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Related Concept Videos

Decreased pulse rate01:14

Decreased pulse rate

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Bradycardia is a medical condition in which the heart rate is slower than normal. It occurs when the heart's natural pacemaker, the sinus node, generates slower electrical impulses than the standard rhythm. In adults, bradycardia is diagnosed when the pulse rate falls below 60 beats per minute, indicating a deviation from the normal heart rate range.
There are specific risk factors that can elevate the likelihood of developing bradycardia. Advanced age is a significant factor, with...
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Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

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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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Depolarizing Blockers: Pharmocokinetics01:19

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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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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
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The regulation of heart rate is a complex process controlled by the autonomic nervous system (ANS), hormonal influences, and intrinsic cardiac mechanisms. The ANS has two main components: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).
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Programmed Electrical Stimulation in Mice
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Decrease in heart rate following the administration of sugammadex in adults.

Trent Sims1, Joshua Peterson1, Mohammed Hakim2

  • 1Department of Anesthesiology, The University of Kansas, Kansas City, Kansas, USA.

Journal of Anaesthesiology, Clinical Pharmacology
|April 12, 2021
PubMed
Summary
This summary is machine-generated.

Sugammadex reversal of neuromuscular blockade is associated with a low incidence of bradycardia (7%) in adults. This study found no significant hemodynamic changes or association with initial sugammadex dose.

Keywords:
Anesthesianeuromuscular blockade reversalperioperative management

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Sugammadex offers an alternative to acetylcholinesterase inhibitors for reversing steroidal neuromuscular blocking agents (NMBAs).
  • Preclinical studies noted rare bradycardia and cardiac arrest with sugammadex.
  • The incidence and factors influencing bradycardia require further investigation.

Purpose of the Study:

  • To prospectively evaluate the incidence of bradycardia following sugammadex administration in adult patients.
  • To identify potential mitigating factors for bradycardia after sugammadex use.

Main Methods:

  • Prospective, open-label trial involving 200 adult patients receiving sugammadex.
  • Continuous heart rate (HR) monitoring post-administration.
  • Bradycardia defined as HR <60 bpm or a ≥10 bpm decrease if baseline HR was <70 bpm.

Main Results:

  • Bradycardia occurred in 7% of patients (13/200), a median of 4 minutes post-sugammadex.
  • Two patients with bradycardia had cardiac comorbidities; one required ephedrine treatment.
  • No significant blood pressure changes were observed.

Conclusions:

  • The incidence of bradycardia after sugammadex administration is low.
  • Bradycardia in this cohort was not linked to significant hemodynamic alterations.
  • Initial sugammadex dose was not a significant risk factor for bradycardia on multivariable analysis.