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Anesthetic Agents and Surgery during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Succinylcholine is the most commonly used agent for inducing paralysis prior to intubation and the initiation of actual surgical procedures. An estimated 10–20 percent of patients may have lowered cholinesterase activity. Reduced cholinesterase activity pregnancy is part of the physiological changes during pregnancy. Therefore, pregnant patients usually require a lower dose of succinylcholine than non-gravid women do. Newborns may be exposed to sufficient drug to induce neuromuscular blockade, which will necessitate supportive therapy. Other common agents used for neuromuscular blockade are vecuronium bromide, pancuronium bromide, and atracurium besylate (Box 6.2). Succinylcholine is a depolarizing agent, while the other three neuromuscular blocking agents (vecuronium bromide, pancuronium bromide, and atracurium besylate) are non-polarizing.
Cholinergic Antagonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Vishal S. Gulecha, Manoj S. Mahajan, Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Cardiovascular side effects of succinylcholine are mainly associated with increased catecholamine release. Succinylcholine-induced tachycardia is seen frequently. Use of succinylcholine in pediatric and adult patients may slow systole after the second dose. These effects can be overcome with atropine or glycopyrrolate (Lerman and Chinyanga, 1983).
Neurosurgery: Spine surgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
M.V.S. Satya Prakash, M. Senthilnathan
Denervation of the spinal cord may respond with exaggerated hyperkalemia if succinylcholine is given. This response commonly starts 48 hours after injury and lasts for 9 months, which necessitates avoidance of succinylcholine in patients with spinal cord injury (10).
Prehospital Drug Assisted Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Jeffrey L. Jarvis, John W. Lyng, Brian L. Miller, Michael C. Perlmutter, Heidi Abraham, Ritu Sahni
RSI, RSA, and DSI use a sedative agent paired with a paralytic to achieve rapid relaxation of protective airway reflexes and to facilitate insertion of ET tube or supraglottic airway. Multiple studies have shown that the use of any paralytic has been associated with higher first-pass success rates when compared with sedation-only intubation (1, 77–83). The two most common agents used in for prehospital RSI are succinylcholine and rocuronium, however other agents, such as vecuronium, are used by some agencies. The optimal agent for prehospital DAAM is unclear. Succinylcholine was initially promoted for emergency use because its shorter duration of action would, theoretically, allow for more rapid return of spontaneous respirations in the case of failed intubation. Others have argued that the longer duration of rocuronium is beneficial because it allows for optimal muscle relaxation, facilitating ventilation between airway insertion attempts. Succinylcholine is associated with shorter time to desaturation when compared with rocuronium (84, 85). There is conflicting evidence concerning intubation success and mortality with succinylcholine and rocuronium (84, 86, 87). If using rocuronium, intubation success is higher when using larger doses (above 1.2 mg/kg) (88, 89).
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].
A case of bipolar disorder onset with subsequent catatonia in a 14-year-old boy treated successfully with electroconvulsive therapy
Published in Nordic Journal of Psychiatry, 2019
Anna-Clara Patton, Elin Thörnblom, Helena Salonen Ros, Robert Bodén
After the second session of ECT, the patient regained speech and mobility. He expressed suffering from headache. During the day he wet his pants and had light fever 38.5 °C. The fever spontaneously decreased over the day. During the evening, he showed an increased response latency in speech and expressed depressive ideation. With no improvement the following day the patient received his third ECT. During the rest of the day he displayed a normal speech, and was able to play piano and defeated ward staff in table tennis. The patient said he had vague memories for the last weeks and no memory of his catatonia. However, he remembered the persecutory delusions and being observed by cameras and had believed there were aliens in the cellar. He described earlier psychotic symptoms with good insight. No signs of catatonia were observed during day three after daily ECT with bilateral electrode placement. The stimulus was bidirectional and brief pulse (0.5 ms) and given with a total charge of 201, 179 and 126 mC, respectively. Anesthesia was induced by 150 mg sodium thiopental + 50 µg remifentanil. Succinylcholine was used as muscle relaxant. Seizure duration on EEG was 99–102 s, maximum ictal heart rate 160–170 bpm during all three treatments. As per clinical routine, a repeated dose of sodium tiopenthal (50 mg) was administrated after 90 s of epileptic activity to avoid prolonged seizures.