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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: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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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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Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

373
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.
Unlike...
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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

426
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.
Although all competitive neuromuscular blockers are designed...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

434
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Rocuronium-Induced Anaphylaxis in the Perioperative Period: A Clinical Review.

David E Harris

    AORN Journal
    |December 27, 2023
    PubMed
    Summary

    Rocuronium can trigger severe anaphylaxis, a hypersensitivity reaction often occurring after the first dose. Prompt recognition and emergency treatment with epinephrine are crucial for patient survival.

    Keywords:
    anaphylaxishypersensitivity reactionnondepolarizing neuromuscular blocking agent (NMBA)rocuroniumsugammadex

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    Area of Science:

    • Anesthesiology
    • Immunology
    • Critical Care Medicine

    Background:

    • Rocuronium, a nondepolarizing neuromuscular blocker, is widely used for endotracheal intubation.
    • Hypersensitivity reactions, including life-threatening anaphylaxis, are potential adverse effects of rocuronium administration.
    • Anaphylaxis can be IgE-mediated or non-IgE-mediated and may not present with typical cutaneous symptoms.

    Approach:

    • This article reviews the risk factors, pathophysiology, clinical presentation, and diagnostic strategies for rocuronium-induced anaphylaxis.
    • It details emergency management protocols, emphasizing epinephrine and fluid resuscitation.
    • The role of diagnostic testing, including histamine and tryptase level measurement and skin testing, is discussed.

    Key Points:

    • Anaphylaxis presentation can include hypotension and bronchospasm, with cutaneous signs potentially absent.
    • Transesophageal echocardiography may be necessary to exclude other causes of hypotension.
    • Early diagnosis and intervention are critical, with definitive diagnosis requiring specific laboratory tests post-reaction.

    Conclusions:

    • Perioperative nurses play a vital role in managing anaphylaxis emergencies and advocating for diagnostic testing.
    • Understanding rocuronium-induced anaphylaxis is essential for optimizing patient safety during anesthesia and intubation procedures.
    • Prompt recognition and appropriate management can significantly improve outcomes for patients experiencing anaphylactic reactions to rocuronium.