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Related Concept Videos

Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Allergic Reactions: Anaphylaxis01:30

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Anaphylaxis is a severe, life-threatening hypersensitivity reaction mediated by Immunoglobulin E (IgE) antibodies. When IgE binds to allergens, it triggers the release of mediators– histamine, leukotrienes, and prostaglandins from mast cells and basophils. These mediators cause vasodilation, edema, and inflammation, leading to various symptoms.The primary allergens causing anaphylaxis include food items (e.g., peanuts, shellfish), drugs (e.g., penicillin, asparaginase, corticotropin,...
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Skeletal Muscle Relaxants: Adverse Effects01:21

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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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Related Experiment Video

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Measuring Local Anaphylaxis in Mice
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Early skin and challenge testing after rocuronium anaphylaxis.

E M Schulberg1, A R Webb2, H Kolawole2

  • 1Anaesthetic Registrar, Department of Anaesthesia, Peninsula Health, Frankston, Victoria.

Anaesthesia and Intensive Care
|June 2, 2016
PubMed
Summary

Early skin testing for rocuronium anaphylaxis enabled safe, urgent surgery. This case study demonstrates a strategy for managing patients needing immediate procedures after severe allergic reactions.

Keywords:
anaesthesiaanaphylaxisneuromuscular blocking agentsremifentanilrocuronium

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Area of Science:

  • Anesthesiology
  • Allergology
  • Clinical Immunology

Background:

  • Severe anaphylaxis to rocuronium can complicate urgent surgical procedures.
  • Standard allergy testing requires a 4-6 week waiting period, often delaying necessary surgeries.

Observation:

  • A patient experienced severe anaphylaxis and cardiovascular collapse post-rocuronium induction for laparoscopic cholecystectomy.
  • Surgery cancellation necessitated an alternative management strategy due to the patient's condition.

Findings:

  • Limited early skin and challenge testing for rocuronium and cisatracurium was performed in the ICU.
  • This early testing identified a safe neuromuscular blocking agent, allowing for subsequent surgery.

Implications:

  • Early skin testing can be a viable strategy for patients requiring urgent surgery after recent anaphylaxis.
  • This approach may help mitigate risks associated with anesthetic management in high-risk patients.