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61. Sugammadex for the Reversal of Neuromuscular Blockade in Adult Patients: A Review of Clinical Effectiveness and Cost-Effectiveness

for the recovery of neuromuscular blockade in adult patients, as compared with other pharmacological reversal agents or spontaneous recovery. Based on the identified published literature, sugammadex is associated with a quicker recovery from rocuronium or vecuronium-induced muscle relaxation, results in a shorter time to extubation, and is associated with a reduced likelihood of residual postoperative paralysis in comparison with neostigmine or spontaneous recovery. Similarly, safety data suggest

2016 Canadian Agency for Drugs and Technologies in Health - Rapid Review

62. Guideline for the perioperative management of people with inherited salt-wasting alkaloses (Gitelman?s syndrome and Bartter?s syndrome) undergoing non-urgent surgical procedures

with Bartter’s/Gitelman’s syndromes. Clin Nephrol. 2007 Mar;67(3):193–7. 4. Abston PA, Priano LL. Bartter’s syndrome: anesthetic implications based on pathophysiology and treatment. Anesth Analg. 1981 Oct;60(10):764–6. 5. Nishikawa T, Dohi S. Baroreflex function in a patient with Bartter’s syndrome. Can Anaesth Soc J. 1985 Nov;32(6):646–50. 6. Chenoweth D. Successful use of isoflurane and vecuronium in a patient with Bartter’s syndrome: a case study. AANA J. 1987 Nov;55(5):434–6. 7. Higa K, Ishino H, Sato S

2015 Royal College of Anaesthetists

63. Perioperative management of people with inherited salt-wasting alkaloses (Gitelman?s syndrome and Bartter?s syndrome) undergoing non-urgent surgical procedure

with Bartter’s/Gitelman’s syndromes. Clin Nephrol. 2007 Mar;67(3):193–7. 4. Abston PA, Priano LL. Bartter’s syndrome: anesthetic implications based on pathophysiology and treatment. Anesth Analg. 1981 Oct;60(10):764–6. 5. Nishikawa T, Dohi S. Baroreflex function in a patient with Bartter’s syndrome. Can Anaesth Soc J. 1985 Nov;32(6):646–50. 6. Chenoweth D. Successful use of isoflurane and vecuronium in a patient with Bartter’s syndrome: a case study. AANA J. 1987 Nov;55(5):434–6. 7. Higa K, Ishino H, Sato S

2015 Renal Association

64. Nitrous oxide added at the end of isoflurane anesthesia hastens early recovery without increasing the risk for postoperative nausea and vomiting: a randomized clinical trial Full Text available with Trip Pro

with thiopental 5 mg·kg-1, vecuronium 0.1 mg·kg-1, and fentanyl 1-2 μg·kg-1 iv and maintained with isoflurane. Indicators of early recovery (time to extubation, eye opening, following commands, orientation) were assessed by an anesthesiologist unaware of the group assignment. The incidence and severity of PONV was measured at two and 24 hr postoperatively.Altogether, 82 participants completed the study (42 in GO2, 40 in GN2O) and were analyzed. The mean (SD) time of N2O administration in GN2O patients

2018 EvidenceUpdates

65. Incidence of Anaphylaxis to Sugammadex in a Single-Center Cohort of 19,821 Patients. (Abstract)

Incidence of Anaphylaxis to Sugammadex in a Single-Center Cohort of 19,821 Patients. Sugammadex is a modified cyclodextrin that is being increasingly used in anesthetic practice worldwide for the reversal of the aminosteroid neuromuscular blockers rocuronium and vecuronium. Its safety profile, however, is incompletely understood. One such aspect is the incidence of anaphylactic reactions that occur after its administration. While several case reports exist in the literature, there is a paucity

2020 Anesthesia and Analgesia

66. Erroneous neuraxial administration of neuromuscular blocking drugs: Clinical and human factors analysis. (Abstract)

was prolonged following epidural administration of vecuronium, pancuronium, cisatracrium and suxamethonium. Five patients required emergency airway interventions. Intrethecal gallamine caused convulsions and muscle spasms migrating up the body. Syringe swap was the primary cause for the majority of errors and perceptual errors were the most common. Implementation of recommendations could have prevented the errors.Following the epidural injection of NMBDs the effects are delayed and prolonged

2020 European Journal of Anaesthesiology

67. [Efficacy of vecuronium in the elimination of human-machine confrontation resulting from mechanical ventilation in newborns]. (Abstract)

[Efficacy of vecuronium in the elimination of human-machine confrontation resulting from mechanical ventilation in newborns]. 20416229 2010 08 03 2013 11 21 1008-8830 12 4 2010 Apr Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics Zhongguo Dang Dai Er Ke Za Zhi [Efficacy of vecuronium in the elimination of human-machine confrontation resulting from mechanical ventilation in newborns]. 303-5 Wang Zhao-Kang ZK Department of Pediatrics, People's Hospital of Binyang County (...) , Nanning 530405, China. Wu Bao-Zhen BZ chi Journal Article Randomized Controlled Trial China Zhongguo Dang Dai Er Ke Za Zhi 100909956 1008-8830 0 Neuromuscular Nondepolarizing Agents 7E4PHP5N1D Vecuronium Bromide IM Blood Gas Analysis Humans Infant, Newborn Neuromuscular Nondepolarizing Agents therapeutic use Respiration, Artificial adverse effects Vecuronium Bromide therapeutic use 2010 4 27 6 0 2010 4 27 6 0 2010 8 4 6 0 ppublish 20416229 1008-8830(2010)04-0303-03

2010 Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics Controlled trial quality: uncertain

68. Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine. Full Text available with Trip Pro

Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine. Acetylcholinesterase inhibitors cannot rapidly reverse profound neuromuscular block. Sugammadex, a selective relaxant binding agent, reverses the effects of rocuronium and vecuronium by encapsulation. This study assessed the efficacy of sugammadex compared with neostigmine in reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia.Patients (...) aged ≥18 years, American Society of Anesthesiologists class 1-4, scheduled to undergo surgery under general anesthesia were enrolled in this phase III, multicenter, randomized, safety-assessor blinded study. Sevoflurane anesthetized patients received vecuronium 0.1 mg/kg for intubation, with maintenance doses of 0.015 mg/kg as required. Patients were randomized to receive sugammadex 4 mg/kg or neostigmine 70 μg/kg with glycopyrrolate 14 μg/kg at 1-2 post-tetanic counts. The primary efficacy

2010 BMC anesthesiology Controlled trial quality: uncertain

69. Effects of sugammadex doses up to 32 mg/kg alone or in combination with rocuronium or vecuronium on QTc prolongation: a thorough QTc study. (Abstract)

Effects of sugammadex doses up to 32 mg/kg alone or in combination with rocuronium or vecuronium on QTc prolongation: a thorough QTc study. Sugammadex reverses the effects of rocuronium- and vecuronium-induced neuromuscular blockade, which are achieved by encapsulation. It is known that some non-antiarrhythmic drugs have the potential to delay cardiac repolarization and it is therefore recommended that the effects of all new drugs on the QT interval are assessed.This thorough corrected QT (QTc (...) ) study evaluated the effect of sugammadex alone and in combination with rocuronium or vecuronium on the individually corrected QTc interval (QTcI).This was a randomized, double-blind, six-period crossover, placebo-controlled study, with an open-label active-controlled component (moxifloxacin). The study was designed according to International Conference on Harmonization (ICH) E14 guidelines. The study was conducted in a clinical research unit from November 2006 to April 2007. Healthy male and female

2010 Clinical drug investigation Controlled trial quality: predicted high

70. Sugammadex rapidly reverses moderate rocuronium- or vecuronium-induced neuromuscular block during sevoflurane anaesthesia: a dose-response relationship. Full Text available with Trip Pro

Sugammadex rapidly reverses moderate rocuronium- or vecuronium-induced neuromuscular block during sevoflurane anaesthesia: a dose-response relationship. Sugammadex shows a dose-response relationship for reversal of neuromuscular block (NMB) during propofol anaesthesia. Sevoflurane, unlike propofol, can prolong the effect of neuromuscular blocking agents (NMBAs), increasing recovery time. This open-label, randomized, dose-finding trial explored sugammadex dose-response relationships, safety (...) , and pharmacokinetics when administered for reversal of moderate rocuronium- or vecuronium-induced NMB during sevoflurane maintenance anaesthesia.After anaesthesia induction with propofol, adult patients were randomized to receive single-dose rocuronium 0.9 mg kg⁻¹ or vecuronium 0.1 mg kg⁻¹, with maintenance doses as needed. Anaesthesia was maintained with sevoflurane. NMB was monitored using acceleromyography. After the last dose of NMBA, at reappearance of T(2), single-dose sugammadex 0.5, 1.0, 2.0, or 4.0 mg kg

2010 British Journal of Anaesthesia Controlled trial quality: uncertain

71. Acceleromyographic monitoring of neuromuscular block over the orbicularis oris muscle in anesthetized patients receiving vecuronium. (Abstract)

Acceleromyographic monitoring of neuromuscular block over the orbicularis oris muscle in anesthetized patients receiving vecuronium. To evaluate the level of neuromuscular block acceleromyographically over the orbicularis oris muscle.Prospective, randomized, controlled study.Operating room of a university-affiliated hospital.36 adult, ASA physical status I and II women scheduled for mastectomy with air-oxygen-isoflurane-fentanyl anesthesia.Patients were randomized to two groups (...) . In the orbicularis oris group (n=18), the facial nerve was stimulated and movement of the orbicularis oris muscle was measured acceleromyographically. In the control group (n=18), adduction of the thumb was quantified mechanically.Onset and recovery of neuromuscular block caused by vecuronium 0.1 mg/kg were compared between the groups.Time to onset of neuromuscular block in the orbicularis oris group was significantly shorter than in the control group (176 + or - 52 vs. 220 + or - 34 sec, mean + or - SD; P

2010 Journal of clinical anesthesia Controlled trial quality: uncertain

72. Neuromuscular blockade by vecuronium during induction with 5% sevoflurane or propofol. Full Text available with Trip Pro

Neuromuscular blockade by vecuronium during induction with 5% sevoflurane or propofol. This randomized trial investigated whether 5% sevoflurane potentiated neuromuscular blockade by vecuronium. General anaesthesia was induced with 5% sevoflurane in oxygen in 16 patients or with propofol in 16 patients. After loss of consciousness, vecuronium was administered to all participants at randomly assigned doses of 25, 30, 35 or 40 μg/kg. Neuromuscular blockade was assessed by use of acceleromyography

2010 The Journal of international medical research Controlled trial quality: uncertain

74. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient

in November 2012 and included the timeframe of 2001 to November 22, 2012 (to capture literature published since the previous guidelines were created) using the following terms: neuromuscular blocking agents , neuromuscular blockers, cisatracurium, atracurium, rocuronium, vecuronium, pancuronium, succinylcholine , and sugammadex , each alone and in combination with sedation , analgesia, monitoring, electroencephalogram (EEG), Bispectral Index (BIS), shock, oxygen delivery, oxygen consumption, pregnancy (...) nervous system and at presynaptic muscarinic receptors in the peripheral sympathetic nervous system, with the former resulting in vagolytic action and the latter increasing norepinephrine release, both of which cause tachycardia. Rocuronium, more so than vecuronium, has affinity for muscarinic receptors at other sites within the parasympathetic nervous system. The remaining nondepolarizing agents have even weaker affinities for the muscarinic receptor ( ). The most significant manifestation

2016 Society of Critical Care Medicine

75. Syringe labelling in critical care areas review

/ml. mg/ml. Vecuronium mg/ml. Morphine mg/ml. Fentanyl micrograms/ml. micrograms/ml. Ephedrine mg/ml. Atropine micrograms/ml. Glycopyrronium micrograms/ml. Ondansetron mg/ml. Diazepam mg/ml. Midazolam mg/ml. Neostigmine micrograms/ml. Naloxone micrograms/ml. Labetalol mg/ml. Lidocaine %. Bupivacaine %. Heparin units/ml. Protamine mg/ml. STANDARD BACKGROUND COLOURS FOR USER-APPLIED SYRINGE DRUG LABELS Drug class Examples Pantone ® colour (uncoated) Anti-emetics Metoclopramide, Ondansetron Pantone ® (...) 156 (salmon) Induction agents Thiopental, etomidate, ketamine, propofol Yellow Hypnotics Diazepam, lorazepam, midazolam Pantone ® 151 (orange) Hypnotic antagonists Flumazenil Pantone ® 151 (orange with white diagonal stripes) Depolarising neuromuscular blocking drugs Suxamethonium Pantone ® 805 (fluorescent or warm red lettering out of black above, red below) Non-depolarising neuromuscular blocking drugs Atracurium, Vecuronium Pantone ® 805 (fluorescent or warm red) Neuromuscular blocking drug

2016 Association of Anaesthetists of GB and Ireland

76. Neostigmine Methylsulfate Injection, USP

, p. 712 of article) 99 Table 16 Calculated effective doses of neostigmine for 50% (ED 50 ) and 80% (ED 80 ) recovery of the TOF in children and adults (based on Table 2, p. 712 of article) 100 Table 17. Summary of study findings 102 Table 18. Mean TH and TOF values at 15 minutes after neostigmine administration (from Table 1 on p. 576 of article) 105 Table 19. Recovery times from Rocuronium and Vecuronium after Neostigmine administration (based on tables 3 and 4 in the article) 108 Table 20 (...) . Summary of the Caldwell et al. study results 111 Table 21. TOF ratios at different times following vecuronium and neostigmine administration (Table 2 on p. 1170 of the article) 114 Table 22. Summary of pharmacodynamic effects of neostigmine for patients with normal renal function (NL) and end-stage renal disease (RF) [mean (SD)] (based on Table 1 on p. 135 of the article) 117 Reference ID: 3187027Clinical Review Arthur Simone, MD, PhD NDA 203629 Neostigmine Sulfate Injection, USP 6 Table 23. Time

2014 FDA - Drug Approval Package

77. Task Force 5: Pediatric Cardiology Fellowship Training in Critical Care Cardiology

inhibitors, calcium channel antagonists, beta-adrenergic antagonists, nitric oxide donors) • Commonly used antiarrhythmic agents (eg, digoxin, adenosine, esmolol/propranolol, procainamide, lido- caine, amiodarone) • Pulmonary vasodilators (eg, inhaled nitric oxide, prosta- cyclin, PDE5 inhibitors) • Prostaglandin E 1 • Neuromuscular blocking agents (eg, pancuronium, vecuronium, rocuronium, succinylcholine) • Analgesics and sedatives (eg, opiates, ketamine, benzo- diazepines, dexmedetomidine

2015 American Heart Association

78. Retrospective Analysis of the Safety and Efficacy of Sugammadex Versus Neostigmine for the Reversal of Neuromuscular Blockade in Children. (Abstract)

Retrospective Analysis of the Safety and Efficacy of Sugammadex Versus Neostigmine for the Reversal of Neuromuscular Blockade in Children. Sugammadex, with its novel mechanism of action of encapsulation and noncompetitive binding of aminosteroid neuromuscular-blocking agents (rocuronium and vecuronium), may offer distinct advantage to pediatric patients where residual neuromuscular blockade may be poorly tolerated. Data describing its use in the pediatric population are limited, and no large

2019 Anesthesia and Analgesia

79. Propofol sparing effect of dexmedetomidine and magnesium sulfate during BIS targeted anesthesia: A prospective, randomized, placebo controlled trial. (Abstract)

of propofol and vecuronium, Ramsay sedation score, BIS values and hemodynamic parameters intraoperatively.Propofol required in group D was significantly lower 101.3 ± 16.5 than group M and N with dose of 114 ± 15.5 and 160.50 ± 25.08 respectively (p <0.001). Dose requirement of vecuronium was significantly reduced in group M 5.4 ± 0.8 and group D 6.6 ± 1.2 as compared to N 7.9 ± 1.4 (p <0.001). No significant differences were seen regarding baseline hemodynamics, RSS and BIS values in all groups. After

2019 Journal of anaesthesiology, clinical pharmacology Controlled trial quality: uncertain

80. Factors associated with post-intubation sedation after emergency department intubation: A Report from The National Emergency Airway Registry. (Abstract)

with a higher odd of post-intubation sedation compared to a long-acting neuromuscular blocking agent (i.e. rocuronium or vecuronium) (1.89; 1.68-2.12).Post-intubation sedation rates in NEAR are higher than previously reported and multiple factors including the indication for intubation and succinylcholine use, are associated with higher odds of receiving post-intubation sedation.Copyright © 2019 Elsevier Inc. All rights reserved.

2019 American Journal of Emergency Medicine

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