Skip to main content

Residual Neuromuscular Block



The clinical implications of residual neuromuscular block are important.

TOF ratio to as low as 0.63, may cause difficulty breathing and swallowing, and decreases inspiratory force and peak expiratory flow rate.

TOF ratio to 0.85 is associated with general discomfort, malaise, ptosis and blurred vision.

Other more recent studies with volunteers have shown that TOF ratios of 0.6 to 0.7 are associated with decreased upper esophageal tone and a decrease in the coordination of the esophageal musculature during swallowing.
 Fluoroscopic study of these individuals while swallowing demonstrated significant pharyngeal dysfunction resulting in misdirected swallowing, leading to a four to five-fold increase in the risk of aspiration.

 A TOF recovery = 0.90 is required to return esophageal tone and pharyngeal coordination to baseline. Only with this degree of recovery do patients manifest normal swallowing, fully protect their airways, and resume normal respiratory function. It may require this more robust level of neuromuscular recovery to minimize the postoperative risk of aspiration and pneumonia

NMB drugs also interfere with hypoxic ventilatory control.

In vitro, while application of acetylcholine to the carotid body results in hyperventilation, application of anticholinergics eliminated the increase in neuronal activity of the carotid body sinus nerve that otherwise occurs with hypoxia. In awake volunteers who have received atracurium, vecuronium or pancuronium, with a train-of-four ratio of 0.70, the hypoxic ventilatory drive is reduced by 30%.
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more