martes, 5 de enero de 2016

RNM y sugammadex/Neuromuscular relaxants and sugammadex

Monitoreo neuromuscular, uso de relajantes musculares, y su reversión en un hospital de enseñanza de tercer nivel 2.5. años después de introducir sugammadex. Cambios de opinión y práctica clínica
Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice.
Anesthesiol Res Pract. 2015;2015:367937. doi: 10.1155/2015/367937. Epub 2015 Jan 22.
Parálisis residual. ¿Influencia la evolución después de cirugía ambulatoria?
Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery?
Curr Anesthesiol Rep. 2014 Dec;4(4):290-302.
Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it's use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice.
KEYWORDS: Ambulatory surgery; Calabadion; NMBA; Neostigmine; PORC; Residual paralysis; Respiratory complications; Sugammadex

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