Skip to main content

Not only aminoglycoside .....also Colistin


The traditional text book of anesthesia tells us about the the interaction between aminoglycoside and the non depolarizing muscle relaxants...

It is true ...the aminoglycoside prolong the action of muscle relaxants.....

But it is not only o for aminoglycoside .....Colistin also...

You may not be be familiar with Colistin...it highly used in many areas (Lebanon one of these countries)..

Here is the Colistin issue and its implications on anesthesia practice..(report from the anesthesia safety news letter)


Colistin, otherwise known as Polymyxin E, is a drug seeing a resurgence in use against multi-drug-resistant Gram negative bacteria, in particular Acinetobacter, E-coli, Klebsiella, and P. aeruginosa.

 This drug, initially developed in the 1950s, was supplanted by the aminoglycosides because of the concern for significant nephrotoxicity and neurotoxicity associated with Polymyxin E.

Of particular concern to anesthesiologists is the neuromuscular blockade due to non-competitive blockade. This blockade is independent of that caused by our common clinical neuromuscular blocking agents, known to accentuate such blockade, and not reversed by neostigmine.

Recently  case  report where an individual receiving Colistin to treat a multi-drug- resistant Acinetobacter required surgery and intuba- tion. Unaware of the implication of the antibiotic treatment, the anesthesiologist administered a small, 20-mg dose of rocuronium to facilitate intubation. This resulted in a very deep and prolonged period of neuromuscular blockade, requiring almost 24 hours before measurable evidence of spontaneous recovery 


Comments

Popular posts from this blog

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...