Muscle Relaxant Agent Research Articles

Comparison of supraglottic airway device and endotracheal tube in former preterm infants receiving general anesthesia: a randomized controlled trial

To date, endotracheal tube (ETT) remains the mainstream for preterm infants receiving general anesthesia. We aim to compare the perioperative respiratory adverse events between using supraglottic airway device (SAD) and ETT in former preterm infants receiving general anesthesia. Former preterm infants below 52 weeks of postmenstrual age scheduled for herniorrhaphy were randomized to receive SAD or ETT for general anesthesia. Infants with severe congenital cardiopulmonary disease, prolonged oxygen or mechanical ventilation dependence, and recent respiratory tract infection were excluded. Muscle relaxant agents and opioids were avoided in this study. 40 infants were assigned into SAD or ETT groups. Infants in the SAD group had a much lower rate of intraoperative desaturation than those in the ETT group (21.1% vs. 73.7%, p = 0.003). Incidences of other intraoperative and postoperative 24-h respiratory adverse events were similar between groups, including laryngospasm/bronchospasm, cough and stridor during anesthesia, and postoperative apnea, bradycardia, and supplemental oxygen use. All participants were extubated successfully in the operation room. SAD is recommended in former preterm infants receiving general anesthesia for herniorrhaphy in their early infancy as it much decreases the incidence of intraoperative desaturation compared to ETT.

Comparison of the effects of remifentanil and fentanyl on awakening and hemodynamic parameters in probe curettage cases

Aim: We aimed to investigate the effects of two different opioids, fentanyl, and remifentanil, on waking parameters, hemodynamic effects, duration of stay in the post-anesthesia care unit (PACU), pain and nausea and vomiting in patients undergoing probe curettage surgery. Methods: Sixty-six patients scheduled for probe curettage surgery were randomly divided into Fentanyl (Group F, n = 33) and Remifentanil (Group R, n = 33) groups. For induction of anesthesia, 2.5 mg/kg propofol was administered as a bolus in both groups, 2.5 mcg/kg fentanyl in Group F and 2-4 mcg/kg i.v. remifentanil in Group R. No muscle relaxant agent was used. The laryngeal mask size was selected according to the patient’s body weight. For induction of anesthesia, 2.5 mg/kg propofol was administered as a bolus in both groups, 2.5 mcg/kg fentanyl in Group F, and 2-4 mcg/kg i.v. remifentanil in Group R. No muscle relaxant was used. The laryngeal mask size was selected according to the patient’s body weight and the cuff pressure was adjusted to 60 cm H2O using a manometer. Results: The demographic data of both groups were similar in our study. Extubation time was shorter in Group R. The difference between the groups was significant (p

Comparison of three different doses of cis-atracurium under isoflurane anesthesia

Aims: In this study; we compared the effects of three different doses of cis-atracurium, a nondepolarizing muscle relaxant agent, on neuromuscular blockade duration, endotracheal intubation quality and hemodynamic parameters under isoflurane anaesthesia.
 Methods: A total of 60 patients (ASA I-II) were included in the study. Patients were premedicated with 10 mg diazepam intramuscularly 45 minutes before the operation. After the patients were transferred to the operating room, they were monitored noninvasively for heart rate and arterial blood pressure. Train of Four (TOF)-GUARD acceleration monitor was used for neuromuscular evaluation. All patients were administered 1 mg/kg fentanyl and 2 mg/kg propofol at induction, and anaesthesia maintenance was provided with 1.5% isoflurane+50% N2O+50% O2. The patients were divided into three groups according to the dose of cisatracurium administered: 0.15 mg/kg was administered to Group 1, 0.20 mg/kg was administered to Group 2, and 0.40 mg/kg cis-atracurium was administered to Group 3. Endotracheal intubation was performed at 120 seconds, and the block time of 99-100% (effect onset time) was recorded.
 Result: Although the endotracheal intubation quality was evaluated as excellent and/or good in all three groups, the intubation quality of Group 3 was statistically higher than the other two groups (p

General anaesthesia for laparoscopic umbilical hernia repair in a patient with pseudocholinesterase deficiency: a case report

Pseudocholinesterase deficiency is a condition that causes prolonged muscle weakness when succinylcholine or mivacurium is used as a neuromuscular blocking agent. It can be either inherited or acquired. The practice of not using these two muscle relaxant agents may suggest that PED is not a significant problem for general anesthesia. This case report describes the successful discharge of a patient with a preexisting diagnosis of PED who underwent laparoscopic umbilical hernia repair under GA with neuromuscular monitoring without complications.

A comparative study to evaluate the optimum intubating dose of rocuronium bromide versus succinylcholine chloride as an ideal intubating muscle-relaxing agent

Background: Rocuronium bromide is a new amino steroidal neuromuscular blocking agent which is structurally related to vecuronium and its onset time and intubating conditions are comparable with succinylcholine and without the undesirable side effects. Aims and Objectives: This study was planned to evaluate the ideal intubating dose of rocuronium bromide by comparing intubating conditions achieved by its different doses of rocuronium bromide and to consider rocuronium as an ideal intubating muscle relaxing agent, in place of succinylcholine chloride for elective long surgeries. Materials and Methods: This study was conducted on 120 patients who fulfilled the eligibility criteria. These patients were randomized into four groups of 30 each by block randomization technique. Each group received rocuronium bromide 0.6 mg/kg, 0.9 mg/kg, 1.2 mg/kg, and succinylcholine chloride 1 mg/kg, respectively. Results: Out of all the three doses of rocuronium bromide 0.9 mg/kg produced a similar intubating condition as succinylcholine chloride in the dose of 1 mg/kg without undue prolongation of the neuromuscular blockade. Conclusion: Rocuronium bromide can be used as an alternative to succinylcholine as an ideal intubating muscle relaxing agent.

Investigation of CNS depressant and muscle relaxant effects of the ethnomedicinal plant Macropanax dispermus on Swiss Albino mice and its effect against oxidative stress.

Since plant-based natural drugs are widely accepted in modern times and possess numerous pharmacological effects with an extensive therapeutic range, an ethnomedicinal plant native to Bangladesh was selected to investigate for investigation of its various pharmacological effects. Macropanax dispermus has been traditionally used and has demonstrated numerous pharmacological effects in preclinical investigations. Therefore, this research aimed to assess the central nervous system (CNS) depressant and antioxidant activities of the crude methanol extracts of the stem barks (MDMS), leaves (MDML), and their different fractions. The CNS depressant activity was assessed using the hole cross, rota-rod, and elevated plus maze tests on Swiss Albino mice, while the antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl free radical, hydrogen peroxide (H2O2) nonradical scavenging, and ferric reducing power assays. The conducted assays successfully demonstrated that the chloroform fraction of MDML is a significantly (P < 0.001) effective CNS depressant, muscle relaxant, and anxiolytic agent with excellent antioxidative effects compared to standard and control. The aqueous fraction of MDML also acted as a significantly (P < 0.001) active CNS depressant and muscle relaxant, and it was a highly active ferric-reducing agent. All effects were dose and concentration-dependent. The presence of various phytochemicals might contribute to these activities. However, further research is suggested to isolate their active compounds and evaluate their mechanisms of action.

Effect of Interpectoral-Pectoserratus Plane (PECS II) Block on Recovery Room Discharge Time in Breast Cancer Surgery.

Background and Objectives: The increase in the incidence and diagnosis rate of breast cancer demands the optimization of resources. The aim of this study was to assess whether the supplementation of the interpectoral-pectoserratus plane block (PECS II) reduces surgery and post-anesthesia care unit (PACU) time in patients undergoing breast cancer surgery. Materials and methods: This was a retrospective data-analysis study. In 2016, PECS II block was introduced as a supplement to general anesthesia for all mastectomies with or without axillary resections in South Jutland regional hospital, Denmark. The perioperative data of patients operated 3 years before and 3 years after 2016 was retrieved through the Danish anesthesia database and patient journals and systematically analyzed. Female patients aged over 18 years, with no use of muscle relaxant, intubation, and inhalation agents, were included. The eligible data was organized into two groups, i.e., Block and Control, where the Block group received PECS II Block, while the Control group received only general anesthesia. Parameters such as surgery time, anesthesia time, PACU time, opioid consumption, and the incidence of postoperative nausea and vomiting (PONV) in PACU were retrieved and statistically analyzed. Results: A total of 172 patients out of 358 patients met eligibility criteria. After applying exclusion criteria, 65 patients were filtered out. A total of 107 patients, 51 from the Block and 56 from the Control group, were eligible for the final analysis. The patients were comparable in demographic parameters. The median surgery time was significantly less in the Block group (78 min (60-99)) in comparison to the Control group (98.5 min (77.5-139.5) p < 0.0045). Consequently, the median anesthesia time was also shorter in the Block group (140 min (115-166)) vs. the Control group (160 min (131.5 to 188), p < 0.0026). Patients from the Block group had significantly lower intraoperative fentanyl consumption (60 µg (30-100)) as compared with the Control group (132.5 µg (80-232.5), p < 0.0001). The total opioid consumption during the entire procedure (converted to morphine) was significantly lower in the Block group (16.37 mg (8-23.6)) as compared with the Control group (31.17 mg (16-46.5), p < 0.0001). No statistically significant difference was found in the PACU time, incidences of PONV, and postoperative pain. Conclusions: The interpectoral-pectoserratus plane (PECS II) block supplementation reduces surgery time, anesthesia time, and opioid consumption but not PACU time during breast cancer surgery.

Commonly Used Muscles Relaxant and Reversal Agents for Children Treated Under General Anaesthesia - A Retrospective Cohort Study

Background: Pediatric patients going through dental systems and who are incredibly uncooperative, unfortunate, restless, or actually safe without any assumption for conduct improvement are gone through for general anaesthesia (GA) to do the treatment. Changes in the training and advancement of general sedative medications have impacted the utilization of muscle relaxants and inversion specialists in pediatric patients. Aims: The aim of the review was to survey the commonly used muscle relaxant and reversal agents for pediatric patients treated under general anesthesia in Saveetha dental college from March 2020 to February 2021. Setting and Design: A retrospective study was conducted on pediatric patients treated under general anesthesia to determine the commonly used muscle relaxants and reversal agents. Materials and Methods: From pediatric patients visiting private dental hospital, those who are treated under general anesthesia from March 2020 to February 2021 considered as inclusion . Exclusion criteria involve those who are not treated under general anesthesia. The final sample size 100. The age , gender, muscle relaxants and reversal agents prescribed were considered and tabulated and SPSS (Statistical Package for the Social Sciences, Chicago,USA) was used to analyze the data. The results were compared using descriptive statistics and Chi-square-test. Then 0.05 was set to be a P value for the level of significance. Results: From the results of the study, atracurium(99%) and vecuronium(1%) were the commonly used muscle relaxants and neostigmine + glycopyrrolate(100%) was the commonly used reversal agents for pediatric patients treated under general anesthesia. Conclusions: From the study , there were only a few standard drugs like atracurium and vecuronium used as muscle relaxant and neostigmine + glycopyrrolate reversal agents were used for pediatric patients who were treated under general anesthesia .

YSZ/MoS2 modified carbon based sensor for the determination of muscle relaxant agent chlorzoxazone: A novel electroanalytical strategy

YSZ/MoS2 modified carbon based sensor for the determination of muscle relaxant agent chlorzoxazone: A novel electroanalytical strategy

Special Considerations in Pediatrics for Rapid Intubation Sequence

The rapid intubation sequence (RISS) in children is a fundamental procedure used in emergency situations and pediatric critical care to ensure a safe airway and establish effective mechanical ventilation. This study aims to provide a comprehensive and up-to-date review of SIR in children, focusing on key aspects related to its clinical application. The essential steps of SIR in children are reviewed in detail, including pre-preparation, administration of sedative and muscle relaxant agents, induction of anesthesia, laryngoscopy, insertion of the endotracheal tube, confirmation of proper tube position, and subsequent respiratory support. Anatomic and physiologic differences between children and adults are highlighted, and specific considerations to be taken into account when performing SIR in this vulnerable population are described. In addition, the different drugs used for sedation and muscle relaxation in pediatric RDS are discussed in depth, highlighting dosages, pharmacologic effects, and potential associated complications. The importance of careful selection of appropriate agents and doses based on the child's age, weight, and clinical condition is discussed. It also addresses the use of specific medical equipment in pediatric RDS, such as pediatric laryngoscopes, adapted endotracheal tubes, pediatric videolaryngoscopy devices and capnographs, highlighting their relevance in the accurate visualization of the airway and confirmation of adequate intubation. Finally, the importance of adequate training, clinical expertise and multidisciplinary collaboration in the successful performance of SIR in children is highlighted. Emphasis is placed on the need for continuous monitoring and meticulous evaluation throughout the procedure, as well as the implementation of strategies to minimize risks and potential complications.

In Silico and In Vitro Screening of Novel Pyridazine Analogs as Muscle Relaxant Agent on Acetylcholine Muscarinic Receptor

Background:: Among Nitrogen-containing heterocyclic compounds, pyridazine derivatives serve as a necessary scaffold as they possess various pharmacological activities. Thus, in recent times, the design of novel synthetic schemes and the selection of a new target for the action of pyridazine derivatives have attracted the attention of researchers. Objective:: This study has focused on synthesizing and evaluating the muscle relaxant activity of pyridazine analogs by in-silico screening and rotarod test. Methods: In the present work, pyridazine derivatives were synthesized from substituted pyridine and maleic anhydride yielding intermediates (1a-5a), which on reaction with hydrazine, yielded final pyridazine derivatives (1b-5b). They were then screened for muscle relaxant action by an in-silico docking study against muscarinic acetylcholine receptors with protein data bank ID: 5CXV with the use of Autodock 4.2 and Biovia discovery studio tools. Compounds were further tested for muscle relaxant activity by the rotarod test. Results: Synthesis of the designed compounds was carried out successfully. Obtained result showed that the final compounds (1b-5b) showed 1-3 interactions with acetylcholine muscarinic receptor with -7.2 to -7.9 Kcal/mole affinities. The findings were compared to the typical drug diazepam, which has one interaction with the target and binding energy of -7.7 Kcal/mole. Moreover, the result of the rotarod test showed that substitution by electron-withdrawing groups causes more muscle relaxant activity when compared with the electron releasing groups. Conclusion:: The results of the experimental study showed that pyridazine derivatives could serve as a promising template for the further design and development of muscle relaxant agents.

Feasibility and Safety of Remazolam versus Propofol When Inserting Laryngeal Masks Without Muscle Relaxants During Hysteroscopy.

This study aimed to evaluate the efficacy and safety of remazolam compared with propofol in patients who underwent laryngeal mask airway (LMA) insertion without the use of muscle relaxant agents during hysteroscopic surgery. A total of 72 patients undergoing hysteroscopy with LMA insertion were assigned to two groups. The patients in the remazolam group received 0.3 μg/kg sufentanil, 0.3 mg/kg remazolam and 1.2 mg/kg remifentanil, whereas the patients in the propofol group received 0.3 μg/kg sufentanil, 2.0 mg/kg propofol and 1.2 mg/kg remifentanil for insertion of the LMA. The primary endpoint was the summed score of the insertion conditions. The secondary endpoints included hemodynamics, the duration of induction, the duration of insertion, tidal volume, plateau pressure and adverse events. No difference was identified between the propofol group and remazolam group in the median summed score [18.0 (18.0, 18.0), 18.0 (17.0, 18.0), respectively, P > 0.05]. The induction duration was significantly longer (P < 0.05) in the remazolam group than propofol group. The cost of dopamine (P < 0.05) was significantly lower in the remazolam group compared with the patients in the propofol group, while the plateau pressure (P < 0.05) and the incidence of transient mild laryngospasm (P < 0.05) were significantly higher in the remazolam group. No differences were identified between the two groups in terms of heart rate, tidal volume, injection pain or hiccups (P > 0.05). Remazolam provided similar insertion conditions and better hemodynamic stability than propofol during LMA insertion without the use of muscle relaxant agents. However, a higher incidence of transient mild laryngospasm was found in the remazolam group, which should be considered.

Rocuronium with sugammadex as a rescue reversal agent to solve conflicting recommendations for thyroid or parathyroid surgery. A prospective study

IntroductionFor thyroid or parathyroid surgery, there is a challenge to select a muscle relaxant agent allowing a good quality for tracheal intubation without any residual effect at the time of intraoperative neural monitoring. Patients and methodsIn this monocentric study, non-morbidly obese adult patients without risk factors for difficult tracheal intubation who underwent thyroid or parathyroid surgery with intraoperative neural monitoring were prospectively included. After rocuronium injection (0.5 mg.kg−1) during propofol-sufentanil induction, intubation conditions were evaluated using the Copenhagen score. The surgeon positioned the electrodes NIM® and tested the vagal nerve before recurrent nerve dissection. The signal was considered positive when the wave amplitude exceeded 100 μV. If not, sugammadex (2 mg.kg−1) was administered. The dissection began when the signal was positive. ResultsFrom January 2022 to June 2022, 48 out of 50 patients, 39 (81%) female, met inclusion criteria and were prospectively recruited in the study (two patients had predictable difficult intubation criteria). Intubation conditions were clinically acceptable for 46/48 (96%) of patients. The time delay from rocuronium injection to vagal stimulation was 43 min (mean) +/− 11 (SD). The vagal stimulation was positive in 45 patients (94%). In the 3 remaining patients, sugammadex successfully reversed residual curarization and allowed positive vagal stimulation. DiscussionThis prospective study shows that the use of 0.5 mg.kg−1 rocuronium with sugammadex as a rescue reversal agent allows good quality and safety for intubation conditions and intraoperative neural monitoring in patients scheduled for thyroid or parathyroid surgery.

Phenanthroindolizidine Alkaloids Secondary Metabolites Diversity in Medicinally Viable Plants of the Genus Tylophora

Plants of the genus Tylophora have commonly been used in traditional medicine in various communities, especially in the tropical and subtropical regions of climatic zones. Of the nearly 300 species reported in the Tylophora genus, eight are primarily used in various forms to treat a variety of bodily disorders based on the symptoms. Certain plants from the genus have found use as anti-inflammatory, anti-tumor, anti-allergic, anti-microbial, hypoglycemic, hypolipidemic, anti-oxidant, smooth muscle relaxant, immunomodulatory, and anti-plasmodium agents, as well as free-radical scavengers. Pharmacologically, a few plant species from the genus have exhibited broad-spectrum anti-microbial and anti-cancer activity, which has been proven through experimental evaluations. Some of the plants in the genus have also helped in alcohol-induced anxiety amelioration and myocardial damage repair. The plants belonging to the genus have also shown diuretic, anti-asthmatic, and hepato-protective activities. Tylophora plants have afforded diverse structural bases for secondary metabolites, mainly belonging to phenanthroindolizidine alkaloids, which have been found to treat several diseases with promising pharmacological activity levels. This review encompasses information on various Tylophora species, their distribution, corresponding plant synonyms, and chemical diversity of the secondary metabolic phytochemicals as reported in the literature, together with their prominent biological activities.

237 Frequency of Discharge Prescriptions Known to Increase Fall Risk for Older Adults: Estimates of Incidence in the United States

The Centers for Disease Control and Prevention estimate that 36 million older adults fall each year in the United States, and 32,000 die due to falls. Several classes of potentially inappropriate medications commonly prescribed at ED discharge are known to elevate fall risk, including opioids (Relative Risk 1.4), benzodiazepines (Odds Ratio (OR) 1.6), sedatives/hypnotics (OR 1.5), muscle relaxants (OR 1.3), and anticholinergic agents (OR 1.6). However, little research has been done to characterize the frequency of ED prescriptions of such medications. Our objective was to estimate the annual incidence of discharge prescriptions for medications known to increase fall risk for older adults in the United States. In a hypothesis-generating exercise, we also sought to describe visit characteristics associated with prescriptions for medications that increase fall risk so that we can tailor future work to reduce potentially harmful prescriptions. This was a descriptive, retrospective observational study of the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2019 dataset. We limited our analysis to patients age 65+ who were discharged without inpatient or observation admission. We categorized patients as having received at least one ED discharge prescription for a medication known to increase fall risk (opioid, benzodiazepine, sedative/hypnotic, muscle relaxant, and/or anticholinergic agent) versus those who did not. We also generated descriptive statistics for patients in both groups. The analysis was performed with Stata/MP version 17.0, and the iweight function was used to generate national estimates. Out of a sample of 16.9 million discharged patients age 65+, an estimated 2.3 million received a prescription for at least one medication that is known to increase fall risk. The most commonly prescribed classes of medications were: opioids (1.5 million), anticholingeric agents (323,000), muscle relaxants (269,000), benzodiazepines (153,000), and sedative/hypnotics (31,000). These estimates were generated from the following unweighted results: a sample size of 2,137 patients who met inclusion criteria, and 291 who received medications known to increase fall risk (176 opioid, 52 anticholinergic, 45 muscle relaxant, 14 benzodiazepine, and 4 sedative/hypnotic). Given the small sample size for the less common prescriptions, comparisons in the Table are done using pooled data for all patients with prescriptions of interest. Approximately 2.3 million older adults received prescriptions at the time of ED discharge for medications that are known to increase fall risk. The role that these prescriptions play in causing falls and other adverse health outcomes after ED discharge has not been thoroughly investigated.

Fatal multiorgan failure in baclofen overdose: An autopsy case report

Baclofen is a synthetic derivative of GABA and is used as a muscle relaxant or antispasmodic agent. It is used in the management of various muscle spasticity resulting from conditions such as cerebral palsy, spinal cord injuries, and stroke. The reported potential adverse effects following overdose are marked impairment in consciousness, acute kidney injury, seizures, coma, and respiratory failure. Since there is no specific antidote available to treat baclofen toxicity, the mainstay of management remains supportive treatment. Herein we describe a case of baclofen overdose in a 62-years-old male who consumed 15 tablets of 25 mg tablets of baclofen (375 mg) and died due to multiorgan failure after 5 days of poisoning. Although many reports in the published medical literature describe the clinical manifestations and the management of baclofen toxicity, only a few reports presented the fatality in baclofen overdose. Furthermore, no report documented the death following lethal multiorgan failure resulting from baclofen overdose, and from India to the best of our knowledge.

Efficacy of Different Doses of Cisatracurium for Intubation for Surgeries under General Anaesthesia- A Randomised Clinical Study

Introduction: Cisatracurium is a new non depolarising, Neuromuscular Blocking Drug (NMBD) with fast onset and short duration of action. It is a stereoisomer of atracurium with a potency of approximately 3 to 4 times greater than that of atracurium. As it is devoid of histamine release, it reduces the chances of adverse effects during operative procedures. However, the optimum intubating dosage needs to be established in patients. This warrants the need for studies focusing on the efficacy of different doses of cisatracurium and their outcomes. Aim: To study the efficacy of three different doses of cisatracurium {2x Effective dose (ED) 95, 4x ED95, and 6x ED95} for the time of onset of action, duration and haemodynamic stability offered for intubation. Materials and Methods: A double-blind, randomised clinical study was conducted from December 2017 to July 2019 at a tertiary care hospital and research center, Kolhapur, Maharashtra, India. Total 90 patients, undergoing surgeries under general anaesthesia were allocated into three groups, group A received 0.1 mg/kg, group B received 0.2 mg/kg and group C received 0.3 mg/kg of cisatracurium. Time taken for Train Of Four (TOF) to reach 0 was taken as the onset of action, and appearance of TOF 2/3 or patient’s attempt to breathe was taken as duration of action. Haemodynamic changes were also assessed preoperatively and postintubation immediately after confirmation of placement of ETT. Results: Mean age 33.23±6.26 years in group A, 37.70±10.80 years in group B, 38.23±8.764 years in group C (p-value=0.06). Least time was required for the TOF to become zero by group C (5.10±1.01 minutes) as compared to groups A and B (9.91±1.39 and 7.48±1.45 minutes) which was statistically significant (p-value &lt;0.001). The duration of action was also more in group C (49.83±5.33) compared to group A (27.23±6.97) and group B (36.17±7.62) (p-value=0.00001). Group C had better haemodynamic stability as the heart rate remained more stable than group A and group B. Conclusion: Higher dose of cisatracurium provides faster onset, longer duration of action with better cardiovascular stability. This predictable recovery from non depolarising muscle relaxation makes it a good choice of muscle relaxant agent for intubation.

Bispectral index scores predicting complications after tracheal intubation

BackgroundTracheal intubation is a procedure that may cause various complications. The primary aim of this study is to investigate whether the Bispectral Index™ (BIS) can predict tracheal intubation complications sooner than other monitoring parameters. MethodsA total of 55 consecutive patients were intubated. Sociodemographic data, the reason for tracheal intubation, diagnosis, starting dose or dose increase of a vasopressor drug, use of sedatives and muscle-relaxing agents, vital signs, BIS scores, and end-tidal CO2 values before the procedure, during laryngoscopy, and within 30 min after tracheal intubation were recorded along with their tracheal intubation-related complications. ResultsThe mean age of the patients was 75.1 ± 14.4 years. Pneumonia (n = 17, 30.9%) and sepsis (n = 14, 25.5%) were found to be the two most prominent diagnoses. The most common indications for intubation were a low Glasgow Coma Scale score of ≤8 (67.3%) and respiratory failure (61.8%). Postintubation hemodynamic instability developed in 38 patients (69.1%).The BIS value obtained at minute 3 was the lowest among all measurements. Significantly lower values of BIS (minute 3) were found for patients with postintubation hemodynamic instability (46 vs. 72, p = 0.039). Using ketamine (OR = 8.99, 95% CI: 1.60–50.47, p = 0.013) and systoloc blood pressure (OR = 1.03, 95% CI: 1.01–1.05, p = 0.017) were found to be significant risk factors for the development of postintubation hemodynamic instability. ConclusionIn this study, the lowest BIS values were detected at minute three after intubation. The BIS values obtained at minute three were found to be significantly associated with the development of postintubation hemodynamic instability.

Beyond relaxed: magnesium chloride anaesthesia alters the circulatory metabolome of a marine mollusc (Perna canaliculus).

The New Zealand Green-lipped mussel industry is well-established providing vastly to aquaculture exports. To assess mussel health and reproduction status, visual examination of organs and/or collection of haemolymph is commonly applied. Anesthetics, such as magnesium chloride (MgCl2) can be utilized to prevent muscle contraction and keep shells open during sampling. The specific effects of muscle relaxing agents on baseline metabolism in invertebrates is unknown, but it is evident that molecular, cellular and physiological parameters are altered with these chemical applications. To this end, metabolomics approaches can help elucidate the effects of relaxing agents for better assessment of their use as a research tool. Adult Green-lipped mussels were anaesthetized for 3h in a MgCl2 bath, whereafter haemolymph samples were collected and analyzed via gas chromatography-mass spectrometry applying methyl chloroformate alkylation derivatization. Anesthetized mussels were characterized as non-responsive to manual manipulation, with open valves, and limited siphoning function. Metabolite profiling revealed significant increases in the abundances of most metabolites with an array of metabolic activities affected, resulting in an energy imbalance driven by anaerobic metabolism with altered amino acids acting as neurotransmitters and osmolytes. This research is the first to use ametabolomics approach to identify the metabolic consequences of this commonly used bivalve relaxing technique. Ultimately the use of MgCl2 anesthetization as a sampling strategy should be carefully evaluated and managed when performing metabolomics-related research.

Use of Botulinum Toxin Injections for the Treatment of Chronic Anal Fissure: Results From an American Society of Colon and Rectal Surgeons Survey.

Chronic anal fissure (CAF) is commonly treated by colorectal surgeons. Pharmacological treatment is considered first-line therapy. An alternative treatment modality is chemical sphincterotomy with injection of botulinum toxin (BT). However, there is a lack of a consensus on the BT administration procedure among colorectal surgeons. A national survey approved by the American Society of Colon and Rectal Surgeons (ASCRS) Executive Council was sent to all members. An eight-question survey was sent via ASCRS email correspondence between December 2019 and February 2020. Questions were derived from available meta-analyses and expert opinions on BT use in CAF patients and included topics such as BT dose, injection technique, and concomitant therapies. The survey was voluntary and anonymous, and all ASCRS members were eligible to complete it. Responses were recorded and analyzed via an online survey platform. 216 ASCRS members responded to the survey and 90% inject 50-100U of BT. Most procedures are performed under MAC anesthesia (56%). A majority of respondents (64%) inject into the internal sphincter and a majority (53%) inject into 4 quadrants in the anal canal circumference. Some respondents perform concomitant manual dilatation (34%) or fissurectomy (38%). Concomitant topical muscle relaxing agents are not used uniformly among respondents. Injection of BT for CAF is used commonly by colorectal surgeons. There is consensus on BT dosage, administration site, technique, and the use of monitored anesthesia care.