doses [5]. Rocuronium has a rapid onset of action and a moderate duration of action and can be used in rapid sequence induction [6]. The development of sugammadex has allowed the evaluation of the use of the steroid group of the nondepolarizing neuromuscular blocking agents in rapid sequence induction, as sugammadex allows the rapid reversal of these nondepolarizing neuromuscular blocking agents in cases of failed intubation [7,8]. The clinical trial by Duarte et al revealed that the ideal body weight (IBW) should be used in the calculation of a sugammadex dose in the reversal of a moderate neuromuscular block in morbidly obese patients [9].
Deep versus moderate neuromuscular block in laparoscopic bariatric surgeries: effect on surgical conditions and pulmonary complications
Published in Egyptian Journal of Anaesthesia, 2019
Mohamed M. Abu Yazed, Sameh Abdelkhalik Ahmed
The introduction of neuromuscular blocking agents in anesthesia has been associated with numerous benefits. It specifically improves the intubation condition, increases the depth of anesthesia, decreases airway edema, and improves surgical exposure [1–3]. Despite that, it has also been associated with several drawbacks, such as postoperative dysfunction of respiratory muscles that predispose to postoperative pulmonary complications [4,5]. The risk of postoperative respiratory complications increases significantly in morbidly obese patients, sometimes approaching 100% incidence, especially with increasing body mass index (BMI) and presence of obesity hypoventilation syndrome [6]. Respiratory complications must be considered and properly managed in the perioperative management of bariatric surgeries, as they account for about 12% of mortality rates [7].